Background This prospective controlled clinical trial aimed to compare the efficacy of methylprednisolone, dexamethasone, and hydrocortisone at equivalent doses in patients with severe COVID-19. Methods In total, 106 patients with mild to moderate COVID-19-related acute respiratory distress syndrome (ARDS) were randomized to receive either dexamethasone (6 mg once a day), methylprednisolone (16 mg twice a day), or hydrocortisone (50 mg thrice a day) for up to 10 days. All participants received a standard of care for COVID-19. The primary and secondary efficacy outcomes included all-cause 28-day mortality, clinical status on day 28 assessed using the World Health Organization (WHO) eight-category ordinal clinical scale, number of patients requiring mechanical ventilation and intensive care unit (ICU) care, number of ventilator-free days, length of hospital and ICU stay, change in PaO 2 :FiO 2 ratios during the first 5 days after treatment, and incidence of serious adverse events. P -values below 0.008 based on Bonferroni’s multiple-testing correction method were considered statistically significant. Results According to the obtained results, there was a trend toward more favorable clinical outcomes in terms of needing mechanical ventilation and ICU care, number of ventilator-free days, change in PaO 2 :FiO 2 ratios during the first 5 days after treatment, clinical status score at day 28, length of ICU and hospital stay, and overall 28-day mortality in patients receiving dexamethasone compared to those receiving methylprednisolone or hydrocortisone; however, likely due to the study’s small sample size, the difference between groups reached a significant level only in the case of clinical status score on day 28 ( p -value = 0.003). There was no significant difference in the incidence of serious adverse events between the study groups. Conclusion Based on the results, severe cases of COVID-19 treated with dexamethasone might have a better clinical status at 28-day follow-up compared to methylprednisolone and hydrocortisone at an equivalent dose. Larger multicenter trials are required to confirm our findings.

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Background: We aimed to determine the level of health literacy (HL), and its association with general health. In addition, we investigated the direct and indirect association of socioeconomic status (SES) and general health among the adult population in Iran. Methods: This cross-sectional study involved 750 literate adults' people. The SES was assessed based on the owning of assets. HL was evaluated using a validated questionnaire in Iran. General health was assessed using the WHO general health questionnaire. The simple and adjusted linear regression models, and structural equation modeling (SEM) were used for data analysis. Results: In adjusted model, female gender, higher level of education, use of books, pamphlets, or brochures as a source of health information, the higher level of SES were positively associated with higher HL. In addition, the HL was significantly associated with higher scores of general health. Results of SEM showed that the direct effect of SES on general health was not significant, but the indirect effect via HL was significant (path coefficient: 0.24; p<0.001). Conclusion: Results of our study indicated HL is strongly associated with general health among the adult population. SES had a significant indirect association with general health via the effect on health literacy.

Background: We aimed to determine the level of health literacy (HL), and its association with general health. In addition, we investigated the direct and indirect association of socioeconomic status (SES) and general health among the adult population in Iran.Methods: This cross-sectional study involved 750 literate adults' people. The SES was assessed based on the owning of assets HL was evaluated using a validated questionnaire in Iran. General health was assessed using the WHO general health questionnaire. The simple and adjusted linear regression models, and structural equation modeling (SEM) were used for data analysis.Results: In adjusted model, female gender, higher level of education, use of books, pamphlets, or brochures as a source of health information, the higher level of SES was positively associated with higher HL. In addition, the HL was significantly associated with higher scores of general health.Results of SEM showed that the direct effect of SES on general health was not significant, but the indirect effect via HL was significant (path coefficient: 0.24; p<0.001).Conclusion: Results of our study indicated HL is strongly associated with general health among the adult population. SES had a significant indirect association with general health via the effect on health literacy.

Introduction Considering the anticoagulant actions of vitamin D, we hypothesize that vitamin D status might affect the required dose of warfarin for maintaining the therapeutic international normalized ratio (INR). Methods In a retrospective single-center cohort study, serum levels of 25-hydroxyvitamin D were assessed for 89 subjects receiving a stable dose of warfarin for 3 months or longer and had a stable INR between 2 and 3.5 for at least three consecutive visits. A warfarin sensitivity index (WSI), defined as the steady-state INR divided by the mean daily warfarin dose, was used for measuring the warfarin dose response. The relation between the serum level of 25-hydroxyvitamin D and WSI value and the difference in the mean WSI value between the subjects with different vitamin D status categories (sufficient, insufficient, and deficient) were assessed. Results Twenty-one subjects had vitamin D deficiency, 43 had vitamin D insufficiency, and only 25 had normal levels of 25-hydroxyvitamin D. Based on the multiple linear regression analysis, there was a significant but weakly positive correlation between WSI and 25-hydroxyvitamin D serum levels, as the value of WSI increases by almost 0.0027434 for every unit increase in 25-hydroxyvitamin D serum level ( p value = 0.041). Using one-way ANOVA analysis, there was a trend in a significant difference between the groups with different vitamin D status categories regarding the mean WSI value ( F = 2.95, p value = 0.057), as subjects with sufficient vitamin D state compared to those with vitamin D deficiency had a higher WSI value. Conclusions Although the study’s limitations limit our ability to draw definite conclusions, the present data suggest that in addition to other traditional factors, vitamin D status might also affect warfarin sensitivity and maintenance dose requirement. However, to more clearly explain this link, further studies with high involvement subjects are required.