Incidence Of COVID-19 Infection Research Articles

Does intravesical BCG for bladder cancer protect from COVID-19?

The study aimed to correlate the history of intravesical BCG as well as infantile BCG immunization with the incidence and severity of COVID-19 infection. Retrospective data collection of patients with high-risk non muscle invasive bladder cancer (NMIBC) from two Canadian centers. Data collection included a history of BCG instillation, infantile immunization, and the development of COVID-19 infection. Admission and/ or mortality because of COVID-19 was reported. We could include data from 348 patients: including 188 and 160 patients from Ontario and British Columbia respectively. COVID-19 affected 15% of these patients. Intravesical BCG was used in 44% of these patients. Intravesical BCG and/or infantile BCG immunization did not correlate with the incidence of COVID-19 infection. Previous intravesical BCG and/ or a history of infantile BCG vaccination were not more/ less frequent in patients who had COVID-19 infection.

SARS-CoV-2 vaccine breakthrough infection and the evaluation of safety precaution practice before and after vaccination among healthcare workers in South West, Nigeria

IntroductionWorldwide, it has been reported that fully vaccinated people still die of COVID-19-associated symptoms, generating public uncertainty about the safety and effectiveness of the vaccines. Hence, this research is aimed at assessing the incidence of COVID-19 breakthrough infection among vaccinated Health Workers and the possible effect of changes in the practice of post-vaccination safety precautions.MethodThis was a Health facility-based descriptive cross-sectional study. Data were collected using self-administered questionnaires distributed at the participant’s work unit across the selected health facilities. The nasopharyngeal specimen was also obtained from the participants and analysed using STANDARD Q COVID-19 Ag Test rapid chromatographic immunoassay for the detection of antigens to SARS-CoV-2. All data were input and analyzed using SPSS version 20.ResultsThere was a statistically significant relationship between the vaccination status of respondents and the post-vaccination test result (χ2 = 6.816, df = 1, p = 0.009). The incidence of COVID-19 infection among the vaccinated and unvaccinated HCWs was 2% and 8% respectively. 5 of the 15 respondents who tested positive for COVID-19 had been fully vaccinated. However, all 5 of them did not practice safety measures after vaccination. None of the respondents who practised safety measures after vaccination tested positive for COVID-19. The remaining 10 respondents that tested positive for COVID-19 had not been vaccinated though they practised safety precautions.ConclusionVaccination and the practice of safety precautions will go a long way to preventing future COVID-19 breakthrough infections.

The Impact of COVID-19 Infection on Patients with Severe Chronic Pulmonary Hypertension: A Prospective Study from a Single Referral Center.

Background and Objectives. COVID-19 infection has a significant burden on global morbidity and mortality, especially in elderly people and in patients with chronic respiratory and cardiovascular diseases, such as pulmonary hypertension (PH). We aimed to evaluate the impact of COVID-19 infection on patients diagnosed with severe chronic PH. Materials and Methods. A single-center prospective cohort study was performed. Patients were enrolled from 1 November 2020 to 31 December 2022. Follow-up was until 31 December 2023. Data were collected on PH diagnosis, clinical presentation, outcomes, brain natriuretic peptide (BNP) levels, pulmonary function test with lung diffusion capacity for carbon monoxide (DLCO), and computed tomography pulmonary angiography (CTPA) analysis. Results. During the 26 months of our study, 51 PH patients were diagnosed with COVID-19 infection. The majority, 44 (86.3%) of all COVID-19 infected patients, were treated on an outpatient basis, and 7 (13.7%) required hospitalization. During the follow-up period, 8 (15.7%) patients died: 4 (7.8%) due to complications of COVID-19 infection, and the other 4 (7.8%) died in the later stages of the follow-up period after recovery from acute COVID-19 infection. Therefore, the in-hospital mortality in our study was 43% (n = 3). As mentioned above, the overall mortality was 7.8% (n = 4). Higher BNP levels in the third month after COVID-19 were associated with higher mortality rates (p = 0.028). Lung function, including DLCO, did not significantly worsen with COVID-19. In our study, 24 patients (47.1%) were referred for a follow-up CTPA scan and one of them developed typical fibrotic lung changes after COVID-19. Conclusions. The incidence of COVID-19 infection in patients diagnosed with PH was 34%. In our patients with severe chronic PH, the overall mortality rate due to COVID-19 infection was low. Pulmonary fibrosis was a rare complication in our cohort. COVID-19 infection in severe PH may increase the risk of worsening chronic heart failure.

Safety and Efficacy of the Ayurvedic Formulation Guduchi Ghana Vati as a Preventive Remedy in COVID-19.

Background and objectives Guduchi (Tinospora cordifolia) is a well-known Ayurvedic herb used as a preventive and curative remedy for various infections and immunity-related conditions. This study aimed to evaluate Guduchi Ghana Vati as a preventive remedy for COVID-19 and non-COVID-19 infections in a healthy population. Materials and methods An open-labeled, multi-centric, randomized, comparative, interventional, prospective community-based clinical study was conducted on healthy individuals at the community level in five different districts of Rajasthan by the National Institute of Ayurveda (NIA), Jaipur, India. Participants were divided into two groups. One group received Guduchi Ghana Vati as an intervention for 45 days, and the control group did not receive any intervention. Incidences of COVID-19 infection, non-COVID-19 infections, their severity, and hospitalization requirements were assessed. Safety was evaluated through monitoring of adverse reactions. Results Among the 10,022 participants who completed the study, the incidence of COVID-19 infection was found to be lower in those taking Guduchi Ghana Vati compared to the control group; however, the difference was statistically non-significant. The severity of COVID-19 based on the WHO ordinal scale was found to be significantly lower in the Guduchi Ghana Vati group compared to the control group. The number of episodes and severity of non-COVID-19 illness were also significantly lower in participants taking Guduchi Ghana Vati compared to the control group. No major adverse drug reactions were observed. Conclusion Guduchi Ghana Vati has the potential to act as a safe and effective remedy for the prevention of infection and immunity-related conditions, including COVID-19.

Efficacy of Health Surveillance and Polymerase Chain Reaction Testing in Judo During the COVID-19 Pandemic.

Background The COVID-19 pandemic necessitated infection control for all sporting activities. More careful infection control measures are required in judo, where close contact with opponents cannot be avoided. The Medical Science Committee of the All Japan Judo Federation (AJJF) established infection control guidelines for daily practice and competitions. Infection control measures were also implemented at the national tournament organized by the AJJF. Objective and methods This study aimed to examine the effectiveness of pre-tournament health surveys and PCR testing in guidelines for judo tournaments. Participants had to complete a health survey one to two weeks before the tournament. Initially, PCR testing was performed on all athletes; however, the final policy was to conduct PCR testing only on athletes with an infected person (risk team testing method). The effectiveness of these methods was also examined. Results In 16 competitions between October 2020 and March 2023, 6980 contestants were registered, and PCR testing was performed on 3672 athletes; 29 (0.79%) had a positive PCR test. Only two contestants were unable to attend the tournament because of the health survey. No competition-related cluster outbreaks were observed. From May 2022, the competition was held under the guideline that only teams at risk of infection were tested and could only compete when they tested negative. No teams were tested according to this guideline. In the competitions organized within this guideline, only one person could not compete because of the information provided in the health survey. No clusters were observed in any of the competitions. The incidence of COVID-19 infection in the first week after the convention was 20 (0.60%) in testing only at-risk teams and 21 (0.57%) in testing all competitors, which was not significantly different.(p=0.62) Conclusion During the COVID-19 epidemic, health surveillance was necessary to prevent the registration of competitors at risk of infection prior to tournaments. If teams at risk of infection could be identified, PCR testing of all athletes might not be mandatory, and competitions could be organized safely. The Judoinfectious disease control guidelines we have developed might be used for other contact sports in the future when other infectious diseases are prevalent.

Testing Positive for Covid-19, Signs and Symptoms, Treatment, and Covid-19-Related Anxiety: A Case of Factory Workers

Objective: This paper investigated the incidence of COVID-19 contraction, signs and symptoms, treatment, pandemic-related anxiety, and related factors in factory workers.
 Methods: This was a descriptive study conducted in a factory operating in the textile industry. No sampling was performed. The sample consisted of 287 volunteers. Data were collected using a sociodemographic characteristics questionnaire and the Coronavirus Anxiety Scale Short Form.
 Results: Less than half the participants tested positive for COVID-19 (41.1%). They were treated at home (68.6%) or in a hospital (19.5%). The most common symptoms were fatigue, joint pain, change in the sense of taste, and headache. The mean duration of home and hospital treatment was 7.00±0.00 and 12.49±6.14, respectively. Participants had a mean anxiety scale score of 7.65±3.71. Less than half the
 participants (31%) had high COVID-19 anxiety levels. The incidence of COVID-19 infection and anxiety was higher in participants who were on medication for chronic illnesses. Age and BMI were correlated with hospitalization for COVID-19.
 Conclusions: The incidence of COVID-19 infection is high among factory workers. Therefore, authorities should consider them a priority group for vaccination and provide them with training on COVID-19 risk factors and preventive measures.

Perbandingan Luaran Maternal dan Perinatal Kehamilan Terkonfirmasi Covid-19 antara Gelombang Pertama dan Kedua Pandemi

Background : New cases of COVID-19 continued to emerge due to the new variants. Pregnant women are more susceptible to severe infections.Objective : To compare the effect of COVID-19 infection on maternal and perinatal outcomes in the first and second waves.Method : An analytical observational study with a cross-sectional design was used. Samples were selected by consecutive sampling from the medical record data of RSUP Dr. Kariadi Semarang, Indonesia, with 47 cases during the first wave (1 August 2020 to 14 May 2021) and 47 cases during the second wave (16 May to 30 September 2021). Data were analysed using univariate, chi-square, fisher’s exact, and logistic regression tests with a significant value of p <0,05.Results and Discussion : Pneumonia, ICU admission, and oxygen consumptions were higher in the second than the first wave as 87.23% VS 70.21%; p = 0.044, 36.17% VS 14.89%; p = 0.018, 65.96% VS 12.77%; p < 0.0001 respectively. The severe COVID-19 infection and maternal mortality increased in the second wave (51,06% VS 14,89%; p = 0.009; 29,79% VS 8,51%; p = <0.001). There were no differences in perinatal outcomes between the first and second waves such as fetal distress, fetal growth retardation, low birth weight, nICU admission, and mortality (0.00% VS 8.51%; p = 0.117, 0.00% VS 4.26%; p = 0.495, 12.77% VS 25.53%; p = 0.116, 12.77% VS 21.28%; p = 0.272, 4.26% VS 8.51%; p = 0.677). The incidence of COVID-19 infection in neonates remained low in both waves at 17.02% VS 12.77%; p = 0.562.Conclusion : Even though a high number of severe diseases to maternal deaths were found during the second wave, neonatal COVID-19 infections remained low.

Impact of the COVID-19 pandemic on lung transplant patients and on a cohort of patients with rare lung disease: A single-center study

IntroductionDue to the COVID-19 pandemic, France underwent several lockdown periods during 2020. Our aim was to evaluate its clinical and social impact on lung transplant (LT) patients treated at Strasbourg University Hospital, by comparing three periods: first lockdown (T1: March-May 2020), end of the first lockdown (T2: May-October 2020), and second lockdown (T3: November-December 2020) and the incidence of COVID-19 infections. A cohort of patients with rare lung disease (RLD) was also studied during T2. MethodsWe used clinical and paraclinical data collected during routine follow-up. A questionnaire was submitted to each patient at each period to assess their lifestyle, adherence to protective measures against COVID-19, contacts with their family and friends, and contagion risk. The incidence of new COVID-19 cases was also assessed. ResultsOverall, 283 LT and 57 RLD patients were included. We observed only eight COVID-19 cases over the three periods (n = 4 during T1, n = 0 during T2, and n = 4 during T3) in LT patients, with 37.5 % of patients hospitalized, no ICU transfers, and 100 % favorable outcomes. No case of COVID-19 was diagnosed in the RLD cohort. When comparing the three periods in the LT group, fewer patients limited their out-of-home activities during T2 (p < 0.0001). The frequency of these activities increased after the first lockdown, for the purchase of basic necessities (p < 0.0001), and professional activity continued (p = 0.008). We observed a significant increase in unscheduled medical consultations and in the prescription of anti-infective treatments during the end of the lockdown (p = 0.0002 and p = 0.005, respectively). Adherence to lockdown and to protective measures was high in both groups of patients. ConclusionCOVID-19 incidence remained low in both groups and there were significant lifestyle evolutions in LT patients and in those with RLD between first and second lockdown.

"Effect of COVID-19 Vaccination on Menstrual Cycle Patterns of Reproductive-Age Women: A Multi-centric Observational Study."

The study was conducted to know the impact of COVID-19 vaccination on menstrual cycle patterns and pre- and post-menstrual symptoms in women aged 18-45 years. COVID-19 vaccination was introduced to combat the dreadful impacts of human coronavirus infection. The two indigenously developed COVID-19 vaccines approved for use in India are COVISHILED and COVAXIN. To investigate the effects of COVID-19 vaccination on the menstrual cycle, pre- and post-menstrual symptoms and to establish the correlation with the type of vaccine received. Multi-centric observational study conducted in six institutes of national importance in different states of India over one year. A total of 5709 female participants fulfilling inclusion criteria were enrolled. Data about the impact of vaccines (COVISHIELD and COVAXIN) and prior COVID-19 infection on the menstrual cycle and its associated symptoms were obtained using all participants' online and offline interviews. Of 5709 participants, 78.2% received COVISHIELD and 21.8% COVAXIN. Of the total 5709 participants, 333(5.8%) developed post-vaccination menstrual disturbances, with 32.7% having frequent cycles, 63.7% prolonged cycles, and 3.6% inter-menstrual bleeding. A total of 301 participants noticed changes in the amount of bleeding, with 50.2% excessive, 48.8% scanty, and 0.99% amenorrhea followed by heavy bleeding. Furthermore, the irregularities of the menstrual cycle (p=0.011) and length (0.001) were significantly higher in the COVAXIN group (7.2%) as compared to the COVISHIELD (5.3%) group. A total of 721 participants complained of newly developed/worsening pre- and post-menstrual symptoms. These symptoms were significantly higher in the COVISHIELD group (p=0.031), with generalized weakness and body pains as the main complaints (p=0.001). No significant difference was observed in the incidence of COVID-19 infection with these vaccines. No significant associations were observed when comparing menstrual abnormalities among those with COVID-19 infection (p>0.05). COVISHILED and COVAXIN vaccines were associated with menstrual cycle disturbances and pre-and post-menstrual symptoms in a small proportion of participants, with 94.7% having no change in the amount of bleeding during menstruation post-vaccination. The menstrual irregularities observed were significantly higher with the COVAXIN vaccine. Others: Further, long-term studies are required to confirm that the impact of COVID-19 vaccination on the menstrual cycle may be short-lasting, with no severe effects on women's menstrual health.

Efficacy and Safety of Tixagevimab-Cilgavimab (Evusheld or AZD7442) As Pre-Exposure Prophylaxis for COVID-19 Among Allogeneic Hematopoietic Stem Cell Transplant Recipients

Background: Tixagevimab-Cilgavimab (Evusheld or AZD7442) is a combination of two monoclonal antibodies directed against viral spike proteins from binding to hosts' enzyme receptors, thus blocking viral entry into cells. The drug is FDA approved for use as pre-exposure prophylaxis (PrEP) in immunocompromised patients including Allogeneic hematopoietic stem cell transplant (Allo-HSCT) recipients. It has potential to both prevent and treat COVID-19, reducing incidence of severe infections and death for up to 6 months. Allo-HSCT patients are at higher risk of COVID-19, and may fail to mount a robust immune response to vaccination. In this study, we investigate the efficacy and safety of Evusheld in Allo-HSCT recipients 6 months following transplant at our institution. Methods: We performed a retrospective analysis of Allo-HSCT recipients treated at our institution between January 2021 to January 2023. Descriptive statistics related to the participant baseline characteristics, treatment, and transplant data were reported. The incidence of COVID-19 infections and safety data between two groups (Evusheld versus non-Evusheld) were estimated. Results: A total of 48 Allo-HSCT recipients were included in our study, 23 (47.9%) patients received PrEP Evusheld. The median age at transplant was 54.6 years. Patients were predominantly males (58.3%). Notable comorbidities included hypertension (56.3%), diabetes (20.8%), hyperlipidemia (27.1%), and cardiovascular diseases (20.8%). Indications for transplant included acute myeloid leukemia (47.9%), acute lymphocytic leukemia (6.3%), chronic myelogenous leukemia (8.3%), myelodysplastic syndromes (18.8%), and other hematologic malignancies (18.8%) (Table 1). The efficacy and safety results of Evusheld were shown in Table 2. The median time from transplant to Evusheld administration was approximately 100 days. There was no significant difference in the incidence of Covid infection (RR=0.842, 95% CI: 0.196-3.615, p=1.00) or severe Covid infection (RR=0.69, 95% CI: 0.10-4.60, p=1.00) between the two groups following transplant. All-cause mortality (death or hospice) was also comparable between the two groups (RR=0.375, 95% CI: 0.080-1.748, p=0.272). The rate of severe acute graft-versus-host (GVHD) and infections were comparable between the two groups, including clostridium difficile, cytomegalovirus (CMV), BK virus, human herpesvirus-6 (HHV-6), Epstein-Barr virus (EBV), and other bacterial and fungal infections. Conclusions: Our study found no evidence of efficacy of Evusheld against COVID-19 after Allo-HSCT transplant. This lack of efficacy may be attributed to the emergence of the XBB.1.5 subvariant of omicron during the study period. We also found no difference in all-cause mortality between the two groups. Further data is required to gain a comprehensive understanding of the potential use of Evusheld in transplant populations.

Religion, Covid-19 and mental health

Covid-19 and the resulting lockdowns affected various aspects of people’s lives, including their mental health. Using data from an online survey, we investigate the role of religiosity in mediating the effect of Covid-19 on mental health. From February-March 2021, we conducted online surveys in the USA among 5178 individuals. These surveys elicited responses on (i) the incidence of Covid-19 infections among the respondents or their immediate social networks, (ii) religious beliefs and practices, and (iii) mental health. Employing the CES-D scale, which tests for depression in clinical settings, we find that while the incidence of a Covid-19 infection is associated with significantly worse mental health, this negative association is significantly smaller for religious people. We show that the mental health benefits of being religious emanate from the ability to participate in religious activities.

Characteristics of pediatric COVID-19 infections and the impact of influenza and COVID-19 vaccinations during the first two years of the pandemic.

The data regarding the demographics of SARS-CoV-2 in the pediatric population has been published based on several single-center experiences or on metanalyses over short time frames. This article reports data on the demographics of pediatric patients with COVID-19 on a global scale using the TriNetX COVID-19 Research Network. In addition, we examined the risk of COVID-19 infection in relation to the body mass index (BMI) category and the protective value of influenza and COVID-19 immunization against COVID-19 infection. The incidence of COVID-19 infection was higher in the younger age group (≤6 years old), but no gender differences. The incidence of COVID-19 infection was higher among African Americans/Black race (28.57%) White race (27.10%), and obese patients; across all age groups, all genders, all races, and ethnicities (p < 0.0001). The incidence of MIS-C was also higher in patients with obesity (OR 1.71, CI 1.36-2.14). We found that the patients who were neither vaccinated for COVID-19 nor influenza within one year before their COVID-19 diagnoses compared to those who received influenza vaccine only, had significantly higher odds for hospitalization (OR 1.19, CI 1.18-1.21), development of MIS-C (OR 1.52, CI 1.32-1.74), and more importantly mortality (OR 1.47, CI 1.26-1.71). In addition, those patients who were neither vaccinated for COVID-19 nor influenza within one year before their COVID-19 diagnoses, compared to those who received at least one dose of COVID-19 vaccine, had significantly higher odds for hospitalization (OR 1.11, CI 1.04-1.19). However, those patients who did not receive the influenza vaccine within one year before their COVID-19 diagnoses nor received the COVID-19 vaccine had much higher odds for hospitalization (OR 1.46, CI 1.41-1.51), MIS-C (OR 3.72, CI 2.11-6.56), and mortality compared to those who received both vaccinations (OR 13.55, CI 1.91-9.62). Using the multiplicative interaction scale, we found a positive interaction between the COVID-19 vaccine and the influenza vaccine; they both combined have a larger effect than each separately. Our study is the largest of its kind (to date) examining the global demographic of the pandemic and the first of a kind to find a link between influenza vaccine and COVID-19-related hospitalization, MIS-C, and mortality in the pediatric population.

Outpatient management of sarcoidosis in the COVID-19 pandemic

Introduction. COVID-19 infection alters the body’s immune tolerance, which can affect the course of systemic diseases caused by alterations in immune function. Patients with sarcoidosis, just like patients with systemic diseases, have impaired immune system function. They receive immunosuppressive therapy, so they are at risk of infectious diseases, including the viral ones.Aim. To investigate the course of sarcoidosis in the period 2020-2022, the incidence of COVID-19 infection in patients treated by the pulmonologist of the sarcoidosis-polyclinic office of the Krasnoyarsk Regional Clinical Hospital and to evaluate the incidence of sarcoidosis after COVID-19.Materials and methods. 301 outpatient charts of patients diagnosed with sarcoidosis were analyzed. Anamnestic data, information on vaccination against COVID-19, results of physical examination, multispiral computed tomography of thoracic organs in dynamics, data and methods of morphological verification, the volume of the received therapy for sarcoidosis were assessed.Results. There was evidence that the combination of active sarcoidosis and COVID-19 did not contribute to a severe course of viral infection and progression in the course of granulomatosis. In patients with baseline moderate or severe pulmonary function impairment due to sarcoidosis and long-term use of systemic glucocorticosteroids, no increase in the incidence of adverse COVID-19 outcomes was noted. When analyzing fatal cases, it became known that in the first case, chronic recurrent sarcoidosis and prolonged use of systemic glucocorticosteroids were the factors determining the adverse prognosis in COVID- 19 In the second case, the combination of sarcoidosis with cardiovascular disease, diabetes mellitus, and obesity were adverse outcome factors. New cases of sarcoidosis after COVID-19 have been reported, this may be explained by the interaction between SARS-CoV-2 and human immune system, imbalance of proand anti-inflammatory cytokines, disruption of interferon production. However, this statement requires further research.

Risk factors associated with blood vitamin D levels in COVID-19 patients

The two main factors associated with infectious diseases are the presence of antigens that enter the body and the immune system. It has been recently reported that vitamin D may be associated with the immune system. This study aimed to analyze the relationship between blood vitamin D levels and the occurrence of COVID-19 infection. This study used a cross-sectional approach for analytical survey research. The population in this study were all lecturers at Malahayati University. The total population participating in this study was 62 lecturers at Malahayati University. Direct competitive chemiluminescence immunoassays were used to measure vitamin D levels, while interviews collected other variables. Logistic regression analysis has been used to analyze the collected data. Results: There was a significant relationship between vitamin D levels and the incidence of COVID-19 infection (p= 0,020; OR= 4,9) &amp; the habit of always wearing long clothes for more than 10 years is significantly related to blood vitamin D levels (p= 0,021; OR= 5,07). In conclusion, the lower the vitamin D level, the greater the risk of being infected with COVID-19, and the longer you wear long clothes, the higher the risk of having low blood vitamin D levels.

Musculoskeletal corticosteroid injections were used safely in patients during the COVID-19 pandemic

Objectives: Studies have highlighted that corticosteroid use can cause immunocompromise. During the COVID-19 pandemic, caution was advised on corticosteroid injections (CSIs) use and the possibility of increasing patients’ susceptibility to COVID-19. CSI is commonly used to manage pain, which is increasingly important with prolonged waiting lists. This study aimed to assess the occurrence of COVID-19 infection following the administration of CSI for musculoskeletal pain. Methods: A prospective cohort study of patients receiving CSI for musculoskeletal conditions through the COVID-19 pandemic was followed. It monitored post-injection through clinical review and telephone follow-up as to whether they were diagnosed with COVID-19 or had its symptoms. Patients were administered either half or full-dose corticosteroids as per guidance at the time. Patients were followed up at 8 weeks, 3 and 6 months. Results: One hundred and ninety-six patients were included (100 males and 96 females). One hundred and fourteen patients received 40 mg of Depo-Medrone, and 90 received 20 mg of Depo-Medrone. No patients suffered COVID-19 symptoms or had positive viral polymerase chain reaction (PCR) tests by 3-month follow-up. By the 6-month follow-up, four of the cohort had mild symptoms and a positive PCR test for COVID-19. None required hospitalization. Conclusion: Our study demonstrated only a 2% incidence of COVID-19 infection following the administration of CSI for musculoskeletal pain within the 6-month follow-up, despite a high local prevalence for infection. We observed no correlation between CSI and COVID-19 acquisition and noted no clear increase in risk. We would therefore endorse CSI use if required for patients after careful patient selection and shared decision-making.

Enhanced recovery program after laparoscopic colorectal surgery during the era of COVID-19: a randomized controlled trial

BACKGROUND: COVID-19 pandemic affected health services and made patients delay consultation for medical health problems. Due to the high infectivity of the virus, hospital became full off COVID-19 infected patients, the state of emergency was announced, and the people was forced to stay at home. Moreover, as people were worried to get infected, a decrease in the number of medical consultations was recorded. So, the role of enhanced recovery program is present in decreasing hospital stay, especially for those patients with GI cancer and emergent surgeries.METHODS: The investigators included all patients who were subjected to laparoscopic colorectal surgery at our center between (December 2019 to December 2021) for benign and malignant conditions. Sample size consists of 50 patients, divided into 2 equal groups. Group 1 included 25 patients who were subjected to enhance recovery program after laparoscopic colorectal surgery. Group 2 included 25 patients who were subjected to the traditional way: nothing orally until the disappearance of ileus, then a fluid diet followed by a regular diet after laparoscopic colorectal surgery.RESULTS: Most of the patients tolerated the early oral feeding. The times to first passage of flatus and stool were significantly earlier in group 1. Hospital stay was also significantly less in the early feeding group 1. Operative time and amount of blood loss of early had an effect on the tolerability oral feeding, while age, gender and type of operation had no such effect. The incidence of COVID-19 infection was low in group 1.CONCLUSIONS: Enhanced recovery program after laparoscopic colorectal surgery during the era of COVID-19 decrease postoperative complications and shorten hospital stay and lower healthcare cost and incidence of COVID-19 infection.

Application of N-Acetyl-Glucosaminil-N-Acetyl-Muramyl Dipeptide during Triple Component Anti-Helicobacter Pylori Therapy in the Period of Coronavirus Infection COVID-19

Aim: evaluation of the incidence of COVID-19 infection after three-component H. pylori eradication therapy while taking N-acetyl-glucosaminyl-N-acetyl-muramyl dipeptide (GMDP).Materials and methods. A prospective randomized comparative clinical study was carried out. The study included 208 patients (147 men, 61 women; mean age — 48.1 ± 14.5 years) with duodenal ulcer associated with Helicobacter pylori (H. pylori) who underwent eradication therapy. H. pylori in the gastric mucosa was detected by a morphological method and a rapid urease test before treatment and 6-8 weeks after the end of treatment and the withdrawal of all drugs. Patients were divided into three groups according to treatment protocols: omeprazole 0.04 g/day, clarithromycin 1 g/day, amoxicillin 2 g/day (OСA; n = 103); omeprazole 0.04 g/day, clarithromycin 1 g/day, amoxicillin 2 g/day + GMDP 0.001 g/day (OCAL1; n = 61) or 0.01 g/day (OCAL10; n = 44) for 10 days. Detection of SARS-CoV-2 RNA by PCR was carried out from April 2020 to April 2022. Tracking completeness was 96.6 %.Results. The frequency of H. pylori eradication depending on “intention to treat” (ITT) and “per protocol” (PP): OCA — 79 % (95 % CI: 71-87) and 83 % (95 % CI: 75-91); OCAL1 — 95 % (95 % CI: 88-100) and 97 % (95 % CI: 92-100); OCAL10 — 96 % (95 % CI: 89-100) and 98 % (95 % CI: 93-100) respectively. The frequency of adverse reactions depending on ITT and PP: OCA — 24 % (95 % CI: 16-33) and 26 % (95 % CI: 17-35); OCAL1 — 2 % (95 % CI: 0.01-8) and 2 % (95 % CI: 0.01-8); OCAL10 — 2 % (95 % CI: 0.01-7) and 2 % (95 % CI: 0.01-7). The incidence of COVID-19 infection depending on ITT and PP: OCA — 9 % (95 % CI: 3-14) and 9 % (95 % CI: 3-15); OCAL1 + OCAL10 — 1 % (95 % CI: 0.003-1.9) and 1 % (95 % CI: 0.001-2.9), respectively.Conclusions. In H. pylori-infected patients, GMDP (an immunomodulator based on L. bulgaricus) at a dose of 1-10 mg/day, during a 10-day triple eradication therapy, allows a significant (p &lt; 0.05) increase in the frequency of H. pylori eradication and reduce the incidence of adverse reactions compared with a 10-day protocol without adjuvant therapy with GMDP. There was a significant (p &lt; 0.05) decrease in the incidence of COVID-19 infection after H. pylori eradication therapy with GMDP.

Overview of the cardio-metabolic impact of the COVID-19 pandemic.

Evidence has shown that cardiometabolic disorders (CMDs) are amongst the top contributors to COVID-19 infection morbidity and mortality. The reciprocal impact of COVID-19 infection and the most common CMDs, the risk factors for poor composite outcome among patients with one or several underlying diseases, the effect of common medical management on CMDs and their safety in the context of acute COVID-19 infection are reviewed. Later on, the changes brought by the COVID-19 pandemic quarantine on the general population's lifestyle (diet, exercise patterns) and metabolic health, acute cardiac complications of different COVID-19 vaccines and the effect of CMDs on the vaccine efficacy are discussed. Our review identified that the incidence of COVID-19 infection is higher among patients with underlying CMDs such as hypertension, diabetes, obesity and cardiovascular disease. Also, CMDs increase the risk of COVID-19 infection progression to severe disease phenotypes (e.g. hospital and/or ICU admission, use of mechanical ventilation). Lifestyle modification during COVID-19 era had a great impact on inducing and worsening of CMDs. Finally, the lower efficacy of COVID-19 vaccines was found in patients with metabolic disease.

COVID-19 Maternal Prevention Behavior and Future Intention to Vaccinate for Children

During the COVID-19 pandemic, this study aimed to understand how a mother's current COVID-19 prevention behaviors were associated with the mother's future intention to vaccinate their children against COVID-19. Using a cross-sectional online survey, mothers who had at least one child between 3 and 15 years old were recruited. COVID-19 prevention behaviors evaluated were wearing a mask, appropriate coughing/sneezing, social distancing, staying home, and handwashing. Participants' age, marital status, race, educational level, incidence of COVID-19 infection in the household, healthcare worker in the household, and future intention to vaccinate children were obtained. Among the 595 participants, 38.3% indicated they did not intend to use the COVID-19 vaccine for their children. Participants with no intention for vaccination had lower mean scores on wearing masks (p < 0.0001), social distancing (p < 0.0001), staying home (p < 0.0001), and handwashing (p < 0.05). The incidence of COVID-19 infection in the household was associated with a lower mean score of staying home (p < 0.01). Our findings indicate that most mothers were compliant with the CDC recommended guidelines at the time of the survey. Mothers who indicated high adherence to prevention behaviors had a higher likelihood to consider vaccination for their children. Now that the COVID-19 vaccine is available for children as young as six months, healthcare providers need to be aware of the relationship between current prevention behaviors and future intention to vaccinate. They need to counsel parents appropriately with recommendations for children to keep practicing prevention behaviors.

To Compare the Maternal and Fetal Outcomes of COVID-19-Affected Expectant Mothers During the First and Second COVID-19 Waves: Data From a Tertiary Care Referral Hospital in Punjab.

Coronavirus 2019 (COVID-19) infection, declared pandemic in March 2020 by the World Health Organization, paved the way for newer researchin the field of medicine. The second wave, beginning in March 2021, appeared to be more devastating. The purpose of this study is to evaluate the clinical characteristics, effects of COVID-19 infection in pregnancy, and obstetric and perinatal outcomes in thefirst and second waves. This study was conducted from January 2020 to August 2021 at the Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab. The patients were enrolled immediately after each infected woman was identifiedas per the inclusion and exclusion criteria. Demographic details of the patients,associated comorbid conditions, intensive care unit (ICU) admission, and treatment details were noted. Neonatal outcomes wererecorded. The testing of pregnant women was done as per the Indian Council of Medical Research (ICMR) guidelines. There were3421 obstetric admissions and 2132 deliveries during this period. Group 1 had 123 COVID-19-positive admissions, while group 2 had 101 admissions. The incidence of COVID-19 infection in pregnancy was 6.54%. In both groups, the majority of patients were between the ages of 21 and 30. About 80(66%) of the admissions in group 1and 46(46%) in group 2 were in the gestational age of 29-36 weeks.Multiparity was more common in both groups, with 58% of cases in group 1 and 79% of cases in group 2. Obstetric comorbidities werecommon in both groups, seen in 46% of cases in group 1 and 78% of cases in group 2. The majority ofpatients were asymptomatic in group 1, with an 89% incidence, whereas only33% of patients in group 2 were without symptoms. In biological data,D-dimers, prothrombin time, and platelet count were altered in 11%, 14%, and 17% of cases, respectively, in group 2, with almost normal data in group 1. Most cases in group 2 (52%) were critical cases in the moderate and severe categories requiring intensive care unit (ICU) treatment, whereas there was only single ICU admission in group 1. The overall case fatality rate (CFR) in group 2 was found to be 19.8(20/101). Delivery by cesarean section was done in 38.2% of cases in group 1, while in 33% of cases in group 2, with a significant p-value of 0.001. About 29% of cases in group 1 and 34% of cases in group 2 underwent vaginal delivery. The rate of abortion was almost similar in both groups. Only two cases in group 1 and nine cases in group 2 had intrauterine fetal death. Observations of neonatal outcomes suggested that five cases in group 2 and two cases in group 1 had severebirth asphyxia. Only one case in group 1 and four cases in group 2 had positive COVID-19 status. Maternal mortality was significantly higher in group 2 with 20 cases, while only one case was in group 1. Anemia and pregnancy-induced hypertension were the chief comorbidities in this group. COVID-19 infection during pregnancy may be associated withmaternal mortality while having a minimal effect on neonatal morbidity and mortality. The possibility of maternal-fetal transmission cannot be ruled out completely. The severity and characteristics of COVID-19 may vary in each wave, and we need to modify treatment strategies. More studies ormeta-analyses reports are required to authenticate this transmission.