Positive Coronavirus Disease 2019 Research Articles

Nutrition delivery across hospitalisation in critically ill patients with COVID-19: An observational study of the Australian experience

BackgroundData on nutrition delivery over the whole hospital admission in critically ill patients with COVID-19 are scarce, particularly in the Australian setting. ObjectivesThe objective of this study was to describe nutrition delivery in critically ill patients admitted to Australian intensive care units (ICUs) with coronavirus disease 2019 (COVID-19), with a focus on post-ICU nutrition practices. MethodsA multicentre observational study conducted at nine sites included adult patients with a positive COVID-19 diagnosis admitted to the ICU for >24 h and discharged to an acute ward over a 12-month recruitment period from 1 March 2020. Data were extracted on baseline characteristics and clinical outcomes. Nutrition practice data from the ICU and weekly in the post-ICU ward (up to week four) included route of feeding, presence of nutrition-impacting symptoms, and nutrition support received. ResultsA total of 103 patients were included (71% male, age: 58 ± 14 years, body mass index: 30±7 kg/m2), of whom 41.7% (n = 43) received mechanical ventilation within 14 days of ICU admission. While oral nutrition was received by more patients at any time point in the ICU (n = 93, 91.2% of patients) than enteral nutrition (EN) (n = 43, 42.2%) or parenteral nutrition (PN) (n = 2, 2.0%), EN was delivered for a greater duration of time (69.6% feeding days) than oral and PN (29.7% and 0.7%, respectively). More patients received oral intake than the other modes in the post-ICU ward (n = 95, 95.0%), and 40.0% (n = 38/95) of patients were receiving oral nutrition supplements. In the week after ICU discharge, 51.0% of patients (n = 51) had at least one nutrition-impacting symptom, most commonly a reduced appetite (n = 25; 24.5%) or dysphagia (n = 16; 15.7%). ConclusionCritically ill patients during the COVID-19 pandemic in Australia were more likely to receive oral nutrition than artificial nutrition support at any time point both in the ICU and in the post-ICU ward, whereas EN was provided for a greater duration when it was prescribed. Nutrition-impacting symptoms were common.

Evaluation of the relationship between TAFI level and prognosis in COVID-19 patients.

Serum thrombin-activated fibrinolysis inhibitor (TAFI) levels were measured in coronavirus disease 2019 (COVID-19) patients requiring intensive care, clinical hospitalization, and outpatient follow-up. The relationships between serum TAFI levels and prognosis were determined. Ninety patients who had positive COVID-19 PCR test results were randomly selected and included in the study. Subgroups were formed according to the clinical characteristics of the patients as follows: mild, moderate, and severe. Venous blood samples were taken from all patients, and serum C-reactive protein (CRP), lactate dehydrogenase (LDH), fibrinogen, D-dimer, ferritin, and TAFI levels were measured. The results were evaluated by comparing each group. The one-way ANOVA test to determine differences between subgroups resulted in p-values lower than 0.05 for all biochemical analytes (CRP, LDH, fibrinogen, D-dimer, ferritin, and TAFI). Regarding serum TAFI levels, there were significant differences in the severe group (853.04 ± 338.58 ng/mL) compared to the mild group (548.33 ± 264.17 ng/mL). ROC curve analysis to predict mortality revealed that TAFI levels were able to detect 85% of deaths. In addition, ROC analysis revealed that serum TAFI levels could detect 86% of intubated cases. The disease progression is more severe in patients with high TAFI levels, and high TAFI levels are associated with mortality and intubation rates. Further studies are needed to determine serum TAFI levels as a biomarker of prognosis in COVID-19 patients.

A Retrospective Study on Prevalence and Profile of Reverse Transcriptase Polymerase Chain Reaction Positive Severe Acute Respiratory Syndrome Corona Virus 2 Samples Tested in a Tertiary Care Hospital, South India

Introduction: In December 2019, the first outbreak of severe acute respiratory syndrome coronavirus 2 disease was reported in Wuhan, China, which was later re-named by the World Health Organization (WHO) as coronavirus disease 2019 (COVID-19). Severe illness was seen in approximately 20%–30% of patients needing intensive care unit intervention. Some of them presented with acute respiratory distress syndrome, Shock, acute cardiac injury, organ dysfunction, and acute renal injury. Aim: This study aims to estimate the prevalence of reverse transcriptase polymerase chain reaction (RT-PCR)-positive COVID-19 samples among the total samples tested and their profile among the positive COVID-19 samples at a tertiary care hospital, south India, and will also highlight the comorbid conditions associated with increased morbidity and mortality. Materials and Methods: Nasopharyngeal and oropharyngeal samples from suspected COVID-19 patients were collected and tested by real-time RT-PCR and the targeted genes were identified. Results: In our study, the prevalence of COVID-19 RT-PCR positivity was found to be 3.1%. Among the positive samples, males were found to be 58.2% and females were 41.8%. Symptomatic patients were less of which 17.65% were male and 7.98% were female. Among the positive patients, 83 patients had severe symptoms that needed intensive care and died of complications. The patients with comorbid conditions had diabetes as the leading cause of death. Conclusion: The present study concluded that mortality was found to be more among COVID-positive males, elderly people above 60 years of age with comorbid conditions.

Facilitating oral COVID-19 therapy utilization through a pharmacy consult service

BackgroundTwo oral therapies, nirmatrelvir/ritonavir (Paxlovid) and molnupiravir (Lagevrio), are now available for the treatment of coronavirus disease 2019 (COVID-19). Treatment guidelines recommend using these agents for nonhospitalized adults with mild to moderate COVID-19 who are at high risk of disease progression. Despite guideline recommendations, therapy is frequently underutilized, resulting in lost opportunity to prevent severe outcomes including death. ObjectiveThis study aimed to describe the implementation of a pharmacy consult service for oral COVID-19 therapy within the ambulatory care setting. Practice descriptionUpon receipt of a positive COVID-19 test result, providers were encouraged to place a pharmacy consult for review. Information required within the consult submission served as a simple guide for determining eligibility for therapy. Once submitted, the pharmacist would identify which oral COVID-19 medication and dosage was most appropriate. In addition, for nirmatrelvir/ritonavir, the pharmacist would provide clear and concise instructions on how to manage any significant drug-drug interactions identified. Upon consult completion, the provider would order the appropriate therapy. Practice innovationWe depict an interdisciplinary approach to facilitate oral COVID-19 therapy utilization at a health care system level. EvaluationVeterans with a positive COVID-19 test from January 10, 2022, to July 10, 2022, were identified. A chart review was then used to collect relevant patient demographics and outcomes. The primary outcome was the eligibility for and subsequent prescribing of oral COVID-19 therapy. ResultsOf the 245 positive COVID-19 cases, 172 (70%) were eligible for oral COVID-19 therapy. Of those eligible, 118 (68.6%) were offered therapy and 95 (80.5%) accepted. Nirmatrelvir/ritonavir was the predominant agent used with 16% requiring renal dosage adjustment. Pharmacists identified 167 significant drug-drug interactions with nirmatrelvir/ritonavir encompassing 42 unique medications. Fourteen of the interactions warranted the utilization of molnupiravir. ConclusionThe utilization of a pharmacy consult service has facilitated interdisciplinary team collaboration and ultimately empowered the utilization of oral COVID-19 therapy.

Treatment with prophylactic oral anticoagulants and the risk of mortality in COVID-19 patients: a nationwide cohort study.

Venous thromboembolism has been reported in patients with coronavirus disease 2019 (COVID-19). It remains unclear if premorbid use of prophylactic oral anticoagulation, for reasons other than COVID-19, protects against death in patients with COVID-19. The aim of this study was to estimate if the risk of all-cause mortality, hospital admission or intensive care unit (ICU) admission for individuals with verified SARS-CoV-2 was lower if patients used oral anticoagulant (OAC) therapy prior to a positive COVID-19 status. Data were obtained using national health registries. Cohort entry was the day of a positive SARS-CoV-2 test, and individuals were followed for 14 days or until death or hospital admission. Adjusted Cox proportional hazard regressions and competing risk analyses were used to estimate the risk of all-cause mortality, hospital admission and ICU admission in OAC users compared with patients with no use of OAC. In this nationwide cohort study a total of 244 522 individuals were included (median age 35 years (interquartile range 21-52); 124 095 (51%) female), among whom 3710 (1.5%) were OAC users. In the adjusted Cox regression cohort, there was no difference in risk of all-cause mortality in OAC versus non-OAC users. (hazard ratio (HR) 1.13, 95% CI 0.99-1.30). Hospital admission risk (HR 1.11, 95% CI 1.02-1.20) was slightly increased in OAC users, and there was no difference between the groups regarding the risk of ICU admission (HR 0.96, 95% CI 0.74-1.24). In individuals with confirmed SARS-CoV-2, pre-existing treatment with OAC was not associated with prophylactic benefits in the prevention of hospital admission, ICU admissions or death. Prescription patterns should remain unchanged.

Neonatal Multisystem Inflammatory Syndrome Associated with COVID-19 Exposure in Two Cases from Iran

Introduction: Immune dysregulation happens after exposure to corona virus disease-2019 (COVID-19) and affects many organs. It is confirmed with a positive COVID-19 test history, fever, and the involvement of 2 or more organs, but it is hard to diagnose in neonates. Case Presentation: There were 2 Persian neonates admitted to the Neonatal Intensive Care Unit or neonatal ward of the Children’s Medical Center, Tehran, Iran, with sepsis in this case presentation. The trunk and extremities were affected by macular rashes in both cases. COVID-19 tests in both cases were negative, but both of their mothers were affected by COVID-19 before delivery. In both cases, systemic and macular rashes responded to corticosteroids. Conclusions: Macular rash can present multisystem inflammatory disease in neonates. Neonates with a positive history of COVID-19 in parents or relatives should be considered for this syndrome.

Epidemiology, clinical characteristics and risk factors of coronavirus disease 2019 (COVID-19) in Casablanca.

This is an analytical cross-sectional study of coronavirus disease 2019 (COVID-19) based on data collected between 1 November 2020 and 31 March 2021 in Casablanca focusing on the disease's epidemiological status and risk factors. A total of 4569 samples were collected and analysed by reverse-transcription polymerase chain reaction (RT-PCR); 967 patients were positive, representing a prevalence of 21.2 % for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The mean age was 47.5±18 years, and infection was more common in young adults (<60 years). However, all age groups were at risk of COVID-19, and in terms of disease severity, the elderly were at greater risk because of potential underlying health problems. Among the clinical signs reported in this study, loss of taste and/or smell, fever, cough and fatigue were highly significant predictors of a positive COVID-19 test result (P<0.001). An assessment of the reported symptoms revealed that 27 % of COVID-19-positive patients (n=261) experienced loss of taste and/or smell, whereas only 2 % (n=72) of COVID-19-negative patients did (P<0.001). This result was consistent between univariate (OR=18.125) and multivariate (adjusted OR=10.484) logistic regression analyses, indicating that loss of taste and/or smell is associated with a more than 10-fold higher multivariate adjusted probability of a positive COVID-19 test (adjusted OR=10.48; P<0.001). Binary logistic regression model analysis based on clinical signs revealed that loss of taste and/or smell had a performance index of 0.846 with a P<0.001, confirming the diagnostic utility of this symptom for the prediction of COVID-19-positive status. In conclusion, symptom evaluation and a RT-PCR [taking into account cycle threshold (C t) values of the PCR proxy] test remain the most useful screening tools for diagnosing COVID-19. However, loss of taste/smell, fatigue, fever and cough remain the strongest independent predictors of a positive COVID-19 result.

Vaccine hesitancy in patients with COVID-19 who have back pain.

Musculoskeletal pain is among the most common symptoms in patients diagnosed with coronavirus disease 2019 (COVID-19), and it has placed a significant burden on health worldwide during the pandemic. This study explored vaccine hesitancy and associated factors in patients with positive COVID-19 polymerase chain reaction test results who were hospitalized and had back pain. A cross-sectional study was conducted among 170 hospitalized COVID-19 patients over 18 years of age. Data were analyzed using descriptive statistics with IBM SPSS ver. 25.0. COVID-19 patients who were married considered COVID-19 vaccinations riskier than unmarried COVID-19 patients. Patients who had not been vaccinated expressed higher levels of distrust towards COVID-19 vaccines than patients who had been vaccinated. Participants had relatively little hesitation toward the Sinovac vaccine. High vaccine confidence was found in all participants regardless of vaccination status. Those who had not received the COVID-19 vaccine reported higher risk perceptions than those who had received at least 1 dose of any COVID-19 vaccine. Measurements of the hesitancy of vaccinated and non-vaccinated patients or members of society towards vaccines can be an important parameter for health authorities to find solutions.

Simple Symptom-Based Prediction of COVID-19: A Single-Center Study of Outpatient Fever Clinic in Japan.

Coronavirus disease 2019 (COVID-19) symptoms are not fully understood in non-hospitalized individuals in Japan, and COVID-19 differentiation by symptoms alone remained challenging. Therefore, this study aimed to examine COVID-19 prediction from symptoms using real-world data in an outpatient fever clinic. We compared the symptoms of COVID-19-positive and negative patients who visited the outpatient fever clinic at Imabari City Medical Association General Hospital and tested for COVID-19 from April 2021 to May 2022. This retrospective single-center study enrolled 2,693 consecutive patients. COVID-19-positive patients had a higher frequency of close contact with COVID-19-infected patients compared with COVID-19-negative patients. Moreover, patients with COVID-19 had high-grade fever at the clinic compared with patients without COVID-19. Additionally, the most common symptom in patients with COVID-19 was sore throat (67.3%), followed by cough (62.0%), which was approximately twice as common in patients without COVID-19. COVID-19 was more frequently identified in patients having a fever (≥37.5℃) with a sore throat, a cough, or both. The positive COVID-19 rate reached approximately half (45%) when three symptoms were present. These results suggested that COVID-19 prediction by combinations of simple symptoms and close contact with COVID-19-infected patients might be useful and lead to recommendations for testing of COVID-19 in symptomatic individuals.

Relationship of Viral Load with the Laboratory Markers and Prognosis in COVID-19 Patients.

Coronavirus disease 2019 (COVID-19) viral load determined from the cycle threshold (CT) values may be a marker of disease severity and predict disease progression. Our study aimed to investigate the relationship between SARS-CoV-19 cycle thresholds or viral load, laboratory markers, and patient prognosis. Patients who were admitted to Imam Reza Hospital at Mashhad University of Medical Sciences between March 2020 and March 2021 and had COVID-19 polymerase chain reaction (PCR)-confirmed at random were included in this cross-sectional study. Patients were randomly selected from those who tested positive on nasopharyngeal and oropharyngeal reverse transcription-PCR samples. The inclusion criteria were all patients older than 16 years with positive COVID-19 PCR results. Samples with Ct values of ≤36 were considered positive for SARS-CoV-2 RNA. Patients who did not have laboratory markers were excluded. We used SPSS Version 16 (Pearson correlation, analysis of variance, and logistic regression tests) to analyze the data. A P ≤ 0.05 was considered statistically significant. In our study, serum lactate dehydrogenase and aspartate aminotransferase were found to be laboratory biomarkers inversely correlated with COVID-19 Ct values, indicating higher viral load (r = -0.14; P = 0.024 and r = -0.12; P = 0.053, respectively). Also, the platelet count is lower in patients with higher viral loads (r = 0.18; P < 0.001). However, we found no correlation between the viral load and some laboratory biomarkers such as ferritin, white blood cell and lymphocyte count, alanine transaminase, and c-reactive protein (P > 0.05). The patient's length of hospital stay was not correlated with their viral load (P > 0.05). The COVID-19 viral load has been linked to some laboratory indicators and may be used to predict patient death. These discoveries might help in the treatment of COVID-19 disease.

Are Gastrointestinal Symptoms Important in Patients with COVID-19?

Our study aimed to present the general characteristics of patients in our country with coronavirus disease 2019 (COVID-19) having gastrointestinal system symptoms and the effects of gastrointestinal system symptoms on prognosis in the light of literature. This retrospective single-center study included patients who tested positive for COVID-19 in polymerase chain reaction test and were treated as symptomatic inpatients between April 1, 2020, and May 15, 2020, at the Bursa City Hospital in Turkey. In our study, 292 patients with positive COVID-19 polymerase chain reaction test and symptoms were included to investigate the effect of gastrointestinal system symptoms in COVID-19 patients. Patients with at least 1 gastrointestinal system symptom were named group 1, and patients with no gastrointestinal system symptoms were named group 2. Compared with group 1 (145 patients), group 2 (147 patients) had patients with significantly older age (P = .010) and significantly higher rates of intensive care unit admission (P = .023), intubation (P = .021), and exitus (P = .004). The white blood cell count (P = .001) and C-reactive protein (P = .001) values were significantly higher in group 2 than in group 1. COVID-19 is primarily a disease with respiratory symptoms, but gastrointestinal system symptoms are also seen. In our study, we found that patients with gastrointestinal system symptoms had a better prognosis. The reason for this may be the early hospitalization of the patients due to gastrointestinal system symptoms and the early initiation of treatment. However, comprehensive studies are still needed to elucidate this further.

A hybrid deep learning approach for COVID-19 detection based on genomic image processing techniques

The coronavirus disease 2019 (COVID-19) pandemic has been spreading quickly, threatening the public health system. Consequently, positive COVID-19 cases must be rapidly detected and treated. Automatic detection systems are essential for controlling the COVID-19 pandemic. Molecular techniques and medical imaging scans are among the most effective approaches for detecting COVID-19. Although these approaches are crucial for controlling the COVID-19 pandemic, they have certain limitations. This study proposes an effective hybrid approach based on genomic image processing (GIP) techniques to rapidly detect COVID-19 while avoiding the limitations of traditional detection techniques, using whole and partial genome sequences of human coronavirus (HCoV) diseases. In this work, the GIP techniques convert the genome sequences of HCoVs into genomic grayscale images using a genomic image mapping technique known as the frequency chaos game representation. Then, the pre-trained convolution neural network, AlexNet, is used to extract deep features from these images using the last convolution (conv5) and second fully-connected (fc7) layers. The most significant features were obtained by removing the redundant ones using the ReliefF and least absolute shrinkage and selection operator (LASSO) algorithms. These features are then passed to two classifiers: decision trees and k-nearest neighbors (KNN). Results showed that extracting deep features from the fc7 layer, selecting the most significant features using the LASSO algorithm, and executing the classification process using the KNN classifier is the best hybrid approach. The proposed hybrid deep learning approach detected COVID-19, among other HCoV diseases, with 99.71% accuracy, 99.78% specificity, and 99.62% sensitivity.

A Single Center Review of COVID-19 Testing and Vaccination in the Transgender and Nonbinary Population.

Purpose: The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected transgender and nonbinary (TGNB) persons. We evaluated COVID-19 testing and vaccination rates among TGNB patients at our institution. Methods: We compared COVID-19 testing and vaccination rates between TGNB patients and a cisgender population matched by age, race, and ethnicity. Data were collected through September 22, 2021. Demographic variables, testing rates, and vaccination rates were collected. Descriptive statistics were calculated, and regression was performed on outcomes of interest: any vaccination dose, at least one test, and at least one positive test. Gender modality was the exposure of interest. Results: There were 5050 patients: 1683 cisgender men, 1682 cisgender women, and 1685 TGNB individuals. TGNB patients were more likely to be on Medicaid/Medicare and more likely to be single. The number of patients with at least one test was similar between TGNB (n = 894, 53.1%) and cisgender (n = 1853, 55.1%) groups. The number of patients who had at least one positive test was higher among cisgender patients (n = 238, 7.1%) compared with TGNB patients (n = 73, 4.3%). Vaccination rates were significantly greater among TGNB patients. Compared with cisgender patients, TGNB patients had greater odds of vaccination (adjusted odds ratio [aOR] = 1.25 [95% confidence interval; CI 1.06-1.48]). Compared with cisgender patients, TGNB patients had lower odds of having at least one positive COVID-19 test (aOR = 0.51 [95% CI 0.36-0.72]). Conclusion: Our institutional experience found that vaccination rates for TGNB patients were higher and COVID-19 positivity lower than for cisgender patients.

Effects of COVID-19 on Retinal and Choroidal Thickness by Optical Coherence Tomography.

The aim of our study was to evaluate the subclinical changes in the macula, retinal nerve fiber layer (RNFL), and choroidal thickness after coronavirus disease 2019 (COVID-19) infection using spectral domain optical coherence tomography. Our study was prospectively designed and involved 170 eyes of 85 patients. Patients with polymerase chain reaction (PCR)-positive COVID-19 infection were examined in the ophthalmology clinic before and after infection were included. All included patients had mild COVID-19 with no hospitalization and no need for intubation. Control ophthalmic examination was repeated at least 6 months after PCR positivity. Macular and choroidal thickness and RNFL parameters were compared before and at least 6 months after PCR-positive COVID-19 infection using optical coherence tomography. When the mean macular thickness data were evaluated, a significant decrease was detected in the inner (mean difference, -3.37 µm; 95% CI: -6.09 to -0.65, P = 0.021) and outer (mean difference, -6.56 µm; 95% CI: -9.26 to -3.86, P < 0.001) temporal segments and the inner (mean difference, -3.39 µm; 95% CI: -5.46 to -1.32, P = 0.002) and outer (mean difference, -2.01 µm; 95% CI, -3.70 to -0.31, P = 0.018) su p erior segments in the post-COVID-19 measurements compared with pre-COVID-19 measurements. Similarly, on RNFL evaluation, some thinning was evident in the temporal superior (mean = 1.14 µm, P = 0.004) and temporal inferior (mean = 1.30 µm, P = 0.032) regions. All choroidal regions, including central, nasal 500 µm and 1500 µm and temporal 500 µm and 1500 µm, exhibited significant thinning ( P < 0.001). At least 6 months after mild COVID-19 infection, significant thinning was seen in the temporal and superior quadrants of the macula, the temporal superior and temporal inferior regions of the RNFL, and all measured areas of choroidal regions.

The trend of paediatric cases during the first year of the COVID-19 pandemic in North Sumatra, Indonesia

ObjectiveThe aim of the study was to describe the epidemiology of coronavirus disease 2019 (COVID-19) cases in children in North Sumatra Province during the period June 2020 to July 2021. MethodsThis study included samples from children in North Sumatra Province aged 0–17 years, suspected to have COVID-19. A case of COVID-19 was confirmed by RT-PCR in the Microbiology Laboratory, Faculty of Medicine, Universitas Sumatera Utara, Indonesia. Data were collected from June 2020 to July 2021. Demographic data including age, sex, and date of diagnosis were collected. A descriptive statistical analysis was performed, and ratios or percentages were compared. ResultsA total of 117 650 people were tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and 2222 (1.9%) children were positive. The age group 6-11 years had the highest proportion of cases with 679/2222 cases (30.6%). Overall, the number of positive COVID-19 cases peaked in July 2021, with 650 cases and a positivity rate of 3.0%. In 2020, the greatest proportion of cases occurred in the age group of 12–14 years; however, this changed to the age group 6-11 years in 2021. ConclusionsCOVID-19 was detected in all paediatric age groups in North Sumatra during the study period. Incidence peaks occurred due to mass gatherings, public holidays, and the introduction of a new variant in Indonesia. Children accounted for a much higher proportion of SARS-CoV-2 infection compared to those reported in other studies and could have played a role as the source of transmission in society.

The Survival Probability of Covid-19 Patients with Type 2 Diabetes Mellitus during Pandemic at Al Ihsan Hospital, West Java Province, Indonesia

BACKGROUND: The high prevalence of diabetes mellitus (DM) in the population causes DM to become one of the most common comorbidities of coronavirus disease 2019 (COVID-19). Patients with diabetes have a higher risk of experiencing serious complications from COVID-19 and even death. AIM: This study was aimed to determine the difference in survival probability of COVID-19 patients, based on their DM status and to determine the association between type 2 DM and COVID-19 mortality at Al Ihsan Hospital, West Java Province, Indonesia. METHODS: The population of this retrospective cohort study were COVID-19 patients, aged ≥18 years and were treated at Al Ihsan Hospital, from March 2020 to December 31, 2021. Differences in survival probability were obtained from survival analysis with Kaplan–Meier. Cox Proportional Hazard regression was used to determine the association between type 2 DM and COVID-19 mortality. RESULTS: Totally, 308 confirmed positive COVID-19 patients were recruited in this study. During the 21 days of observation, survival probability of COVID-19 patients with type 2 DM was significantly lower than those without type 2 DM (71.24% vs. 84.13% respectively, with p = 0.0056). There was a statistically significant association between type 2 DM and COVID-19 mortality after controlling for age, cough symptoms, acute respiratory distress syndrome, vaccination, chronic kidney disease, ventilator use, antiviral therapy, and the percentage of bed occupation rate COVID-19 isolation at admission. The adjusted hazard ratio showing association between type 2 DM and COVID-19 mortality in the final model of multivariate analysis was 2.68 (95% CI 1.24–5.73). CONCLUSIONS: The survival probability of COVID-19 patients with type 2 DM was significantly lower than those without type 2 DM. COVID-19 patients with DM in Al Ihsan Hospital were almost 3 times more likely to be fatal as compared COVID-19 patients without DM.

Limitation of Interpreting a Single COVID Cycle Threshold Value

Abstract The United States reported its first case of coronavirus disease 2019 (COVID-19) in January 2020. There was limited testing capacity at the time, and the causative agent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was indeed extremely infectious. Testing, therefore, has become a vital part of controlling the COVID-19 pandemic. Nucleic acid amplification tests, such as polymerase chain reaction platform, a value called cycle threshold (Ct) is reported. This number represents the number of polymerase chain reaction test cycles it takes for the sample to become positive. It is inversely proportional to the amount of viral RNA present in the sample. Therefore, a high Ct value infers a low quantity of viral RNA, and conversely, a low Ct value implies high viral RNA, which in turn correlates with infectivity. When interpreted appropriately with the right clinical context, it could be used to assess the infectiousness of an individual. In September 2021, a 73-year-old man who previously completed a primary series of Moderna vaccine (2 injections) presented to the hospital with chest pain. Cardiac catheterization showed multivessel coronary artery disease and was deemed to have unstable angina. The plan was to undergo coronary aortic bypass graft surgery. Preoperative routine testing revealed a positive COVID-19 polymerase chain reaction test with a high Ct value. During the hospital stay, it was shown that he had a decreased Ct value and thus was determined to have an acute case of asymptomatic COVID-19 infection. His surgery was delayed according to the isolation protocol per Centers for Disease Control and Prevention for safety precautions. He eventually underwent coronary aortic bypass graft after completion of isolation and had an uneventful postoperative course. It was also documented that he had serological seroconversion consistent with acute COVID-19 infection. This case illustrates that reporting Ct values is useful in a certain clinical context, but clinicians need to be familiar with the transmissibility and history of SARS-CoV-2 infection as well as understanding the interpretation of positive tests. The appropriate clinical approach and management should be assessed based on exposure history, epidemiology, physical examination, radiographic assessment, and laboratory studies.

Frontal QRS-T angle in patients with the suspicion of Coronavirus disease 2019 (COVID-19): could it be used as a predictive gravity sign even before the diagnosis by PCR?

Coronavirus disease 2019 (COVID-19) has been an ongoing global public health concern, causing serious challenges in diagnosing the disease timely. We investigated the value of the frontal QRS-T (fQRS-T) angle in patients visiting the emergency department with the suspicion of COVID-19. A hundred and thirty-seven patients with the complaint of dyspnea were evaluated retrospectively. The patients with a history of coronary artery disease, heart failure, pulmonary disease, hypertension, diabetes mellitus, or using any medication such as heart rate controllers or antiarrhythmic drugs were excluded from the study. The angle between frontal QRS- and T-wave axis was defined as the fQRS-T angle, and the patients were divided into two groups based on the fQRS-T angle (group 1, <90° and group 2, ≥90°). Demographic, clinical, electrocardiographic data and rRT-PCR results were compared between the groups. The mean value of the fQRS-T angle of all participants was 45.26°. There was no significant difference between the groups according to the demographic and clinical data. Subjects with wider fQRS-T angle (group 2) had higher heart rates (p = 0.018), higher corrected QT values (p = 0.017), and higher QRS axis (p = 0.001). The patients in group 2 had a higher number of positive COVID-19 rRT-PCR test results compared to subjects with the normal fQRS-T angle (p = 0.002). In multivariate regression analysis, fQRS-T angle (p = 0.027, OR: 1.013, 95% CI: 1.001-1.024) was found as an independent variable affecting the PCR test results. Prompt diagnosis, initiating preventive and protective measures in an early stage of COVID-19 are crucial. In suspected COVID-19 infection, the use of faster-resulting tests and diagnostic tools for COVID-19 allows patients to be diagnosed and treated in a timely manner for recovery, thereby optimizing patient management. Therefore, the fQRS-T angle can be used in patients with dyspnea as a part of diagnostic scores of COVID-19, even before the rRT-PCR test results and overt disease.

A Nurses' Guide for Egyptian Women Regarding Female Sexual Function During COVID-19 Pandemic: A Quasi-Experimental Study.

The pandemic of coronavirus disease 2019 (COVID-19) is still affecting individuals all over the world. Restrictions resulting from lifestyle changes have been demonstrated to cause mental and sexual health issues. This research was performed to assess the effect of the COVID-19 pandemic on female sexual function in Egypt and also to assess the knowledge and information for those with sexual dysfunction before and after the administration of nursing guidelines. A quasi-experimental research design was carried out for women diagnosed with positive COVID-19 at Isolation Hospital in Heart and Chest Hospital-Zagazig University. The study comprised a purposive sample of 496 women who were active COVID-19 patients. A structured interviewing form and a female sexual function index would be utilized to collect data. The nursing guidelines were designed by the researcher and given to women with positive COVID-19 after assessment of their knowledge and information concerning sexual health during this pandemic. According to the findings of this study, the incidence of normal sexual function and sexual dysfunction was 62.7% and 37.3%, respectively. Nearly half of the participating women (46.7%) were 25-34 years of age. 63.7% of them were residing in rural areas. Before guidelines administration: poor knowledge (23.5%), fair knowledge (68.4%), and good knowledge (8.1%); and after intervention: poor knowledge (0.0%), fair knowledge (29.4%), and good knowledge (70.6%) were recorded. Women with sexual dysfunction had statistically higher accurate information following the administration of nursing guidelines regarding sexual function.

Cutaneous Manifestations Associated with COVID-19 Infection in a COVID-Designated Hospital in North Chennai - A Descriptive Cross-Sectional Study.

Coronavirus disease 2019 (COVID-19) affects different organ systems, including the skin. There are reports on cutaneous manifestations of COVID-19 available in the literature. In this study, we have tried to describe the dermatological signs of COVID-19 in different categories of patients. A descriptive cross sectional study was conducted to describe various cutaneous manifestations of COVID-19 in different categories of reverse transcriptase polymerase chain reaction (RT-PCR)-positive COVID-19 patients in a COVID-designated tertiary care hospital. Approval was obtained from the Institutional Ethical Committee, and 5460 RT-PCR-confirmed COVID-19-positive patients were included under five categories. Investigators following a strict COVID protocol examined and documented the findings. Investigations and treatment were carried out as per the protocol, and the study was conducted for a period of 6 months. Out of the 5460 patients studied, 1.9% patients had cutaneous manifestations. Vasculitis (24%) and maculo papular rash (19%) were the common findings. The incidence of vasculitis was 44.4%, 61%, and 6.6% in categories A, B, and C, respectively. Maculopapular rash and urticaria were the common findings in categories D and E, respectively. COVID digit was seen in only one case. Other manifestations such as acne, adverse drug reaction, erythroderma, and bullous disorders were also noted. Cutaneous manifestations because of vascular pathology were the most common association in severe COVID-19, which indicates that the presence of vasculitic skin signs correlated with disease severity and elevated d-dimer values. Urticaria and maculo-papular rash were transient and did not give any clue to the diagnosis or severity of the disease.