Management Of COVID-19 Patients Research Articles

Progressive muscle relaxation alleviates anxiety and improves sleep quality among healthcare practitioners in a mobile cabin hospital: a pre-post comparative study in China

ObjectiveTo investigate the anxiety levels, sleep quality and potential risk factors of healthcare practitioners involved in the management of COVID-19 patients in a mobile cabin hospital, and further to assess the impact of progressive muscle relaxation (PMR) on their anxiety levels and sleep quality.MethodsWe conducted a pre-post self-controlled trial. Healthcare practitioners meeting the inclusion criteria underwent daily 30-min PMR sessions for seven consecutive days. The Pittsburgh Sleep Quality Index (PSQI) and Hamilton Anxiety Scale (HAMA) were used to assess the anxiety and sleep quality of subjects pre- and post-intervention. Statistical analysis was performed using the Wilcoxon test, Mann–Whitney U test, Kruskal-Wallis H test, and Spearman rank correlation.ResultsA total of 94 participants completed the study. No statistically significant differences in HAMA or PSQI total scores were observed between groups categorized based on demographic variables such as age, sex, and years of education (p > 0.05). The PSQI total score and its components (excluding sleep medication usage) exhibited a positive correlation with the HAMA total score and its psychological anxiety component (p < 0.05), and a correlation was observed between somatic anxiety manifestations and several components of the PSQI. The PSQI total scores before and after intervention were 10.0 (8.0, 13.0) and 8.0 (6.0, 9.0) respectively (p < 0.001); the HAMA total scores were 8.0 (5.0, 13.0) and 6.0 (4.0, 9.5) respectively (p < 0.001). The detection rates of poor sleep and anxiety states, along with their severity, significantly decreased post-intervention (p < 0.001).ConclusionHealthcare practitioners experience prominent anxiety and sleep issues in the mobile cabin hospital. PMR can be an effective intervention for improving the anxiety and sleep quality of healthcare professionals during support periods in the mobile cabin hospital. However, trials with larger samples are necessitated to further affirm these preliminary findings.

COVID-19 associated pulmonary embolism: clinical, biochemical and CT imaging findings.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection represented a disruptive pathology that emerged in late 2019 with profound implications ranging from individual health to health systems and world economy. Our study aimed to evaluate clinical, biochemical and computerized tomography (CT) parameters values in determining the severity of pulmonary embolism (PE) associated with COVID-19. We performed an observational cohort study evaluating demographic, clinical, biochemical, coagulation markers, as well as CT imaging parameters. In our study on 186 patients with COVID-19, we found that 31 patients (16,66%) had pulmonary embolism. Significant correlations for the patients with PE were detected in C-reactive protein, lactate dehydrogenase, serum ferritin, IL-6, serum myoglobin, NT-proBNP, D-dimers, serum proteins, transaminases as well as white cell blood counts. Patients with pulmonary embolism had a more severe lung involvement, with thrombi distribution mainly involving the lower lobes. Early identification of PE is an important step for timely and efficient treatment in the intensive care management of COVID-19 patients. Our study showed that high plasmatic values of lactate dehydrogenase, ferritin, IL-6, white blood cells and D-dimers and low proteins serum levels are strongly linked with COVID-19-associated pulmonary embolism.

Research Trends in Proteomic Studies Using Serum from COVID-19 Patients: A Bibliometric Analysis.

The COVID-19 pandemic significantly impacted the global populace, resulting in a staggering number of deaths across the globe. New approaches and biomarkers to evaluate disease progression are crucial for improving disease management. In this context, serum proteomics has emerged as a promising tool for identifying molecular alterations related to COVID-19. This work carried out a bibliometric evaluation of the current status and trends of studies applying serum proteomics to COVID-19 subjects. The search was performed using Web of Science and Scopus databases, and the results were analyzed in VOSviewer software. The investigation was limited to articles published between January 2020 and February 2023. The analysis found 48 articles, primarily experimental studies. China is the most influential country in this field, followed by the USA. The co-occurrence analysis performed by VOSviewer showed 170 keywords, of which 9 reached the occurrence threshold and were divided into two groups. The most cited words were related to biomarker identification and the use of proteomics for diagnosing and treating COVID-19. The most cited proteins include those classically associated with the immune system (IgG, IgM, interleukins, CXCL, CCL, MCP, CRP) and SAA1, SAA1, ApoA-1, TTR (prealbumin), SerpinA and ITIH4. Other studies have validated the predictive value of these serum markers and have the potential to improve the management of COVID-19 patients. The findings highlighted in this bibliometric study can help the researchers design new projects to enhance our understanding of the complex interplay between SARS-CoV-2 and host immunity.

Knowledge and Confidence Level among Emergency Healthcare Workers in Airway Management and Resuscitation of Suspected Covid-19 Patients: A Cross-Sectional Study in Penang and Kelantan

INTRODUCTION: COVID-19 cases in Malaysia have followed a never-ending course of spike and fall since it was first detected. Though the prominent role of infection control standard precautions were strictly applied, cases among emergency healthcare workers (EHCW) contracting the disease continue to rise. Our study aims to evaluate the knowledge and confidence level and the factors that may influence the knowledge and confidence level among EHCW in airway management and resuscitation of suspected COVID-19 patients. MATERIALS AND METHODS: This was a cross-sectional study conducted in tertiary hospitals in Penang and Kelantan using a validated questionnaire. The territories evaluated include the possible method of transmission, proper steps during resuscitation, airway management and intubation, intensive care management, and etiquette of personal protective equipment. RESULTS: Out of 543 EHCW eligible for the study, only 300 participants responded to the questionnaire. Our study showed only 15.3% of respondents had good knowledge and 62.3% had high confidence in airway management and resuscitation of suspected COVID-19 patients. Significant associations were seen in knowledge and confidence level among respondents with previous experience attending continuing medical education (F=7.041, P=0.008 and F=19.398, P<0.001 respectively). Significant associations were also demonstrated in confidence level among respondents with previous simulation training experience (F=13.905, P<0.001). CONCLUSION: Our study revealed that most EHCW had poor knowledge and moderately adequate confidence in the airway management and resuscitation of suspected COVID-19 patients. A more comprehensive and strategized training program needs to be conducted to help in improvement of the knowledge and confidence level among EHCW.

Efficacy of Linezolid in the management of pneumonic COVID-19 patients. Bioinformatics-based clinical study.

At the beginning in July 2023, there has been a significant increase in daily hospital admissions attributed to the new variant of COVID-19. Aim of this study is to explore the clinical benefits and outcomes of using linezolid in the management of pneumonic COVID-19 patients. The study included 230 patients with SARS-CoV-2 infection confirmed by RT-PCR. Group 1: 118 patients were managed with Linazolid alongside steroids. Group 2: (control group) patients treated according to the Protocol for Egyptian COVID-19 management outlines and WHO guidelines (112 patients). Each patient group was categorized into 3 age groups: 20-40 years, 41-65 years, and over 65 years. Patients were carefully followed up until recovery or mortality. A docking analysis was carried out to investigate the potential of linezolid to act as an Mpro inhibitor. Group 1's average recovery time was 15.1 days in contrast to 18.7 days for Group 2 (control). There were no deaths reported. In silico investigations revealed that Linezolid was able to achieve a binding mode comparable to that of the co-crystalized inhibitor. Linazolid is considered an effective antiviral weapon against SARS-COV-2. It could be used in the management plan of pneumonic individuals due to SARS-COV-2 infection. We recommend using it to combat the current wave caused by Omicron EG-5 Variant.

D-Dimer As A Parameter Of Disease And Death Of Covid-19 Patients In Islamic Hospital, Surabaya

Background: Previous studies of Community Associated Pneumonia (CAP) and Chronic Obstructive Pulmonary Disease (COPD), patients have shown that D-Dimer increases higher in severe cases and can be used as a prognostic biomarker and whilst D-Dimer> 1 mcg/ ml tends to be death for hospitalized adult patient with a diagnosis of Covid-19. However, D-Dimer's role in Covid-19 patients has not been fully studied.  We aim to conduct research on D-Dimer as a parameter of Clinical Severity and Death of Covid-19 Patients in Islamic Hospital, in Surabaya. Methods: This type of research is an analytic observational study with a retrospective approach. The population in this study were all patient’s data retrieved from the Dahlia Room’s database from June to July 2020 which were taken through EMR (an Electrical Medical Records) from a total of 189 patients with the total sample of 82 patients. Data analysis in this study used chi-square (X2) with a significant value of p <0.05. Results: Age over 60 years is associated with a higher risk of severe Covid-19 infection (P<0.05). A history of hypertension significantly affects the severity of Covid-19 infection (P < 0.05). The proportion of recoveries (53.7%) was higher than the number of deaths (46.3%), although the majority of patients experienced severe clinical severity (39%).  Laboratory parameters, such as D-dimer values, correlated significantly with patient age (P = 0.027, <0.05). Conclusion: The study highlights the importance of factors such as age and history of comorbid diseases in predicting the severity of Covid-19 infection. A better understanding of these risk factors can help in more effective management and management of Covid-19 patients.

The Development and Pre-testing of Attitude and Practice Questionnaire on Ethical Decision-making During a Pandemic Among Paediatric Healthcare Professionals in Malaysia

Malaysia is facing a widespread COVID-19 pandemic, affecting clinical admission to hospitals. The decision-making for admission, ventilation, and aggressive management for COVID-19 patients, especially children, can be challenging. However, no single tool exists to simultaneously evaluate the domains for attitude and practice on ethical decisions for children during the pandemic. The current study aims to develop and validate an attitude and practice questionnaire on ethical decision-making during a pandemic among medical doctors working in paediatric settings. Relevant domains were identified to generate items and form a research tool through literature reviews, focus groups, and opinions of experts. The questionnaire underwent a series of validation processes, including content, face validity and exploratory factor analysis (EFA). The developed questionnaire demonstrated a satisfactory item-level content validity index, face validity, and construct validity. The minimum item content validity index (I-CVI) of the attitude items was 0.80, and the maximum was 1.00, while the minimum and maximum I-CVI for the practice section were 0.80 and 1.00, respectively. Item-level face validity index (I-FVI) of 1.00 for both domains was obtained, showing all the items were above the cutoff value (0.60). For the EFA, all the items had satisfactory factor loading (>0.3) as well as Cronbach’s alpha (>0.6). This study showed a good level of I-CVI, I-FVI, and EFA in the new questionnaire. The instrument is valid and thus reliable for assessing attitudes and practices on ethical decision-making during a pandemic among medical doctors working in paediatric settings.

Identification of the essential and critical factors of decision-making for COVID-19 patient management: a mixed-method study

Background: Understanding the contributing factors for decision-making based on the disease stage is highly crucial to improving patient care. Aim: This study aimed to identify the critical and essential factors to enhance clinical decision-making for COVID-19 patients. Methods: This mixed-method research was conducted in two phases. In the first phase, a systematic literature review was performed using defined search strategies across four databases, including PubMed, Scopus, Web of Science, and IEEE. A total of 136 studies were obtained. Next, a questionnaire-based survey was conducted to validate the findings from the review and to categorize the factors into essential and critical factors. The content validity ratio was used to categorize the factors accordingly. The identified factors were classified into six main categories based on the stages of care and the corresponding decision-making. Results: The expert panel consisted of 10 clinicians from various fields. The potential factors were categorized into six categories. A total of 293 factors were found in the literature review. The findings of the consensus survey revealed 10 factors related to the decisions on the length of stay, eight factors for ward referral decisions, one factor for decisions on home referrals, six factors for deterioration diagnosis decisions, two factors for discharge decisions, and 10 factors for decisions on intensive care unit referrals. In addition, the study identified respiratory rate, oxygen saturation at administration, arterial oxygen pressure, sequential organ failure assessment score, and glomerular filtration rate as significant decision-making factors for COVID-19 patient management. Conclusion: For medical emergencies (e.g., COVID-19 management), fewer but more significant factors may increase the efficiency of decision-making, thereby improving the quality of patient management. On this basis, this study identified the essential and critical factors for decision-making at different stages of COVID-19 patient management. Relevance for Patients: This study identified the most important factors in diagnosing the deterioration of COVID-19 patients to improve the treatment outcome of COVID-19 patients.

Promising role of traditional Indian Ayurvedic medicine in treatment, management and better clinical outcomes of COVID-19 patients: a retrospective study

IntroductionThe Coronavirus disease (COVID-19) has negatively impacted the lives of people globally. To date, no specific treatment has emerged to combat the disease. Hence, there is an urge for immediate therapy against infections like COVID-19 through the inclusion of various traditional medicines including Ayurveda. MethodsThis retrospective study was performed on 300 patients who were treated using the Holistic Ayurveda protocol at the COVID Health Care (CHC) centre. Out of 300 patients, 258 who took the AYURAKSHA Kit regularly along with the other Ayurvedic medicines for treatment were selected for this study. Demographic distribution, viral clearance, and haematological parameters of COVID-19 patients were analysed. ResultsThe maximum number of COVID-19 positive cases (31.4%) were found in the age group 20–29 years whereas the age group 40–49 years (11.52 days) and ≥ 60 years (11.5 days) took the maximum time (P = 0.035) for viral clearance. The haematological investigations showed that the Ayurveda treatment maintained the admitted patients' blood profile and coagulation profile. Strikingly, liver and kidney profiles improved post-treatment as Serum Glutamic-Oxaloacetic Transaminase (P = 0.000), Serum Glutamic Pyruvic Transaminase (P = 0.000), Urea (P = 0.000), and Creatinine (P = 0.002) levels were significantly reduced. Likewise, a significant reduction in inflammation markers like C-reactive Protein (P = 0.000), Erythrocyte Sedimentation Rate (P = 0.003), and serum Ferritin (P = 0.000) was also observed. No adverse treatment effects were observed during follow-up of the patients. ConclusionThe above outcomes showed that the Holistic Ayurveda Protocol in treating COVID-19 patients is safe, acceptable and effective. Thus, suggesting the possible integration of Ayurvedic treatment in combating such deadly diseases.

Knowledge, attitudes and practices towards COVID-19 among healthcare workers: A cross-sectional survey from Kiambu County, Kenya.

The knowledge possessed by healthcare workers (HCWs), along with their attitudes and practices play a vital role in effectively managing a pandemic. This is crucial considering that HCWs are exposed to great risk at the forefront of such crises. We aimed to describe the knowledge, attitude, and practices (KAP) of HCWs during the COVID-19 pandemic in Kiambu county, Kenya. A cross-sectional study using a structured questionnaire was conducted from 11th March 2021 to 12th August 2021. Bloom's cutoff points were used to determine KAP scores (>80%: good, 60-79%: medium and <60% poor). Multivariable ordinal logistic regression analyses were conducted, calculating adjusted odds ratios (AOR) at a 95% confidence interval. Spearman's rank correlations were used to examine the relationship between KAP scores. 438 HCWs participated in the study, majority of whom were female (64.5%), had obtained a diploma (59.6%) and were informed through government websites (78.6%). 43.0% had good knowledge, 17.5% good attitudes, and 68.4% good practice. 23.0% had medium knowledge, 35.6% medium attitude, 15.7% medium practice, while 34.0% had poor knowledge, 46.9% poor attitude and 15.9% poor practice. Only 68.9% of the caregivers correctly recognized the county's COVID-19 isolation centre and only 7.9% chose the two correct documents for the entry of data for a suspected COVID-19 case. Furthermore, the general attitude towards their own personal safety and their training regarding PPEs (17.8% and 23.8% strongly agreed with the contrary) were less compelling. There was a significant positive association between obtaining information from international government sites [AOR: 1.382 (1.058-1.807); p = 0.0178)] and good knowledge. Referring to local government sites for information regarding COVID-19 produced better attitudes [AOR: 1.710 (1.194-2.465); p = 0.0036] and produced almost twice the odds of having better practice [AOR: 1.800 (1.181-2.681); p = 0.0048]. There was a significant correlation between knowledge and practice (r = -0.330, p = 2.766×10-11), and knowledge and attitude (r = -0.154, p = 6.538×10-3). This study emphasizes the substantial impact that governing bodies have on shaping favorable KAP. As a result, it's crucial for local government platforms to prioritize the dissemination of up-to-date information that aligns with international standards. This information should be tailored to the specific region, focusing on addressing deficiencies in healthcare practices and patient management. The identification of a significant number of HCWs lacking confidence in managing COVID-19 patients and feeling unprotected underscores a clear need for improvement in their understanding and implementation of preventive measures. This gap can be bridged by adequately equipping HCWs with locally manufactured PPEs. This aspect is crucial for pandemic preparedness, and we further advocate for the creation of a locally produced repository of medical equipment. These actions are pivotal in improving future crisis management capabilities.

Building Perspectives for Resilient Health System: Lessons Learned from the Experience of Patients and Health Professionals during COVID-19

The study seeks to explore experiences and perceived needs of patients in source isolation and healthcare professionals’ management of COVID-19 patients to inform practice in the event of emerging health disaster. Participants were recruited through snowball and purposive sampling strategy. We conducted semi-structured telephone interviews to understand their subjective evaluations of these events. We applied inductive thematic analysis, which yielded six themes. The health events resulting from COVID-19 varied and shaped patient perspectives. Response to care received and trust in healthcare providers was encouraging, including expressions of gratitude and resilience towards discomfort brought on by isolation. Processing COVID-19 in isolation describes how patients cognitively and psychologically dealt with the illness. Clinicians’ experiences of working in isolation centred around workflow management, maintaining safety, focus on patient-centric approach and expanding roles of health workers, even as complacency towards COVID-19 was on the rise. Effective deployment of resources, efforts of experienced clinicians and staff, along with cooperation and resilience of patients, paves the way for the system to endure through the crisis. These lessons can be preserved for practice as global health entities are pushing for pandemic response, preparedness and prevention through measures such as the pandemic treaty.

Herbal-based therapeutics for diabetic patients with SARS-Cov-2 infection.

Human SARS Coronavirus-2 (SARS-CoV-2) has infected more than 170 million people worldwide, being responsible for about 3.5 million deaths so far. Despite ongoing investigations, there is still more tounderstand the mechanism of COVID-19 infection completely. However, it has been evidenced that SARS-CoV-2 can cause Coronavirus disease (COVID-19) notably in diabetic people. Approximately 35% of the patients who died of this disease had diabetes. A growing number of studies have evidenced that hyperglycemia is a significant risk factor for severe SARS-CoV-2 infection and plays a key role in COVID-19 mortality and diabetes comorbidity. The uncontrolled hyperglycemia can produce low-grade inflammation and impaired immunity-mediated cytokine storm that fail multiple organs and sudden death in diabetic patients with SARS-CoV-2 infection. More importantly, SARS-CoV-2 infection and interaction with ACE2 receptors also contribute to pancreatic and metabolic impairment. Thus, using of diabetes medications has been suggested to be beneficial in the better management of diabetic COVID-19 patients. Herbal treatments, as safe and affordable therapeutic agents, have recently attracted a lot of attention in this field. Accordingly, in this review, we intend to have a deep look into the molecular mechanisms of diabetic complications in SARS-CoV-2 infection and explore the therapeutic potentials of herbal medications and natural products in the management of diabetic COVID-19 patients based on recent studies and the existing clinical evidence.

Economic Hardships in Managing COVID-19 Patients in the Intensive Care Unit: A Retrospective Observational Study at a Tertiary Care Hospital in North India.

The information on healthcare expenditure is crucial to know the impact of the pandemic on public health budgets, thereby correctly managing the ongoing crisis and preparing for subsequent waves. To estimate the length of stay and cost incurred on COVID-19 patients who died in the ICU. It is a record-based descriptive study conducted on 76 deceased COVID-19 patients admitted to the ICU of a dedicated COVID-19 hospital (DCH) between April and October 2020. Central Government Health Services (CGHS) package rate list, Delhi-NCR, was used as a reference for the cost of the ICU bed, ventilator, investigations, and procedures. The median duration of stay in the hospital was 12 days, and in the ICU, it was eight days. The median total cost of managing the patient was 91,235.6 INR; of this, the median total cost for ICU stay per patient was 6,904 INR. The major proportion of total expenses was contributed by personal protective equipment (PPE) kits, an average of 11,091.33 INR per month. The median cost of stay in the ICU, on the ventilator, in the ward, and mean cost of investigations were higher among those with associated co-morbidities. Most elderly male with co-morbidities lost their battle after ventilator support in the ICU. Patients with co-morbidities and severe disease not only have a long duration of hospitalization and poor survival rate but also fetch an economic burden close to one lakh on the institute.

Healthcare professionals’ understanding and perception of drug-related issues linked to off-label pharmacological medications used for COVID-19

ABSTRACT Background To evaluate the opinions of healthcare workers regarding drug therapy problems linked to anti-infective medicines used for the treatment of COVID-19 infection in Pakistan. Research methodology This cross-sectional study was conducted from January to October 2022 using a self-administered questionnaire developed by the authors, having three sections: demographics, knowledge, and perception. The study was validated by research experts and pilot-tested on 30 subjects. The study included medical doctors, nurses, pharmacists from Punjab’s government and private medical institutes. Results In this study, 382 of 400 participants replied. The mean knowledge score was 9.52 (SD 2.97), showing that participants had adequate knowledge of COVID-19 pharmacological interventions. The knowledge scores were significantly higher of those who treated COVID-19 patients and were from Lahore. Many doctors considered that elderly patients and those with blood disorders were at greater risk of experiencing drug-related problems. Most pharmacists support electronic prescription systems. Many doctors thought the lack of unified treatment guidelines, multiple prescribers, and self-medication were key obstacles in managing COVID-19 patients. Conclusion Most respondents had adequate knowledge. Older patients with comorbidities are at risk of adverse effects. Self-medication, polypharmacy, and multiple prescriptions can lead to misdiagnosis and complications. Electric prescriptions, team effort, and training programs can decrease these issues.

Digital health for remote home monitoring of patients with COVID-19 requiring oxygen: a cohort study and literature review.

The clinical course and outcome of COVID-19 vary widely, from asymptomatic and mild to critical. Elderly patients and patients with comorbidities are at increased risk of respiratory failure and oxygen requirements. Due to the massive surge, the pandemic has created challenges for overwhelmed hospitals. Thus, the original home management of COVID-19 patients requiring oxygen and remote monitoring by a web app and a nurse at home were implemented in our center. We aimed to evaluate the outcome of patients with COVID-19 requiring oxygen who benefited from home remote monitoring management. We performed a retrospective cohort study on all COVID-19 patients requiring oxygen (< 5 L/min) who consulted from October 2020 to April 2021 at our emergency department and were managed with home remote monitoring by a web app and an in-home nurse. We also carried out a literature review of studies on COVID-19 patients requiring oxygen with remote monitoring. We included 300 patients [184 (61.3%) male patients, median age 51 years]. The main comorbidities were cardiovascular disease (n = 117; 39.0%), diabetes mellitus (n = 72; 24.0%), and chronic respiratory disease (n = 32; 10.7%). Among the 28 (9.3%) patients readmitted to the hospital, 6 (1.9%) were hospitalized in the intensive care unit, and 3 (0.9%) died. In the multivariable analysis, risk factors for unplanned hospitalization were chronic respiratory failure (odds ratio (OR) =4.476, 95%CI 1.565-12.80), immunosuppression (OR = 3.736, 95%CI 1.208-11.552), and short delay between symptoms onset and start of telemonitoring (OR = 0.744, 95%CI 0.653-0.847). In the literature review, we identified seven other experiences of remote monitoring management. Mortality rate and unplanned hospitalization were low (maximum 1.9 and 12%, respectively). Our study confirms the safety of home remote monitoring of patients with COVID-19 who require oxygen, as well as our literature review. However, patients with chronic respiratory failure and immunosuppression should be closely monitored.

Design and technical evaluation of an AMBU-BAG based low-cost ventilator-AARMED

The COVID-19 pandemic has caused a significant strain on the healthcare system worldwide, resulting in an acute shortage of ventilators. Conventional ventilators are costly, and production is difficult to scale up during a rapidly spreading pandemic. Ambu bags offer a low-cost solution for manual ventilation, but their lack of precise control over parameters makes them unsuitable as a replacement for conventional ventilators. To address this issue, we propose the AARMED (Ambu bag Attachment for Rapid Mass Emergency Deployment) system, which is a low-cost and easy-to-assemble mechanical resuscitator that can achieve most of the recommended modes and parameter ranges for managing COVID-19 patients. AARMED can operate in volume-control, pressure-control, and assist-controlled modes continuously over long periods, making it suitable for use in emergency settings. The AARMED system has been tested using an ISO certified Test-lung over various parameter settings and has been found to be an effective alternative to costly conventional ventilators. It has a battery backup of 2.5 h under normal operating conditions, making it an ideal transport ventilator. In conclusion, the AARMED system offers a low-cost and easy-to-assemble solution for mechanical ventilation in emergency settings. Its ability to achieve most of the recommended modes and parameter ranges for managing COVID-19 patients makes it a viable alternative to conventional ventilators in resource-constrained settings.

Mixed Aspergillosis and Mucormycosis Infections in Patients with COVID-19: Case Series and Literature Review.

Mucormycosis and aspergillosis are angioinvasive infections mainly occurring in immunocompromised patients. However, mixed infection with mucormycosis and aspergillosis in post-COVID-19 patients is rare. In this report, we will report four cases and comprehensively review the published literature on COVID-19 associated mixed infection of aspergillosis and mucormycosis. Besides four of our cases, we searched for published articles using PubMed/MEDLINE, Scopus, and Web of Science databases from the beginning of 2020 until October 2023. During the COVID-19 pandemic, we analyzed 52 cases (4 from our research and 48 from other studies). The most common underlying disease (59.6%) was diabetes mellitus. However, 19.2% of COVID-19 patients had no underlying condition. Interestingly, rhino-orbital-cerebral mucormycosis featured prominently in India and Iran, while other countries primarily reported a higher prevalence of pulmonary cases. In conclusion, this study highlights the presence of mixed aspergillosis and mucormycosis in COVID-19 patients who previously had common underlying diseases or even a healthy immune system. Therefore, managing COVID-19 patients should involve screening serum and respiratory samples using biomarkers to detect superinfections.

Incidence of breakthrough infection after COVID vaccination and effect of post-covid-19 syndrome on medical students in a tertiary care hospital in Telangana

Even though many breakthrough infections have been reported in the Telangana region, adequate data regarding them are not available. In addition, there is evidence that SARS-CoV-2 infection can result in long-term physical and mental health consequences. To estimate the incidence of breakthrough infections after COVID-19 vaccination and the effect of Post COVID 19 syndrome on staff and medical students in a tertiary care hospital in Telangana.1. To detect the incidence of breakthrough infections in staff and students in our institute; 2. To measure the effect of post-COVID-19 syndrome on the staff, undergraduate, and postgraduate medical students in our institute This study was carried out in a tertiary care medical college located near Hyderabad. This was a cross-sectional retrospective and prospective study where data was collected from individuals who were PCR-confirmed COVID-19-infected individuals diagnosed from December 2021 to July 2022. The cases were classified according to AIIMS clinical guidance for the management of adult COVID-19 patients. To assess the post-COVID syndrome in the staff and medical students, complaints of breathlessness, fatigue, difficulty in concentrating, and mood changes were further evaluated by using the modified dyspnea Medical Research Council scale, Fatigue Assessment scale (FAS), and Depression, Anxiety, Stress scale -21(DASS-21) respectively. Statistical analysis was performed using SPSS software version 23. The incidence of breakthrough infections was found to be 9.40%. The maximum number was observed in second-year medical undergraduates followed by medical post-graduates. A total of 40 participants (21.16%) reported suffering from post-COVID-19 syndrome. Fatigue was the most common symptom reported, followed by post-exertion malaise and headache. The incidence of breakthrough infections shows that increased awareness and prompt management of post –COVID syndrome is crucial in the post pandemic era.

Genetic Analysis and Epidemiological Impact of SARS-CoV-2: A Multinational Study of 1000 Samples Using RT-PCR

The ongoing global public health challenge posed by the COVID-19 pandemic necessitates continuous research and surveillance efforts. In this study, we comprehensively analyzed over 1000 COVID-19 RT-PCR tests conducted on a cohort of 1200 patients in Saudi Arabia. Our primary goal was to investigate mutations in specific genes RdRp, N, and E different infection and recovery stages in Saudi patients with SARS-CoV-2. We also extended our analysis to include patients of various nationalities residing in Saudi Arabia, with the overarching objective of assessing these genes as markers for COVID-19 presence and progression. To diagnose and investigate potential genetic variations in COVID-19, we engaged RT-PCR. Our study primarily focused on detecting mutations in the RdRp, N, and E genes in Saudi patients with SARS-CoV-2, as well as individuals from various national residing in Saudi Arabia. This molecular technique provided valuable insights into the virus’s genetic makeup during infection and recovery. In our analysis of 671 positive COVID-19 cases, diverse gene involvement patterns were observed. Specifically, 55.91% had mutations in all three genes (RdRp, N, and E), 62.33% in both N and E genes, and 67.16% in RdRp and N genes. Additionally, 30.75% exhibited mutations exclusively in the RdRp gene, and 51.58% had mutations in the N gene. The N gene, in particular, showed high sensitivity as a marker for identifying active viral circulation. Regarding the temporal dynamics of the disease, the median duration between a positive and a subsequent negative COVID-19 RT-PCR test result was approximately 33.86 days for 44% of cases, 14.31 days for 30%, and 22.67 days for 4%. The insights from this study hold significant implications for managing COVID-19 patients during the ongoing pandemic. The N gene shows promise as a marker for detecting active viral circulation, potentially improving patient care and containment strategies. Establishing a defined positive threshold for diagnostic methods and correlating it with a low risk of infection remains a challenge. Further research is needed to address these complexities and enhance our understanding of COVID-19 epidemiology and diagnostics.

The clinical course of hospitalized COVID-19 patients and aggravation risk prediction models: a retrospective, multi-center Korean cohort study.

Understanding the clinical course and pivotal time points of COVID-19 aggravation is critical for enhancing patient monitoring. This retrospective, multi-center cohort study aims to identify these significant time points and associate them with potential risk factors, leveraging data from a sizable cohort with mild-to-moderate symptoms upon admission. This study included data from 1,696 COVID-19 patients with mild-to-moderate clinical severity upon admission across multiple hospitals in Daegu-Kyungpook Province (Daegu dataset) between February 18 and early March 2020 and 321 COVID-19 patients at Seoul Boramae Hospital (Boramae dataset) collected from February to July 2020. The approach involved: (1) identifying the optimal time point for aggravation using survival analyses with maximally selected rank statistics; (2) investigating the relationship between comorbidities and time to aggravation; and (3) developing prediction models through machine learning techniques. The models were validated internally among patients from the Daegu dataset and externally among patients from the Boramae dataset. The Daegu dataset showed a mean age of 51.0 ± 19.6 years, with 8 days for aggravation and day 5 being identified as the pivotal point for survival. Contrary to previous findings, specific comorbidities had no notable impact on aggravation patterns. Prediction models utilizing factors including age and chest X-ray infiltration demonstrated promising performance, with the top model achieving an AUC of 0.827 in external validation for 5 days aggravation prediction. Our study highlights the crucial significance of the initial 5 days period post-admission in managing COVID-19 patients. The identification of this pivotal time frame, combined with our robust predictive models, provides valuable insights for early intervention strategies. This research underscores the potential of proactive monitoring and timely interventions in enhancing patient outcomes, particularly for those at risk of rapid aggravation. Our findings offer a meaningful contribution to understanding the COVID-19 clinical course and supporting healthcare providers in optimizing patient care and resource allocation.