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Background and Aims: Data mining methods are effective and well-known tools for developing predictive models and extracting useful information from various data of patients. The present study aimed to predict the severity of patients with COVID-19 by applying the rule mining method using characteristics of medical images. Method(s): This retrospective study has analyzed the radiological data from 104 COVID-19 hospitalized patients diagnosed with COVID-19 in a hospital in Iran. A data set containing 75 binary features was generated. Apriori method is utilized for association rule mining on this data set. Only rules with confidence equal to one were generated. The performance of rules is calculated by support, coverage, and lift indexes. Result(s): Ten rules were extracted with only X-ray-related features on cases referred to ICU. The Support and Coverage index of all of these rules was 0.087, and the Lift index of them was 1.58. Thirteen rules were extracted from only CT scan-related features on cases referred to ICU. The CXR_Pleural effusion feature has appeared in all the rules. The CXR_Left upper zone feature appears in 9 rules out of 10. The Support and Coverage index of all rules was 0.15, and the Lift index of all rules was 1.63. the CT_Adjacent pleura thickening feature has appeared in all rules, and the CT_Right middle lobe appeared in 9 rules out of 13. Conclusion(s): This study could reveal the application and efficacy of CXR and CT scan imaging modalities in predicting ICU admission to a major COVID-19 infection via data mining methods. The findings of this study could help data scientists, radiologists, and clinicians in the future development and implementation of these methods in similar conditions and timely and appropriately save patients from adverse disease outcomes.Copyright © 2023 The Authors. Health Science Reports published by Wiley Periodicals LLC.
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Background: COVID-19 has led to the demand for finding effective antiviral agents. Preliminary experiments showed Umifenovir inhibit replication in vivo. There is limited data on the clinical efficacy of COVID-19-infected pneumonia. Therefore, we aimed to evaluate this medication based on clinical findings. Methods: The present study was designed to investigate the advantages and disadvantages of Umifenovir and compared to empirical treatments. For this purpose, multi-stage sampling was considered. 56 people who had mild-to-moderate symptoms without signs of pneumonia, were selected by accidental non-random sampling method and divided into two groups [(group A with Hydroxychloroquine (HCQ) and group B in combination with Umifenovir] by randomized block sampling (1:1). During the study, three patients left the case group. Their clinical signs and symptoms were evaluated on 3rd, 7th, and 14th day after taking these medicines in the disease course. The SPSS software was used for data analysis and the significance level was considered to be p<0.05. Results: On the seventh day after visiting the patients, there were statistically significant differences in recuperation dry cough (p=0.001), weakness (p=0.004), gastrointestinal symptoms (p=0.043) and shortness of breath (p=0.001) between the two groups so that group B patients (HCQ and Umifenovir) had a faster recovery. In patients treated with HCQ and Umifenovir compared to the control group, myalgia (p=0.03), gastrointestinal symptoms (p=0.047) and weakness (p=0.007) improved significantly earlier during the illness. Conclusion: Evaluation of the clinical findings in mild-to-moderate COVID-19 patients' symptoms was performed and it was shown that recuperation was faster in the group who received both HCQ and Umifenovir. Copyright 2022, Journal of Iranian Medical Council. All rights reserved.
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Background: Kidney transplant recipients are among vulnerable individuals with increased risk of developing COVID-19. Long-term immunosuppression and multiple co-morbidities might affect clinical characteristics of COVID-19 in such patients. In this study, we describe clinical presentations and the incidence of Acute Kidney Injury (AKI) in 9 kidney transplant patients with COVID-19. Methods: This retrospective case series was conducted on 9 kidney transplant recipients with COVID-19 who were admitted in Imam Khomeini Hospital Complex during the first wave of the disease in Iran from February 20 to 20th April 2020. The diagnosis of COVID-19 infection was confirmed by either positive results of quantitative RT-PCR on nasopharyngeal swabs or typical findings in chest CT scanning. Results: The median age of patients was 51 years and the graft was functional in all cases before COVID-19 infection. Most patients complained of fever (8 cases), followed by cough (7 cases) and shortness of breath (5 cases). Eight cases had lymphopenia, and leukopenia was reported in 4 cases. AKI occurred in 8 cases. The increase in serum creatinine level resolved partially in most cases, but those who required renal replacement therapy had worse prognosis. Those who survived the acute illness are still alive after more than 16 months with functioning graft. Conclusion: It was shown in our study that similar to general population, fever and respiratory symptoms are presenting features of COVID-19 in kidney transplant recipients. Lymphopenia is more prominent and the course of COVID-19 infection is more likely to be complicated by AKI in such patients. Copyright 2022, Journal of Iranian Medical Council. All rights reserved.
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Background: A better understanding of the pattern of epidemic-related referrals to healthcare centers might allow the identifica-tion of vulnerabilities and the required changes that the healthcare management system should undergo. Objectives: This study aimed to investigate the COVID-19 referral pattern and the role of media and health management planning in changing the trends. Methods: Data extracted from the electronic medical database of Imam Khomeini Hospital Complex (IKHC), located in Tehran, Iran, from February 20 to June 4, 2020 were examined. Individuals were divided into two groups, COVID-19 positive and negative. We used Google Trends to evaluate Google Internet search queries and also available policy documents, programs, and official news related to COVID-19 in Iran during the mentioned period. Results: In this study, 8647 individuals aged 46.05 ± 16.5 years were referred to IKHC. Approximately 57% were male, and 70% were COVID-19 positive. The most clinical symptoms were dyspnea, fever, cough, and myalgia. Chronic kidney disease (CKD) and type 2 diabetes mellitus were the most common underlying health conditions. In the first two weeks, the percentage of negative cases was higher than positive cases and then the pattern was reversed, when people searched for information about COVID-19 in media. Conclusions: Proper and timely information and education to people through the media and health management measures can be effective in reducing unnecessary visits to health centers, preventing the exhaustion of medical staff, and controlling the disease during epidemics.
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Background: Studies have shown that CT could be valuable for prognostic issues in COVID-19. Objectives: To investigate the prognostic factors of early chest CT findings in COVID-19 patients. Methods: This retrospective study included 91 patients (34 women, and 57 men) of real-time reverse transcription polymerase chain reaction (RT-PCR) positive COVID-19 from three hospitals in Iran between February 25, 2020, to March 15, 2020. Patients were divided into two groups as good prognosis, discharged from the hospital and alive without symptoms (48 patients), and poor prognosis, died or needed ICU care (43 patients). The first CT images of both groups that were obtained during the first 8 days of the disease presentation were evaluated considering the pattern, distribution, and underlying disease. The total CT-score was calculated for each patient. Univariate and multivariate analysis with IBM SPSS Statistics v.26 was used to find the prognostic factors. Results: There was a significant correlation between poor prognosis and older ages, dyspnea, presence of comorbidities, especially cardiovascular and comorbidities. Considering CT features, peripheral and diffuse distribution, anterior and paracardiac involve-ment, crazy paving pattern, and pleural effusion were correlated with poor prognosis. There was a correlation between total CT-score and prognosis and an 11.5 score was suggested as a cut-off with 67.4% sensitivity and 68.7% specificity in differentiation of poor prognosis patients (patients who needed ICU admission or died). Multivariate analysis revealed that a model consisting of age, male gender, underlying comorbidity, diffused lesions, total CT-score, and dyspnea would predict the prognosis better. Conclusions: Total chest CT-score and chest CT features can be used as prognostic factors in COVID-19 patients. A multidisciplinary approach would be more accurate in predicting the prognosis.
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The outbreak of coronavirus disease 2019 (COVID-19) has involved more than 159 countries and more than 5 million people worldwide. A 40-year-old man with a history of rheumatoid arthritis treated with prednisolone, Disease-Modifying Anti-Rheumatic Drugs (DMARDs), and biologic agents was admitted with chief complaints of fever, chills, malaise, myalgia, and dyspnea. Chest computed tomography showed bilateral subsegmental atelectasis and diffuse ground-glass opacities in both lungs inducing the suspicion of COVID-19 infection. The oro-nasopharynx swab sample for COVID-19 polymerase chain reaction was positive. In addition to supportive care, lopinavir/ritonavir 400/100 mg twice daily and oseltamivir (75 mg) twice daily were started in combination with a starting dose of hydroxychloroquine (400 mg). The methotrexate dose was decreased, and the dose of prednisolone was increased to 30 mg for 10 days. Azathioprine and adalimumab were continued at previous doses. The use of biologic agents and DMARDs in rheumatic patients is a serious challenge in the COVID-19 pandemic. In conclusion, during the COVID-19 pandemic, due to the key roles of cytokines in the promotion of the disease, the rheumatic patients may benefit from continuing their previous treatment, which may have protective effects.