Confirmed COVID-19 Disease Research Articles

Compliance Among Healthcare Workers on Hydroxychloroquine Prophylaxis in a Tertiary Care Teaching Hospital during COVID-19 Pandemic

Background: The Indian Council of Medical Research (ICMR), under the Ministry of Health and Family Welfare, recommended chemoprophylaxis with Hydroxychloroquine (HCQ) for asymptomatic healthcare workers treating patients with suspected or confirmed COVID-19 disease during the initial period of the pandemic. Compliance remains a major determining factor behind the success of any Community prophylaxis program. Objective: The study aimed to assess the extent of compliance with the Hydroxychloroquine (HCQ) prophylaxis schedule as per ICMR guidelines among healthcare workers and to find out the factors associated with compliance. Methods: Informed consent was obtained from the study participants, and a questionnaire on parameters and associated factors affecting compliance were filled out by every study participant upon completion of their HCQ prophylaxis. Results: A total of 160 participants were enrolled in the study. The majority of the staff enrolled was the nursing staff (34%). 66% of the total participants were involved in the care of the suspected or confirmed case of COVID-19. The major source of information about HCQ prophylaxis for COVID- 19 infection among all the participants was from the Institutional circular (56%). 10% of healthcare workers believed that HCQ could give them 100% prevention against COVID-19 infection. 56% of the enrolled healthcare workers consumed the medicine on the same day of collection throughout the schedule. 24% of enrolled healthcare workers completed the full course as per ICMR guidelines. The most motivating factor for compliance was the presence of cases of COVID-19 in the hospital. The most common factor for lack of compliance among enrolled healthcare workers was cited to be no contact with COVID-19-positive patients. Conclusion: In our study, 24% of healthcare workers enrolled for HCQ prophylaxis completed the full course of the prescribed regimen as per ICMR guidelines. The main reason for the lack of compliance was the absence of direct contact with COVID-19-positive patients, followed by fear of ADRs.

Intensive Care Unit Mortality Trends during the First Two Years of the COVID-19 Pandemic in Greece: A Multi-Center Retrospective Study.

Data on COVID-19 mortality among patients in intensive care units (ICUs) from Eastern and/or Southern European countries, including Greece, are limited. The purpose of this study was to evaluate the ICU mortality trends among critically ill COVID-19 patients during the first two years of the pandemic in Greece and to further investigate if certain patients' clinical characteristics contributed to this outcome. We conducted a multi-center retrospective observational study among five large university hospitals in Greece, between February 2020 and January 2022. All adult critically ill patients with confirmed COVID-19 disease who required ICU admission for at least 24 h were eligible. In total, 1462 patients (66.35% males) were included in this study. The mean age of this cohort was 64.9 (±13.27) years old. The 28-day mortality rate was 35.99% (n = 528), while the overall in-hospital mortality was 50.96% (n = 745). Cox regression analysis demonstrated that older age (≥65 years old), a body mass index within the normal range, and a delay in ICU admission from symptom onset, as well as worse baseline clinical severity scores upon ICU admission, were associated with a greater risk of death. Mortality of critically ill COVID-19 patients was high during the first two years of the pandemic in Greece but comparable to other countries. Risk factors for death presented in this study are not different from those that have already been described for COVID-19 in other studies.

Delineating COVID-19 subgroups using routine clinical data identifies distinct in-hospital outcomes

The COVID-19 pandemic has been a great challenge to healthcare systems worldwide. It highlighted the need for robust predictive models which can be readily deployed to uncover heterogeneities in disease course, aid decision-making and prioritise treatment. We adapted an unsupervised data-driven model—SuStaIn, to be utilised for short-term infectious disease like COVID-19, based on 11 commonly recorded clinical measures. We used 1344 patients from the National COVID-19 Chest Imaging Database (NCCID), hospitalised for RT-PCR confirmed COVID-19 disease, splitting them equally into a training and an independent validation cohort. We discovered three COVID-19 subtypes (General Haemodynamic, Renal and Immunological) and introduced disease severity stages, both of which were predictive of distinct risks of in-hospital mortality or escalation of treatment, when analysed using Cox Proportional Hazards models. A low-risk Normal-appearing subtype was also discovered. The model and our full pipeline are available online and can be adapted for future outbreaks of COVID-19 or other infectious disease.

Clinical presentation, ICU management and outcome in severe COVID-19 disease – A prospective observational study

Aim: We conducted a prospective, observational study to describe the clinical characteristics, management, and outcomes of patients with moderate to severe coronavirus disease admitted to the Intensive Care Unit (ICU). Methods: The study was conducted from 1st July 2020 to 31st December 2020. The criteria for ICU admission included a positive Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) for the novel Coronavirus (SARS-CoV-2) and oxygen saturation of less than 90% with or without oxygen. Results: A total of 621 patients were included (median age, 59 years [interquartile range {IQR}, 48-68]; 75.8% were males. The common comorbidities were hypertension (323 [52%]), and diabetes mellitus. 96 (15.5%) patients underwent mechanical ventilation, 18 (2.9%) received renal replacement therapy, and 223 (36%) died. The median age in non-survivors was significantly higher [63 years (IQR 55-71)] vs. 57 years (IQR 46-66)] (p < 0.001). Hypoxia (oxygen saturation (SpO2 < 90%) and shortness of breath suggestive of impending respiratory failure were the most common symptoms necessitating ICU admission. A low absolute lymphocyte count (ALC), and high levels of inflammatory biomarkers which persisted for seven days after diagnosis were significantly associated with non-survival. Multivariate logistic regression analysis showed shortness of breath (SOB), hypoxia (SpO2 < 90% on oxygen), use of neuromuscular blockers, and chronic kidney disease as independent risk factors associated with mortality as were the severity scores (APACHE and SOFA). Conclusion: This single-center case series provides clinical characteristics and outcomes of patients with confirmed COVID-19 disease admitted to the COVID ICU. These findings are important for guiding research and preparing for future pandemics.

Analyses of Kidney Biomarkers in Patients With SARS-CoV-2 (COVID-19)

The new coronavirus was first reported in China and caused a widespread global outbreak of pneumonia that spread rapidly across this country and many other countries. Acute kidney injury is one of the important complications of COVID-19, which has been shown in some cases. Exploring the diagnostic features of biomarkers of kidney function in COVID-19 patients may lead to better patient management. We collected laboratory data from 206 people with confirmed COVID-19 disease and evaluated their renal biomarkers, Blood Urea Nitrogen (BUN), and creatinine. The age range of the patients was almost 62 years old. The mean age in the dead patients and recovered patients was 71 and 54 years old, respectively. The average LDH value was 755 U/L, and creatine phosphokinase (CPK) was 267 U/L in the patients. The average BUN was 59.1 U/L, and creatinine was 1.5 U/L in COVID-2019 patients. Among all 193 patients, laboratory results revealed that 163 (85.4 %) patients had an elevated BUN level. Based on creatinine levels for total patients, laboratory results revealed that 49 (25.4 %) patients had an elevated value. The average BUN value in dead patients was 85 mg/dL, while in recovered patients was 40.5 mg/dL (P<0.0001). Also, the average creatinine level in dead patients was 1.86 mg/dL, while in recovered patients was 1.24 mg/dL (P=0.0004). Inflammation following COVID-19 disease causes kidney damage and elevated urea and creatinine levels, which may increase the risk of death in these patients.

Efficacy and safety of regdanvimab in patients with mild to moderate COVID-19: A rapid review and meta-analysis.

This study aimed to evaluate the efficacy and safety of regdanvimab, an anti-SARS-COV-2 monoclonal antibody approved by the European Medicines Agency in November 2021, for the treatment of confirmed COVID-19 disease. Cochrane Library, PubMed, medRxiv and Google Scholar were searched for relevant evidence up to October 27, 2022. The quality of included studies was assessed using the Cochrane risk of bias tools. Data were analysed using RevMan software. Eight studies involving 4793 patients were included. A significant difference was observed between the regdanvimab and no-regdanvimab groups in terms of length of hospital stay (mean difference [MD]= -1.15, 95% confidence interval [CI]: -1.80 to -0.43), clinical recovery (odds ratio [OR] =2.09, 95% CI: 1.38 to 3.18), disease progression (OR =0.23, 95% CI: 0.16 to 0.33), the need for oxygen therapy (OR =0.33, 95% CI: 0.25 to 0.43) and duration of oxygen therapy (MD = -3.00, 95% CI: -4.44 to -1.56). However, no significant difference was detected between 2 groups regarding mortality rate (OR =0.46, 95% CI: 0.11 to 1.89), need for mechanical ventilation (OR =0.39, 95% CI: 0.08 to 1.89) and hospital admission rate (OR =0.61, 95% CI: 0.35 to 1.03). The incidence of adverse events was similar in both groups (OR =0.96, 95% CI: 0.77 to 1.18). Regdanvimab was not effective in reducing mortality and hospital admission rate in patients with mild to moderate COVID-19, but it was effective in improving other efficacy outcomes. Further research is needed to confirm these findings.

Increased risk of diabetic ketoacidosis in an Urban, United States, safety-net emergency department in the COVID-19 era

<abstract><sec> <title>Aims</title> <p>The incidence of diabetic ketoacidosis (DKA) increased during the COVID-19 pandemic but estimates from low-resource settings are limited. We examined the odds of DKA among emergency department (ED) visits in the Los Angeles County Department of Health Services (DHS) (1) during the COVID-19 pandemic compared to the pre-COVID era, (2) without active COVID infections, and (3) stratified by effect modifiers to identify impacted sub-groups.</p> </sec><sec> <title>Methods</title> <p>We estimated the odds of DKA from 400,187 ED visits pre-COVID era (March 2019–Feb 2020) and 320,920 ED visits during the COVID era (March 2020–Feb 2021). Our base model estimated the odds of DKA based on the COVID era. Additional specifications stratified by effect modifiers, controlled for confounders, and limited to visits without confirmed COVID-19 disease.</p> </sec><sec> <title>Results</title> <p>After adjusting for triage acuity and interaction terms for upper respiratory infections and payor, the odds of DKA during the COVID era were 27% higher compared to the pre-COVID era (95%CI 14–41%, p < 0.001). In stratified analyses, visits with private payors had a 112% increased odds and visits with Medicaid had a 20% increased odds of DKA during the COVID era (95%CI 7–36%, p = 0.003).</p> </sec><sec> <title>Conclusions</title> <p>We identified increased odds of DKA during the COVID pandemic, robust to a variety of specifications. We found differential effects by the payor; with increased odds during COVID for privately-insured patients.</p> </sec></abstract>

Covid19 and Pneumonia Detection Using Deep-Leaning

Abstract: It became clear that humanity must learn to live with and adapt to any pandemic such has Covid - 19 , especially in light of the fact that the vaccines currently in development do not prevent the infection but only lessen the intensity of the symptoms. It is crucial to diagnose both pneumonia and COVID-19 since they both have an impact on the lungs. In this study, the automatic detection of the Coronavirus disease was carried out using a data-set of X-ray pictures from patients with common bacterial pneumonia, confirmed Covid-19 disease, and normal occurrences.The current approach for detection and diagnosis of COVID-19 is the RT-PCR and rapid test as known rapidtest is not so effective and RT-PCR is time-consuming and, in lots of instances, no longer less expensive as a consequence the development of new low-price rapid tests of diagnostic gear to aid medical evaluation is needed. The study’s objective is to assess the effectiveness of cutting- edge convolutional neural network designs for medical picture categorization that have been recently suggested. In particular, the Transfer Learning method was utilised. Transfer learning makes it possible to detect many problems in small collectionsof medical image data, frequently with outstanding outcomes. The data sets used in this investigation are a collection of 5144 X-ray images, including 460 images with verified Covid-19 illness,3418 photos with confirmed common bacterial pneumonia, and 1266 images of healthy conditions. The information was gatheredfrom X-ray pictures that were accessible in public medical repositories. According to the data, Deep Learning combined with X-ray imaging may be able to identify important biomarkers for the Covid-19 disease. CNN achieved the highest accuracy99.49% and specificity, followed by VGG-16 at 67.19% and densenet at 91.94

Comparison of COVID-19 survival in relation to CPAP length of treatment and by comorbidity and transmission setting (community or hospital acquired) in a medium-sized UK hospital in 2020: a retrospective study

ObjectiveTo estimate continuous positive airway pressure (CPAP) length of treatment effect on survival of hospitalised COVID-19 patients in a medium-sized UK Hospital, and how this effect changes according to the...

A differential therapeutic consideration for use of corticosteroids according to established COVID-19 clinical phenotypes in critically ill patients

ObjectiveTo determine if the use of corticosteroids was associated with Intensive Care Unit (ICU) mortality among whole population and pre-specified clinical phenotypes. DesignA secondary analysis derived from multicenter, observational study. SettingCritical Care Units. PatientsAdult critically ill patients with confirmed COVID-19 disease admitted to 63 ICUs in Spain. InterventionsCorticosteroids vs. no corticosteroids. Main variables of interestThree phenotypes were derived by non-supervised clustering analysis from whole population and classified as (A: severe, B: critical and C: life-threatening). We performed a multivariate analysis after propensity optimal full matching (PS) for whole population and weighted Cox regression (HR) and Fine-Gray analysis (sHR) to assess the impact of corticosteroids on ICU mortality according to the whole population and distinctive patient clinical phenotypes. ResultsA total of 2017 patients were analyzed, 1171 (58%) with corticosteroids. After PS, corticosteroids were shown not to be associated with ICU mortality (OR: 1.0; 95% CI: 0.98–1.15). Corticosteroids were administered in 298/537 (55.5%) patients of “A” phenotype and their use was not associated with ICU mortality (HR=0.85 [0.55–1.33]). A total of 338/623 (54.2%) patients in “B” phenotype received corticosteroids. No effect of corticosteroids on ICU mortality was observed when HR was performed (0.72 [0.49–1.05]). Finally, 535/857 (62.4%) patients in “C” phenotype received corticosteroids. In this phenotype HR (0.75 [0.58–0.98]) and sHR (0.79 [0.63–0.98]) suggest a protective effect of corticosteroids on ICU mortality. ConclusionOur finding warns against the widespread use of corticosteroids in all critically ill patients with COVID-19 at moderate dose. Only patients with the highest inflammatory levels could benefit from steroid treatment.

Women’s Experiences of Symptoms of Suspected or Confirmed COVID-19 Illness During the Pandemic

ObjectiveTo explore experiences of symptoms of suspected or confirmed COVID-19 illness among women using the CovidWatcher mobile citizen science app. DesignConvergent parallel mixed-methods design. ParticipantsTwenty-eight self-identified women consented for follow-up after using CovidWatcher. Participants’ ages ranged from 18 to 83 years old. MethodsWe collected data via semistructured, virtual interviews and surveys: the COVID-19 Exposure and Family Impact Survey and Patient-Reported Outcomes Measurement Information System measures. We used directed content analysis to develop codes, categories, themes, and subthemes from the qualitative data and summarized survey data with descriptive statistics. ResultsWe derived five themes related to symptom experiences: (a) Physical Symptoms, (b) Mental Health Symptoms, (c) Symptom Intensity, (d) Symptom Burden, and (e) Symptom Trajectories. Subthemes reflected more nuanced experiences of suspected or confirmed COVID-19 disease. For those without COVID-19, anxiety and mental health symptoms were still present. Of those who attested to one of the PROMIS-measured symptoms, all but one had at least mild severity in one of their reported symptoms. ConclusionThis study demonstrates the cross-cutting impact of the COVID-19 pandemic on individuals who identify as women. Future research and clinical practice guidelines should focus on alleviating physical and mental health symptoms related to the ongoing pandemic, regardless of COVID-19 diagnosis. Furthermore, clinicians should consider how patients can use symptom reconciliation apps and tracking systems.

Nasopharyngeal Wash with Normal Saline Decreases SARS-CoV-2 Viral Load: A Randomized Pilot Controlled Trial.

Background Although great progress has been made over the past 2 years in the scientific understanding of the biology, epidemiology, and pathogenesis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), case morbidity and fatality rates remain a great concern and continue to challenge the healthcare resources worldwide as novel variants emerge. There is therefore an urgent need for affordable and readily available strategies to reduce viral transmission. Previous studies in non-COVID-19 patients have demonstrated that administration of low-salt (isotonic but 0.0375% Na) and isotonic saline (0.9% Na) solutions has been associated with an immediate, significant reduction in the microbial antigens and a related decline of microbial burden. The aim of the present study was to determine the effect of nasal washes with normal saline 0.9% on nasopharyngeal viral load and outcome in hospitalized patients with COVID-19 pneumonia. Methods We performed a prospective, randomized, pilot, controlled trial in 50 patients with confirmed COVID-19 disease. Patients were randomized into two groups, the normal saline group (received normal saline 0.9% solution for nasopharyngeal wash) and the control group (no treatment). In the normal saline group, nasopharyngeal wash was performed every 4 hours for a 16-hour period. Twenty-four hours after the baseline nasopharyngeal swab (and 8 hours after the last wash in the normal saline group), a second nasopharyngeal swab was collected for the semiquantitative estimation of the SARS-CoV-2 viral load as determined by cycle threshold (Ct) values. Results In the normal saline group, mean N gene Ct values increased significantly 24 hours after the baseline measurement [ΔCtday2−day1 = 1.87 ± 3.11 cycles, p = 0.007 (95% CI: 0.55 to 3.18)], indicating a decline in SARS-CoV-2 nasopharyngeal viral load by 8.9%. A significant decrease in mean N gene Ct values was observed in the control group, indicating an increase in viral load [ΔCtday2-day1 = −2.12 ± 2.66, p < 0.001 (95% CI: −3.20 to −1.05)] by 9.7%. The difference between the two groups 24 hours after admission and nasopharyngeal wash was 3.09 cycles (p = 0.005, 95% CI: 0.97 to 5.20). Conclusion Nasal washes with normal saline effectively decreased the viral load during hospitalization and at follow-up.

In-Hospital predictors of severity and mortality among neuro-covid patients: a covid-19 retrospectivecase control study

Background: Global studies have exemplified that COVID-19 has neurological manifestations. This study gives an insight to the impact of COVID-19 on the nervous system in Alexandria, Egypt and identifies in-hospital predictors of severity and mortality among Neuro-COVID patients. Methods: This single centre, retrospective case-control study was conducted from August 1st, 2020 to January 31st, 2021, on patients admitted at the COVID-19 Isolation Hospital in Alexandria University, Egypt. A Neuro-COVID patient was defined as any patient with confirmed COVID-19 disease and evidence of one or more new onset nervous system clinical presentation. Results: Out of 1073 in-patients, 352 were Neuro-COVID patients (183 [52%] females and 169 [48%] males). The mean age was 36.64 ± 18.97 years and 161 (45.7%) had comorbidities. Most common involvement was neuromusculoskeletal system (240 [68.2%]), followed by central nervoussystem (164 [46.6%]) and peripheral nervous system (125 [35.5%]), whereas, psychiatric disorders (4 [1.1%]) were the least common. Myalgia (215 [61.1%]); anosmia (118 [33.5%]); headache (100 [28.4%]); ageusia (80 [22.7%]); altered level of consciousness (56 [15.9%]); arthralgia (43 [12.2%]) and dizziness (12 [3.4%]) were predominant presentations. Female Neuro-COVID patients were twice as more likely to be critical than moderate (P =0.030). Critical cases with nervous system presentations manifested 12 times higher risk of death when compared to severe cases (P &lt;0.001). Conclusions: Nervous system involvement was predominant and clinically significant in COVID-19. Disease severity was identified as an independent predictor of mortality in hospitalised Neuro-COVID patients.

Gene Network Analysis of the Transcriptome Impact of SARS-CoV-2 Interacting MicroRNAs in COVID-19 Disease.

According to the World Health Organization (WHO), as of June 2022, over 536 million confirmed COVID-19 disease cases and over 6.3 million deaths had been globally reported. COVID-19 is a multiorgan disease involving multiple intricated pathological mechanisms translated into clinical, biochemical, and molecular changes, including microRNAs. MicroRNAs are essential post-transcriptional regulators of gene expression, being involved in the modulation of most biological processes. In this study, we characterized the biological impact of SARS-CoV-2 interacting microRNAs differentially expressed in COVID-19 disease by analyzing their impact on five distinct tissue transcriptomes. To this end, we identified the microRNAs’ predicted targets within the list of differentially expressed genes (DEGs) in tissues affected by high loads of SARS-CoV-2 virus. Next, we submitted the tissue-specific lists of the predicted microRNA-targeted DEGs to gene network functional enrichment analysis. Our data show that the upregulated microRNAs control processes such as mitochondrial respiration and cytokine and cell surface receptor signaling pathways in the heart, lymph node, and kidneys. In contrast, downregulated microRNAs are primarily involved in processes related to the mitotic cell cycle in the heart, lung, and kidneys. Our study provides the first exploratory, systematic look into the biological impact of the microRNAs associated with COVID-19, providing a new perspective for understanding its multiorgan physiopathology.

Antibodies against Spike protein correlate with broad autoantigen recognition 8 months post SARS-CoV-2 exposure, and anti-calprotectin autoantibodies associated with better clinical outcomes.

Autoantibodies to multiple targets are found during acute COVID-19. Whether all, or some, persist after 6 months, and their correlation with sustained anti-SARS-CoV-2 immunity, is still controversial. Herein, we measured antibodies to multiple SARS-CoV-2 antigens (Wuhan-Hu-1 nucleoprotein (NP), whole spike (S), spike subunits (S1, S2 and receptor binding domain (RBD)) and Omicron spike) and 102 human proteins with known autoimmune associations, in plasma from healthcare workers 8 months post-exposure to SARS-CoV-2 (n=31 with confirmed COVID-19 disease and n=21 uninfected controls (PCR and anti-SARS-CoV-2 negative) at baseline). IgG antibody responses to SARS-CoV-2 antigens were significantly higher in the convalescent cohort than the healthy cohort, highlighting lasting antibody responses up to 8 months post-infection. These were also shown to be cross-reactive to the Omicron variant spike protein at a similar level to lasting anti-RBD antibodies (correlation r=0.89). Individuals post COVID-19 infection recognised a common set of autoantigens, specific to this group in comparison to the healthy controls. Moreover, the long-term level of anti-Spike IgG was associated with the breadth of autoreactivity post-COVID-19. There were further moderate positive correlations between anti-SARS-CoV-2 responses and 11 specific autoantigens. The most commonly recognised autoantigens were found in the COVID-19 convalescent cohort. Although there was no overall correlation in self-reported symptom severity and anti-SARS-CoV-2 antibody levels, anti-calprotectin antibodies were associated with return to healthy normal life 8 months post infection. Calprotectin was also the most common target for autoantibodies, recognized by 22.6% of the overall convalescent cohort. Future studies may address whether, counter-intuitively, such autoantibodies may play a protective role in the pathology of long-COVID-19.

EPIDEMIOLOGY AND CLINICAL CHARACTERISTICS OF CARDIOVASCULAR DYSFUNCTION IN CRITICALLY ILL COVID-19 PATIENTS: A PROSPECTIVE COHORT STUDY

Background:Early reports indicate that cardiac involvement can commonly occur in COVID-19 patients. This prospective observational study aimed to evaluate myocardial dysfunction in critically ill COVID-19 patients. Methods:Forty adult patients with confirmed COVID-19 disease admitted to the intensive care unit of a tertiary care hospital were included, following which demographic, baseline laboratory and serial echocardiography was done on days 1, 3, 5 &amp; 7 to assess global or regional wall motion abnormality, left ventricular function [ejection fraction (LVEF), E/e) and right ventricular function [tricuspid annular plane excursion (TAPSE), tricuspid regurgitation (TR) jet)]. Any new onset ECG changes were also noted. Results:Patients (n=40) had median (IQR) age of 51.5 (38.5- 63.5) and median (IQR) SOFA score of 5.5 (5- 7). Median (IQR) P/F ratio of the included patients at the time of recruitment was 250 (180- 300) and median (IQR) Charlsons comorbidity index was 2 (1- 4). Proportion (95% CI) of patients died during hospital stay was 15 (7.1- 29.1) %. We found that, on day 1, 25% patients had mild to moderate LV dysfunction. Although LVEF was statistically higher in patients receiving mechanical ventilation, LVEF, E/e, TAPSE and TR jet did not change significantly from base line till day 7, in both mechanically ventilated and nonventilated patients, or in survivors and non-survivors. However, LVEF correlated with PaO2/FiO2 ratio (P/F) ratio at day 3 (rho= 0.46, p=0.003), 5 (rho= 0.47, p=0.002) and 7 (rho= 0.41, p=0.01), whereas TR jet with correlated inversely wit P/F ratio at day 1 (rho= -0.39, p=0.01) and 3 (rho= -0.39, p=0.01). Conclusion: Our study highlights that although P/F ratio correlated with both left ventricular and right function, the dynamics of both left ventricular and right ventricular function was non- progressive in both mechanically ventilated and as well as spontaneously breathing patients, and similar in both survivors and non survivors.

Comparing the Characteristics of Mucormycosis Between Cases with and without COVID-19; a Cross-sectional Study.

Introduction:Mucormycosis as a rare but life-threatening disease with 46-96% mortality, which challenged the healthcare system during the COVID-19 pandemic. This study aimed to compare the characteristics of mucormycosis between cases with and without COVID-19.Methods:This cross-sectional study was done in two referral hospitals, Imam Hossein and Labbafinezhad Hospitals, Tehran, Iran, between 21 March to 21 December 2021. Data related to all hospitalized adults subject with the diagnosis of mucormycosis during the study period was collected from patients’ profiles and they were divided into two groups of with and without COVID-19 based on the results of real time PCR. Then demographic, clinical, and laboratory findings as well as outcomes were compared between the two groups.Results:64 patients with the mean age of 53.40±10.32 (range: 33-74) years were studied (53.1% male). Forty-three (67.2%) out of the 64 subjects had a positive COVID-19 PCR test. The two groups had significant differences regarding some symptoms (cough (p < 0.001), shortness of breath (p = 0.006)), acute presentation (p = 0.027), using immunosuppressive (p = 0.013), using corticosteroid (p < 0.001), and outcomes (mortality (p = 0.018), need for intubation (p < 0.001)). 22 (34.3%) patients expired during hospital admission. Univariate analysis showed the association of in-hospital mortality with need for ventilation (p < 0.001), sinus involvement (p = 0.040), recent use of dexamethasone (p = 0.011), confirmed COVID-19 disease (p = 0.025), mean body mass index (BMI) (p =0.035), hemoglobin A1c (HbA1c) (p = 0.022), and median of blood urea nitrogen (BUN) (p =0.034). Based on the multivariate model, confirmed COVID-19 disease (OR = 5.01; 95% CI: 1.14-22.00; p = 0.033) and recent use of dexamethasone (OR= 4.08, 95% CI: 1.05-15.84, p = 0.042) were independent predictors of mortality in this series. Conclusion:The mucormycosis cases with concomitant COVID-19 disease had higher frequency of cough and shortness of breath, higher frequency of acute presentation, higher need for immunosuppressive, corticosteroid, and ventilator support, and higher mortality rate. The two groups were the same regarding age, gender, BMI, risk factors, underlying diseases, symptoms, and sites of involvement.

Зміни деяких показників тромбоутворення та активності запалення як маркерів тяжкості перебігу та прогнозу захворювання у пацієнтів з COVID-19 та коморбідною есенціальною гіпертензією

The purpose of the study was to determine the features of thrombosis (D-dimer) and inflammation (procalcitonin) in patients with COVID-19 with acute respiratory syndrome in combination with essential hypertension and to determine their role as markers of severity and prognosis of comorbid pathology. Materials and methods. A retrospective study of the medical records of 232 patients with confirmed COVID-19 disease with acute respiratory syndrome was performed. Patients were divided into two groups: with comorbid essential hypertension (main group) and without essential hypertension (comparison group), which amounted to 149 and 83 persons, respectively. The information obtained from the medical records included demographic data, symptoms and course of the disease, complications, instrumental and laboratory results (including peripheral blood platelet count, international normalized ratio, D-dimer and procalcitonin levels), and data of patients’ treatment. Results. According to the results of the study, the number of patients hospitalized in the intensive care unit with respiratory viral disease COVID-19 and comorbid hypertension, both in absolute and relative terms, was significantly higher (p = 0.005). The number of patients in this group who required non-invasive lung ventilation was also significantly higher (39% versus 17%), indicating a more severe and rapid course of the disease. In terms of hospitalization, both groups of patients had no significant differences, but the mortality rate in the group with comorbid essential hypertension was significantly higher (p = 0.005). In our study, level of D-dimer in patients of both study groups exceeded the reference values, but it was significantly higher in patients of the main group, compared with patients in the comparison group (p = 0.005). According to the platelet counts and international normalized ratio in patients of both groups no significant differences were found (p = 0.10 and p = 0.32, respectively), there was only a slight increase in peripheral blood leukocytes at the time of hospitalization in patients of the main group (p = 0.083). In addition, in patients with combined pathology, the mortality rate was higher and, at the same time, it was in these patients that direct correlations of strong density were found between D-dimer and procalcitonin with mortality (r = 0.77, and r = 0.72, respectively, p = 0.001 and p = 0.003). Conclusion. In patients with COVID-19 with acute respiratory syndrome, there is a significant increase in markers of thrombosis (D-dimer) and inflammatory activity (procalcitonin), while the severity of their changes is significantly greater in patients with comorbid essential hypertension. Patients with COVID-19 with acute respiratory syndrome in combination with essential hypertension have a more severe course of the disease and a significantly higher mortality rate, which is associated with a tendency to develop thrombocytopenia and is associated with changes in markers of thrombosis and inflammation. Determination of D-dimer and procalcitonin levels are reliable markers for both severity and prognosis in patients with COVID-19 with severe acute respiratory syndrome, and especially in conditions of comorbidity with essential hypertension, which may have a significant impact on strategy selection and tactics of treatment of such patients

Contrast enhanced ultrasonography (CEUS) a novel tool to detect intestinal epithelial barrier dysfunction in severe COVID-19 disease.

Ten patients with confirmed COVID-19 disease were studied. Nine patients required intensive care treatment, among them four needed extracorporeal membrane oxygenation (ECMO). Contrast enhanced ultrasonography (CEUS) was performed by one experienced investigator as a bolus injection of up to 2.4 ml of sulphur hexafluoride microbubbles via a central venous catheter. B-Mode evaluation and strain elastography showed mural edema of the small bowel with a thickness of up to 10 mm in all patients. We applied color coded Doppler sonography (CCDS) and power mode with flow-adapted parameters and early, dynamic capillary arterial contrast enhancement of bowel wall structures <10 s to assess perfusion of the small bowel. In all patients, reactive hyperemia was seen in the entire small bowel. In a subgroup of seven patients microbubbles translocated into the intestinal lumen. Thus, high-grade intestinal barrier disruption secondary to SARSCoV-2 infection can be postulated in these patients.This is the first description of perfusion changes and a disruption of the small bowel epithelial barrier in COVID-19 Patients using contrast ultrasonography and elastography.

The Prognostic Effect of Clinical and Laboratory Findings on in-hospital Mortality in Patients with Confirmed COVID-19 Disease

Background: COVID-19 is known as a global health issue, which can cause high mor-bidity and mortality in patients. It is necessary to identify biomarkers, clinical and laboratory find-ings and effects on patients' mortality. Objective: This study aimed to evaluate the prognostic effect of clinical and laboratory findings on in-hospital mortality in patients with confirmed COVID-19. Methods: This retrospective cross-sectional study (February-August 2020) was conducted on adult patients with COVID-19 who were hospitalized in one of the main reference hospitals affiliated with Shiraz University of Medical Sciences, southern Iran. Patients with uncompleted or missed medical files were excluded from the study. Clinical and laboratory findings were extracted from the patients' medical files and then analyzed. The patients were categorized and later compared as survivor and nonsurvivors groups. Results: 345 patients were enrolled and 205 (59.4%) were male. The mean±SD of age was 53.67±16.97 years, and 32 (9.3%) out of the total did not survive. Hypertension (28.4%) and diabe-tes (25.5%) were the most prevalent comorbidities. All clinical symptoms were similar in both groups, except fever, which was observed significantly more in nonsurvivors (P=0.027). The dura-tion of hospitalization was 9.20±5.62 (range; 2-42) days, which was higher in nonsurvivors (P&lt;0.001). The results of Multivariate Logistic Regression Model showed that CRP (OR=1.032, P=0.01) and INR (OR=48.88, P=0.049) were the predictor factors for in-hospital mortality in hospi-talized patie&lt;nts with confirmed COVID-19. Conclusion: The current study showed that in-hospital mortality was 9.3%. It was found that CRP and INR were the predictor factors for in-hospital mortality in hospitalized patients with confirmed COVID-19.