COVID-19 Positive Patients Research Articles

Postoperative Outcomes of Emergent Gastrointestinal Surgical Interventions in COVID-19 Positive versus COVID-19 Negative Patients: A retrospective Study

Postoperative Outcomes of Emergent Gastrointestinal Surgical Interventions in COVID-19 Positive versus COVID-19 Negative Patients: A retrospective Study

Estimating the effect of realistic improvements of metformin adherence on COVID-19 mortality using targeted machine learning

BackgroundType 2 diabetes elevates the risk of severe outcomes in COVID-19 patients, with multiple studies reporting higher case fatality rates. Metformin is a widely used medication for glycemic management. We hypothesize that improved adherence to metformin may lower COVID-19 post-infection mortality risk in this group. Utilizing data from the Mexican Social Security Institute (IMSS), we investigate the relationship between metformin adherence and mortality following COVID-19 infection in patients with chronic metformin prescriptions. MethodsThis is a retrospective cohort study consisting of 61,180 IMSS beneficiaries who received a positive polymerase chain reaction (PCR) or rapid test for SARS-CoV-2 and had at least two consecutive months of metformin prescriptions prior to the positive test. The hypothetical intervention is improved adherence to metformin, measured by proportion of days covered (PDC), with the comparison being the observed metformin adherence values. The primary outcome is all-cause mortality following COVID-19 infection. We defined the causal parameter using shift intervention, an example of modified treatment policies. We used the targeted learning framework for estimation of the target estimand. FindingsAmong COVID-19 positive patients with chronic metformin prescriptions, we found that a 5% and 10% absolute increase in metformin adherence is associated with a respective 0.26% (95% CI: −0.28%, 0.79%) and 1.26% (95% CI: 0.72%, 1.80%) absolute decrease in mortality risk. InterpretationSubject to the limitations of a real-world data study, our results indicate a causal association between improved metformin adherence and reduced COVID-19 post-infection mortality risk.

Impact of recurrent COVID-19 disease waves on acute myocardial infarction epidemics: results from a regional network

Aims To assess the impact of COVID-19 related public containment measures during recurrent COVID-19 waves on hospital admission rate for acute myocardial infarction (AMI). Methods and results: Clinical characteristics, reperfusion therapy modalities, COVID-19 status and in-hospital mortality of consecutive AMI patients who were admitted in a regional AMI network were recorded during one year starting in March 2020 and were compared with the year before. The COVID-19 study period encompassed two waves: the first in March-May 2020 and the second in October-December 2020. A total of 1349 AMI patients were hospitalised of which 725 during the pre-COVID period and 624 during the COVID period (incidence rate ratio of 1.16, p = 0,006). The impact was predominantly present in the first wave (32% reduction: n = 204 vs 152) and evanished during the second wave (3% increase (152 vs 156). A similar pattern was observed for ACS with cardiac arrest with a 92% reduction (n = 36 vs 3) during the first wave and no change during the second wave (18 vs 18). After correction for temperature and air quality, COVID-19 epidemic remained associated with a decrease of AMI hospitalisation (p = 0.046). Reperfusion strategy for AMI patients, were comparable between both study periods. The in-hospital mortality between the two periods was comparable (2.6% versus 1.9%), but COVID-19 positive ACS patients (n = 7) had a high mortality rate (14%). Conclusion COVID-19 related public containment measures resulted during the first wave in a 32% reduction of AMI hospitalisation, but this impact was not visible anymore during the second wave.

The dynamics and outcomes of AKI progression during the COVID-19 pandemic.

Acute kidney injury (AKI) associated with COVID-19 is associated with poor prognosis. This study assessed the hitherto uninvestigated impact of COVID-19 on the progression and clinical outcomes of patients with AKI. Data from 576 patients with AKI admitted between 13/3/20 and 13/5/20 were studied. Increasingly complex analyses, from logistic regressions to competing-risk and multi-state models, have revealed insights into AKI progression dynamics associated with PCR-confirmed COVID-19 acquisition and death. Meta-analyses of case fatality ratios among patients with AKI were also conducted. The overall case-fatality ratio was 0.33 [95% CI (0.20-0.36)]; higher in COVID-19 positive (COVID+) patients 0.52 [95% CI (0.46-0.58)] than in their negative (COVID-) counterparts 0.16 [95% CI (0.12-0.20)]. In AKI Stage-3 patients, that was 0.71 [95% CI (0.64-0.79)] among COVID+ patients with 45% dead within 14 days and 0.35 [95% CI (0.25-0.44)] in the COVID- group and 28% died within 14 days. Among patients diagnosed with AKI Stage-1 within 24 h, the probability of progression to AKI Stage-3 on day 7 post admission was 0.22 [95% CI (0.17-0.27)] among COVID+ patients, and 0.06 [95% CI (0.03, 0.09)] among those who tested negative. The probability of discharge by day 7 was 0.71 [95% CI (0.66, 0.75)] in COVID- patients, and 0.27 [95% CI (0.21, 0.32)] in COVID+ patients. By day 14, in AKI Stage-3 COVID+ patients, that was 0.35 [95% CI (0.25, 0.44)] with little change by day 10, that is, 0.38 [95% CI (0.29, 0.47)]. These results are consistent with either a rapid progression in severity, prolonged hospital care, or high case fatality ratio among AKI Stage-3 patients, significantly exacerbated by COVID-19 infection.

Prognostic accuracy of early warning scores for predicting serious illness and in-hospital mortality in patients with COVID-19.

A simple bedside triage tool is essential to stratify COVID-19 patients in the emergency department (ED). This study aimed to identify an early warning score (EWS) that could best predict the clinical outcomes in COVID-19 patients. Data were obtained from medical records of 219 laboratory-confirmed COVID-19 positive patients. We calculated 13 EWSs based on the admission characteristics of the patients. Receiver operating characteristic (ROC) curve analysis was used to assess the performance of the scores in predicting serious illness and in-hospital mortality. The median patient age was 51 (38, 60) years, and 25 (11.4%) patients died. Among patients admitted with mild to moderate illness (n = 175), 61 (34.9%) developed serious illness. Modified National Early Warning Score (m-NEWS) (AUROC 0.766; 95% CI: 0.693, 0.839) and Rapid Emergency Medicine Score (REMS) (AUROC 0.890; 95% CI: 0.818, 0.962) demonstrated the highest AUROC point estimates in predicting serious illness and in-hospital mortality, respectively. Both m-NEWS and REMS demonstrated good accuracy in predicting both the outcomes. However, no significant difference was found between m-NEWS (p = 0.983) and REMS (p = 0.428) as well as some other EWSs regarding the AUROCs in predicting serious illness and in-hospital mortality. We propose m-NEWS could be used as a triage score to identify COVID-19 patients at risk of disease progression and death especially in resource-poor settings because it has been explicitly developed for risk stratification of COVID-19 patients in some countries like China and Italy. However, this tool needs to be validated by further large-scale prospective studies.

Impact of COVID-19 on patients undergoing scheduled procedures for chronic venous disease.

The COVID-19 pandemic has drastically altered the medical landscape. Various strategies have been employed to preserve hospital beds, personal protective equipment, and other resources to accommodate the surges of COVID-19 positive patients, hospital overcapacities, and staffing shortages. This has had a dramatic effect on vascular surgical practice. The objective of this study is to analyze the impact of the COVID-19 pandemic on surgical delays and adverse outcomes for patients with chronic venous disease scheduled to undergo elective operations. The Vascular Surgery COVID-19 Collaborative (VASCC) was founded in March 2020 to evaluate the outcomes of patients with vascular disease whose operations were delayed. Modules were developed by vascular surgeon working groups and tested before implementation. A data analysis of outcomes of patients with chronic venous disease whose surgeries were postponed during the COVID-19 pandemic from March 2020 through February 2021 was performed for this study. A total of 150 patients from 12 institutions in the United States were included in the study. Indications for venous intervention were: 85.3% varicose veins, 10.7% varicose veins with venous ulceration, and 4.0% lipodermatosclerosis. One hundred two surgeries had successfully been completed at the time of data entry. The average length of the delay was 91 days, with a median of 78days. Delays for venous ulceration procedures ranged from 38 to 208 days. No patients required an emergent intervention due to their venous disease, and no patients experienced major adverse events following their delayed surgeries. Interventions may be safely delayed for patients with venous disease requiring elective surgical intervention during the COVID-19 pandemic. This finding supports the American College of Surgeons' recommendations for the management of elective vascular surgical procedures. Office-based labs may be safe locations for continued treatment when resources are limited. Although the interventions can be safely postponed, the negative impact on quality of life warrants further investigation.

Outcomes of tracheostomies performed in COVID-19 positive patients at Hospital Central del Estado Chihuahua, Mexico

Outcomes of tracheostomies performed in COVID-19 positive patients at Hospital Central del Estado Chihuahua, Mexico

Is perioperative COVID-19 really associated with worse surgical outcomes among vaccinated patients?

During the surge of the SARS-CoV-2 pandemic, studies revealed high complication and morbidity rates following surgical procedures in COVID-19 positive patients. Anesthetic and surgical societies swiftly developed strategies to mitigate these risks, including a recommended postponement of elective surgeries for a minimum of 7weeks post-COVID infection. Nowadays, with a predominantly vaccinated population, it has become crucial to discern the influencing factors on post-COVID morbidity and mortality and a reevaluation of the existing recommendations pertaining to elective surgery. A single-center case-control study was conducted, including patients who underwent surgery between November 2021 and March 2022 and met the inclusion criteria. Eighty COVID-19 positive patients were matched 1:1 with 80 controls, each undergoing an identical intervention within a 2-week time frame. The primary outcome was 30-day postoperative mortality and secondary outcome postoperative complications (respiratory and thromboembolic). At the time of surgery, 88.8% of patients in the case group and 92.5% in the control group had received at least one vaccine dose. Mortality and morbidity did not show a significant difference when comparing the case and control groups (7.5% vs 6.2%, p = 0.755; 11.3% vs 8.9%, p = 0.541 respectively). In the COVID-positive group, mortality was significantly associated with age over 70years, ASA score over III, RCRI over 1, emergency procedures, and absence of thromboembolic prophylaxis. In contrast to previously reported findings, we did not observe an increased morbi-mortality in patients with perioperative COVID-19 infection. It may not be necessary to delay elective interventions, except in cases with a high-risk.

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.

Outcome of COVID-19 Positive Patients in a COVID-19 Dedicated Referral Hospital

Introduction: The COVID-19 pandemic in Bangladesh is a manifestation of the global outbreak of the coronavirus illness 2019 (COVID-19), which is caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Bangladesh is the second most affected country in South Asia, following India.
 Objective: The aim of the study was to evaluate the outcome of COVID-19 Positive patients admitted in Central Police Hospital Dhaka, Bangladesh.
 Methodology: This was an observational cross-sectional study conducted in Central Police Hospital, Rajarbag Dhaka, Bangladesh during April 2020 to October 2020 and a total of 200 confirmed COVID-19 positive admitted patients from Covid Ward were enrolled in this study. The formal permission was taken from the registrar and the director of the hospital and the data were collected from the hospital registered copy and preserved in Microsoft Excel Software. The collected data were analyzed by Statistical Package for Social Sciences (SPSS) software, version-23.0.
 Results: In this study a total of 200 study subjects were enrolled. All the study subjects100% were police personnel and their family members. Among the study subjects, 90(45%) were constable to sub-inspector and followed by 50(25%) inspector to upwards, 20(10%) retired police personnel and 40(20%) of their family members. The majority 60(30%) belonged to the age group (40-49) years. According to gender distribution, 89% patients were male and only 11% patients were female. Among the females (n=22), 7(31.81%) were observed pregnant and 15(68.19%) were observed non pregnant. Distribution by severity, 85% cases were mild to moderate and 15% cases were severe (critical) and received treatment in the ICU. According to the distribution of critical patients by age, 5%, 10%, 40% and 45% of the patients belonged to age group (0-39) years, (40-49) years, (50-59) years and above 60 years respectively. Only 12.3% patients received plasma therapy. Among the study subjects, the survival rate was 99% and the death rate was only 1%. According to the age distribution of the death cases, 0% death case belonged to age group (0-49) years and followed by 0.5% death case (50-60) years and 0.5% death case above 60 years.
 Conclusion: Among the front line fighters against Ccovid 19 Pandemic, police forces were the most vulnerable to be affected by the infection due to their close association with the population. Survival rate was high (99%) in contrast to the world perspective.

CLINICAL FEATURES AND SHORT-TERM OUTCOME OF COVID-19 IN PEDIATRIC PATIENTS IN A TERTIARY CARE HOSPITAL OF CENTRAL INDIA: A CROSS-SECTIONAL STUDY

Objectives: To fill the knowledge gap and make a clinical profile (frequency, clinical features and outcome) of COVID-19 paediatric patients attending the tertiary care hospital of central India. Methodology: This cross-sectional study was carried out in Department of Paediatrics, R.D Gardi Medical College, Ujjain, M.P among 88 age group of 0-18 years admitted consented COVID-19 positive pediatric patients over a period of one year (March 2021 to April 2022). Results: Fever was the most common (76%) complaint, followed by fatigue/ malaise (52%), dry cough and runny nose (45%). Fever stayed for the longest duration (2.80±2.30 days), followed by loss of smell (1.97±2.43 days). Skin rashes stayed for the least duration (0.09±0.39 days). Stunting was observed in 28% participants. Hospital acquired pneumonia was seen in many (26%), along with liver dysfunction in 19%, ARDS in 18%, meningitis/ encephalitis in 16%, MIS-C in 8% and septic shock in 7%. Most of the study participants (49%) had received Azithromycin; while Ivermectin was given to very few participants (16%). Mean duration of stay in hospital was observed to be 9.01±7.95 days. COVID-19 severely hampered the vulnerable section of the society, i.e., the children. Conclusion: The prevalence was found to be more in females, and increased with advancing age. Overcrowding and under nutrition favoured its spread. Children presented with variable complications, as well.

The RdRp genotyping of SARS-CoV-2 isolated from patients with different clinical spectrum of COVID-19

BackgroundThe evolution of SARS-CoV-2 has been observed from the very beginning of the fight against COVID-19, some mutations are indicators of potentially dangerous variants of the virus. However, there is no clear association between the genetic variants of SARS-CoV-2 and the severity of COVID-19. We aimed to analyze the genetic variability of RdRp in correlation with different courses of COVID-19.ResultsThe prospective study included 77 samples of SARS-CoV-2 isolated from outpatients (1st degree of severity) and hospitalized patients (2nd, 3rd and 4th degree of severity). The retrospective analyses included 15,898,266 cases of SARS-CoV-2 genome sequences deposited in the GISAID repository. Single-nucleotide variants were identified based on the four sequenced amplified fragments of SARS-CoV-2. The analysis of the results was performed using appropriate statistical methods, with p < 0.05, considered statistically significant. Additionally, logistic regression analysis was performed to predict the strongest determinants of the observed relationships. The number of mutations was positively correlated with the severity of the COVID-19, and older male patients. We detected four mutations that significantly increased the risk of hospitalization of COVID-19 patients (14676C > T, 14697C > T, 15096 T > C, and 15279C > T), while the 15240C > T mutation was common among strains isolated from outpatients. The selected mutations were searched worldwide in the GISAID database, their presence was correlated with the severity of COVID-19.ConclusionIdentified mutations have the potential to be used to assess the increased risk of hospitalization in COVID-19 positive patients. Experimental studies and extensive epidemiological data are needed to investigate the association between individual mutations and the severity of COVID-19.

The continued financial effect of COVID: Increasing costs for non-elective major lower extremity amputations

BackgroundThe COVID-19 pandemic necessitated changes in processes of care, which significantly impacted surgical care. This study evaluated the impact of these changes on patient outcomes and costs for non-elective major lower extremity amputations (LEA). MethodsThe 2019–2021 Florida Agency for Health Care Administration database was queried for adult patients who underwent non-elective major LEA. Per-patient inflation-adjusted costs were collected. Patient cohorts were established based on Florida COVID-19 mortality rates: COVID-heavy (CH) included nine months with the highest mortality, COVID-light (CL) included nine months with the lowest mortality, and pre-COVID (PC) included nine months before COVID (2019). Outcomes included in-hospital patient outcomes and hospitalization cost. Results6132 patients were included (1957 PC, 2104 CH, and 2071 CL). Compared to PC, there was increased patient acuity at presentation, but morbidity (31%), mortality (4%), and length of stay (median 12 [8–17] days) were unchanged during CH and CL. Additionally, costs significantly increased during the pandemic; median total cost rose 9%, room costs increased by 16%, ICU costs rose by 15%, and operating room costs rose by 15%. When COVID-positive patients were excluded, cost of care was still significantly higher during CH and CL. ConclusionsDespite maintaining pre-pandemic standards, as evidenced by unchanged outcomes, the pandemic led to increased costs for patients undergoing non-elective major LEA. This was likely due to increased patient acuity, resource strain, and supply chain shortages during the pandemic. Key messageWhile patient outcomes for non-elective major lower extremity amputations remained consistent during the COVID-19 pandemic, healthcare costs significantly increased, likely due to increased patient acuity and heightened pressures on resources and supply chains. These findings underscore the need for informed policy changes to mitigate the financial impact on patients and healthcare systems for future public health emergencies.

The impact of novel coronavirus infection on blood pressure variability in patients undergoing painless gastrointestinal endoscopy

ObjectiveThis study aims to examine the impact of COVID-19 infection on blood pressure variability among patients undergoing painless gastrointestinal endoscopy. Materials and methodsWe conducted an analysis on a cohort of 53 patients who received painless gastroscopy at the First Affiliated Hospital of Zhengzhou University between November 2022 to January 2023. Non-invasive cuff pressure measurements were taken every minute upon the patient's arrival. Systolic Blood Pressure (SBP), Diastolic Blood Pressure (DBP), Mean Arterial Pressure (MAP), and Pulse Pressure (PP) were recorded both 5 min before and after induction. The variability in these parameters was calculated as the standard deviation (SD) over the mean, multiplied by 100%. Patients were grouped based on their history of COVID-19 infection. ResultsOur findings revealed significant differences in blood pressure variability between patients with a history of COVID-19 infection and those without. Prior to, substantial increases in variability were observed in DBP, MAP, and PP, while no significant change was in SBP. Following induction, COVID-19 positive patients exhibited heightened variability in all parameters. The most pronounced changes were seen in Pulse Pressure both before and after induction, suggesting a heightened cardiovascular response in patients with a history of COVID-19. These differences were statistically significant, indicating a clear impact of COVID-19 on cardiovascular stability during endoscopic procedures. ConclusionThe study underscores the influence of COVID-19 on increased blood pressure variability in patients undergoing painless gastrointestinal endoscopy. These findings highlight the need for vigilant cardiovascular monitoring in COVID-19 affected individuals during similar medical procedures.

COVID-19 AND CLINICAL AND IMMUNOLOGICAL ASPECTS OF THE ORAL CAVITY IN WOMEN

The study included 254 Covid-19 positive patients, from which 105 eligible patients were selected. The aim of the study was to determine the damage to the oral cavity in various degrees of severity of coronovirus infection, for early prediction of the clinical course of COVID-19 by using modern methods for studying local immune and inflammatory responses of the oral mucosa. During the study, the state of the oral cavity, laboratory data, including the determination of the level of IgA and IL-17, were studied, as well as bacteriological culture was carried out. During the study, an oral manifest was determined, indicating a high expression of ACE-2 receptors in the oral cavity, an inverse correlation with the clinical course of the disease and the state of the oral cavity, a complete blood count is less informative compared to determining the level of IgA and IL-17.

Epidemiology, clinical features and prognostic factors in patients with Covid-19 and acute limb ischaemia - A single center study.

The aim of this study was to determine the incidence, clinical and paraclinical characteristics and outcomes of Covid-19 positive patients presenting in the Emergency Department (ED) with and treated for acute limb ischaemia (ALI) during a 2-year period. This retrospective study was conducted in the ED of St. Spiridon County Clinical Emergency Hospital in Iasi, north-east region of Romania. The patients included in this study presented in the ED between March 1st, 2020 and February 28th, 2022 with ALI and Covid-19. During the study period, a total number of 141018 patients were evaluated in our ED, 8578 (representing 6,08%) patients being diagnosed with Covid-19. Of them, 98 (1.14% of all with Covid-19) presented ALI. The mean age was 70.9 ± 10.23 and 67.3% of the patients were males. At admission, 57% of patients had Covid-19-related pneumonia, identified on X-ray or CT scan. Of all patients, 81 (82%) were diagnosed with ALI in lower limbs with 10% of them having affected both limbs. 95% of the patients presented comorbidities, the main being cardiac (85%), diabetes mellitus (37%), vascular (24%) and neurological (22.6%). Non-survivor patients were more likely to have Covid-19 pneumonia on chest X-ray or CT scan, 92% versus 44% (OR 15, CI 3.3; 68, p < .01), lymphopenia 96% versus 70% (OR 10.2, CI 1.30; 80.9, p < .01), a NLR over 9.77% versus 30% (OR 7.5, CI 2.6; 21.4, p < .01), acidosis 65% versus 33% (OR 3.8, CI 1.4; 9.7, p < .01), abnormal AST, 69% versus 29% (OR 5.4, CI 2; 14.5, p < .01) and secondary amputation, 38.5 versus 11.1% (OR 5, CI 1.7; 14.7, p < 0.1). Overall, the mortality rate was 26.5%. The prevalence of ALI in patients infected with Covid-19 who were evaluated in our ED was 1.14%. The highest mortality rate was probably related to Covid-19 pneumonia. We observed that patients with Covid-19 pneumonia, lymphopenia, a NLR >9, metabolic acidosis, increased AST at ED admission and secondary amputation had a higher mortality.

Association between acute stroke and COVID-19 infection among patients with acute stroke

BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS COV 2) infection is associated with multiple neurological complications. Cerebrovascular accidents are considered as one of the common neurological complications associated with corona virus (COVID-19). It may represent the first presentation of the patients of COVID-19 or may occur anytime during the course of the disease.ResultsThis study included 381 patients after the diagnosis of cerebrovascular accident. The mean age of the participants was 57.1 ± 15 years. 53.5% of the participants were males and 46.5% were females. The participants had COVID-19 infection in past 3 months with mean duration was 35.5 ± 18 days. The mean NIHSS among the participants was 10.5 ± 6.2. Small artery stroke was higher among PCR negative patients and controls, while large artery stroke was higher among PCR positive patients. 26% of patients with stroke and confirmed COVID-19 infection developed stroke immediately after COVID-19 infection (within 1 week). Within 1 month from getting infection with COVID-19, 41.7% of patients developed stroke and 32.3% had developed stroke after 1 month of infection with COVID-19. Female gender, older age of the patients and presence of vascular risk factors were associated with increased severity of infection as evidenced by higher NIHSS and more ICU admission among COVID-19 positive patients.ConclusionsCOVID-19 infection has been associated with both venous and arterial stroke, especially in elderly patients. COVID-19 infection was associated with increased stroke severity as evidenced by higher NIHSS and more ICU admission. Small vessel disease was higher among COVID-19 negative patients, while large artery stroke was higher among positive COVID-19 patients.

A cross-sectional and population-based study from primary care on post-COVID-19 conditions in non-hospitalized patients

BackgroundCurrent research on post-COVID-19 conditions (PCC) has focused on hospitalized COVID-19 patients, and often lacks a comparison group. This study assessed the prevalence of PCC in non-hospitalized COVID-19 primary care patients compared to primary care patients not diagnosed with COVID-19.MethodsThis cross-sectional, population-based study (n = 2539) analyzed and compared the prevalence of PCC in patients with a positive COVID-19 test (n = 1410) and patients with a negative COVID-19 test (n = 1129) never hospitalized for COVID-19 related conditions. Participants were identified using electronic health records and completed an electronic questionnaire, available in English and Spanish, including 54 potential post COVID-19 symptoms. Logistic regression was conducted to assess the association of PCC with COVID-19.ResultsPost-COVID-19 conditions are prevalent in both groups, and significantly more prevalent in patients with COVID-19. Strong significant differences exist for the twenty most reported conditions, except for anxiety. Common conditions are fatigue (59.5% (COVID-19 positive) vs. 41.3% (COVID-19 negative); OR 2.15 [1.79–2.60]), difficulty sleeping (52.1% (positive) vs. 41.9% (negative); OR 1.42 [1.18–1.71]) and concentration problems (50.6% (positive) vs 28.5% (negative); OR 2.64 [2.17–3.22]). Similar disparities in prevalence are also observed after comparing two groups (positive vs. negative) by age, sex, time since testing, and race/ethnicity.ConclusionsPCC is highly prevalent in non-hospitalized COVID-19 patients in primary care. However, it is important to note that PCC strongly overlaps with common health symptoms seen in primary care, including fatigue, difficulty sleeping, and headaches, which makes the diagnosis of PCC in primary care even more challenging.

Perinatal outcomes of COVID-19 affected pregnant women in a tertiary care center of eastern India

Pregnancy is an immune-compromised state and pregnancy affected with COVID-19 infection is at a higher risk of adverse perinatal results. Data on feto-maternal outcomes in pregnancies infected with COVID-19 is sparse, which makes it difficult to draw conclusions on vertical transmission.To study the perinatal outcomes of covid-19 affected pregnant women.A prospective observational study was conducted over eighteen months, on 320 COVID-19 positive antenatal patients. Clinical manifestations of pregnancies with COVID-19, demographic profile, pregnancy outcomes were recorded. Important laboratory parameters were assessed along with COVID-19 inflammatory markers like serum ferritin,D-Dimer, CRP etc. Neonatal outcomes assessed included APGAR score, fetal deaths, birth weight, NICU admissions. Neonatal infections were screened by testing for SARS-CoV-2 positivity in neonatal throat swab samples.61.5% of patients complained of pain abdomen, followed by bleeding PV in 1.9%. 52.19% of the patients were asymptomatic for COVID-19 symptoms, followed by fever in 34.69%. Most common risk factor associated was hypothyroidism. Anemia was found in 22%, coagulation parameters were elevated in 30% and COVID-19 inflammatory markers were raised in more than 90% cases. Maternal and neonatal ICU admission rates were 4.69% and 30.34% respectively. Neonatal infection rate was 3.1%.COVID-19 was mainly seen in primigravida, without affecting the birth weight of babies. Coagulation profile and renal parameters were deranged in 30 percent of the patients, without any life any threatening complications. COVID-19 specific inflammatory markers showed derangement in more than 90% cases, although majority of them were asymptomatic. The rate of COVID-19 positivity among newborns was 3.1%.

Correlation study of CBC derivatives and biochemical prognostic marker in covid-19 patients

: SARS-CoV2 infection induces inflammatory responses and acute lung injury in human beings. Infection causes certain haematological and biochemical changes in patients. This study aimed analyze the correlation between CBC derivatives and biochemical prognostic marker in COVID-19.: Total 80 individuals selected, 50 COVID-19 positive patients and 30 subjects negative for COVID-19 RT-PCR test. Blood collected was sent to NLR, RDW, assayed in Beckman Coulter DxH 800. Serum CRP estimated by Immuno-turbidimetric method, ferritin by CLIA. Plasma collected estimate for D-DIMER by CLIA. Unpaired T test &amp; Pearson correlation (IBM SPSS 22.0) were used. : Elevated levels of NLR (p value &amp;#60;0.001), RDW (p value &amp;#60;0.001), FERRITIN (p value &amp;#60;0.001), D-D-DIMER (p value &amp;#60;0.001), CRP (p value &amp;#60;0.001) some research parameters like LHD and RSF show significant decrease. In current study the NLR positively correlate to CRP (r value=0.5, p value &amp;#60;0.001), NLR positively correlate to D-DIMER (r value=0.3, p value&amp;#60;0.05), RDW positively correlated to CRP (r value=, 0.3, p value &amp;#60;0.05), RDW negatively correlated to ferritin (r value=-0.439, p value &amp;#60;0.001)LHD negatively correlated ferritin (r value=-0.316, p value=&amp;#60;0.05), MAF negatively correlated to D-dimer (r value=-0.244 &amp;#60;0.05), MSCV positively correlated with CRP (r value=0.336, p value= &amp;#60;0.05).: The cytokine storm produced during covid-19 infection which inturn develop neutrophilia and lymphopenia, CRP production and also cause elevation of procoagulants &amp;D-dimer. RDW and CRP are positively correlated they are elevated during inflammatory conditions.RDW and FERRITIN show negative correlation. Retrospective study have some limitation so future studies will reveal more information.