Complications in Pregnant Women and Newborns Before and During the COVID-19 Pandemic.

Background: One of the high-risk groups exposed to the coronavirus disease 2019 (COVID-19) pandemic was pregnant women at risk of pregnancy complications due to a weakened immune system and inability to use various drugs to treat COVID-19. Accordingly, this study was conducted to investigate the complications in pregnancy before and during the COVID-19 pandemic. Material and Methods: This cross-sectional study was performed on all pregnant women in Shahroud, Iran. The time interval from February 18, 2019, to February 17, 2020, was considered before the COVID-19 pandemic and from February 18, 2020, to February 17, 2021, was considered the COVID-19 pandemic. Sampling was conducted by census and included 6851 pregnant women. The required information was extracted from hospitals' health deputy registration system and high-risk pregnancy registration program. Result: Based on the findings, hypertension disorder, gestational diabetes, placental abruption, pre-eclampsia, cesarean section, hospitalization in neonatal intensive care unit (NICU), preterm birth, and hospitalization in other hospital wards increased by 1.88%, 1.93%, 0.12%, 0.45%, 5.45%, 1.00%, 1.20%, and 1.40%, respectively, in 2020 compared to 2019. A statistically significant difference was also observed between them (p < 0.05). Also, the regression results showed that the chances of high blood pressure, Gestational Diabetes Mellitus (GDM), placental abruption, and cesarean section were increased by 10.91, 1.53, 5.51, and 2.83 times, respectively. Conclusions: Pregnancy complications have increased during the COVID-19 pandemic. As a result, there is a need to take appropriate health and medical measures to reduce the risks associated with the COVID-19 epidemic for pregnant women and neonates.

Socioeconomic inequalities in employees' health-enhancing physical activity: Evidence from the SHAHWAR cohort study in Iran.

BACKGROUND: Increasing level of physical activity (PA) among working population is of particular importance, because of the high return of investment on employees' PA. This study was aimed to investigate socioeconomic inequalities in Health-Enhancing Physical Activity (HEPA) among employees of a Medical Sciences University in Iran. METHODS: Data were extracted from the SHAHWAR Cohort study in Iran. Concentration index (C) and Wagstaff decomposition techniques were applied to determine socioeconomic inequality in the study outcomes and its contributors, respectively. RESULTS: Nearly half of the university employees (44.6%) had poor HEPA, and employees with high socioeconomic status (SES) suffered more from it (C = 0.109; 95% CI: 0.075, 0.143). Also, we found while poor work-related PA (C = 0.175; 95% CI: 0.142, 0.209) and poor transport-related PA (C = 0.081, 95% CI: 0.047, 0.115) were more concentrated among high-SES employees, low-SES employees more affected by the poor PA at leisure time (C = -0.180; 95% CI: -0.213, -0.146). Shift working, and having higher SES and subjective social status were the main factors that positively contributed to the measured inequality in employees' poor HEPA by 33%, 31.7%, and 29%, respectively, whereas, having a married life had a negative contribution of -39.1%. The measured inequality in poor leisure-time PA was mainly attributable to SES, having a married life, urban residency, and female gender by 58.1%, 32.5%, 28.5%, and -32.6%, respectively. SES, urban residency, shift working, and female gender, with the contributions of 42%, 33.5%, 21.6%, and -17.3%, respectively, were the main contributors of poor work-related PA inequality. Urban residency, having a married life, SES, and subjective social status mainly contributed to the inequality of poor transport-related PA by 82.9%, -58.7%, 36.3%, and 33.5%, respectively, followed by using a personal car (12.3%) and female gender (11.3%). CONCLUSIONS: To reduce the measured inequalities in employees' PA, workplace health promotion programs should aim to educate and support male, urban resident, high-SES, high-social-class, and non-shift work employees to increase their PA at workplace, and female, married, rural resident, and low-SES employees to increase their leisure-time PA. Active transportation can be promoted among female, married, urban resident, high-SES, and high-social-class employees and those use a personal car.

The Impact of COVID-19 Pandemic on Physical Activity Levels Among Health Care Workers: Longitudinal Results From the SHAHWAR Study.

OBJECTIVE: The aim of the present study was to investigate physical activity (PA) changes during the COVID-19 pandemic among health care workers. METHODS: In a follow-up study, staff PA was compared before and during the COVID-19 pandemic. Logistic regression model was used to determine the related factors with PA changes. RESULTS: Total PA (MET minutes a week) among participants (n = 449) showed a statistically significant decrease during the pandemic compared with before the pandemic: 3785.5 ± 2237.09 versus 2363 ± 2452.90, P < 0.0001. Although transport-related PA decreased in medical and administrative department staff (3851 ± 22.83.4 vs 2446.7 ± 2477.6, P < 0.0001 and 3593.8 ± 2094.3 vs 2122.6 ± 2373.8, P < 0.0001, respectively), the decrease was associated with employment in the administrative and nonshift sectors with odds ratios of 2.37 (1.38 to 4.08) and 2.04 (1.28 to 3.26), respectively. CONCLUSION: Promoting PA at home and leisure is especially recommended to achieve the recommended PA levels.

Risk Factors Associated with Mortality in COVID-19 Patient's: Survival Analysis.

Background: The effect of related factors on recovery or death rates may vary from country to country. Therefore, we aimed to investigate the relationship between demographic, clinical, laboratory factors on the survival rates of confirmed cases of COVID-19 in Shahroud, Iran. Methods: This is an analytical study of the estimation of the survival of patients with COVID-19. Patients who had positive PCR test were considered as COVID-19 cases, and the 2-month survival of these patients was estimated. Among the diseases, heart disease and diabetes were considered as separate variables, and the patients' histories of other diseases were included in the model as comorbidities. Results: Of 396 confirmed patients hospitalized, 109 patients (27.5%) had a history of heart disease, 100 (25.3%) were diabetic, and 80 (20.2%) had a history of other comorbidities. The number of deaths due to the disease was 59 (14.9%). The median age of those who died was 76 years. The multivariate Cox regression analysis shows that heart disease increases hazard ratio more than two times (HR=2.37, 95% CI: 1.33-4.23). The neutrophil-to-lymphocyte ratio (NLR) factor, (HR=1.15, 95% 1.08-1.22), and older age (HR=1.06, 95% CI: 1.03-1.08) increases the risk of death significantly. Conclusion: The heart disease history, NLR factor and older age are associated with death of COVID-19 and may be helpful for the early warning and prediction of disease progression.

COVID-19 epidemic effects on sleep quality among health sector workers: A follow up study.

Health care workers (HCWs) were vulnerable to sleep disturbances in normal circumstances. Poor sleep quality (PSQ) is common during the coronavirus disease 2019 (COVID-19) epidemic. The aim of this study is evaluation of sleep quality among healthcare workers during COVID-19 epidemic in a cohort study. In a follow-up study, we assessed sleep quality in 453 Iranian HCW participants in late-April 2021, after approximately 8 weeks of the epidemic of COVID-19. In order to compare the sleep quality in the two time intervals, during and before COVID-19, we used the recorded data of the same group of participants who were enrolled in a study named SHAHWAR (SHAhroud Health care Workers Associated Research) cohort that is focused on the health of HCWs who work at the Shahroud university of medical sciences. Data collection process in the SHAHWAR study started on October 2, 2019 and continued until February 19, 2020. Our results showed sleep quality worsened among shift-workers during COVID-19 outbreak; however, it was improved among non-shift staff. Sleep quality was more likely to be worsening if HCWs had shift-working roles [OR: 1.84(1.11-3.06), and if they experienced death in their families [OR: 5.06(1.60-12.80)]; however, having a paramedical role was a protective effect [OR: 0.52(0.27-092)], for poor quality sleep. Sleep quality worsened during the epidemic among HCWs. A greater impact, in terms of higher PSQI index, in this group of workers was seen in shift working staff.

SARS-CoV2 among Health Sector Workers and Related Factors in a Referral Hospital in Northeast of Iran: A Retrospective Analysis.

We aimed to identify the prevalence of SARS-CoV2 and its related factors among suspected health sector workers (HSWs) by conducting a descriptive analytical study on the SARS-CoV2 registered data in Shahroud region, Iran. Among the 267 suspected HSWs, 15.7% were confirmed vs. 29.1% of the suspected non-HSW cases, and the difference between two groups was significant. Among the related variables, after adjusting for age and sex, being asymptomatic (OR = 0.43), having fever (OR = 3.28), inpatient (OR = 7.14), and no history of flu vaccination (OR = 2.33) were significantly associated with the confirmed HSWs. It is recommended that all HSWs be screened and close contacts of confirmed cases be followed up.

Epidemiological patterns of syndromic symptoms in suspected patients with COVID-19 in Iran: A Latent Class Analysis.

BACKGROUND: Early diagnosis and supportive treatments are essential to patients with coronavirus disease 2019 (COVID-19). Therefore, the current study aimed to determine different patterns of syndromic symptoms and sensitivity and specificity of each of them in the diagnosis of COVID-19 in suspected patients. STUDY DESIGN: Cross-sectional study . METHODS: In this study, the retrospective data of 1,539 patients suspected of COVID-19 were obtained from a local registry under the supervision of the officials at Shahroud University of Medical Sciences, Shahroud, Iran. A Latent Class Analysis (LCA) was carried out on syndromic symptoms, and the associations of some risk factors and latent subclasses were accessed using one-way analysis of variance and Chi-square test. RESULTS: The LCA indicated that there were three distinct subclasses of syndromic symptoms among the COVID-19 suspected patients. The age, former smoking status, and body mass index were associated with the categorization of individuals into different subclasses. In addition, the sensitivity and specificity of class 2 (labeled as "High probability of polymerase chain reaction [PCR]+") in the diagnosis of COVID-19 were 67.43% and 76.17%, respectively. Furthermore, the sensitivity and specificity of class 3 (labeled as "Moderate probability of PCR+") in the diagnosis of COVID-19 were 75.92% and 50.23%, respectively. CONCLUSION: The findings of the present study showed that syndromic symptoms, such as dry cough, dyspnea, myalgia, fatigue, and anorexia, might be helpful in the diagnosis of suspected COVID-19 patients.

COVID-19 re-infection in Shahroud, Iran: a follow-up study.

Although many people became infected and recovered during the COVID-19 epidemic, the immunity duration and re-infection in recovered patients have recently attracted many researchers. The aim of this study was to evaluate the recurrence of the infection in recovered individuals over a 9-month period after the onset of the COVID-19 epidemic. In this study, data related to COVID-19 patients in Shahroud city were collected using the electronic system for registering suspicious patients and also by checking patients' hospital records. In this study, from 20 March 2020 to 20 November 2020 (9 months), a total of 8734 suspected patients with respiratory symptoms were observed and followed up. RT-PCR was positive for 4039 patients. During this period, out of the total number of positive cases of COVID-19, 10 cases became re-infected after complete recovery. The risk of re-infection was 2.5 per thousand (0.95 CI 1.2-4.5). The mean time interval between the first infection and re-infection was 134.4 ± 64.5 days (range 41-234 days). The risk of re-infection between male and females was not statistically different (1.98 per 1000 women and 2.96 per 1000 men). Exposure to COVID-19 may not establish long-term protective immunity to all patients and may predispose them to re-infection. This fact can be reminded that the use of masks, social distancing and other preventive measures are very important in recovered patients and should be emphasised especially in health care personnel who are more exposed to the virus.

Crooked, coiled and crimpled are three Ly6-like proteins required for proper localization of septate junction components.

Cellular junction formation is an elaborate process that is dependent on the regulated synthesis, assembly and membrane targeting of constituting components. Here, we report on three Drosophila Ly6-like proteins essential for septate junction (SJ) formation. SJs provide a paracellular diffusion barrier and appear molecularly and structurally similar to vertebrate paranodal septate junctions. We show that Crooked (Crok), a small GPI-anchored Ly6-like protein, is required for septa formation and barrier functions. In embryos that lack Crok, SJ components are produced but fail to accumulate at the plasma membrane. Crok is detected in intracellular puncta and acts tissue-autonomously, which suggests that it resides in intracellular vesicles to assist the cell surface localization of SJ components. In addition, we demonstrate that two related Ly6 proteins, Coiled (Cold) and Crimpled (Crim), are required for SJ formation and function in a tissue-autonomous manner, and that Cold also localizes to intracellular vesicles. Specifically, Crok and Cold are required for correct membrane trafficking of Neurexin IV, a central SJ component. The non-redundant requirement for Crok, Cold, Crim and Boudin (Bou; another Ly6 protein that was recently shown to be involved in SJ formation) suggests that members of this conserved family of proteins cooperate in the assembly of SJ components, possibly by promoting core SJ complex formation in intracellular compartments associated with membrane trafficking.

Single-stranded polyinosinic acid oligonucleotides trigger leukocyte production of proteins belonging to fibrinolytic and coagulation cascades.

The present study assessed the inductory effects of ds- and ssRNA on the leukocyte production of proteins belonging to fibrinolytic and coagulation cascades. Murine splenocytes were stimulated with dsRNA [polyinosinic:polycytidylic acid (polyIC)] and ssRNA sequences [polyinosinic acid (polyI), polycytidylic acid (polyC), and polyuridylic acid (polyU)]. The expression of plasminogen (Plg), tissue factor (TF), IL-6, and IFN-alpha was assessed. Intracellular transduction mechanisms activated by oligonucleotides were evaluated using specific inhibitors of signaling pathways and genetically modified mice. polyIC efficiently and dose-dependently induced the expression of Plg, IL-6, and IFN-alpha, whereas TF was not induced by polyIC. polyI was unable to trigger IFN-alpha production, and it was efficiently inducing Plg and TF. IFN-alphaR and dsRNA-dependent protein kinase signaling were not required for the polyI-induced production of Plg or TF. Neither polyU nor polyC induced the expression of Plg or TF. Importantly, the presence of U- and C-nucleotide strands in the dsRNA significantly reduced expression of Plg and TF compared with polyI alone. Exposure of splenocytes to polyI activated the NF-kappaB pathway followed by the expression of TF and IL-6. In contrast, Plg production did not require NF-kappaB, was only partly down-regulated by p38 MAPK inhibitor, and was efficiently inhibited by insulin, indicating a different mechanism for its induction. ssRNA exerts its TF-generating properties through NF-kappaB activation in an IFN-alpha-independent manner. The expression of fibrinolytic versus coagulation proteins is regulated through distinctly different transduction pathways. As fibrinolytic and coagulation cascades are important components of inflammatory homeostasis, these findings might have importance for development of new, targeted therapies.

Uric acid, a nucleic acid degradation product, down-regulates dsRNA-triggered arthritis.

Uric acid, the naturally occurring degradation product of purine metabolism, is a danger signal, driving maturation of dendritic cells. It is well known that uric acid crystals display potent proinflammatory properties--the cause of gout--whereas the biological properties of soluble uric acid are less well documented. We have demonstrated previously that nucleic acids of endogenous and exogenous origin display proinflammatory properties. The aim of the present study was to assess the impact of soluble uric acid on in vivo inflammatory responses. Mice were administered with uric acid suspension in saline or saline alone prior to induction of neutrophil-mediated inflammation, delayed-type hypersensitivity, histamin-induced edema (measure of vasodilation capacity), as well as double-stranded (ds)RNA-triggered arthritis. Frequency and severity of arthritis were decreased significantly in mice exposed to dsRNA and simultaneously treated with uric acid as compared with saline-treated controls. Also, granulocyte-mediated inflammatory response and vasodilation capacity were reduced significantly in mice treated with uric acid as compared with their control group. The data suggest that down-regulation of inflammation was mediated by skewing the inflammatory response from the peripheral sites to the peritoneal cavity and down-regulating vasodilatatory capacity and thereby affecting leukocyte migration. In contrast, the T cell-mediated delayed-type hypersensitivity reaction was not affected significantly in mice exposed to uric acid. These findings demonstrate that uric acid displays a potent, distant anti-inflammatory effect in vivo. This property seems to be mediated by down-regulation of neutrophil influx to the site of inflammatory insult.

Requirement of type I interferon signaling for arthritis triggered by double-stranded RNA.

OBJECTIVE: Arthralgias and overt arthritides are often associated with viral infections. Viral infections expose the infected host to proinflammatory double-stranded RNA (dsRNA), which can cause joint inflammation and is a potent activator of interferon-alpha (IFNalpha). The aim of this study was to determine the role of IFNalpha and dsRNA-related signaling molecules in the onset of joint inflammation induced by viral dsRNA. METHODS: IFNalpha and different forms of RNA were injected into the knee joints of wild-type mice, mice lacking the type I interferon receptor (IFNAR(-/-)), and mice deficient in dsRNA-dependent protein kinase (PKR(-/-)). Histologic evidence of joint damage and the ability of splenocytes to produce cytokines in response to dsRNA or IFNalpha were assessed. RESULTS: Viral dsRNA, but not short single-stranded RNA, induced arthritis. The arthritis was aggravated by intracellular delivery of dsRNA. The expression of PKR was not mandatory for dsRNA-induced joint inflammation. In contrast, IFNalpha/beta signaling was important for dsRNA-induced joint inflammation because IFNAR(-/-) mice did not develop arthritis. Furthermore, intraarticular deposition of IFNalpha induced arthritis in PKR(-/-) and control mice, whereas IFNAR(-/-) mice were protected. The arthritogenic effect of IFNalpha was attenuated by in vivo depletion of monocyte/macrophages. CONCLUSION: Arthritis triggered by dsRNA is not dependent on the expression of the dsRNA-signaling molecule PKR (or Toll-like receptor 3, as previously shown), but is associated with the ability to produce type I IFN and is critically dependent on type I IFN receptor signaling. The intrinsic arthritogenic properties of IFNalpha implicate a role of this cytokine in joint manifestations triggered by various interferogenic stimuli.

Arthritogenic properties of double-stranded (viral) RNA.

Viral infections often lead to arthralgias and overt arthritic states. The inflammatogenic compound of the viruses giving rise to such an outcome has to date not been identified. Because expression of dsRNA is a common feature of all viruses, we decided to analyze whether this property leads to the induction of arthritis. Histological signs of arthritis were evident already on day 3 following intra-articular administration of dsRNA. Arthritis was characterized by infiltration of macrophages into synovial tissue. It was not dependent on acquired immune responses because SCID mice also raised joint inflammation. NF-kappa B was activated upon in vitro exposure to dsRNA, indicating its role in the induction/progression of arthritis. Importantly, we found that dsRNA arthritis was triggered through IL-1R signaling because mice being deficient for this molecule were unable to develop joint inflammation. Although dsRNA is typically recognized by Toll-like receptor 3, Toll-like receptor 3 knockout mice developed arthritis, indicating that some other receptors are instrumental in the inducing of inflammation. Our results from in vitro experiments indicate that proinflammatory cytokines and chemokines stimulating monocyte influx were readily triggered in response to stimulation with dsRNA. These findings demonstrate that viral dsRNA is clearly arthritogenic. Importantly, macrophages and their products play an important role in the development of arthritis triggered by dsRNA.