Polymerase Chain Reaction Test Research Articles

Prognostic value of serum amyloid A protein as a biomarker in the diagnosis of 2019 novel coronavirus disease (COVID-19)

BackgroundThe current study aimed to evaluate the prognostic value of serum amyloid A protein )SAA( protein as a biomarker in diagnosing 2019 novel coronavirus disease )COVID-19( infection. MethodsThe study was conducted on 123 patients with definitive COVID-19 infection referred to Shahid Beheshti and Sina hospitals in Hamedan province, Iran. Five-milliliter blood samples were taken from all included patients and serum was isolated using a centrifuge at 10,000 rpm for 10 minutes. Laboratory tests were conducted, including c-reactive protein (CRP), Erythrocyte Sedimentation Rate (ESR), potassium level, sodium blood test, platelets (PLT), complete blood count (CBC), lymphocyte count, and neutrophil count. The SAA enzyme-linked immunosorbent assay (ELISA) Kit was applied to measure the SAA level in serum samples. Results123 patients included 73 males and 50 females, age ±50. Sixty-six (53.7%) patients had negative CRP while 80 (65%) patients had normal ESR. Potassium levels were not normal among 111 (94.9%) patients. Seventy-seven (63.1%) patients had normal CBC, while 108 (87.8%) patients had neutrophils above the normal range. 94 (97.9%) patients over the age of 50 were positive for SAA. In terms of gender, men were the most frequent patients with SAA. There was a statistically significant relationship between the serum level of SAA and outcomes of patients with COVID-19 (p = 0.0001). 94% of patients with SAA ≤50 were recovered from COVID-19 infection. The sensitivity rate of SAA compared to polymerase chain reaction (PCR) and computed tomography scan (CT scan) tests was 93% and 99%, respectively. Moreover, the accuracy of SAA compared to PCR and CT scan tests was 52% and 96%, respectively. ConclusionResults indicate the SAA is a sensitive, but not specific biomarker in the early detection of COVID-19. The quantitative levels of SAA can be useful in predicting treatment outcomes among patients with COVID-19.

Relation Between Monocyte-to-lymphocyte Ratio and Depressive Symptoms in Patients with Non-severe COVID-19 Infection

Background and Aim: Mental health of non-hospitalized patients and those with non-severe infections has attracted lower attention in comparison to other patients. Circulating monocytes are deeply involved in all stages of COVID-19 infection. The present study aimed to investigate the relationship between monocyte-to-lymphocyte ratio (MLR) and depressive symptoms in patients with non-severe COVID-19 infection. Methods: The study included 312 patients with non-severe COVID-19 infection diagnosed on the basis of a positive reverse-transcriptase polymerase chain reaction (RT-PCR) test of nasopharyngeal swabs. Depressive symptoms were assessed using the validated Arabic version of the 7-item Hamilton Depression Rating Scale (HAMD). According to the obtained scores, patients were classified to have mild (10-13), moderate (14-17), or severe depression (>17). Results: The present study included 312 patients with non-severe COVID-19. According to HAMDS, clinically significant depression was diagnosed in 144 patients (46.2 %). They comprised 38 patients (12.2 %) with mild depression, 30 patients (9.6 %) with mild-tomoderate depression and 76 patients (24.4 %) with moderate-to-severe depression. Multivariate logistic regression analysis identified male sex [OR (95% CI): 2.07 (1.27-3.36), p = 0.003], presence of dyspnea [(OR (95 % CI): 1.99 (1.21-3.27), p = 0.007], D dimer levels [OR (95% CI): 2.32 (1.19-4.52), p = 0.013], MLR [OR (95% CI): 0.52 (0.28-0.99), p = 0.046] and abnormal CT findings [OR (95% CI): 1.79 (1.08-2.95), p = 0.023] as significant predictors of depression in the studied patients. Conclusion: Low MLR is related to depressive symptoms in patients with non-severe covid-19 infection. Other predictors include male sex, dyspnea, abnormal CT findings and elevated D-dimer levels.

Bartonella endocarditis: lessons learnt from an African cohort

Abstract Background Bartonella (B) quintana endocarditis is a preventable, vector-borne, and important cause of blood culture-negative endocarditis (BCNE). The ESC guideline for the management of endocarditis recommends blood serology (IgG titer ≥800) and polymerase chain reaction (PCR) testing on both blood and valvular tissue for diagnosis. Access to these molecular technologies is limited in Africa and there is a paucity of B. quintana endocarditis research on the continent. Purpose Record the clinical picture and explore the risk factors for disease and the diagnostic utility of immunofluorescence (IFA) in PCR-proven cases with B. quintana endocarditis. Methods Data were analysed from a prospective observational cohort study of patients with infective endocarditis managed at our institution. All BCNE cases from October 2019 to January 2024 were evaluated to identify patients with PCR-proven B. quintana on valvular tissue. A commercially available IFA was used for blood serology testing. 16S rRNA PCR testing with sequencing was performed on valvular tissue. Results Thirty five of the 58 cases (60.3%) with BCNE were diagnosed with Bartonella endocarditis. A diagnosis of PCR-proven B. quintana endocarditis was made in 21 cases. Of these, seven patients (33.3%) were either homeless or lived in informal housing. Thirteen patients (61.9%) had an alcohol-use disorder. Four patients (19%) were Human Immunodeficiency (HIV) virus- positive. Eighteen patients (85.7%) reported the onset of symptoms more than two weeks before presentation. Common presenting symptoms were dyspnea (n=21;100%), loss of weight (n=10;47.6%) and fever (n=7;33.3%). Common clinical features were digital clubbing (n=17;80.9%), pallor (n=13; 61.9%), microscopic haematuria (n=12; 57.1%) and severe regurgitant lesions (n=21; 100%). Blood serology was available in 17 patients with an IgG titer (1≥256) in all patients apart from one (1:64). Only one case (5.8%) had an IgG titre ≥800. The most common isolated valve lesion on echocardiography was severe aortic regurgitation (n=10;47.6%). Surgical replacement and repair were performed in 17(80.9%) and 4(19%) patients respectively. The one-, three- and six-month mortality was 14%, 14 % and 14% respectively. No cases of relapse were reported. Discussion B.quintana is the most prevalent cause of BCNE in our centre. The typical clinical and echocardiographic profile was consistent with the reported literature of a destructive endocarditis in a patient with a low socioeconomic background. Despite this, the surgical outcome is fair and comparable to European data. The IFA used in this study is different to the assay referenced in the ESC guideline and may explain the relatively low serology titres observed (despite PCR-proven disease). Further study with the commercial IFA is needed to determine a cut-off titre that will give a comparable sensitivity to the referenced in-house IFA.Destructive aortic valve endocarditisResultant severe aortic regurgitation

Infantile Intraparenchymal Brain Abscess due to Streptococcus pyogenes

Introduction Group A ß-hemolytic streptococcus (GABHS) are the most common bacterial cause of tonsillitis, and can cause noninvasive diseases such as pharyngitis and impetigo, as well as more severe invasive diseases. The incidence of invasive disease is 1-3/100,000 per year, and the morbidity and mortality rate is high. GABHS is rarely lead to brain abscesses. Case Report Acute phase reactants were found to be high in a 40-day-old patient who presented with fever, irritability and focal seizures. Acute phase reactants were high. Transfontanel ultrasonography showed increased thickness, echo and blood supply in the meninges. Brain magnetic resonance imaging (MRI) and diffusion MRI revealed a thick-walled abscess in the right cerebral hemisphere and parietooccipital parenchyma with diffusion restriction on diffusion-weighted images. Cerebrospinal fluid (CSF) polymerase chain reaction (PCR) test revealed S. pyogenes,and S. pyogenes grown in CSF culture. Initially, meropenem, vancomycin, metronidazole antibiotherapy was applied. Treatment was revised to cefotaxime and vancomycin after culture antibiogram and was completed for 8 weeks. Seizures regressed. Control brain imaging showed improvement. Restriction in left lower extremity movements remained. Physical therapy and rehabilitation was recommended and he was discharged. Conclusion GABHS, which is the causative agent of acute tonsillitis, rarely causes invasive disease which has high mortality and morbidity.

Investigating Transmission Patterns and Genome Sequencing of SARS-CoV-2 in University College Dublin

Abstract Background This study describes the investigation and management of multiple outbreaks of SARS-Cov2 during the second and third wave of the pandemic at University College Dublin, Ireland from September 2020 to September 2021. Methods Relevant data were gathered as part of the public health outbreak investigations led by the UCD Internal Covid Control Team (ICCT) in collaboration with the public health teams of the Health Service Executive (HSE). Results are presented for PCR (polymerase chain reaction) confirmed cases and their close contacts, reported to the UCD ICCT between September 2020 to September 2021. Results There were 214 cases notified to ICCT. Among these, 153 cases were in residence on-campus cases. 73 epidemiologically linked clusters identified, where the number of cases linked with each cluster varied between 1 to 27. Additional cases during this period had no obvious epidemiological link to the identified clusters. Of 902 close contacts with PCR test results, 31.5% (n = 284) tested positive. 77% (n = 219) self-reported with mild to moderately symptoms while 23% (n = 65) self-reported as asymptomatic. Retrospective Whole Genome Sequence (WGS) analysis was undertaken after the outbreaks had subsided. The test positive cases were grouped into 6 clusters, and it was shown that many of the apparent sporadic cases were included in these clusters. Conclusions The proportion of close contacts testing positive varied significantly throughout the pandemic, with testing policy and type of exposure having the greatest impact. Whole genome sequencing can give a better understanding of webs of transmission to complement epidemiological investigations. It is now possible to undertake sequencing in real time where it can make a contribution to outbreak control and resolution. Public Health professionals should become familiar with WGS and bioinformatics as useful tools in their armory for the control of all communicable diseases not only SARS-CoV-2. Key messages • Combined epidemiological investigations and Whole Genome Sequencing (WGS) provide crucial insights into campus COVID-19 outbreaks, guiding effective control measures. • WGS integration enhances understanding of transmission patterns, identifies clusters, and equips public health professionals with data-driven approaches for outbreak management beyond SARS-CoV-2.

Detection of Brucella militensis in the Serum of Patients Suspected of Brucellosis by the Omp31 Gene Amplification, Compared to the Serological Diagnostic Tests

Background and Objectives: Brucellosis is one of the most common infectious diseases with a global spread. It has a high prevalence in Iran. This study aims to diagnose brucellosis caused by Brucella melitensis in the serum of patients by the amplification of omp31 gene, compared to the serological tests. Methods: Blood samples were collected from 200 people suspected of brucellosis. The samples were evaluated by serological tests including Rose Bengal test, Wright test, Coombs-Wright test, gel agglutination test, and 2-mercaptoethanol (2ME) test. DNA extraction was done by the phenol/chloroform extraction method. Molecular detection with polymerase chain reaction (PCR) method was done using the specific primers of the Omp31 gene. Data were analyzed in SPSS software, version 23 using the analysis of variance. Results: Of 200 patients, 122 were female and 78 were male with a mean age of 45.17±17.43 years. The results of PCR test for the omp31 gene were positive in 14.5% of cases, which was consistent with the results of serological tests (13.8%). The sensitivity of Wright, Coombs-Wright, 2ME, and gel agglutination tests, compared to PCR, was 89.7, 75.9, 55.2 and 55.2%, respectively. Most of the affected people were housekeepers (41.5%) and urban residents (75.5%). Muscle pain (68%) and leg pain (62.3%) were the most common symptoms. Consumption of non-pasteurized dairy products was the highest risk factor (17%). Conclusion: The diagnosis of brucellosis by the omp31 gene amplification has higher sensitivity and accuracy compared to the serological tests. Considering the importance of rapid and timely diagnosis of brucellosis to control its clinical complications, the molecular diagnosis method is recommended as a diagnostic method.

Outcomes of COVID-19 in Pregnant Women: A Retrospective Analysis of 300 Cases in Jordan

Background: The impact of COVID-19 on pregnancy remains a critical area of research, with growing evidence suggesting that maternal infection, particularly in the third trimester, may lead to significant complications Aims: The primary aim was to investigate the maternal and neonatal outcome of pregnant Jordanian women with COVID-19. The secondary aim included exploring demographics, obstetrics characteristics, and comorbidities among these women. Methods: A retrospective comprehensive review of the records of 300 cases of pregnant women with COVID-19, who were treated between November 2020 and April 2021 at Queen Alia Military Hospital (a main referral center for patients with COVID-19) in Jordan. All cases were confirmed by the rapid antigen test (RAT) + long polymerase chain reaction (PCR) test used to detect SARS-CoV-2 by amplifying viral RNA from patient samples. Women infected with COVID-19 were categorized into four groups according to the RCOG guidelines for COVID-19 infection in pregnancy: asymptomatic, mild, moderate, and severe cases. All cases were managed following the Royal College of Obstetricians and Gynecologists protocol for COVID-19 in pregnancy. Data extracted from patient’s records included demographic information, COVID-19 clinical manifestations, obstetric history, diagnostic findings, treatment plans, comorbidities, gestational age at diagnosis, treatment protocols, and maternal and neonatal outcomes. Results: The mean age was 29.7 years; 98.3% were nonsmokers; 8% had previous miscarriages, and 67.3% had the infection in the third trimester. Iron deficiency anemia affected 30.3%, while 18.3% had comorbidities, mainly hypothyroidism. Most women were asymptomatic 61.7%, but 33% had respiratory symptoms, 4.7% needed intensive care unit (ICU) admission, and 2.7% resulted in maternal deaths. First-trimester and second-trimester miscarriages were recorded in 2.67% and 3.67% of cases, respectively, while preterm labor occurred in 3.0% of pregnancies. Additionally, age and hospitalization duration had a positive correlation with the neonatal outcomes (r = 0.349, p < 0.01), (r = 0.376, p < 0.01), respectively. Furthermore, COVID-19 presentation and treatment options demonstrated a strong positive correlation (p-value <0.01). On the other hand, maternal death had a strong negative correlation with poor neonatal outcomes (r = −0.776, p < 0.01). Conclusion: The study showed that COVID-19 in pregnant women, particularly in the third trimester, is associated with significant neonatal complications, with age, hospitalization duration, and COVID-19 severity strongly impacting outcomes.

Plasmodium ovale Malaria in Travelers and Immigrants to the United States: A Case Series.

Malaria in child travelers caused by Plasmodium ovale spp. is less well characterized than malaria due to other Plasmodium species. Commonly used diagnostic tests often lack adequate sensitivity to identify P. ovale spp., and a missed diagnosis may have serious consequences. We present a case series of eight children in the United States with P. ovale malaria, all of whom had traveled to or immigrated from malaria-endemic areas. Two children developed clinical malaria, including one with severe malaria; two had isolated splenomegaly; and four were asymptomatic siblings of the children with splenomegaly. Seven of the eight children had negative blood smear readings, and the diagnosis was made by polymerase chain reaction testing. Two children had concurrent P. malariae infection despite presumptive antimalarial treatment before immigration. These findings suggest a need for reconsideration of screening and diagnostic evaluation for P. ovale malaria in high-risk groups.

Characteristics and outcomes of patients hospitalized for infection with Influenza A, SARS-CoV-2 or respiratory syncytial virus in the season 2023/2024 in a large German primary care centre

BackgroundIn addition to the persistence of SARS-CoV-2 infections, those with Influenza A/B and RSV have reappeared in 2022/23. To compare the development of prevalence, clinical outcomes and risk factors, we analysed data of the season 2023/24 from the same region/hospital as for 2022/23.MethodsPatients covering the whole age range with a positive polymerase chain reaction (PCR) test for SARS-CoV-2, Influenza A/B, RSV were included from the internal, neurological and paediatric units of the RoMed hospital Rosenheim, Germany/Bavaria, from August 1st 2023 to 29th February 2024.ResultsOf 932 patients included, 912 showed single infections with SARS-CoV-2, Influenza A or RSV (47.9% female, median age 68.0 years; 52.9% SARS-CoV-2, 23.2% Influenza A, 21.8% RSV). Co-infections (2.0%) and Influenza B (0.1%) were negligible. In patients of age ≥ 18 years (n = 628, 68.5% SARS-CoV-2, 26.0% Influenza A, 5.6% RSV), patients with Influenza A were younger compared to SARS-CoV-2 (p < 0.001), with RSV similar to SARS-CoV-2. Heart failure and asthma were the most prevalent comorbidities for RSV, immunosuppression for Influenza A. Admission to Intensive Care Unit (ICU) occurred in 111 patients (17.0% of SARS-CoV-2, 17.2% Influenza A, 28.6% RSV), and 59 patients died (8.8% SARS-CoV-2, 8.6% Influenza A, 20.0% RSV). Low-flow oxygen supplementation and non-invasive ventilation (NIV) were most frequent for RSV (68.6% and 20.0%, respectively), oxygen demand upon admission for Influenza A (39.3%), without differences in high-flow oxygen supply or length of hospital stay. Among patients aged < 18 years (n = 284, 21.4% SARS-CoV-2, 18.0% Influenza A, 57.1% RSV), 15 were admitted to ICU (4.8% SARS-CoV-2, 3.8% Influenza A, 6.0% RSV); none of them died. Oxygen supply via high-flow, low-flow or upon admission was highest for RSV (23.8%, 70.2%, 21.4%, respectively), as well as the length of hospital stay.ConclusionBetween 8/2023 to 2/2024, a large population of patients hospitalized due to respiratory tract infection, showed relative contributions of SARS-CoV-2, Influenza A or RSV similar to those in 2022/23. The findings underline that in both, adults and children, RSV posed a relatively higher clinical risk than Influenza A and SARS-CoV-2, though absolute numbers remained highest for SARS-CoV-2.

Molecular characterization and immunopathological investigation of Avian reticuloendotheliosis virus in breeder flocks in Egypt

BackgroundReticuloendotheliosis virus (REV) is an oncogenic immunosuppressive retrovirus that infects different kinds of avian species; posing significant economic losses to the poultry industry worldwide.MethodsIn Egypt, there is an unidentified disease associated with the runting-stunting syndrome with neoplasia, suspected to be REV, that has been continuously monitored in several breeder flocks. To diagnose and analyze REV by cell cultures, enzyme-linked immunosorbent assay (ELISA), histopathological investigation, the polymerase chain reaction (PCR) test, and sequencing analysis, 200 blood samples, and 50 tissue specimens were collected. The current study targets the occurrence and genetic characteristics of a viral neoplastic disease, resembling REV infection, circulating in breeder flocks from 2022 to 2023 in the Ismailia, El-Sharqia, and El-Dakahliya governorates.ResultHere, REV was isolated on chicken embryo fibroblast cell culture; exhibiting cell aggregation, rounding, and cell detachments. Collectively, only 70 serum samples were positive for anti‐REV antibodies with seroprevalence rates of 35% based on the ELISA test. The histopathological observation demonstrated lymphoreticular tumors in the liver, spleen, and other examined organs. The immunohistochemical staining method confirmed the REV-positive signals in all examined organs (liver, kidney, spleen, bursa, ovaries) except for the heart. The PCR assay of the LTR gene assessed 370 base pairs with only 5 positive samples with a percentage of 16.6%. Three positive samples were further sequenced and submitted to the Genbank under accession numbers (PP763709, PP763710, PP763711). Phylogenetic analysis of the REV-LTR gene showed that our three isolates (Sharquia-1-REV, Ismilia-2-REV, Mansoura-3-REV) are REV subtype III which predominantly circulated in breeders in Egypt. These three isolates are highest similar to American, Chinese, and Taiwanese REV reference strains, and other Egyptian strains with nucleotide identity percentages of 100%, 99%, and 99%; respectively, and on the amino acid identity level were with (99–100%), (98%, 99%), (99%, 100%); respectively.ConclusionsThis study established that REV infection was extensively distributed in the breeders and became one of the causes of the clinical outbreaks of tumors, raising awareness of REV as the causative agent of avian oncogenic disease in Egypt.

Impact of rapid blood culture identification PCR panel on optimal antibiotic use in methicillin-susceptible Staphylococcus aureus bacteremia.

In this retrospective study of 200 patients with methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia, the implementation of the BioFire® blood culture identification polymerase chain reaction (PCR) panel was associated with a decreased time to optimal MSSA antibiotic therapy and shorter durations of empiric anti-MRSA antibiotic therapy and bacteremia. The findings demonstrate the significant role of rapid PCR testing and routine stewardship review in optimizing antimicrobial therapy and management of MSSA bacteremia.

Effects of COVID-19 pandemic on epidemiological features of viral respiratory tract infections in children: a single-centre study.

The epidemiology of respiratory infections may vary depending on factors such as climate changes, geographical features, and urbanization. Pandemics also change the epidemiological characteristics of not only the relevant infectious agent itself but also other infectious agents. This study aims to assess the impact of the COVID-19 pandemic on the epidemiology of viral respiratory infections in children. We retrospectively reviewed the medical records of children aged ≤18years with laboratory-confirmed viral respiratory infections other than COVID-19 from January 2018 to March 2023. Data on demographic characteristics, month and year of admission, and microbiological results were collected. During the study period, 1,829 respiratory samples were sent for polymerase chain reaction testing. Rhinovirus was identified in 24% of the patients, mixed infections in 21%, influenza virus in 20%, and respiratory syncytial virus in 12.5%. A 38.6% decrease in viral respiratory infections was observed in 2020, followed by a 188% increase in 2021. The respiratory syncytial virus was significantly more common in the post-pandemic period (13.8%) compared to the pre-pandemic period (8.1%), but no seasonal shift in respiratory syncytial virus infection was observed. There was also a yearly increase in influenza infections in the post-pandemic period compared to the pre-pandemic period. After the COVID-19 pandemic, the frequency of parainfluenza virus infections increased during the summer months, and this finding provides a new contribution to the existing literature.

Does infection with COVID-2019 during labor increase the risk for obstetric anal sphincter injuries?

To investigate the association between coronavirus disease 2019 (COVID-19) infection during the peripartum period and obstetric anal sphincter injuries (OASIS). A retrospective cohort study was conducted, including all singleton vaginal deliveries and cesarean deliveries due to failed vacuum extraction, between June 2020 and January 2022 at a large tertiary medical center. OASIS complication during childbirth was compared between women with and without peripartum diagnosis of COVID-19, defined as a positive polymerase chain reaction test obtained within 1 week before delivery or up to 3 days after delivery. Universal screening for COVID-19 was implemented. A logistic regression model was used to adjust for confounding variables. The study included 22 911 women, among whom 468 (2.0%) tested positive for COVID-19 and 22 443 women had no COVID-19 diagnosis. After adjusting for confounding variables, peripartum infection with COVID-19 was found to be independently associated with OASIS (adjusted odds ratio 4.38, 95% confidence interval 2.00-9.61; P < 0.001). Infection with COVID-19 during the peripartum period significantly increases the risk for OASIS by more than fourfold. These findings emphasize the importance of understanding the impact of COVID-19 on birth complications, such as OASIS, to improve public health measures and enhance obstetric outcomes during pandemics.

Risk of SARS-CoV-2 infection in healthcare workers with insufficient use of personal protective equipment in Denmark.

The aim was to evaluate the role of insufficient use of personal protective equipment (PPE) in SARS-CoV-2 transmission risk for healthcare workers (HCW) during the COVID-19 pandemic. Prospective study within the COBRA cohort, including 15,127 HCW. Daily assessment of insufficient use of PPE, defined as self-reported PPE failure or noncompliance, in relation to SARS-CoV-2 infection ascertained by polymerase chain reaction (PCR) test. Statistical analysis involved calculating incidence rate ratios with 95% confidence intervals (CI). The included HCW contributed to 780,515 risk days including 67,723 d (8.7%) with insufficient PPE use and 133 events (positive PCR test). Self-reported insufficient use of PPE was slightly associated with infection with COVID-19 in HCW, but the data were statistically consistent with parameter values ranging from a protective effect to a to a doubling in risk (IRR 1.3, 95% CI 0.8; 2.3). Sensitivity analyses restricted to high-risk departments and to a period with a sufficient supply of PPE and a fully developed testing system, respectively, confirmed these findings. Insufficient use of PPE among HCW during the pandemic in Denmark was uncommon but associated with a slightly increased risk of COVID-19 among HCW. However, the findings are uncertain due to the limited number of cases and the potential for misclassification bias stemming from the self-reported nature of the exposure.

The effectiveness of liver function tests in the prediction of mortality in patients with COVID-19

Objective: To evaluate the impact of liver function test abnormalities on mortality in critically ill coronavirus disease-2019 patients. Method: The single-centre, retrospective study was conducted at the Department of Anaesthesiology and Reanimation, Mersin City Training and Research Hospital, Turkiye, and comprised data from March 2020 to January 2022 of patients with positive real-time reverse transcription polymerase chain reaction test on nasopharyngeal swab sample for coronavirus disease-2019. Comorbidities, demographic data, admission to and discharge from the intensive care unit, Acute Physiology and Chronic Health Evaluation II scores, complete blood count on the first and second day of hospitalisation, coagulation parameters, biochemical analysis, 7-day, 28-day and total mortality of the patients in the intensive care unit were recorded. The patients were then divided into groups, with Group 1 having patients with normal liver enzymes, Group 2 having patients with abnormal liver enzymes, and Group 3 having patients with liver damage. Data was analysed using SPSS 20. Results: Of the 940 subjects, 587(62.4) were males and 353(37.6) were females. The overall mean age of the patients was 67.11±16.65 years. There were 395(42%) patients in Group 1, 534(56.8%) in Group 2 and 11(1.2%) in Group 3. Gamma-glutamyl transferase-1s, aspartate aminotransferase-2nd and albumin-2nd were significant predictors of mortality (p&lt;0.05). Conclusion: High gamma-glutamyl transferase, aspartate aminotransferase and low albumin levels in critically ill coronavirus disease-2019 patients could be considered indicators of high mortality rate. Key Words: Coronavirus, Critical illness, Liver function test, Pandemic.

Long COVID-19 and Coexistence of Fatigue and Depression: A Cross-sectional Study from Saudi Arabia.

Coronavirus disease 2019 (COVID-19) is associated with various manifestations even after infection resolution. This study aimed to assess the prevalence of post-COVID-19 fatigue and its predictors. We conducted a nationwide cross-sectional study among Polymerase Chain Reaction test confirmed COVID-19 cases in Saudi Arabia from July 2021 to February 2022. We collected data through telephonic interviews covering socio-demographics, comorbidities, body mass index, smoking, illness severity, and COVID-19 vaccination status. We assessed fatigue using Fatigue Severity Scale while depression was assessed using Patient Health Questionnaire-2. Logistic regression was employed to analyze the relationship between post-COVID-19 fatigue and depression. The analysis included 361 participants with a mean age of 37 ± 10.5 years, among whom 43% were female. Approximately 10% had comorbidities, and 21% were current smokers. Nearly two-thirds (68%) of the participants reported mild illness. The prevalence of perceived fatigue was 22.7%, while fatigue measured by the Fatigue Severity Scale was 14.4%. The multivariable logistic regression model revealed that COVID-19 severity and depression were significant predictors of post-COVID-19 fatigue; adjusted odds ratio 1.87 (95% CI: 1.10 to 3.18) and 14.3 (95% CI: 4.55 to 45.0), respectively. Our findings suggest a higher prevalence of perceived fatigue compared to that measured by the Fatigue Severity Scale, underscoring the importance of using a valid assessment tool for fatigue among COVID-19 patients to ensure proper management. The significant association between post-COVID-19 fatigue and depression highlights the need for psychological assessment of COVID-19 patients to enhance their post-infection quality of life.

Avian astrovirus caused mortality in pheasant (Phasianus colchicus, Linnaeus, 1758) farm inHungary.

We present the clinical symptoms, pathologic lesions and diagnostic possibilities of the avian astrovirus-related mortality in a pheasant colony. In addition to enteritis in chicks, we also confirmed acute nephrosis. The genome section of the astrovirus was detected and verified by polymerase chain reaction (PCR) testing. After sequencing the isolated genome section based on BLAST driver analysis (601-base pair-long) avian astrovirus has the same ORF-1b gene as turkey astrovirus 1 (TAstV1).

Sociodemographic differences in the response to changes in COVID-19 testing guidelines.

During the coronavirus disease 2019 (COVID-19) pandemic, Sweden emphasized voluntary guidelines over mandates. We exploited a rapid change and reversal of the Public Health Agency of Sweden's COVID-19 testing guidelines for vaccinated and recently infected individuals as a quasi-experiment to examine sociodemographic differences in the response to changes in pandemic guidelines. We analyzed daily polymerase chain reaction tests from 1 October 2021 to 15 December 2021, for vaccinated or recently infected adults (≥20 years; n = 1596321) from three Swedish regions (Stockholm, Örebro, and Dalarna). Using interrupted time series analysis, we estimated abrupt changes in testing rates at the two dates when the guidelines were changed (1 November and 22 November). Stratified analysis and meta-regression were employed to explore sociodemographic differences in the strength of the response to the guideline changes. Testing rates declined substantially when guideline against testing of vaccinated and recently infected individuals came into effect on 1 November [testing rate ratio: 0.50 (95% confidence interval, CI 0.41, 0.61)], and increased again from these lowered levels by a similar amount upon its reversal on 22 November [testing rate ratio: 2.19 (95% CI: 1.69, 2.85)]. Being Sweden-born, having higher household income, or higher education, were all associated with a stronger adherent response to the guideline changes. Adjusting for stratum-specific baseline testing rates and test-positivity did not influence the results. Our findings suggest that the population was responsive to the rapid changes in testing guidelines, but with clear sociodemographic differences in the strength of the response.

Acute coronary syndrome or cardiac involvement due to leptospirosis: A case report

Leptospirosis is a globally prevalent zoonotic infection. Cardiac involvement in leptospirosis, including myocarditis, can be easily missed due to non-specific symptoms and concurrent multiorgan dysfunction. A 46-year-old male presented to the emergency department with weakness, fever, palpitations, and widespread joint and muscle pain. His temperature was 40&amp;deg;C, and his blood pressure dropped to 50/30 mm Hg. The patient, with elevated high-sensitivity troponin levels in laboratory findings, was referred to the cardiology department. Anti-ischemic treatment was started for a preliminary diagnosis of acute coronary syndrome. The leptospirosis polymerase chain reaction (PCR) test in serum was positive, whereas the urine Leptospira PCR test was negative. The patient presented with septic shock and elevated cardiac biomarkers and was re-evaluated based on electrocardiogram and echocardiogram findings. Considering these clinical and laboratory results, acute coronary syndrome was ruled out, and myocardial involvement due to leptospirosis was considered. This case highlights the importance of recognizing cardiac involvement in leptospirosis.

Epidemiology of Morbidity and Mortality of COVID-19 Patients During the Period of June 2020-September 2021 in Sulianti Saroso Infectious Disease Hospital, Indonesia.

The increasing mortality rate of COVID-19 has remained an international public health concern. Limited studies on clinical treatment and morbidity in hospital settings are available in Indonesia. This present study aims to analyse demographic characteristics, clinical signs and treatment in COVID-19 patients and their association to the mortality case in Sulianti Saroso Infectious Disease Hospital. The study applied a retrospective cohort approach to all COVID-19 inpatients confirmed by polymerase chain reaction (PCR) testing in Sulianti Saroso Infectious Disease Hospital from 1 June 2020 to 30 September 2021. Overall survival rates until the end of the study were calculated using the Kaplan-Meier method and compared using the log-rank test. A Cox regression model was used to evaluate the crude and adjusted hazard ratios for associated factors. We collected 1,970 inpatient data that met our inclusion and exclusion criteria. Most of them were 19 years old-59 years old (73.2%) and male (52.6%), and 966 (49%) patients had comorbidities. Approximately 63.9%, 89.2%, 89.8%, 82%, and 14.1% of the patients had ferritin levels ≤ 800, received antiviral treatment, were treated in non-intensive wards, had a moderate or mild clinical stage and did not survive, respectively. In the adjusted analysis, mortality was associated with sex (hazard ratio [HR]: 1.12; 95% CI: 1.02, 1.23), presence of comorbidity (HR: 1.19; 95% CI: 1.08, 1.30) and favipiravir (FPV) plus azithromycin treatment (HR: 1.21; 95% CI: 1.06,1.39). FPV treatment (HR: 1.35; 95% CI: 1.04, 1.75) was associated with higher mortality. Tailored approaches to treatment, considering individual risk factors and comorbidities, are crucial in improving patient outcomes.