The effect of interferon in the therapy of severe coronavirus infection.

BACKGROUND: So far, several protocols have been used for the treatment of coronavirus disease-2019 (COVID-19). In this study, we aimed to study the effect of interferon on the treatment of hypoxemia caused by COVID-19. MATERIALS AND METHODS: This was a quasi-experiment with a nonequivalent group design. All participants were admitted to Shahid Beheshti Hospital, Qom province. In total, 60 patients were enrolled in the study, and inclusion criteria were age over 18 years, positive PCR test result, pulmonary involvement in computed tomography (CT) scan, and SpO2 level below 93%. Individuals were divided into two control (hydroxychloroquine + lopinavir/ritonavir [Kaletra]) and intervention (hydroxychloroquine + lopinavir/ritonavir [Kaletra] + interferon-ß 1a [recigen]) groups. The data were analyzed in Stata/SE 14.2 using Chi-square, t-test, and Mann-Whitney U test. RESULTS: The mean ± standard deviation (SD) age of patients was 63 ± 16.12 years and 43.3% were male. In terms of outcome variables, 20% of patients in the intervention group and 53.3% of subjects in the control group died and this difference was significant (P = 0.007). According to the quick sequential organ failure assessment (qSOFA) score, the severe cases were 16.7% in the intervention group and 50% in the control group (P = 0.006). In addition, the median days of hospitalization were 11.5 days-significantly higher than those in the control group (5.5 days) (P < 0.001). CONCLUSION: Based on the results of this study, the use of interferon in the treatment of COVID-19 can improve health and reduce the severity of the disease and mortality.

Discharge of Confirmed COVID-19 Patients Based on WHO or Regional Criteria? A Cohort Study.

BACKGROUND: Increasing the number of COVID-19 patients raises concerns about the capacity of the health care system. This issue emphasizes reducing the admission rate and expediting patient discharge. OBJECTIVE: This study aimed to develop a discharge protocol for COVID-19 patients based on the existing capacity of the healthcare system and to assess its post-discharge outcomes. METHODS: This is a multicenter cohort study. All COVID-19 patients referred to selected medical centers in Qom, Iran, from Feb. 19 to Apr. 19, 2020, were target populations. Eligible patients were classified into a) the criterion group and b) the non-criterion group. Patients were followed up daily for 14 days after discharge by phone, and the required data was gathered and recorded in follow-up form. Univariate (chi-square and t-tests) and multivariate multiple (multivariate probit regression) analysis were used. RESULTS: A total of 2775 patients were included in the study (1440 people in the criterion group and 1335 in the non-criterion group). Based on multivariate probit regression, death was statistically associated with discharge outside our criteria (p<0.001), rising age (p<0.001), and being male (p=0.019), and readmission were associated with discharge outside our criteria (p<0.001), rising age (p=0.009), and having the history of underlying diseases (p=0.003). Furthermore, remission had statistically significant associations with discharge based on our criteria (p<0.001), decreasing age (p=0.001), and lack of a history of underlying diseases (p<0.001). CONCLUSION: Mortality and readmission were significantly lower according to our discharge criteria. Our designed criteria apply to less developed and developing countries due to the limited capacity and resources available in the health care system.

Comparing the Sensitivity and Specificity of Lung CT-scan with RT-PCR for Diagnosis of COVID-19.

BACKGROUND: The lung is one of the major organs affected by the SARS-CoV-2 virus. Lung CT scan and RT-PCR are the most valuable diagnostic methods in the early diagnosis and management of COVID-19. Due to the possible inconsistency of the false-negative results for the RT-PCR test, in our study, we aimed to evaluate the sensitivity and specificity of lung CT-scan as an accurate diagnostic method of COVID-19. METHODS: In this cross-sectional study, patients suspected of COVID-19 and referred to Shahid Beheshti Hospital in Qom city from February 26 to April 13, 2020, were enrolled. For a definitive diagnosis of COVID-19, chest CT scan and RT-PCR testing was performed for 644 patients, and both sensitivity and specificity of lung CT scan were evaluated. RESULTS: According to the findings, and comparing to the RT-PCR test as the gold standard, sensitivity, specificity as well as, positive predictive and negative predictive values of lung CT-scan were found as follow; 94.47% (95% CI: 90.73 - 97.02%), 24.71% (95% CI: 20.70 - 29.07%), 40.73% (95% CI: 36.58 - 44.99%), 89.08% (95% CI: 82.4 - 94.05%), respectively. CONCLUSION: According to the findings, the lung CT scan has a better diagnostic value than RTPCR in symptomatic patients who were referred to the hospital for COVID-19 diagnosis. Performing lung CT-scan in patients with negative RT-PCR tests should be assessed.

Efficacy of Common Bile Duct Stenting on the Reduction in Gallstone Migration and Symptoms Recurrence in Patients with Biliary Pancreatitis Who Were Candidates for Delayed Cholecystectomy.

BACKGROUND: In patients with severe biliary pancreatitis, delayed cholecystectomy associated with a high risk of recurrence is recommended. The current study aimed to evaluate the effect of common bile duct (CBD) stenting on reducing gallstones migration and recurrence of symptoms in patients with pancreatitis and delayed cholecystectomy candidates. METHODS: To this purpose, the randomized, controlled clinical trial was performed on 40 patients with biliary pancreatitis who were candidates for delayed cholecystectomy. Patients were randomly divided into two groups of A and B that underwent CBD stenting after ERCP and received endoscopic treatment without stenting, respectively. A checklist recorded demographics and complications. Group A was followed up after four weeks to remove the stent and record the complications. Group B underwent MRCP to examine the migration of new gallstones as well as the complications. RESULTS: Of the 40 patients, 20 subjects (11 males and 9 females) were allocated to each group, matched for demographic variables. In the one-month follow-up, only one subject in group A manifested symptoms of gallstone migration and recurrence, while in group B, recurrence was observed in 6 patients (P = 0.037). There was no significant difference in the success rate of ERCP and the incidence of complications between the two groups. CONCLUSION: CBD stenting in patients with biliary pancreatitis and gallstone could reduce the risk of recurrence and remigration of gallstones in delayed cholecystectomy cases.

Clinical Manifestation of Patients Who Died Due to COVID-19; A Retrospective Study from Qom-Iran.

BACKGROUND: The coronavirus disease 2019 (COVID-19) has become a pandemic health problem worldwide. In this study, we attempted to explain the clinical and laboratories characteristics of non-surviving patients, to identify the probable factors affecting disease progression. METHODS: In a retrospective study, we assessed the data from dead adult patients who were hospitalized and laboratory diagnosed with COVID-19 during March 2020. The data were obtained from electronic medical records. Moreover, a checklist including demographic, clinical, laboratorial, imaging, and treatment data was completed for each one of the patients. In case of lack of information, a member of the research team contacted the first-degree relatives via phone. RESULTS: Totally, 50 patients were enrolled in this study. The mean age was 68.0 ± 14.1 years. Of them, 29 (58%) patients were male. Notably, the median (IQR) hospitalization time was 4.0 (2.7-6.2) days and the duration between the first symptoms to death was 10.0 (5.0-14.5) days. Also, pre-existing morbidity was reported in 42 (84%) patients, and hypertension was the most common one with 28 (54%) patients. Interestingly, body temperature more than 37.5°C was reported in only 20 (40%) patients. Nevertheless, neutrophilia (≥7109/L) and lymphopenia (<1.0 109/L) were observed in 27 (54%) and 29 (58%) patients, respectively. Also, elevated levels of creatinine, lactate dehydrogenase (LDH), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were common, which may be indicators of aggravation of the patients' status. CONCLUSION: Besides age and underlying diseases, elevated creatinine level, neutrophil count, and the inflammatory indices along with the reduced lymphocyte count can be considered as indicators of disease progression. Hence, they should be considered for admission and surveillance of patients.

Comparison between Brush Cytology and Forceps Biopsy under Fluoroscopic Guidance for the Diagnosis of Proximal Cholangiocarcinoma.

BACKGROUND Cholangiocarcinoma is the second most common malignant liver cancer. Its early diagnosis plays an important role in the success of treatment. The aim of this study was to compare the use of cold forceps biopsy without cholangioscopy with brush cytology in the diagnosis of cholangiocarcinoma. METHODS In this prospective study, we enrolled 19 patients. Endoscopic retrograde cholangiopancreatography (ERCP) was performed for all individuals. Sampling was performed from the narrowing site using the brush method. Then, a cold forceps biopsy was performed under fluoroscopy. RESULTS The mean age of the patients was 63.31 ± 11.12 years and most of them were men (63.16 %). The brush cytology and the cold forceps biopsy diagnosed 31.85% and 68.42% of the samples as cholangiocarcinoma, respectively. According to the McNemar test, there was a statistically significant difference between the diagnostic results of the brush cytology and cold forceps biopsy. So that more cholangiocarcinoma cases were diagnosed using forceps biopsy (p = 0.016). No complications such as perforation, bleeding, cholangitis, and leakage were reported during the cold forceps procedure. CONCLUSION Cold forceps biopsy under fluoroscopy is better than cytology brush in the diagnosis of proximal cholangiocarcinoma. It is recommended to be used as a low-cost alternative in cases where cholangioscopy is not available.

Application of neurocomputing for data approximation and classification in wireless sensor networks.

A new application of neurocomputing for data approximation and classification is introduced to process data in a wireless sensor network. For this purpose, a simplified dynamic sliding backpropagation algorithm is implemented on a wireless sensor network for transportation applications. It is able to approximate temperature and humidity in sensor nodes. In addition, two architectures of "radial basis function" (RBF) classifiers are introduced with probabilistic features for data classification in sensor nodes. The applied approximation and classification algorithms could be used in similar applications for data processing in embedded systems.