Positive Real-time Polymerase Chain Reaction Research Articles

The pattern of neurological disorders requiring hospitalization during the COVID-19 era: an experience from Fayoum University Hospital, Egypt

BackgroundCoronavirus was primarily discovered in December 2019, causing pneumonia and severe acute respiratory syndrome. It was reported several neurological symptoms associated with COVID-19. Both the central and peripheral nervous systems could be affected which might result in a higher mortality rate in hospitalized patients. This study aimed to determine the spectrum of neurological clinical presentations among patients admitted to Fayoum University Hospital before, during, and after the COVID-19 era and to examine the influence of COVID-19 vaccines mandated by the Egyptian government on neurological disorders.MethodsThis is a historical cohort study that was conducted on patients admitted to the Neurology Department at Fayoum University Hospital before, during, and after COVID-19 outbreaks from January 1st, 2018, to July 31, 2022. All participants had undergone thorough history taking and neurological examination and the necessary investigations according to the suspected diagnosis. All hospitalized patients during the COVID-19 pandemic were positive for the virus, as determined by either a positive rapid antigen test or a positive real-time reverse transcription polymerase chain reaction (RT-PCR).ResultsIt was shown that the patients hospitalized during the COVID-19 era were notably older, smokers, and diabetic in comparison to other groups. Cerebrovascular disorders were more prevalent in the COVID-19 pandemic. Surprisingly, compared to prior times, individuals with autoimmune-mediated neurological diseases had higher hospitalization rates than those with other neurological disorders. Patients who were not vaccinated reported more vascular complications than those who got them. However, patients who received vaccination exhibited significantly higher neurological complications as regards, exacerbation of paroxysmal disorders.ConclusionIt was concluded that the frequency of hospitalizations with cerebrovascular disorders and autoimmune-mediated illnesses was significantly influenced during the pandemic era. Although COVID-19 vaccinations have potential adverse effects, they have played a crucial role in preventing serious neurological problems.

Comparison of nailfold capillaroscopy findings in COVID-19 survivors with and without rheumatic disease: a case-control study

Purpose: The aim of this study was to evaluate the nailfold capillaroscopy (NFC) findings of patients with rheumatic disease and healthy controls (HCs) who survived coronavirus disease 2019 (COVID-19).
 Materials and Methods: This study included patients with axial spondyloarthritis (axSpA), psoriatic arthritis (PsA), and rheumatoid arthritis (RA) who recovered from COVID-19 and HCs. NFC was performed for all participants. NFC findings of the three groups [patients with COVID-19 (group 1), HCs with COVID-19 (group 2), and HCs without COVID-19 (group 3)] were compared.
 Results: A total of 142 individuals (group 1, n = 42; group 2, n = 50; group 3, n = 50) were included in the study. Hospitalization and oxygen therapy were more common in group 1 than in group 2. The median time from a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-positive real-time polymerase chain reaction (RT-PCR) test to NFC was 10.3 (6.3–24.4) weeks in group 1 and 17.1 (6.1–44.9) weeks in group 2. All NFC findings did not differ among the groups except for capillary ramifications, which were higher in group 1 than in groups 2 and 3. Underlying rheumatic disease was the only predictor that was significantly associated with capillary ramifications.
 Conclusion: The NFC findings of COVID-19 survivors with and without rheumatic disease were substantially similar to those of HCs who did not have COVID-19. Capillary ramifications may result from an underlying rheumatic disease in patients with axSpA, PsA, and RA.

New onset or recurrence of uveitis following COVID-19 infection

BackgroundWhile the 2019 novel coronavirus disease (COVID-19) pandemic has resulted in millions of cases worldwide, there is increasing recognition of a wide range of ocular manifestations associated with the virus, including uveitis. Uveitis is an inflammatory condition of the uveal tract of the eye that can lead to permanent vision loss if not treated promptly. Here we report a retrospective observational study of patients who presented with new onset or recurrent uveitis following COVID-19 infection.MethodsThis is a retrospective observational study conducted at the Beijing Tongren Hospital. We identified patients who presented with symptoms of non-infectious active uveitis with positive real-time reverse transcription polymerase chain reaction (RT-PCR) of COVID-19 within 4 weeks. All patients received ophthalmic examinations, including anterior and posterior segment imaging, to assess the extent of ocular involvement.ResultsThe 18 patients with a total of 33 eyes included in this study presented with symptoms of active uveitis within 4 weeks of their positive COVID-19 RT-PCR test. Among them, 9 patients presented with the development of uveitis following COVID-19 infection, and 9 patients had relapsed uveitis after COVID-19 infection. Treatment with corticosteroids resulted in improvement of symptoms and resolution of inflammation in all cases. In this study, all patients did not experience any adverse drug reactions during treatment.ConclusionOur observational study highlights the potential for new onset or recurrence of uveitis following COVID-19 infection.Trial registrationhttps://www.chictr.org.cn/; identifier: ChiCTR2100044365, date: 03/17/2023.

Predicting Mortality of COVID-19 in Kidney Transplant Recipients With Developed Scores.

COVID-19 is a recently discovered β-subtype coronavirus infection due to SARS-CoV-2. Approximately 20% of COVID-19 patients have moderate to severe clinical manifestations and 5% progress to critical illness. Kidney transplant patients form a special group. In our study, we aimed to evaluate the success of the COVID-gram score and systemic immuno-inflammation index score in predicting the risk of mortality during hospitalization among kidney transplant patients. Our study included 50 kidney transplant patients with positive real-time reverse transcription polymerase chain reaction COVID-19 tests between March 2020 and March 2021. Risk scores were calculated using baseline clinical data collected retrospectively from the patient cohort. The mean age was 54.3 ± 10.2. The mortality rate was 12%. When we compared the COVID-gram and systemic immuno-inflammation index scores between survivors and nonsurvivors, we did not find any difference. Kidney and other solid-organ transplant patients are at greater risk of infection and mortality than other groups. Accurate risk-predicting tools are imperative for managing the COVID-19 pandemic with limited health resources.

Cytokine profile levels and their relationship with parasitemia and cardiomyopathy in people with Chagas disease in Spain. A prospective observational study

Immunoregulatory networks may have a role in controlling parasitemia in the chronic phase of human Chagas disease. The aim was to describe the serum cytokine profile of Trypanosoma cruzi in chronically infected patients and to evaluate its relationship with parasitemia and Chagas cardiomyopathy.This prospective observational study included adult patients with chronic Chagas disease. Demographic and clinical data were collected, and peripheral blood samples were used to perform T. cruzi real-time polymerase chain reaction (RT-PCR) and determine the serum cytokine profile.Fifty-eight patients were included; 17 (29.3%) had positive RT-PCR results. This group had a higher median concentration of TNF-α (p = 0.003), IL-6 (p = 0.021), IL-4 (p = 0.031), IL-1β (p = 0.036), and IL-17A (p = 0.043) than those with a negative RT-PCR. Patients with cardiac involvement had a higher median concentration of IL-5 (p = 0.016) than those without.These results reinforce the key role that cytokines play in Chagas disease patients with parasitemia and cardiac involvement.

Incidence, Risk Factors and Clinical Impact of Sars-Cov-2 Prolonged Viral Shedding in Patients Diagnosed with Hematologic Malignancies

Patients with hematologic malignancies (HM) infected by SARS-CoV-2 present a higher risk of prolonged viral shedding, severe infection and mortality. However, data regarding clinical outcomes and viral evolution of prolonged COVID-19 in HM are still scarce. Our aim was to describe the incidence, risk factors, clinical outcomes and viral evolution of the protracted SARS-CoV-2 infection in patients with HM. We collected clinical data and respiratory samples of patients with HM who consulted at Vall d´Hebron Universitary Hospital and were diagnosed with a laboratory-confirmed SARS-CoV-2 infection between March 2020 and March 2023. Prolonged COVID-19 was defined as a positive real-time reverse transcription polymerase chain reaction (rRT-PCR) with a cycle threshold (Ct) <35 beyond 30 days since microbiological diagnosis with the same genotyped viral variant. Whole-genome sequencing of the virus was performed following the ARTIC, v4.1 protocol on a MiSeq platform. We considered an exacerbation of persistent COVID-19 the reappearance of symptoms and/or a positive SARS-CoV-2 rRT-PCR after initial clinical improvement or a previous negative rRT-PCR. Results: Among a total of 400 patients with HM developed COVID-19, 269 patients (67.25%) were eligible for prolonged COVID-19 assessment, whereas 52 patients (13%) died due to COVID-19 before day 30 and 79 patients (19.5%) did not have follow-up rRT-PCR. Prolonged COVID-19 was documented in 126 of 269 evaluable patients (46.8%) with a median time of rRT-PCR positivity of 60 days (IQR 43-95). Median age of patients with prolonged COVID-19 was 68 years and 46.8% were female. The main HM was lymphoma (58.7%), the majority of patients were under active treatment (78.6%), and the most frequent active therapy was anti-CD20 monoclonal antibodies+/- chemotherapy (25.4%). In the univariate analysis, active treatment with bispecific T-cell engagers antibodies (BiTEs) (OR 9.2; p=0.048) and anti-CD38 monoclonal antibodies (mAb) (OR 4.9; p=0.02), heavily pretreated patients (> 2 previous lines of therapy) (OR 3.1; p=0.02), and severe/critical acute COVID-19 (OR 7.4; p=<0.01) were significantly associated with prolonged viral shedding. Vaccination (OR 0.2; p=<0.01) and the development of an optimal humoral vaccine-induced immunogenicity (anti-spike IgG >260 BAU/mL) (OR 0.1; p=<0.01) were significantly associated with an inferior risk of developing prolonged COVID-19. In the multivariate analysis, active treatment with anti-CD20 mAb, BiTEs, and BTK inhibitors; lack of vaccination; an impaired humoral vaccine-induced immunogenicity and severe acute COVID-19 remained significantly associated with prolonged COVID-19 (Figure 1). CAR T-cell therapy also showed a trend to develop prolonged COVID-19 but did not reach statistical significance (OR 14.4; p=0.08). Prolonged COVID-19 clinical spectrum in HM ranged from a chronic asymptomatic infection in 29.4% of cases (37/126) to severe infection and COVID-19 related death in 16.7% of cases (21/126). During prolonged COVID-19, 51.6% of patients (65/126) experienced an increase in the severity of the infection, 54% (68/126) patients suffered a delay/interruption of their hematologic treatment, and 22.2% (28/126) had to suspend it indefinitely. A 55.6% of patients (70/126) experienced an exacerbation of persistent COVID-19 with a median of 1 episode (IQR 1-2) per patient. Through those exacerbations, 84.3% (59/70) required hospital readmission with a median of 17 days of length of stay (IQR 9-27). To treat prolonged COVID-19, 55.6% of patients (70/126) required a median of 1 course of antiviral treatment and 31% (39/126) received convalescent plasma. Of note, 37.3% of prolonged COVID-19 patients (47/126) developed a pneumopathy being organizing pneumonia the most frequent one in 28.6% (36/126) of cases. Finally, data of the kinetics of viral load and intra-host viral mutations in prolonged COVID-19 patients with a positive rRT-PCR beyond 90 days will be available for the congress. In conclusion, prolonged COVID-19 is frequent in patients with HM and clinical repercussion are severe. Patients with risk factors for prolonged viral replication, particularly those with a suboptimal humoral vaccine-induced immunogenicity and acute severe disease, require a personalized diagnostic, therapeutic and follow-up.

Thyroid Function Test Abnormalities in Children and Adolescents with COVID-19: A Case-Control Study

Background: There is a lack of conclusive evidence regarding thyroid function test (TFT) abnormalities in COVID-19, especially among children. Objectives: This study aimed to investigate TFT abnormalities in COVID-19 pediatric patients compared to healthy children. Methods: This study was conducted on 37 COVID-19-positive children who were admitted to Namazi Hospital from January 21 to March 1, 2022, compared with 37 healthy children. Within 48 h of positive real-time polymerase chain reaction (PCR) results for severe acute respiratory syndrome coronavirus 2, a blood sample was taken to measure serum levels of thyroid-stimulating hormone (TSH) and total thyroxine (tT4) in the two groups. Additional tests, including free and total triiodothyronine, free T4, and thyroperoxidase antibodies, were also conducted on cases. The chi-square, Pearson correlation coefficient, and analysis of variance tests were used for data analysis. Results: Twenty-five patients were male, and 49 were female, with a mean age of 7.99 ± 5.02. The abnormal TFT and TSH frequency was significantly higher in the case group than in the control group. Nevertheless, there was no significant difference between the case and control groups regarding tT4 abnormalities. We could not establish an association between the mean of TSH and tT4 and age groups in the two groups and between abnormalities of TFTs and COVID-19 severity. Conclusions: Although abnormalities of TFT were significantly more common among COVID-19 children, they were not associated with the disease severity. However, studies with larger sample sizes are recommended to evaluate thyroid abnormalities and their clinical course in COVID-19 children.

A Population-Based Test-Negative Matched Case-Control Analysis of SARS-CoV-2 Vaccine Effectiveness Among Pregnant People in Ontario, Canada

ObjectivePregnancy is a risk factor for severe SARS-CoV-2 infection, which can result in adverse pregnancy outcomes, thus making understanding vaccine effectiveness (VE) in this population important. This study aimed to assess the VE of mRNA COVID-19 vaccines against symptomatic SARS-CoV-2 infection and COVID-19-related hospitalization in pregnant people. MethodsPopulation-based matched test-negative case-control study of pregnant people aged 18–49 years, of 12 or more weeks gestation in Ontario, Canada, symptomatic with possible SARS-CoV-2 infection, and having at least 1 positive (n = 1842) or negative (n = 8524) real-time polymerase chain reaction (RT-PCR) SARS-CoV-2 test between December 14, 2020, and December 31, 2021. The exposure was receipt of ≥1 dose of mRNA COVID-19 vaccine versus no vaccination. Exposure was further stratified by number and recency of doses. The primary outcome was a positive SARS-CoV-2 RT-PCR test. As a secondary outcome, VE for COVID-19-related hospitalization was assessed. ResultsIn the primary outcome analysis, there were 1821 positive cases, matched to 1821 negative controls. The mean (SD) maternal age was 31 (5) years. When compared to those unvaccinated, receipt of ≥1 dose was associated with an estimated VE of 39% (95% CI 29%–48%) for symptomatic infection, and 85% (95% CI 72%–92%) for COVID-19 hospitalization. VE estimates demonstrated waning with increased time since last vaccination. ConclusionsmRNA COVID-19 vaccines provide protection against symptomatic COVID-19 illness and are highly effective at preventing severe illness in pregnant people. The observed effect of vaccine waning highlights the importance of booster doses to provide optimal protection for pregnant people.

Biochemical Analysis of Ferritin and D-dimer in COVID-19 Survivors and Non-survivors.

Background COVID-19 is a major cause of illness and mortality. The management of COVID-19-related illnesses might change if variables connected to their severity and the requirement for ICU admission could be found. The severity of COVID-19 might be efficiently predicted with several laboratory measures, such as ferritin levels and D-dimer analysis. Objectives This study aimed to evaluate the association between serum D-dimer and ferritin levels and their effects on mortality in patients with COVID-19. Methods This retrospective observational study included all patients with positive real-time polymerase chain reaction (RT-PCR) results for COVID-19 who were hospitalized in the Ministry of Health South Al-Qunfudah General Hospital between March and September 30, 2020. Their laboratory parameters, serum D-dimer, and ferritin levels were evaluated. IBMSPSSStatistics for Windows, Version 26.0 (released 2019; IBM Corp., Armonk, New York, United States) was used to analyze the data. Results A total of 318 COVID-19 patients were analyzed; 56.9% (n=181) were male and 43.1% (n=137) were female. Of these, 78.6% (n=250) survived, including 58% of men and 42% of women. The mean D-dimer was 2.1 mcg/mL (SD=3.16) and the mean ferritin was 698.59 ng/mL (SD=603.11). Non-recovered patients were substantially older (66.16 years old) and had higher D-dimer (5.46) mcg/mL and ferritin levels (992.96) ng/mL. Intubation length and gender did not affect survival. Of the non-survivors, 95.6% (n=239) were admitted to the ICU, and 50% (n=34) required mechanical ventilation. Conclusions COVID-19 infection mortality dramatically increased with older age and increased mean ferritin and plasma D-dimer values, which were significantly higher in COVID-19 non-survivors than in survivors. Therefore, assessing and monitoring these laboratory markers in the early stages of the disease may have a significant impact on preventing disease progression and death.

Lösemi tanısı ile takipli çocuk hastalarda COVID-19 enfeksiyonunun değerlendirilmesi

Aims: The coronavirus disease 2019 (COVID-19) has been the cause of a global health crisis since the end of 2019. The aim of this study was to evaluate the clinical findings and treatment results of COVID-19 disease in pediatric patients with leukemia.
 Methods: All the children and adolescents with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive real-time polymerase chain reaction (PCR) and the presence of underlying leukemia were included in the study.
 Results: A total of 44 leukemia patients with COVID-19 infection were included in the study. Their primary diseases were as follows: 36 patients were newly diagnosed with acute lymphoblastic leukemia (ALL), four patients were relapsed ALL, two patients were refractory ALL, and two patients were acute myeloblastic leukemia. The mean age of patients was 104± 62 months. COVID-19 was asymptomatic in 11.4% of patients, mild in 84%, and moderate in 4.5% whereas none of our patients had a severe infection. No severe complications and/or death were observed in our study group.
 Conclusion: It has been found that the clinical course of COVID-19 is mild in children and adolescents with leukemia and undergoing chemotherapy or immunosuppressive therapy.

COVID-19 pneumonia; predictors of severity and outcome in Erbil city hospitals

Background and objective: Corona infections disease nowadays is one of the major burden on national health institutes. The aim of the study is to identify the parameters that can predict the mortality in moderate to severely ill COVID-19 infected patients. Methods: A prospective cross sectional study was carried out in Erbil Hospitals, Kurdistan region/Iraq from December 2020 to December 2021 on a sample of 100patients with positive real-time polymerase chain reaction. The data of enrolled patients were collected by direct interview with patients or with their relatives and filled in a prepared questionnaire. The patients were followed up from their admission to hospital until their discharge alive or dead. Results: The mortality rate of hospitalized patients was 44% for 100 patients. Budesonide nebulizer were given to all of the patients. The mortality rate was significantly higher in old COVID-19 patients. The COVID-19 patients presented with dyspnea, hypertension and renal failure were significantly associated with higher mortality rates. High respiratory rate, low oxygen saturation and high C-reactive protein level were accompanied with higher mortality rates of COVID-19 patients. Conclusion: The early predictors of mortality in patients with moderate to severe COVID-19 infection were elderly age, clinical presentation of dyspnea, clinical co-morbidity with hypertension and renal failure, high respiratory rate, low oxygen saturation and elevated levels of C-reactive protein.

General Hospitalization and Intensive Care Unit-Related Factors of COVID-19 Patients in Northeastern Colombia: Baseline Characteristics of a Cohort Study.

Objective This study aims to describe demographic and clinical characteristics and the factors associated with the risk of COVID-19 general hospitalization and intensive care unit (ICU) care of patients who consulted in a third-level hospital in Santander, Colombia. Methods We used baseline data from an ambidirectional cohort study. We included all patients with positive real-time polymerase chain reaction (PCR) tests for COVID-19 who came to the emergency room (ER) for respiratory symptoms related to COVID-19. Information regarding patients' baseline characteristics and symptoms was collected through telephone interviews and review of medical records. Vital signs were extracted from medical records as well. Results We enrolled 3,030 patients, predominantly men, with a median age of 60(interquartile range (IQR): 44-73). Symptoms of the acute phase varied between men and women. Men presented with more respiratory symptoms, and women had general symptoms. Hypertension, obesity, and diabetes were common risk factors for hospital admission. Antibiotic consumption may also play a role in hospital admission. Conclusions Male sex, older age,hypertension, obesity, prior thrombotic events, and self-medicated antibiotics were associated with general hospitalization. Hypertension, obesity, diabetes, and cancer were associated with ICU admission. The Charlson comorbidity index (CCI) is a powerful tool for evaluate the impact of pre-existing health conditions on COVID-19 hospital admission. We highlight the importance of these findings as possible predictors in our region.

The Assessment of Neurological Development of the Infants with Prenatal COVID-19 Exposure

Objective: The effects of prenatal coronavirus 2019 disease (COVID-19) exposure on the infantile neurological development are unknown. It has been considered that the inflammatory, thrombotic, and vascular changes occurred in the placentas taken from pregnant women diagnosed with COVID-19 and the inflammatory nature of COVID-19 infection may lead to negative obstetric and neurological events. We aimed to assess the potential neurological effects of prenatal COVID-19 exposure on the infant.
 Methods: The present study included 2–12-month-old infants born to women with positive real-time reverse transcription polymerase chain reaction test results for COVID-19 from the population of pregnant patients under routine follow-up. The neurological examinations and the Denver II Developmental Screening Test (DDST II) were performed for 41 infants aged 2–12 months to assess the neurological effects of prenatal COVID-19 exposure.
 Results: The average gestational age of the infants was 38.7 ± 1.9 weeks, and the average birth weight was 3198 ± 543 g. Eight of the infants had a history of hospitalization in the neonatal intensive care unit. The neurological examination and the neuromotor development of 40 (96%) infants were normal for their age group. Only one infant had abnormal neurological examination and DDST II result.
 Conclusion: The findings of the study suggest that prenatal COVID-19 exposure has no negative neurological impact on infants. Long-term prospective studies with larger sample sizes are needed for more comprehensive assessment of the neurological effects of prenatal COVID-19 exposure on the infants.

The effect of diabetes mellitus on COVID-19 mortality among patients in a tertiary-level hospital in Bandung, Indonesia.

Immune system dysregulation in people with diabetes mellitus (DM) increases the risk of acquiring severe infection. We compared the clinical characteristics and laboratory parameters of coronavirus disease 2019 (COVID-19) patients with and without DM and estimated the effect of DM on mortality among COVID-19 patients. A retrospective cohort study collecting patients' demographic, clinical characteristics, laboratory parameters and treatment outcomes from medical records was conducted in a hospital in Bandung City from March to December 2020. Univariable and multivariable logistic regression was performed to determine the association between DM and death. A total of 664 COVID-19 patients with positive real-time reverse transcription polymerase chain reaction for severe acute respiratory syndrome coronavirus 2 were included in this study, of whom 147 were with DM. Half of DM patients presented HbA1c ≥10%. DM patients were more likely to present with comorbidities and severe to critical conditions at admission (P <0.001). Laboratory parameters such as neutrophil-lymphocyte count ratio, C-reactive protein, D-dimer, ferritin, and lactate dehydrogenase were higher in the DM group. In the univariate analysis, variables associated with death were COVID-19 severity at baseline, neurologic disease, DM, age ≥60 years, hypertension, cardiovascular disease, and chronic kidney disease. DM remained associated with death (aOR 1.82; 95% CI 1.13-2.93) after adjustment with sex, age, hypertension, cardiovascular disease, and chronic kidney disease. In conclusion, COVID-19 patients with DM are more likely to present with a very high HbA1c, comorbidities, and severe-critical illness. Chronic inflammation in DM patients may be aggravated by the disruption of immune response caused by COVID-19, leading to worse laboratory results and poor outcomes.

Investigation of SARS-CoV-2 in vaginal secretions of women with coronavirus disease 2019

Abstract Objectives The present study investigates the presence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the vaginal swabs of female patients diagnosed with coronavirus disease 2019 (COVID-19) based on a positive real-time reverse transcription polymerase chain reaction (RT-PCR) test on a combined throat and nasopharyngeal swab. Methods This study included 48 female patients hospitalized in two tertiary hospitals diagnosed with COVID-19 based on a positive RT-PCR test of the combined throat and nasopharyngeal swab samples, along with clinical and radiological findings. The IBM SPSS software package was used for the statistical analysis of the study data. Results SARS-CoV-2 positivity was detected in only one patient (2.08 %) in the present study from RT-PCR tests of vaginal swab samples. This patient was a 64-year-old, postmenopausal woman who tested positive for SARS-CoV-2 in a RT-PCR test of a vaginal swab sample six days after having tested positive in an RT-PCR test of a combined throat and nasopharyngeal swab. The patient’s partner also tested positive for SARS-CoV-2 in an RT-PCR of a combined throat and nasopharyngeal swab. Conclusions The present study is the first to report the presence of SARS-CoV-2 in vaginal secretions in Türkiye. The authors believe there is a need for studies investigating the presence of SARS-CoV-2 in the semen samples of the male partners of female patients to establish whether the presence of SARS-CoV-2 in vaginal secretions can play a role in the transmission of the virus.

Predicting omicron pneumonia severity and outcome: a single-center study in Hangzhou, China.

In December 2022, there was a large Omicron epidemic in Hangzhou, China. Many people were diagnosed with Omicron pneumonia with variable symptom severity and outcome. Computed tomography (CT) imaging has been proven to be an important tool for COVID-19 pneumonia screening and quantification. We hypothesized that CT-based machine learning algorithms can predict disease severity and outcome in Omicron pneumonia, and we compared its performance with the pneumonia severity index (PSI)-related clinical and biological features. Our study included 238 patients with the Omicron variant who have been admitted to our hospital in China from 15 December 2022 to 16 January 2023 (the first wave after the dynamic zero-COVID strategy stopped). All patients had a positive real-time polymerase chain reaction (PCR) or lateral flow antigen test for SARS-CoV-2 after vaccination and no previous SARS-CoV-2 infections. We recorded patient baseline information pertaining to demographics, comorbid conditions, vital signs, and available laboratory data. All CT images were processed with a commercial artificial intelligence (AI) algorithm to obtain the volume and percentage of consolidation and infiltration related to Omicron pneumonia. The support vector machine (SVM) model was used to predict the disease severity and outcome. The receiver operating characteristic (ROC) area under the curve (AUC) of the machine learning classifier using PSI-related features was 0.85 (accuracy = 87.40%, p < 0.001) for predicting severity while that using CT-based features was only 0.70 (accuracy = 76.47%, p = 0.014). If combined, the AUC was not increased, showing 0.84 (accuracy = 84.03%, p < 0.001). Trained on outcome prediction, the classifier reached the AUC of 0.85 using PSI-related features (accuracy = 85.29%, p < 0.001), which was higher than using CT-based features (AUC = 0.67, accuracy = 75.21%, p < 0.001). If combined, the integrated model showed a slightly higher AUC of 0.86 (accuracy = 86.13%, p < 0.001). Oxygen saturation, IL-6, and CT infiltration showed great importance in both predicting severity and outcome. Our study provided a comprehensive analysis and comparison between baseline chest CT and clinical assessment in disease severity and outcome prediction in Omicron pneumonia. The predictive model accurately predicts the severity and outcome of Omicron infection. Oxygen saturation, IL-6, and infiltration in chest CT were found to be important biomarkers. This approach has the potential to provide frontline physicians with an objective tool to manage Omicron patients more effectively in time-sensitive, stressful, and potentially resource-constrained environments.

Association between mannose binding lectin gene polymorphisms and clinical severity of COVID-19 in children.

Mannose-binding lectin (MBL) is a member of innate immunity and acts with MASP (MBL-associated serine protease) to activate the lectin pathway of the complement system. MBL gene polymorphisms are associated with susceptibility to infectious diseases. This study investigated whether MBL2 genotype, serum MBL levels, and serum MASP-2 levels affect the course of SARS-CoV-2 infection. Pediatric patients diagnosed with COVID-19 by positive real-time polymerase chain reaction (PCR) were included in the study. Single nucleotide polymorphisms in the promoter and exon 1 in the MBL2 gene (rs11003125, rs7096206, rs1800450, rs1800451, rs5030737) were identified by a PCR and restriction fragment length polymorphisms analysis. Serum MBL and MASP-2 levels were measured by ELISA. COVID-19 patients were divided into asymptomatic and symptomatic. Variables were compared between these two groups. A total of 100 children were included in the study. The mean age of the patients was 130 ± 67.2 months. Of the patients, 68 (68%) were symptomatic, and 32 (32%) were asymptomatic. The polymorphisms in the - 221nt and - 550nt promoter regions did not differ between groups (p > 0.05). All codon 52 and codon 57 genotypes were determined as wild-type AA. AB genotypes were found 45.6% in symptomatic patients while 23.5% in asymptomatics. Moreover, BB genotype was detected 9.4% in symptomatic and 6.3% in asymptomatic patients (p < 0.001). B allele was more frequent in symptomatic patients (46.3%) compared to asymptomatic patients (10.9%). (p < 0.001). Serum MBL and MASP-2 levels did not differ statistically between the groups (p = 0.295, p = 0.073). These findings suggest that codon 54 polymorphism in the MBL2 gene exon-1 region can be associated with the symptomatic course of COVID-19.

COVID-19 mortality in a patient with left atrial myxoma

Individuals with comorbid conditions, particularly those with cardiovascular diseases, are at a higher risk of mortality due to COVID-19. Among primary cardiac tumours, atrial myxoma is the most commonly reported, accounting for 85% of all cases. Most tumours occur in the left atrium with an associated embolic phenomenon in 40to 50% of patients. In this case report, we describe a 35-year-old woman of West African descent who had a left atrial myxoma and was waiting for surgery. She presented with signs and symptoms of biventricular heart failure, and her severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) test results were negative. She deteriorated and died while being optimized medically before cardiac surgery. Postmortem confirmed a left atrial myxoma, myocardial infarction, bacterial endocarditis, congestive cardiac failure, COVID-19 pneumonia, as well as a positive real-time Reverse Transcription Polymerase Chain Reaction (rRT-PCR) SARS-CoV-2 test on lung swabs. Though uncommon, cardiac myxomas may result in mortality if not managed promptly. COVID-19 may complicate the management of patients with atrial myxoma with mortality.

Effect of Anticoagulants in Pulmonary Thromboembolism in Post-COVID-19 Patients.

Background and objective COVID-19 may predispose to both venous and arterial thromboembolism (VTE and ATE) due to excessive inflammation, immobilization, and hypoxia. The purpose of this study is to evaluate clinical and laboratory risk factors, as well as related medications such as anticoagulants, to predict the risk of thromboembolic disease and/or death in COVID-19 patients. Methods Over a period of 14 months (from August 2020 to September 2021), a total of 145 consecutive patients with signs and symptoms suspicious of pulmonary embolism (PE) were referred for perfusion single-photon emission computed tomography/computed tomography (Q SPECT/CT). All patients had a history of SARS‑CoV‑2 infection, diagnosed with a positive real-time polymerase chain reaction (RT-PCR) test. Results Among the 145 patients included in the study, the risk of PE was found to be greater in elderly patients (odds ratio [OR] [95% CI]: 1.05 [1.02‑1.07]; p<0.001) and in patients with higher maximum d-dimer levels (OR [95% CI]: 1.14 [1.01‑1.3]; p=0.04). We also analyzed the utility of the maximum d-dimer level for predicting acute PE with receiver operating characteristic (ROC) curve analysis. For d‑dimer = 0.5 mg/dL, cut-off sensitivity is 91%, specificity is 23%, and for d-dimer = 1 mg/dL, cut-off sensitivity is 79%, specificity is 43% Conclusion D-dimer titers were higher in the PE group in our study. Another significant finding was that, possibly due to thromboinflammation, anticoagulants did not prevent the development of PE in COVID-19 patients.

Incremental costs of hospital-acquired infections in COVID-19 patients in an adult intensive care unit of a tertiary hospital from a low-resource setting

BackgroundHospital-acquired infections (HAIs) are a global public health problem and put patients at risk of complications, including death. HAIs increase treatment costs, but their financial impact on Serbia’s healthcare system is unknown. Our goal was to assess incremental costs of HAIs in a tertiary care adult intensive care unit (ICU) that managed COVID-19 patients.MethodsA retrospective study from March 6th to December 31st, 2020 included patients with microbiologically confirmed COVID-19 (positive rapid antigen test or real-time polymerase chain reaction) treated in the ICU of the Teaching Hospital for Infectious and Tropical Diseases, University Clinical Centre of Serbia. Demographic and HAI-specific data acquired in our ICU were collected, including total and stratified medical costs (services, materials, laboratory testing, medicines, occupancy costs). Median total and stratified costs were compared in relation to HAI acquisition. Linear regression modelling was used to assess incremental costs of HAIs, adjusted for age, biological sex, prior hospitalisation, Charlson Comorbidity Index (CCI), and Glasgow Coma Scale (GCS) on admission. Outcome variables were length of stay (LOS) in days and mortality.ResultsDuring the study period, 299 patients were treated for COVID-19, of which 214 were included. HAIs were diagnosed in 56 (26.2%) patients. Acinetobacter spp. was the main pathogen in respiratory (38, 45.8%) and bloodstream infections (35, 42.2%), the two main HAI types. Median total costs were significantly greater in patients with HAIs (€1650.4 vs. €4203.2, p < 0.001). Longer LOS (10.0 vs. 18.5 days, p < 0.001) and higher ICU mortality (51.3% vs. 89.3%, p < 0.001) were seen if HAIs were acquired. Patients with ≥ 2 HAIs had the highest median total costs compared to those without HAIs or with a single HAI (€1650.4 vs. €3343.4 vs. €7336.9, p < 0.001). Incremental costs in patients with 1 and ≥ 2 HAIs were €1837.8 (95% CI 1257.8–2417.7, p < 0.001) and €5142.5 (95% CI 4262.3–6022.7, p < 0.001), respectively.ConclusionsThis is the first economic evaluation of HAIs in Serbia, showing significant additional costs to our healthcare system. HAIs prolong LOS and influence ICU mortality rates. Larger economic assessments are needed to enhance infection control practices.