Chest Computed Tomography Severity Score to Predict Adverse Outcomes of Patients with COVID-19

Background@#The novel coronavirus disease 2019 (COVID-19) continues to wreak havoc worldwide. This study assessed the ability of chest computed tomography (CT) severity score (CSS) to predict intensive care unit (ICU) admission and mortality in patients with COVID-19 pneumonia. @*Materials and Methods@#A total of 192 consecutive patients with COVID-19 pneumonia aged more than 20 years and typical CT findings and reverse-transcription polymerase chain reaction positive admitted in a tertiary hospital were included. Clinical symptoms at admission and short-term outcome were obtained. A semi-quantitative scoring system was used to evaluate the parenchymal involvement. The association between CSS, disease severity, and outcomes were evaluated. Prediction of CSS was assessed with the area under the receiver-operating characteristic (ROC) curves. @*Results@#The incidence of admission to ICU was 22.8% in men and 14.1% in women. CSS was related to ICU admission and mortality. Areas under the ROC curves were 0.764 for total CSS.Using a stepwise binary logistic regression model, gender, age, oxygen saturation, and CSS had a significant independent relationship with ICU admission and death. Patients with CSS ≥12.5 had about four-time risk of ICU admission and death (odds ratio 1.66, 95% confidence interval 1.66 – 9.25). The multivariate regression analysis showed the superiority of CSS over other clinical information and co-morbidities. @*Conclusion@#CSS was a strong predictor of progression to ICU admission and death and there was a substantial role of non-contrast chest CT imaging in the presence of typical features for COVID-19 pneumonia as a reliable predictor of clinical severity and patient’s outcome.

Chest Computed Tomography Severity Score to Predict Adverse Outcomes of Patients with COVID-19

Background@#The novel coronavirus disease 2019 (COVID-19) continues to wreak havoc worldwide. This study assessed the ability of chest computed tomography (CT) severity score (CSS) to predict intensive care unit (ICU) admission and mortality in patients with COVID-19 pneumonia. @*Materials and Methods@#A total of 192 consecutive patients with COVID-19 pneumonia aged more than 20 years and typical CT findings and reverse-transcription polymerase chain reaction positive admitted in a tertiary hospital were included. Clinical symptoms at admission and short-term outcome were obtained. A semi-quantitative scoring system was used to evaluate the parenchymal involvement. The association between CSS, disease severity, and outcomes were evaluated. Prediction of CSS was assessed with the area under the receiver-operating characteristic (ROC) curves. @*Results@#The incidence of admission to ICU was 22.8% in men and 14.1% in women. CSS was related to ICU admission and mortality. Areas under the ROC curves were 0.764 for total CSS.Using a stepwise binary logistic regression model, gender, age, oxygen saturation, and CSS had a significant independent relationship with ICU admission and death. Patients with CSS ≥12.5 had about four-time risk of ICU admission and death (odds ratio 1.66, 95% confidence interval 1.66 – 9.25). The multivariate regression analysis showed the superiority of CSS over other clinical information and co-morbidities. @*Conclusion@#CSS was a strong predictor of progression to ICU admission and death and there was a substantial role of non-contrast chest CT imaging in the presence of typical features for COVID-19 pneumonia as a reliable predictor of clinical severity and patient’s outcome.

Response: Utility of the Visceral Adiposity Index and Hypertriglyceridemic Waist Phenotype for Predicting Incident Hypertension (Endocrinol Metab 2017;32:221-9, Mohsen Janghorbani et al.)

No abstract available.

Utility of the Visceral Adiposity Index and Hypertriglyceridemic Waist Phenotype for Predicting Incident Hypertension

BACKGROUND: The aim of this study was to assess the utility of the visceral adiposity index (VAI) and the hypertriglyceridemic waist (HTGW) phenotype as possible hypertension (HTN) predictors in a high-risk population without diabetes and HTN. METHODS: Incident HTN over a 7-year follow-up was assessed among 1,375 first-degree non-diabetic and non-hypertensive relatives of consecutive patients with type 2 diabetes who were 30 to 70 years of age. HTN was defined as a blood pressure reading ≥140/90 mm Hg or the use of antihypertensive medications. We examined the incidence of HTN across VAI quintiles and four groups defined according to baseline fasting serum triglyceride (TG) levels and waist circumference (WC). RESULTS: The VAI and the HTGW phenotype at baseline were related to an increased risk for HTN. In comparison with the lowest VAI quintile, the highest VAI quintile showed a significant associated with HTN in an age- and gender-adjusted model (odds ratio [OR], 1.65; 95% confidence interval [CI], 1.07 to 2.55). Those with HTGW were 2.3 times (OR, 2.27; 95% CI, 1.54 to 3.35) more likely to develop HTN than those with a normal WC and normal TG levels. CONCLUSION: Greater VAI values weakly predicted HTN, whereas the HTGW phenotype was a stronger predictor of incident HTN in an Iranian high-risk population.

Association between Obesity and Bone Mineral Density by Gender and Menopausal Status

BACKGROUND: We investigated whether there were gender differences in the effect of obesity on bone mineral density (BMD) based on menopausal status. METHODS: We assessed 5,892 consecutive patients 20 to 91 years old who were referred for dual-energy X-ray absorptiometry (DXA) scans. All subjects underwent a standard BMD scan of the hip (total hip and femoral neck) and lumbar spine (L1 to L4) using a DXA scan and body size assessment. Body mass index was used to categorize the subjects as normal weight, overweight, and obese. RESULTS: BMD was higher in obese and overweight versus normal weight men, premenopausal women, and postmenopausal women. Compared to men ≥50 years and postmenopausal women with normal weight, the age-adjusted odds ratio of osteopenia was 0.19 (95% confidence interval [CI], 0.07 to 0.56) and 0.38 (95% CI, 0.29 to 0.51) for obese men ≥50 years and postmenopausal women. Corresponding summaries for osteoporosis were 0.26 (95% CI, 0.11 to 0.64) and 0.15 (95% CI, 0.11 to 0.20), respectively. Compared to men <50 years and premenopausal women with normal weight, the age-adjusted odds ratio of low bone mass was 0.22 (95% CI, 0.11 to 0.45) and 0.16 (95% CI, 0.10 to 0.26) for obese men <50 years and premenopausal women, respectively. CONCLUSION: Obesity is associated with BMD of the hip and lumbar spine and overweight and obese individuals have similar degrees of osteoporosis. This result was not significantly different based on gender and menopausal status, which could be an important issue for further investigation.

Conversion from radiologically isolated syndrome to multiple sclerosis

The aim of this study was to estimate the conversion rate from radiologically isolated syndrome [RIS] to definite multiple sclerosis [MS]. During a mean [standard deviation [SD]] follow-up period of 17.4 [5.4] [range 8-29] months, 25 subjects with RIS and without neurological symptom aged 22-45 year from a single-center have been examined for the occurrence of definite MS. The mean [SD] age of participants was 35.1 [6.2] years at first brain magnetic resonance imaging [MRI]. The definite MS were assessed using the revised McDonald's criteria [2010]. Six of 25 patients developed clinical symptom consistent with criteria for definite MS. The conversion rate from RIS to definite MS was 1.5 [95% confidence interval [CI] 0.54, 3.17] per 100 person-months based on 480 person-months of follow-up. Multivariate analysis revealed that presence of contrast-enhancing lesions on the initial MRI was marginally significantly associated with MS [hazard ratio 1.83, 95% CI 0.98, 3.45, P = 0.060]. This is the first estimate of conversion rate from RIS to definite MS in Iran. The conversion rates from RIS to definite MS in these participants are high and intensive follow-up and intervention strategies are recommended for these high-risk individuals. A larger study is warranted to assess this risk in greater detail

Orbital Doppler Evaluation of Blood Flow Velocities in Optic Neuritis

PURPOSE: To evaluate orbital blood flow velocities and optic nerve diameter with Doppler and gray-scale sonography in patients with acute unilateral optic neuritis (ON). METHODS: Orbital Doppler and gray-scale sonography was performed in 46 eyes of 23 patients aged 19- to 47-years with acute unilateral ON. ON was diagnosed by an ophthalmologist on the basis of clinical presentation, presence of decreased visual acuity and assessment of visual evoked potentials. The peak systolic velocity (PSV) and end-diastolic velocity (EDV), as well as the resistance index (RI) and pulsatile index (PI) of the ophthalmic artery (OA), central retinal artery (CRA), posterior ciliary arteries (PCAs) and optic nerve diameter were measured in both eyes. We compared results from affected and unaffected eyes using the paired t-test. The area under the receiver operating characteristic (ROC) curves was used to assess the diagnosis of ON based on measured blood flow parameters of the OA, CRA and PCAs and optic nerve diameter. RESULTS: The mean (standard deviation) optic nerve diameter in eyes with ON was 4.1 (0.8) mm, which was significantly larger than the 3.0 (0.4) mm diameter measured in unaffected control eyes (p 0.05). The mean RI in the PCAs was slightly lower in the eyes with ON than in the contralateral eyes (0.60 vs. 0.64, p < 0.05). The area under the ROC curves indicated that optic nerve diameter was the best parameter for the diagnosis of ON. CONCLUSIONS: Optic nerve diameter was related to ON, but orbital blood flow parameters were not.

prevalence and correlates of hearing loss in drivers in Isfahan, Iran

There are no data on the prevalence of occupational noise-induced hearing loss in drivers using standard audiometric testing. The aim of this study was to estimate the prevalence and risk factors of occupational noise-induced hearing loss in drivers. A cross-sectional study was conducted on a random sample of 4300 long-distance drivers age ?20 years taken out of a total of 10,000 estimated professionals in the city of Isfahan, Iran, from February 2006 through March 2007. The drivers were interviewed and underwent clinical and laboratory examinations including measurement of blood pressure, anthropometric data, and pure-tone audiometry in a sound-treated booths. The mean [SD] age of the participants was 40.8 [11.0] years with a mean [SD] duration of professional driving of 14.7 [9.6] years. The prevalence of bilateral noise-induced hearing loss was 18.1% [95% confidence interval [CI] 17.0-19.3]. The prevalence rates were higher in the left ear only 6.5% [95% CI: 5.8-7.3] than the right ear only 3.0% [95% CI: 2.5-3.9]. Using a stepwise binary logistic regression model for the right and left ear only and for both ears separately, age was a significant independent predictor of bilateral noise-induced hearing loss and for the left or right ear only. When bilateral noise-induced hearing loss was entered in the model, fasting blood glucose was a significant predictor of noise-induced hearing loss. Blood pressure, cholesterol, triglyceride, body mass index, and marital status had no significant independent association with noise-induced hearing loss when other covariates were considered. These findings indicate that noise-induced hearing loss among the long-distance drivers appears to be similar to the world's population endures noise-induced hearing loss caused by occupational exposure to noise, with higher prevalence in the left ear only

Association of body mass index and abdominal obesity with marital status in adults

Obesity continues to be an important public health problem worldwide. The objective of this study was to determine the association of body mass index and abdominal obesity with current marital status among the adult population of Iran. A nation-wide cross-sectional survey was conducted from December 2004 through February 2005.The subjects were selected by stratified probability cluster sampling through household family members in Iran. Weight, height, waist circumference, and marital status of 89,404 men and women aged 15 - 65 [mean: 39.2] years were recorded. Four classes of body mass index, i.e., <18.5, 18.5 - 24.9, 25 - 29.9, and ?30 kg/cm2, and three marital status, i.e., currently-, formerly-, and never-married were used. Abdominal obesity was defined as waist circumference ?102 cm in men and ?88 cm in women. The prevalence of overweight was twofold higher in married men [OR: 2.24; 95% CI: 2.08 - 2.41] and women [OR: 2.36; 95% CI: 2.20 - 2.53] than never-married men and women, even when age, educational level, leisure time physical activity, smoking habits, and place of residence were controlled. The multivariate OR of obesity was increased about threefold in married men [2.82; 95% CI: 2.51 - 3.18] and women [3.64; 95% CI: 3.31 - 3.99]. The prevalence of abdominal obesity was twofold higher among married men [2.02; 95% CI: 1.79 - 2.29] and about threefold higher among married women [2.87; 95% CI: 2.69 - 3.06]. The marital status appears to influence the likelihood of developing overweight, obesity, and abdominal obesity in both men and women in Iran

Peripheral neuropathy in type 2 diabetes mellitus in Isfahan, Iran: prevalence and risk factors

To estimate the prevalence and risk factors of peripheral neuropathy [PN] in people with type 2 diabetes mellitus. 810 patients with type 2 diabetes [289 male and 521 female] from Isfahan Endocrinology and Metabolism Research Centre outpatient clinics, Iran, were examined. Part of the examination included an assessment of neurological function including neuropathic symptoms and physical signs, and nerve conduction velocity. The prevalence of PN was 75.1% [95% confidence interval [CI] 72.1, 78.0]. Peripheral neuropathy was associated with age, proteinuria, and duration of diabetes, insulin-treatment, and presence of retinopathy and ischaemic heart disease [IHD]. The age-adjusted prevalence rate of PN was 78% higher among patients with IHD, 64% higher among patients with any retinopathy, 66% higher among insulin-treated type 2 diabetes, and greater with duration of diabetes. Using a stepwise binary logistic regression model, age, duration of diabetes and proteinuria were significant independent predictors of PN. PN is a common complication in this population of Iranian type 2 diabetic patients. It increases with age, duration of diabetes and proteinuria

Anti-Cardiolipin antibodies and risk of coronary heart disease a hospital-based case-control study

Data concerning the relation between anticardiolipin [aCL] antibodies and coronary heart disease [CLID] in subjects without evidence of overt autoimmune disease are conflicting. The purpose of the present study was to determine whether the presence of aCL antibodies, carries a risk for CHD in a hospital-based case-control study. Using IgG aCL antibody as a risk factor of CHD, a hospital-based case-control study of CHD was conducted in Isfahan, Iran. We examined the sera of 50 CHD cases, aged 10-84 years [mean [Standard Deviation [SD]] 59.7 [12.8] and 100 hospital based controls aged 25-90 [mean [SD] 58.7 [13.7]]. The controls were non-CHD patients, selected from the same hospital as the cases and matched for gender, marital status and age [ +/- 5 years]. Samples were tested for IgG-class antibodies to cardiolipin by enzyme-linked immunosorbent assay [ELISA]. The prevalence of aCL antibody was 2% [95% confidence interval [CI: 0.05 to 10.7]] for cases and 5% [95% CI: 1,6 to 11.3] for controls and this differences was not statistically significant [odds ratio [95% CI]: 0.4 [0.04 to 3.4]]. The odds ratio for IgG aCL antibody did not suggest an increase risk. The mean [SD] of IgG aCL antibody level was higher in control subjects than in patients [2.7 [2.0] versus 4.7 [7.6]; P=0.07]. In a hospital-based. case-control study, the presence of a high IgG aCL antibody level is not an independent risk factor for CHD

Primary results of topical dairy extract [MJ1] versus intralesionally administered meglumine antimonate for treatement of cutaneous leishmaniasis in Isfahan, Iran Arandomized controlled clinical trial

The objectives of this report are to assess the relative efficacy of topical dairy extract [MJ1] compared to intralesional meglumine antimonate in the treatment of histologically proven cutaneous leishmaniasis [CL]. A comparative trial was conducted in which 98 patients with a total of 154 lesions were randomly allocated to the two treatment groups. The first group [control] received meglumine antimonate 0.5-1 cc intralesion administration, for a total of four injections with one week interval. The second group received topical MJ1 agent as a paste applied to the lesions without cover three times a day for 30 days. Response to treatment was assessed at 1, 2, 3 and 8 weeks after the start of therapy. Of the 85 lesions treated with MJ1, the mean size of lesions decreased from 197 [95% confidence interval [CI]: 110 to 284] mm2 to 101.2 [95% CI: 57.3 to 145] mm2, 82 [96.5%] were reduced in size and 3 [3.5%] got worse. Correspondingly, in the 69 lesions treated with meglumine antimonate, the mean size of lesions increased from 113.6 [95% CI: 73.0 to 154.0] to 158.1 [95% CI: 94.9 to 221.0] mm2, 57 [82.6%] were reduced in size and 12 [17.4%] got worse. The differences were statistically significant [p<0.001]. This study demonstrates that topical treatment with MJ1, agent is more effective than Glucantime and is an effective alternative to meglumine antimonate for the treatment of CL

Effect of clinical information on brain CT. scan interpretation: a blinded double crossover study

Errors and variations in interpretation can happen in clinical imaging. Few studies have examined the biased effect of clinical information on reporting of brain CT scans. In a blinded double crossover design, we studied whether three radiologists were biased by clinical information when making CT scan diagnosis of the brain. Three consultant radiologists in three rounds with at least a one month interval assessed 100 consecutive cases of brain CT scan. In the first round, clinical information was not available and 100 films without clinical information were given to radiologists. In the second round, the same 100 films were given and true clinical information was available. In the third round, the same 100 films were given and false clinical information was allocated. In 180 cases [60%] the evaluation resulted in the same diagnosis on all three occasions [95% confidence interval [CI]: 54.5, 65.5], whereas 120 [40%; 95% CI: 34.5,45.5] sets were evaluated differently. 48 cases [16%; 95% CI: 11.9, 20.1] had discordant evaluation with true and 33 [11%; 95% CI: 7.5,14.5] with false clinical information. Discordance without and with true and false clinical information was 39 [13%; 95% CI: 9.2, 16.8]. Correct clinical information improves the brain CT report, while. the report became less accurate after false clinical information was allocated. These results indicate that radiologists are biased by clinical information when reporting brain CT scans

Ultrasonographic measurements of the normal, kidneys, liver, spleen, gallbladder and head of pancreas among radiology department attenders

The purpose of this study was to investigate the ultrasonographic measurements for certain normal abdominal organs. Length and width of gallbladder and length of liver, spleen, kidneys and thickness of the kidneys were measured in a age. And gender-stratified non-consecutive sample of 496 [54.2%] men and 419 [45.8%] women at different ages referred to out ultrasonography unit during one year of daily hospital practice in Kerman, Iran. Findings on ultrasonograms of the kidneys, liver, spleen, gallbladder and head of pancreas were normal in all cases. Patients were scanned by a real time scanner equipped with a 3.5 MHZ medium internal focus transducer. The mean [standard deviation [SDI] liver lengths were 125.6 [8.8] and 119 [7.7] mm, mean [SD] gallbladder length was 49.9 [3.6] and 49.3 [3.5] mm, mean [SD] gallbladder widths were 18.0 [2.3] and 18.2 [1.8] mm and mean [SD] size of pancreatic head was 15.9 [1.6] and 13.8 [1.4] mm in males and females respectively. The mean [SD] renal lengths were 101.5 [5.0] and 98.9 [5.0] mm on the right side and 110.0 [6.3] and 108.0 [6.0] mm on the left side and mean [SD] size of spleen was 93.8 [4.1] and 92.3 [3.2] mm in males and females respectively. The values obtained in this study were slightly lower than those observed in western population

Effect of passive smoking during pregnancy on weight, length and cranical circumference at birth in kerman, Iran

Passive smoking [PS], a well-known health risk, is the major source of indoor pollution. There is some inconsistent evidence that PS during pregnancy may increase the risk of low birth weight. The aim of the present study was to determine the effects of PS exposure during pregnancy on weight, length and cranial circumference at birth of babies born to women who have described themselves as nonsmokers, in Kerman, Iran. A random sample of 702 admitted women aged 11 to 50 years [mean [standard deviation] 26.5 [6.1]] who delivered a live full-term singleton baby without apparent malformation during the six consecutive months from June to December 1994 were interviewed on the second day post-partum and asked about smoking in all household members. They comprised about 36.4% of total deliveries in Bahonar Kerman Medical School Hospital during this period. All women were nonsmokers, 278 [39.6%] were passive smokers while 424 [60.4%] were not exposed to tobacco smoke. Potential confounders, including fetal gender, maternal age, parity, weight gain, complications during pregnancy, maternal education, birth interval and gestation were adjusted for by multiple linear regression analysis. Infants born to passive smokers were on the average 22 gr.lighter than those born to nonsmokers, albeit this difference was not statistically significant [p = 0.56] [95% confidence interval [CI]: -51, 95.7]. A mean reduction of 0.04cm [95% CI: -0.19,0.27] in birth length and 0.05 cm [95%CI: -0.12, 0.22] in cranial circumference was found. In multiple linear regression model, exposure to PS during pregnancy did not show any effect on weight, length and cranial circumference at birth after adjusting for confounding variables

Epidemiology of non-fatal stroke in Kerman, Iran

359 consecutive patients with stroke admitted to the neurology department of Kerman University of Medical Sciences between May 1992 and May 1994 were interviewed within 1 week after admission to the hospital, and their medical records were examined. Detailed history was studies and clinical examinations were performed in all patients and outcomes were recorded. Of the 359 patients studied there were 165 [45.9%] males, and 292 [81.3%] patients had no formal schooling and 67 [18.7%] had some education. Mean [stamdard deviation [SD]] age was 65.4 [12.1] years for men and 63.3 [14.3] years for women. 62.2% of strokes were due to cerebral infarction and 21% due to intracerebral hemorrhage. In 10.4% of the cases, subarachnoid hemorrhage was ascertained as the cause of the stroke; while in 6.4% of the cases, the type of stroke could not be specified with certainty. The diagnosis was based on computed tomography in 93.6% of stroke cases. Hemiplegia was the prominent neurological deficit resulting from insult. The presenting symptoms were hemiparesis or hemiplegia in 79.6%, speech disorder in 38.0% and clouded consciousness in 21.2% of the patients. 63.3% of stroke cases had hypertension. 65.8% had hypercholesterolemia shortly after onset. 16.3% had diabetes mellitus. The overall case-fatality rate at the time of discharge was 24.7%. The rate for intracerebral hemorrhage was 33.6% and for cerebral infarction was 20.3%. The age-gender-adjusted mean annual incidence of stroke in men and women was estimated to be 44.4 and 59.0 per 100.000 population respectively

Acute effect of cigarette smoking on fasting serum glucose level in non-diabetic male smokers

In this study the acute effect of cigarette smoking on fasting serum glucose levels in a group of 202 non-diabetic male smokers aged 19 to 99 years [mean [standard deviation] 41.9 [16.1]] after an overnight fast and tobacco abstinence was examined. The serum glucose concentration before and after smoking a cigarette was measured. American king-size Winston cigarettes [each containing 1.2 mg nicotine] were used for the test. The mean [SD] serum glucose level before smoking was 89.7 [14.5] mg/dl compared to 91.1 [15.1] after smoking a cigarette [P<0.05]. Although a similar difference for light, moderate and heavy smokers was found, it was not statistically significant. The findings show that smoking cigarettes increased plasma glucose concentrations actively and may help to explain why smoking increases risk of ischaemic heart disease

Is a high casual blood glucose value a predictor of later overt diabetes?

A sample of 1220 from a cohort of 10541 people in the West of Scotland who were interviewed and examined in 1974-76, aged 45-64, have been followed up to investigate whether a high casual post-prandial blood glucose level allows a reliable prediction of the later development of overt diabetes. The sample was from the top, middle and bottom quintiles of the blood glucose distribution. Record linkage and reference to general practitioner records was used to contact 903 out of 981 thought to be still alive. Thirty-six [4%] had been given a diagnosis of diabetes. Life table analysis showed that by 14 years, 14% of men with casual blood glucose> 126mg/dl had developed diabetes compared to 3% of men in the remainder of the sample. A high casual blood glucose at baseline remains a significant predictor when taking into account age, systolic and diastolic blood pressure, body mass index, cholesterol and smoking. In multiple logistic regression body mass index is also a significant predictor of later overt diabetes. We conclude that individuals identified even with a casual high blood glucose level could be advised of their risk and recommended to take action

Is the association between blood glucose and all causes and cardiovascular mortality risk dependent on body mass index

We have analyzed data on 10,410 men and women aged 54-64 at entry in the west of Scotland to see if a high casual blood glucose level is a risk factor for subsequent death from cardiovascular disease [CVD] or all causes, independently of body mass index [BMI]. A multiple logistic regression analysis was used and showed that BMI on initial examination is not a predictor of CVD or ischemic heart disease [IHD] deaths 10-14 years later independently of age, serum cholesterol, systolic and diastolic blood pressure, cigarette smoking, and glucose level in either gender. BMI was slightly negatively associated with overall causes of death and stroke deaths in females. High casual blood glucose level was a risk factor for CVD mortality in both genders and a risk factor for all causes, IHD, and stroke mortality in women but not in men. There was no significant interaction between BMI and casual blood glucose level in any of these analysis. This suggests that an increasing trend of the relative risk of CVD and IHD death with increasing BMI is not further supported by the data when adjustment has been made