Confirmed COVID-19 Patients Research Articles

Post-COVID-19 Cognitive Decline and Apoe Polymorphism: Towards a Possible Link?

APOE ε4 polymorphism has been recently described as a possible association with cognitive deficits in COVID-19 patients. This research aimed to establish the correlation between COVID-19 and cognitive impairment, and the APOE gene polymorphism among outpatients. We performed a cross-sectional study with confirmed COVID-19 patients and neurological symptoms that persisted for more than three months from onset. APOE genotypes were determined. The final number of patients included in this study was 219, of which 186 blood samples were collected for APOE genotyping, evaluated 4.5 months after COVID-19. Among the participants, 143 patients (65.3%) reported memory impairment symptoms as their primary concern. However, this complaint was objectively verified through screening tests (Addenbrooke Cognitive Examination-Revised and Mini-Mental State Examination) in only 36 patients (16.4%). The group experiencing cognitive decline exhibited a higher prevalence of the APOE ε4 allele than the normal group (30.8% vs. 16.4%, respectively, p = 0.038). Furthermore, the APOE ε4 allele and anxiety symptoms remained significant after multivariate analysis. This study assessed an outpatient population where cognitive changes were the primary complaint, even in mild cases. Moreover, the ε4 allele, sleep disorders, and anxiety symptoms were more frequent in the cognitive decline group.

Extra pulmonary versus pulmonary presentation of COVID-19 patients: comparative study

BackgroundThe respiratory system is the most frequently affected system by COVID-19. However, a variety of extra-pulmonary systems can be influenced by COVID-19 with subsequent morbidity and mortality.AimThis study aim is to report the most frequent extra pulmonary presentations of COVID-19 with comparison to patients with primary pulmonary presentation. Risk factors for ICU admission in both groups were examined.MethodsIn this prospective comparative cross-sectional study, detailed demographics, medical history, clinical assessment, and computed tomography (CT) scan of the chest were done to all recruited patients with COVID-19.ResultThis study included a total of 1664 confirmed COVID-19 patients. The patients were categorized into two groups. Patients with pulmonary manifestations included 716 patients while 948 patients presented with extrapulmonary manifestations. Patients in the extrapulmonary group were older. The prevalence of certain chronic comorbid conditions was higher in the extra pulmonary group as cardiac, CNS, hepatic, and renal diseases, while chronic respiratory disorders were more prevalent in the pulmonary group (P value: < 0.0001). No significant difference in CT severity score between both groups. CORAD 5 was predominant in the pulmonary group (P value: < 0.0001). Most cases in both groups required hospital admission either inward or in ICU with higher frequency of ICU admission was observed in the pulmonary group. The significant risk factors for ICU admission in both groups were critically ill category of patients, CT severity, low oxygen saturation level, and the presence of comorbid chronic disease (P < 0.0001 with adjusted Odds ratio). CNS, cardiac, renal, and metabolic dysfunctions exert significant risk for ICU admission in the extrapulmonary group.ConclusionAtypical or non-respiratory manifestations could be the presentation of a respiratory pathogen as reported in COVID-19. Our work highlights the extrapulmonary presentation of COVID-19. Older male patients were more prone to present with extra pulmonary symptoms. CNS, cardiac, renal, and metabolic dysfunctions were the most affected systems. This could impact the level of care required for patient management and the extent of resource utility.

Prevalence of COVID-19 Reinfection and Associated Factors: Findings of a Countrywide Cross-Sectional Study in Bangladesh

Background: Information on the extent of COVID-19 reinfection and associated risk factors is scarce in Bangladesh. The present study aimed to determine the prevalence, severity, and associated risk factors of COVID- 19 reinfection. Methods: This countrywide cross-sectional study targeted all COVID-19 patients reported in May 2021 at the Health Information Unit (HIU), Directorate General of Health Services (DGHS), Bangladesh. The study identified 242 re-infected cases among 41408 confirmed COVID-19 patients by reviewing the medical records at HIU, and DGHS. Considering the selection criteria and informed consent, we enrolled 202 re-infected patients. Data were collected through telephone interviews and reviewing medical records using a semi-structured questionnaire and a checklist. Results: The prevalence of COVID-19 reinfection was 0.58%, and most (98.0%) of them were urban residents. Of all, 37.1% had an interval of 3-6 months between two attacks of infections. The severity of reinfection included asymptomatic (6.4%), mild (67.8%), moderate (22.3%), and severe (3.5%) infections. The moderate and severe (25.9% and 7.4%) illness were significantly (p&lt;0.001) higher in the patients having an interval of &lt;3 months between two attacks. The moderate and severe illnesses (73.7% and 5.3%) were significantly (p&lt;0.001) higher among the patients who didn’t maintain social distance. The patients aged 30-39 years had more chance of having mild (AOR=9.26, p=0.009) and moderate (AOR=16.58, p=0.008) infection. Conclusion: To avert COVID-19 reinfection and its severity, patients should be vigilant about preventive practices even after recovery. The study suggests effective interventions aligned with exposure, physical distancing, vaccination, and comorbidities to mitigate COVID-19 reinfection. JOPSOM 2021; 41(1):8-18

New Challenges for Radiology Professionals during the COVID-19 Pandemic

Aims: Analyze the new challenges faced by radiology professionals in managing suspected or confirmed COVID-19 patients and understand their implications for the safety strategies of these professionals and patients.&#x0D; Methodology: The method used was an integrative literature review, conducted by searching for publications in indexed journals in the databases PubMed, SciELO, Scopus, and ScienceDirect, covering the years from 2015 to 2020.&#x0D; Results: In the data analysis, the articles were classified into 20 units of analysis, with information presented as sub-themes related to the publications of the selected studies, with a focus on the synthesis of the results.&#x0D; Conclusion: In conclusion, it is essential that not only all professionals involved in the process possess knowledge and preventive measures, but also that the entire radiology service is adequately prepared to receive patients, thereby ensuring greater stability in terms of environmental biosafety.

The finding of subcutaneous emphysema on chest X-rays of COVID-19 patients at Prof. Dr. I.G.N.G Ngoerah General Hospital

Introduction: Spontaneous subcutaneous emphysema without any invasive medical procedure was a rare and severe complication related to COVID-19 infection. Extensive alveolar damage caused by COVID-19 infection and sudden increase in intrathoracic pressure by cough mechanism were some of the risk factors underlying this event. Unlike the physical examination that could be performed only with limitation, mobile chest X-RAY as one of the imaging modalities was useful and plays an important role in supporting the diagnosis of COVID-19 infection and lung-related complications such as pneumothorax, pneumomediastinum, and subcutaneous emphysema.. Thus, the purpose of this study is to evaluate the findings of subcutaneous emphysema from chest X-rays in COVID-19 patients Methods: The research design was descriptive quantitative which was conducted on May - Sep 2023 at the radiology Department of Prof. Dr. I.G.N.G Ngoerah General Hospital. The target population was all positive confirmed COVID-19 patients who had chest x-rays at Prof. Dr. I.G.N.G Ngoerah General Hospital. The data was collected from secondary sources from SIMARS and PACS and then tabulated and analyzed for gender, PCR results, age, vaccine status, and chest X-RAY findings for all samples. All of the data was analyzed with the SPSS. Result: There were 40 cases collected for COVID-19. Most samples aged were more than 59 years old (42,5%). The mortality rate was 82,5%. with subcutaneous emphysema, 1,08% of all COVID-19 cases. 40% of which was followed by pneumomediastinum, 22,5% by pneumopericardium, and 15% by pneumothorax. The most subcutaneous emphysema region findings were at supraclavicular 88% and anterior cervical 83%. Iatrogenic subcutaneous emphysema is mostly caused by the usage of medical devices (82%). Conclusion: Subcutaneous emphysema was a rare complication of severe COVID-19. Subcutaneous emphysema could be life-threatening if followed by pneumocytes, esophageal rupture, and infection or necrosis.

Physical discomforts, feeling of the high work intensity and the related risk factors of the frontline medical staff during COVID-19 epidemic: an early-outbreak, national survey in China.

Facing the unknown virus, COVID-19 medical staff kept wearing thick personal protective equipment during their work in the early stage of the outbreak. The survey was designed to investigate the physical discomforts, the feeling of the work intensity and the related risk factors of the frontline medical staff during COVID-19 epidemic in the early outbreak. An national survey was carried out in China from March 17th 2020 to March 20th 2020 by applying a standardized WeChat questionnaire survey. The doctors or nurses working in the wards for the confirmed COVID-19 patients on front-line were eligible to participate in the survey. Descriptive analysis and multivariate logistic regression analysis were used. A total number of 515 COVID-19 medical staff, including 190 physicians and 325 nurses participated in this survey. 375 medical staff (72.8%) experienced physical discomforts at work, mostly consist of dyspnea (45.8%), pain (41.0%), chest distress (24.1%), dizziness (18.8%), and weakness (17.5%), while wearing thick isolation clothes at work. The mean onset time and peak time of these symptoms were 2.4 h and 3.5 h after working, respectively. 337 medical staff (65.4%) suffered from sleep disorders. 51 medical staff (10%) were highly worried about being infected by COVID-19 even during their work breaks. 246 medical staffs (47.8%) felt high work intensity and the independent influential factors were the effective daily sleep time and anxiety levels at break time (p = 0.04). The frontline medical staff during COVID-19 epidemic felt different physical discomforts when they wear thick isolation clothes at work in the early outbreak and they felt high work intensity. These precious data will help optimize the work management strategy to ensure the physical and mental health of medical staff in the face of similar outbreaks in future.

THU326 Subcutaneous Insulin Aspart Every 4 Hours In the Treatment Of COVID-19 Patients With Diabetic Ketoacidosis: A Retrospective Study

Abstract Disclosure: D. Chiewchalermsri: None. C. Wanittansirichok: None. C. Sriphrapradang: None. SUBCUTANEOUS INSULIN ASPART EVERY 4 HOURS IN THE TREATMENT OF COVID-19 PATIENTS WITH DIABETIC KETOACIDOSIS: A RETROSPECTIVE STUDY Introduction: COVID-19 infection increases the risk of diabetic ketoacidosis (DKA). To limit the healthcare workers’ exposure when taking care of the COVID-19 patients, treatment of DKA with subcutaneous (SC) rapid-acting insulin analogs every 4 hours was suggested in many professional recommendations. However, the evidence to support this strategy is lacking. We aimed to report the efficacy and safety of SC insulin aspart every 4 hours in the management of DKA in COVID-19 patients. Methods: We retrospectively reviewed all confirmed COVID-19 patients aged &amp;gt;15 years who developed mild-moderate DKA between July 2020 and October 2021 in our institution. Insulin aspart was delivered 0.4 units/kg SC every 4 hours. When blood glucose (BG) decreased to &amp;lt;250 mg/dL, the dose of insulin aspart was reduced to 0.2 units/kg every 4 hours until resolution of DKA. SC Basal insulin 0.15-0.2 units/kg was also initiated at the time of DKA diagnosis. Result: A total of 7 patients had mean age of 67.43±13.19 years with body mass index of 25.49±3.42 kg/m2. Most was 71.4% of female and all had pre-existing type 2 diabetes mellitus. All patients received high-dose steroid for COVID-19 treatment. Initial biochemical parameters were BG of 449±157.3 mg/dL, hemoglobin A1c of 10.58±2.81%, pH of 7.34±0.07, beta-hydroxybutyrate of 4.0±1.51 mmol/L, and HCO3 of 15.5±2.17 mmol/L. Time to resolution of DKA were 12.7±5.82 hours. Conclusion: From our cohort, SC rapid-acting insulin administered every 4 hours could be applied in the selected COVID-19 patients with mild-moderate DKA. Presentation: Thursday, June 15, 2023

OR34-01 Incidence Of Diabetes Following COVID-19 Vaccination And SARS-CoV-2 Infection: A Population-Based Cohort Study

Abstract Disclosure: D. Lui: None. X. Xi: None. M. Chung: None. I. Au: None. F. Lai: None. E. Wan: None. C. Chui: None. X. Li: None. F. Cheng: None. C. Cheung: None. E. Chan: None. C. Lee: None. Y. Woo: None. K.C. Tan: None. C. Wong: None. I. Wong: None. Objectives: The risk of incident diabetes following COVID-19 vaccination remains to be evaluated. Also, it is unclear whether the risk of incident diabetes after SARS-CoV-2 infection is modified by vaccination status or differs by SARS-CoV-2 variants. We evaluated the incidence of diabetes following mRNA (BNT162b2), inactivated (CoronaVac) COVID-19 vaccines, and after SARS-CoV-2 infection. Methods: Two separate COVID-19 vaccination and infection cohorts were extracted from a population-based electronic health database in Hong Kong. The vaccination cohort included people who received ≥ 1 dose of COVID-19 vaccine between February and September 2021, matched with those who did not receive any COVID-19 vaccines up to September 2021. The infection cohort consisted of confirmed COVID-19 patients between January 2020 and March 2022, and people who were never infected up to March 2022. Both cohorts were followed until 15 August 2022. COVID-19 vaccine recipients and COVID-19 patients were 1:1 matched to their respective controls using propensity score. Hazard ratios (HRs) for incident diabetes were estimated using Cox regression models. Results: In the vaccination cohort, we included 167337 CoronaVac and 158378 BNT162b2 recipients with their respective 1:1 matched control. 442 (0.3%) CoronaVac recipients and 693 (0.4%) BNT162b2 recipients were COVID-19 survivors. Upon median follow-up (FU) of 13 months (IQR 11-14), CoronaVac or BNT162b2 vaccination was not associated with increased risks of incident diabetes (CoronaVac: HR=1.00 [95%CI 0.96-1.04]; BNT162b2: HR=0.86 [95%CI 0.83-0.90]), regardless of type 1 or 2. In the infection cohort, we included 145199 COVID-19 patients and 145199 matched controls. Among COVID-19 survivors, 60348 (41.6%) were fully vaccinated and 25792 (17.8%) did not receive any COVID-19 vaccines. Upon median FU of 5 months (IQR 5-6), 2109 COVID-19 patients (all type 2 diabetes) and 1775 non-COVID-19 people (one case of type 1 diabetes) were diagnosed with diabetes following SARS-CoV-2 infection. SARS-CoV-2 infection was associated with significantly higher risk of incident diabetes (1.45% vs 1.22%, HR=1.23 [95%CI 1.15-1.31]) regardless of the predominant circulating variants (non-Omicron, HR=1.87 [95%CI 1.35-2.59]; Omicron, HR=1.21 [95%CI 1.13-1.29]), albeit lower with Omicron variants (p for interaction=0.009). Subgroup analysis showed that fully vaccinated COVID-19 survivors did not have increased risk of incident diabetes (HR=1.01 [95%CI 0.90-1.12]). Conclusions: COVID-19 vaccination was not associated with increased risk of incident diabetes. The risk of incident diabetes increased following SARS-CoV-2 infection, mainly type 2 diabetes. The excess risk was lower, but still statistically significant, for Omicron variants. Fully vaccinated individuals might be protected from the risk of incident diabetes following SARS-CoV-2 infection. Presentation: Sunday, June 18, 2023

Management of suspected or confirmed Covid-19 patients: adaptation of French general practitioners for the first lockdown ending

Le 1er déconfinement a été initié le 11 mai 2020. Cette période d’incertitude a été marquée par de nouvelles missions pour les médecins généralistes (MG) : assurer les demandes de soins pour les patients en contexte de crise tout en limitant le risque de contamination. Le réseau ACCORD (Assembler, Coordonner, COmprendre, Rechercher, Débattre en soins primaires) est un réseau de recherche en soins premiers sur les thématiques de pluriprofessionnalité et d’organisation territoriale des soins1,2. Cette enquête se focalise sur l’adaptation des MG français pendant la période du 1er déconfinement pour l’accueil et la prise en soins ambulatoire des patients potentiellement atteints de Covid-19.

Association between Comorbidities and COVID-19 Mortality: a Cross-Sectional Study in a Community Health Center in Indonesia

Objective: To analyze the risk factors for mortality and comorbidity of COVID-19 patients in a public health center work area in Indonesia.Methods: This was a cross-sectional observational analytic quantitative study using secondary data of 820 confirmed COVID-19 cases in Brebes Public Health Center work area during the period of June 2020–December 2021. Univariate and bivariate analyses were used to analyze the obtained data statistically with a p-value of &lt;0.005 considered significant.Results: Of the 820 confirmed COVID-19 patients, 85.1% recovered and 15.0% died. Analysis on the characteristics of these cases showed that 51.2% females and 48.8 % males were included in this study, with 77.6% of them were &lt;60 years old. No history of comorbidities was identified in 92.1% of the cases. In remaining cases with comorbidities, Diabetes Mellitus was recognized as the most prevalent (n=39, 4.8%). Results of the Chi-Square test demonstrated that comorbidity status (p-value = 0.001), place of quarantine (p p=0.000 p&gt;0.05), and diabetes (p=0.000, OR=2.87, 95% CI 19 1.24-0280) were significantly associated with mortality.Conclusion: Comorbidity status, diabetes, and the place quarantine are risk factors for mortality among COVID-19 confirmed cases, especially in Brebes Public Health Center work area. Thus, it is important to increase knowledge about COVID-19 prevention and risks to prevent transmission among those with higher risks for mortality. Further studies on factors related to sustainable supports for COVID-19 patients are also necessary.

Best-worst scaling in studying the impact of the coronavirus pandemic on health professionals in Ghana

In this study, we utilized a best-worst scaling experiment design to assess the potential factors associated with depression, anxiety, and stress among health professionals following the experience of the COVID-19 pandemic. The maximum difference model was performed to analyze the potential risk factors associated with depression, anxiety, and stress. As a case study, a total of 300 health professionals in Ghana were included in the survey. The majority, 112 (68.7%) male health professionals and 97 (70.8%) female health professionals reported that they had encountered suspected COVID-19 patients. 83 (50.9%) of the male health professionals and 76 (55.5%) of the female health professionals reported that they had encountered confirmed COVID-19 patients. A considerable proportion of the males 59 (36.2%) and females 57 (41.6%) health professionals reported coming into direct contact with COVID-19 lab specimens. The findings indicated that a high proportion of health professionals encountered suspected or confirmed COVID-19 patients, while a considerable proportion had direct contact with COVID-19 lab specimens leading to psychological problems. Risk factors such as contact with confirmed COVID-19 patients, the relentless spread of the coronavirus, death of patients and colleagues, shortage of medical protective equipment, direct contact with COVID-19 lab specimens, and the permanent threat of being infected should be given special attention, and necessary psychological intervention provided for health professionals endorsing these risk factors. Improving the supply of medical protective equipment to meet occupational protection practices, sufficient rest, and improving the vaccination of the population might help safeguard health professionals from depression, anxiety, and stress. Our results provide insight into policy discussions on the mental health of health professionals and interventions that are essential to enhance psychological resilience.

Hubungan nilai D-dimer terhadap mortalitas pada pasien COVID-19 derajat berat di RSUD Dr.pirngadi Medan tahun 2020-2021

Coronavirus is an infectious human disease caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). D-dimer affects the mortality rate of COVID-19 patients due to an impaired immune system and an excessive inflammatory process that leads to tissue damage, leading to death conditions. The increase in COVID-19 severity correlates with an elevation in D-dimer levels. Elevated D-dimer levels have become an important marker in monitoring the condition of severe COVID-19 patients, as they are associated with worse outcomes and increased mortality in severe COVID-19 cases. To determine the relationship between D-dimer levels and mortality in severe COVID-19 patients.This research used a descriptive and analytical study with a cross-sectional design to determine the correlation between D-dimer levels and mortality in severe/critical COVID-19 patients. Data were obtained from secondary sources of medical records of confirmed severe/critical COVID-19 patients at Dr. Pirngadi Regional General Hospital. There is a correlation between D-Dimer levels and mortality in confirmed severe COVID-19 patients with moderate severity. A significant association exists between elevated D-Dimer levels and mortality in confirmed COVID-19 patients with moderate severity. This study also indicated that there are more male COVID-19 patients compared to females. Older individuals (elderly) in this study, aged over 45 years, are more likely to be infected with COVID-19 compared to those under 45 years of age.

Factors Influencing The Duration Of Illness to Mortality In Confirmed COVID-19 Patients Admitted to Hospitals Across Riau Province

This study aims to look at the factors associated with the length of illness to death in COVID-19 patients being treated in hospitals throughout Riau Province. Researchers used secondary data sourced from data from the Online Hospital at the Riau Provincial Health Office. The overall cumulative survival probability for dying was 6.2%, with an overall median survival time of 20 days (IQR: 17-22). The lowest median survival time is the initial saturation value variable, which is 4 days (IQR: 2-5), the use of a respirator is 5 days (IQR: 3-6), and ICU care is 8 days (95% CI: 8-9) ). The final results of multivariate analysis showed that old age had a 1.7 times risk of experiencing death HR 1.747 (95% CI: 1.386-2.202), a low initial saturation value had a 1.6 times risk of experiencing death HR 1.627 (95% CI: 1.155-2.292), care units in the ICU have a 1.9 times risk of dying with HR 1.911 (95% CI: 1.439-2.538) and patients who use respirators have a 1.4 times risk of dying with HR values 1.463 (95% CI: 1.051-2.037). Improvement and readiness of referral health facilities in Riau Province is something that deserves attention as a preventive effort in facing the possibility of the next emerging disease.

Experience of Covid-19 Survivors in Relieving Symptoms of Anosmia

The high stigma of the community and public compliance in implementing health protocols can hamper the reduction of COVID-19 cases. One of the symptoms of COVID-19 is anosmia. The purpose of this study was to find out the experiences of survivors of Covid-19 to relieve symptoms of anosmia. The data collection method in this case study is through in-depth interviews. Data collection was carried out on January 10 2022-February 10 2022. The research design used a qualitative case study with 9 participants from Sumberjo Village who experienced symptoms of anosmia during COVID-19. Data collection tools use mobile phones and stationery. The sampling technique used is snowball. The results showed that all participants tried to eliminate the symptoms of anosmia. Four themes were found regarding the experiences of Covid-19 survivors in relieving anosmia symptoms, theme 1) efforts made to relieve anosmia symptoms were PHBS, use of pharmacological and nonpharmacological drugs, and olfactory training. Theme 2) the feelings felt when confirmed are still enthusiastic, afraid, anxious, and worried. Theme 3) Environmental responses to confirmed COVID-19 patients, including positive responses, are support systems in the family and environment, and negative responses are social stigma. Theme 4) symptoms of anosmia if confirmed with COVID-19 are respiratory tract disorders, muscle stiffness, thermoregulation, sleep disturbance, and fatigue. To relieve the symptoms of mia in the form of nasal irrigation with 0.9% NaCl solution, it is necessary to carry out tests at a later date, even though there are already researchers in several hospitals

The Impact of COVID-19 Vaccination on Bulgarian Patients with Uncomplicated Type 2 Diabetes Mellitus as the Only Chronic Condition

Abstract Objective: This retrospective study aimed to investigate the impact of COVID-19 vaccination on Bulgarian patient cohorts with uncomplicated diabetes mellitus type 2 as the only documented chronic comorbidity. We conducted a comparison of fully vaccinated and non-vaccinated populations, considering gender, age groups and vaccine type, across ambulatory, hospital, and ICU settings. Design: Between March 2020 and June 2022, a comprehensive retrospective analysis was conducted on a national level, utilizing data from the Ministry of Health of the Republic of Bulgaria database obtained after a formal written request. The study included a total of 1,126,946 confirmed COVID-19 patients. Results: Among the 1,126,946 confirmed COVID-19 patients, 3,792 individuals (0.33% of the total confirmed cases) had diabetes mellitus as a single chronic condition. Among the 247,441 hospitalized COVID-19 cases, 1,382 patients (0.56% of the total) had type 2 diabetes mellitus. Notably, the majority of patients requiring hospitalization due to supplemental oxygen requirement were unvaccinated women aged between 60 and 69, accounting for 240 patients. The highest mortality rates were observed in both unvaccinated men and women aged between 70 and 79, with 88 patients in each group. Statistical analysis revealed significant findings in favor of reduced rates of ambulatory care [OR = 0.76 (95% CI 0.6471 to 0.8891); p = 0.0006], intensive care admission [OR = 0.38 (95% CI 0.2698 to 0.5282); p &lt; 0.0001], in-hospital mortality [OR = 0.18 (95% CI 0.0864 to 0.3604); p &lt; 0.0001], and ICU-related mortality [OR = 0.17 (95% CI 0.0893 to 0.3436); p &lt; 0.0001]. The vaccinated cohorts who received BNT162b2 demonstrated the lowest observed death rates, with 9 deaths out of 485 individuals (1.8%) across all age groups. Conclusion: In conclusion, this retrospective analysis indicates reduced mortality in patients with uncomplicated type II diabetes mellitus who received vaccination against SARS-CoV-2. Vaccinated individuals also showed significant reduction in ICU admissions.

The Impact of High D-Dimer on The Clinical Outcome of Covid-19 patients at A Private Hospital in Jakarta

D-Dimer is a fibrin degradation product as the resultof thrombus degradation by fibrinolysis. Elevated D-dimer in the blood is a presumptive marker of thrombosis. D-dimer levels above 1g/mL are risk factors for poorprognosis in patients with COVID-19. To evaluate the impact of high D-Dimer on the clinical outcome of Covid-19 patients at Private Hospital in Jakarta. A retrospective cohort study with convenience sampling was applied in this study. There were 980 patients but only 320 patients were eligible for inclusion criteria. This study only included confirmed COVID-19 patients who were hospitalized from March to June 2021, and the study was conducted from March to June 2022. The gender of the majority patients as the sample was male, 165 (52%) and 155(48%) female patients with moderate severity. Correlation between D-dimer and clinical outcome of COVID-19 patients using Fisher's exact method showed a higher survival rate of 287(89.7%) patients compared to 33(10.3%) patients who died with a p-value &lt;0.05. The survival analysis for COVID-19 patients using the Kaplan Meier method showed that patients receiving D-dimer &lt;500ng/mL had a median survival rate of about 90% after approximately 21 days of treatments, whereas patients whowere receiving &gt;500 ng/mL had a 50% survival rate after 30 days of treatment. Patients receiving D-dimer &lt;500ng/mL had a survival rate of about 90% after undergoing treatment for approximately 21 days, while patients who had D-dimer&gt;500 ng/mL had a survival rate of about 50% after 30 days of treatment. Anticoagulants were given to almost all patients, roughly 10 percent died during hospitalization with hypercoagulation complications.

Poorer outcomes following COVID-19 infection for patients with depression: A cohort analysis in South Korea.

It remains unknown whether patients with pre-existing depressive conditions are at high risk of severe COVID-19. Therefore, this study aims to investigate the association between patients with pre-existing depressive conditions and severe COVID-19. This study is part of the Korea Disease Control and Prevention Agency-COVID19-National Health Insurance Service cohort study of an ongoing large-scale health screening survey of adults 18 years and older residing in South Korea. Pre-existing depression status was measured from 552,860 patients who participated in a biennial health screening from 2019 to 2020. Finally, 29,106 confirmed COVID-19 patients were enrolled and followed up to track any severe clinical events within 1 month of their diagnosis date. Adjusted odds ratio (aOR) and 95% confidence interval (CI) were calculated using multivariate-adjusted logistic regression analysis. We identified 2868 COVID-19 patients with severe clinical events and 26,238 COVID-19 patients without severe clinical events. The moderate-to-severe depressive symptoms group showed an elevated odds of severe outcomes of COVID-19 (aOR, 1.46; 95% CI, 1.25-1.72), including those without vaccination (aOR, 1.32; 95% CI, 1.08-1.61) and those with complete vaccination (aOR, 1.76; 95% CI, 1.18-2.63). In addition, those who were diagnosed with depression along with depressive symptoms at the health screening revealed an increased risk of severe outcomes of COVID-19 (aOR, 2.22; 95% CI, 1.22-4.05). Moderate-to-severe depressive symptoms were associated with higher odds of severe COVID-19 events in both no and complete vaccination groups. Participants with depressive symptoms may be at higher risk of severe outcomes of COVID-19.

Despite low viral titer in saliva samples, Sanger-based SARS-CoV-2 spike gene sequencing is highly applicable for the variant identification

BackgroundThis study aimed to compare the performance of Sanger-based SARS-CoV-2 spike gene sequencing and Next Generation Sequencing (NGS)-based full-genome sequencing for variant identification in saliva samples with low viral titer.MethodsUsing 241 stocked saliva samples collected from confirmed COVID-19 patients between November 2020 and March 2022 in Hiroshima, SARS-CoV-2 spike gene sequencing (nt22735-nt23532) was performed by nested RT-PCR and Sanger platform using in-house primers. The same samples underwent full-genome sequencing by NGS using Illumina NextSeq2000.ResultsAmong 241 samples, 147 were amplified by both the Sanger and the Illumina NextSeq2000 NGS, 86 by Sanger only, and 8 were not amplified at all. The overall amplification rates of Illumina NextSeq2000 NGS and Sanger were 61% and 96.7%, respectively. At low viral titer (< 103 copies/mL), Illumina NextSeq2000 NGS provided 19.2% amplification, while Sanger was 89.7% (p < 0.0001). Both platforms identified 38 wild type, 54 Alpha variants, 84 Delta variants, and 57 Omicron variants.ConclusionsOur study provided evidence to expand the capacity of Sanger-based SARS-CoV-2 spike gene sequencing for variants identification over full-genome by Illumina NextSeq2000 NGS for mass screening. Therefore, the feasible and simple Sanger-based SARS-CoV-2 spike gene sequencing is practical for the initial variants screening, which might reduce the gap between the rapid evolution of SARS-CoV-2 and its molecular surveillance.

Comparison of SARS-Cov-2 omicron variant with the previously identified SARS-Cov-2 variants in Egypt, 2020-2022: insight into SARS-Cov-2 genome evolution and its impact on epidemiology, clinical picture, disease severity, and mortality.

The o severe acute respiratory coronavirus 2 (SARS-CoV-2) pandemic has killed millions of people and caused widespread concern around the world. Multiple genetic variants of SARS-CoV-2 have been identified as the pandemic continues. Concerns have been raised about high transmissibility and lower vaccine efficacy against omicron. There is an urgent need to better describe how omicron will impact clinical presentation and vaccine efficacy. This study aims at comparing the epidemiologic, clinical, and genomic characteristics of the omicron variant prevalent during the fifth wave with those of other VOCs between May 2020 and April 2022. Epidemiological data were obtained from the National Electronic Diseases Surveillance System. Secondary data analysis was performed on all confirmed COVID-19 patients. Descriptive data analysis was performed for demographics and patient outcome and the incidence of COVID-19 was calculated as the proportion of SARS-CoV-2 confirmed patients out of the total population of Egypt. Incidence and characteristics of the omicron cohort from January- April 2022, were compared to those confirmed from May 2020-December 2021. We performed the whole-genome sequencing of SARS-CoV-2 on 1590 specimens using Illumina sequencing to describe the circulation of the virus lineages in Egypt. A total of 502,629 patients enrolled, including 60,665 (12.1%) reported in the fifth wave. The incidence rate of omicron was significantly lower than the mean of incidences in the previous subperiod (60.1 vs. 86.3/100,000 population, p < 0.001). Symptoms were reported less often in the omicron cohort than in patients with other variants, with omicron having a lower hospitalization rate and overall case fatality rate as well. The omicron cohort tended to stay fewer days at the hospital than did those with other variants. We analyzed sequences of 2433 (1590 in this study and 843 were obtained from GISAID platform) Egyptian SARS-CoV-2 full genomes. The first wave that occurred before the emergence of global variants of concern belonged to the B.1 clade. The second and third waves were associated with C.36. Waves 4 and 5 included B.1.617.2 and BA.1 clades, respectively. The study indicated that Omicron-infected patients had milder symptoms and were less likely to be hospitalized; however, patients hospitalized with omicron had a more severe course and higher fatality rates than those hospitalized with other variants. Our findings demonstrate the importance of combining epidemiological data and genomic analysis to generate actionable information for public health decision-making.

Risk management system to reduce COVID-19 infection in health personnelSistema de gestão de riscos para reduzir o contágio de COVID-19 em profissionais de saúde

To assess the occupational factors associated with the occurrence of COVID-19 in health personnel who were exposed to different magnitudes of risk and who followed the United Nations crisis management policy for COVID-19. Cross-sectional survey conducted between April and May 2021. The low-risk group (LRG) were considered to be those who had minimal contact with patients; the medium-risk group (MRG) had contact with non-COVID-19 patients and did not perform instrumental airway intervention; and the high-risk group (HRG) were those who cared for COVID-19 patients and performed instrumental intervention with aerosol generation. Diagnosed COVID-19 disease and the presence of positive IgG antibodies for SARS-CoV-2 measured with Elecsys® anti-SARS-CoV-2 were considered as outcomes. Outcome recorded in 43.8% of the LRG, versus 46.7% in the MRG (odds ratio [OR]: 1.125; 95% confidence interval [CI 95% ]: 0.896-1.414; p = 0.311), and 48.6% in the HRG (OR: 1,214; CI 95%: 0.964-1.530; p= 0.10). Belonging to the high-risk group and the medium-risk group, based on the degree of exposure to confirmed COVID-19 patients in the work area, was not associated with a higher occurrence of disease or seroconversion.