Effect of COVID-19 medications on corrected QT interval and induction of torsade de pointes: Results of a multicenter national survey

Background: There are some data showing that repurposed drugs used for the Coronavirus disease-19 (COVID-19) have potential to increase the risk of QTc prolongation and torsade de pointes (TdP), and these arrhythmic side effects have not been adequately addressed in COVID-19 patients treated with these repurposed medications. Methods: This is the prospective study of 2403 patients hospitalised at 13 hospitals within the COVID-19 epicentres of the Iran. These patients were treated with chloroquine, hydroxychloroquine, lopinavir/ritonavir, atazanavir/ritonavir, oseltamivir, favipiravir and remdesivir alone or in combination with azithromycin. The primary outcome of the study was incidence of critical QTc prolongation, and secondary outcomes were incidences of TdP and death. Results: Of the 2403 patients, 2365 met inclusion criteria. The primary outcome of QTc � 500 ms and �QTc � 60 ms was observed in 11.2 and 17.6 of the patients, respectively. The secondary outcomes of TdP and death were reported in 0.38 and 9.8 of the patients, respectively. The risk of critical QT prolongation increased in the presence of female gender, history of heart failure, treatment with hydroxychloroquine, azithromycin combination therapy, simultaneous furosemide or beta-blocker therapy and acute renal or hepatic dysfunction. However, the risk of TdP was predicted by treatment with lopinavir-ritonavir, simultaneous amiodarone or furosemide administration and hypokalaemia during treatment. Conclusion: This cohort showed significant QTc prolongation with all COVID-19 medications studied, however, life-threatening arrhythmia of TdP occurred rarely. Among the repurposed drugs studied, hydroxychloroquine or lopinavir-ritonavir alone or in combination with azithromycin clearly demonstrated to increase the risk of critical QT prolongation and/or TdP. © 2021 John Wiley & Sons Ltd

Correlation between ways of coping and quality of life in Iranian husbands of women with breast cancer

Background: Palliative nursing care provides the best possible quality of life (QoL) for patients who face life-threatening conditions, such as breast cancer, and their families. It seems that coping with breast cancer can affect couples' QoL. Hence, this study aimed to assess the potential role of ways of coping (WOC) in QoL among husbands of women with breast cancer. Method: In this cross-sectional study, 150 men whose wives were affected by non-metastatic breast cancer and were at least 4 months post-diagnosis, were recruited. The Persian version of the WOC questionnaire (WOCQ) and the World Health Organization's QoL brief questionnaire (WHOQoL-BREF) were used to measure WOC and QoL. ThePearson correlation test was applied to assess bivariate correlation of the variables. Results: A significant direct correlation was found between the total WHOQoL-BREF score and all subscales of WOCQ, except escape-avoidance coping (r=�0.017, P=0.830). Most dimensions of the WHOQoL-BREF and WOCQ subscales were correlated significantly and directly. Nevertheless, escape-avoidance coping had a significant indirect correlation with the physical dimension of WHOQoL-BREF (r=�0.220, P=0.007). Conclusions: Findings indicated a need for coping-based interventions in palliative nursing to improve QoL in husbands of women with breast cancer. © 2020 MA Healthcare Ltd. All rights reserved

Review of school fires in Iran: The causes, consequences and lessons learned Feux d�écoles en Iran: Causes, conséquences et leçons retenues

Fire in Iranian schools has led to death, serious injury and disability for dozens of students and teachers. The aim of this study was to explore the causes, consequences and lessons learned from school fires in Iran. The available literature, including scientific texts, previous research and media reports, was searched using English and Persian keywords. The keywords were: �students, school, Iran, fire, burn and incidents�. No time limitation was imposed. Results showed that 62 school and student dormitory fires have been reported in Iran, of which 14 school fires and 2 student dormitory fires led to human injuries or casualties (25.8). In these incidents, thirty students (19 girls and 11 boys) and one teacher died. More than 60 students, 8 teachers, and 2 staff suffered burn injuries or disabilities. The main causes of the fire incidents were use of non-standard kerosene heaters (38.7) and faulty electrical wiring (35.4). Lack of knowledge about dealing with accidents, inappropriate physical conditions of the school building, lack of fire extinguishers in the building, and carelessness were the main reasons for the deaths and injuries. In conclusion, it is essential to reduce the incidence of fire and prevent its casualties with proper management and standardization of school buildings. © 2020, Mediterranean Club for Burns and Fire Disasters. All rights reserved

Postoperative antibiotic prophylaxis in the prevention of cardiac implantable electronic device infection

Background: The aim of the present study was to determine whether postprocedural antibiotic reduces the risk of infection related to the cardiac implantable electronic device (CIED) implantations. Methods: The present investigation is a randomized, prospective, single-blinded controlled trial. All consecutive patients who presented for new CIED implantation, generator replacement, or upgrade were randomized into the following three groups: (A) no antibiotic, (B) intravenous (IV) antibiotic for 1 day, (C) 1 day IV plus 7 days oral antibiotic. Follow-up was performed on 10-12 days; 1, 3, 6 months; and then every 6 months for 2 years. The primary endpoint was any evidence of infection at the generator pocket or systemic infection related to the procedure at short-term (6-month) and long-term (2-year) follow-ups. Results: Of the 450 patients (72 patients with cardiac resynchronization device) included in the study, the primary endpoint of short-term infection was reached in one patient (0.2) in group A and no patients in groups B and C. The endpoint of long-term infection was reached in nine patients (2) with equal frequency between three randomized groups (three patients in each group). On multivariable analysis, the only independent predictor of infection was defibrillator implantation (odds ratio, 8.5; 95 confidence interval, 1.6-45). Conclusions: The results of this prospective study showed no benefit for the postoperative antibiotic for the prevention of CIED infection. © 2018 Wiley Periodicals, Inc

Comparison of Outcomes with Midodrine and Fludrocortisone for Objective Recurrence in Treating Syncope (COMFORTS trial): Rationale and design for a multi-center randomized controlled trial

Background: The cornerstone of the treatment of vasovagal syncope (VVS) is lifestyle modifications; however, some patients incur life-disturbing attacks despite compliance with these treatments which underscores the importance of pharmacological interventions. Methods: In this open-label multi-center randomized controlled trial, we are going to randomize 1375 patients with VVS who had �2 syncopal episodes in the last year into three parallel arms with a 2:2:1 ratio to receive midodrine, fludrocortisone, or no medication. All patients will be recommended to drink 2 to 3 liters of fluids per day, consume 10 grams of NaCl per day, and practice counter-pressure maneuvers. In medication arms, patients will start on 5 mg of midodrine TDS or 0.05 mg of fludrocortisone BD. After one week the dosage will be up-titrated to midodrine 30 mg/day and fludrocortisone 0.2 mg/day. Patient tolerance will be the principal guide to dosage adjustments. We will follow-up the patients on 3, 6, 9, and 12 months after randomization. The primary outcome is the time to first syncopal episode. Secondary outcomes include the recurrence rate of VVS, time interval between first and second episodes, changes in quality of life (QoL), and major and minor adverse drug reactions. QoL will be examined by the 36-Item Short Form Survey questionnaire at enrollment and 12 months after randomization. Conclusion: The COMFORTS trial is the first study that aims to make a head-to-head comparison between midodrine and fludrocortisone, against a background of lifestyle modifications for preventing recurrences of VVS and improving QoL in patients with VVS. © 2021 Elsevier Inc