RT-PCR Positive COVID-19 Research Articles

Atorvastatin and telmisartan do not reduce nasopharyngeal carriage of SARS-CoV-2 in mild or moderate COVID-19 in a phase IIb randomized controlled trial

Observational studies suggest a reduction in fatal or severe COVID-19 disease with the use of ACE2 inhibitors and statins. We implemented a randomized controlled tree-arm open label trial evaluating the benefits of adding telmisartan (TLM) or atorvastatin (ATV) to lopinavir boosted ritonavir (LPVr) on the SARS-CoV-2 nasopharyngeal viral load in patients with mild / moderate COVID-19 infection in Côte d’Ivoire. RT-PCR positive COVID-19 patients ≥ 18 years, with general or respiratory symptoms for less than 7 days were randomized (1:1:1) to receive LPVr (400 mg/100 mg twice daily), LPVr + TLM (10 mg once daily) or LPVr + ATV (20 mg once daily) for 10 days. The primary endpoint was viro-inflammatory success defined as a composite variable at day 11: Ct ≥ 40 and C-reactive protein < 27 mg/L. We randomized 294 patients: 96 to LPVr, 100 to LPVr + TLM, 98 to LPVr + ATV arms. Baseline characteristics were well balanced between arms. In the primary analysis (missing = failure), 46% patients in the LPVr arm reached viro-inflammatory success at day 11 vs 43% in the LPVr + TLM arm (p = 0.69) and 43% in the LPVr + ATV arm (p = 0.68). The median time from baseline to resolution of COVID-19 related symptoms was not different between arms. Nine patients were hospitalized: 2 in the LPVr arm, 5 in the LPVr + TLM arm and 2 in the LPVr + ATV arm and 4 patients died. Among adults with mild to moderate COVID-19 infection, the addition of telmisartan or atorvastatin, to the standard LPVr treatment is not associated with a better virological or clinical outcome.Trial registration: NCT04466241, registered on 10/07/2020

COVID-19 Infection During Pregnancy and Hearing Loss in Infants: A Clinical Study.

To find the prevalence of hearing loss in children born to mothers who had COVID-19 infection during pregnancy. This was a prospective observational study conducted on 1960 babies born to mothers who were COVID positive during their pregnancy .All children born to RTPCR positive COVID-19 pregnant women were included in the study and babies who had any other risk factor for neonatal SNHL were excluded from the study. All the babies were subjected to OAE, and if it came pass, the test was repeated 2 weeks later. Those patients with repeat OAE also as refer were subjected to Brainstem Evoked Response Audiometry and findings correlated. The study included 1960 neonates who were subjected to neonatal hearing screening by OAE. There were 1020 males (52.04%) and 940(47.96%) females and 80 cases of consanguinity. Fifty babies were excluded due to comorbidities. In the initial OAE test 380 neonates failed (19.9%) following which BERA was done and ten patients was found to Sensorineural hearing loss. The prevalence of hearing loss in our study on babies born to mothers with COVID-19 infection during pregnancy is 0.005. Although these primary results from our study does not indicate any immediate effect of SARS-COV-2 maternal infection on neonatal hearing. More children need to be tested and followed up over an extended period of time to detect any possible delayed auditory effects. Those patients who were identified to have hearing loss in our study will have to be on long term follow-up as we see long terms effects on cognition, memory, heart health, etc. in COVID survivors. Level 1.

Effect of Covid-19 Vaccination on disease Severity among Covid-19 patients admitted in KMCTH

Background: The COVID-19 Pandemic has affected millions of people globally with significant morbidity and mortality. Though the overall case fatality rate (CFR) in Nepal was less than 1% during the initial peak, the CFR is expected to increase during the current second wave of the pandemic. Since no specific effective therapies exist, breaking the chain of transmission sounds logical. COVID-19 vaccine development is believed to be effective and safe in preventing disease adverse outcomes. Aim: Primary aim of the study was to know the COVID-19 vaccination status among the patients admitted with RT-PCR positive for COVID-19 and secondary aim of the study was to observe the difference between the outcome in terms of resources utilization LIKE NON-INVASIVE VENTILATION (NIV), Hi-flow nasal cannula (HFNC) and invasive mechanical ventilation (IMV) in vaccinated and unvaccinated patients. Method: This was a hospital-based Prospective Observational Study. All patients admitted at KMCTH from June 01, 2021 –July 31st 2021 with COVID-19 RT-PCR Positive meeting inclusion criteria were enrolled. Ethical Clearance was taken from KMC-IRC. Result: During the study period, a total of 160 RT-PCR Positive Covid-19 cases were admitted at Kathmandu Medical College Teaching Hospital (KMCTH). Out of the total patients, 74 (46.25%) were not vaccinated for covid-19 whereas 86 (53.75%) patients were vaccinated either with Vero cell (39.53%) or Covishield (60.47%) Covid-19 vaccine. The study showed 2.32% of vaccinated patients required ventilatory support compared to 13.50 % of unvaccinated patients requiring ventilatory support having significant ( p value &lt;0.05) impact on outcome. The relative risk for unvaccinated patients going to ventilator was 5.81 times higher than for vaccinated patients. Conclusion: The authors found out that more than half of the individual admitted were vaccinated (53.75 VS 46.25). Moreover, Vaccination (either with Covishield or Vero cell) appears to be effective in limiting requirement of more advance services like NIV, HFNC, and invasive mechanical ventilator. We recommend a larger, multicenter, randomized study in the future.

Prevalence of Covid-19 and Associated Co-Morbidities at a Tertiary Hospital in Eastern Nepal

Introduction: COVID-19 (coronavirus disease) manifests as asymptomatic, mild, or severe pneumonia-like symptoms. COVID-19 patients with diabetes, chronic obstructive pulmonary disease (COPD), cardiovascular disease (CVD), hypertension, malignancies, HIV, and other comorbidities could develop a life-threatening condition.&#x0D; Objectives: To identify the various comorbid illnesses in COVID-19-positive patients along with its baseline characteristics in a tertiary hospital in eastern Nepal.&#x0D; Methodology: A one-month observational study carried out in RT-PCR positive COVID-19 patients in Birat Medical College and Hospital (BMCTH) Molecular Laboratory from June to July 2021. All the data was entered in a pre-structured proforma. The data was then further entered and analyzed by using Microsoft Excel 2014.&#x0D; Result: There were 354 (22.77%) RT-PCR positive COVID-19 cases and 1200 (77.22%) RT-PCR negative COVID-19 cases. More than half of the COVID-19 positive patients were males 211(59.60%). The most common symptoms were fever (92.3%), cough (83.5%) and tiredness (81.23%). Psycho-social stress such as anxiety, depression and insomnia 123 (34.74%) were common comorbidities followed by diabetes 91(25.70%) and hypertension 72(20.33%).&#x0D; Conclusion: COVID-19 patients were mostly between the 20-30 years of age group. Fever, cough, and throat pain were the commonest presenting symptoms.

Hepatosteatozun COVID-19 Hastalarında Göğüs BT Şiddet Skorlarının Seyrine Etkisi

Background/Aims: In the literature, the temporal variation of CT severity score (CT-SS) values on consecutive CTs, which is an indicator of pneumonia severity, according to the presence of hepatosteatosis was not evaluated. We aimed to investigate the effect of hepatosteatosis on the temporal change of CT-SS in COVID-19 patients. Material and Methods: Our retrospective study included 472 RT-PCR positive COVID-19 patients ( ≥ 18 years old) admitted to our hospital between December 2021 and January 2022. Chest CT severity scores ranging from 0 to 5 were assigned to each lobe of the lung and total CT-SS was obtained. For quantitative analysis, if the hepatic/splenic attenuation ratio was &amp;lt;1, hepatosteatosis was defined. Wilcoxon test was used to evaluate the temporal changes of CT-SS values relative to the presence of hepatosteatosis. p&amp;lt;0.05 was considered statistically significant. Results: Of the total 472 patients, 255/472 (54%) were hepatosteatosis-positive. The frequency of hepatosteatosis was significantly higher in male patients, 167/255 (65.5%) (p&amp;lt;0.001). The mean age was 64.04±14.35 years. There was no significant difference between ICU admission and hepatosteatosis groups (p=0.269). There was no significant difference between mortality and the presence of hepatosteatosis (p=0.429). There was a significant increase between the 1st and the 2nd CT-SS in patients with hepatosteatosis (p&amp;lt;0.001). The increase in the second CT-SS was higher in patients with hepatosteatosis than in patients without hepatosteatosis. Conclusion: Hepatosteatosis may be an indicator of poor prognosis in the temporal change of pneumonia severity in COVID-19 patients.

The Clinical and Laboratory Profile of RT-PCR Positive Covid-19 Patients in District Hospital in Bangladesh

Objective: To assess the clinical and laboratory profile of RT-PCR positive covid-19 patients in district hospital in Bangladesh. Method: This cross-sectional study was done in 250 Bed General Hospital, Tangail, Bangladesh from January 2021 to Dec 2021. We included 95 patients having clinical symptoms and signs of COVID-19, above the age of 18 years, irrespective of sex. We defined probable and confirmed COVID-19 case according to ‘National Guidelines on Clinical Management of Corona Virus Disease 2019 (COVID-19) Version 7.0, published on 28 May 2020.10 Data were collected in structured questionnaire from patients and hospital records. All laboratory tests were performed according to the clinical judgement. Laboratory assessments consisted of RTPCR for COVID-19, complete blood count, coagulation tests, assessment of liver and renal function, C-reactive protein, procalcitonin, lactate dehydrogenase (LDH) and ferreting. Radiological assessments included chest x-ray and high resolution computed tomography (HRCT) scan. Results: During the study, majority were belong to &gt;56 years age group, 43.6% were female and 56.4% were male. Plus, majority didn’t get their vaccination, 89.60%. In addition to that, 42.1% had DM followed by HTN cases was 36.8%, 8.4% had previously history of stroke, 10.5% had CKD. 69.5% had anorexia followed by 58.9% had nausea, 28.4% had vomiting, 14.7% had Abdominal pain. On laboratory investigations, we found most of the patients had elevated levels of C-reactive protein and D-dimer was positive in 99% cases. Plus,75% patient presents emergency signs with SpO2 &lt;90% or respiratory rate &gt;24. Conclusion: Considering the data of this investigation, it can be stated that, COVID-19 impacted mostly senior male patients. Most of them were diabetic and hypertensive. Common symptoms anorexia sore throat, diarrhea, vomiting, nausea, stomach ache. Key test results included lymphopenia, elevated CRP, positive D-dimer. Notwithstanding that most didn’t take ......

Vitamin D in COVID-19

Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) causes coronavirus disease 2019 (COVID-19) with clinical outcome ranging from asymptomatic to severe disease, and even death to some. It posed a terrifying challenge to healthcare system worldwide. Several observational and clinical trials has reported that, Vitamin D deficiency has contributed to acute respiratory distress syndrome. Case fatality rate increases with age and comorbidities, both of which are associated with decreased Vitamin D level. Therefore, this study is done to study the prevalence of 25(OH)Vitamin D in RT-PCR positive COVID-19 cases and RT-PCR negative controls.This is a hospital based cross-sectional study conducted at Jawaharlal Nehru Institute of Medical Sciences, Manipur on 88 RT-PCR positive Covid-19 cases and 88 COVID-19 negative controls over a period of 2 years. Analysis of the sample was done by Liaison 25(OH) Vitamin D Total Chemiluminescence assay(CLIA).In this study, statistically significant (p-0.018) lower plasma 25(OH)Vitamin D level is seen in COVID-19 positive cases (median 28±20.47) when compared to Covid-19 negative controls(median 33.50±10.66). The number of 25(OH) Vitamin D deficient is higher in Covid-19 positive cases when compared to Covid-19 negative controls -46(52.3%) and 30(34%) respectively with a high statistically significant value (p-0.015).COVID-19 positive cases have higher tendency to have suboptimal plasma 25(OH) Vitamin D level which may contribute to the high hospitalization risk in COVID-19 infection. This finding is important as it can identify population at risk, and contribute to interventions in reducing the risk of hospitalization associated with COVID-19 infection.

Predictors of Duration and Demand of Oxygen Therapy in Hospitalized RT-PCR Positive COVID-19 Patients

Background: Among many unexplored and challenging areas of COVID-19, pathophysiology of hypoxia and its management requires special attention for the physicians. The current study aimed to find the predictors of duration and demand of oxygen therapy in RT-PCR positive, hospitalized, COVID-19 patients. Methods: It was a prospective, multicentered, observational study conducted at Chattagram International Medical College (Isolation Ward, CIMC), Chattogram Medical College (COVID Red Zone) and Parkview Hospital Limited (COVID-19 Ward) from January to June 2021 on hospitalised, RT-PCR positive cases of COVID-19 patients of 18 yrs or above who required supplemental oxygen therapy and gave informed consent to be included in the study. All the participants underwent chest HRCT on initial presentation. Results: In this study, 85 consecutive patients of confirmed COVID-19 were recruited under the study. Patients required oxygen for a median duration of 6 days and median value of the maximum oxygen requirement was 7 L/min with a range between 1-100 l/min. In patients with no co-morbidity, one co-morbidity and more than one comorbidity, the median duration of oxygen therapy were 4.5 (3.0-7.8) hours and 7.0 (5.0-14.3) hours respectively. Multiple regression was run to predict maximum oxygen duration and maximum oxygen required for the patients from gender, age, smoking pattern, number of comorbidity and HRCT score; only total number of comorbidity and HRCT severity score added statistically significantly to the prediction, p &lt; 0.05. Conclusion: The results of the study might be helpful in triage of COVID-19 patients, planning as well as clinical decision making. Bangladesh Medical Res Counc Bull 2023; 49(1): 75-80

CT SEVERITY SCORE –A TOOL FOR CLINICAL ASSESSMENT IN COVID 19 PATIENTS ?

Background: COVID-19 is an infection that has widely and rapidly spread all over the world. The clinical presentations being asymptomatic carriers to requiring assisted ventilatory support with increased mortality. Clinical parameters like oxygen saturation, respiratory rate and laboratory parameters like CRP, ferritin, d-dimer etc have been used to classify patients according to disease severity. CT chest manifestations in COVID pneumonia resemble to those seen in any viral infection To establish Aims &amp; Objectives: correlation between CT severity score and Clinico-laboratory parameters in RTPCR proven positive COVID 19 patients and study the role of HRCT chest in clinical management of COVID 19 patients. We collected clinical and laboratory data for analysis of pati Materials and Methods: ents who had RTPCR positive COVID-19 infection and underwent a chest HRCT chest scan with 128 slice CT scanner in our tertiary care hospital. Three radiologists evaluated the scan to determine the CT severity score (CTSS) and studied typical, intermediate &amp; atypical imaging features in each patient and assigned CT severity score for oxygen dependency , the patients were classied radiologically into negative, mild and severe disease The statistical analysis was performed using IBM SPSS and Microsoft excel. Descriptive statistics of patients clinical, and laboratory results were reported as numbers and relative frequencies. Frequencies of CT scores were calculated and compared with other clinical variables. The Pearson correlation coefcient test was used for correlations, and p value less than 0.01 was dened statistically signicant. A Chi square analysis was done to establish relationship between CTSS oxygen dependency, remdesivir and steroid usage. CTSS and oxygen dependency had Results: strong negative Pearson's association. Severe CTSS (10 &amp; above) had 98.3% sensitivity in relation to requirement of O2 in patients, with high negative predictive value 99.3%. Positive likelihood ratio 4.33, negative likelihood ratio 0.02. The Pearson's correlation coefcient showed moderately positive signicant association between CTSS &amp; S.CRP levels, CTSS &amp; S.ferritin level. Signicant P value is seen in severe patients having higher CTSS, treated with steroids and remdesivir. A CT-SS score less than 10 could rule out oxygen dependency Conclusion: and severe form of disease with a high negative predictive value of 99.3% in our cohort. Clinical intervention in patients according to CT severity score can be of value as evident by signicant association demonstrated in our study.

Ultra-Low Dose CT Chest in Acute COVID-19 Pneumonia: A Pilot Study from India.

The rapid increase in the number of CT acquisitions during the COVID-19 pandemic raised concerns about increased radiation exposure to patients and the resultant radiation-induced health risks. It prompted researchers to explore newer CT techniques like ultra-low dose CT (ULDCT), which could improve patient safety. Our aim was to study the utility of ultra-low dose CT (ULDCT) chest in the evaluation of acute COVID-19 pneumonia with standard-dose CT (SDCT) chest as a reference standard. This was a prospective study approved by the institutional review board. 60 RT-PCR positive COVID-19 patients with valid indication for CT chest underwent SDCT and ULDCT. ULDCT and SDCT were compared in terms of objective (noise and signal-to-noise ratio) and subjective (noise, sharpness, artifacts and diagnostic confidence) image quality, various imaging patterns of COVID-19, CT severity score and effective radiation dose. The sensitivity, specificity, positive and negative predictive value, and diagnostic accuracy of ULDCT for detecting lung lesions were calculated by taking SDCT as a reference standard. The mean age of subjects was 47.2 ± 10.7 years, with 66.67% being men. 90% of ULDCT scans showed no/minimal noise and sharp images, while 93.33% had image quality of high diagnostic confidence. The major imaging findings detected by SDCT were GGOs (90%), consolidation (76.67%), septal thickening (60%), linear opacities (33.33%), crazy-paving pattern (33.33%), nodules (30%), pleural thickening (30%), lymphadenopathy (30%) and pleural effusion (23.33%). Sensitivity, specificity and diagnostic accuracy of ULDCT for detecting most of the imaging patterns were 100% (p < 0.001); except for GGOs (sensitivity: 92.59%, specificity: 100%, diagnostic accuracy: 93.33%), consolidation (sensitivity: 100%, specificity: 71.43%, diagnostic accuracy: 93.33%) and linear opacity (sensitivity: 90.00%, specificity: 100%, diagnostic accuracy: 96.67%). CT severity score (range: 15-25) showed 100% concordance on SDCT and ULDCT, while effective radiation dose was 4.93 ± 1.11 mSv and 0.26 ± 0.024 mSv, respectively. A dose reduction of 94.38 ± 1.7% was achieved with ULDCT. Compared to SDCT, ULDCT chest yielded images of reasonable and comparable diagnostic quality with the advantage of significantly reduced radiation dose; thus, it can be a good alternative to SDCT in the evaluation of COVID-19 pneumonia.

Chest CT in covid-19 pneumonia's follow-up: A 30 patients case series.

Lung abnormalities do not fully resolve in all Covid-19 survivors and may progress to fibrosis. Understanding post-COVID lung changes helps identify patients susceptible of post-COVID-19 sequelae. We analyzed scannographic residual lung abnormalities and the full resolution percentage on intermediate- and long-term follow-up (3 months or more). Data from 30 RT-PCR positive COVID-19 patients undergoing at least one follow-up chest CT at Ibn Sina Hospital, with a minimal time interval of 3 months between the RT-PCR and the CT performance were gathered retrospectively. The following elements were analyzed: (1) lung opacities, (2) distribution, (3) dominant lung opacity, (4) Sub-pleural bands, (5) Interlobular septal thickening, (6) Vascular dilatation, (7) Bronchiectasis, (8) Honey combing, (9) Architectural distortion, (10) mosaic attenuation, and (11) Additional findings: Enlarged lymph nodes, Pleural and Pericardial fluid. To evaluate the degree of lung opacification, a score founded on visual evaluation of the lung involvement's percentage was employed. Patients were then subdivided into two categories: (1) no residual opacities and (2) remaining pulmonary opacities. 30 patients were enrolled. The age ranged between 40 and 87 years. CT was indicated for symptoms or functional impairment. The time range between the positive RT-PCR and Follow-up CT varied between 3 and 12 months. CT severity score ranged between o and 23. Residual lung opacities were present in 24 cases (80%). The dominant lung opacities were Ground glass (46.7%), and linear/curvilinear opacities (23.3%). Signs of fibrosis were present in 9 patients (30%). CT abnormalities following Covid-19 pneumonia's prevalence varies based on the extent of the original lung affection and the time gap since the acute phase. Residual anomalies' effects on respiratory physiology, symptoms, and quality of living are unknown. Maintained monitoring of COVID-19 survivors with clinical examination, iterative pulmonary function tests, and HRCT is advised.

Clinical Presentation of COVID-19 and Antibody Responses in Bangladeshi Patients Infected with the Delta or Omicron Variants of SARS-CoV-2.

The clinical presentation of COVID-19 and the specific antibody responses associated with SARS-CoV-2 variants have not been investigated during the emergence of Omicron variants in Bangladesh. The Delta and Omicron variants were identified by post-PCR melting curve analysis of the spike (S) protein receptor binding domain amplicons. Anti-S-protein immunoglobulin-G anti-nucleocapsid (N)-protein immunoglobulin-G and immunoglobulin-A levels were measured by ELISA. The Delta variant was found in 40 out of 40 (100%) SARS-CoV-2 RT-PCR positive COVID-19 patients between 13 September and 23 October 2021 and Omicron variants in 90 out of 90 (100%) RT-PCR positive COVID-19 patients between 9 January and 10 February 2022. The Delta variant associated with hospitalization (74%, 80%, and 40%) and oxygen support (60%, 57%, and 40%) in the no vaccine, dose-1, and dose-2 vaccinated cases, respectively, whereas the Omicron COVID-19 required neither hospitalization nor oxygen support (0%, p &lt; 0.0001). Fever, cough, and breathlessness were found at a significantly higher frequency among the Delta than Omicron variants (p &lt; 0.001). The viral RNA levels of the Delta variant were higher than that of the Omicron variants (Ct median 19.9 versus 23.85; p &lt; 0.02). Anti-spike protein immunoglobulin-G and anti-N-protein immunoglobulin-G within 1 week post onset of Delta variant COVID-19 symptoms indicate prior SARS-CoV-2 infection. The Delta variant and Omicron BA.1 and BA.2 breakthrough infections in the Dhaka region, at 240 days post onset of COVID-19 symptoms, negatively correlated with the time interval between the second vaccine dose and serum sampling. The findings of lower anti-spike protein immunoglobulin-G reactivity after booster vaccination than after the second vaccine dose suggest that the booster vaccine is not necessarily beneficial in young Bangladeshi adults having a history of repeated SARS-CoV-2 infections.

Clinical Characteristics and Early Outcomes of Children with COVID-19 Infection admitted to Children Hospital in Dhaka City

Background: The burden of COVID-19 infection in children is lesser than adult; however, there are only a few data describing COVID-19 in pediatrics. Objective: The purpose of the present study was to determine the clinical characteristics and early outcomes of children with COVID-19 infection admitted to children Hospital in Dhaka city. Methodology: This is a prospective observational study included children of RT-PCR positive COVID-19 cases admitted to Dr. MR Khan Shishu Hospital &amp; ICH between June2020 to November 2020. A total 95 children were enrolled. Patients were categorized clinically and visited every day during their hospital stay. This study included mode of presentation, the pattern of comorbidities, presence of co-infection, clinical trajectory &amp; early outcomes. Clinical outcomes included survival, duration of oxygenation, lengths of hospital stay. Data were analyzed after collection of demographic and clinical data of 95 enrolled children. Results: Among 95 children with COVID-19 admitted to Dr. M R Khan Shishu Hospital &amp; ICH, 56 (58.95%) were male and 39(41.05%) were female. Maximum 35 (36.84%) of the patients were between 1-5 years age group. 65 (68.42%) presented with respiratory symptoms and 19 (20%) presented with gastrointestinal symptoms. Twenty-five patients (26.32%) had significant preexisting comorbidities. Most common symptoms were fever 73(76.84%), cough 65(68.42%), sore throat 24(25.26%), diarrhea 21(22.11%). Oxygenation was required for 5 patients (5.26%). 1 patient (0.95%) had died and 1required ventilatory support in ICU. The median (range) hospital lengths of stay was 7(3-14) days. Conclusion: Most of the children with COVID-19 presented with mild to moderate symptoms &amp; gastrointestinal symptoms were not uncommon. Most of the patients had good prognosis and only few patients required respiratory support. Bangladesh Journal of Infectious Diseases, April 2022;9(Suppl_1): S9-S13

Distribution of ABO Blood Group System, Presentations, Comorbidities, Disease Severity and Outcome of COVID- 19 Patients in Jashore, Bangladesh

Introduction: The whole world has been crippled by COVID- 19 for a long period of time and a lot of its issues still remain unknown. The study was designed to assess the distribution of ABO blood group system, presentation, comorbidities, disease severity and outcome of COVID-19 patients in Jashore, Bangladesh. Methods: This retrospective type of observational study recruited 928 RT-PCR positive COVID-19 patients above 18 years living in the district of Jashore, Bangladesh. Results: Mean age of the study population was 41.55±13.59 years including a significant age difference (p: &lt;0.001) in disease severity and insignificant gender difference were observed (p: 0.291). Fever was frequently presenting symptoms (83.1%) in our study associated with cough 47.1%, fatigue 39.2%, myalgia 38.0%, distaste 35.3%, anosmia or hyposmia 33.3%. Diabetes (p: &lt;0.001), hypertension (p: &lt;0.001), chronic respiratory illness (p: &lt;0.001), coronary artery diseases (p: 0.003) and malignancy (p: 0.003) played as potential risk factors for developing COVID-19 severity. Out of the total study patients, 36.9%, 29.1%, 22.5 and 11.5% COVID- 19 patients came from blood B, O, A an AB respectively. On the other hand 95.5% COVID-19 patients were Rhesus positive. However, we did not found any significant association between disease severity and different ABO and Rh blood group (p: 0.379 and p: 0.092 respectively). A 97.6% of our patients had significantly (p: &lt;0.001) been recovered from COVID-19 where most of the patients (81.1%) were managed at home. Though, 2% and 1.9% of our patients developed severe pneumonia and critically ill COVID-19, we had noticed significantly low mortality rate (1.4%, p: &lt;0.001) in this current study. Conclusion: In this recent study, blood group B constituted the highest number of the COVID-19 patients. Fever, cough and fatigue were the most common presenting feature of COVID-19 patients. Preexistent diabetes, hypertension, chronic respiratory diseases, coronary artery diseases and malignancy played as significant potential risk factors of diease severity of COVID-19. A majority of the patients were significantly managed at home. A minimum portion of the COVID-19 patients developed severe pneumonia and critical illness; and a significant low case fatality occurred in our study. J Bangladesh Coll Phys Surg 2022; 40: 246-252

CXR severity scores of COVID 19 infection in Sri Lanka: findings of a multicenter study during the first wave of the pandemic

Introduction: Chest X-ray initially remained the only imaging modality in the first wave of the COVID -19 pandemic in Sri Lanka similar to many other low resource settings. Sri Lanka claimed a cluster epidemic status achieving a case fatality rate well below the global rate during the first wave. Objectives: To describe degree of lung involvement on CXR as a severity score and correlate severity scores with symptom duration, presence of comorbidities and demographic factors. Methods: A retrospective study at four main hospitals in Sri Lanka included all RT-PCR positive COVID-19 patients who underwent CXR from January to mid May, 2020. Both initial and follow-up CXR were independently double reported by a team of four radiologists and discrepancy reported by a fifth radiologist for radiographic findings and lung involvement. Clinical and demographic data was retrieved from hospital records. A severity score was calculated for each CXR. Associations were analyzed for CXRs with a severity score of 1 or more. Results: 217 CXRs of 133 patients (99 men, mean age 43.9±15.7 years;133 initial CXRs of 132 symptomatic patients; 84 follow-up radiographs of 33 patients) revealed 96(96/133;72.2%) normal initial CXRs. 12 patients with normal initial CXRs(12/96;12.5%) underwent follow up CXR but none was abnormal. Majority (21/37;56.75%) with abnormal CXR had mild (severity score 1-2) lung involvement. A severity score of 1 or more was associated with comorbidities (OR=3.14), male sex (OR=5.93) and increasing age (OR=1.06). Conclusion: Majority of CXR in COVID-19 patients were normal during first wave in Sri Lanka. Majority with abnormal CXR had mild lung involvement.

Pattern of chest computerized tomography scan findings in symptomatic RT-PCR positive Covid-19 patients at the Korle Bu Teaching Hospital, Ghana.

Chest Computerized Tomography (CT) features of Corona Virus Disease 2019 (COVID-19) pneumonia are nonspecific, variable and sensitive in detecting early lung disease. Hence its usefulness in triaging in resource-limited regions. To assess the pattern of chest CT scan findings of symptomatic COVID-19 patients confirmed by a positive RT-PCR in Ghana. This study retrospectively reviewed chest CT images of 145 symptomatic RT-PCR positive COVID-19 patients examined at the Radiology Department of the Korle Bu Teaching Hospital (KBTH) from 8th April to 30th November 2020. Chi-Squared test was used to determine associations among variables. Statistical significance was specified at p≤0.05. Males represent 73(50.3%). The mean age was 54.15±18.09 years. The age range was 5 months-90 years. Consolidation 88(60.7%), ground glass opacities (GGO) 78(53.8%) and crazy paving 43(29.7%) were the most predominant features. These features were most frequent in the elderly (≥65years). Posterobasal, peripheral and multilobe disease were found bilaterally. The most common comorbidities were hypertension 72(49.7%) and diabetes mellitus 42(29.2%) which had significant association with lobar involvement above 50%. The most predominant Chest CT scan features of COVID-19 pneumonia were GGO, consolidation with air bronchograms, crazy paving, and bilateral multilobe lung disease in peripheral and posterior basal distribution.

Investigating COVID-19 transmission and mortality differences between indigenous and non-indigenous populations in Mexico

ObjectivesIndigenous populations have been disproportionately affected during pandemics. We investigated COVID-19 mortality estimates among indigenous and non-indigenous populations at national and sub-national levels in Mexico. MethodsWe obtained data from the Ministry of Health, Mexico, on 2,173,036 laboratory-confirmed RT-PCR positive COVID-19 cases and 238,803 deaths. We estimated mortality per 1000 person-weeks, mortality rate ratio (RR) among indigenous vs. non-indigenous groups, and hazard ratio (HR) for COVID-19 deaths across four waves of the pandemic, from February 2020 to March 2022. We also assessed differences in the reproduction number (Rt). ResultsThe mortality rate among indigenous populations of Mexico was 68% higher than that of non-indigenous groups. Out of 32 federal entities, 23 exhibited higher mortality rates among indigenous groups (P < 0.05 in 13 entities). The fourth wave showed the highest RR (2.40). The crude HR was 1.67 (95% CI: 1.62, 1.72), which decreased to 1.08 (95% CI: 1.04, 1.11) after controlling for other covariates. During the intense fourth wave, the Rt among the two groups was comparable. ConclusionIndigenous status is a significant risk factor for COVID-19 mortality in Mexico. Our findings may reflect disparities in non-pharmaceutical (e.g., handwashing and using facemasks), and COVID-19 vaccination interventions among indigenous and non-indigenous populations in Mexico.

Statin and aspirin as adjuvant therapy in hospitalised patients with SARS-CoV-2 infection: a randomised clinical trial (RESIST trial)

BackgroundStatins and aspirin have been proposed for treatment of COVID-19 because of their anti-inflammatory and anti-thrombotic properties. Several observational studies have shown favourable results. There is a need for a randomised controlled trial.MethodsIn this single-center, open-label, randomised controlled trial, 900 RT-PCR positive COVID-19 patients requiring hospitalisation, were randomly assigned to receive either atorvastatin 40 mg (Group A, n = 224), aspirin 75 mg (Group B, n = 225), or both (Group C, n = 225) in addition to standard of care for 10 days or until discharge whichever was earlier or only standard of care (Group D, n = 226). The primary outcome variable was clinical deterioration to WHO Ordinal Scale for Clinical Improvement ≥ 6. The secondary outcome was change in serum C-reactive protein, interleukin-6, and troponin I.ResultsThe primary outcome occurred in 25 (2.8%) patients: 7 (3.2%) in Group A, 3 (1.4%) in Group B, 8 (3.6%) in Group C, and 7 (3.2%) in Group D. There was no difference in primary outcome across the study groups (P = 0.463). Comparison of all patients who received atorvastatin or aspirin with the control group (Group D) also did not show any benefit [Atorvastatin: HR 1.0 (95% CI 0.41–2.46) P = 0.99; Aspirin: HR 0.7 (95% CI 0.27–1.81) P = 0.46]. The secondary outcomes revealed lower serum interleukin-6 levels among patients in Groups B and C. There was no excess of adverse events.ConclusionsAmong patients admitted with mild to moderate COVID-19 infection, additional treatment with aspirin, atorvastatin, or a combination of the two does not prevent clinical deterioration.Trial Registry Number CTRI/2020/07/026791 (http://ctri.nic.in; registered on 25/07/2020)

Spectrum of HRCT Chest Findings in RT-PCR Positive Asymptomatic COVID-19 Patients at a COVID Designated Hospital in Nepal

Introduction: COVID-19 pandemic is grappling the world with the surge of infection time and again. Clinicians are trying to justify the ethics of public health care. Asymptomatic COVID-19 cases are going undocumented and most of them practice self-isolation. Studies have revealed significant radiological changes among RT-PCR positive asymptomatic COVID-19 cases. The aim of this cross-sectional study was to characterized chest CT findings of asymptomatic RT-PCR-positive patients in one of the COVID-designated hospitals in Nepal. Methods: This was a cross-sectional observational study where RT-PCR positive COVID-19 asymptomatic-close-contacts were subjected to HRCT chest. The HRCT images were evaluated by two radiologists for (a) characterizing the parenchymal involvement and (b) distribution of the involvement. The CT severity score (0-25) was calculated following the semi- quantitative scoring system which depends on the visual assessment of five lung lobes. Results: Out of 43, 26 (60.5%) participants had positive Chest CT scan findings consistent with COVID pneumonia. Bilateral lesions were present in 65% and 77% had multifocal lesions. The ground-glass opacities (92%), mixed (ground-glass opacities and consolidation pattern) (30.7%), and consolidation only (34.6%) were common chest CT findings. The median CT score was 3.5 (IQR; 2-6). Conclusion: Most of the RT-PCR positive COVID-19 asymptomatic patients had CT scan changes in lungs but with lower median CT score value.

Outlook of probable association of TGF-β1, viral load, with levels of some serum biomarkers and their role in the severity of COVID-19 in a sample of Iraqi population

The COVID-19 pandemic remains a rapidly spreading public health emergency with grave consequences. The disease is caused by infection with the severe acute respiratory syndrome coronavirus-2.The current study cohort included an Iraqi population with RT-PCR positive COVID-19 who were divided into two clinical groups: those who were discharged home well (n = 77) and those who required ICU admission/died (n = 23). Here we study, the age and sex on COVID-19 illness with biomarkers: TGF-B, Viral level, LDH, Oxygen prerequisite D-dimer, and CRP, among COVID-19 patients. Data revealed no basic influence of sex introduction on the result. Whereas age of individuals was basically higher P &lt; 0.001 in (required ICU admition /died compared to that of well –discharge patients (38.83±11.74 a long time)). Level of TGF-β1 exposed no significant difference between the two enrolled groups link with viral load and duration. Period conversely had a positive noteworthy relationship with (D-dimer, CRP, LDH. Besides, (D-dimer, LDH, and CRP) levels were on the whole elevated on essentially ICU/admission compared to well-discharged patients group. The middle illness duration in well- released patients were 7.0 days (3-18 days) compared with nine days (6-14 days) in patients required ICU/died with remarkable distinction.