Evaluating Behavioral Changes Prevalence Among Primary and Preschool Children Due to COVID-19 Epidemic

Background: The COVID-19 pandemic and its subsequent changes in the community lifestyle can be associated with problems and complications. It seems very important to identify the problems caused by the COVID-19 pandemic accurately. Objectives: This study aimed to investigate behavioral changes in children due to the COVID-19 pandemic in South Khorasan in 2021. Methods: In this cross-sectional study, 312 children were studied. Inclusion criteria included all children under 12 years of age without apparent mental disorders and chronic diseases affecting behavioral changes. Exclusion criteria were parental separation, experiencing natural disasters in the last two years, losing a first-degree family member in the last two years, and any underlying disease in the child and first-degree family members. The questionnaires included a demographic questionnaire and the Ruther Children's Behavior Questionnaire, completed by parents online due to the COVID-19 epidemic and the new situation. Results: The results showed that the behavioral disorder prevalence was 37.2% (n = 116). The mean scores were 3.10 ± 2.23 for aggression-hyperactivity, 3.11 ± 3.08 for anxiety-depression, 2.65 ± 1.79 for social maladaptation, 2.34 ± 1.83 for antisocial behavior, and 1.59 ± 1.29 for attention deficit. There was no significant relationship between demographic indicators and behavioral disorders (P > 0.05). Conclusions: The results indicated an increase in the prevalence of behavioral disorders in children during the COVID-19 pandemic. Therefore, it seems necessary to identify influencing factors and find appropriate solutions to prevent such disorders.

Evaluation of Clinical Features and Outcomes of Patients with Coronavirus (COVID-19) Admitted to ICU in Southeastern Iran in 2020

Background: Coronavirus, coronavirus disease 2019 (COVID-19), in humans, mainly causes respiratory and gastrointestinal manifestations that can range from a simple cold to severe clinical symptoms or death. On the other hand, COVID-19 patients’ hospitalization in the intensive care unit (ICU) have serious problems, which can affect their mortality; therefore, the awareness of these problems has a main role in decision-making in the early stages. Objectives: This study aimed to evaluate the clinical features and outcomes of patients with COVID-19 admitted to the ICU. Methods: This cross-sectional (descriptive-analytical) study was conducted on patients with COVID-19 pneumonia admitted to the ICU of Valiasr Hospital, Birjand, Iran, in 2020. A total of 111 patients, including 51 female and 63 male subjects, were enrolled in this study using convenience sampling. Demographic data, comorbidities, signs and symptoms, radiological findings, supportive methods of oxygen therapy, and clinical outcomes were collected using a checklist and compared between two groups (i.e., survivors and nonsurvivors). Results: Among 111 patients (including 59 nonsurvivors and 52 survivors), the numbers of mortalities within the age ranges of ≥ 75 and ≤ 44 years were the highest and lowest, respectively. In the survived patients, hypertension (50.8%), diabetes mellitus (47.5%), heart disease (44.1%), and chronic obstructive lung disease (23.7%) were the most common comorbidities. Moreover, dyspnea (81.1%), fever and chills (73%), cough (64.9%), muscle pain (45%), and weakness, and lethargy (42.3%) were the most common symptoms of the patients. Based on the comparison of survived and nonsurvived groups, diarrhea (P < 0.001), sore throat (P < 0.001), nausea (P < 0.001), and vomiting (P < 0.0001) were significantly higher in the group of survived patients. Among the radiological findings (i.e., chest X-ray and high-resolution computed tomography), bronchoalveolar markings (P = 0.05) and pleural effusion (P = 0.02) were higher in the nonsurvived patients. The average Acute Physiology and Chronic Health Evaluation II (APACHE II) score ≥ 16 was reported with a higher mortality rate. Conclusions: Risk factors, including dyspnea, older age, comorbidities, and high APACHE II score, could increase the risk of poor clinical outcomes and help identify ill patients with a poor prognosis at the beginning of ICU admission.

Knowledge, Attitude, and Practice (KAP) Towards COVID-19 Among General Population of South Khorasan Province, Iran: A Quick Online Cross-Sectional Survey

Background: COVID-19 is a highly contagious disease and a pandemic. Knowledge, attitude, and practice of people about this disease can play an essential role in better accepting executive actions set by health officials and national planners. Objectives: This study aimed to determine the level of knowledge, attitude, and practice of the general population of South Khorasan province about COVID-19 and the influencing factors. Methods: This cross-sectional study was performed online on 699 people living in South Khorasan, Iran. The participants were chosen by a convenience sampling technique. The research tool was an adapted questionnaire from researchers that included demographic characteristics, 15 questions on awareness, 12 questions on attitude, and seven questions on practice. Data were analyzed using the independent t test, one-way analysis of variance, and Pearson correlation coefficient. Results: The levels of knowledge, attitude, and practice of the participants were 73.13, 80, and 84.85%, respectively. The most common symptoms of this disease were shortness of breath, dry cough, and fever or headache, in sequence. More than half of the participants (56.90%) felt at risk for contracting the disease. Most participants washed their hands (80%) and used a facemask (79.60%). The correlation between awareness and practice was 0.60. Older, divorced, and low-educated people had lower knowledge and practice. Conclusions: Despite that the levels of knowledge, attitude, and practice of people was good regarding COVID-19 in this study, the continuous informing of the people through television, radio, and social media is needed for maintaining the status quo. Besides, new approaches and policies for the poor, rural populations, the elderly, the illiterate, and the unemployed should be adopted by relevant authorities due to their lower level of knowledge and practice.

Effectiveness of Paradox Therapy on COVID-19 Anxiety in Adult Population in Jahrom, Iran

Background: Since COVID-19 is a new disease with devastating effects worldwide, its emergence and spread aroused confusion, anxiety, and fear among the public. Objectives: The present study aimed to evaluate the effectiveness of paradox therapy on the COVID-19 anxiety in adult population in Jahrom, Iran. Methods: This research was a quasi-experimental study with a pretest-posttest design and a two-month follow-up. The research population encompassed all individuals willing to participate in the present study who were residing in Jahrom during 2020-2021. According to the COVID-19 Anxiety Scale, 30 participants with high levels of COVID-19 anxiety were selected using the convenience sampling method and were randomly assigned to experimental (n = 15) and control (n = 15) groups. The experimental group received eight sessions of paradox therapy; however, the control group remained on the waiting list. The research tools included structured clinical interviews and the COVID-19 Anxiety Scale. Finally, the collected data were analyzed using Friedman’s statistical method. Results: The results showed that paradox therapy was effective in decreasing COVID-19 anxiety (P = 0.001) and its psychological (P = 0.001) and physical (P = 0.002) symptoms, and the scores of the COVID-19-induced psychological and physical symptoms in the posttest phase were significantly lower in the intervention group than the control group (P < 0.001). The decrease was noticed in the follow-up phase as well. Conclusions: According to the results, paradox therapy can effectively reduce anxiety and its psychological and physical symptoms due to COVID-19.

Evaluating COVID-19 Knowledge, Attitudes, and Practice Among the Students of Birjand University of Medical Sciences: A Cross-sectional Survey

Background: With the onset of the coronavirus disease 2019 (COVID-19) pandemic in December 2019, healthcare systems faced an unprecedented challenge. Medical and paramedical students are the front-line warriors in this combat. Objectives: This study aimed to assess COVID-19 knowledge, attitudes, and practice among the students of Birjand University of Medical Sciences, Iran, in 2020. Methods: This cross-sectional analytical study was carried out on 329 students who passed the microbiology course from October 2020 to March 2021. The data collection tool was a researcher-made questionnaire consisting of four sections: demographic data, COVID-19-related knowledge, attitudes towards COVID-19, and participants’ practice. Finally, statistical analysis was performed in SPSS software version 19, and a significance level of 0.05 was considered in all tests. Results: A total of 329 medical, dentistry, pharmacy, and laboratory sciences students participated in this study. The mean score of COVID-19 knowledge was 10.26 ± 1.21 (out of 12). Among the participants, 103 (31.3%) individuals expressed being in crowded places in recent days, and 324 (98.5%) of them confirmed wearing masks. More than half of the students had positive attitudes towards COVID-19 control. The average knowledge was higher in females and medical and laboratory sciences students (P = 0.008). Also, the students' knowledge was inversely related to their practice of wearing a mask (P = 0.015). Conclusions: While students had a high level of COVID-19 knowledge, they had some misconceptions that should be included in educational programs. Students of medical sciences should be responsible for preventive behaviors and strive to be good role models for others.

Clinical, Demographic, and Epidemiological Characteristics of Patients Diagnosed with COVID-19 in Zahedan, Southeastern Iran

: As the epidemic spreads, COVID-19 poses a severe threat to the health of communities. Description of epidemiological characteristics of COVID-19 patients helps with the prevention and scientific control of the pandemic. This descriptive study was conducted to describe the clinical, demographic, and epidemiological characteristics of 65 patients suspected of having COVID-19. A research-made questionnaire was used for data collection. Moreover, the patient's vital signs were examined. The samples were classified into the two groups of subjects with positive and negative RT-PCR test. Descriptive statistics were used for the analysis of data. The most common manifestations were fever, shortness of breath, and dry cough. Moreover, the lowest proportion belonged to Rh-negative in all ABO blood groups. The patients were mainly male, about 44 years old, and their first and most common manifestations were fever, shortness of breath, and dry cough. In vital signs examination, reduction of blood oxygen saturation was the most important finding. Health centers need to consider these signs in treating COVID-19 patients.

A Case of Guillain-Barré Syndrome as the First Presentation of Systemic Lupus Erythematosus

Introduction: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease with different clinical manifestations. Acute [resembling Guillain-Barré syndrome (GBS)] or chronic (chronic inflammatory demyelinating polyradiculoneuropathy) inflammatory polyradiculoneuropathy has been reported in rare SLE cases. Case Presentation: We reported a 39-year-old woman that presented with acute peripheral neuropathy, and she was eventually diagnosed with SLE. She developed distal numbness and paraesthesia followed by progressive upper and lower extremity weakness and difficulty in swallowing and speaking. She had a history of flu-like illness three weeks before to symptoms. Conclusions: Progressive upper and lower extremity weakness along with areflexia and electrodiagnostic findings suggested the diagnosis of Guillain-Barré syndrome. Over a month, significant neurological recovery occurred, and the patient's function continued to recover.

Effectiveness of Transcranial Direct Current Stimulation and Pharmacotherapy in Pain Management in Patients with Chronic Pain

Background: A variety of pharmacological and nonpharmacological methods are used to treat chronic pain. Transcranial direct current stimulation (tDCS) through stimulating the central and peripheral nerves is a different and promising method for the treatment of chronic pain. Objectives: The present study aimed to investigate the effectiveness of tDCS and pharmacotherapy in pain management in patients with chronic pain in Tehran, Iran. Methods: The present study followed a clinical trial design. The statistical population comprised all patients with chronic pain who were referred to Pardis Multidisciplinary Pain Clinic in Tehran within 2020 - 21. A total of 60 patients willing to participate in the study were selected using convenience sampling. The participants were randomly divided into three groups, including pharmacotherapy (treatment by gabapentin with a dosage of 600 mg twice per day), tDCS, and control (n = 20 per group). The research instrument included the McGill Pain Questionnaire. The data were analyzed using repeated-measures analysis of variance with SPSS software (version 24.0). Results: The results showed that both pharmacotherapy and tDCS interventions led to a reduction in the mean scores of pain management components, compared to the control group (P < 0.001). Furthermore, there was no significant difference between the effects of the two experimental groups on pain management components. Conclusions: The tDCS and pharmacotherapy were both shown to be effective in pain management in patients with chronic pain. Therefore, in addition to pharmacotherapy, tDCS is also recommended for the treatment of chronic pain.

Comparison Between Emergency Severity Index Plus Cardiac Troponin I Rapid Test and Emergency Severity Index in Patients Presenting with Low-Risk Chest Pain: A Randomized Clinical Trial

Background: There is difficulty in identifying low-risk patients with acute coronary syndrome in the emergency department (ED). Objectives: The aim of this study was to compare mistriage between the Emergency Severity Index (ESI) plus the cardiac troponin I rapid test (cTnI) and ESI among patients with chest pain. Methods: A randomized clinical trial was conducted from January to April 2019. One hundred patients with low-risk chest pain were randomly allocated to the ESI + cTnI and ESI groups. Triage levels, used resources, and mistriage rate were compared between both groups among patients discharged from the ED and admitted to the cardiac unit (CU) or coronary care unit (CCU). Results: Our samples included 100 patients (age: 52.9 ± 13.92 years; 51% female) who were equally assigned to the ESI + cTnI and ESI groups. Overtriage rate was 6% and 88% for the ESI + cTnI and ESI groups, respectively. The triage level between the ESI + cTnI and ESI groups was significantly different among patients who were discharged from the ED (3.92 vs. 3.00). Conclusions: The ESI + cTnI score seems to be more valid than the ESI scale to triage patients with low-risk chest pain. It is recommended to add cTnI to the ESI for the triage of patients with low-risk chest pain in the ED.