Days Of Illness Research Articles

Severe COVID-19 with persistent respiratory failure-A retrospective cohort study in a tertiary centre in Malaysia.

Management of severe COVID-19 patients with persistent respiratory failure after acute phase treatment is not only challenging, but evidence for treatment is scarce, despite some authors reporting favourable clinical responses to corticosteroid therapy in histologically proven secondary organising pneumonia (OP). This study aimed to report the course of the disease, radiological pattern and clinical outcomes of severe COVID-19 patients with persistent respiratory failure. This was a retrospective cohort study of severe COVID-19 patients who were admitted to a single tertiary centre from 1 January 2021 to 30 June 2021. The clinical data of the patients during admission and clinic follow-up, including radiological images, were traced using electronic medical records. In our cohort, the mortality rate for those with severe COVID-19 was 23.1% (173/749). Among the survivors, 46.2% (266/576) had persistent respiratory failure (PRF) after 14 days of illness. Of them, 70.3% (187/266) were followed up, and 68% (128/187) received oral corticosteroid (prednisolone) maintenance treatment. OP pattern made up the majority (81%) of the radiological pattern with a mean severity CT score of 10 (SD±3). The mean prednisolone dose was 0.68mg/kg/day with a mean treatment duration of 47 days (SD±18). About one-third of patients (67/187) had respiratory symptoms at 4 weeks (SD±3). Among 78.1% (146/187) who had a repeated CXR during follow-up, only 12 patients (8.2%, SD±3) had radiological improvement of less than 50% at 6 weeks (SD±3), with 2 of them later diagnosed as pulmonary tuberculosis. Functional assessments, such as the 6-minute walk test and the spirometry, were only performed in 52.4% and 15.5% of the patients, respectively. Almost half of the patients with severe COVID-19 had PRF, with a predominant radiological OP pattern. More than two-thirds of the PRF patients required prolonged oral corticosteroid treatment. Familiarising clinicians with the disease course, radiological patterns, and potential outcomes of this group of patients may better equip them to manage their patients.

Significance of nested PCR testing for the detection of low-density malaria infection amongst febrile patients from the Malaria Elimination Demonstration Project in Mandla, Madhya Pradesh, India

BackgroundLow-density malaria infections (LDMI) are defined as infections that are missed by the rapid diagnostic test (RDT) and/or microscopy which can lead to continued transmission and poses a challenge in malaria elimination efforts. This study was conducted to investigate the prevalence of LDMI in febrile cases using species-specific nested Polymerase Chain Reaction (PCR) tests in the Malaria Elimination Demonstration Project, where routine diagnosis was conducted using RDT.MethodsEvery 10th fever case from a cross-sectional community based fever surveillance was tested with RDT, microscopy and nested PCR. Parasite DNA was isolated from the filter paper using Chelex based method. Molecular diagnosis by nested PCR was performed targeting 18SrRNA gene for Plasmodium species.ResultsThe prevalence of malaria was 2.50% (436/17405) diagnosed by PCR, 1.13% (196/17405) by RDT, and 0.68% (118/ 17,405) by microscopy. Amongst 17,405 febrile samples, the prevalence of LDMI was 1.51% (263/17405) (95% CI 1.33–1.70), which were missed by conventional methods. Logistic regression analysis revealed that illness during summer season [OR = 1.90 (p < 0.05)] and cases screened within three days of febrile illness [OR = 5.27 (p < 0.001)] were the statistically significant predictors of LDMI.ConclusionThe prevalence of malaria among febrile cases using PCR was 2.50% (436/17405) as compared to 1.13% (196/17405) by RDT. Higher number of the LDMI cases were found in subjects with ≤ 3 days mean duration of reported fever, which was statistically significant (p < 0.001). This observation suggests that an early detection of malaria with a more sensitive diagnostic method or repeat testing of the all negative cases may be useful for curtailing malaria transmission. Therefore, malaria elimination programme would benefit from using more sensitive and specific diagnostic methods, such as PCR.

Perbandingan Jumlah Leukosit pada Anak yang Menderita DBD dengan Syok dan tanpa Syok di RSUD Dr H Chasan Boesoirie Ternate Periode Januari-Desember 2020

&lt;p&gt;&lt;em&gt;Dengue hemorrhagic fever (DHF), a dengue virus infection transmitted by Aedes aegypti mosquito, has become one of the main global diseases. White blood cell count is one of laboratory parameters examined on DHF with daily variation. The purpose is to identify the white blood cell count comparison between pediatric DHF patient with and without shock based on the day of illness. On this retrospective cross-sectional analytic study, the study subjects were DHF patients aged 1-17 years old with and without shock according to the WHO 2011 criteria. Secondary data was obtained from medical record of patients admitted in the pediatric ward, d&lt;/em&gt;&lt;em&gt;r H Chasan Boesoirie General Hospital, in January-December 2020. The Mann-Whitney statistical test was utilized to analyze white blood cell count and patient’s characteristics The white blood cell average count of DHF patients with shock decreased on day 3 of illness, reached the lowest point on day 4 of illness (2220/mm&lt;sup&gt;3) &lt;/sup&gt;and increased on day 5 of illness (6585/mm&lt;sup&gt;3&lt;/sup&gt;). The white blood cell average count of DHF patients without shock tends to be stable day by day. Regarding the while blood cell count comparison between DHF with and without shock patients, statistical significance was only identified on fever day 6 (p=0,026). So, there was a significant difference of average white blood cell count of DHF with and without shock on day 6 of illness.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;em&gt;.&lt;/em&gt;&lt;/p&gt;&lt;em&gt;Keywords: Dengue Hemorrhagic Fever, Shock, White Blood Cell.&lt;/em&gt;

Clinical presentation, viral kinetics, and management of human monkeypox cases from New Delhi, India 2022.

We describe the clinical and demographic characteristics, virological follow-up, and management of five confirmed monkeypox cases from New Delhi, India without any international travel history. The viral load kinetics and viral clearance were estimated in oropharyngeal swabs (OPS), nasopharyngeal swabs (NPS), EDTA blood, serum, urine, and various lesion specimens on every fourth day of follow-up ranging from 5 to 24 post onset day (POD) of illness. Allfive cases presented with mild to moderate-grade intermittent fever, myalgia, and lesions on the genitals, groins, lower limb, trunk, and upper limb. Four cases had non-tender firm lymphadenopathy. No secondary complications or sexually transmitted infections were recorded in these cases except for the presence of viral hepatitis B infection marker hepatitis B virus surface antigen(HBsAg) in one case. All the cases were mild and had a good recovery. Ahigher viral load was detected in lesion fluid (POD 9), followed by lesion roof (POD 9), urine (POD 5), lesion base (POD 5), and OPS/NPS (POD 5). The monkeypox virus(MPXV) DNA was detected in clinical samples from 5th to 24th POD. These monkeypox cases without international travel history suggest the underdiagnosed monkeypox infection in the community. This emphasizes the need for active surveillance of MPXV in the high-risk population such as men having sex with men and female sex workers.

Comparison of total lymphocytes, neutrophils to lymphocytes ratio, and C-reactive protein in vaccinated and non-vaccinated severe COVID-19 patients

Background &amp; objective: SARS-CoV-2 virus caused acute respiratory illness called COVID-19 with rising case mortality rates. One of the preventive measures to arrest the spread of a contagious disease is the use of vaccines. We assessed the effectiveness of the inactivated vaccine (Coronavac) through three inflammatory parameters e.g., total lymphocyte count, neutrophil-lymphocyte ratio, and C-reactive protein (CRP), in severe COVID-19 patients.&#x0D; Methodology: This study was an observational study with a retrospective cross-sectional design. The study was conducted in the Intensive Care Unit (ICU) of Hasan Sadikin Hospital Bandung, from January 2021 to December 2021. The data of total lymphocyte count, neutrophil-lymphocyte ratio, and C-reactive protein, was collected retrospectively from the medical record documents of 54 patients of COVID-19. The assessment was performed on severe COVID-19 subjects on the 7th day of illness. Data normality test was done using the Shapiro Wilk test. Study data were not normally distributed, and statistical analyses were performed using the Mann-Whitney test for numerical data and the Chi-Square test for categorical data.&#x0D; Results: There were significant differences in inflammation parameters, e.g., total lymphocyte count, neutrophil-lymphocyte ratio, and CRP, between the two groups (P &lt; 0.0001) and the subject outcome between two groups (P &lt; 0.0001). Total lymphocyte count in severe vaccinated COVID-19 patients was higher than in non-vaccinated patients, while neutrophil-lymphocyte ratio and CRP were lower in vaccinated subjects. Mortality was also lower in the vaccinated patients compared to unvaccinated patients.&#x0D; Conclusion: The inactivated vaccine (Coronavac) effectively reduces the mortality rate of severe COVID-19 patients based on inflammatory parameters including total lymphocyte count, neutrophil-lymphocyte ratio, and C-reactive protein.&#x0D; Abbreviations: ACE: Angiotensin Converting Enzyme; ARB: Angiotensin Receptor Blocker; ARDS: Acute Respiratory Distress Syndrome; BMI: Body Mass Index; CFR: Case Fatality Rate; COVID-19: Coronaviruses Disease 2019; CRP: C-Reactive Protein; IL: Interleukin; NLR: Neutrophil Lymphocyte Ratio; SPSS: Statistical Product Service Solution; TLC: Total Lymphocyte Count; TNF: Tumor Necrosis Factor; VEGF: Vascular Endothelial Growth Factor&#x0D; Citation: Sudjud RW, Zulfariansyah A, Ardiana K. Comparison of total lymphocytes, neutrophils to lymphocytes ratio, and C-reactive protein in vaccinated and unvaccinated severe COVID-19 patients. Anaesth. pain intensive care 2022;26(5):656-662; DOI: 10.35975/apic.v26i5.2018

Incidence of Kawasaki Disease Before and After the COVID-19 Pandemic in Japan

Global studies have reported that the incidence of Kawasaki disease (KD) declined during the COVID-19 pandemic. These studies suggest that the global pandemic and its accompanying mitigation measures may provide an important opportunity to explore the hypothesis of a KD pathogenesis. To compare changes in KD incidence in Japan before and after the start of the COVID-19 pandemic. This cohort study was conducted using the data set from Japan's 26th nationwide KD survey that obtained information on patients who were diagnosed with KD in Japan from January 1, 2019, through December 31, 2020. Kawasaki disease incidence rates were calculated by referring to the national population data in the vital statistics data for Japan. A total of 28 520 patients were identified (16 236 male individuals [56.9%]; median [IQR] age, 26 [14-44] months). A total of 17 347 patients were diagnosed with KD in 2019 and 11 173 were diagnosed in 2020, representing a 35.6% reduction in the number of patients diagnosed in 2020 compared with the previous year. Patient distributions for days of illness at the first hospital visit were almost identical in 2019 and 2020, suggesting that the decrease in KD incidence likely was not associated with pandemic-related delays in seeking treatment. The proportion of patients diagnosed with KD who were younger than 12 months was significantly larger in 2020 than in 2019 (21.6% vs 19.4%; P < .001). Compared with KD incidence among younger patients, the incidence among those 24 months and older declined rapidly after initiation of COVID-19 special mitigation measures, with a greater percentage reduction (58.3% reduction in July), but rebounded faster after the end of the special mitigation period. By contrast, the incidence among patients younger than 12 months declined moderately after the initiation of the special mitigation period, with a lower percentage reduction (40.3% reduction in October), and rebounded at a later phase. In this cohort study, the number of patients diagnosed with KD decreased by approximately one-third across Japan in 2020, with no indication that parents avoided a hospital visit. Differences in KD incidence reduction patterns before and after the initiation of COVID-19 pandemic mitigation measures were found in patients with KD aged younger than 12 months compared with those 24 months or older, suggesting a potential KD pathogenesis involving transmission among children.

Prospects of Hyaluronidase Therapy in Novel COVID-19 Infection with Damage to Lungs

INTRODUCTION: In recent years, the production and regulation of synthesis of hyaluronic acid in COVID-19 has been actively studied. Hyaluronan plays a significant role in development of severe lung damage in COVID-19 and is a potential therapeutic target the action on which will probably improve prognosis for patients with COVID-19.&#x0D; AIM: To study prospects of using bovhyaluronidaze azoximer in complex treatment of patients with COVID-19 with lung damage at the inpatient stage.&#x0D; MATERIALS AND METHODS: Thirty five patients (6 men and 29 women) aged 58.9 12.9 years hospitalized with COVID-19 infection, were examined. Capillary blood saturation (SpO2) was 80.1 8.6%, the volume of lung damage in X-ray computed tomography (X-ray CT) was 45.1 19.4% on the right and 40.0 19.5% on the left. All the patients received treatment according to the Temporary Guidelines: prevention, diagnosis and treatment of novel coronavirus infection. Ver. 14 (27.12.2021). Besides, as part of complex treatment for COVID-19, bovhyaluronidaze azoximer was administered intramuscularly on the 21.9 6.8th day of illness with a course of 10 injections (once in 3 days).&#x0D; RESULTS: In the course of comprehensive treatment including bovhyaluronidaze azoximer, increase in SpO2 was recorded: in 7 patients ― after 1 injection (4.2 1.7%), in 24 ― after 2 injections (5.4 0.6%), another 4 patients did not show any significant increase in SpO2 after the first two injections. Increase in SpO2 after the 1st injection inversely correlated with age (r = -0.34; p 0.05) and the initial saturation (r = -0.38; p 0.05). Increase in SpO2 after the second injection correlated with the day of illness on which treatment with bovhyaluronidaze azoximer began (r = -0.36; p 0.05).&#x0D; CONCLUSION: Use of bovhyaluronidaze azoximer in complex treatment for COVID-19 with the lung damage at the inpatient stage can be effective in younger patients with more expressed initial reduction of SpO2, and also in case of administration of the drug in the early stages of the disease. The data obtained in the pilot study, dictate the necessity of studying the level of hyaluronic acid in blood of patients with COVID-19 and lung damage and its role in risk stratification of such patients.

Features of the course of COVID-19 in children undergoing outpatient treatment

Objective: to study the clinical and epidemiological features of the course of a new coronavirus infection in children of different ages undergoing outpatient treatment.The study participants were 812 children with COVID-19 aged from 1 month to 17 years, who were on outpatient treatment in the children's polyclinic of the city of Kirov from July to December 2021. The average age of patients with COVID-19 was 5.9 ± 1.1 years. Among the sick young children there were 28%, adolescents — 16%. In 76% of cases, contact with patients with a new coronavirus infection was detected, mainly in the family, as well as in educational institutions. In 70% of cases, an early request for medical help was registered — in the first three days of illness. In most cases (89%), a mild severity of the disease was established with the development of subfebrile fever and pharyngitis. Rhinitis phenomena were recorded in 20% of cases. 7% of children complained of a dry cough. Lung tissue lesion (RG1) was detected in 5% of patients, gastrointestinal tract — 5%. In adolescents, the phenomena of rhinitis, pharyngitis, dry cough were less common than in other age groups. Recombinant interferon alpha-2b and umifenovir were used for etiotropic therapy. All children recovered within 7—10 days from the onset of the disease.

Guillain-Barré syndrome as an early complication of a new coronavirus infection SARS-CoV-2 (clinical case)

The new strain of coronavirus SARS CoV-2 can affect any organ and system of the body. The pathogenesis of these lesions is due to both direct damage to body cells by the virus and the development of immunopathological reactions that can lead to demyelinating diseases of the nervous system. The article presents a clinical case of the development of Guillain-Barré syndrome associated with coronavirus disease in a 71-year-old man who developed after infection with a new strain of SARS CoV-2 virus. The man was hospitalized on the seventh day of the disease with complaints of unproductive cough, weakness, fever in the range of 37.5-38.7°C, shortness of breath during exercise. The clinical diagnosis was confirmed by the presence of SARS CoV-2 RNA in the nasopharyngeal secretion. According to digital radiography, the presence of interstitial pneumonia was determined. Against the background of treatment, the condition gradually improved and on the 14th day after the onset of the disease, a negative PCR result (SARS CoV-2 (-) RNA) was obtained. However, on the 16th day of hospital stay (23-24th days of the disease) he was diagnosed with polyneuropathy (Guillain-Barré syndrome), severe tetraparesis. Despite the therapy, the condition gradually deteriorated due to the progression of polyneuropathy. On the 9th day after the onset of neurological symptoms (25th days of illness), on the background of severe neurological deficits, the signs of respiratory and cardiovascular insufficiency developed, which led to the death of the patient. It has been shown that the course of Guillain-Barré syndrome, which developed after infection with a new strain of SARS CoV-2 virus, in this case has a severe course and lethal outcome of the disease. It is necessary to look for clinical predictors that would predict the occurrence of neurological complications in patients with coronavirus disease.

COMPARATIVE ANALYSIS OF CLINICAL AND LABORATORY DATA OF LUNG AFFECTION IN PATIENTS WITH COVID-19 WITH THOSE OF PANDEMIC INFLUENZA A/H1N1

Influenza viruses, in particular A ‒ A(H3N2) and A(H1N1)pdm09, as well as influenza B virus, mainly (98%) of the B/Victoria line, continue to circulate during the current epidemic season. The level of influenza vaccination remains low, about 0.6% of the population of Ukraine, and among occupational and epidemiological risk groups ‒ 22.8%, according to the Public Health Centre of the Ministry of Health of Ukraine. In the COVID-19 pandemic, simultaneous circulation of influenza viruses and SARS-CoV-2 can lead to difficulties in differential diagnosis and treatment. Comparison of clinical and laboratory features of severe influenza complicated by pneumonia caused by pandemic influenza virus A(H1N1)pdm09 in the epidemic season of 2015/2016 Kharkiv RCIDH with COVID-19 on clinical and laboratory data was the aim of the work. Patients and research methods. The analysis of clinical symptoms and laboratory examination data of 19 patients with influenza complicated by community-acquired pneumonia of clinical group IV who were treated at the Kharkiv Regional Hospital and their comparison with those of patients with COVID-19 according to the literature. Results and discussion. Among the studied patients, men predominated ‒ 12 persons (63.2%) aged 50.68±11.95 years. The predominant number had concomitant diseases. At the beginning of the disease, moderate weakness, headache, fever, minor catarrhal phenomena and, as a result, delayed hospitalization prevailed. From 3‒4 days of the disease the condition significantly worsened, shortness of breath and cyanosis joined. Typical initial symptoms of COVID-19 are fever of varying degrees (73%), unproductive cough (59%) and shortness of breath or shortness of breath. Conclusions. In patients with COVID-19 and severe influenza, a more acute onset of the disease was reported, with moderate weakness, headache and fever up to 38°C and symptoms of pharyngitis. Influenza patients often show a delay in seeking medical attention and hospitalization for 6.21±1.46 days of illness. The severity of the disease in influenza is due to the accession of community-acquired pneumonia, in contrast to COVID-19, where the typical features are diffuse, mostly subpleural lung affection. Vaccination of people at risk before the start of the epidemic season is necessary to prevent severe complications of influenza caused by the pandemic virus A(H1N1)pdm09 in the context of the COVID-19 pandemic. Keywords: influenza, pneumonia, COVID-19, diagnosis.

Fungal complications with the new coronavirus infection COVID-19

BACKGROUND: The growth of fungal pathology observed in the last decade, including life-threatening invasive mycoses, is associated with the spread of immunodeficiency states of various etiologies. The COVID-19 pandemic has made a negative contribution, causing a significant increase in the number of patients with fungal complications.&#x0D; AIM: To characterize the types of fungal complications in the acute period of a new coronavirus infection COVID-19 based on an analysis of the clinical course and therapeutic tactics for managing the underlying disease.&#x0D; MATERIALS AND METHODS: The results of a bacteriological study of 1284 cultures from sputum samples of patients with suspected secondary pneumonia in COVID-19 are considered. The study included 404 cultures of various types of fungi. The analysis of the clinical picture was carried out in 70 patients with fungal complications of various localization, who were treated in a regional covid hospital. This group included the results of microbiological examination of sputum, bronchoalveolar lavage (BAL), scrapings from lesions in the oropharynx, urine, blood, biopsy and autopsy material. The study was conducted from April 01, 2020 to December 31, 2021. The patients were divided into subgroups depending on the isolated pathogen: Candida spp. ― 64 patients, and fungi (Aspergillus spp. and Mucor spp.) ― 6 patients; outcome of the disease: favorable 66, lethal 4.&#x0D; RESULTS: In the microbial landscape of the respiratory tract in patients with COVID-19, gram-negative microbial flora prevailed, one third of the cultures were represented by fungi. During the two years of the pandemic, the proportion of fungal cultures increased from 26.9% in 2020 to 34.2% in 2021, while maintaining sensitivity to amphotericin B and fluconazole in most cases. In 2021, there was a negative growth trend in the sputum of molds of the species Aspergillus spp. (5 cultures) and Mucor spp. (1 culture).&#x0D; Typical fungal complications of COVID-19 were: candidiasis stomatitis caused by Candida albicans (71%), candidiasis of other urogenital localizations in the form of candiduria (20%), lung damage of mixed viral-fungal etiology in isolated cases, leading to death due to invasive mycosis. Only fungal flora was isolated in 57.1% of cases, various combinations of fungal and bacterial flora in 42.9%. Candidiasis stomatitis was diagnosed on average on day 11.61.08 of COVID-19, which corresponded to days 2-3 of hospitalization. Preceding outpatient treatment, in most cases, included antibiotics and hormonal therapy with glucocorticosteroids. Urogenital Urogenital fungal infection was diagnosed on the 17.75.17 day of illness, on the second week of hospital treatment (8.03.11 days). Fungal flora in sputum was determined on average on the 18.54.33 day of illness, on the second third week of hospitalization against the background of intensive immunosuppressive therapy.&#x0D; CONCLUSION: Risk factors for the development of fungal complications are the age of patients older than 50 years, overweight and hypertension, uncontrolled use of antibiotics and glucocorticosteroids at the prehospital stage. Mycoses are recorded in both severe and moderate COVID-19. An additional factor in their development is immunosuppressive therapy of the underlying disease. The most formidable complication of the course of COVID-19, worsening the prognosis of survival, is the addition of fungi with invasive growth Aspergillus spp., Mucor, as well as the development of fungal-bacterial associations with damage to the lung tissue.&#x0D; In the context of the ongoing SARS-CoV-2 pandemic, the use of immunomodulatory agents, including the combined use of corticosteroids and targeted immunosuppressive drugs, it is important to develop a risk-based approach in diagnosis and treatment for patients at risk of generalized and invasive mycoses.

Developing and validating clinical features-based machine learning algorithms to predict influenza infection in influenza-like illness patients

BackgroundSeasonal influenza poses a significant risk, and patients can benefit from early diagnosis and treatment. However, underdiagnosis and undertreatment remain widespread. We developed and compared clinical feature-based machine learning (ML) algorithms that can accurately predict influenza infection in emergency departments (EDs) among patients with influenza-like illness (ILI). Material and methodsWe conducted a prospective cohort study in five EDs in the US and Taiwan from 2015 to 2020. Adult patients visiting the EDs with symptoms of ILI were recruited and tested by real-time RT-PCR for influenza. We evaluated seven ML algorithms and compared their results with previously developed clinical prediction models. ResultsOut of the 2189 enrolled patients, 1104 tested positive for influenza. The eXtreme Gradient Boosting achieved superior performance with an area under the receiver operating characteristic curve of 0.82 (95% confidence interval [CI] = 0.79–0.85), with a sensitivity of 0.92 (95% CI = 0.88–0.95), specificity of 0.89 (95% CI = 0.86–0.92), and accuracy of 0.72 (95% CI = 0.69–0.76) in the testing set over cut-offs of 0.4, 0.6 and 0.5, respectively. These results were superior to those of previously proposed clinical prediction models. The model interpretation revealed that body temperature, cough, rhinorrhea, and exposure history were positively associated with and the days of illness and influenza vaccine were negatively associated with influenza infection. We also found the week of the influenza season, pulse rate, and oxygen saturation to be associated with influenza infection. ConclusionsThe clinical feature-based ML model outperformed conventional models for predicting influenza infection.

Clinical Course and Outcomes among COVID-19 Patients at the Hospitel in Bangkok: A Retrospective Study.

A hospitel is a hotel that has been designated as an extension of the healthcare facilities during the COVID-19 pandemic in resource-limited settings. However, the clinical course and outcomes of patients with COVID-19 admitted to this unique type of facility have never been studied. We retrospectively reviewed the medical records of adult patients with COVID-19 who were admitted to a single hospitel in Bangkok, Thailand. Risk factors with respect to chest X-ray progression and clinical progression were analyzed using a logistic regression. A total of 514 patients were recruited, with a mean (standard deviation) age of 35.6 (13.4) years, and 58.6% were women. Patients were admitted after a median (interquartile range) of 3 (2–6) days of illness and were classified with mild (12.3%), moderate (86.6%), and severe (1.1%) conditions. Favipiravir and corticosteroids were prescribed in 26.3% and 14.9% of patients, respectively. Chest X-ray progression was found in 7.6% of patients, and hospital transfer occurred in 2.9%, with no deaths. Favipiravir use (odds ratio (OR) 3.3, 95% confidence interval (CI) 1.4–7.5, p = 0.005), nausea/vomiting after admission (OR 32.3, 95% CI 1.5–700.8, p = 0.03), and higher oxygen saturation on admission (OR 1.99; 95% CI 1.22–3.23, p = 0.005) were factors associated with chest X-ray progression. Additionally, an oxygen requirement on admission was an independent risk factor for hospital transfer (OR 904, 95% CI 113–7242, p < 0.001). In a setting where the hospitel has been proposed as an extension facility for patients with relatively non-severe COVID-19, most patients could achieve a favorable clinical outcome. However, patients who require oxygen supplementation should be closely monitored for disease progression and promptly transferred to a hospital if necessary.

COVID-19-Associated Rhino-Mucormycosis and Pulmonary Aspergillosis Infection

In the current pandemic, the incidence of fungal infections-associated COVID-19 is surging. Diabetes mellitus, overzealous steroid, and antibiotic use for COVID-19 management may cause or exacerbate the fungal disease. In paranasal sinus (PNS), ethmoids followed by the maxillary sinus are commonly involved with the risk of intra-orbital or/and intracranial involvement is quite common. In lungs, COVID-19 infection has higher mortality rate, if there is an associated fungal infection. Aspergillus fumigates is the most common fungus that cause lung infection and present as discrete lesion different from COVID-19 manifestation. Two cases of COVID-associated fungal infections, i.e., rhino-mucormycosis and pulmonary aspergillosis are described here. In the first case, computed tomography (CT) of PNS was done for the complaints of mild right-sided facial swelling and mild restriction of the eye globe on day 27 of illness. CT showed hyperdense content involving the right-sided nasal sinus with the remodeling of bones with erosion and thinning of the inferior and medial orbital wall with the extension of soft tissue into the extraorbital space. The patient was treated with Amphotericin B and posaconazole oral suspension as the first-line antifungal monotherapy. In the second case, on complaints of cough with expectoration on the 20th day of illness, X-ray chest and CT chest were done which confirmed a thick-walled cavity in the right lung and other post COVID features. The tracheal aspirate culture was suggestive of Aspergillus fumigatus and Aspergillus antigen galactomannan was found positive in the fluid. The patient was treated for the same with antifungal therapy. Hence it is important to pay attention to the high probability of fungal infections in COVID-19 patients. The association of coronavirus with mucormycosis of the PNSs and aspergillosis of the lung must be given outmost consideration. Noncontrast CT of the PNSs is usually the first investigation of choice for PNS involvement, and CT chest help in the diagnosis of pulmonary fungal infection. Uncontrolled diabetes and use of steroids are two of the main factors for aggravating factors. Both early surgical intervention and anti-fungal treatment should be sought for the management.

A randomized trial of probiotic supplementation in nurses to reduce stress and viral illness

Animal studies demonstrate how the gut microbiota influence psychological health and immunity to viral infections through their actions along multiple dynamic pathways in the body. Considerable interest exists in probiotics to reduce stress and illness symptoms through beneficial effects in the gut, but translating pre-clinical evidence from animal models into humans remains challenging. We conducted a large trial in nurses working during the 2020 COVID19 pandemic year to establish whether daily ingestion of the probiotic Lactobacillus rhamnosus HN001 reduced perceived stress and the number of days participants reported symptoms of a viral illness. Our results showed no significant difference in perceived stress or the average number of illness days between probiotic supplemented nurses and the placebo group. Stress and viral illness symptoms reduced during the study for all participants, a trajectory likely influenced by societal-level factors. The powerful effect of a well-managed public health response to the COVID19 pandemic and the elimination of COVID19 from the community in 2020 may have altered the trajectory of stress levels and reduced circulating viral infections making it difficult to detect any effect of probiotic supplementation. Our study highlights the challenge in controlling environmental factors in human trials.

State mental health insurance parity laws and college educational outcomes

We examine the effect of the state-level full parity mental illness law implementation on mental illness among college-aged individuals and human capital accumulation in college. We utilize administrative data on completed suicides and grade point average (GPA) and survey data on reported mental illness days and decisions to disenroll from college between 1998 and 2008 in a difference-in-differences (DD) analysis to uncover the causal effects of state-level parity laws. We find that state-level parity law reduces youth suicide rate and propensity to report any poor mental health day, increases college GPA, and does not change the propensity to disenroll from college.

NEUROTHERAPY IN PARKINSON’S DISEASE: THE PATH FORWARD AFTER SARS-COV-2 INFECTION AND CONTRACTING COVID-19, AND LONG COVID?

There is growing evidence to support the view that a variety of neurological, neurocognitive and neuropsychiatric sequelae occur following SARS-CoV-2 infection and NeuroCovid 19. Furthermore, scholars report that various syndromes, including Parkinson's disease (PD), can develop within a short period of time following on from COVID-19. Although the mechanism of this phenomenon is not fully understood and it is not known whether this is in fact an acceleration of the development of PD already 'smouldering' in the body or related to a viral infection, these patients need rehabilitation assistance. Recently, as adjuvant therapy, transcranial direct current stimulation (tDCS) has been shown to improve the motor and non-motor function of patients with Parkinson's disease (PD), including neurocognitive impairment and therefore potentially change their quality of life. The aim of this article is to show the effectiveness of tDCS in the treatment of the patient with newly diagnosed Parkinson's disease after infection with the SARS-CoV-2 virus and the contracting of NeuroCovid 19, and equally developing long COVID. The motivation would be to help other patients with a similar situation during the COVID-19 pandemic. A 62-year-old man, an academic Art Teacher, was infected with SARS-CoV-2 and contracted NeuroCOVID-19 on November 11, 2021. Initially, he lost his sense of smell (anosmia), of taste (ageusia), developed headaches, and dizziness. After 10 days of illness, the patient developed severe, level two infextion (according to Wise 2020), and he was hospitalized, sedated and mechanically ventilated for 30 days. After discharge from hospital, the patient was still weak with different symptoms. Four months later he was diagnosed with long COVID and also the neurodegenerative disease PD (according to the DSM-5 criteria). He received levodopa therapy, and was referred to the Reintegration and Training Center of the Polish Neuropsychological Society for further treatment. The functional neuromarker, that is hypoactivation of the left dorsolateral prefrontal cortex (DLPFC), obtained with the use of QEEG/ERPs was helpful in choosing the appropriate tDCS protocol. Neurostimulation with the use of anodal tDCS over these area of the brain was administered systematically for 20 days. He also received individual sessions of art therapy for 20 day. After the treatment the patient improved and returned to his previous work as a university art teacher. The proposed anodal tDCS over the left dorsolateral prefrontal cortex (DLPFC), in combination with goal-oriented individual art therapy, offered to the patient, was effective in the reduction of all his syndromes. ERPs can be useful in the diagnosis and treatment of patients following infection by SARS-CoV-2 who contracted COVID-19, developed long COVID and additionally PD. It allows for the detection of the functional neuromarker of PD (e.g., hypoactivation of the dorsolateral prefrontal cortex, DLPFC) and enabled the choosing of a proper tDCS protocol with the anode over these region of the brain, and also the selection of effective neurostimulation. The proposed protocol of tDCS tailored by the neuromarker offered to our patient, was effective in the reduction of longCOVID symptoms as well as early PD symptoms.

Clinical cases of extrapulmonary manifestations in patients with coronavirus disease (COVID-19)

The aim of the work – to provide variants of extrapulmonary manifestations of coronavirus disease (COVID-19) based on the analysis of the relevant course of the disease in adults. Results. The paper presents two clinical cases of coronavirus disease (COVID-19) with the manifestation of extrapulmonary symptoms, which required some individualization of therapy. The first clinical observation showed that in a 56-year-old patient with moderate COVID-19, the development of oxygen dependence on the 8th day of the disease was combined with the manifestation of extrapulmonary symptoms in the form of cutaneous manifestations. Individualization of glucocorticosteroid therapy and endothelioprotective therapy has been shown to be effective in regressing both oxygen dependence and cutaneous vasculitis. The second clinical observation showed that in a 35-year-old patient, moderate COVID-19 without oxygen dependence was accompanied by the development of extrapulmonary manifestations, namely short-lasting diarrheal syndrome, which manifested in the onset of the disease and of the development of orchiepididymitis on the 9th day of illness, which required the appointment of anti-inflammatory therapy. Conclusions. The abovementioned clinical observations of COVID-19 cases show relatively rare cases of SARS-CoV-2- associated extrapulmonary manifestations in patients with moderate disease, but their development necessitated individualization of treatment.

Therapeutic Window of Intravenous Immunoglobulin (IVIG) and its correlation with IVIG-resistant in Kawasaki Disease: a retrospective study

ObjectiveTo investigate the optimal timing of initial intravenous immunoglobulin (IVIG) treatment in Kawasaki disease (KD) patients. MethodsKD patients were classified as the early group (day 1-4), conventional group (day 5-7), conventional group (day 8-10), and late group (after day 10). Differences among the groups were analyzed by ANOVA and Chi-square analysis. Predictors of IVIG resistance and the optimal cut-off value were determined by multiple logistic regression analyses and receiver operating characteristic (ROC) curve analysis. ResultsThere were no significant differences in IVIG resistance among the 4 groups (p = 0.335). The sensitivity analysis also confirmed no difference in the IVIG resistance between those who started the initial IVIG ≤ day 7 of illness and those who received IVIG >day 7 of illness (p = 0.761). In addition, patients who received IVIG administration more than 7 days from the onset had a higher proportion of coronary artery abnormalities (p = 0.034) and longer length of hospitalization (p = 0.033) than those who started IVIG administration less than 7 days. The optimal cut-off value of initial IVIG administration time for predicting IVIG resistance was >7 days, with a sensitivity of 75.25% and specificity of 82.41%. ConclusionsIVIG therapy within 7 days of illness is found to be more effective for reducing the risk of coronary artery abnormalities than those who received IVIG >day 7 of illness. IVIG treatment within the 7 days of illness seems to be the optimal therapeutic window of IVIG. However, further prospective studies with long-term follow-up are required.

Role of T Lymphocyte Activation Profile in Predicting SARS-CoV-2 Severity: Experience from Tertiary Care Centre of North India.

BackgroundImmune dysregulation plays a key role in determining COVID-19 disease severity. We aimed to analyze the T cell activation profile in COVID − 19 cases and its predictive role in disease severity and outcome.Material & methodsThis was a prospective observational pilot study from a tertiary care COVID-19 hospital. Peripheral blood samples obtained between the fifth and seventh day of COVID-19 illness, were subjected to lymphocyte subset analysis using multicolor flowcytometry using a single tube, 8 antibodies (CD45, CD19, CD3, CD4, CD8, CD38, HLADR, and CD56) analysis. Correlation between lymphocyte subset analysis and clinical profile was determined.Results26 patients including 11 with mild disease and 15 with severe disease were enrolled. The median age was 58 years (range: 33–81), with a male: female ratio of 1.36:1. Significant lymphopenia was observed in the severe group compared to the mild group (p < 0.02). The absolute numbers of CD3+, CD4+, CD8 + T cells, B cells, and NK cells were significantly reduced in the severe group as compared to the mild group (p < 0.05). In patients with severe disease, the proportion of CD8 + and CD4 + T cells were significantly higher than those in patients with mild disease (p = 0.0372). Using ROC analysis, a CD4:8 T cell ratio of ≥ 2.63 and an activated (CD38 + HLA-DR+) CD8 T cell proportion of > 15.85% of the total CD8 T cell population, significantly determined the severe disease category.ConclusionsSevere COVID-19 is associated with severe lymphopenia, altered CD4/CD8 ratio and markedly increased CD8 T cell activation profile.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12288-022-01558-6.