COVID-19 Chest CT Quantification: Triage and Prognostic Value in Different Ages.

Objective: We evaluated the triage and prognostic performance of seven proposed computed tomography (CT)-severity score (CTSS) systems in two different age groups.Design: Retrospective study.Setting: COVID-19 pandemic.Participants: Admitted COVID-19, PCR-positive patients were included, excluding patients with heart failure and significant pre-existing pulmonary disease.Methods: Patients were divided into two age groups: ≥65 years and ≤64 years. Clinical data indicating disease severity at presentation and at peak disease severity were recorded. Initial CT images were scored by two radiologists according to seven CTSSs (CTSS1-CTSS7). Receiver operating characteristic (ROC) analysis for the performance of each CTSS in diagnosing severe/critical disease on admission (triage performance) and at peak disease severity (prognostic performance) was done for the whole cohort and each age group separately.Results: Included were 96 patients. Intraclass correlation coefficient (ICC) between the two radiologists scoring the CT scan images were good for all the CTSSs (ICC=0.764-0.837). In the whole cohort, all CTSSs showed an unsatisfactory area under the curve (AUC) in the ROC curve for triage, excluding CTSS2 (AUC=0.700), and all CTSSs showed acceptable AUCs for prognostic usage (0.759-0.781). In the older group (≥65 years; n=55), all CTSSs excluding CTSS6 showed excellent AUCs for triage (0.804-0.830), and CTSS6 was acceptable (AUC=0.796); all CTSSs showed excellent or outstanding AUCs for prognostication (0.859-0.919). In the younger group (≤64 years; n=41), all CTSSs showed unsatisfactory AUCs for triage (AUC=0.487-0.565) and prognostic usage (AUC=0.668-0.694), excluding CTSS6, showing marginally acceptable AUC for prognostic performance (0.700).Conclusion: Those CTSSs requiring more numerous segmentations, namely CTSS2, CTSS7, and CTSS5 showed the best ICCs; therefore, they are the best when comparison between two separate scores is needed. Irrespective of patients' age, CTSSs show minimal value in triage and acceptable prognostic value in COVID-19 patients. CTSS performance is highly variable in different age groups. It is excellent in those aged ≥65 years, but has little if any value in younger patients. Multicenter studies with larger sample size to evaluate results of this study should be conducted.

Relationship between Health Literacy and Proper Antibiotic Use Awareness in Tehran 2019-2020.

Background: Improper use of antibiotics is one of health care problems that can lead to side effects or antibiotic resistance without benefit. This study aimed to evaluate the association between health literacy and knowledge on appropriate use of antibiotics in a population sample from Tehran. Methods: This was a cross-sectional, descriptive-analytic study on adults aged between 18 and 65 years. Health literacy was measured by the Health literacy for Iranian Adults (HELIA: Health Literacy for Iranian Adults) questionnaire, and awareness about proper antibiotic use was evaluated by a checklist designed based on a literature review and expert's opinion in domains of knowledge and attitude. Both an online Google Forms questionnaire and a paper questionnaire completed by outpatients from particular clinics in Tehran's north, west, or center were used to collect the data. SPSS Version 22 was used to analyze the data. Results: Out of 359 participants, 59.6% were women, and 66.8% had a university education level. Internet and health care workers were the main sources of health information. The mean score of health literacy was 71.4 out of 100, and 67.4% of the respondents had excellent or sufficient health literacy. The mean antibiotic awareness score was 10.5 out of 13, and the score in the domain of attitude was higher than knowledge. There was a significant relationship between health literacy and awareness about proper antibiotic use (P < 0.001). Health literacy was significantly higher in women (P = 0.001), people with higher education levels (P = 0.001), and financial sufficiency (P = 0.0038). Also, there was a significant relationship between awareness about proper antibiotic usage and age (P = 0.007) and financial sufficiency (P < 0.001) of the respondents. The online questionnaire users were not different in terms of their health literacy, but they were more educated and aware of antibiotics. Conclusion: The level of health literacy and awareness about the proper use of antibiotics in this study was good. level of health literacy was closely related to knowledge about the proper use of antibiotics, thus, it seems that promoting health literacy may increase awareness about proper antibiotic use.

CT-severity score in COVID-19 patients: for whom is it applicable best?

Background: lung involvement in COVID-19 can be quantified by chest CT scan. We evaluated the triage and prognostication performance of seven proposed CT-severity score (CTSS) systems in two age groups of ≥65 and <65 years old. Methods: Confirmed COVID-19 patients by reverse transcriptase polymerase chain reaction (RT-PCR) admitted from February 20th, 2020 to July 22nd were included in a retrospective single center study. Clinical disease severity at presentation and at peak disease severity were recorded. CT images were scored according to seven different scoring systems (CTSS1-CTSS7). The cohort was divided into two age groups of ≥65 and <65 years old. Receiver operator characteristic (ROC) curves for each age group for diagnosis of severe/critical disease on admission (for triage) were plotted. Such curves were also plotted for predicting severe/critical disease at peak disease severity (for prognostication), and critical disease at peak severity (for prognostication). Areas under the curve (AUCs), best thresholds, and corresponding sensitivities (Sens.) and specificities (Spec.) were calculated. Results: 96 patients were included with a mean age of 63.6±17.4 years. All CTSSs in 65-year-old or more group (N=55) showed excellent performance (AUC=0.80-0.83, Sens.+Spec.= 155-162%) in triage and excellent or outstanding performance (AUC=0.81-0.92, Sens.+Spec.= 153-177%) in prognostication. In the younger group (N=44), all CTSSs were unsatisfactory for triage (AUC=0.49-0.57) and predicting severe/critical disease (AUC=0.67-0.70), but were acceptable for predicting critical disease (AUC=0.70-0.73, Sens.+Spec.= 132-151%). Conclusion: CTSS is an excellent tool in triage and prognostication in patients with COVID-19 ≥65 years old, but is of limited value in younger patients.

Expression Pattern of Inflammatory and Anti-Inflammatory Cytokines and Key Differential Transcription Factors in Peripheral Blood Mononuclear Cells of Iranian Coronavirus Disease 2019 Patients with Different Disease Severity.

The purpose of this research was to investigate the gene expression levels of inflammatory cytokines interferon (IFN)γ, tumor necrosis factor (TNF)α, interleukin (IL)1ß, IL2, IL6, IL8, and IL17, and anti-inflammatory cytokines IL4, IL10, IFNα, and IFNß, as well as relevant key transcription factors (TFs), including GATA3, PU1, NF-κB (nuclear factor kappa-light-chain-enhancer of activated B cells), IRF3 (interferon regulatory factor 3), BCL6 (B cell lymphoma 6 protein), FOXP3 (forkhead box P3), RORγt, and T-bet (T-box expressed in T cell) in Iranian patients with moderate and severe coronavirus disease 2019 (COVID-19). Fifty-six patients with COVID-19, and 25 healthy controls (HCs) age and sex matched were investigated. Based on the interim guidance of COVID-19 from the World Health Organization, the patients were classified into 33 moderate and 23 severe patients with COVID-19. The gene expression levels of cytokines and relevant TFs were quantified in peripheral blood mononuclear cells by quantitative real-time polymerase chain reaction (qRT-PCR). The gene expression levels of TFs RoRγ (RAR-related orphan nuclear receptor γ), NF-κB, and T-bet were significantly higher in patients with COVID-19 compared with HCs. Furthermore, the gene expression levels of cytokines, including IL2, IFNγ, IL6, TNFα, IL1ß, IL8, and IL17, were significantly higher in patients with COVID-19 than HCs. However, there was a significant increase for IL6, TNFα, and IL17 in severe compared with moderate patients with COVID-19. Finally, The Spearman correlation analysis revealed a significantly positive correlation for IL6 and TNFα, IL6 and IL2, IL6, IFNγ, and IL2 and IFNγ. These data suggest that expression of IL6, TNFα, and IL17 as well as the synergic effect of elevated values of IL2 and IFNγ should be considered in the treatment and management of patients with severe COVID-19.