Effect of famotidine on cognitive and behavioral dysfunctions induced in post-COVID-19 infection: A randomized, double-blind, and placebo-controlled study.

OBJECTIVES: This is an investigation of the efficacy and safety of famotidine, a selective histamine H2 receptor antagonist, on improvement of cognitive impairment, depression and anxiety symptoms developing post-COVID-19, in a 12-week, randomized controlled trial. METHODS: A total of 50 patients with a confirmed diagnosis of COVID-19 and a score ≤ 23 on the Mini-Mental State Examination (MMSE) test or a score ≤ 22 on the Montreal Cognitive Assessment (MoCA) were randomly assigned to either the famotidine (40 mg twice daily) or the placebo group. Changes in MMSE scores at weeks 6 and 12 were the primary outcome, while changes in other scales were the secondary outcomes. Participants and evaluators were blinded. RESULTS: At weeks 6 and 12, patients in the famotidine group had significantly higher MMSE scores (p = 0.014, p < 0.001, respectively). Regarding the MoCA scale, the famotidine group had a significantly higher score at weeks 6 and 12 (p = 0.001, p < 0.001, respectively). Considering the HAM-D scale (Hamilton Depression Rating Scale), at weeks 6 and 12, the famotidine group experienced a larger reduction (p = 0.009, p = 0.02, respectively). Additionally, comparison of the HAM-A scale scores (Hamilton Anxiety Rating Scale) at weeks 6 and 12 showed a statistically significant larger reduction in the famotidine group (p = 0.04, p = 0.02, respectively). The two groups did not differ in the frequency of adverse effects. CONCLUSION: Our study supports safety and efficacy of famotidine in treating cognitive impairment, depression and anxiety symptoms induced by COVID-19. TRIAL REGISTRATION: This trial was registered at the Iranian registry of clinical trials (IRCT: www.irct.ir; registration number: IRCT20090117001556N138).

Classical Presentation of Disseminated Blastomycosis in a 44-Year-Old Healthy Man 3 Months After Diagnosis of COVID-19.

BACKGROUND During the COVID-19 pandemic, the incidence of opportunistic infections, including fungal infections, has increased. Blastomycosis is caused by inhalation of an environmental fungus, Blastomyces dermatides, which is endemic in parts of the USA and Canada. This case report is of a 44-year-old man from the American Midwest who presented with disseminated blastomycosis infection 3 months following a diagnosis of COVID-19. CASE REPORT Our patient initially presented to an outpatient clinic with mild upper-respiratory symptoms. He tested positive for SARS-CoV-2 via polymerase chain reaction (PCR). Three months later, he presented to our emergency department due to some unresolved COVID-19 symptoms and the development of a widely disseminated, painful rash of 1-week duration. A positive Blastomyces urine enzyme immunoassay was the first indication of his diagnosis, which was followed by the identification of the pathogen via fungal culture from bronchoscopy samples and pathology from lung and skin biopsies. Given the evidence of dissemination, the patient was treated with an intravenous and oral antifungal regimen. He recovered well after completing treatment. CONCLUSIONS The immunocompetent status of patients should not exclude disseminated fungal infections as a differential diagnosis, despite the less frequent manifestations. This is especially important when there is a history of COVID-19, as this may predispose once-healthy individuals to more serious disease processes. This case supports the recent recommendations made by the U.S. Centers for Disease Control and Prevention (CDC) for increased vigilance regarding fungal infections in patients with a history of COVID-19.

Honey and Nigella sativa against COVID-19 in Pakistan (HNS-COVID-PK): A multicenter placebo-controlled randomized clinical trial.

Until now, no specific and effective treatment exists for coronavirus disease 2019 (COVID-19). Since honey and Nigella sativa (HNS) have established antiviral, antibacterial, antiinflammatory, antioxidant, and immunomodulatory properties, we tested their efficacy for this disease in a multicenter, placebo-controlled, and randomized clinical trial at four medical care facilities in Pakistan. RT-PCR confirmed COVID-19 adults showing moderate or severe disease were enrolled in the trial. Patients were randomly assigned in a 1:1 ratio to receive either honey (1 g kg-1 day-1 ) and Nigella sativa seeds (80 mg kg-1 day-1 ) or a placebo for up to 13 days along with standard care. The outcomes included symptoms' alleviation, viral clearance, and 30-day mortality in the intention-to-treat population. Three hundred and thirteen patients, 210 with moderate and 103 with severe disease, underwent randomization from April 30 to July 29, 2020. Among the moderate cases, 107 were assigned to HNS, whereas 103 were assigned to the placebo group. Among the severe cases, 50 were given HNS, and 53 were given the placebo. HNS resulted in ~50% reduction in time taken to alleviate symptoms as compared to placebo (moderate cases: 4 vs. 7 days, Hazard Ratio [HR]: 6.11; 95% Confidence Interval [CI]: 4.23-8.84, p < 0.0001 and for severe cases: 6 vs. 13 days, HR: 4.04; 95% CI: 2.46-6.64; p < 0.0001). HNS also cleared the virus earlier than placebo in both moderate cases (6 vs. 10 days, HR: 5.53; 95% CI: 3.76-8.14, p < 0.0001) and severe cases (8.5 vs. 12 days, HR: 4.32; 95% CI: 2.62-7.13, p < 0.0001). HNS further led to a better clinical score on day 6 with normal activity resumption in 63.6% vs. 10.9% among moderate cases (OR: 0.07; 95% CI: 0.03-0.13, p < 0.0001) and hospital discharge in 50% versus 2.8% in severe cases (OR: 0.03; 95% CI: 0.01-0.09, p < 0.0001). In severe cases, the mortality rate was less than 1/4th in the HNS group than in placebo (4% vs. 18.87%, OR: 0.18; 95% CI: 0.02-0.92, p = 0.029). No HNS-related adverse effects were observed. HNS, compared with placebo, significantly improved symptoms, expedited viral load clearance, and reduced mortality in COVID-19 patients. This trial was registered on April 15, 2020 with ClinicalTrials.gov Identifier: NCT04347382.

Applied Geophysics for Managed Aquifer Recharge.

Increasing water stress and decreasing supplies caused by growth and climate variability have expanded demand for managed aquifer recharge (MAR) projects to provide water supply resilience. Some of the most important factors in determining the performance of a MAR project include site selection, subsurface hydrogeologic characteristics and associated properties of the storage zone. Costs for invasive subsurface investigations to address these factors have slowly increased over the past two decades, with drilling costs increasing dramatically by as much as 30% or more since COVID-19 hit, a result of supply chain issues, steel prices, and manpower challenges. This paper provides a high-level review of major geophysical methods that have become more mainstream over the past decade or two to supplement invasive subsurface investigations and are very cost effective when compared to drilling boreholes and installing wells, which provide only point data. The more commonly used surface geophysical methods include ground-based and airborne time-domain electromagnetic methods (TEM), electrical resistivity, and seismic reflection. Airborne TEM methods (AEM) collect data very quickly, avoiding ground-based access constraints, and land-based methods are especially efficient using towed arrays. Electrical resistivity measurements provide resolution comparable to TEM but require more time than towed methods. Seismic reflection surveys are more expensive than other methods but typically have a much greater depth of penetration and can provide high resolution information on aquifer geometry, geology, and faults. Borehole geophysics is one of the more common methods used in MAR, providing near hole formation data and ground truths surface geophysics.

Vertex metric resolvability of COVID antiviral drug structures

In November of 2019 year, there was the first case of COVID-19 (Coronavirus) recorded, and up to 3rd of April of 2020, 1,116,643 confirmed positive cases, and around 59,158 dying were recorded. Novel antiviral structures of the 2019 pandemic disease Coronavirus are discussed in terms of the metric basis of their molecular graph. These structures are named arbidol, chloroquine, hydroxy-chloroquine, thalidomide, and theaflavin. Metric dimension or metric basis is a concept in which the whole vertex set of a structure is uniquely identified with a chosen subset named as resolving set. Moreover, the fault-tolerant concept of those structures is also included in this study. By this concept of vertex-metric resolvability of COVID antiviral drug structures are uniquely identified and help to study the structural properties of the structure. [ FROM AUTHOR]

The prevalence of violence and its association with mental health among the Iranian population in one year after the outbreak of COVID-19 disease.

BACKGROUND: COVID-19 spread between and across nearly every country, with considerable negative health consequences. The current study aimed to determine the prevalence of violence and its association with mental health among Iranians older than 15 years in 2020. METHODS: Data was collected through National Mental Health Survey on 24,584 Iranians older than 15 years in 2020. were analyzed to determine the prevalence of violence and its association with mental health. Multi-stage sampling method was used, and data on demographic characteristics and domestic-social violence and mental health (GHQ-28) were collected. Data analysis was administered using descriptive statistics and a chi-square test at a 95% level. RESULTS: The mean age of participants was 44.18 ± 16.4 years. The overall prevalence of domestic and social violence was 11.4% and 5.5%, respectively. Verbal violence was the most common type; with 61.8% and 66.8% for domestic and social violence, respectively. A suspected case of mental disorder, female gender, being younger than 25 years, living apart together, unemployment, low education, and history of COVID-19 infection presented a significant association with domestic and social violence (p > 0.05). CONCLUSION: In comparison to the previous study in 2015, the prevalence of violence has increased. Therefore, domestic and social violence are the social concerns of Iranian society, indicating the necessity of appropriate interventions, particularly for those suspected of mental disorders and young women with low education levels.

Efficient, accurate and fast pupil segmentation for pupillary boundary in iris recognition

Iris recognition is a robust biometric system—user-friendly, accurate, fast, and reliable. This biometric system captures information in a contactless manner, making it suitable for use during the COVID-19 pandemic. Despite its advantages such as high security and high accuracy, iris recognition still suffers from pupil deformation, motion blur, eyelids blocking, reflection occlusion and eyelashes obscure. If the pupillary boundary is not accurately segmented, iris recognition may suffer tremendously. Moreover, reflections in iris image may lead to an incorrect pupillary boundary segmentation. The segmentation accuracy can also be affected and reduced because of the presence of an unwanted noise created by the motion blur effect in iris image. Additionally, the pupillary boundary might change from circular shape to uneven or irregular shape because of the interference and obstruction in pupil region. Therefore, this work is carried out to determine an accurate, efficient and fast algorithm for the segmentation of pupillary boundary. First, the iris image is pre-processed with Wiener filter. Next, the respective iris image is assigned with a specific threshold. After that, the pixel property in iris image is computed to determine the pupillary boundary coordinates which are acquired from the measured pixel list and area in iris image. Finally, morphological closing is used to remove reflections in the inner region of pupil boundary. All experiments are implemented with CASIA v4 database and Matlab R2020a.

Vertex metric resolvability of COVID antiviral drug structures

In November of 2019 year, there was the first case of COVID-19 (Coronavirus) recorded, and up to 3 rd of April of 2020, 1,116,643 confirmed positive cases, and around 59,158 dying were recorded. Novel antiviral structures of the 2019 pandemic disease Coronavirus are discussed in terms of the metric basis of their molecular graph. These structures are named arbidol, chloroquine, hydroxy-chloroquine, thalidomide, and theaflavin. Metric dimension or metric basis is a concept in which the whole vertex set of a structure is uniquely identified with a chosen subset named as resolving set. Moreover, the fault-tolerant concept of those structures is also included in this study. By this concept of vertex-metric resolvability of COVID antiviral drug structures are uniquely identified and help to study the structural properties of the structure. [ FROM AUTHOR] Copyright of Journal of Intelligent & Fuzzy Systems is the property of IOS Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Neuropsychiatric symptoms in the psychiatric counseling of patients admitted with COVID-19 infection.

BACKGROUND: Covid-19 patients suffer from psychiatric disorders too. The present study was designed to investigate the rate of psychiatric consultation requests in a general hospital. Reasons for consultation requests, types of psychiatric diagnoses, and factors in consultation requests were also investigated. METHODS: This cross-sectional study included all patients admitted with Covid-19 and referred to psychiatric consultation service in a major Covid-19 center in Tehran, Iran (2020). After acceing patients' electronic files, records of patients' demographic information, positive psychiatric symptoms, past psychiatric history and DSM5 diagnoses were made. Statistical analyses were done in SPSS 26 using descriptive statistics and chi-square and Fisher's exact test (p<0.05). RESULTS: Out of 1791 Covid-19 hospitalized patients, 132 patients (7.3%) had been referred to psychiatric consultation service. The most common reason for requests were restlessness and aggression (23.5%). Meanwhile, 92.4% of the patients were diagnosed to suffer from at least one psychiatric disorder including insomnia (64%), delirium (30.3%), anxiety due to hypoxia (15.3%) and generalized anxiety disorder (10.6%). CONCLUSION: Although studies report a high prevalence of psychiatric disorders in Covid-19 patients, requests for psychiatric consultations and consideration of psychiatric disorders are still remarkably low. The most common disorders appeared to be insomnia, delirium and anxiety.

Survey on Mental Health Status in Iranian Population Aged 15 and Above One Year after the Outbreak of COVID-19 Disease: A Population-Based Study.

BACKGROUND: Mental disorders are the most common health problems that affect different population groups. According to the national survey in 2015 based on General Health Questionnaire-28 (GHQ-28), 23.44% of Iranians older than 15 years were suspected of having a mental disorder. The study aimed to determine the mental health status of the population over 15 years of age in the Islamic Republic of Iran, one year after the outbreak of COVID-19 in 2020. METHODS: The population-based study was performed on 24584 individuals over 15 years of age in Iran between December and February, 2020. The GHQ-28 was completed through telephone interviews. Data were analyzed using descriptive statistics, chi-square test, independent t-test, and multiple logistic regression at 95% confidence level. RESULTS: The results showed that the mean age of participants was 44.18±16.47 years. The prevalence of mental disorders was 29.7%. Mental disorder was associated with female gender (OR=1.195, 95% CI 1.10-1.29), 25-44 years (OR=1.206, 95% CI 1.06-1.36), urban life (OR=1.116, 95% CI 1.04-1.19), illiteracy (OR=1.286, 95% CI 1.11-1.48), being divorced (OR=1.924, 95% CI 1.50- 2.45), and unemployment (OR=1.657, 95% CI 1.40-1.94). Among the participants and their families, 14.7% and 32.3% were infected with the disease, respectively. The COVID-19 mortality rate in their families was 13.2%. The prevalence of mental disorders in infected people (40% vs. 27.3%) and bereaved families (39.6% vs. 35.3%) was more than the non-infected groups. CONCLUSION: Our results showed that in Iran, the mental health of the general population had a rising trend compared to 2015, especially in people infected with COVID-19 and bereaved families. The observed difference may be due to the prevalence of the COVID-19 epidemic and rapid demographic, social, and economic changes in Iran. Planning to improve mental health in the mentioned population should be considered for the post COVID-19 era.

Phenotypic Adaptation to Antiseptics and Effects on Biofilm Formation Capacity and Antibiotic Resistance in Clinical Isolates of Early Colonizers in Dental Plaque.

Despite the wide-spread use of antiseptics in dental practice and oral care products, there is little public awareness of potential risks associated with antiseptic resistance and potentially concomitant cross-resistance. Therefore, the aim of this study was to investigate potential phenotypic adaptation in 177 clinical isolates of early colonizers of dental plaque (Streptococcus, Actinomyces, Rothia and Veillonella spp.) upon repeated exposure to subinhibitory concentrations of chlorhexidine digluconate (CHX) or cetylpyridinium chloride (CPC) over 10 passages using a modified microdilution method. Stability of phenotypic adaptation was re-evaluated after culture in antiseptic-free nutrient broth for 24 or 72 h. Strains showing 8-fold minimal inhibitory concentration (MIC)-increase were further examined regarding their biofilm formation capacity, phenotypic antibiotic resistance and presence of antibiotic resistance genes (ARGs). Eight-fold MIC-increases to CHX were detected in four Streptococcus isolates. These strains mostly exhibited significantly increased biofilm formation capacity compared to their respective wild-type strains. Phenotypic antibiotic resistance was detected to tetracycline and erythromycin, consistent with the detected ARGs. In conclusion, this study shows that clinical isolates of early colonizers of dental plaque can phenotypically adapt toward antiseptics such as CHX upon repeated exposure. The underlying mechanisms at genomic and transcriptomic levels need to be investigated in future studies.

Factors Influencing the Levels of Awareness on Malaysian Healthy Plate Concept among Rural Adults in Malaysia

Malaysian Healthy Plate was launched in 2017 as a vital component of the Malaysian Ministry of Health’s “Quarter-Quarter-Half” program. It is predicted that this concept will bring positive change to the citizen’s dietary habits;however, the residents in rural areas may experience less exposure to this campaign, or lack of understanding to the concept of Malaysian Healthy Plate. Hence, this study aims to assess factors affecting the campaign’s awareness among the rural population in Malaysia. The National Health and Morbidity Survey (NHMS) 2019 focused on Non-Communicable Diseases (NCDs). Data collection was carried out from July to September 2019. Questionnaires that pertained to awareness, knowledge, and practice were included in this nationwide survey. Data collected from adults in rural areas aged 18 years old and above were used as respondents for the statistical analysis. Complex sample multiple logistic regression analysis was conducted to determine the association between the independent variables and awareness of the Malaysian Healthy Plate concept. About four fifths (83.2%) of rural adults in Malaysia were unaware of the Malaysian Healthy Plate concept after three years of implementation. The unawareness was significantly higher in males (91.3%), adults aged above 60 years old (91.8%), adults of others ethnicity (88.5%), those without formal education (95.2%), widows/widowers/divorcees (88.1%), retirees/adults who were not working (88.4%), and household income at the bottom 40% (B40) (85.0%). Unawareness of this concept was significantly associated with male gender (aOR = 4.12;95% CI: 3.06–5.56);age, 40–59 years (aOR = 1.46;95% CI:1.08–1.97);without formal education (aOR = 3.47;95% CI:1.34–9.01);working in private sector (aOR = 2.75;95% CI: 1.59–4.77);self-employed (aOR = 2.78;95% CI: 1.58–4.87);retirees (aOR = 2.32;95% CI: 1.23–4.36);and unpaid workers (aOR = 2.61;95% CI: 1.51–4.51). Awareness of the Malaysian Healthy Plate concept is associated with rural adults being males, with older age, with lower socio-economic status, without partner, and without job. This study suggests that a more effective strategy is needed to increase the awareness of the Malaysian Healthy Plate concept among rural adults.

The prevalence of violence and its association with mental health among the Iranian population in one year after the outbreak of COVID-19 disease (preprint)

Objective   The current study aimed to determine the prevalence of violence and its association with mental health among Iranians older than 15 years in 2020.Methods Data was collected through National Mental Health Survey on 24,584 Iranians older than 15 years in 2020.  were analyzed to determine the prevalence of violence and its association with mental health. Multi-stage sampling method was used, and data on demographic characteristics and domestic-social violence and mental health (GHQ-28) were collected. Data analysis was administered using descriptive statistics and chi-square test at 95% level.Results The mean age of participants was 44.18±16.4 years. The overall prevalence of domestic and social violence was 11.4% and 5.5%, respectively. Verbal violence was the most common type; 61.8% and 66.8% for domestic and social violence, respectively. A suspected case of mental disorder, female gender, being younger than 25 years, living apart together, unemployment, low education, and history of COVID-19 infection presented a significant association with domestic and social violence (p>0.05).Conclusion  In comparison to the previous study in 2015, the prevalence of violence has increased. Therefore, domestic and social violence are the social concerns of Iranian society, indicating the necessity of appropriate interventions, particularly for those suspected of mental disorders and young women with low education levels.

Mental Stress and Its Effects on Vascular Health.

Coronary artery disease continues to be a major cause of morbidity and mortality despite significant advances in risk stratification and management. This has prompted the search for alternative nonconventional risk factors that may provide novel therapeutic targets. Psychosocial stress, or mental stress, has emerged as an important risk factor implicated in a higher incidence of cardiovascular events, and although our understanding of this far ranging and interesting phenomenon has developed greatly over recent times, there is still much to be learned regarding how to measure mental stress and how it may impact physical health. With the current coronavirus disease 2019 global pandemic and its incumbent lockdowns and social distancing, understanding the potentially harmful biological effects of stress related to life-changing events and social isolation has become even more important. In the current review our multidisciplinary team discusses stress from a psychosocial perspective and aims to define psychological stress as rigorously as possible; discuss the pathophysiologic mechanisms by which stress may mediate cardiovascular disease, with a particular focus to its effects on vascular health; outline existing methods and approaches to quantify stress by means of a vascular biomarker; outline the mechanisms whereby psychosocial stressors may have their pathologic effects ultimately transduced to the vasculature through the neuroendocrine immunologic axis; highlight areas for improvement to refine existing approaches in clinical research when studying the consequences of psychological stress on cardiovascular health; and discuss evidence-based therapies directed at reducing the deleterious effects of mental stress including those that target endothelial dysfunction. To this end we searched PubMed and Google Scholar to identify studies evaluating the relationship between mental or psychosocial stress and cardiovascular disease with a particular focus on vascular health. Search terms included "myocardial ischemia," "coronary artery disease," "mental stress," "psychological stress," "mental∗ stress∗," "psychologic∗ stress∗," and "cardiovascular disease∗." The search was limited to studies published in English in peer-reviewed journals between 1990 and the present day. To identify potential studies not captured by our database search strategy, we also searched studies listed in the bibliography of relevant publications and reviews.

Influence of COVID-19 on the Tourism Industry in China: An Artificial Neural Networks Approach.

Prior to COVID-19, the tourism industry was one of the important sectors of the world economy. This study intends to measure the perception of Chinese tourists concerning the spread of COVID-19 in China. The crowding perception, xenophobia, and ethnocentrism are the measurement indicators of the study. A five-point Likert scale is used to predict the perception of the tourists in various destinations. The Kaiser-Mayer-Olkin test and Cronbach's alpha are conducted to ensure the validity and reliability of the corresponding items. SPSS version 21 is used to obtain factor loading, mean values, and standard deviation. Regression analysis is used to measure the strength of the constructs' relationship and prove the hypotheses. Questionnaires have been filled from 730 Chinese respondents. Artificial neural networks and confusion matrices are used for validation and performance evaluation, respectively. Results show that crowding perception, xenophobia, and ethnocentrism caused the spread of COVID-19 during the epidemic. Hence, the tourism industry in China is adversely affected by COVID-19. The crisis management stakeholders of the country need to adopt policies to reduce the spread of COVID-19. The tourism sector needs to provide confidence to the tourists. It will provide ground for the mental strength of the tourists in China.

Transcriptomic Stress Response in Streptococcus mutans following Treatment with a Sublethal Concentration of Chlorhexidine Digluconate.

Despite the widespread use of antiseptics such as chlorhexidine digluconate (CHX) in dental practice and oral care, the risks of potential resistance toward these antimicrobial compounds in oral bacteria have only been highlighted very recently. Since the molecular mechanisms behind antiseptic resistance or adaptation are not entirely clear and the bacterial stress response has not been investigated systematically so far, the aim of the present study was to investigate the transcriptomic stress response in Streptococcus mutans after treatment with CHX using RNA sequencing (RNA-seq). Planktonic cultures of stationary-phase S. mutans were treated with a sublethal dose of CHX (125 µg/mL) for 5 min. After treatment, RNA was extracted, and RNA-seq was performed on an Illumina NextSeq 500. Differentially expressed genes were analyzed and validated by qRT-PCR. Analysis of differential gene expression following pathway analysis revealed a considerable number of genes and pathways significantly up- or downregulated in S. mutans after sublethal treatment with CHX. In summary, the expression of 404 genes was upregulated, and that of 271 genes was downregulated after sublethal CHX treatment. Analysis of differentially expressed genes and significantly regulated pathways showed regulation of genes involved in purine nucleotide synthesis, biofilm formation, transport systems and stress responses. In conclusion, the results show a transcriptomic stress response in S. mutans upon exposure to CHX and offer insight into potential mechanisms that may result in development of resistances.

Health Care Professionals' Perception of Stress During COVID-19 Pandemic in Iran: A Qualitative Study.

BACKGROUND: The health care professionals have a unique role in controlling the pandemic of COVID-19 and decreasing its mortality and morbidity. The burden of care and psychological impact of working in this circumstance can be unfavorable for many caregivers. In this qualitative study, the health care professionals' perception of stress during COVID-19 pandemic in Iran was assessed and several implications were proposed. MATERIALS AND METHODS: The participants were selected among staff who were providing medical services to patients with COVID-19 infection at the largest teaching hospital in Iran. Quota sampling was used to include physicians, nurses, and other paramedics. The grounded theory was selected to develop interview questions. Moreover, the thematic approach was applied to analyze the data content and data analysis was performed based on open and axial coding following the implementation of codes in MAQDA software. RESULTS: A wide range of psychological reactions including anxiety, feelings of guilt, depression, and anger were detected in the staff. Uncertainty accompanied by the pandemic of COVID-19 and shortcomings in preparation for crisis management were recognized as the two main sources of stress among health care professionals. CONCLUSION: Based on the findings of the study, it is important to identify and evaluate the mental health needs of healthcare professionals. To reduce stress among health staff at COVID-19 care centers, it seems that the optimal strategy is simultaneous improvement in equipment and crisis management.

Health Care Professionals' Perception of Stress During COVID-19 Pandemic in Iran: A Qualitative Study

Background The health care professionals have a unique role in controlling the pandemic of COVID-19 and decreasing its mortality and morbidity. The burden of care and psychological impact of working in this circumstance can be unfavorable for many caregivers. In this qualitative study, the health care professionals' perception of stress during COVID-19 pandemic in Iran was assessed and several implications were proposed. Materials and Methods The participants were selected among staff who were providing medical services to patients with COVID-19 infection at the largest teaching hospital in Iran. Quota sampling was used to include physicians, nurses, and other paramedics. The grounded theory was selected to develop interview questions. Moreover, the thematic approach was applied to analyze the data content and data analysis was performed based on open and axial coding following the implementation of codes in MAQDA software. Results A wide range of psychological reactions including anxiety, feelings of guilt, depression, and anger were detected in the staff. Uncertainty accompanied by the pandemic of COVID-19 and shortcomings in preparation for crisis management were recognized as the two main sources of stress among health care professionals. Conclusion Based on the findings of the study, it is important to identify and evaluate the mental health needs of healthcare professionals. To reduce stress among health staff at COVID-19 care centers, it seems that the optimal strategy is simultaneous improvement in equipment and crisis management.

A quadruple blinded placebo controlled randomised trial to evaluate the effectiveness of an Iodine complex for patients with mild to moderate COVID-19 in Pakistan (I-COVID-PK): A structured summary of a study protocol for a randomised controlled trial.

OBJECTIVES: The objective of the study is to measure the efficacy of ionic-iodine polymer complex [1] for clinical and radiological improvement in coronavirus disease 2019 (COVID-19) patients. TRIAL DESIGN: The trial will be closed label, randomized and placebo-controlled with a 1:1:1:1 allocation ratio and superiority framework. PARTICIPANTS: All PCR confirmed COVID-19 adult patients including non-pregnant females, with mild to moderate disease, will be enrolled from Shaikh Zayed Post-Graduate Medical Complex, Ali Clinic and Doctors Lounge in Lahore (Pakistan). Patients with any pre-existing chronic illness will be excluded from the study. INTERVENTION AND COMPARATOR: In this multi-armed study ionic-iodine polymer complex with 200 mg of elemental iodine will be given using three formulations to evaluate efficacy. Patients will be receiving either encapsulated iodine complex of 200 mg (arm A), iodine complex syrup form 40 ml (arm B), iodine complex throat spray of 2 puffs (arm C) or empty capsule (arm D) as placebo; all three times a day. All the 4 arms will be receiving standard care as per version 3.0 of the clinical management guidelines for COVID-19 established by the Ministry of National Health Services of Pakistan. MAIN OUTCOMES: Primary outcomes will be viral clearance with radiological and clinical improvement. SARS-CoV-2 RT-PCR and HRCT chest scans will be done on the admission day and then after every fourth day for 12 days or till the symptoms are resolved. RT-PCR will only be shown as positive or negative while HRCT chest scoring will be done depending on the area and severity of lung involvement [2]. Time taken for the alleviation of symptoms will be calculated by the number of days the patient remained symptomatic. 30-day mortality will be considered as a secondary outcome. RANDOMISATION: Stratification for initial COVID-19 status (or days from initial symptoms as a proxy), age groups, gender, baseline severity of symptoms and co-morbidities will be used to ensure that the study arms remain balanced in size for the 1:1:1:1 allocation ratio. Randomization will be done using the lottery method. As patients are being admitted at different times, they will be recruited after obtaining their voluntary written informed consent following all standard protocols of the infection, control and disinfection. BLINDING (MASKING): This is a quadruple (participants, care providers, investigators and outcomes assessors) blinded study where only the study's Primary Investigator will have information about the arms and their interventions. NUMBERS TO BE RANDOMISED (SAMPLE SIZE): 200 patients will be randomized into four groups with three experimental and one placebo arm. TRIAL STATUS: Protocol Version Number is 2.3 and it is approved from IRB Shaikh Zayed Hospital with ID SZMC/IRB/Internal0056/2020 on July 14th, 2020. The recruitment is in progress. It was started on July 30, 2020, and the estimated end date for the trial is August 15, 2021. TRIAL REGISTRATION: Clinical Trial has been retrospectively registered on www.clinicaltrials.gov with registration ID NCT04473261 dated July 16, 2020. FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). With the intention of expediting dissemination of this trial, the conventional formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines.