---

In December 2019, the new acute respiratory disease spread in China presented with fever and dry cough known to be resulted from the new Corona Virus as the COVID-19. In Iran, the first case was reported on 20th of February 2020. Our management team in Golestan University of Medical Sciences held an immediate meeting to decide how to manage the cases suspected to the COVID-19.The two main hospitals had been selected as the Corona center in the Golestan province, northern Iran. Admitting patients other than COVID-19 has been stopped in these hospitals, and all patients had been transferred to the other hospital in Gorgan city and those in the recovery state had been transferred to a hotel prepared for this purpose. The capacity of Sayyad-e-Shirazi hospital was 300 bed for admission and 25 ICU beds that had been increased to 44 ICU beds (30 percent increases) to be prepared for COVID-19 admission. Clinical groups and specialists had been organized with special duty for each part. After 3 months of COVID-19 crisis, Sayyad-e-Shirazi hospital with 300 beds is in a good shape and admission of severe cases has been decreased.

---

Background and Objective: Since the onset of the COVID-19 (Corona Virus Disease 2019) pandemic, several challenges have been proposed to the disease and the causing viral agent. Accurate and rapid diagnosis of the virus is essential to control the spread and progression of the disease. Choosing a suitable sample in different phases of the disease will reduce the false-negative results. This study was performed to identify the SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) genome in the blood samples of COVID-19 patients.
Methods: This descriptive-analytical study was performed by census method on 100 whole blood samples of patients (50 recovery and 50 deceased) with a definitive diagnosis of COVID-19 (positive Real-Time RT-PCR test of nasopharyngeal swab samples) admitted to Shahid Sayyad Shirazi educational and medical center in Gorgan during 2020-21. Clinical and laboratory findings were compared in the two groups of patients. The viral nucleic acid was extracted from the whole blood samples of the patients, and the presence of the virus genome was investigated using primer and probes via the Real-Time RT-PCR method.
Results: The age of the recovered patients (49.06±15.1 years) was significantly was lower than deceased patients (58.3±12.4 years) (P<0.05). Clinical symptoms including cough, shortness of breath, sputum secretion, and vomiting in deceased patients were significantly more than recovery group (P<0.05). The lymphocytes count and platelet level in the deceased group were lower than in the recovered group. Level of lactate dehydrogenase (LDH) was higher in the deceased group in compare to recovered group (P<0.05). The virus genome identified in the blood samples of 7 patients (3 recovered and 4 deceased), which had no significant relationship with the outcome of the disease.
Conclusion: The use of blood samples for the diagnosis of COVID-19 is not appropriate.

---

Background and Objective: With the increase in the spread of COVID-19, mental health consequences such as fear, anxiety, and depression have become prevalent. This study aimed to investigate the predictive role of fear of COVID-19 and quarantine fatigue on depression in congenital heart disease patients during the pandemic.
Methods: This descriptive-analytical study was conducted on 105 patients with congenital heart disease (6 men and 99 women) who were referred to Shahid Rajaee Hospitals and Tehran Heart Center during 2021-22. Data were collected using a depression scale, a fear scale for COVID-19, and a quarantine fatigue questionnaire.
Results: The results showed that 28.6% of patients with congenital heart disease experienced mild depression, while 7.6% had severe depression. Quarantine fatigue was found to be mild in 43.8% of patients. Additionally, fear of COVID-19 (r=0.195, P=0.001) and quarantine fatigue (r=0.617, P=0.001) were significantly correlated with depression in congenital heart patients.
Conclusion: Fear of COVID-19 is related to depression caused by coronavirus and quarantine fatigue in patients with congenital heart disease.
 

---

Background and Objective: COVID-19 is a rapidly spreading acute respiratory syndrome worldwide. COVID-19 vaccination has been widely used as a means to control the disease. This study aimed to investigate the relationship between demographic characteristics and COVID-19 vaccination in patients with COVID-19.
Methods: This descriptive-analytical study was conducted on 1124 patients with a definitive diagnosis of COVID-19 in Minoodasht, Iran, in August 2021. The instruments used in this study included a demographic data questionnaire and a checklist assessing patient characteristics.
Results: The majority of COVID-19 patients were men (51.8%), aged between 35 to 45 years (26%), and married (76.5%). COVID-19 vaccination was administered to 26.6% of the patients. Patients who received vaccination (27.1%) used masks less than unvaccinated patients (72.9%) (P<0.05). Of the patients with COVID-19, 8.2% were hospitalized. The mean duration of hospitalization for vaccinated patients (7.8±6.4 days) was lower than that for unvaccinated patients (8.3±5.9 days); however, this difference was not significant. Age, education, underlying disease, and mask usage were associated with COVID-19 vaccination (P<0.05). With an increase in underlying disease and age, vaccination rates increased, while vaccination rates decreased with the use of masks and lower education.
Conclusion: Attention to demographic factors and certain characteristics of individuals is necessary to improve COVID-19 vaccination rates. Previous COVID-19 vaccination does not decrease the number of hospitalization days in patients with COVID-19.
 

---

Background and Objective: Due to the spread of the new coronavirus disease 2019 (COVID-19), the amount of physical activity and exercise in people’s lifestyles was greatly reduced to reduce interpersonal contact to control the infection. The current study aimed to investigate students’ physical fitness levels during the quarantine period of COVID-19, and the study examined its changes after four months of training at home.
Methods: This quasi-experimental study was done on thirty-two students (16 males and 16 females) in Shahrekord University, Iran during 2019-21. Physical fitness (swimming, Sit-ups, jumping rope, and flexibility) was measured and compared three times before the start of the Coronavirus, one year after the beginning of the Coronavirus, and after four months of exercise at home.
Results: COVID-19 leads to a decrease in the level of physical fitness in the post-exam phase compared to the pre-exam phase. Due to the restrictions related to the quarantine period, students’ physical fitness levels showed a significant reduction in the post-corona period compared to the pre-corona period. In addition, four months of training at home showed a significant effect on physical fitness indicators, compared to the time of quarantine, in such a way that the average of physical fitness factors increased significantly (P<0.05). Therefore, growing measures are needed to motivate and support students to maintain a conscious level of physical fitness to avoid any threat to the population’s health, especially in quarantine conditions.
Conclusion: The quarantine period during the outbreak of COVID-19 caused a decrease in the physical fitness of the studied students, and performing four-month exercises at home increased their physical fitness.

---

Background and Objective: Considering hypertension as the most prevalent comorbidity among patients diagnosed with COVID-19, this study intended to investigate clinical characteristics and in-hospital mortality risk factors among COVID-19 patients with hypertension history.
Methods: This descriptive-analytical study was conducted on 527 hypertensive patients (277 male and 250 female) a mean age of 64.73±13.13 years infected with COVID-19 and hospitalized at Sayyad Shirazi Hospital, Gorgan Iran from February to September 2020. The patients’ data were extracted from the hospital information system and completed by patients’ medical records and telephone calls. The association between the risk factors and in-hospital mortality was identified by employing the logistic regression analysis in three various models, including model 1 (demographic data and patients’ history), model 2 (model 1 plus vital signs and pulse oximetry measurement at hospital admission) model 3 (model 2 plus laboratory findings at hospital admission). Each model individually described the odds ratios (ORs) with 95% confidence intervals (95% CIs) for every risk factor. Furthermore, a corrected area under the receiver-operating characteristics curve (AUC) was estimated to evaluate the model’s discriminatory power.
Results: Among 527 hospitalized patients, 88 patients (16.6 %) died during 6.48 days of hospitalization, of which 47 patients were men. In model 1, opium consumption (CI95%=1.16-3.85, OR=2.11) and cognitive impairment at admission (CI95%=0.98-5.40, OR=2.30) were significantly associated with higher mortality (AUC=0.65). In model 2, after adding vital signs and oxygen saturation, cognitive impairment association lost its association, and only opium consumption (CI95%=1.09-3.19, OR=1.87) and oxygen saturation (CI95%=0.90-0.95, OR=0.93) were associated with in-hospital mortality. (AUC=0.73). In model 3, after incorporating laboratory findings, with an AUC of 0.79 (CI95%=0.70-0.90), each percent higher oxygen saturation at admission was associated with a 7% decrease in in-hospital mortality (CI95%=0.88-1.00, OR=0.93). Although opium consumption and higher creatinine level lead to higher mortality, the associations were not significant.
Conclusion: Regarding the association of oxygen saturation at admission with in-hospital mortality among hypertensive patients diagnosed with COVID-19, the pulse oximetry measurement data upon admission would be crucial in evaluating these patients.

---

Background and Objective: Coronavirus disease 2019 (COVID-19) can lead to organ failure by the occurrence of mechanisms such as increased thrombosis and, subsequently, increased lactate dehydrogenase (LDH). This study was conducted to determine LDH serum levels in COVID-19 patients and the factors affecting their mortality.
Methods: This descriptive-analytical study was conducted on 212 patients (57 males and 155 females) with COVID-19 with a mean age of 49.19±10.6 referring to Imam Ali Hospital in Chabahar, Iran during 2021. After obtaining patients’ informed consent and demographic information, the heparinized peripheral blood sample was taken from them. The LHD levels were determined using an autoanalyzer.
Results: Twenty-nine (13.67%) patients died. The mean LDH serum level of 29 deceased patients (708.420±96.25 U/L) was not statistically significant compared to survivors (640.360±96.80 U/L in 183). The comparison between the surviving and deceased groups showed that 25% of the deceased patients were hospitalized in the intensive care unit (ICU), and 90.90% of the survivors were hospitalized in the internal ward (P<0.05). All the deceased and 85.85% of the survivors were 40 years old and above, and this difference was not statistically significant. Furthermore, 24.56% of the deceased were male, 90.32% of the survivors were female (P<0.05), 22.72% of the deceased had a university education, and 88.69% of the survivors had a diploma or under-diploma education (P<0.05), and 71.42% of the deceased patients had thin, and 91.37% of the survivors were overweight (P<0.05).
Conclusion: There was no difference in the LDH serum levels of the COVID-19 survivors and deceased. The age of 40 years and above, lean and morbidly obese body mass indices, male gender, and the need for hospitalization in the ICU were determined as risk factors.

---

Background and Objective: The outbreak of coronavirus disease 2019 (COVID-19) has had many psychological impacts on the relatives of patients with COVID-19, which can influence their physical health. This study was conducted to determine Obsessive-Compulsive Disorder (OCD) and its link to the physical health of relatives of patients with COVID-19.
Methods: This case-control study was conducted on 98 relatives of patients with COVID-19 (the case group) with a mean age of 38.56±9.09 years and 98 family members without patients (the control group) with a mean age of 35.79±9.88 years referring to health centers in Gorgan, Iran during 2022. The subjects were selected by a simple random sampling method after extracting the list of patients with COVID-19 from the Health Information Software (NAB) system of health centers. For each selected case, according to the list of families in the NAB system, a family confirmed with a lack of COVID-19 infection was selected as the control group using the simple random sampling method. The data collection tools included the Yale-Brown obsessive-compulsive scale (Y-BOCS) and the patient health questionnaire-15 (PHQ-15).
Results: The mean OCD score in the case group (6.46±5.87) was significantly higher than that in the control group (2.04±3.76) (P<0.05). The mean physical health disorder of the case group (7.60±4.32) was significantly higher than that in the control group (3.43±3.98) (P<0.05). A significant direct linear correlation was found between OCD and physical health in both groups (r=0.39, P<0.001).
Conclusion: The levels of OCD and physical health disorders were significantly higher in family members with a COVID-19 patient than in family members without a COVID-19 patient.

---

Background and Objective: Fatigue is considered one of the factors effective in changing the electrical activity of muscles so that it is directly linked to increasing the potential of muscular injuries and functional decline in various stages of sports. The present study was conducted to evaluate the frequency of electrical activity of lower limb muscles before and after fatigue during running in individuals with a history of coronavirus disease 2019 (COVID-19) compared to healthy individuals.
Methods: This quasi-experimental research was conducted on 14 women with a history of COVID-19 over the past two months (the experimental group) and 14 women without a history of COVID-19 (the control group) with an age range of 18-30 years using the convenience sampling method in the city of Ardabil. The fatigue protocol started using a sophisticated treadmill at a speed of 6 km/h, and the treadmill speed was accelerated by 1 km/h every 2 minutes. The Borg’s Rating of Perceived Exertion (RPE) 6-20 Scale was used to determine the participants’ final moment of fatigue. A steady-state running fatigue protocol ended at a score higher than 17 on the Borg’s RPE 6-20 scale or 80% of maximum heart rate. Electromyography data were analyzed using the data LITE biometrics software before and after the fatigue protocol.
Results: There was a statistically significant increase in the frequency of the electrical activity of the vastus lateralis (VL) muscle between the post-test of the control group and the experimental group (d=0.410, P=0.035). The pretest-posttest difference of the frequency of electrical activity of the VL muscle after fatigue compared to before fatigue during the loading response phase during running had a statistically significant increase in the experimental group than in the control group (d=0.602, P=0.016). The frequency of the activity of the semitendinosus muscle increased after fatigue compared to before fatigue during the mid-stance phase of running (d=0.261, P=0.005). The impact of fatigue on the frequency of the activity of the VL muscle during the push-off phase of running was statistically significant (d=0.140, P=0.049). The frequency of the activity of the VL muscle increased after fatigue compared to before fatigue during the push-off phase of running in the experimental group.
Conclusion: The increased electrical activity of the lower limb muscles in various phases of running after fatigue in individuals with a history of COVID-19 can be attributed to decreased neuromuscular coordination.

---

Background and Objective: The coronavirus disease 2019 (COVID-19) pandemic has posed a significant threat to both healthy individuals and those with chronic diseases, including liver cirrhosis. This study aimed to evaluate the clinical and laboratory manifestations and treatment outcomes of patients with liver cirrhosis who were infected with COVID-19.
Methods: This retrospective descriptive study was conducted on 9 patients (4 women and 5 men) with liver cirrhosis infected with COVID-19 hospitalized at Shahid Sayyad Shirazi Educational and Therapeutic Center in Gorgan, Iran during 2019-20. COVID-19 infection was diagnosed by a positive polymerase chain reaction (PCR) test. The Child-Pugh score was used to classify the severity of liver disease. Demographic and clinical data, including initial symptoms and complaints, laboratory results, need for intensive care unit (ICU) admission, length of hospital stay, and treatment outcomes, were extracted from patients’ medical records.
Results: The severity of liver disease was classified as Class B in 7 patients. Comorbidities included cardiovascular diseases and hypertension in 2 patients each, as well as diabetes and asthma in one patient each. Clinical manifestations at the time of COVID-19 diagnosis included ascites in 6 patients; fever in 5 patients; respiratory distress and anorexia in 4 patients each; cough, oxygen saturation less than 93%, and muscle pain in 3 patients each; nausea and vomiting in 2 patients; and abdominal pain and decreased level of consciousness in one patient each. Albumin levels were less than 4 g/dL in all patients. Hemoglobin was less than 12 g/dL in 7 patients. Thrombocytopenia was observed in 8 patients, leukocytosis in one patient, and leukopenia and pancytopenia in 4 patients each. Alanine transaminase (ALT) and aspartate transaminase (AST) levels were higher than 40 U/L in 6 and 5 patients, respectively. Only one patient died, a 60-year-old woman with a history of fatty liver disease, cardiovascular disease, and uncontrolled Class C cirrhosis.
Conclusion: The most common clinical manifestations in patients with liver cirrhosis infected with COVID-19 consisted of ascites, fever, respiratory distress, and anorexia, and the most common laboratory manifestations were hypoalbuminemia and thrombocytopenia.