Electrocardiographic parameters and mortality in patients with SARS-CoV-2 infection: A single center study.

Background: Coronavirus disease 2019 (COVID-19) is a pandemic outbreak of RNA coronaviruses (SARS-CoV-2), associated with acute respiratory distress syndrome, multiple organ failure, and death. The surface electrocardiogram is the first line assessment of cardiac electrical system. We aimed to interpret classically the electrocardiographic parameters at admission and during hospital course and association of them with prognosis in patients admitted with diagnosis of infection with SARS-CoV-2. Methods: Surface electrocardiograms (ECG) were obtained from 180 patients with SARS-CoV-2 infection at a large tertiary referral university hospital at north of Iran in Babol. The electrocardiographic waves, intervals and segments in addition to supraventricular and ventricular arrhythmias were depicted. Our cohort included two groups: discharged alive and dead during the hospital course. We compared the ECG characteristics of patients who died vs. survived ones. Results: Some ECG parameters of 180 hospitalized patients were significantly associated with mortality, like heart rate (p< 0.001), bundle branch block (P= 0.035), fragmented QRS (P= 0.015), ST elevation (P= 0.004), T p-e duration (P= 0.006), premature atrial and ventricular complexes (P= 0.030, P= 0.004) and atrial fibrillation (P= 0.003). Conclusion: The SARS-CoV-2 infection had several impacts on cardiac electrical system which may monitored with a simple and easily accessible tool like ECG. This tool also helpful in the risk stratification of patients.

Impact of Negative Fluid Balance on Mortality and Outcome of Patients with Confirmed COVID-19.

Purpose: Maintaining the proper fluid balance is a fundamental step in the management of hospitalized patients. The current study evaluated the impact of negative fluid balance on outcomes of patients with confirmed COVID-19. Methods: We considered the negative fluid balance as a higher output fluid compared to the input fluid. The fluid balance was categorized into four groups (group 4: -850 to -500 ml/day; group 3: -499 to -200 ml/day, group 2: -199 to 0 ml/day, and group 1 : 1 to 1000 ml/day) and included ordinally in the model. The outcomes were all-cause mortality, length of hospitalization, and improvement in oxygen saturation. Results: The fluid balance differed significantly among nonsurvivors and survivors (MD: -317.93, 95% CI: -410.21, -225.69, and p < 0.001). After adjusting for potential confounders, there was a significantly lower frequency of mortality in patients with negative fluid balance compared to the controls (aRR: 0.69, 95% CI: 0.57, 0.84, and p < 0.001). Similarly, the length of hospitalization was significantly shorter in the negative fluid balance group in comparison to the control group (aMD: -1.01, 95% CI: -1.74, -0.28, and p=0.006). Conclusion: We determined that the negative fluid balance was associated with favorable outcomes in COVID-19 patients. The negative fluid balance was associated with the reduced mortality rate and length of hospitalization as well as improvement in oxygen saturation. Moreover, the NT-proBNP >781 pg/mL and fluid balance >-430 mL might be the predictors for positive fluid balance and mortality, respectively.

A Multiple-Center, Retrospective Study of Characteristics and Outcomes of Hospitalized COVID-19 Patients with Cardiovascular Disease in North Iran.

Background: In this retrospective study, we investigated the outcomes and demographic characteristics of COVID-19 patients with and without a history of CVD. Methods: This large retrospective, multicenter study was performed on inpatients with suspected COVID-19 pneumonia who were admitted across four hospitals in Babol, Northern Iran.Demographic data, clinical data, and cycle threshold value (Ct) results of Real Time PCR were obtained. Then, participants were divided into two groups: (1) cases with CVDs, (2) cases without CVDs. Results: A total of 11097 suspected COVID-19 cases with a mean ± SD age of 53 ±25.3 (range: 0 to 99) years were involved in the present study. Out of whom 4599 (41.4%) had a positive RT-PCR result. Of those, 1558 (33.9%) had underlying CVD. Patients with CVD had significantly more co-morbidities such as hypertension, kidney disease, and diabetes. Moreover, 187 (12%) and 281 (9.2%) of patients with and without CVD died, respectively. Also, mortality rate was significantly high among the three groups of Ct value in patients with CVD, with the highest mortality in those with Ct between 10 and 20 (Group A = 19.9%). Conclusions: In summary, our results highlight that CVD is a major risk factor for hospitalization and the severe consequences of COVID-19. Death in CVD group is significantly higher compared to non-CVD. In addition, the results show that age-related diseases can be a serious risk factor for the severe consequences of COVID-19.

Investigating the Psychometric Properties of the Persian Version of the Massachusetts Youth Screening Instrument (MAYSI-2).

This study was done to prepare a Persian version of the MAYSI-2 and investigate its psychometric properties among the adolescents of the Juvenile Correction and Rehabilitation Center in Mashhad. By available study sample 329 male adolescents were selected. The findings showed that the Cronbach's alpha values for subscales were from .74 to .91. Compound reliability was also obtained in different scales between .72 and .98 indicating the optimal reliability of the scale. The CVR and CVI indicating the appropriate content validity. The results of CFA showed that the factor loading of the items was more than .5. The scale had good structural validity. The GFI of .90, IFI of .91, and RMSEA of .072 were all within the acceptable limits. Convergent and divergent validity indicators showed that the subscales benefited from the convergent validity. Our results showed that the Persian version of the MAYSI-2 had desirable psychometric properties. Therefore, it can be used for assessing mental health problems of juvenile delinquent and upcoming research.

Optimal cut points of N-terminal of the prohormone brain natriuretic peptide (NT-proBNP) in patients with COVID-19.

BACKGROUND: COVID19 patients may suffer from multiple cardiovascular complications. Recently, N-terminal of the prohormone brain natriuretic peptide (NT-proBNP) was a potentially independent risk factor for COVID-19 in-hospital death. The present study aimed to find new optimal cut points for NT-proBNP across censored survival failure time outcomes in hospitalized COVID-19 patients. RESULTS: This cohort study was conducted on 272 patients with COVID-19 whose initial records were recorded from March 2020 to July 2020. Demographic characteristics, clinical examinations, and laboratory measurements were collected at the beginning of the admission registered in the patient record system located in the hospital. We used the maximally selected rank statistics to determine the optimal cut points for NT-proBNP (the most significant split based on the standardized log-rank test). Survival time was defined as the days from hospital admission to discharge day. In this cohort study, two optimal cut points for NT-proBNP were 331 (pg/mL) and 11,126 (pg/mL) based on a survival model. The adjusted HR of NT-proBNP for in-hospital death was 3.41 (95% CI: 1.22-9.51, P = 0.02) for medium against low category, and 3.84 (95% CI: 1.30-11.57, P = 0.01) for high in comparison with low group. CONCLUSIONS: We reported a dramatically increased concentration of NT-proBNP among COVID-19 patients without heart failure in both severe and non-severe cases. Moreover, our study showed that a high level of NT-proBNP was highly associated with the prolonged survival time of patients with COVID-19. NT-proBNP is a strong prognostic indicator of in-hospital death in the second week of admission.

Clinically suspected myocarditis in COVID-19 patients: Case series and review of the literature.

This Study describes eleven patients positive for severe acute respiratory syndrome coronavirus 2. In our cases, females and younger patients developed more severe disease. In contrast, improvement in left ventricular ejection fraction and N-terminal prohormone brain natriuretic peptide within the first week of treatment contributed to promising outcomes.

Characteristics and outcomes of hospitalized patients with cardiovascular complications of COVID-19.

Introduction: To address cardiovascular (CV) complications and their relationship to clinical outcomes in hospitalized patients with COVID-19. Methods: A total of 196 hospitalized patients with COVID-19 were enrolled in this retrospective single-center cohort study from September 10, 2020, to December 10, 2020, with a median age of 65 years (IQR, 52-77). Follow-up continued for 3 months after hospital discharge. Results: CV complication was observed in 54 (27.6%) patients, with arrhythmia being the most prevalent (14.8%) followed by myocarditis, acute coronary syndromes, ST-elevation myocardial infarction, cerebrovascular accident, and deep vein thrombosis in 15 (7.7%), 12 (6.1%), 10(5.1%), 8 (4.1%), and 4 (2%) patients, respectively. The proportion of patients with elevated high-sensitivity troponin I, N-terminal pro-B-type natriuretic peptide, left ventricular diastolic dysfunction, and heart failure with preserved ejection fraction was greater in the CV complication group. Severe forms of COVID-19 comprised nearly two-thirds (64.3%) of our study population and constituted a significantly higher share of the CV complication group members (75.9%vs 59.9%; P =0.036). Intensive care unit admission (64.8% vs 44.4%; P =0.011) and stay (5.5days vs 0 day; P =0.032) were notably higher in patients with CV complications. Among 196patients, 50 died during hospitalization and 10 died after discharge, yielding all-cause mortality of 30.8%. However, there were no between-group differences concerning mortality. Age, heart failure, cancer/autoimmune disease, disease severity, interferon beta-1a, and arrhythmia were the independent predictors of all-cause mortality during and after hospitalization. Conclusion: CV complications occurred widely among COVID-19 patients. Moreover,arrhythmia, as the most common complication, was associated with increased mortality.

Narrative therapy for depression and anxiety among children with imprisoned parents: A randomised pilot efficacy trial.

This study aimed to determine the efficacy of narrative group therapy in reducing depression and anxiety among children with imprisoned parents. The study design was a randomised clinical trial with an experimental group, and waiting list group as the control group. Eighty-five children with imprisoned parents were selected by convenience sampling method. They were randomly assigned to the experimental and control groups. The experimental group received the narrative group therapy while the control group did not. The research measurement instrument comprised the Children's Depression Inventory (CDI) and the Revised Children's Manifest Anxiety Scale (RCMAS). Analysis of univariate covariance (ANCOVA) and independent t-test was employed to test the study hypothesis. The findings showed that depression and anxiety reduced among children with imprisoned parents with a high effect size (anxiety = 0.90 and depression = 3.05). Thus, the principle and techniques of narrative therapy and the benefits of group therapy reduced depression and anxiety among children with imprisoned parents. Therefore, this study showed that this intervention can be useful for children with imprisoned parents.

Group life skills training for promoting mental health in women after released from prison: A randomized pilot efficacy trial.

The aims of the researchers were to determine the effectiveness of Life Skills Training for promoting mental health in the women after released. The study design was semi-experimental with pretest, posttest, follow-up, and control group. One hundred and fifty women after released were selected by convenience sampling. They were randomly assigned to experimental group and control group. The experimental group received the life skills training, while the control group did not. The research measurement instrument comprised the General Health Questionnaire. MANCOVA models were used to test the study hypothesis. We analyzed data and thus believe that mental health increased among women.

Cognitive Group Therapy Based on Schema-Focused Approach for Reducing Depression in Prisoners Living With HIV.

Depression is one the most common mental disorders in prisons. People living with HIV are more likely to develop psychological difficulties when compared with the general population. This study aims to determine the efficacy of cognitive group therapy based on schema-focused approach in reducing depression in prisoners living with HIV. The design of this study was between-groups (or "independent measures"). It was conducted with pretest, posttest, and waiting list control group. The research population comprised all prisoners living with HIV in a men's prison in Iran. Based on voluntary desire, screening, and inclusion criteria, 42 prisoners living with HIV participated in this study. They were randomly assigned to an experimental group (21 prisoners) and waiting list control group (21 prisoners). The experimental group received 11 sessions of schema-focused cognitive group therapy, while the waiting list control group received the treatment after the completion of the study. The various groups were evaluated in terms of depression. ANCOVA models were employed to test the study hypotheses. Collated results indicated that depression was reduced among prisoners in the experimental group. Schema therapy (ST) could reduce depression among prisoners living with HIV/AIDS.

The Effect of Saffron on Depression among Recovered Consumers of Methamphetamine Living with HIV/AIDS.

BACKGROUND: From one hand, depression is one of the symptoms that occur after abstinence from methamphetamine. On the other people living with HIV/AIDS are in isolation due to the nature of their illness and depression is one of the most common mental health problems they experience. OBJECTIVES: This study was aimed at determining the effectiveness of saffron on reducing depression among recovered consumers of methamphetamine living with HIV/AIDS. METHODS: The design of this study was semi-experimental with pre-test, post-test and control (placebo) groups. The statistical population consisted of all recovered consumers of methamphetamine living with HIV/AIDS who were referred to the Positive Club. Fifty-seven (57) recovered consumers of methamphetamine, living with HIV/AIDS, were selected by convenience sampling method. They were randomly assigned to an experimental (saffron) group and a control (placebo) group. The experimental group received 30 ml of saffron per day for 8 weeks, whereas the control (placebo) group received placebo the same way. BDI-II was used in this study as a measurement instrument. ANCOVA models were used for statistical inference. RESULTS: The findings showed that saffron and its ingredients had been effective in reducing depression among this group (P < 0.05). CONCLUSION: In fact, saffron with its active ingredients (Crusin and Saffranal) by serotonin and dopamine secretion in the brain, help in reducing depression among recovered consumers of methamphetamine living with HIV/AIDS.

The Effectiveness of Solution-Focused Brief Couple Therapy on Marital Satisfaction Among Married Prisoners and Their Wives.

This study aimed to determine the effectiveness of the Solution-Focused Brief Couple Therapy (SFBCT) on marital satisfaction among married prisoners and their wives. The study design was semiexperimental with a pretest, a posttest, and a control group. Fifty couples (100 people) were selected by convenience sampling. They were randomly assigned to the experimental group and the control group. The experimental group received the SFBCT, while the control group did not. The research measurement instrument comprised the ENRICHES Couple Scale (ECS). Multivariate analyses of covariance (MANCOVA) models were used to test the study hypothesis. The results showed that marital satisfaction increased among prisoners and their wives. So the principles and techniques of SFBCT did have an effect on marital satisfaction of this particular group.

Comparing Motivational Interviewing-Based Treatment and its combination with Nicotine Replacement Therapy on smoking cessation in prisoners: a randomized controlled clinical trial.

BACKGROUND: The prevalence of smoking is much higher in prisoners than it is in the general population. Prisoners who smoke cause many health problems for themselves and other prisoners. Therefore, we should help them stop smoking. OBJECTIVE: To compare the effects of motivational interviewing-based (MI-based) treatment and its combination with nicotine replacement therapy (NRT) on smoking cessation in prisoners at Mashhad Central Prison. METHODS: The study was designed as a double-blind, randomized, controlled clinical trial, and it began in February 2013 and ended in February 2014. Two hundred and thirteen prisoners met the inclusion criteria and were enrolled in the study. They were divided randomly into three groups, i.e., MI-based treatment, MI with NRT, and the control group, which didn't receive any therapy. The outcome measures were reported after intervention and at a 90-day follow-up, and changes in the CO levels in expired air and nicotine dependency were measured. RESULTS: The average age of the subjects was 37.59 ± 8.76, and their mean duration of imprisonment was 3.3 ± 1.90 years. They smoked an average of 21.84 ± 8.72 cigarettes per day. Analysis of the concentration of CO in expired air in the pre-test, post-test, and at the follow-up for the three groups showed that the variations in the mean CO concentrations in the MI group and the MI with NRT group at the pre-test and at the post-test were statistically significant (p < 0.001), but no significant changes occurred between the post-test and the follow-up (p > 0.050). In addition, the results indicated that CO concentration in expired air in the MI with NRT group was statistically significant, with better efficacy of smoking cessation, compared with control group and the MI group after the follow-up (p = 0.02). CONCLUSIONS: Motivational interviewing combined with NRT for smoking cessation is more effective than MI alone, and it resulted in a significant decrease in the CO concentration in expired air at the 90-day follow-up.

Association of two common polymorphisms of apolipoprotein A5 gene with metabolic syndrome indicators in a North Iranian population, a cross-sectional study.

BACKGROUND: Metabolic syndrome is an obesity dependent disorder with a worldwide high prevalence. Regarding the high prevalence of Metabolic syndrome in Iran we analyzed the influence of -1131T>C (rs662799) and c.56C>G (S19W, rs3135506) polymorphisms of the novel apolipoprotein gene, ApoA5, on some Metabolic Syndrome indicators in population from north of Iran. METHODS: 199 volunteers from Babol city-Iran were divided in two groups of low (N = 99, TG ≤ 103 mg/dl) and high (N = 100, TG ≥ 150 mg/dl) serum levels of Triglycerides (TG). We amplified the gene fragments containing -1131T>C and c.56C>G polymorphisms by PCR method and revealed the polymorphisms by RFLP analysis. RESULTS: We found a significant association (p = 0.016, Independent t-test) between high levels of TG and -1131T>C polymorphism but not between this polymorphism and serum HDL-C concentrations. Carriers of the C allele had a 1.97 times higher odds ratio to be in the high-TG group than those of the TT genotype (95%, CI = 1.05-3.68). We observed no association between -1131T>C polymorphism with either Waist-to-Hip Ratio (WHR) or Body-Mass-Index (BMI). In the case of c.56C>G polymorphism, although it showed a significant relationship with WHR (p = 0/040, Independent t-test), but failed to correlate with either levels of TG (p = 0.594) or HDL-C (p = 0.640) in serum. CONCLUSION: Our study confirms that ApoA5 gene polymorphisms, -1131T>C and c.56C>G are associated with the two criteria of Metabolic Syndrome, TG and WHR, respectively.

Smoking crushed hyoscine/scopolamine tablets as drug abuse.

BACKGROUND: Hyoscine N-butyl bromide/scopolamine (H/S) is a type of anticholinergic agent that is commonly used as an antispasmodic drug. We have evaluated the effects of crushed H/S smoking in prisoners who illicitly abused this drug. METHODS: All imprisoned cases with at least a 3-month history of HS were evaluated from April 2012 to September 2012. Demographic information, history, and clinical findings were studied. RESULTS: In total, 36 male cases with a mean (SD, min-max) age of 33.3 (3.6, 27-42) years were included. All subjects were cigarette smokers with a history of substance abuse and were under Methadone Maintenance Therapy (MMT). The majority (75%) of participants smoked H/S tablet with pin, and others used aluminum foil. Hallucinations were the most common neurological features. Amnesia (88%), insomnia (83%), palpitation (86%), flushing (86%), irritability (94%), and inability to concentrate (91%) were the most common findings. Among them, auditory (61%), visual (72%), and tactile (72%) hallucinations were reported. CONCLUSIONS: This is the first case study of hyoscine smoking abuse. We found that H/S acts similar to other hallucinogens. Concurrent abuse of H/S in cases under MMT could be a future trend of abuse. Clinicians should be aware of abuse potential of H/S in treatment of some patients for drug overdose.

The relationship between acute myocardial infarction and periodontitis.

BACKGROUND: Periodontitis is common in adults and cardiovascular diseases (CVD) are the most common cause of adult death in the world. This study aimed to investigate the relationship between CVD and periodontitis. METHODS: Sixty patients with myocardial infarction (MI) as case and 63 subjects with periodontitis without MI as control were studied. Periodontitis was assessed according to Ramfjord periodontal diseases index and the number of missing teeth besides classic risk factors of MI were recorded. RESULTS: The patients who lost more than 10 teeth were at more risk of myocardial infarction (OR=2.73). There was a significant relationship between mean attachment loss and MI (p=0.0001). There was also a relation between attachment loss more than 3 mm and MI with OR of 4. Significant difference between mean PDI (periodontal disease index) was seen in case and control groups (p=0.0001). Subjects with PDI>4 were at more risk of periodontal diseases (OR=7.87). CONCLUSION: The results show the presence of significant relation between periodontitis and MI which could serve as an alarm to treat periodontitis carefully.

Effects of soy on metabolic biomarkers of cardiovascular disease in elderly women with metabolic syndrome.

BACKGROUND: This study ascertained the effects of soy, in the forms of textured soy protein (TSP) and soy nuts, on lipid profiles, apolipoproteins, inflammatory and prothrombotic markers, and blood pressure in elderly women diagnosed with metabolic syndrome (MetS). METHODS: This was a 12-week parallel, randomized, controlled trial conducted in rural health centers of Babol, Iran. Participants were 75 women, ages 60-70 years, who were diagnosed with MetS. Subjects were randomized to one of the following 3 groups: i) soy nut (35 g/d), ii) TSP (35 g/d), and iii) control. Blood biochemical markers measured at baseline and at the end of the study included: triglycerides (TG), cholesterol, HDL-C, LDL-C, VLDL-C, ApoB100, ApoAI, C-reactive protein (CRP), and fibrinogen. RESULTS: Soy nuts significantly improved LDL-C, VLDL-C, and ApoB100levels (P < 0.05), while fewer, significant improvements were observed in these variables in the TSP group compared to mean changes from baseline (P < 0.001). Similar results were found for ApoAI in the treatment groups (P < 0.01). Serum total cholesterol (TC) decreased significantly in the treatment groups compared with the control group (P < 0.005). Differences from the control group in terms of TG, HDL-C, fibrinogen, CRP, and blood pressure were not significant. CONCLUSION: Both forms of soy improved lipid profiles. The group that consumed soy nuts had greater improvement than the TSP group. Therefore, moderate daily intake of soy may be a safe, inexpensive, and practical method to improve the risk of cardiovascular disease (CVD) and reduce the need for medical treatment. IRCT ID: IRCT 138804212130N1.

HLA-DRBeta1, circulating Th1/Th2 cytokines and immunological homunculus in coronary atherosclerosis.

Coronary atherosclerotic disease is one of the most endangering health disorder worldwide. This study was designed to investigate the correlation between HLA-DR1 alleles and circulating Th1/Th2 type cytokines in coronary atherosclerosis. By Elisa, Th1/Th2 type cytokines were determined in serum samples of 31 subjects with unstable angina, 27 subjects with chronic stable angina and 24 individuals as normal control. By SSP-PCR, more than 100 alleles of HLA-DRBeta1 were typed in 24 subjects who had skewed serum levels of Th1/Th2 type cytokines. Lipid profiles were determined by the routine methods of clinical laboratory in all subjects. The mean serum concentration of IL-10 in normal control subjects was higher in comparison to the patient groups.0.33±0.59 pg/ml versus 0.064±0.3 pg/ml in unstable angina pectoris group (p<0.028) and 0.22±0.6 pg/ml in chronic stable subjects. There was no statistically significant difference among the groups in serum levels of other desired cytokines (IFN-Gamma, IL-4). 33.33% of normal control subjects were HLA-DR16 positive whereas none of the subjects with chronic stable angina or individuals with unstable angina pectoris was positive for this antigen. The mean concentration of serum LDL-cholesterol in normal control group was high 142.046±35.40 (pg/ml).This preliminary study shows that the atherogenic effect of the LDL- cholesterol may be dampened by HDL-cholesterol through anti inflammatory cytokine IL-10 and HLA-DR16, a phenomenon interpretable via immunological homunculus theory.

Investigation of the effect of ginger on the lipid levels. A double blind controlled clinical trial.

OBJECTIVE: To study the effect of fine powder of ginger on lipid level in volunteer patients. METHODS: This is a double blind controlled clinical trial study in 2 cardiac clinics Cardiac Disease Clinic, Babol, north of Iran, between April to May 2004. We randomly divided the patients with hyperlipidemia into 2 groups, treatment group (receiving ginger capsules 3 g/day in 3 divided doses) and placebo group (lactose capsule 3 g/day in 3 divided doses) for 45 days. All subjects with diabetes mellitus, hypothyroidism, nephrotic syndrome, and alcohol drinking, pregnancy and peptic ulcer were excluded. Lipid concentrations profile before and after treatment was measured by enzymatic assay. RESULTS: Forty-five patients in the treatment group and 40 patients in placebo group participated in this study. There was a significant reduce in triglyceride, cholesterol, low density lipoprotein (LDL), very low density lipoprotein (VLDL), levels of before and after study separately in each group (p<0.05). Mean changes in triglyceride and cholesterol levels of ginger group were significantly higher than placebo group (p<0.05). Mean reduction in LDL level and increase in high density lipoprotein level of ginger group were higher than the placebo group, but in VLDL level of placebo was higher than ginger (p>0.05). CONCLUSION: The results show that ginger has a significant lipid lowering effect compared to placebo.

Evaluation of 'partnership care model' in the control of hypertension.

One of the shared common goals of World Hypertension League (WHL) and World Health Organization (WHO) is the control of hypertension. Despite many local and international interventions, the goal has not been achieved. This study evaluated an intervention based on the partnership care model to control hypertension in a rural population in the north of Iran. The results showed that the intervention was effective in decreasing systolic and diastolic blood pressure and in increasing the rate of controlled hypertensives (based on criteria of WHO/WHL). The intervention also had positive effects on health-related quality of life, body mass index, anxiety, high density lipoprotein level and compliance score. Based on these results, the partnership care model is effective in hypertension control and is recommended as a model to replace previous approaches in hypertension control.