Clinical Characteristics Of COVID-19 Research Articles

Genomic Surveillance and Molecular Characterization of SARS-CoV-2 Variants During the Peak of the Pandemic in Türkiye.

SARS-CoV-2 is a highly transmissible coronavirus and has caused a pandemic of acute respiratory disease. Genomic characterization of SARS-CoV-2 is important for monitoring and assessing its evolution. A total of 1.346 nasopharyngeal swab samples were collected but only 879 SARS-CoV-2 high-quality genomes were isolated, subjected to Next Generation Sequencing and analyzed both statistically and regarding mutations comprehensively. The distribution of clades and lineages in different cities of Türkiye and the association of SARS-CoV-2 variants with age groups and clinical characteristics of COVID-19 were also examined. Furthermore, the frequency of the clades and lineages was observed in 10months. Finally, non-synonymous mutations not defined in specific SARS-CoV-2 variants (during that period) were identified by performing mutation analysis. B.1.1.7 (Alpha) and B.1.617.2 (Delta) SARS-CoV-2 variants which have also been identified in our study from March to December 2021. We observed a significant association of SARS-CoV-2 variants with age groups and cities. Also, E:T9I, S:A27S, S:A67V, S:D796Y, S:K417N, S:N440K, S:R158X, S:S477N (below 1%-frequency) were determined as specific mutations belonging and shared with the Omicron variant that appeared later. Our study has highlighted the importance of constant monitoring of the genetic diversity of SARS-CoV-2 to provide better prevention strategies and it contributes to the understanding of SARS-CoV-2 from the past to the present.

Shift in Demographic Involvement and Clinical Characteristics of COVID-19 From Wild-Type SARS-CoV-2 to the Delta Variant in the Indian Population: In Silico Analysis.

The Delta variant (B.1.617.2) was considered the most dangerous SARS-CoV-2 strain; however, in-depth studies on its impact based on demographic and clinical characteristics of COVID-19 are scarce. We aimed to investigate the shift in demographic and clinical characteristics of the COVID-19 pandemic with the emergence of the SARS-CoV-2 Delta variant compared with the wild-type (WT) strain (B.1). A cross-sectional study of COVID-19 cases in the Indian population caused by the WT strain (B.1) and Delta variant of SARS-CoV-2 was performed. The viral genomic sequence metadata containing demographic, vaccination, and patient status details (N=9500, NDelta=6238, NWT=3262) were statistically analyzed. With the Delta variant, in comparison with the WT strain, a higher proportion of young individuals (<20 years) were infected (0-9 years: Delta: 281/6238, 4.5% vs B.1: 75/3262, 2.3%; 10-19 years: Delta: 562/6238, 9% vs B.1: 229/3262, 7%; P<.001). The proportion of women contracting infection increased (Delta: 2557/6238, 41% vs B.1: 1174/3262, 36%; P<.001). However, it decreased for men (Delta: 3681/6238, 59% vs B.1: 2088/3262, 64%; P<.001). An increased proportion of the young population developed symptomatic illness and were hospitalized (Delta: 27/262, 10.3% vs B.1: 5/130, 3.8%; P=.02). Moreover, an increased proportion of the women (albeit not men) from the young (Delta: 37/262, 14.1% vs B.1: 4/130, 3.1%; P<.001) and adult (Delta: 197/262, 75.2% vs B.1: 72/130, 55.4%; P<.001) groups developed symptomatic illness and were hospitalized. The mean age of men and women who contracted infection (Delta: men=37.9, SD 17.2 years; women=36.6, SD 17.6 years; P<.001; B.1: men=39.6, SD 16.9 years; women=40.1, SD 17.4 years; P<.001) as well as developing symptoms or being hospitalized (Delta: men=39.6, SD 17.4 years; women=35.6, SD 16.9 years, P<.001; B.1: men=47, SD 18 years; women=49.5, SD 20.9 years, P<.001) were considerably lower with the Delta variant than the B.1 strain. The total mortality was about 1.8 times higher with the Delta variant than with the WT strain. With the Delta variant, compared with B.1, mortality decreased for men (Delta: 58/85, 68% vs B.1: 15/20, 75%; P<.001); in contrast, it increased for women (Delta: 27/85, 32% vs B.1: 5/20, 25%; P<.001). The odds of death increased with age, irrespective of sex (odds ratio 3.034, 95% CI 1.7-5.2, P<.001). Frequent postvaccination infections (24/6238) occurred with the Delta variant following complete doses. The increased involvement of young people and women, the lower mean age for illness, higher mortality, and frequent postvaccination infections were significant epidemiological concerns with the Delta variant.

Clinical characteristics of COVID-19 in children: a large multicenter study from Iran.

During the COVID-19 pandemic, pediatric cases typically exhibit milder symptoms and lower mortality rates. However, the delay in pediatric vaccination poses major risks for children. This multicenter study aimed to comprehensively analyze demographic characteristics, clinical features, disease severity, and risk factors for ICU admission in Iran. This observational study enrolled children aged 0-21 years with confirmed or probable COVID-19 diagnoses, referred from selected hospitals across 17 counties in Mazandaran province, Iran, between February 19 and August 14, 2021. Patients were categorized into mild, moderate, severe, or critical cases based on clinical and radiographic criteria. Data were extracted from medical records and analyzed using statistical methods. Logistic regression analysis was performed to identify factors associated with ICU admission and disease severity. Among the 1,031 children included in the study, 61 were diagnosed with MIS-C. The distribution of patients by severity was 156 mild, 671 moderate, and 204 severe/critical cases. Age distribution significantly differed across severity groups (P < 0.001), with 55.19% aged over 5 years and 54% being male. 11.44% had underlying diseases. Fever (71.97%) was the most common symptom, followed by cough (34.43%) and dyspnea (24.83%). Within the inpatient group, 19.77% required ICU admission, with 0.91% mortality, including 3 MIS-C cases. Children with underlying diseases, gastrointestinal symptoms, and obesity had 4.16, 3.10-, and 2.17-times higher likelihood of ICU admission, respectively. Our study emphasized the importance of recognizing pediatric COVID-19 severity and symptoms. While fever, cough, and dyspnea prevailed, mortality rates were relatively low. However, comorbidities, obesity, and gastrointestinal symptoms linked to ICU admission, stressing early intervention. BMI also impacted disease severity and admission rate. Vaccination and targeted interventions are essential for protecting vulnerable children and easing healthcare strain.

Manifestation of epidemic process, clinical and epidemiological characteristics of adult patients in the early period of the COVID-19 epidemic in Russia

BACKGROUND: The COVID-19 pandemic became a challenge and caused significant social and economic damage to most countries. For the most objective assessment of the epidemiological and clinical features of COVID-19 during different periods of the epidemic, studies based on a large volume of data on patients identified throughout the Russian Federation are necessary. AIM: To analyze the epidemic process and clinical and epidemiological features of adult patients with COVID-19 identified during the first and second periods of the rise and decline in the incidence of COVID-19 in Russia. MATERIALS AND METHODS: This study included patients aged ≥18 years with a confirmed diagnosis of COVID-19 and identified in the periods from March 2, 2020, to June 30, 2020 (n=286,205) and from November 1, 2020, to January 31, 2021 (n=1 655 022), in Russia. RESULTS: At the early stage of the COVID-19 epidemic in Russia, two periods of the rise and fall in incidence were noted: March–August 2020 and September 2020–May 2021, using the Wald–Wolfowitz test. The median age of the patients with COVID-19 in the first and second periods were 50.0 [37–62] and 52.0 [39–64] years, respectively, and women accounted for 55.5 and 60.1% of the patients, respectively. The distributions of patients according to disease severity in the first and second periods were as follows: mild, 63.0 and 74.4%; moderate, 29.0 and 20.1%; severe, 4.9 and 3.5%; extremely severe, 3.1 and 2.1%, respectively. In the first and second periods, cases were dominated by patients aged 50–59 years (20.5%) and 60–69 years (20.5%), respectively. In both periods, the median duration from the onset of symptoms to diagnosis was 4 days, the median disease durations were 16.0 [12–21] and 13 [10–17], and the median duration of hospitalization were 15.0 [12–20] and 13.0 [10–18]. The hospitalization rates were 48.4 and 25.6% in the first and second periods; transfer rates to the ICU, 7.8 and 10.3%; and invasive mechanical ventilation rates, 5.6 and 7.7%, respectively. In both periods, the median age at death was 73 [66–82] years, with a higher proportion of men aged 30–39, 40–49, 50–59, and 60–69 years. The presence of one or more chronic diseases, as well as male sex, increased the likelihood of death (odds ratio = 10.2 and 1.3 in the first period; odds ratio = 16.0 and 1.6 in the second period). CONCLUSIONS: In the early period of the COVID-19 epidemic in Russia, related to the spread of the wild strain of SARS-CoV-2 and genetically closely related variants, the manifestations of the epidemic process and clinical and epidemiological characteristics of patients varied. In the second period with higher incidence and mortality rates than the first period, the frequency of severe and extremely severe COVID-19 and the frequency and duration of hospitalizations decreased; however, the frequency of transfers into the intensive care unit and artificial lung ventilation slightly increased.

Prognostic significance of the chemerin level in coronavirus disease 2019 patients.

Increased serum chemerin levels have been reported in several inflammatory diseases. Few studies have investigated the relationship between chemerin and clinical features of COVID-19. Thus, chemerin may modulate the development and progression of COVID-19. We compared the serum chemerin concentration between patients with and without SARS-CoV-2 infection and its association with the severity and prognosis of COVID-19 pneumonia. This is a prospective, single-center, cross-sectional study. We enrolled COVID-19 patients who presented to our tertiary hospital and healthy controls. The COVID-19 patients were conducted and the dates of symptom onset were recorded. After admission to the hospital and stabilization, blood samples were obtained for routine hemogram, biochemistry, and chemerin. The chemerin level was 37.93 ± 17.3 ng/mL in patients followed in the ICU, 29.41 ± 12.79 ng/mL in inpatients, 30.48 ± 10.86 ng/mL in outpatients, and 25.12 ± 9.82 ng/mL in healthy controls. The difference between patients treated in the ICU and healthy controls was significant (P < .001). The high-sensitivity C-reactive protein (hs-CRP), ferritin, procalcitonin (PCT), and D-dimer levels were significantly higher in the intensive care unit (ICU) group (P < .001). Moreover, the chemerin level of patients who died was significantly higher than that of those who survived (P < .001). The chemerin level was increased in COVID-19 patients and also increased with increasing disease severity. The chemerin level was higher in the COVID-19 patients than healthy controls and was significantly higher in patients who died compared to those who did not.

Unveiling parental perspectives: COVID-19 vaccination for children in India.

Irrespective of the availability of a safe and effective COVID-19 vaccine and its success rate in adults, administering vaccines to children remains a challenge for healthcare workers. Children's vaccine hesitancy among parents remains substantial and is exacerbated due to misleading information. In the present study, we aimed to investigate the hesitancy of parents and their concern about the vaccination and clinical characteristics of COVID-19 in their children. A cross-sectional web-based and offline survey comprised of questions about the demographic of children, the status of COVID-19 infection, its severity, vaccination status, sources of information, willingness, concerns and attitude of parents to vaccinate their children against the COVID-19 virus, was conducted. Overall, 846 responses from parents fulfilling the inclusion criteria were analysed by GraphPad Prism 5. Out of the 846 responses, 51.2% (n = 433) of children were vaccinated against COVID-19. Out of vaccinated children (51.2%), 60.3% (n = 261) had experienced adverse events. Around 21% (n = 98) of children had a history of exposure to the SARS-CoV-2 virus. Among the infected children, 14.3% were asymptomatic and 85.7% had symptoms. Approximately 8% of children had comorbidities, with chronic lung diseases and asthma being the most common. Among the 846 participating parents, 59.5% were mothers and the remaining 40.5% were fathers. A total of 2.7% and 22.2% of parents were found hesitant to administer the COVID-19 vaccine to their children aged 15-18 years and below 15 years, respectively. Among hesitant parents, mothers were found slightly more hesitant as compared to fathers. Also, 35.5% of parents were found hesitant about their own COVID-19 vaccination. Furthermore, the concern for COVID-19 vaccine unwillingness among parents is that a child has already achieved natural immunity after COVID-19 infections (76.8%) followed by vaccine safety and its side effects. The motivating factors to convince parents for their children's COVID-19 vaccination were if their doctors recommend it, followed by detailed information on vaccine side effects and efficacy in children. The most trusted source of information for the parents was found to be the healthcare workers. These results suggest that data and reviews regarding the safety and efficacy of the COVID-19 vaccine readily available in the public domain could serve as a highly effective strategy for promoting and implementing widespread vaccination among children. By providing easily accessible and comprehensive information, public health authorities can address parental concerns, dispel misconceptions and foster a greater sense of trust in the vaccination process.

Predictors to Intensive Care Unit admission among patient with coronavirus disease in Sukraraj Tropical and Infectious Disease Hospital, Nepal: A case-control study.

The clinical features of COVID-19 are vary widely, ranging from asymptomatic states or mild upper respiratory tract infections to severe pneumonia. Previous studies have shown that 20.0% of COVID-19 patients are hospitalized, out of which 10.0-20.0% are admitted to the Intensive Care Unit. The present study aims to assess predictors associated with COVID-19 leading to Intensive Care Unit admission among reverse transcriptase- polymerase chain reaction (RT-PCR) positive patients in Sukraraj Tropical and infectious disease hospital, Nepal. A case-control study was conducted from June 2022 to July 2022 among patients admitted to Sukraraj Tropical and Infectious Disease Hospital. A hospital-based age (± 2 years) and sex-matched case-control study design were adopted in which ICU admitted (case group, n = 33) and general ward admitted (control group, n = 66) were included. Data were collected using a structured questionnaire comprising of socio-demographic, clinical, and preventive predictors. Data were analyzed using the Statistical Package for Social Science version 11.5. The Chi-square test and conditional logistic regression to determine the predictors associated with ICU admission. High blood pressure, high C-reactive protein and poor application of preventive practices were found to be the predictors of ICU admission. Conditional logistics regression analyses revealed that independent risk factors associated with ICU admission were elevated blood pressure (AOR = 2.22; 95% CI 1.05-4.71, p = 0.015) and abnormal C-Reactive Protein (AOR = 2.92; 95% CI 1.24-6.84, p = 0.012) at the time of hospital admission were more likely to get admitted to ICU. Likewise, patients with poor preventive practice (AOR = 3.34; 95% CI 1.19-9.31, p = 0.02) more likely to get admitted to ICU than patient with good preventive practices.These research findings hold potential significance for facilitating early triage and risk assessment in COVID-19 patients.

Clinical Characteristics of COVID-19 in Gynecological Cancer Patients during Chemotherapy-An Observational Study.

Infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) affects multiple organs throughout the body, which puts chemotherapy patients at even greater risk. This study aims to identify the clinical characteristics of gynecological cancer patients infected with SARS-CoV-2 during chemotherapy. Gynecological cancer patients infected with SARS-CoV-2 during chemotherapy from August 1, 2022, to January 31, 2023, were enrolled in this observational cohort study. Patients in the control group were not infected with SARS-CoV-2. All continuous variables, including blood cells (leukocytes, neutrophils, lymphocytes) and biochemical indices (alanine transaminase (ALT), Aspartate transferase (AST), lactate dehydrogenase (LDH), albumin and creatinine) were repeatedly measured and analyzed statistically by the generalized additive mixed model (GAMM). Latent class analysis was estimated for the high-risk factors of severe COVID-19. The primary outcome was to develop a severe condition. During the study period, there were 71 patients with chemotherapy in our center. Of the 57 cases infected with SARS-CoV-2, 14 patients without infection, the infection rate was 80.28%. 52 cases out of the 57 infected patients were included in this study, 9.62% (5/52) cases showed severe disease, and 1 patient died. 51 cases survived during the acute coronavirus disease 2019 (COVID-19) phase. If chemotherapy is given after SARS-CoV-2 infection, tissues and organs that are sensitive to chemotherapy are more likely to be re-damaged by COVID-19. The plasma levels of leukocytes, neutrophils, lymphocytes, ALT, and AST decreased; LDH and creatinine in plasma showed a linear increase, while plasma albumin decreased, and platelets showed no apparent trend. The changes in blood cells and biochemical indices were most evident in relapsed patients and patients with COVID-19 within 2 weeks after chemotherapy. Latent class analysis showed that all severe COVID-19 patients were classified into class 1; the patients of class 1 showed a shorter interval between chemotherapy and COVID-19, and the higher baseline of AST, ALT, and LDH, the more cycles of chemotherapy and the advanced stage. The interval between chemotherapy and COVID-19 is associated with damage to tissues and organs. Clinical factors and laboratory factors indicate poor health conditions among patients with gynecological cancer and COVID-19.

Algorithms for predicting COVID outcome using ready-to-use laboratorial and clinical data.

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an emerging crisis affecting the public health system. The clinical features of COVID-19 can range from an asymptomatic state to acute respiratory syndrome and multiple organ dysfunction. Although some hematological and biochemical parameters are altered during moderate and severe COVID-19, there is still a lack of tools to combine these parameters to predict the clinical outcome of a patient with COVID-19. Thus, this study aimed at employing hematological and biochemical parameters of patients diagnosed with COVID-19 in order to build machine learning algorithms for predicting COVID mortality or survival. Patients included in the study had a diagnosis of SARS-CoV-2 infection confirmed by RT-PCR and biochemical and hematological measurements were performed in three different time points upon hospital admission. Among the parameters evaluated, the ones that stand out the most are the important features of the T1 time point (urea, lymphocytes, glucose, basophils and age), which could be possible biomarkers for the severity of COVID-19 patients. This study shows that urea is the parameter that best classifies patient severity and rises over time, making it a crucial analyte to be used in machine learning algorithms to predict patient outcome. In this study optimal and medically interpretable machine learning algorithms for outcome prediction are presented for each time point. It was found that urea is the most paramount variable for outcome prediction over all three time points. However, the order of importance of other variables changes for each time point, demonstrating the importance of a dynamic approach for an effective patient's outcome prediction. All in all, the use of machine learning algorithms can be a defining tool for laboratory monitoring and clinical outcome prediction, which may bring benefits to public health in future pandemics with newly emerging and reemerging SARS-CoV-2 variants of concern.

DIFFERENTIAL DIAGNOSIS OF COMMUNITY-ACQUIRED PNEUMONIA FROM COVID-19 BY COMPUTED TOMOGRAPHY

The retrospective study was conducted on data collected from tertiary Care Hospitals from January 2020 to May 2021 to compare CT manifestations and clinical features of COVID-19 with CAP and evaluate the diagnostic accuracy of CT in patients with COVID-19 and CAP. The study included one hundred sixty patients with COVID-19 and 115 with CAP diagnosed during the same time. Clinical data and CT images of the participants were collected. Results showed that 134 (84.3%) patients in the COVID-19 group had ground glass opacities on CT scans. In the COVID-19 group, the typical early presentation was single or multiple small round lesions. 51 (31.8%) patients had small lesions, and 83 (51.8%) had large patches, areas of fusion, or density shadows with spots. In the CAP group, 69 (60%) patients had consolidation, and 45 (39.1%) had ground glass shadows. There was a significant difference in density between both groups (P &lt;.001). Of observed imaging and clinical manifestations, ground glass shadows, number of leukocytes, and age factor are clinically significant in diagnosing COVID-19. In the CAP group, major characteristics were the thickening of the bronchial wall, accumulation of textures and fibrous cords, and consolidated lung lesions. In COVID-19, common imaging manifestations of GGO and consolidation. Clinically, a CT scan should be used along with history and examination for early and accurate diagnosis of COVID-19.

Impact of the COVID-19 pandemic on the health of infant children in the Moscow region

The SARS-CoV-2 pandemic has had an impact on the healthcare system and people’s health. The consequences of this influence require study and analysis to further predict population health and healthcare development. Different age groups have significant differences in. features of the disease, epidemiology and consequences. Newborns and infants make up only a small part of the pediatric population affected by COVID-19. Data on the epidemiological and clinical features of COVID-19 in infants are limited. Assessing the impact of the pandemic on this age group through the analysis of morbidity, mortality, hospitalizations, and dispensary observation is of interest to public health. The pandemic has had an impact on public health and public health. The consequences of this influence require comprehensive analysis. The analysis of the main indicators showed that the peak of the pandemic infant children in the Moscow Region occurred in 2021, when the highest incidence and referrals for COVID-19 were registered. The highest level of hospitalization was in 2022. In the period 2020-2021 there was a decrease in morbidity and hospitalizations, which differs from trends in older children and adults. The pandemic had no impact on the coverage of medical examinations of infants, as well as on the mortality rate and the structure of the main causes of death.

Diabetes Mellitus after COVID-19 Vaccination in a Patient with Impaired Glucose Metabolism: Case Report

SCIENTIFIC RELEVANCE. The clinical features of COVID-19 in patients with comorbidities, including diabetes mellitus (DM), have already been discussed in the medical literature. However, the available data on blood glucose levels in patients with DM during SARS-CoV-2 infection and after COVID-19 vaccination are clearly insufficient to estimate the importance of the changes taking place.AIM. The study aimed to show that patients with DM or impaired glucose metabolism need glycaemic monitoring during COVID-19 disease and after COVID-19 vaccination, drawing on the example of a clinical case.MATERIALS AND METHODS. The study analysed the medical records of a 58-year-old male patient newly diagnosed with DM. He received inpatient and outpatient treatment after COVID-19 vaccination and SARS-CoV-2 infection in February–November 2021. In 2014, the patient was diagnosed with impaired glucose metabolism, including fasting hyperglycaemia (≤ 9 mmol/L), which was corrected by diet.RESULTS. After vaccination with Gam-COVID-Vac component 1 in February 2021, the patient developed polydipsia, polyuria, and arterial hypertension. His laboratory findings were as follows: blood glucose, 25 mmol/L; glycated haemoglobin, 10.7%; fasting insulin, 28.4 μIU/mL; calcium, 2.45 mmol/L; and 25-hydroxyvitamin D, 21 ng/mL. The patient was diagnosed with new-onset type 2 DM, admitted to the endocrinology department of a multidisciplinary hospital, and discharged when his condition stabilised after 14 days of treatment. After vaccination with Gam-COVID-Vac component 2, the patient’s glucose levels did not change. In November 2021, the patient was diagnosed with SARS-CoV-2 infection. Even though all symptoms had resolved within 3 days, the virus persisted in the blood for 12 days without clinical manifestations of the disease. This was confirmed by repeated polymerase chain reaction testing. The patient had moderate hyperglycaemia despite antidiabetic treatment; his glucose levels were restored to normal without hospitalisation.CONCLUSIONS. Timely vaccination against COVID-19 in patients with DM, hypertension, and obesity contributes to a mild course of COVID-19 and helps avoid complications in the lungs and other organs. For patients with DM or glucose metabolism disorders, blood glucose monitoring is advisable for detecting and correcting possible hyperglycaemia after vaccination and/or recovery from COVID-19.

Clinical features of COVID-19 in Italian outpatient children and adolescents during Parental, Delta, and Omicron waves: a prospective, observational, cohort study.

COVID-19 features changed with the Omicron variant of SARS-CoV-2 in adults. This study aims to describe COVID-19 symptoms in children and adolescents during the Parental, Delta, and Omicron eras. A single-centre, prospective observational study was conducted on individuals aged 0-20 years attending the University Hospital of Padua (Italy) from April 2020 to December 2022. COVID-19 cases were defined by positive SARS-CoV-2 molecular detection and/or serology; patient/family symptoms and virological positivity were considered to determine the infection onset. Variables were summarized and compared using appropriate tests of descriptive statistics. A total of 509 cases [46% female, median age eight years (IQR: 4-12)] were studied. Three-hundred-eighty-seven (76%), 52 (10%), and 70 (14%) subjects experienced COVID-19 during the Parental, Delta, and Omicron waves, respectively. All subjects developed an asymptomatic/mild COVID-19. Overall, the most frequent symptoms were fever (47%) and rhinitis (21%), which showed a significant increasing incidence from the Parental to Omicron waves (p < 0.001). Conversely, diarrhea was most common during the pre-Omicron eras (p = 0.03). Stratifying symptoms according to the age group, fever, rhinitis, and skin rashes were observed more frequently among infants/toddlers; conversely, fatigue was more common in children older than five years. The duration of symptoms was similar across different SARS-CoV-2 variants of concern (VOCs); conversely, the number of symptoms varied according to the age group (p < 0.0001). This study showed differences in COVID-19 clinical presentation among infants, children, and adolescents and confirmed Omicron infection is more likely to be associated with upper respiratory symptoms. However, further population-based studies are needed to support these findings. In addition, active surveillance will play a crucial role in assessing the disease severity of future VOCs.

A retrospective study on epidemiological and clinical characteristics of COVID-19 in Baluchistan (Pakistan) and its future perspectives

A retrospective study on epidemiological and clinical characteristics of COVID-19 in Baluchistan (Pakistan) and its future perspectives

Clinical features of COVID-19 among patients with end-stage renal disease on hemodialysis in the context of high vaccination coverage during the omicron surge period: a retrospective cohort study

BackgroundWe determined the clinical presentation and outcomes of the Omicron variant of severe acute respiratory syndrome coronavirus 2 infection in hemodialysis patients and identified the risk factors for severe coronavirus disease (COVID-19) and mortality in the context of high vaccination coverage.MethodsThis was a retrospective cohort study involving hemodialysis patients who were vaccinated against COVID-19 during March–September 2022, when the Omicron variant was predominant, and the COVID-19 vaccination rate was high. The proportion of people with severe COVID-19 or mortality was evaluated using univariate logistic regression.ResultsEighty-three (78.3%) patients had asymptomatic/mild symptoms, 10 (9.4%) had moderate symptoms, and 13 (12.3%) had severe symptoms. Six (5.7%) patients required intensive care admission, two (1.9%) required mechanical ventilation, and one (0.9%) was kept on high-flow nasal cannula. Of the five (4.7%) mortality cases, one was directly attributed to COVID-19 and four to pre-existing comorbidities. Risk factors for both severe COVID-19 and mortality were advanced age; number of comorbidities; cardiovascular diseases; increased levels of aspartate transaminase, lactate dehydrogenase, blood urea nitrogen/creatinine ratio, brain natriuretic peptide, and red cell distribution; and decreased levels of hematocrit and albumin. Moreover, the number of COVID-19 vaccinations wasa protective factor against both severe disease and mortality.ConclusionsClinical features of hemodialysis patients during the Omicron surge with high COVID-19 vaccination coverage were significant for low mortality. The risk features for severe COVID-19 or mortality were similar to those in the pre-Omicron period in the context of low vaccination coverage.

Factors influencing the severity of COVID-19 course for patients with diabetes mellitus in tashkent: a retrospective cohort study

BACKGROUND: Since the very first outbreak, scientists have been trying to determine the most critical pathogenetic mechanisms for the development of COVID-19 and related complications, analyze individual subpopulations of patients with chronic diseases and develop optimal tactics to combat not only the infection itself but also its acute and chronic complications.AIM: to assess the COVID-19 course among patients with Type 1 and Type 2 DM.MATERIALS AND METHODS: A retrospective cohort study of Tashkent inhabitants, who had COVID-19 from April to D ecember 2020, was performed. The data were obtained from the single electronic database of registered cases of COVID-19. All data were analyzed using a logistic regression in STATA 17.0 software. Further, the matched case-control study was performed for patients with type 2 DM and no DM based on age, gender, and BMI.RESULTS: Of the 5023 analyzed subjects, 72.63% had no diabetes mellitus (DM), 4.24% had type 1 DM, 15.19% had type 2 DM, and 7.94% was diagnosed with DM during the COVID-19 infection. DM, overweight, and obesity were associated with severe COVID-19; the most significant risk of a severe course was found in persons with type 2 DM. The risk of a lethal outcome and the need for prescription of glucocorticoids did not show a significant association with diabetes in Tashkent. The clinical features of COVID-19 were more common in patients with type 2 DM, especially for shortness of breath, chest pain, and arrhythmia. The persons receiving SU have complained of dyspnea significantly more often than matched patients without DM. Metformin and DPP4i were the groups of drugs that were not associated with significantly increased risk of hospitalization of patients because of COVID-19. The matched case-control study did not reveal statistically significant differences in the disease course severity, need for hospitalization and glucocorticoids, and death depending on the glucose-lowering therapy preceding the onset of COVID-19.CONCLUSION: Diabetes, age and overweight/obesity were associated with severe course of COVID-19 in Tashkent. There was no statistical difference in COVID-19 severity depending on initial glucose-lowering therapy.

Assessment of Inspiratory Effort in Spontaneously Breathing COVID-19 ARDS Patients Undergoing Helmet CPAP: A Comparison between Esophageal, Transdiaphragmatic and Central Venous Pressure Swing.

The clinical features of COVID-19 are highly variable. It has been speculated that the progression across COVID-19 may be triggered by excessive inspiratory drive activation. The aim of the present study was to assess whether the tidal swing in central venous pressure (ΔCVP) is a reliable estimate of inspiratory effort. Thirty critically ill patients with COVID-19 ARDS underwent a PEEP trial (0-5-10 cmH2O) during helmet CPAP. Esophageal (ΔPes) and transdiaphragmatic (ΔPdi) pressure swings were measured as indices of inspiratory effort. ΔCVP was assessed via a standard venous catheter. A low and a high inspiratory effort were defined as ΔPes ≤ 10 and >15 cmH2O, respectively. During the PEEP trial, no significant changes in ΔPes (11 [6-16] vs. 11 [7-15] vs. 12 [8-16] cmH2O, p = 0.652) and in ΔCVP (12 [7-17] vs. 11.5 [7-16] vs. 11.5 [8-15] cmH2O, p = 0.918) were detected. ΔCVP was significantly associated with ΔPes (marginal R2 0.87, p < 0.001). ΔCVP recognized both low (AUC-ROC curve 0.89 [0.84-0.96]) and high inspiratory efforts (AUC-ROC curve 0.98 [0.96-1]). ΔCVP is an easily available a reliable surrogate of ΔPes and can detect a low or a high inspiratory effort. This study provides a useful bedside tool to monitor the inspiratory effort of spontaneously breathing COVID-19 patients.

Clinical course and native antibody development after COVID-19 infection in 50 pediatric oncology patients.

10063 Background: Pediatric oncology patients are at higher risk for severe COVID-19 infection compared to healthy children. However, pediatric cancer patients appear to be at lower risk of severe infection compared to adults with cancer. Lower rates of native antibody development have been seen in adults with hematologic malignancies particularly those with a history of transplant or anti-CD20 therapy. Data on the clinical characteristics of COVID-19 and antibody development after infection in children with cancer are limited. This study aims to describe the clinical manifestations of COVID-19 infection in pediatric caner patients, identify variables associated with severe infection, and evaluate native antibody development. Methods: REsearch on COVid-19 in Oncology to Inform Recovery and Mitigate Future Risk (RECOVOR) is an IRB approved institutional cohort study at Dana-Farber Cancer Institute. Pediatric patients with cancer who had COVID-19 are eligible 1-12 months following qtPCR confirmed infection. Blood samples are collected at 2 timepoints (3-12 months after COVID-19 infection and 6-9 months later) and undergo research analysis as well as clinical Anti-SARS-COV-2 (antibody response only to native infection) testing. Results: We report on the first 50 patients enrolled on the RECOVOR study from March 2021 to Dececember 2022 (COVID infection between March 2020 and November 2022). In this cohort, 56% (28/50) were male, 60% (30/50) had hematologic malignancies, 28% (14/50) had solid tumors, and 12% (6/50) had CNS tumors. Median patient age was 10.4 years (range 1-22 years). Most patients (86%; 43/50) were on active cancer treatment, of which 76% (33/43) had modifications in cancer-directed therapy due to COVID-19 infection. 76% of patients with COVID-19 were symptomatic and 26% (13/50) were hospitalized for COVID-19 symptoms. COVID-19 directed treatments were administered to 44% (22/50) of patients, most commonly antivirals (n = 12), monoclonal antibodies (n = 9), steroids (n = 3) and IVIG (n = 2). Native COVID-19 antibody testing 3-12 months post infection was performed for 88% (44/50) of patients, with 64% (28/44) seropositive at a median time of 5 months post-infection. Repeat antibody testing at timepoint 2 was available for 20 patients, with 14/14 remaining seropositive, 6/7 remaining seronegative, and 1 converting from seronegative to seropositive. Conclusions: The clinical characteristics of COVID-19 seen in this cohort of 50 pediatric oncology patients is consistent with prior reports, highlighting a high risk of hospitalization in this population. This study is the first to evaluate COVID-19 antibody development in pediatric cancer patients and showed that 63% of patients developed antibodies. Pediatric enrollment is ongoing and additional analyses are underway to assess factors associated with severe COVID-19 infection and/or associated antibody response.

COVID-19 Among Patients with Psoriasis: A Single-Center Retrospective Cross-Sectional Study.

Psoriasis patients may have been affected by COVID-19 differently than the normal population due to using different types of treatments, including immunosuppressive agents and biological therapies, the probability of lower effectiveness, and different side effects of the vaccines. This study aimed to evaluate the epidemiologic and clinical features of COVID-19 and the effect of the psoriasis treatment on it. Psoriasis patients followed up in our clinic between March 2020 and July 2022 were evaluated in terms of clinicodemographic characteristics, treatment methods, and COVID-19 vaccination status and compared regarding COVID-19 history. A total of 110 patients (female:male ratio=1:1.2) with a mean age of 45.6±14.3 years were evaluated. Thirty patients (27.2%) developed COVID-19 during psoriasis treatment. Unvaccinated patients had COVID-19 (6/11, 55%) more frequently than vaccinated ones (24/99, 24%), but it was not statistically significant (p=0.067). Although patients who received biological therapy were also more frequently infected with SARS-CoV-2 than patients who received other types of therapies (18/53 [34%] versus 12/57 [21%], respectively), the difference was again not statistically significant.A patient with hypertension using acitretin was hospitalized for pulmonary involvement because of COVID-19. No exacerbation of psoriasis was observed in patients who developed COVID-19, while psoriasis flares occurred following COVID-19 mRNA vaccination in two patients. Patients with psoriasis should get vaccinated against COVID-19, as vaccination prevents the disease and does not result in serious side effects. Although using biological agents for the treatment of psoriasis could be related to a higher risk of getting COVID-19, these agents do not increase the risk of severe COVID-19. Therefore, they may be beneficial in reducing the risk of both psoriasis exacerbations and severe COVID-19 due to the cytokine storm among patients using biological for psoriasis.However, large-scale and controlled studies are needed to support our conclusions.

Clinical Features of COVID-19 in Patients with Congenital Central Hypoventilation Syndrome.

Background: The clinical course of COVID-19 in patients with congenital central hypoventilation syndrome (CCHS) is unknown. Methods: We conducted a cross-sectional questionnaire study in 43 patients with CCHS who had COVID-19. Results: The median age of patients was 11 [interquartile range (IQR) 6-22] years and 53.5% required assisted ventilation (AV) through tracheostomy. Disease severity ranged from asymptomatic infection (12%) to severe illness with hypoxemia (33%) and hypercapnia requiring emergency care/hospitalization (21%), increased AV duration (42%), increased ventilator settings (12%), and supplemental oxygen demand (28%). The median duration to return to baseline AV (n = 20) was 7 (IQR 3-10) days. Patients with polyalanine repeat mutations required increased AV duration compared with those with nonpolyalanine repeat mutations (P = 0.048). Patients with tracheostomy required increased oxygen during illness (P = 0.02). Patients aged ≥18 years took longer to return to baseline AV (P = 0.04). Conclusions: Our study suggests that all patients with CCHS should be vigilantly monitored during COVID-19 illness.