Positive COVID-19 Test Research Articles

Prolonged rapid antigen test positivity among COVID-19 patients.

Most guidelines recommend a symptom-based strategy to determine the duration of isolation among COVID-19 patients.[1] Antigen tests has been shown to have a higher positive predictive value for viral culture positivity than reverse transcriptase-polymerase chain reaction (RT-PCR) and is therefore likely to be a good tool to determine the duration of infectiousness.[2] Until recently, Government of Kerala guidelines recommended a rapid antigen test- (RAT) based strategy for discharge and duration of isolation in COVID-19 patients.[3] RAT had to be done on the 10th day for mild illness and 14th day for severe illness. If RAT was negative, the patients were fit for discharge and if positive, it was repeated every alternate day till negative (complete guidelines are given in supplementary appendix). These guidelines provided us a unique opportunity to study the duration of antigen positivity in COVID-19 and factors predicting prolonged antigen positivity. We retrospectively analysed the data of COVID-19 patients (diagnosed by a RT-PCR based test or a RAT) admitted between 1st August 2020 and 30th November 2020, who underwent RAT test for discontinuing isolation. We used the STANDARD Q COVID-19 Ag Test (SD Biosensor, Inc), which is a rapid chromatographic immunoassay for the qualitative detection of specific SARS-CoV-2 antigens.[4] Clinical details of the patients were retrieved from electronic medical records. We defined prolonged antigen positivity as RAT positivity ≥14 days from the onset of symptoms or from first positive COVID-19 test, whichever earlier. Factors predicting prolonged RAT positivity were assessed by Chi-square test. Variables that were found to be significant (P < 0.05) on univariate analysis were included in a multivariate analysis using binary logistical regression to determine independent predictors of prolonged RAT positivity. Of the 508 patients included in the study, 279 (54.9%) were males. Median age of the patients was 47 years (interquartile range: 33–61). Diabetes mellitus (DM) was the most common comorbidity (34.3%); 12% of the patients received corticosteroids, while remdesivir was used in 11.6%. Supplemental oxygen and invasive mechanical ventilation (IMV) was required in 9.8% and 2.6% patients, respectively. In-hospital mortality was 2.4%. The mean number of days until turning negative by RAT was 12.9 ± 3.1 days [Figure 1]. About 119 patients (23.4%) remained positive ≥14 days. Univariate analysis showed that age ≥65 years, male sex, DM, hypertension, chronic kidney disease, chronic liver disease, remdesivir use, corticosteroid use, requirement for supplemental oxygen, and IMV were significant predictors of RAT positivity ≥14 days [Table 1]. On multivariate analysis, only DM [OR: 2.37 (95% CI: 1.32–4.06, P = 0.003)] and requirement of supplemental oxygen [OR: 4.92 (1.07–22.72), P = 0.040] were found to be independent predictors of RAT positivity ≥14 days.Figure 1: Day of turning negative by rapid antigen test (x-axis shows the days from the first test/onset of symptoms whichever is earlier)Table 1: Prolonged antigen positivity among various groupsOur study showed that the mean duration for RAT negativity was 12.9 days and in 23.4% patients, it took ≥14 days for RAT negativity. Considering the previous studies that correlate antigen positivity and infectiousness in COVID-19, our observations call for exploring the requirement for a longer duration of isolation, and the role of RAT in deciding the duration of isolation. Supplementary materials Classification of COVID-19 patients and discharge guidelines as per Health and Family Welfare Department, Government of Kerala. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Risk for Postpartum Depressive Symptoms Among Pregnant Women in a Tertiary Care Setting with and Without a Positive COVID-19 Test

Risk for Postpartum Depressive Symptoms Among Pregnant Women in a Tertiary Care Setting with and Without a Positive COVID-19 Test

DETERMINATION OF HEALTH BEHAVIORS AND HAND HYGIENE PRACTICES OF HEALTH PERSONNEL WORKING AS A NURSE IN A TRAINING RESEARCH HOSPITAL AND HAVE DIAGNOSIS WITH COVID-19

Aim: This study was conducted to evaluate the health behaviors and hand hygiene practices of healthcare workers who have positive COVID-19 test and work as nurses before and after the pandemic. Materials and Methods: The study, which was descriptive and crosssectional, included 99 health personnel who worked as nurses at a training research hospital and tested positive for COVID-19. A questionnaire consisting of 55 questions in total, 25 questions about demographic information and 30 questions about health behaviors and hand hygiene practices, was directed to the participants. Results: 11% of the participants reported that they washed at least 10 times a day before the pandemic, 9.1% reported that they continued this washing practice for 20 seconds, and 5.1% reported that they participated in the training programs related to personal health and hygiene. Both pre-pandemic and post-pandemic rates in the same title are 86.9%, 90.9%, 68.7%, respectively. Conclusion: There was no difference in health behaviors and hand hygiene practices before and after the pandemic in healthcare workers. Despite this, improving the factors (more specific nutrition, good manpower planning, vaccination, etc.) related to the frequent catching of COVID

Impact of COVID-19 in immunosuppressive drug-naïve autoimmune disorders: Autoimmune gastritis, celiac disease, type 1 diabetes, and autoimmune thyroid disease.

Few conflicting data are currently available on the risk of SARS‐CoV‐2 infection in patients with autoimmune disorders. The studies performed so far are influenced, in most cases, by the treatment with immunosuppressive drugs, making it difficult to ascertain the burden of autoimmunity per se. For this reason, herein we assessed the susceptibility to COVID‐19 in immunosuppressive drug‐naïve patients with autoimmune diseases, such as autoimmune gastritis (AIG), celiac disease (CD), type 1 diabetes (T1D), and autoimmune thyroid disease (AITD). Telephone interviews were conducted on 400 patients—100 for each group—in May 2021 by looking at the positivity of molecular nasopharyngeal swabs and/or serology for SARS‐CoV‐2, the need for hospitalization, the outcome, and the vaccination status. Overall, a positive COVID‐19 test was reported in 33 patients (8.2%), comparable with that of the Lombardy general population (8.2%). In particular, seven patients with AIG, 9 with CD, 8 with T1D, and 9 with AITD experienced COVID‐19. Only three patients required hospitalization, none died, and 235 (58.7%) were vaccinated, 43 with AIG, 47 with CD, 91 with T1D, and 54 with AITD. These results seem to suggest that autoimmunity per se does not increase the susceptibility to COVID‐19. Also, COVID‐19 seems to be mild in these patients, as indicated by the low hospitalization rates and adverse outcomes, although further studies are needed to better clarify this issue.

The Impact of Pneumococcal Vaccination on SARS-CoV-2 Infection in Health Care Workers Vaccinated Against Influenza in the 2021- 2022 Vaccination Campaign

Introduction: Widespread administration of vaccines should be considered the best preventive strategy in Public Health. Influenza, pneumococcal disease, and Sars-CoV-2 are major public health problems. The last influenza vaccine season, as well as the previous one, took place in the midst of a pandemic. This led to the need to evaluate the possible relationship between influenza and pneumococcal vaccines in the susceptibility and severity of COVID-19 disease. Secondary bacterial infections (SBI) contribute to a significant proportion of influenza-related mortality, with Streptococcus pneumoniae as the main co-infecting pathogen. Vaccines against bacterial pathogens can reduce the incidence and severity of co-infections. The Influenza Vaccination Campaign runs annually for four months, from October 1 to January 31 of the following year; for the Pneumococcal Program, it is recommended to use the influenza vaccination campaign as an opportunity to immunize against pneumococcus as well. Aim of the study: The study aims to compare the trend of COVID infections - during the period from November 1, 2021 to May 31, 2022 - among health care workers who received regular flu vaccination, and to assess, whether among those who also received pneumococcal vaccination during their lifetime, they were better protected against SARS-CoV-2. Materials and Methods: The scenario was defined through extrapolation of data recorded in the Lazio Region's Regional Vaccine Registry (AVR). The sample of 964 individuals consisted of healthcare workers who underwent influenza vaccination during the last Vaccine Campaign (October 2021-January 2022 period) in the ASL of Viterbo. We explored the relationship between pneumococcal vaccination and COVID-19 test positivity. Within the identified cohort, the number of pneumococcal vaccinations administered over a lifetime and the swab positivity for Sars-CoV-2 was noted. The following data were considered: • Number of HCP who underwent influenza vaccination during the last vaccination campaign; • Number of HCP who underwent influenza vaccination who also received pneumococcal vaccination during their lifetime; • Number of HCP who underwent influenza vaccination and contracted SARS-CoV-2 during the period from November 1, 2021 to May 31, 2022; • Number of HCP who received influenza vaccination and also received pneumococcal vaccination during their lifetime and were infected with SARS-CoV-2 during the period from November 1, 2021 to May 31, 2022. Results: Analysis of the data collected shows that 65.5% of the healthcare workers in our sample, all of whom were vaccinated against influenza during the last Vaccination Campaign, did not contract Sars-CoV-2 infection during the observation period (November 1, 2021-May 31, 2022).

Elucidating Pathways Mediating the Relationship Between Male Sex and COVID-19 Severity.

PurposeTo examine associations between male sex and SARS-CoV-2 test positivity, severe COVID-19 disease, and death in a single-site cohort, and assess whether male sex impacts risk for severe COVID-19 disease through socioeconomic status (SES), comorbidities, or inflammation.Materials and MethodsWe conducted a retrospective cohort study with data collected from University of Washington Medicine EMR from March 1 to September 29, 2020. All persons, regardless of age, were included if they had a conclusive diagnostic COVID-19 PCR test result. Our exposure was sex assigned at birth. We used Poisson regression to assess associations between sex and COVID-19 test positivity, disease severity and COVID-19 related death, and linear regression to compare viral cycle threshold at the first positive test. We conducted mediation analyses to assess interventional indirect effects of male sex on severe COVID-19 risk through socioeconomic status (SES, based on area deprivation and insurance type), comorbidities, and inflammation status. Models controlled for age and race/ethnicity.ResultsOf 32,919 males and 34,733 females included, 1469 (4.5%) and 1372 (4.0%) tested positive for SARS-CoV-2, respectively. Males were 14% more likely to test positive (RR = 1.14; 95% CI: 1.06–1.23), had 80% higher risk for severe COVID-19 disease (RR = 1.80; 95% CI: 1.39–2.33) and had 58% higher risk for death (RR = 1.58; 95% CI: 1.10–2.26) compared to females after adjusting for age and race/ethnicity. Mediation analyses indicated non-significant interventional indirect effects of male sex on severe COVID-19 disease through elevated inflammatory markers, SES and comorbidities, but the greatest effect was through the inflammation pathway.ConclusionMales appear to be at higher risk at all steps of the continuum of COVID-19 illness. The strongest mediating signal, albeit non-significant, is with inflammatory pathways. Further elucidation of causal pathways linking sex and COVID-19 severity is needed in larger cohorts.

Inaugural Seizures Revealing COVID-19 in an Immunocompetent Infant at the University Teaching Hospital (UTH) of Bouak&amp;#233;

Introduction: Children are likely to present with atypical and non-specific clinical manifestations of COVID-19, unlike adults. The aim of this observation is to identify the difficulties related to the diagnosis and the curative and preventive management of SARS-CoV-2 infection in children. Observation: This is a 15-month-old infant admitted for febrile seizures. The interrogation revealed signs evolving 48 hours before his admission marked by post-prandial vomiting, wet cough, hypotonia, food refusal, incessant crying, fever, and seizures. His antecedents can be summed up as an uneventful pre- and per-natal period, good eating habits, good psychomotor and staturo-ponderal development, and outdated vaccination. The physical and paraclinical examination made it possible to retain the diagnosis of severe pneumonia. The initial management consisted of oxygenation, hydroelectrolyte intake, antibiotic therapy, and neurosedation. The evolution 3 days later was marked by a worsening of the clinical features, and the hypothesis of infection with SARS-CoV-2 was raised. The nasopharyngeal swab for COVID-19 RT-PCR performed was positive. The infant was isolated in the intensive care unit, where he received oxygen therapy with a mask, enteral nutrition, antibiotic therapy, corticosteroid therapy, and adequate nursing. The evolution was favorable 48 hours later. In addition, his asymptomatic mother and 14-year-old brother were placed in isolation after a positive RT-PCR COVID-19 test. Her father who was very often away from home for professional reasons was negative for COVID-19 RT-PCR. They all four live in the same 3-room house. Conclusion: Childhood COVID-19 has many facets. Clinicians should think about it in the face of any infectious manifestation, in order to avoid delays in treatment and improve the prognosis.

Premorbid echocardiography and risk of hospitalization in COVID-19.

BackgroundCOVID-19 has caused a global pandemic unprecedented in a century. Though primarily a respiratory illness, cardiovascular risk factors predict adverse outcomes. We aimed to investigate the role of baseline echocardiographic abnormalities in further refining risk in addition to clinical risk factors.MethodsAdults with COVID-19 positive RT-PCR test across St Luke’s University Health Network between March 1st 2020-October 31st 2020 were identified. Those with trans-thoracic echocardiography (TTE) within 15–180 days preceding COVID-19 positivity were selected, excluding severe valvular disease, acute cardiac event between TTE and COVID-19, or asymptomatic patients positive on screening. Demographic, clinical, and echocardiographic variables were manually extracted from patients’ EHR and compared between groups stratified by disease severity. Logistic regression was used to identify independent predictors of hospitalization.Results192 patients met inclusion criteria. 87 (45.3%) required hospitalization, 34 (17.7%) suffered severe disease (need for ICU care/mechanical ventilation/in-hospital death). Age, co-morbidities, and several echocardiographic abnormalities were more prevalent in those with moderate-severe disease than in mild disease, with notable exceptions of systolic/diastolic dysfunction. On multivariate analysis, age (OR 1.039, 95% CI 1.011–1.067), coronary artery disease (OR 4.184, 95% CI 1.451–12.063), COPD (OR 6.886, 95% CI 1.396–33.959) and left atrial diameter ≥ 4.0 cm (OR 2.379, 95% CI 1.031–5.493) predicted need for hospitalization. Model showed excellent discrimination (ROC AUC 0.809, 95% CI 0.746–0.873).ConclusionsBaseline left atrial enlargement is an independent risk factor for risk of hospitalization among patients with COVID-19. When available, baseline LA enlargement may identify patients for (1) closer outpatient follow up, and (2) counseling vaccine-hesitancy.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10554-022-02565-4.

SARS-COV-2 Rapid Antigen Test in Comparison with RT-PCR for Laboratory Diagnosis of COVID-19 in a Southwest State of Nigeria

Objectives: Rapid and accurate identification of persons infected with SARS-CoV-2 which causes COVID-19 is key to managing the pandemic. The urgent need to scale up access to COVID-19 testing in Nigeria has led to the government’s introduction of the use of COVID-19 Ag rapid diagnostic test (RDT) across various settings in the country. However, field performance evaluation of the rapid SARS-CoV-2 antigen detection test is required to be conducted periodically and compared with the gold standard real-time reverse transcription-polymerase chain reaction (RT-PCR) test for diagnosis of COVID-19 cases. Design: A prospective COVID-19 screening and un-blinded verification of the performance of the STANDARD Q COVID-19 Ag test kit. Setting: The rapid SARS-CoV-2 antigen detection test, StandardTM Q COVID-19 Ag kit was compared with the RT-PCR test for detection of SARS-CoV-2 in nasopharyngeal samples for COVID-19 screening from persons and personnel attending a national youth camp orientation exercise during the second wave of the COVID-19 outbreak (January to March 2021) in Ondo state, southwest Nigeria. Participants: Three hundred fifty-one persons and personnel were screened for COVID-19 infection. Results: Of 351 respondents screened, 68 (19.4%) were positive, and 264 (75.2%) were negative for both COVID-19 Ag RDT and RT-PCR assay. The rapid SARS-CoV-2 antigen detection test’s sensitivity and specificity were 78.16% (95% CI = 68.02% - 86.31%) and 100.0% (95% CI = 98.61% - 100.0%), respectively and the diagnostic accuracy was 94.59% (95% CI: 92 - 97). Respondents that were symptomatic had a higher test sensitivity of 78.6% (49.2 - 95.3) compared to those without symptoms 78.1% (66.9 - 86.9) (p TM Q COVID-19 Ag kit can be an appropriate rapid antigen test that could be used to screen for positive COVID-19 tests to guide decision-making for clinical management of persons infected with COVID-19, especially for closed settings and other clinical care settings.

The timing of a major operative intervention after a positive COVID-19 test affects post-operative mortality

The timing of a major operative intervention after a positive COVID-19 test affects post-operative mortality

Impact of COVID-19 on Surgical Volume: Single-Center Experience from Addis Ababa, Ethiopia.

The COVID-19 pandemic has caused substantial disruptions to surgical-care delivery mainly due to diversion of available resources from surgical to COVID-19 care, reduced flow of patients, supply-chain interruptions and social distancing and restriction measures. The purpose of this study was to understand the impact of the pandemic on surgical volume in our hospital. A descriptive cross-sectional study was done at Tikur Anbessa Specialized Hospital. A 2- year data was collected from March 2019 up to March 2021 from the operation theatre registration books. The data registry at the admission records office was also reviewed to extract the number pf patients on the elective surgery waiting list. Data were recorded, analyzed and reported using SPSS software package 26. The findings showed that there was a significant drop in surgical volume during the COVID-19 era. Surgical volume has dropped by 19% for emergency and by 32% for elective surgeries. COVID-19 test positivity of patients was identified as the single most important reason for elective operation cancellation during the first wave of the pandemic, contributing to as high as 85% of the reasons. The outcome of our study showed that COVID-19 has adversely affected elective and emergency surgical volume in our institution. This has also led to a dramatic increase in the surgical waiting list load. We recommend immediate surgical systems strengthening measures to re-build the surgical care ecosystem significantly affected by COVID-19. Surgical and anesthesia systems strengthening should be an integral part of pandemic preparedness and management.

Predictors and time to recovery from COVID-19 among patients attended at the treatment centers in Ekiti State, South West, Nigeria.

Introductiontime to clinical recovery from COVID-19 infection and associated factors has not been explored in Nigeria. This study was conducted to assess the predictors and time to recovery from COVID-19 among patients attended to at the treatment centers in Ekiti State, South West.Methodsa facility-based retrospective cohort study was conducted between March 2020 to October 2021. Laboratory confirmed COVID-19 positive test result of 586 patients receiving treatment at the treatment centres in Ekiti were included. Data were extracted from COVID-19 intake forms and medical records of patients. Data were analysed using descriptive statistics and survival analysis methods including Cox proportional hazards regression model. Level of significance was set at 5%.Resultsthe mean age of the patients was 43.46 (SD 0.74) years. Forty-seven percent (47%) of the patients were aged 25-44 years, fifty-one percent (51%) were males. The median recovery time of COVID-19 patients was 21 days (IQR: 14-23). Being a male-patient (95% CI 20.46-21.54), older age (95% CI 20.14-21.86), not admitted in the hospital (95% CI 22.74-23.26), and associated multiple co-morbidities (95% CI 17.65-28.35) were associated with delayed recovery time. Predictors of recovery time of patients from COVID-19 infection were admission status (aHR: 0.71, 95%CI 0.56-0.88; p=0.002) and symptoms on admission (aHR: 0.81, 95%CI 0.66-0.99; p=0.020).Conclusionpatients with comorbidities, older and those not admitted were more likely to have a delayed clinical recovery from COVID-19. Knowledge of the predictors might help health professionals in risk stratification and better management of patients with COVID-19.

Prominent Pseudo-Angiovascular invasion by benign gallbladder epithelium and bile emboli in a patient with delayed cholecystectomy due to COVID-19 positive test

Lymphovascular invasion is a hallmark of malignant neoplasms, however the presence of benign epithelium within vessels has been reported in benign processes, albeit infrequently. The proposed mechanism to explain this phenomenon entails mechanical displacement of benign epithelium into the vascular spaces during surgical manipulation or diagnostic interventions. We report a case of numerous benign epithelial vascular emboli in a cholecystectomy specimen. A 29-year-old male presented with acute calculous cholecystitis. Surgery was delayed for several weeks due to COVID-19 infection. Histologic examination of the gallbladder showed subacute cholecystitis, widespread vascular epithelial emboli with associated fibrin deposition and bile embolism supporting an in vivo process. The epithelial emboli were localized in small veins and arterioles with D2–40−/CD31+/CD34+ endothelium. The displaced epithelium showed benign cytologic features, was negative for p53 expression, and had a Ki-67 labelling index like the benign background mucosa, supporting a benign process. There was no evidence of dysplasia or malignancy in the specimen after thorough sampling. Persistent inflammation, mucosal ulceration, transmural mucosal herniation (Rokitansky-Aschoff sinuses), and protracted surgical manipulation secondary to adhesive disease are favored to be the underlying causes of this unusual histologic finding. Although we presume an uneventful outcome, clinical follow up was recommended. COVID-19 infection likely contributed to this phenomenon by causing a delay in the surgical management.

Double Face Mask Use for COVID-19 Infection Prevention and Control Among Medical Students at Makerere University: A Cross-Section Survey.

IntroductionThe second wave of COVID-19 greatly affected the health care and education systems in Uganda, due to the infection itself and the lockdowns instituted. Double masking has been suggested as a safe alternative to double-layered masks, where the quality of the latter may not be guaranteed. This study aimed to determine patterns of double mask use among undergraduate medical students at Makerere University, Uganda.MethodsWe conducted a descriptive cross-sectional study using an online questionnaire. All students enrolled at the College of Health Sciences; Makerere University received the link to this questionnaire to participate. Logistic regression analysis was used to assess factors associated with double mask use.ResultsA total of 348 participants were enrolled. The majority (61.8%) were male; the median age was 23 (range: 32) years. Up to 10.3%, 42%, and 4.3% reported past COVID-19 positive test, history of COVID-19 symptoms, and having comorbidities, respectively. Up to 40.8% had been vaccinated against COVID-19. More than half (68.7%) believed double masking was superior to single masking for COVID-19 IPC, but only 20.5% reported double masking. Participants with a past COVID-19 positive test [aOR: 2.5; 95% CI: 1.1–5.8, p = 0.026] and participants who believed double masks had a superior protective advantage [aOR: 20; 95% CI: 4.9–86.2, p < 0.001] were more likely to double mask. Lack of trust in the quality of masks (46.5%) was the most frequent motivation for double masking, while excessive sweating (68.4%), high cost of masks (66.4%), and difficulty in breathing (66.1%) were the major barriers.ConclusionVery few medical students practice double masking to prevent COVID-19. Coupled with inconsistencies in the availability of the recommended four-layered masks in Uganda and increased exposure in lecture rooms and clinical rotations, medical students may be at risk of contracting COVID-19.

Likely community transmission of COVID-19 infections between neighboring, persistent hotspots in Ontario, Canada.

Introduction: This study aimed to produce community-level geo-spatial mapping of confirmed COVID-19 cases in Ontario Canada in near real-time to support decision-making. This was accomplished by area-to-area geostatistical analysis, space-time integration, and spatial interpolation of COVID-19 positive individuals. Methods: COVID-19 cases and locations were curated for geostatistical analyses from March 2020 through June 2021, corresponding to the first, second, and third waves of infections. Daily cases were aggregated according to designated forward sortation area (FSA), and postal codes (PC) in municipal regions Hamilton, Kitchener/Waterloo, London, Ottawa, Toronto, and Windsor/Essex county. Hotspots were identified with area-to-area tests including Getis-Ord Gi*, Global Moran's I spatial autocorrelation, and Local Moran's I asymmetric clustering and outlier analyses. Case counts were also interpolated across geographic regions by Empirical Bayesian Kriging, which localizes high concentrations of COVID-19 positive tests, independent of FSA or PC boundaries. The Geostatistical Disease Epidemiology Toolbox, which is freely-available software, automates the identification of these regions and produces digital maps for public health professionals to assist in pandemic management of contact tracing and distribution of other resources. Results: This study provided indicators in real-time of likely, community-level disease transmission through innovative geospatial analyses of COVID-19 incidence data. Municipal and provincial results were validated by comparisons with known outbreaks at long-term care and other high density residences and on farms. PC-level analyses revealed hotspots at higher geospatial resolution than public reports of FSAs, and often sooner. Results of different tests and kriging were compared to determine consistency among hotspot assignments. Concurrent or consecutive hotspots in close proximity suggested potential community transmission of COVID-19 from cluster and outlier analysis of neighboring PCs and by kriging. Results were also stratified by population based-categories (sex, age, and presence/absence of comorbidities). Conclusions: Earlier recognition of hotspots could reduce public health burdens of COVID-19 and expedite contact tracing.

Experience in treatment of patients with arterial and venous thrombosis with proven COVID-19

Background. COVID-19 is represented by a large number of different phenotypes, ranging from asymptomatic progress to the development of severe multiple organ dysfunction syndrome. The mechanisms of development of multiple organ dysfunction syndrome are multifactorial, including hypercoagulation with the formation of blood clots. They are often diagnosed as thrombotic complications with detection of blood clots not only in the veins and pulmonary arteries, but also in the heart and main arteries. An observational study shows that the incidence of venous and arterial thrombosis is as high as 31% in patients with COVID-19 pneumonia. However, large studies have not yet been conducted.Aim. To generalize and analyze our own observations of the clinical course of patients with thrombosis and COVID-19.Methods. The study included 5 male patients who had arterial and venous thrombosis and COVID-19 positive test. Results The experience of treatment of 5 patients with COVID-19 with arterial and venous thrombosis was analyzed. All patients showed characteristic changes in the coagulogram. The patient who, upon admission, had a negative test for COVID-19, and characteristic changes in the coagulogram appeared on the day of recurrent thrombosis, was of greatest interest. All patients received standard treatment and were discharged with improvement after testing negative for COVID-19.Conclusion. Generalization of the clinical course of patients with COVID-19 and thrombosis of various vascular regions allowed us to develop treatment tactics for these groups of patients.

The Psychological Impact of COVID-19 on Healthcare Workers in Saudi Arabia: A Year Later Into the Pandemic.

Objective: The COVID-19 pandemic poses unprecedented challenges to healthcare workers worldwide. This study sought to estimate the prevalence of depression, anxiety, and stress among healthcare workers in Saudi Arabia, and to identify the factors associated with these psychological disorders.Methods: A cross-sectional questionnaire-based study was conducted from January 21 to March 2, 2021. Physicians, pharmacists, nurses, and other healthcare workers from different parts of Saudi Arabia were recruited through snowball sampling. Psychological outcomes were measured using the Depression, Anxiety, and Stress Scale (DASS-21). Pearson's chi-square test was used to explore the bivariate association between diverse characteristics and each outcome. Multiple logistic regression analyses were performed to identify factors associated with depression, anxiety, and stress.Results: A total of 501 healthcare workers completed the survey, of whom 60% were female and nearly half were pharmacists. The majority (76.25%) of respondents reported that a family member, friend, or colleague had contracted COVID-19, and more than one-third (36%) knew someone who died due to COVID-19. Overall, the estimated prevalence rates of depression, anxiety, and stress were 54.69, 60.88, and 41.92%, respectively. The multivariate analysis revealed that healthcare workers with chronic diseases, nurses, and healthcare workers from the southern region were more likely to suffer from depression and stress. Further, individuals with positive COVID-19 test results showed a greater proportion of depressive symptoms compared to others. In addition, knowing someone who died due to COVID-19 and having a chronic illness were predisposing factors for anxiety.Conclusion: After more than a year, the prevalence of depression, anxiety, and stress remains substantial among healthcare workers in Saudi Arabia. The findings can help guide efforts to mitigate the psychological impact of the pandemic.

P-BN34 A single centre study of outcomes for Hiatal Surgery during the Covid-19 pandemic

BackgroundCovid-19 has had a significant adverse impact on our ability to maintain provision of surgical interventions for a range of conditions, due to the diversion of resources to care for Covid related emergency admissions. Furthermore, there is clear evidence demonstrating how covid-19 infection in the peri-operative period is associated with dramatically increased rates of morbidity for patients. It has therefore become incumbent on healthcare providers to create peri-operative care pathways which can facilitate delivery of surgical care in a Covid safe environment. MethodsIn response to the Covid-19 pandemic our institution implemented a ‘Covid-lite’ pathway in order to allow the admission for patients for surgical procedures on the basis of urgent need. This included patients requiring surgery benign upper GI conditions. Patients underwent pre-operative PCR Covid testing,and asked to isloate from time of swab until admission for surgery. Post-opertive operative care was provided on the elective surgical ward which is is all single rooms, and was maintianed as a Covid free environment. We conducted a review of outcomes for all patients undergoing hiatal procedures between January 2020 – April 2021. Surgeries included were Para-Oesophageal Hernia Repair (POH), Anti-reflux Surgery (ARS) & surgery for achalasia (LCM). The primary outcome measure was the rate of Covid-19 infection in the peri-operative period. Measurements were also taken of length of stay, and any signifcant morbidity.ResultsHiatal surgery was performed on 42 patients in this time period (28 female, 14 male). The median age was 73 years. Three patients underwent elective ARS and 39 had repair of POH. All ARS procedures were performed laparoscopically. For those having POH repair, 31 cases were elective admissions. 30/31 cases had laparoscopic procedures, with 50% of emergency cases also treated laparoscopically. All elective maptients were managed via the The median length of stay for elective cases was 2 days vs. 14.5 for emergencies (p = 0.001). Zero patients returned positive Covid-19 tests pre-operatively or during their inpatient stay. Two patients were re-admitted within 30 days, although neither were related to covid-19.ConclusionsThese results indicate that it is possible to safely maintain the provision of hiatal surgery in the Covid-19 era for both elective and emergency cases. The use of a dedicated pathway demonstrates our ability to minimise risk of peri-operative Covid-19 infection and any associated morbidity or mortality. Although there has been a significant attempt prioritise surgery for patients with cancer during the Covid-19 pandemic, these resuts provide a strong case that it possible to provide safe and timely interventions for other necessary surgical interventions with appropriate risk reducing measures.

Exposure risk and COVID-19 infection among frontline health-care workers: A single tertiary care centre experience

BackgroundThere is limited data on frontline health-care workers and risk of COVID-19 from the developing nations. It is imperative to identify those at higher risk to prevent further transmission. We assessed the relationship between exposure risk and COVID-19 among front-line health-care workers who were primary contacts of a COVID-19 patient. MethodsA retrospective cohort study was conducted among front-line health-care workers in a tertiary care hospital who were exposed to a COVID-19 patient. Information on demographic factors, medical history, exposure related factors and subsequently COVID-19 lab reports were collected. An exposure risk assessment designed collating various exposure related factors categorized the participants into those with high and low risk. We used logistic regression to estimate the odds ratio of our primary outcome, a positive COVID-19 test when the independent variables were exposure risk, age, gender and occupation. ResultsAmong1858 frontline workers who were primary contacts of a COVID-19 patient at the hospital, 106 (5.7%) incident reports of a positive COVID-19 test were recorded. None of the exposure related factors had any significant association with a positive COVID-19 test. However, high exposure risk category was significantly associated with COVID-19 positive test at the end of quarantine. ConclusionCOVID-19 was more frequent among front-line health-care workers who belonged to high exposure category. Education at different levels of service delivery at hospitals is required for best practice in order to prevent COVID-19 among health care providers. There is need to develop additional strategies to ensure that the information is translated in to practice.

The Impact of COVID-19 on Physical Performance and Mental Health-A Retrospective Case Series of Belgian Male Professional Football Players.

Rationale: As every season, physical performance of players of Royal Antwerp FC's first team was regularly tested and mental well-being and mood were assessed during football season 2020–2021. Just like in the general population, several professional athletes were infected by SARS-CoV-2 during that season. COVID-19 is a complex disorder affecting multiple body systems, potentially damaging lungs, affecting the cardiovascular system or causing muscle weakness. Therefore, the impact of COVID-19 on performance was a major concern for the affected football players and their entourage.Objectives: To retrospectively examine the influence of COVID-19 on physical performance and mental health in professional football athletes during the season 2020–2021.Methods: Thirty-three professional athletes (age: 25.37 ± 4.11 years; height: 182.75 ± 7.62 cm; weight: 78.90 ± 8.97 kg) of a Belgian first division football club were assessed weekly during the 2020-2021 season. Weekly assessments comprised strength values of the hamstrings, hip abductors and hip adductors, jump performance, a modified Hooper questionnaire to assess mental status and nose swab PCR tests for COVID-19. Data analysis was performed from 2 weeks prior to COVID-19 contamination up to 8 weeks after the first positive test. Post-hoc Bonferroni correction was applied when performing statistical analysis.Results: Eleven players tested positive for COVID-19. Duration of contamination was 13 ± 7 days. There was no statistically significant difference before and after COVID-19 infection for jump performance, and adductor and abductor muscle strength (p > 0.05). Functional hamstring strength improved significantly 2 weeks (MD: 41.48; 95%CI: −3.79 to 86.75; p = 0.009) and 4 weeks (MD: 34.76; 95%CI: −8.91 to 78.42; p = 0.019) after COVID-19, whereas mood (MD: −0.60; 95%CI: −1.46 to 0.26; p = 0.041), stress levels (MD: −0.83; 95%CI: −1.85 to 0.20; p = 0.020) and total wellness (MD: −2.41; 95%CI: −5.25 to 0.43; p = 0.015) showed a significant reduction 8 weeks after confirmed COVID-19.Conclusion: Physical performance varied considerably across outcomes before and 8 weeks after COVID-19 contamination in a sample of first division football players. However, affected football players' overall well-being, stress levels and mood diminished after a positive COVID-19 test.