Coronavirus Disease 2019 Positive Patients Research Articles

Evaluation of the Progress of Coronavirus Disease-19 Pneumonia using the British Society of Thoracic Imaging Reporting Model: A Validation Study

Abstract: Background: SARS-COV-2 (also known as severe acute respiratory syndrome corona virus-2), emerged as a pandemic and became an overwhelming global concern, causing substantial morbidity and mortality worldwide. Reverse transcription polymerase chain reaction (RT-PCR) is considered a gold standard in detecting clinically symptomatic patients but can have false negative and false positive results. As chest X-Ray (CXR) is considered as a baseline investigation in many hospitals, BSTI reporting model during COVID-19 pandemic has been a useful tool in diagnosis of COVID-19 pneumonia. Objective: To validate the British Society Thoracic Imaging (BSTI) coding system in the evaluation of the progress of the disease severity in patients with coronavirus disease-2019 (COVID-19) pneumonia. Materials and Methods: This is a cross sectional observational study. Total 450 CXRs (which included both the baseline and serial CXRs) of 225 COVID positive patients (RT-PCR positive for COVID-19 on nasal swabs) were included. These were retrospectively reviewed and reported by two Radiologists (having experience of at least 5 years in Radiology Reporting) in Corona Ward in Dr. Ruth K M Pfau Civil Hospital Karachi, Pakistan, for the duration of 10 months from 1st March 2020 till 31st December 2020. BSTI coding system was used to classify and interpret the CXR imaging findings as normal, definitive, indeterminate and non-COVID for baseline (CXR on 1st day of admission) and follow up CXRs (done in between 3rd and 7th day of admission). Data was analyzed using SPSS version 25. Numeric data was assessed for distribution using Shapiro-Wilks test. Median and interquartile range (IQR) were reported for numeric variables. Frequencies and percentages were reported for categorical data. Kappa statistics was applied to assess the agreement between BSTI scoring at baseline and follow-up CXRs. A p-value ≤0.05 was considered as statistically significant. Result: CXRs (including 225 baseline and 225 follow up CXRs) of 225 RT-PCR COVID-19 positive patients were analyzed. Interval change in BSTI coding system was noted, increase in frequency of probable/definitive COVID-19 findings were diagnosed on serial CXRs. The BSTI scoring at baseline and follow-up showed moderate agreement with kappa statistics as 60.3% (p=0.001). Conclusion: BSTI coding system can be helpful to classify the COVID-19 disease on CXR and filter for the prognosis of disease severity in the serial radiographs. Utilization of BSTI reporting model for reporting CXRs, even before RT-PCR, in future COVID pandemic can be considered as a useful tool.

The Effect of COVID-19 Pandemic on Acute Appendicitis Presentation

Background: Acute appendicitis is the most frequent emergency abdominal condition in general surgical practice. Appendectomy can be performed as open surgery or laparoscopically. Coronavirus disease 2019 (COVID-19), the highly contagious viral illness caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), differing in the diagnosis. Aim of the study: To analyze the impact of the COVID-19 pandemic on the time elapsed between onset of symptoms and diagnosis of Acute Appendicitis and the effect of this delay on disease progression. Methods: A prospective study was conducted in the Department of General Surgery at surgical ward in Baghdad Teaching Hospital during the period of one year from first of July 2020 till first of July 2021. A hundred patients were enrolled in this study. Results: This study included 100 patients complained from acute appendicitis, divided into two groups 52 of them were COVID-19 positive and 48 of them COVID-19 were negative patients. The mean time elapsed from onset of symptoms to surgical intervention was (73.44 hours) in COVID-19 positive patients versus mean (28.56 hours) in COVID-19 negative patients, and the results were statistically significant (p<0.0001). Total patients who presented with complicated appendicitis were (36), 26 of them were COVID-19 positive, of them 8 patients presented with perforation. Conclusion: The increase in complicated cases of acute appendicitis seems to be associated with the delay from time of symptoms onset to surgical intervention.

Clinicopathologic Features and Outcome of COVID-19 Patients Attended at a Secondary Hospital in Bangladesh during the Pandemic

Background: Coronavirus Disease 2019 (COVID-19) is an acute respiratory diseasethat can present varieties of clinical and pathologic manifestation. Sometimes it presentwith severe manifestation which ultimately lead to respiratory failure and death.COVID-19 patients with other comorbidities may develop a life-threatening situation.Objective: To describe the clinicopathologic features and outcome of COVID-19patients admitted in Combined Military Hospital (CMH) Rangpur, Bangladesh.Materials and method: This cross-sectional study was conducted at CMH Rangpur,Bangladesh, from 1 May 2021 to 30 August 2021 among purposively selected 416 casesof COVID-19 positive patients. Data were collected from the medical records of thehospital admitted patients in a structured case report form. Results: Highest numbers ofthe respondents were in the age group of 31-50 years (49.03%) with male predominance(72.28%). About 89% were Muslim and 54.81% were educated up to higher secondarylevel. Fever (90.86%) was the common presenting symptoms followed by cough(73.55%), sore throat (30.28%). About 24.51%, 23.07%, 11.05% had hypertension,diabetes mellitus and respiratory comorbidities respectively. Lymphopenia (75.24%)and elevated C-Reactive Protein (54.08%) were observed in most of the cases. Only8.17% patients had critical illness that needed intensive care unit admission. Majority(91.82%) fully recovered from the illness while 1.92% expired. Conclusions: The mostcommonly reported symptom was fever (90.86%) among all the COVID-19 positivepatients. Majority (62.25%) of the patients belonged to mild cases. Overall mortalitywas 1.92%. In most cases the clinical presentation is that of a respiratory infection withsymptom severity ranging from a mild influenza like illness.
 Delta Med Col J. Jan 2021;9(1):3-8

P1222 Gut microbiome differences regarding lifestyle and the history of COVID-19 infection in ulcerative colitis patients

Abstract Background The microbiome contributes to the pathogenesis of ulcerative colitis (UC) but the contribution of different lifestyle and environmental factors to the compositional variability of the gut microbiota is unclear. Also, it is known that microbiota plays an important role in infectious diseases like coronavirus disease 2019 (COVID-19). Methods In 6-month time (June 2021 to December 2021) 49 UC outpatients from Riga East Clinical University Hospital were included in a Cross-sectional study. All patients were divided into groups according to COVID-19 status (COVID-19posvs COVID-19neg) within 6 months. The effect of the lifestyle (smoking cigarettes, alcohol intake, sports activities, and high psychological stress level) and COVID-19 to the gut microbiota in patients with UC was investigated. For taxonomical classifying of the gut microbiome metagenome data, MetaPhlAn v.2.6.0 tool was used. In further analysis gut microbiome (mostly bacteria phyla) and related data was analysed with SPSS 20.0. Results Out of 49 patients, 31(63%) were male and 18(37%) were female, the mean age was Md=38 [IQR:34-51]. Fourteen patients (28.6%) have been COVID-19 pos and 35(71.4%) COVID-19 neg. There were no statistically significant differences between COVID-19 pos and COVID-19 neg patients and their microbiota, nor between COVID-19 pos symptomatic 12(24.5%) and asymptomatic 37(75.5%) patients and their gut microbiome. Out of 49, 24(49%) were doing sports, of those 18(51.4%) were COVD-19neg vs. 6 (42.9%) COVID-19pos, p=0.82. Evaluating differences in the gut microbiome regarding physical activities there was no statistical significance. Of 49 patients, 30(61.2%) have smoked before, while 19(38.8%) haven’t smoked. Medium smoking time was 8 years Md=8 [IQR:4.50-20.0]. Analysing gut microbiome in smokers/non-smokers, and the length of smoking, there were found no statistically significant differences. Thirty-five (71.4%) were using alcohol, and 14(28.6%) were not. Those who were using alcohol had statistically significantly more Firmicutes in their gut microbiome Md= 64.8[IQR:53.7-70.4] than no users Md=48[IQR:37.5-66.3], p=0.041. Regarding high stress levels, those who had less stress 18(36.7%), had more Actinobacteria in their gut microbiome Md=11.7[IQR:6.92-14.8] vs stressful patients 31(63.3%) Md=6.03[IQR:2.23-13.8], p=0.03. Conclusion There were no changes in gut microbiome in COVID-19 positive and COVID-19 negative patients, nor in smokers and no smokers. Alcohol users had more bacteria Firmicutes in their gut microbiome. There were no differences in gut microbiome in UC patients doing or lacking sports. UC patients with less stress had more Actinobacteria in their gut microbiome.

Identification and Speciation of Various Fungal Co-infections in COVID-19 Patients by Different Laboratory Diagnostic Methods: A Retrospective Observational Study

Introduction: Respiratory illness caused by a novel coronavirus was first noted in December 2019 in Wuhan, Hubei Province, China. Later, the novel coronavirus was referred to as Severe and critical Acute Respiratory Syndrome Coronavirus-2 (SARS- CoV-2) by the International Committee on Taxonomy of Viruses (ICTV). However, the types of co-infected pathogens and the proportion of co-infection in SARS-CoV-2-positive patients were unclear. Co-infection with certain pathogens may also hinder accurate disease diagnosis. Aim: To determine the most suitable sample type for a better culture outcome and to identify the various opportunistic fungal infections related to Coronavirus Disease 2019 (COVID-19) patients. Materials and Methods: This retrospective observational study was conducted between November 2021 to January 2022 at Department of Microbiology, Government Medical College, Surat, Gujarat, India. The data collection was done in the month of November 2021 followed by data analysis in December 2021 to January 2022. A total of 252 suspected cases of fungal co-infection were sampled (including swabs, tissues, skin scrapings, Cerebrospinal fluid (CSF), sputum, pus, and drain) from different wards for fungal wet mount Potassium Hydroxide (KOH) and culture. The data was entered into Microsoft Excel (Windows 10), and analysis was performed using Microsoft Excel, including frequency distribution and percentage. Results: A total of 252 samples were received. Demographic details showed that individuals aged 41-50 years were more commonly affected, and males were affected more than females. Among the sample types, tissue samples showed the highest positivity 43 (17%), followed by scraping materials 14 (6%). Out of the total 252 cultures performed, 70 were positive. In terms of fungal speciation, Mucor species accounted for 24 (34.28%) isolates, while Aspergillus flavus accounted for 26 (37.14%), followed by other isolated fungal species. Conclusion: Fungal co-infection is observed in COVID-19 positive patients, which not only contributes to morbidity but also increases mortality. Tissue samples demonstrated the highest culture positivity. The culture results showed a higher frequency of Mucor species isolates and Aspergillus flavus compared to other isolates.

A comparative study on COVID-19 disease severity and outcome among patients admitted before and after vaccination at tertiary care hospital.

Coronavirus disease 2019 (COVID-19) is a novel infectious disease caused by SARS CoV-2 that emerged in Wuhan, China, and has rapidly spread worldwide. The mortality rate of critically ill COVID-19 patients is high. The objective of the study was to assess the COVID-19 disease severity and outcome among COVID-19 positive patients admitted before and after vaccination. A prospective observational study conducted among all patients aged more than 18 years were included in the study. The patients who were positive before vaccination and received at least one dose of vaccine and positive after receiving two doses of vaccination included in the study. Disease severity was assessed in terms of high-resolution computed tomography (HRCT) score, intensive care unit (ICU) admission, SpO2 maintained, oxygen, plasma exchange, steroids received and on mechanical ventilation, and outcome was assessed on prognosis and stabilized/discharged to home. A total of 172 were participated in the study with 101 (58.7%) males and 71 (41.3) females, respectively. Amongst them, 92 were affected before vaccination and 80 were affected before vaccination. The patients admitted in the ICU were 56 (32.6%) and 116 (67.4%) were not admitted in the ICU; among the patient admitted in ICU 42 (45.7%) before vaccination, and 14 (17.5%) were after vaccination, and difference was statistically significant with P- value <0.001. SPO2, steroids given, plasma exchange, oxygen >10 litres given and mechanical ventilation were positively associated with the vaccine received and disease severity with P- value <0.05. The severe COVID-19 had the worst outcome in the unvaccinated patients in terms of severity. Most partially vaccinated patients got infected before developing immunity; receiving at least one vaccination dose significantly reduced illness severity.

A case-control autopsy series of liver pathology associated with novel coronavirus disease (COVID-19)

BackgroundAlthough severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) responsible for coronavirus disease 2019 (COVID-19) is most well-known for causing pulmonary injury, a significant proportion of patients experience hepatic dysfunction. The mechanism by which SARS-CoV2 causes liver injury is not fully understood. The goal of this study was to describe the hepatic pathology in a large cohort of deceased patients with COVID-19 as compared to a control group of deceased patients without COVID-19. MethodsConsented autopsy cases at two institutions were searched for documentation of COVID-19 as a contributing cause of death. A group of consecutive consented autopsy cases during the same period, negative for SARS-CoV-2 infection, was used as a control group. The autopsy report and electronic medical records were reviewed for relevant clinicopathologic information. H&E-stained liver sections from both groups were examined for pertinent histologic features. Select cases underwent immunohistochemical staining for CD 68 and ACE2 and droplet digital polymerase chain reaction (ddPCR) assay for evaluation of SARS-CoV2 RNA. Results48 COVID-19 positive patients (median age 73, M:F 3:1) and 40 COVID-19 negative control patients (median age 67.5, M:F 1.4:1) were included in the study. The COVID-19 positive group was significantly older and had a lower rate of alcoholism and malignancy, but there was no difference in other comorbidities. The COVID-19 positive group was more likely to have received steroids (75.6 % vs. 36.1 %, p < 0.001). Hepatic vascular changes were seen in a minority (10.6 %) of COVID-19 positive cases. When all patients were included, there were no significant histopathologic differences between groups, but when patients with chronic alcoholism were excluded, the COVID-19 positive group was significantly more likely to have steatosis (80.9 % vs. 50.0 %, p = 0.004) and lobular inflammation (45.7 % vs. 20.7 %, p = 0.03). Testing for viral RNA by ddPCR identified 2 of the 18 (11.1 %) COVID-19 positive cases to have SARS-CoV-2 RNA detected within the liver FFPE tissue. ConclusionsThe most significant findings in the liver of COVID-19 positive patients were mild lobular inflammation and steatosis. The high rate of steroid therapy in this population may be a possible source of steatosis. Hepatic vascular alterations were only identified in a minority of patients and did not appear to play a predominant role in COVID-19 mediated hepatic injury. Low incidence of SARS-CoV-2 RNA positivity in liver tissue in our cohort suggests hepatic injury in the setting of COVID-19 may be secondary in nature.

Transmissibility of severe acute respiratory syndrome coronavirus 2 among household contacts of coronavirus disease 2019-positive patients: A community-based study in India.

This study identified the risk factors for severe acute respiratory syndrome coronavirus 2 infection among household contacts of index patients and determined the incubation period (IP), serial interval, and estimates of secondary infection rate in Kerala, India. We conducted a cohort study in three districts of Kerala among the inhabitants of households of reverse transcriptase polymerase chain reaction-positive coronavirus disease 2019 patients between January and July 2021. About 147 index patients and 362 household contacts were followed up for 28 days to determine reverse transcriptase polymerase chain reaction positivity and the presence of total antibodies against SARS-CoV-2 on days 1, 7, 14, and 28. The mean IP, serial interval, and generation time were 1.6, 3, and 3.9days, respectively. The secondary infection rate at 14 days was 43.0%. According to multivariable regression analysis persons who worked outside the home were protected (adjusted odds ratio [aOR], 0.45; 95% confidence interval [CI], 0.24-0.85), whereas those who had kissed the coronavirus disease 2019-positive patients during illness were more than twice at risk of infection (aOR, 2.23; 95% CI, 1.01-5.2) than those who had not kissed the patients. Sharing a toilet with the index patient increased the risk by more than twice (aOR, 2.5; 95% CI, 1.42-4.64) than not sharing a toilet. However, the contacts who reported using masks (aOR, 2.5; 95% CI, 1.4-4.4) were at a higher risk of infection in household settings. Household settings have a high secondary infection rate and the changing transmissibility dynamics such as IP, serial interval should be considered in the prevention and control of SARS-CoV-2.

ASSESSMENT OF OPERATION THEATRE STAFF KNOWLEDGE, ATTITUDE, AND PRACTICES REGARDING THE PREPARATION OF COVID-19 POSITIVE PATIENTS FOR SURGICAL PROCEDURE: A CROSS-SECTIONAL SURVEY

Since its discovery in December 2019, coronavirus disease-2019 (COVID-19) has become an increasingly serious global health concern due to its sharp rise in cases and fatalities. Since occupational therapy staff members are the initial line of defence against the COVID-19 epidemic , having sufficient knowledge, practise, and attitudes (KPA) about the disease may improve their capacity to prevent self-infection, lower mortality, and deliver quality medical care during the pandemic. This study aimed to evaluate the OT staff at RMI's KPA toward COVID-19. This cross-sectional research was conducted at Rehman Medical Institute Peshawar using a questionnaire survey completed by OT staff members at various OTs. The research team physically distributed questionnaires. This 21-item survey is divided into four main sections to evaluate the respondents' demographics, practises, and attitudes regarding COVID-19. In all, 178 people took part in the research. Most were women. Males made up 51% (n = 90) and 49% (n = 88). To establish the overall score, we computed the average of all correct answers given by participants to the knowledge section questions.  92 (51.6%) participants had a solid knowledge of COVID-19 symptoms and high-risk patients, while the remaining 86 (48.4%) had a rudimentary understanding of the disease. Similarly, 149 participants (83.7%) reported good practices, and 29 (16.3%) reported poor practices. 92 (51.6%) participants had a solid knowledge of COVID-19 symptoms and high-risk patients, while the remaining 86 (48.4%) had a rudimentary understanding of the disease. Furthermore, after being in contact with the patient and colleagues, some of them became concerned about returning home and infecting their family members. According to the findings, 111 (62.3%) of the participants had a positive attitude toward COVID-19 positive patients, while the remaining 67 (37.7%) had a negative attitude. As the worldwide COVID-19 danger develops, OT Staff from Rehman Medical Institute Peshawar exhibits acceptable KAP regarding COVID-19. There was a considerable gap in OT Staff expertise and attitude. During this epidemic, institution policymakers and OT staff should continue ongoing education, training, and follow-up updates.

Clinical Characteristics of the SARS-CoV-2 Alpha, Delta, Delta plus and Omicron Variants versus the Wild Type in Iraqi Patients

     Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome called coronavirus 2 (SARS-CoV-2). Due to its concerning rate of transmission and intensity, coronavirus was classified as a pandemic on March 11, 2020. With the continuous evolution of the viral genome and mutations that may alter infectivity, disease severity or interactions with host immunity, SARS-CoV-2 has evolved into many variants: Alpha (B.1.1.7 lineage), Delta (B.1.617.2 lineage), Delta plus (B.1.617.2.1), Omicron (B.1.1.529 lineage) and other variants. Thus, this study aimed to find and provide database for local clinical characteristics of different variants of SARS-COV-2 and severity of infection with viral load compared with the wild type. A total of 247 nasal swabs were collected from COVID-19 positive patients between March 2021 to March 2022. Specimens were tested by using real time reverse transcriptase polymerase chain reaction rRT-PCR assay to confirm the infection after RNA extraction by specialized kits. Results showed Alpha, Delta, Delta plus and Omicron variants presence in local population at the same time of their global spread at high rates with different cases of severity. The finding showed increase in severity with Alpha 79/87 (90%), wild type 26/32 (81%) (with 3 mortality cases), Delta/ Delta plus 68/84 (80%) and Kappa only one case. Also, Alpha along with the wild type was more associated to severe and critical cases, while mild to moderate group appeared with Omicron variant (32/43 (74%)). In addition, there was an increase in the severity among older patients (&gt;40) and in men more than the women. Results indicate that although the wild type was no less dangerous or severe than Alpha or other variants, but with continuous appearence of new variants led to its reduced prevalence. In conclusion, findings demonstrated that most of the severe and critical cases had infection with Alpha, wild type than Delta or Delta plus variants. Whereas mild to moderate cases occurred in Omicron variants.

Evaluation of semen DNA integrity and related parameters with COVID-19 infection: a prospective cohort study

BackgroundIn the context of Corona Virus Disease 2019 (COVID-19) global pandemic, Its impact on male reproductive function should be concerned.MethodsOur study is a prospective cohort study that recruited participants infected or uninfected with COVID-19 between December 2022 and March 2023. All laboratory tests and questionnaire data were completed at the First Affiliated Hospital of Nanchang University. A total of 132 participants were enrolled, with 78 COVID-19 positive patients as the positive group and 54 COVID-19 negative participants as the negative group. Semen quality was assessed by the fifth World Health Organization criteria. The general characteristics of semen samples were assessed using CASA (computer-assisted sperm analysis). DNA damage and the high density stainability was assessed by sperm chromatin structure analysis (SCSA) based on flowcytometry.ResultsThe sperm concentration, progressive motility and motility in COVID-19 negative group were significantly higher than positive group. In the following DNA damage analysis, a remarkably lower sperm DNA fragmentation index (DFI) in the COVID-19 negative group. In the positive group, unhealthy lifestyles had no significant effect on semen parameters, DNA fragmentation and nuclear compaction.ConclusionsAfter excluding the interference of unhealthy lifestyle, the COVID-19 infection can have a significant impact on the quality of semen, especially the DFI,. Therefore, it shows that COVID-19 can adversely affects male fertility, and this result provides advisory guidance for clinicians.

Efficacy of three antimicrobial mouthwashes in reducing SARS-CoV-2 viral load in the saliva of hospitalized patients: a randomized controlled pilot study

This study aimed to evaluate the efficacy of 3 mouthwashes in reducing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load in the saliva of coronavirus disease 2019 (COVID-19) patients at 30 min, 1, 2 and 3 h after rinsing. This pilot study included 40 admitted COVID-19 positive patients (10 in each group). Saliva samples were collected before rinsing and at 30 min, 1, 2 and 3 h after rinsing with: Group 1—0.2% Chlorhexidine digluconate (CHX); Group 2—1.5% Hydrogen peroxide (H2O2); Group 3—Cetylpyridinium chloride (CPC) or Group 4 (control group)—No rinsing. Viral load analysis of saliva samples was assessed by Reverse Transcription quantitative PCR. Mean log10 viral load at different time points was compared to that at baseline in all groups using a random effects linear regression analysis while for comparison between groups linear regression analysis was used. The results showed that all groups had a significantly reduced mean log10 viral load both at 2 (p = 0.036) and 3 (p = 0.041) hours compared to baseline. However, there was no difference in mean log10 viral load between any of the investigated mouthwashes and the control group (non-rinsing) at the evaluated time points. Although a reduction in the SARS-CoV-2 viral load in the saliva of COVID-19 patients was observed after rinsing with mouthwashes containing 0.2% CHX, 1.5% H2O2, or CPC, the reduction detected was similar to that achieved by the control group at the investigated time points. The findings of this study may suggest that the mechanical action of rinsing/spitting results in reduction of SARS-CoV-2 salivary load.

Retrospective Analysis of Hematological Abnormalities in Older Diabetic Patients with SARS-CoV-2 Infection

Background: Understanding the severity of Coronavirus Disease 2019 (COVID-19) in elderly diabetic patients is crucial, considering the impact of age, comorbidities, and clinical biomarkers. However, the assessment of common haematological markers in this specific population remains limited. Methods: We conducted a retrospective cohort study involving 27 elderly patients (mean age: 61.81±7.14 years) with COVID-19 infection. We analysed the medical e-records of COVID-19 positive patients who presented to a COVID-19 centre in Qatar in July 2020. Real-Time Polymerase Chain Reaction was used to confirm COVID-19 infection using throat-swab upper respiratory samples. Clinical haematological parameters were analysed and compared with normal ranges. Results: Among the 27 patients investigated, 51.85% were male. A low viral load (cycle threshold (Ct) ≥ 30) was observed in 7.4% of patients, while 92.59% had a high viral load (Ct &lt; 30). At presentation, 59.25% of patients were symptomatic. The observed haematological abnormalities ranked in descending order of frequency were as follows: high red blood cell counts, and high mean platelet volume (52% each), high platelet distribution width (48%), low haemoglobin values, and low haematocrit values (22% each), leukopenia, neutropenia, and lymphopenia (15% each), thrombocytosis, thrombocytopenia, leucocytosis, and neutrophilia (7% each), and lymphocytosis (4%). Conclusion: Our study highlights the common occurrence of haematological abnormalities in older diabetic patients with COVID-19 infection. Monitoring haematological parameters may be valuable in managing these patients, especially in severe cases, and could facilitate early identification of individuals requiring intensive care, potentially reducing mortality. Keywords: Geriatric Medicine; Public Health; Real-Time Polymerase Chain Reaction; Risk Factor; SARS-CoV-2; Symptomatic Infection; Thrombocytopenia; Viral Load

[Impact of the COVID-19 pandemic on the care of major trauma patients: analysis from the TraumaRegister DGU®].

The treatment of major trauma patients requires intensive care capacity, which is acritical resource particularly during the coronavirus disease 2019 (COVID-19) pandemic. Therefore, the aim of this study was to analyze the impact on major trauma care considering the intensive care treatment of COVID-19 positive patients. Demographic, prehospital, and intensive care treatment data from the TraumaRegister DGU® of the German Trauma Society (DGU) in 2019 and 2020 were analyzed. Only major trauma patients from the state of Bavaria were included. Inpatient treatment data of COVID-19 patients in Bavaria in 2020 were obtained using IVENA eHealth. In total, 8307 major trauma patients were treated in the state of Bavaria in the time period investigated. The number of patients in 2020 (n = 4032) compared to 2019 (n = 4275) was not significantly decreased (p = 0.4). Regarding COVID-19 case numbers, maximum values were reached in the months of April and December with more than 800 intensive care unit (ICU) patients per day. In the critical period (> 100patients with COVID-19 on ICU), aprolonged rescue time was evident (64.8 ± 32.5 vs. 67.4 ± 30.6 min; p = 0.003). The length of stay and ICU treatment of major trauma patients were not negatively affected by the COVID-19 pandemic. The intensive medical care of major trauma patients could be ensured during the high-incidence phases of the COVID-19 pandemic. The prolonged prehospital rescue times show possible optimization potential of the horizontal integration of prehospital and hospital.

Is alveolar osteitis more prevalent since COVID-19? A cross-sectional study

Objectives: The aim of the study was to analyze the association between post-extraction alveolar osteitis and coronavirus disease 2019 (COVID-19) in a single center. Material and Methods: A monocentric cross-sectional study was carried out at NSVK Sri Venkateshwara Dental College and Hospital located in Bannerughatta, Bengaluru in the Department of Oral and Maxillofacial Surgery from January 2021 to August 2022. The study sample comprised 50 participants; an extraction of one or more teeth was performed on women and men between the age group of 15–83 years and returned with complication of alveolar osteitis. Demographic details such as age, gender, medical history, personal habits, COVID-19 immunization history, history of COVID-19, and its complications were acquired from the patient’s case history files throughout the study and recorded. Descriptive statistics were used to analyze the collected data. Chi-square test was used to check for association between the groups. Results: Females (62%) were majority of the study participants with an average age of 40 years. Of the patients reported to the hospital, 46% were COVID-positive, 38% were smokers, 48% consumed alcohol, and 80% presented with some underlying systemic condition. A statistically significant association was seen between history of COVID-19 positive patients and systemic condition with P = 0.014 (P ≤ 0.05). Conclusion: Patients with systemic conditions were more prone to dry socket; however, personal habits such as smoking, alcohol, and use of tobacco showed no direct relationship. According to study, previous history of COVID-19 infection did not have significant effects in regards to alveolar osteitis. Thus, more research on recovered COVID-19 patients should be done to understand the etiology of dry socket.

Impact of COVID-19 on cancer services and patients' outcomes: a retrospective single-center study.

Our main objective was to assess the impact of the coronavirus disease 2019 (COVID-19) on cancer services and cancer patients in terms of disease severity, morbidity and mortality. Secondary objectives were to characterize cancer type, affected age groups, gender, comorbidities, infectivity, and to identify cancer treatment delay and its complications after COVID-19 infection. A retrospective analysis of electronic health records of polymerase chain reaction (PCR)-confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infected cancer patients from April 2020 to March 2021 was done. The following parameters were investigated upon-new and follow-up cases during the pandemic and its preceding years (2018-2019, 2019-2020), age, sex, type of cancer, comorbidities, presentation, symptomatology and treatment for COVID-19, time to recovery, complications, delay in treatment and survival outcome. Statistical analysis using chi-square testing was done on the above variables. There was a 50.49% reduction in the number of new and follow-up cases as compared to that of the previous years. Seventy-four out of 310 (23.87%) COVID-19 positive cancer patients were aged in their sixth decade with the commonest type being hematological malignancies. A proportion of 84.8% (n=263) patients were asymptomatic. Univariate analysis was statistically significant for mortality with regard to age ≥60 years (P=0.034), type of malignancy (P=0.000178), hypertension (P=0.0028), symptomatology of COVID-19 infection (P=0.0016), site of treatment and oxygen/intervention (P<0.0001). There was an average delay in treatment time of 5 to 6 weeks. Multivariate analysis showed that gastrointestinal (GI) and hepato-pancreato-biliary (HPB) malignancies and oxygen requirement (>2 L/min) were responsible for the 20.65% mortality rate. The pandemic significantly affected the care of cancer patients with decreased cases, late presentation, delayed treatment with potentially worse mortality outcome. Although they have decreased immunity, majority were asymptomatic. Most of the fatalities were in the GI and HPB malignancies.

Incidence of Major Limb Arterial Thrombosis in Positive versus Negative COVID-19 Patients: A Cross-Sectional Retrospective Study

Introduction: The main goal of this cross-sectional retrospective study was to analyze the incidence and outcomes of acute limb ischemia (ALI) in patients suffering from coronavirus disease 2019 (COVID-19) in comparison to non-COVID-19 patients. Method: We performed a retrospective cross-sectional study across two centers under the Dubai Health Authority in Dubai, United Arab Emirates. Our study included 43 patients who were hospitalized for ALI between 2017 and 2021. They were divided into two groups according to our exclusion and inclusion criteria. Statistical analyses were performed using SPSS, version 26.0 (IBM Corp., Armonk, NY, USA). Proportions were compared by χ² or Fisher’s exact tests. Results: A group of consecutive patients were hospitalized with ALI between 2017 and 2021. This study showed the amputation rate in COVID-19-infected patients (2/11 [18.2%]) was found to be higher than that in patients with non-COVID-19 infections (1/32 [3.1%]). Moreover, the percentage of failed limb salvage procedures also proved to be higher (4/11 [36.36%]) in the COVID-19-positive group versus (3/32 [9.37%]) in the non-COVID-19 group. Conclusions: ALI is a life-threatening condition that is caused by multiple predisposing factors in the general population and by a clot-forming process in the severe acute respiratory syndrome coronavirus 2 group as a result of hypercoagulable mechanisms. The management of ALI is not standardized and should be determined on a case-by-case basis. Due to the multiple complications of COVID-19, the mortality rate in patients with COVID-19 associated with ALI is significantly higher than in patients with isolated ALI. Therefore, it is essential to investigate the underlying mechanisms and clinical presentations of this condition to develop effective management strategies and minimize mortality.

Risk factors of postoperative intensive care unit admission during the COVID-19 pandemic: A multicentre retrospective cohort study

BackgroundDuring the Coronavirus disease 2019 (COVID-19) pandemic, intensive care unit (ICU) capacity was scarce. Since surgical patients also require ICU admission, determining which factors lead to an increased risk of postoperative ICU admission is essential. This study aims to determine which factors led to an increased risk of unplanned postoperative ICU admission during the COVID-19 pandemic. MethodsThis multicentre retrospective cohort study investigated all patients who underwent surgery between 9 March 2020 and 30 June 2020. The primary endpoint was the number of surgical patients requiring postoperative ICU admission. The secondary endpoint was to determine factors leading to an increased risk of unplanned postoperative ICU admission, calculated by multivariate analysis with odds ratios (OR's) and 95% confidence (CI) intervals. ResultsOne hundred eighty-five (4.6%) of the 4051 included patients required unplanned postoperative ICU admission. COVID-19 positive patients were at an increased risk of being admitted to the ICU compared to COVID-19 negative (OR 3.14; 95% CI 1.06–9.33; p = 0.040) and untested patients (OR 0.48; 95% CI 0.32–0.70; p = 0.001). Other predictors were male gender (OR 1.36; 95% CI 1.02–1.82; p = 0.046), body mass index (BMI) (OR 1.05; 95% CI 1.02–1.08; p = 0.001), surgical urgency and surgical discipline. ConclusionA confirmed COVID-19 infection, male gender, elevated BMI, surgical urgency, and surgical discipline were independent factors for an increased risk of unplanned postoperative ICU admission. In the event of similar pandemics, postponing surgery in patients with an increased risk of postoperative ICU admission may be considered.

Neuroimaging Spectrum in COVID-19 Infection: A Single-Center Experience.

Background and Purpose  The ongoing coronavirus disease 2019 (COVID-19) pandemic is a multisystemic disease and involvement of the nervous system is well established. The neurological and neuroimaging features of the disease have been extensively evaluated. Our study aimed to elucidate the neuroradiological findings in COVID-19 infected patients admitted to our institute during the first and second waves of the pandemic in India. Methods  This was a single-center retrospective study of all COVID-19 positive patients who underwent neuroimaging between March 2020 and May 2021. The presenting neurological complaints, the imaging findings in computed tomography (CT) imaging, and/or magnetic resonance imaging (MRI) were recorded. They recorded the findings in the subheadings of ischemic stroke, hemorrhagic stroke, parainfectious demyelination, acute encephalitis syndrome, and changes of global hypoxic changes. Patients with age-related, chronic, and incidental findings were excluded. Results  The study comprised of 180 COVID-19 positive patients who underwent neuroimaging. CT scan was performed for 169 patients, MRI for 28, and a combination of both CT and MRI was performed for 17 patients. Seventy percent of patients were males, and median age was 61.5 years (interquartile range: 48.25-70.75). Out of the 180 patients, 66 patients had nonspecific findings that could not be attributed to COVID-19 infection. In the remaining 114 patients, 77 (42.7%) had ischemic findings, while 22 (12.2%) had hemorrhagic stroke. Hypoxic ischemic changes were noted in five patients. The rest of the patients had a spectrum of changes including, cerebellitis (3), tumefactive demyelination (1), COVID-19-associated encephalitis (1), hemorrhagic acute demyelinating encephalomyelitis (1), transverse myelitis (1), cytotoxic lesions of corpus callosum (1), Guillain-Barre syndrome (1), and COVID-19-associated microhemorrhages (1). Conclusion  Neurological manifestations of COVID-19 infection are not uncommon, and our understanding of this topic is expanding. A complex interplay of neurotropism and direct central nervous system invasion, immune activation and cytokine storm, vasculitis, and parainfectious processes are implicated in the pathophysiology. While the most common imaging finding was ischemic stroke, followed by hemorrhagic stroke, a diverse range of parainfectious findings was also noted in our study.

A Retrospective Analysis of Co-morbidities in Stroke Patients with COVID (P14-5.016)

<h3>Objective:</h3> To analyze the effects of co-morbidities established as stroke risk factors in the setting of coronavirus disease 2019 (COVID-19). <h3>Background:</h3> Given the protean sequelae of COVID-19 and its emerging interplay on chronic disease states, the effects of well-established stroke risk factors must be analyzed in this context. <h3>Design/Methods:</h3> We conducted a retrospective analysis on 29 patients who presented with acute stroke and were found to be COVID-19 positive from 3/2020 through 8/2021. Information was collected on demographic variables, medical history, and pertinent clinical parameters. Stroke outcomes were assessed via the following: binarized modified Rankin scale score (mRSS) on discharge (4–6: poor outcome vs 0–3: good outcome [ref]), and whether mortality resulted. A series of logistic regression models adjusted for age, gender, body mass index, presence of diabetes mellitus (DM), presence of hyperlipidemia, prior history of coronary artery disease and/or cerebrovascular disease, and mean arterial pressure at admission were run to assess the association of these parameters with stroke outcomes in a cohort of COVID-19 positive stroke patients. All analyses were conducted using SAS Studio OnDemand for Academics (SAS Institute Inc., Cary, NC). <h3>Results:</h3> Among 29 COVID-19 patients (mean age 63.6 ± 13.4 years, 65.5% males), tested clinical parameters were not shown to be significantly associated with stroke outcomes across a series of logistic regression models. Regarding mortality, presence of DM showed 5.89 times the odds of mortality (OR: 5.89; 95% CI: 0.67, 52.47; p-value: 0.11). When assessing for binarized mRSS at discharge, presence of DM showed 2.97 times the odds of a poor outcome (OR: 2.97, 95% CI: 0.27, 32.58; p-value: 0.37). <h3>Conclusions:</h3> Analysis via adjusted logistic regression models revealed a statistically insignificant positive association between DM and both outcomes: worse mRSS and mortality. Further research is needed with larger patient cohorts and employing matched controls without COVID. <b>Disclosure:</b> Dr. Sheikh has nothing to disclose. Dr. Ansari has nothing to disclose. Dr. Elsekaily has nothing to disclose. Dr. Ayub has nothing to disclose. Dr. Triay has nothing to disclose. Miss Angelette has nothing to disclose. Ms. Gaudet has nothing to disclose. Dr. Kelley has nothing to disclose.