Post-discharge health assessment in survivors of coronavirus disease: a time-point analysis of a prospective cohort study.

PURPOSE:  The objective of this study was to quantitatively evaluate psychological and quality of life-related complications at three months following discharge in hospitalized coronavirus disease 2019 (COVID-19) patients during the pandemic in Iran. METHODS: In this time-point analysis of prospective cohort study data, adult patients hospitalized with symptoms suggestive of COVID-19 were enrolled. Patients were stratified in analyses based on severity. The primary outcomes consisted of psychological problems and pulmonary function tests (PFTs) in the three months following discharge, with Health-related quality of life (HRQoL) as the secondary outcome. Exploratory predictors were determined for both primary and secondary outcomes. RESULTS: 283 out of 900 (30%) eligible patients were accessible for the follow-up assessment and included in the study. The mean age was 53.65 ± 13.43 years, with 68% experiencing a severe disease course. At the time of the final follow-up, participants still reported persistent symptoms, among which fatigue, shortness of breath, and cough were the most common. Based on the regression-adjusted analysis, lower levels of forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) ratio was associated with higher levels of depression (standardized ß = - 0.161 (SE = 0.042), P = 0.017) and stress levels (standardized ß =- 0.110 (SE = 0.047), P = 0.015). Furthermore, higher levels of anti-SARS-CoV-2 immunoglobulin-M (IgM) were associated with significantly lower levels of depression (standardized ß = - 0.139 (SE = 0.135), P = 0.031). CONCLUSIONS: There is an association between lung damage during COVID-19 and the reduction of pulmonary function for up to three months from acute infection in hospitalized patients. Varying degrees of anxiety, depression, stress, and low HRQoL frequently occur in patients with COVID-19. More severe lung damage and lower COVID-19 antibodies were associated with lower levels of psychological health.

Measuring the burden of comorbidity for ischaemic heart disease and four common non-communicable diseases in Iran, 1990-2017: a modelling study based on global burden of diseases data.

OBJECTIVE: This modelling study aimed to estimate the comorbidity burden for four common non-communicable diseases with ischaemic heart diseases (IHD) in Iran during a period of 28 years. DESIGN: Analysis of the burden of comorbidity with IHD based on data included prevalence rates and the disability weight (DW) average for calculating years lived with disability (YLDs) from the Iran population based on the Global Burden of Disease (GBD) study. SETTING: Population-based available data in GBD 2017 study of Iran population. PARTICIPANT: The source of data was the GBD 2017 Study. We evaluated IHD, major depressive disorder (MDD), diabetes mellitus (DM), ischaemic stroke (IS), and osteoarthritis (OA) age-standardised prevalence rates and their DW. MAIN OUTCOME MEASURES: A new formula that modified the GBD calculator was used to measure the comorbidity YLDs. In the new formula, some multipliers were considered, measuring the departure from independence. RESULT: The contribution of total comorbidity for each combination of IHD with DM, MDD, IS and OA was 2.5%, 2.0%, 1.6% and 2.9%, respectively. The highest YLD rates were observed for IHD_MDD, 16.5 in 1990 and 17.0 in 2017. This was followed by IHD_DM, from 11.5 to 16.9 per 100 000. The YLD rates for IHD_OA changed slightly (6.5-6.7) per 100 000, whereas there was a gradual reduction in the trends of IHD-IS, from 4.0-4.5 per 100 000. CONCLUSION: Of the four comorbidities studied, the highest burden was due to the coexistence of MDD with IHD. Our results highlight the importance of addressing the burden of comorbidities when studying the burden of IHD or any other non-communicable disease.

Gastrointestinal manifestations in patients with coronavirus disease-2019 (COVID-19): Impact on clinical outcomes.

Background: In this study, we summarized the data on gastrointestinal (GI) involvement and the potential association with clinical outcomes among the patients admitted to Khorshid Hospital. Materials and Methods: We investigated 1113 inpatients (≥18 years old) diagnosed with coronavirus disease-2019 (COVID-19) from March to June 2020 in Khorshid Hospital. We collected demographic details, clinical information, vital signs, laboratory data, treatment type, and clinical outcomes from patients' medical records. The data of patients with GI symptoms were compared with those without GI symptoms. Results: A total of 1113 patients were recruited (male = 648). GI symptoms were observed in 612 (56.8%) patients (male = 329), the most common of which were nausea 387 (34.7%), followed by diarrhea 286 (25.7%), vomiting 260 (23.4%), and abdominal pain 168 (15.0%). The most prominent non-GI symptoms were cough 796 (71.5%), fever 792 (71.2%), shortness of breath 653 (58.7%), and body pain 591 (53.1%). The number of patients who were discharged, died, and were admitted to intensive care unit was significantly different in groups on the basis of GI and non-GI symptoms (P = 0.002, 0.009, 0.003). Conclusion: While COVID-19 was predominantly diagnosed in males, GI symptoms were more commonly reported by females. The results indicated that GI symptoms in COVID-19 patients are common, and the symptoms are not correlated with the severity of the disease. Moreover, the presence of GI symptoms was positively related to milder disease. Among COVID-19 positive patients, the clinical outcomes of the GI group were promising, compared to those of non-GI group.

Healthcare workers' sleep and mood disturbances during COVID-19 outbreak in an Iranian referral center.

PURPOSE: This study aimed to assess the frequency of sleep and mood disturbances, and their association with COVID-like symptoms in healthcare workers (HCWs) with and without positive Coronavirus RT-PCR in a corona referral center. METHODS: This study was a cross-sectional, anonymous survey of adult HCWs. Data collection was performed in May and June 2020, while governmental restrictions were in place. The participants completed the forms including six separate parts: personal and occupational information, Insomnia Severity Index (ISI), Generalized Anxiety Disorder-7 (GAD-7), Patient's Health Questionnaire (PHQ-9), Pittsburgh Sleep Quality Index (PSQI), and COVID-like symptoms and Coronavirus RT-PCR status. RESULTS: Among the 372 HCW participants, 245 (66%) were women and  mean age was 34.5 ± 7.1 years (age range 23 to 58). The mean scores of all questionnaires except ISI were significantly higher in the HCWs with positive Coronavirus RT-PCR than another group (PSQI, 9 ± 3.4 vs. 6.9 ± 3.1; GAD-7, 9.8 ± 3.6 vs. 7.9 ± 5.3; PHQ-9, 12.8 ± 6.1 vs. 9.5 ± 6.4, P < 0.05; and ISI, 13.8 ± 5.3 vs. 12.3 ± 6 P = 0.163). Positive association between COVID-like symptoms and sleep and mood disturbances was found in the group without a positive test result. Analysis of questionnaires showed higher scores in the group directly involved except for ISI (P < 0.001 and P = 0.053 respectively). CONCLUSIONS: During the COVID-19 pandemic, the HCWs in this sample experienced a high rate of sleep and mood disturbances. There was also a strong association between sleep and mood disturbances and COVID-like symptoms in the group without a positive RT-PCR result. With all this considered, effective psychological support for HCWs during crisis seems to be necessary.

Pharmacological interventions for preventing anthracycline-induced clinical and subclinical cardiotoxicity: A network meta-analysis of metastatic breast cancer.

OBJECTIVE: Doxorubicin- and epirubicin-induced cardiotoxicities are life threatening for those suffering from breast cancer. Comparing the effects of different strategies on the prevention of these agent-induced cardiotoxicities remains unexplored.Data sources: A comprehensive review of clinical trials was performed on the prevention of epirubicin- and/or doxorubicin-induced cardiotoxicity in HER2-positive metastatic breast cancer patients. The reduction in ejection fraction was directed at evaluating cardiac toxicity.Data summary: Fourteen articles evaluated cardiotoxicity as a condition among 2945 individuals, evaluating doxorubicin, epirubicin, Liposomal Doxorubicin (LD), Pegylated Liposomal Doxorubicin (PLD), dexrazoxane plus doxorubicin or epirubicin, and Angiotensin-Converting Enzyme Inhibitors (ACEIs) plus doxorubicin. Pooled Odds Ratio (OR) of 0.043 with a 95% credible interval (CrI) between 0.005 and 0.22 indicated that the dexrazoxane plus epirubicin reduced the number of cardiac events compared with doxorubicin. Furthermore, doxorubicin and epirubicin represented the most effective interventions with a 52% probability of success. Also, the best treatment for reducing Congestive Heart Failure (CHF) was dexrazoxane plus epirubicin with a probability of 43%. For the Left Ventricular Ejection Fraction (LVEF) reduction outcome, ACEIs plus doxorubicin was ranked first with a success probability of 61.2% and they could significantly prevent the reduction in LVEF compared with LD, epirubicin, or doxorubicin. CONCLUSION: Our data suggested that angiotensin-converting enzyme inhibitors and dexrazoxane plus epirubicin were the most effective interventions for preventing cardiotoxicity and CHF. However, ACEIs plus doxorubicin was the best treatment for preventing LVEF reduction.

Age-Dependent Clinical Features and Prognosis of COVID-19 Patients.

Background: The clinical and paraclinical symptoms of COVID-19 differ across age groups. This study investigated the differences between these parameters and their outcomes in young, middle-aged, and elderly patients admitted to a COVID-19 referral center. Materials and Methods: This retrospective study encompassed patients with COVID-19 hospitalized at Khorshid Hospital (Isfahan, Iran) during February 23 to April 30, 2020. The patients' predisposing conditions, clinical and paraclinical findings, and outcomes were compared among three young, middle-aged, and elderly groups. Results: Of the 1185 hospitalized patients with suspected COVID-19, 1065 were discharged or died at the end of the study. Among these 1065 patients, 654 patients with the mean age of 57.7 years had positive PCR results or typical CT scans and were included in the study, of whom 77 (11.8%), 353 (54%), and 234 (34.2%) patients were assigned into the young, middle-aged, and elderly groups, respectively. There was no statistically significant difference among the three groups regarding the prevalence of clinical symptoms. Moreover, CRP, ESR, WBC, BUN, Cr, and lymphocytes were higher in the elderly group. The ground-glass opacity (GGO) (24.1%), GGO-consolidation (27.4%), and consolidation (10.3%) were the most common CT scan findings in the young, middle-aged, and elderly groups, respectively. Fifty-three patients (8.1%) died, and the mortality rates were 10.36%, 7.27%, and 3.8% in the elderly, middle-aged, and young groups, respectively. Conclusion: COVID 19 symptoms do not depend on age; however, paraclinical findings differ across young, middle-aged, and elderly patients.