Coronavirus Disease 2019 Polymerase Chain Reaction Research Articles

Comparison of clinical characteristics and disease burden of febrile seizures in children with and without COVID-19

BackgroundFebrile seizures (FS) are the most common seizure disorder in children and a common neurologic complication in children with coronavirus disease 2019 (COVID-19). This study aimed to identify differences in clinical characteristics and disease burden between FS with and without COVID-19.Materials and methodsWe conducted a retrospective analysis of medical data at our hospital from December 2019 to July 2023, focusing on hospitalized patients under the age of 14 diagnosed with FS who underwent COVID-19 polymerase chain reaction (PCR) testing. Descriptive statistics and analysis of variance were employed to compare the COVID-19 and non-COVID-19 groups in terms of clinical characteristics and disease burden.ResultsA total of 514 patients were included, with 106 testing positive for COVID-19 and 408 testing negative. Patients with COVID-19 were older (34.87 ± 6.16 vs. 28.61 ± 11.35 months, P < 0.001) and had a higher proportion of males (79.2% vs. 62.3%, P = 0.001). The COVID-19 group had longer seizure durations (4.57 ± 4.38 vs. 3.22 ± 2.91 min, P = 0.006) and more complex FS (25.5% vs. 15.9%, P = 0.022). Laboratory tests showed lower lymphocyte counts in the COVID-19 group (1.87 ± 1.48 vs. 2.75 ± 1.51 × 103/µL, P < 0.001) and higher creatine kinase levels (158.49 ± 82.89 vs. 110.89 ± 56.11 U/L, P < 0.001). No significant differences were found in hospital costs, length of hospitalization, and intensive care unit admissions.ConclusionClinicians should be knowledgeable about the distinct clinical characteristics of FS in children with COVID-19. Despite distinct features, the prognosis remains favorable and does not require excessive intervention. Ongoing monitoring and research are needed to fully understand the impact of COVID-19 on FS and optimize management strategies.

Sociodemographic characteristics and COVID-19 testing rates: spatiotemporal patterns and impact of test accessibility in Sweden.

Diagnostic testing is essential for disease surveillance and test-trace-isolate efforts. We aimed to investigate if residential area sociodemographic characteristics and test accessibility were associated with Coronavirus Disease 2019 (COVID-19) testing rates. We included 426 224 patient-initiated COVID-19 polymerase chain reaction tests from Uppsala County in Sweden from 24 June 2020 to 9 February 2022. Using Poisson regression analyses, we investigated if postal code area Care Need Index (CNI; median 1.0, IQR 0.8-1.4), a composite measure of sociodemographic factors used in Sweden to allocate primary healthcare resources, was associated with COVID-19 daily testing rates after adjustments for community transmission. We assessed if the distance to testing station influenced testing, and performed a difference-in-difference-analysis of a new testing station targeting a disadvantaged neighbourhood. We observed that CNI, i.e. primary healthcare need, was negatively associated with COVID-19 testing rates in inhabitants 5-69 years. More pronounced differences were noted across younger age groups and in Uppsala City, with test rate ratios in children (5-14 years) ranging from 0.56 (95% CI 0.47-0.67) to 0.87 (95% CI 0.80-0.93) across three pandemic waves. Longer distance to the nearest testing station was linked to lower testing rates, e.g. every additional 10 km was associated with a 10-18% decrease in inhabitants 15-29 years in Uppsala County. The opening of the targeted testing station was associated with increased testing, including twice as high testing rates in individuals aged 70-105, supporting an intervention effect. Ensuring accessible testing across all residential areas constitutes a promising tool to decrease inequalities in testing.

Factors in Vaccine Refusal by Patients Applying for COVID-19 PCR Test.

This study was designed to determine the reasons for vaccine rejection in patients who applied for the coronavirus disease-2019 (COVID-19) polymerase chain reaction (PCR) test but did not receive the vaccine. The study was conducted prospectively in the emergency department of a tertiary hospital between 31.01.2022 and 31.05.2022. 1000 patients who applied for the COVID-19 PCR test and refused to be vaccinated were included. The COVID-19 status of the participants, reasons for their application, number of PCR tests, methods of obtaining information about the vaccine, and reasons for the rejection of the vaccine were questioned. 54.6% of the participants were male and 45.4% were female. 60.7% of the patients applied for testing due to symptoms, 25.4% due to contact with people with symptoms, and 23.9% due to travel. 43.3% of the cases had COVID-19 infection; 53.6% of them had tested an average of 2-5 times in the last year. Most of the information about the vaccine was taken from social media, television, medical publications, and people around, respectively. Of the participants, 62.0% believed that COVID-19 vaccines had side effects, 47.3% believed that it had no protection, and 30.9% believed that there was not enough study on the subject. As the age grew, the rate of learning information from social media increased. The most common reasons for COVID-19 vaccine rejection were vaccine side effects, doubtful vaccine protection, and concerns about the lack of sufficient studies on the vaccine. The higher the education level, the higher the vaccine rejection rate.

Association of carbon monoxide poisonings and carboxyhemoglobin levels with COVID-19 and clinical severity.

Coronavirus disease 2019 (COVID-19), which recently spread throughout the entire world, is still a significant health issue. Additionally, the most common cause of risky poisoning in emergency services is carbon monoxide (CO) poisoning. Both disorders seem to merit more research as they have an impact on all bodily systems via the lungs. To determine how arterial blood gas and carboxyhemoglobin (COHb) levels affect the clinical and prognostic results of individuals requiring emergency treatment who have both COVID-19 and CO poisoning. Between January 2018 and December 2021, 479 CO-poisoning patients participated in this single-center, retrospective study. Patients were primarily divided into two groups for analysis: Pre-pandemic and pandemic periods. Additionally, the pandemic era was divided into categories based on the presence of COVID-19 and, if present, the clinical severity of the infection. The hospital information system was used to extract patient demographic, clinical, arterial blood gas, COVID-19 polymerase chain reaction, and other laboratory data. The mean age of the 479 patients was 54.93 ± 11.51 years, and 187 (39%) were female. 226 (47%) patients were in the pandemic group and 143 (30%) of them had a history of COVID-19. While the mean potential of hydrogen (pH) in arterial blood gas of all patients was 7.28 ± 0.15, it was 7.35 ± 0.10 in the pre-pandemic group and 7.05 ± 0.16 in the severe group during the pandemic period (P < 0.001). COHb was 23.98 ± 4.19% in the outpatients and 45.26% ± 3.19% in the mortality group (P < 0.001). Partial arterial oxygen pressure (PaO2) was 89.63 ± 7.62 mmHg in the pre-pandemic group, and 79.50 ± 7.18 mmHg in the severe group during the pandemic period (P < 0.001). Despite the fact that mortality occurred in 35 (7%) of all cases, pandemic cases accounted for 30 of these deaths (85.7%) (P <0.001). The association between COHb, troponin, lactate, partial arterial pressure of carbon dioxide, HCO3, calcium, glucose, age, pH, PaO2, potassium, sodium, and base excess levels in the pre-pandemic and pandemic groups was statistically significant in univariate linear analysis. Air exchange barrier disruption caused by COVID-19 may have pulmonary consequences. In patients with a history of pandemic COVID-19, clinical results and survival are considerably unfavorable in cases of CO poisoning.

To PCR or not? The impact of shifting policy from PCR to rapid antigen tests to diagnose COVID-19 during the omicron epidemic: a nationwide surveillance study.

Coronavirus disease 2019 (COVID-19) had caused huge impacts worldwide. Polymerase chain reaction (PCR) is the mainstay diagnostic modality. In most hospitals in Taiwan, samples for PCR are collected at emergency department (ER) or outdoor clinics to avoid virus spread inside hospitals. Home rapid antigen test (RAT) is a feasible, low-cost, and convenient tool with moderate sensitivity and high specificity, which can be performed at home to reduce hospital visits. Due to comparably low severity of omicron variant and high vaccine coverage (~80% residents fully vaccinated with AstraZeneca, Moderna, or Pfizer BioNTech COVID-19 vaccines as of March 2022), the policy was shifted from containment to co-existing with COVID-19 in Taiwan. Virus spread rapidly in the community after the ease of social restrictive measurements. To acquire a confirmed diagnosis, PCR testing was requested for people with suspected COVID-19 infection. As a consequence, people with respiratory symptoms or contact history surged into hospitals for PCR testing, thus, the medical capacity was challenged. The diagnostic policy was altered from PCR to RAT, but the impact of diagnostic policy change remains unclear. We conducted this study to investigate the number of COVID-19 cases, PCR testing, hospitalizations, mortalities, and hospital visits during the epidemic and evaluate the impact of diagnostic policy change on hospital visits. The diagnostic policy change was implemented in late May 2022. We used nationwide and hospital-based data of COVID-19 cases, PCR testing, hospitalizations, mortalities, and hospital visits before and after policy change as of 31 Jul 2022. During the omicron epidemic, significant and synchronous increase of COVID-19 patients, PCR testing, hospital visits were observed. COVID-19 cases increased exponentially since April 2022 and the COVID-19 patients peaked in June (1,943, 55,571, and 61,511 average daily new cases in April, May, and June, respectively). The PCR testing peaked in May (85,788 daily tests) with high positive rate (81%). The policy of RAT as confirmatory diagnosis was implemented on 26 May 2022 and a substantial decline of PCR testing numbers occurred (85,788 and 83,113 daily tests in May and June). People hospitalized for COVID-19 peaked in June (821.8 patients per day) and decreased in July (549.5 patients). The mortality cases also peaked in June (147 cases/day). This trend was also validated by the hospital-based data with a significant decrease of emergency department visits (11,397 visits in May while 8,126 visits in June) and PCR testing (21,314 in May and 6,158 in June). The proportion of people purely for PCR testing also decreased (10-26 vs. 5-14%, before and after policy change, respectively). The impact of diagnostic policy change was a complicated issue and our study demonstrated the huge impact of diagnostic policy on health seeking behavior. The PCR testing numbers and emergency department visits had substantial decrease after diagnostic policy change, and the plateau of epidemic peak eased gradually in ~1 month later. Widespread RAT application may contribute to the decreased hospital visits and preserve medical capacity. Our study provides some evidences for policy maker's reference.

Anxiety in hospitalised families: lessons from the early phase of the COVID-19 pandemic.

In the early phase of the coronavirus disease 2019 (COVID-19) pandemic, children with COVID-19 in Singapore required hospital isolation. We aimed to explore the psychological experiences of children and their caregivers isolated in a tertiary university hospital due to COVID-19. A prospective mixed-methods design was used to evaluate the psychological status of hospitalised family units with one or more children aged <18 years who had severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Patient medical records were reviewed for demographic and clinical information. Parents and children ≥7 years of age underwent a psychologist-administered telephone-based interview. Self-reported, age-appropriate instruments, Short Mood and Feelings Questionnaire, and Screen for Adult/Child Anxiety-Related Disorders, were used to assess anxiety and depression, respectively. Participants were also interviewed qualitatively. Fifteen family units were hospitalised between March 2020 and May 2020. Of these, 13 (73%) family units were recruited. The median age of the children and median hospitalisation duration were 57 months and 21 days, respectively. Median number of COVID-19 polymerase chain reaction swabs performed for each child was eight. All children had asymptomatic to mild SARS-CoV-2 disease. The criteria indicative of anxiety disorder were met by 40% of adults and 80% of children, while the criteria indicative of separation anxiety were met by 60% of parents and 100% of children. One child met the criteria indicative of depression. Uncertainty, separation, prolonged hospitalisation and frequent swabs caused significant reported anxiety. Families, especially children, had heightened anxiety while in hospital isolation. Therefore, home-based recovery from COVID-19 and psychological support for children and their families, with focus on early recognition of anxiety disorders, are recommended. We support review of paediatric isolation policy as the pandemic evolves.

Conduct of body donation and cadaveric dissection training during the COVID-19 pandemic: challenges, impacts and mitigation.

The new coronavirus disease 2019 (COVID-19) has had a substantial impact on the Silent Mentor Programme (SMP), a programme in which members of the public may pledge their bodies to be used for medical training and research after their death. This study aimed to explore the conduct of body donations and simulation surgery training during the COVID-19 pandemic from the viewpoints of the committee members of the SMP and the next-of-kin of body donor pledgers. This study utilised a qualitative exploration method to seek an in-depth understanding of this phenomenon. In-depth individual interviews were carried out. Thematic analysiswas used to identify patterns of themes. The COVID-19 polymerase chain reaction (RT-PCR) test is compulsory before accepting a body donation, and this resulted in the turning down of several donations. Being a donor is the final wish of pledgers and this turning down led to a negative emotional remorseful feeling in the next-of-kin of pledgers. From the perspective of students, it is feared that the conduct of the programme, particularly the home visit session being held online, has impeded teaching of humanistic values, compassion, and empathy, which is the prime philosophy of the programme. Previous to the pandemic, the programme ceremonies were well-attended, denoting the utmost respect and recognition of the mentors; however, travel restrictions due to the pandemic limiting in-person attendance resulted in ceremonies becoming less impactful. Continuous postponements of cadaveric dissection training also resulted in students missing training opportunities, hence potentially impairing their professional practice and humanistic values in the medical profession. Counselling interventions should be directed at easing the negative psychologicalimpacton the next-of-kin of pledgers. As the COVID-19 pandemic may pose a significant impediment to achieving the educational outcomes of cadaveric dissection training, efforts to make up for these gaps are essential.

Hybrid Immunity Provides Protective Advantage Over Vaccination or Prior Remote Coronavirus Disease 2019 Alone.

The protective efficacy of prior coronavirus disease 2019 (COVID-19) with or without vaccination remains unknown. This study sought to understand if 2 or more messenger RNA (mRNA) vaccine doses provide additional protection in patients with prior infection, or if infection alone provides comparable protection. We conducted a retrospective cohort study of the risk of COVID-19 from 16 December 2020 through 15 March 2022, among vaccinated and unvaccinated patients of all ages with and without prior infection. A Simon-Makuch hazard plot illustrated the incidence of COVID-19 between groups. Multivariable Cox proportional hazards regression was used to examine the association of demographics, prior infection, and vaccination status with new infection. Among 101 941 individuals with at least 1 COVID-19 polymerase chain reaction test prior to 15 March 2022, 72 361 (71.0%) received mRNA vaccination and 5957 (5.8%) were previously infected. The cumulative incidence of COVID-19 was substantially higher throughout the study period for those previously uninfected and unvaccinated, and lowest for those previously infected and vaccinated. After accounting for age, sex, and the interaction between vaccination and prior infection, a reduction in reinfection risk was noted during the Omicron and pre-Omicron phases of 26% (95% confidence interval [CI], 8%-41%; P = .0065) to 36% (95% CI, 10%-54%; P = .0108), respectively, among previously infected and vaccinated individuals, compared to previously infected subjects without vaccination. Vaccination was associated with lower risk of COVID-19, including in those with prior infection. Vaccination should be encouraged for all including those with prior infection, especially as new variants emerge and variant-specific booster vaccines become available.

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.

An evaluation of the laboratory and clinical data of the Crimean-Congo hemorrhagic fever patients during the Covid-19 pandemic

In this study, the purpose was to investigate the demographic, laboratory, and clinical characteristics of the Crimean-Congo Hemorrhagic Fever (CCHF) cases that were treated in our hospital during the Coronavirus disease-2019 (COVID-19) pandemic. It was also investigated whether the patients hospitalized with a provisional diagnosis of CCHF who tested negative for CCHF PCR were infected with COVID-19. In our study, data (epidemiological, clinical, laboratory, prognosis) from 38 patients diagnosed with CCHF through reverse-transcriptase polymerase chain reaction (PCR) and viral-RNA and/or Immunoglobulin M antibodies using ELISA between May 2020 and November 2022 were investigated retrospectively. Of all the patients, 23 were CCHF PCR (+) and 15 were CCHF PCR (-).15 (65.2%) of PCR (+) patients and 9 (60%) of PCR (-) patients were engaged in farming. 65.2% of PCR (+) and 26.7% of PCR (-) patients presented with a history of tick bites. 21 (91.3%) of PCR (+) and 12 (80%) of PCR (-) patients had a history of rural living. Among the PCR (+) patients, 65.2%, 17.4%, and 17.4% received treatment for CCHF in 2022, 2021, and 2020 respectively. 87% of PCR (+) and 60% of PCR (-) patients were discharged after full recovery. The most common symptoms were fever, diffuse body ache, weakness, and headache. Significant differences were found between PCR (+) and PCR (-) patients in terms of leukocytes, LDH, INR, NEU, PLT, fibrinogen, and NLR values. 3 patients hospitalized with a provisional diagnosis of CCHF tested negative for CCHF PCR and positive for COVID-19 PCR. Thoracic CT, clinical, and laboratory findings of these patients showed no differences from the other patients. The possibility of misdiagnosis should be considered in CCHF and COVID-19 infections due to their similar symptoms and indications. Extensive multicentric studies need to be conducted to investigate the causes of the increased number of CCHF cases during the pandemic.

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.

Fetal Diaphragmatic Excursion Is Decreased in Hospitalized Pregnant Women Infected with COVID-19 during the Second and Third Trimesters.

In the present study, we aimed to evaluate coronavirus disease 2019 (COVID-19) infection effects on fetal diaphragm thickness and diaphragmatic excursion, which together show the quality of diaphragmatic contractions. One hundred and ninety-two pregnant women were included in this prospective case-control study. Patients were divided into four groups according to their COVID-19 infection history in their second or third trimester: hospitalized COVID-19-infected pregnant women group (n = 48), outpatient COVID-19-infected pregnant women group (n = 48), common cold (COVID-19 polymerase chain reaction negative) pregnant women group (n = 48), and noninfected healthy controls (n = 48). The number of patients was determined by power analysis following the pilot study. All participants underwent an ultrasound examination to determine fetal diaphragm parameters at 32 to 37 weeks of gestation. Demographic characteristics were similar among the four groups. The gestational age at ultrasound examination and gestational age at delivery were similar among the groups. Neonatal intensive care unit (NICU) admission rate was significantly higher in the hospitalized COVID-19-infected pregnant women group than the other groups. The fetal diaphragm thickness during inspiration and expiration, and fetal costophrenic angles at inspiration and expiration were similar among the groups. Fetal diaphragmatic excursion was significantly decreased in the hospitalized COVID-19-infected pregnant women group compared with the other groups. Our results indicated that moderate maternal COVID-19 infection decreased fetal diaphragmatic excursion, and ultrasonographic evaluation of fetal diaphragmatic excursion before delivery can provide critical information to predict whether infants will require NICU admission. · Diaphragm ultrasound as a new technique for characterizing the diaphragm's structure and function.. · Fetal diaphragmatic excursion is decreased in the presence of moderate COVID-19 infection.. · Ultrasonographic evaluation of fetal diaphragmatic excursion provides critical information to predict NICU admission..

The Effect of COVID-19 Pandemic on Foreign Body Aspiration.

This article evaluates the effect of coronavirus disease 2019 (COVID-19) pandemic on clinical course and management of cases that underwent bronchoscopy for suspected foreign body aspiration (FBA) in children. The patients who underwent bronchoscopy with a presumptive diagnosis of FBA between July 2018 and December 2021 were evaluated for demographic features, clinical findings, management details, and outcomes. Patients were divided in two groups: before pandemic (group A) and during pandemic (group B). In total 79 cases with a median age of 5 years (4-5) in group A (n = 47) and 3 years (2-3) in group B (n = 32) were included (p < 0.05). The witnessed aspiration was significantly higher in group B (90.6%) when compared to group A (53%) (p < 0.05). Admission time was less than 48 hours in 30 cases (64%) in group A and 23 cases (72%) in group B (p = 0.002). The intervention time was less than 24 hours in 30 cases (64%) in group A, 9 cases (28%) in group B (p = 0.002). Bronchoscopy was performed after COVID-19 polymerase chain reaction (PCR) testing in all cases in group B. The positive FBA rate was 38% (n = 18) in group A, and 59% (n = 19) in group B (p = 0.067). During pandemics, bronchoscopy for FBA was performed in younger infants than before pandemic and witnessed aspiration was significantly more common in that period. The differences in age groups and symptoms may be explained by spending more time at home during pandemics. Waiting for the PCR test results causes delays in the intervention. However, this delay did not cause any respiratory distress.

Reactivation of Tuberculosis and COVID-19 in Pediatric Patients

Abstract Objective Mycobacterium tuberculosis is an immobile aerobic bacillus that causes tuberculosis (TB) disease. We aimed to evaluate the association between coronavirus disease 2019 (COVID-19), COVID-19-related drugs, TB reactivation, and TB incidence during the pandemic. Methods Eight patients who were diagnosed as having TB in Meram Medical Faculty, Necmettin Erbakan University between March 1, 2020, and December 31, 2021, at the beginning of the pandemic, were enrolled in this study. The presence of COVID-19 infection was confirmed using COVID-19 antibody tests and the patients' COVID-19 history. We evaluated the demographic data, laboratory findings, imaging tests, and pathology results of all patients. Results We checked all our patients with TB using COVID-19 antibodies (immunoglobulin [Ig]G + IgM) or polymerase chain reaction. Seven of the eight patients were female (87.5%). The median age was 16 years. Family screening of all patients was negative, and they had bacillus Calmette–Guérin vaccine scars. Two patients had chronic diseases. One was diagnosed as having primary ciliary dyskinesia in our department (patient no. 8) and the second was under follow-up by the rheumatology department with a diagnosis of juvenile idiopathic rheumatoid arthritis. Conclusion There has been an increase in the incidence of TB in children, especially in adolescents, during the pandemic period. This may be due to the pathogenic structure of the COVID-19 virus with an unknown mechanism. In addition, lifestyle changes and changes in health care policies during the pandemic may have caused this. Further research should be performed on this topic.

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.

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.

Strong Association between Vitamin D Receptor Gene and Severe Acute Respiratory Syndrome coronavirus 2 Infectious Variants.

A coronavirus disease 2019 (COVID-19) disease, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has created significant concern since December 2019 worldwide. The virus is known to be highly transmissible. Heterogenic clinical features even vary more among SARS-CoV-2 variants from asymptomatic forms to severe symptoms. Previous studies revealed an association between COVID-19 and vitamin D deficiency resulting from its low levels in COVID-19 patients. To our knowledge, there is no scientific investigation that evaluates the direct association between SARS-CoV-2 variants of concern and vitamin D receptor ( VDR ) gene markers in Cyprus. Thus, the present study aimed to identify the putative impact of VDR gene polymorphisms on SARS-CoV-2 infection among different variants. The nasopharyngeal swabs were taken from a total number of 600 patients who were admitted to Near East University Hospital COVID-19 Polymerase Chain Reaction (PCR) Diagnosis Laboratory for routine SARS-CoV-2 real-time quantitative reverse transcription PCR (RT-qPCR) test. The RT-qPCR negative resulting samples were taken as control samples ( n = 300). On the contrary, the case group consisted of patients who were SARS-CoV-2 RT-qPCR positive, infected with either SARS-CoV-2 Alpha ( n = 100), Delta ( n = 100), or Omicron ( n = 100) variants. Two VDR gene polymorphisms, Taq I-rs731236 T > C and Fok I-rs10735810 C > T, were genotyped by polymerase chain reaction-restriction fragment length polymorphism. The mean age of the COVID-19 patient's ± standard deviation was 46.12 ± 12.36 and 45.25 ± 12.71 years old for the control group ( p > 0.05). The gender distribution of the patient group was 48.3% female and 51.7% male and for the control group 43% female and 57% male ( p > 0.05). Significant differences were observed in genotype frequencies of FokI and TaqI variants between SARS-CoV-2 patients compared to the control group ( p < 0.005). Furthermore, the risk alleles, FokI T allele and TaqI C, were found to be statistically significant (odds ratio [OR] = 1.80, 95% confidence interval [CI] = 1.42-2.29, OR = 1.62, 95% CI = 1.27-2.05, respectively) in COVID-19 patients. The highest number of patients with wild-type genotype was found in the control group, which is 52.9% compared with 17.5% in the case group. Moreover, most of the COVID-19 patients had heterozygous/homozygous genotypes, reaching 82.5%, while 47.1% of the control group patients had heterozygous/homozygous genotypes. Our results suggested that patients with FokI and TaqI polymorphisms might tend to be more susceptible to getting infected with SARS-CoV-2. Overall, findings from this study provided evidence regarding vitamin D supplements recommendation in individuals with vitamin D deficiency/insufficiency in the peri- or post-COVID-19 pandemic.

Early Postoperative Pulmonary Edema Attributable to Reverse Stress-Induced Cardiomyopathy in a Recently Infected COVID-19 Patient: A Case Report

The coronavirus disease 2019 (COVID-19) pandemic has increased the incidence of stress-induced cardiomyopathy (SICMP). A 33-year-old woman without any notable medical history underwent an emergency operation to treat a ruptured ectopic pregnancy. She entered hemorrhagic shock attributable to massive bleeding of the ruptured ectopic sac, followed by rapid transfusion and hydration, and vasopressor therapy. Her COVID-19 rapid antigen test was negative before surgery. After surgery, her vital signs were stable and she was mentally alert. However, about 1 hour later, she developed pulmonary edema, was re-intubated, and was admitted to the intensive care unit. There, echocardiography revealed reverse SICMP, and a COVID-19 polymerase chain reaction test was positive. She recovered well on conservative treatment. After 9 days, her echocardiography profile was normal and she was discharged without any cardiac symptoms or complications. Anesthesiologists should be aware that COVID-19-infected patients may develop postoperative SICMP.

Long-term self-reported health and disability after COVID-19 in public employees

BackgroundAlthough the symptomatology has been assessed in multiple studies among persons recovering from coronavirus disease 2019 (COVID-19), less is known regarding long-term general health and disability. We aimed to assess long-term self-reported disability in public employees after predominantly mild COVID-19 in comparison with individuals who had negative COVID-19 polymerase chain reaction (PCR) test results.MethodsPublic employees within Region Västra Götaland were offered tests to identify SARS-CoV-2 infection (n = 56,221) and were invited to complete an online survey that included the World Health Organization Disability Assessment Schedule. Questionnaires were sent out between January 26 and March 5, 2021. A total of 14,222 (25.3%) employees responded, of which 10,194 (18%) were included (women n = 8749, 85.8%). Of these, 7185 (70.5%) participants had a negative PCR test result (controls). A total of 1425 (14%) had a positive PCR result and were categorized in the sub-acute phase (4–12 weeks post COVID-19), and 1584 (15.5%) had a positive PCR test and were categorized in the post COVID-19 phase (> 12 weeks).ResultsFifty-two percent of controls rated disability of varying degrees, versus 73% and 64% of participants in the sub-acute and post COVID-19 phase, respectively. Being “emotionally affected” was the most frequently reported disability in the sub-acute phase, the post COVID-19 phase, as well as in controls. The proportion of participants reporting difficulties for 20–30 days was higher in the sub-acute phase than in the post COVID-19 phase (27.9% vs. 21.8%, p < 0.001) as well as in a comparison between participants in the post COVID-19 phase and controls (21.8% vs 14.2%, p < 0.001). Compared with controls, severe disability was more common in the post COVID-19 phase among both women (15.8% vs. 10.7%,), and men (9.8% vs. 6.8%).ConclusionsDisability was present in all groups; however, reported disability was greater in the sub-acute phase than in the post COVID-19 phase. The higher levels of disability reported in the COVID-19 patient population may indicate a persisting need for rehabilitation and recovery. In general, women reported a greater degree of disability than men in the sub-acute and post COVID-19 phases.

Ethical Considerations Surrounding Employment Mandated Coronavirus Disease 2019 Vaccination and Allergy Skin Testing for the Coronavirus Disease 2019 Vaccine.

Ethical Considerations Surrounding Employment Mandated Coronavirus Disease 2019 Vaccination and Allergy Skin Testing for the Coronavirus Disease 2019 Vaccine.