Positive RT-PCR Research Articles

Factors associated with severe acute respiratory syndrome in pregnant/postpartum women with COVID-19 receiving care at referral centers in northeastern Brazil: Secondary analysis of a cohort study

BackgroundAt the beginning of the COVID-19 pandemic, the greater risks associated with the new SARS-CoV-2 pathogen in pregnant women were as yet unclear. This study analyzed factors associated with severe acute respiratory syndrome (SARS) in pregnant/postpartum women with COVID-19. MethodsA prospective and retrospective cohort study was conducted in eight referral centers in northeastern Brazil between April 2020 and December 2021 involving pregnant/postpartum women with a positive COVID-19 RT-PCR test. A multivariate analysis was then conducted using a hierarchical logistic regression model to evaluate the association between the independent variables and the presence of SARS. FindingsOf 611 patients included, 522 were pregnant and 83 were postpartum, at the time of admission. Criteria for SARS were present in 215 patients (35·2%). Factors associated with SARS included overweight and/or obesity (adjusted odds ratio/AOR: 1·95; 95%CI: 1·21–3·12; p = 0·0054), parity ≥2 (AOR: 1·72; 95%CI: 1·21–2·45; p = 0·0025), gestational age <34 weeks (AOR: 3·54; 95%CI: 2·47–5·07; p < 0·0001) and duration of symptoms >7 days (AOR: 1·97; 95%CI: 1·35–2·89; p = 0·0004). SARS increased the likelihood of requiring oxygen therapy (RR = 8·80; 95%CI: 6·25–12·40; p = 0·0000), mechanical ventilation (RR = 8·15; 95%CI: 4·67–14·21; p = 0·0000), and admission to an ICU (RR = 6·54; 95%CI: 4·70–9·11; p = 0·0000), and of maternal near miss (RR = 10·82; 95%CI: 1·20–22·47; p = 0·0000) and maternal death (RR = 8·12; 95%CI: 3·11–21·09; p = 0·0000). InterpretationIn patients with COVID-19, parity ≥2, overweight/obesity, gestational age <34 weeks and duration of symptoms >7 days increased the risk of SARS. Cesarean sections, oxygen therapy, and mechanical ventilation were more common in patients with SARS.

Association of perinephric fat stranding with CT severity scores and mortality in COVID-19 patients

Aims: To investigate the relationship between the presence of perinephric fat stranding (PFS) with three consecutive chest CT severity scores (CT-SS), mortality and intensive care unit admission in COVID-19 patients. Methods: This single-center retrospective study, included 457 (?18 years) COVID-19 patients with positive RT-PCR tests. A radiologist calculated three consecutive CT-SS for COVID-19 pneumonia using a visual scoring system ranging from 0 to 25 points. Grades of PFS on CTs were defined as none, mild, moderate or severe. Firstly, patients were divided into two groups, with and without PFS. The Association of PFS with demographic and laboratory data, CT-SS, and mortality rates were analyzed. We divided patients into four subgroups based on PFS grading and investigated temporal changes of mean CT-SS of three consecutive CTs in each PFS subgroup using a paired-sample test and Wilcoxon signed-rank test. Results: Patients with PFS were associated with older age (p&lt;0.001) and had higher CT-SS (p=0.03). We found a particularly strong association between PFS and mortality (p&lt;0.001) and intensive care unit admission (p=0.001). Statistical associations were found between PFS and elevated serum BUN (p=0.004), creatinine (p=0.007), CRP (p=0.02), and ferritin (p=0.005). In multivariate logistic regression analysis, older age was associated with 1.067-fold (p&lt;=0.001), PFS 1.964-fold (p=0.007), elevated serum creatinine 3.630-fold (p=0.005) higher risks of mortality. In PFS subgroups other than severe, there were significant increases between the first and second CT-SS (p&lt;0.001, p&lt;0.001, p=0.003). Conclusion: Perinephric fat stranding is an important CT finding that can alert clinicians to the poor prognosis of COVID-19 patients in early periods.

Neurological diagnoses in hospitalized COVID-19 patients during the B.1.1.529 surge.

Emerging variants and sublineages of SARS-CoV-2 have differing disease severity, transmissibility, and immune evasion. The neurological conditions associated with the original strain of SARS-CoV-2 are well established. Our study assessed the neurological presentations specific to hospitalized patients during the B.1.1.529 (Omicron) variant surge in New York City. A total of 178 cases with positive RT-PCR result within 6 weeks before admission, and subsequent development of select neurological conditions during the SARS-CoV-2 B.1.1.529 (Omicron) surge between December 1, 2021 and February 28, 2022, were included from 12,800 SARS-CoV-2-positive hospital admissions. Clinical data from acute hospitalizations were compared to findings of inpatient neurological cases with COVID-19 infections from the initial surge in NYC in the same hospital system. Compared to SARS-CoV-2 infections of the original strain, COVID-19 cases hospitalized during the Omicron surge (B.1.1.529) were associated with incidental and/or asymptomatic COVID-19 cases (96, 53.9%) and an increased incidence of pre-existing neurological and immunocompromising conditions. Encephalopathy, seizures, and stroke remained the most prevalent neurological conditions identified in hospitalized COVID-19 cases during the study period, reflecting a similar distribution of neurological presentations associated with the original strain. In our cohort of 178 admitted SARS-CoV-2-positive patients with select neurological conditions during the Omicron B.1.1.529 surge, 54% of COVID-19 cases were considered incidental and/or asymptomatic, and the identified neurological conditions resembled those associated with the original SARS-CoV-2 strain. Further studies characterizing neurological presentation in Omicron sublineages and other variants are warranted in an ongoing COVID-19 pandemic.

Correlation of ocular manifestations with severity of systemic disease and conjunctival SARS-CoV-2 in COVID-19 Positive patients

Abstract Background: Ocular manifestations of SARS-CoV-2 and the associated risk factors require a comprehensive analysisincludingConjunctival swab (CS) RT-PCR results irrespective of ocular involvement. Aims: To study the correlation of ocular manifestations &amp; systemic COVID-19 status with clinical risk factors, during first &amp; second outbreaks (FO &amp; SO) of COVID19 pandemic in western India. CS RT-PCR results of diagnosed COVID-19 patients with positive nasopharyngeal swab (NPS) RT-PCR with or without ocular manifestations to be evaluated. Material and Methods: Prospective study conducted with confirmed COVID-19 cases with positive NPS RT-PCR during FO &amp; SO of COVID-19 pandemic in year 2020 &amp; 2021 in western India. Ocular manifestations &amp; CS RT-PCR results were evaluated with systemic COVID-19 status. CS was collected within 48 hours of admission for RT-PCR analysis with repeat test within 72 hours upon increasing severity of COVID-19 stage. Result: Thirty-two (20.51%,13 FO,19 SO) patients had uniocular complaints, redness being the commonest during both the outbreaks. Out of 32 patients with ocular symptoms (OS), 87.5% had refractive error, 75% had diabetes &amp; 53.1% had moderate COVID-19, (P=&lt;0.0001, significant). 25% &amp; 18.8% patients with OS had history of use of protective eye gears &amp; covid vaccine respectively. 103 &amp; 80 CS from 103 &amp; 53 patients of FO &amp; SO respectively were tested. All primary (183) &amp; repeat (93) CS were negative for RT-PCR.Conclusion: Ocular involvement in diagnosed COVID-19 cases is variable. SARS-CoV-2 presence in conjunctival samples is inconsistent irrespective of systemic severity, probably due to intermittent shedding of virus. Keywords: COVID-19 ocular manifestations, first outbreak, second outbreak, CS RT-PCR

Outcome and Severity of COVID-19 in Vaccinated and Unvaccinated patients

Background: The coronavirus disease of 2019 (COVID-19) pandemic is the world's worst problem and the global health disaster of our time. In order to fully comprehend the advantages of COVID-19 immunization, illness attenuation must be considered. This should be done by investigating whether those who contract COVID-19 despite vaccination experience milder symptoms than those who are unvaccinated. The COVID-19 pandemic brought on by is still a serious public health issue on a global scale. Aim: To evaluate the significant impact and efficacy of vaccination in positive SARS-CoV-2 patients during different timelines of a pandemic. Methodology: This is a cross sectional study involving 212 PCR-positive SARS-CoV-2 patients with their clinical–epidemiological findings admitted at Ziauddin Hospital between the years 2021 to 2022. SARS-CoV-2. RNA positivity was determined using qualitative RT-PCR with in vitro diagnostic kits, following the manufacturer's recommendations. SARS-CoV-2 positive patients had at least one positive RT-PCR test result, while SARS-CoV-2 negative patients had solely negative RT-PCR test findings. The data was provided through electronic patient records. The patients were categorized into Asymptomatic, Mild, Moderate and Severe/Critical as per WHO and CDC guidelines. Results: Among total of 212 patients there were 5(2.4%) vaccinated and 20(9.4%) unvaccinated asymptomatic, 6(2.8%) vaccinated and 12(5.7%) unvaccinated mild, 16(7.5%) vaccinated and 39(18.4%) unvaccinated moderate and 27(12.7%) vaccinated and 87(41%) unvaccinated severely/critically ill patients. The association between the severity of illness and vaccination status of patients showed significantly positive results with a p-value of 0.005. Conclusion: It was concluded that vaccine plays a significant role in the course of illness and severity of disease, this study investigated the impact of vaccination status on patients with positive SARS-CoV-2 to compare the severity and course of illness between the vaccinated and unvaccinated groups based on a number of clinical indicators. but the efficacy of these vaccines remains a point of concern for future studies. Key words: COVID-19, pneumonia, SARS-CoV-2, immunization

#2955 THE IMPACT OF SARS-COV-2 INFECTION ON LONG-TERM RENAL FUNCTION IN PATIENTS WITH GLOMERULAR DISEASES

Abstract Background and Aims We sought to evaluate the long-term effects of SARS-CoV-2 infection on renal function in patients with glomerular diseases. Method A total of 451 patients with biopsy-proven glomerular disease and at least 12 months of follow-up after COVID-19 pandemic onset were included in the study. A SARS-CoV-2 infection was diagnosed based on a positive RT-PCR and/or antigen test. Multivariate Cox proportional hazards regression analysis was performed to identify the independent predictors of a composite endpoint (≥30% decline in eGFR, ESRD). In addition, a multivariate linear regression analysis was developed to identify the impact of SARS-CoV-2 infection on eGFR decline at 12 months after pandemic onset. Results Since 26th February 2020, when the first case of SARS-CoV-2 infection was diagnosed in Romania, 23.1% of patients had a SARS-CoV-2 infection during a follow-up period of 2.5 y (0.8-2.6). The most frequent glomerular disease was IgA nephropathy (22.6%), followed by lupus nephritis (11.5%) and membranous nephropathy (9.5%). 71.8% of the study cohort received various regimens of immunosuppression. Patients with SARS-CoV-2 infection were younger and more likely to have received immunosuppressive therapy compared to patients without infection, but the renal function at baseline was similar between the study groups (eGFR, 52±31.2 vs 52.1±29.3 ml/min, respectively; p = 0.78). 17.6% of patients reached the composite endpoint, while 12.3% progressed to ESRD. Those with SARS-CoV-2 infection were more likely to reach the composite endpoint compared to those without infection [prevalence of composite endpoint, 26.7% vs. 14.8%, p = 0.006; OR, 2.1 (95%CI, 1.23-3.58), p = 0.006) (Figure 1). Similarly, there was a significant decline of eGFR in the first year of follow-up between the two study groups [-2.24 (-24.8; 20.9) vs. +2.31 (-16.8; 27.5) ml/min, respectively, p = 0.004]. In multivariate Cox proportional hazards regression analysis, the independent predictors of the composite endpoint were baseline eGFR (HR, 0.94; 95%CI, 0.92-0.95, p&amp;lt;0.001), the occurrence of SARS-CoV-2 infection (HR, 1.91; 1.16-3.12, p = 0.01) and male gender (HR, 1.64; 95%CI, 1.01-2.66, p = 0.04). When taking into account the severity of SARS-CoV-2 infection, a severe infection was the most important predictor of the composite endpoint (HR, 2.1; 95%CI, 1.02-4.29, p = 0.04) (Figure 2). The results remained consistent when restricting the analysis to ESRD as an endpoint. When taking into account the eGFR slope at 12 months after COVID-19 pandemic onset as the outcome variable in multivariate linear regression analysis, the SARS-CoV-2 infection occurrence independently determined a reduction of eGFR by 4.62 ml/min/1.73m2 (β coefficient, -4.62; 95%CI, -7.74 to -1.5, p = 0.004). Conclusion There is a significant impact of SARS-CoV-2 infection on long-term renal function in patients with glomerular diseases, while those with severe infection had a greater decline of eGFR and a worse renal survival.

A report on SARS-CoV-2 first wave in Ecuador: drug consumption dynamics.

Introduction: The first COVID-19 wave in Ecuador started in March 2020 and extended until November. Several types of drugs have been proposed as a potential treatment during this period, and some affected people have self-medicated. Method: A retrospective study was conducted with 10,175 individuals who underwent RT-PCR tests for SARS-CoV-2 from July to November 2020. We compared the number of positive and negative cases in Ecuador with symptoms and drug consumption. The Chi-square test of independence compared clinical and demographic data and PCR test results. Odds ratios analyzed drug consumption dynamics. Results: Of 10,175 cases, 570 were positive for COVID-19, while 9,605 were negative. In positive cases, there was no association between the RT-PCR result and sex, age, or comorbidities. When considering demographic data, Cotopaxi and Napo had the highest rates of positive cases (25.7% and 18.8%, respectively). Manabí, Santa Elena, and Guayas regions had fewer than 10% positive cases. The Drug consumption dynamic analysis showed that negative COVID-19 cases presented higher drug consumption than positive cases. In both groups, the most consumed medication was acetaminophen. Acetaminophen and Antihistamines had higher odds of consumption in positive PCR cases than in negative. Symptoms like fever and cough were more related to positive RT-PCR results. Conclusion: The first COVID-19 wave in Ecuador has affected the provinces differently. At a national level, the consumption of drugs has been highly associated with self-medication.

Design of a rapid electrochemical biosensor based on MXene/Pt/C nanocomposite and DNA/RNA hybridization for the detection of COVID-19

Since the rapid spread of the SARS-CoV-2 (2019), the need for early diagnostic techniques to control this pandemic has been highlighted. Diagnostic methods based on virus replication, such as RT-PCR, are exceedingly time-consuming and expensive. As a result, a rapid and accurate electrochemical test which is both available and cost-effective was designed in this study. MXene nanosheets (Ti3C2Tx) and carbon platinum (Pt/C) were employed to amplify the signal of this biosensor upon hybridization reaction of the DNA probe and the virus's specific oligonucleotide target in the RdRp gene region. By the differential pulse voltammetry (DPV) technique, the calibration curve was obtained for the target with varying concentrations ranging from 1 aM to 100 nM. Due to the increase in the concentration of the oligonucleotide target, the signal of DPV increased with a positive slope and a correlation coefficient of 0.9977. Therefore, at least a limit of detection (LOD) was obtained 0.4 aM. Furthermore, the specificity and sensitivity of the sensors were evaluated with 192 clinical samples with positive and negative RT-PCR tests, which revealed 100% accuracy and sensitivity, 97.87% specificity and limit of quantification (LOQ) of 60 copies/mL. Besides, various matrices such as saliva, nasopharyngeal swabs, and serum were assessed for detecting SARS-CoV-2 infection by the developed biosensor, indicating that this biosensor has the potential to be used for rapid Covid-19 test detection.

Clinical spectrum and outcomes of cancer patients affected with COVID-19 in Indian population: A single-center retrospective study

Introduction: Cancer patients affected with COVID-19 are at high risk of severe infection and death which depends upon their functional status, cancer type and treatment modality. In this study, we measured outcome by mortality and length of stay in hospital and intensive care unit, need of oxygen and respiratory assist devices and performance status after discharge.&#x0D; Methodology: This retrospective observational study was carried out in active cancer patients with confirmed positive RT-PCR for SARS-CoV-2 between April 2021 and August 2021. Patients with cancer treated more than 6 months back, those in remission and home isolation were excluded. Demographic profile, cancer type, staging and treatment, severity of COVID, treatment, oxygen supplementation, as well as ICU and hospital stay were analyzed. Statistical analysis was done using descriptive and inferential analysis. Significance was assessed at 5% level of significance. Chi-square/ Fisher Exact test was used to find the significance of the study parameters on categorical scale between two or more groups, non-parametric setting for qualitative data analysis. Fisher Exact test was used when cell samples were very small. P £ 0.01 was considered as strongly significant.&#x0D; Results: Out of 92 patients, there were 17 deaths (mortality 18.4%). Mortality was associated with cancer stage, comorbidities, severity of COVID symptoms, use of oxygen, high flow nasal cannula, non-invasive ventilation and decreased Eastern Cooperative Oncology Group score on discharge (P = 0.001). Age, raised C-reactive protein and D dimer levels were associated with increased severity of COVID-19.&#x0D; Conclusion: Cancer patients with COVID-19 have increased morbidity and mortality affected by various factors related either to pre-existent cancer or the newly acquired COVID-19.&#x0D; Abbreviations: CRP - C-reactive protein; ECOG - Eastern Cooperative Oncology Group score; RT-PCR - Reverse Transcriptase Polymerase Chain Reaction; HFNC - High Flow Nasal Cannula&#x0D; Key words: COVID-19; Critical Illness; Neoplasms; Death; Oxygen&#x0D; Citation: Kakati SD, Das A, Ninu M, Kakati B. Clinical spectrum and outcomes of cancer patients affected with COVID-19 in Indian population: A single-center retrospective study. Anaesth. pain intensive care 2023;27(5):506-512.&#x0D; DOI: 10.35975/apic.v27i5.2305&#x0D; Received: July 18, 2023; Reviewed: August 09, 2023; Accepted: August 17, 2023

Individual components of metabolic syndrome as a prognostic factor for morbidity and mortality in COVID-19

Background: COVID-19 has emerged as a rapidly spreading pandemic with millions of deaths. We aimed to investigate whether metabolic syndrome can be used as a prognostic factor for the outcome of patients infected with this viral disease, regarding the ICU stay, the requirement of mechanical ventilation (MV) and mortality. Methodology: This retrospective study included 90 patients admitted to intensive care unit (ICU) of Ain Shams University for pneumonic COVID-19 with a confirmed positive RT-PCR for COVID-19 and positive changes on chest computed tomography, over a period of 10 months from July 2021 to April 2022. They were divided into two groups according to the presence or absence of metabolic syndrome. The primary outcome measured was the length of ICU stay. Secondary outcome was the percentage of patients requiring mechanical ventilation (MV) and the mortality rate in the two groups. Results: Patients with metabolic syndrome had higher liver transaminases, random blood glucose, triglycerides, ferritin, and P/F ratio compared to those without metabolic syndrome (P &lt; 0.05). Components of metabolic syndrome such as hypertension, type 2 diabetes mellitus, and obesity significantly increased the risk of hospitalization and mortality in COVID-19 patients (P &lt; 0.05). Conclusion: Metabolic syndrome is a better prognostic indicator for severe disease outcomes in patients with COVID-19 than its individual components. Although patients with metabolic syndrome didn’t have a higher need for mechanical ventilation, they had longer duration of ICU stay and a higher mortality rate. Abbreviations: ACE-2: angiotensin-converting enzyme-2, hs-CRP: High sensitivity C-reactive protein,ICU: Intensive care unit, MV: Mechanical ventilation, MS: Metabolic syndrome, ROC: Receiver operating characteristic Key words: Metabolic Syndrome; COVID-19; ICU; Mechanical ventilation; Mortality Citation: Refaat SA, Elshaer AN, Hamza AH, Abdou AMH, SakrHAM. Individual components of metabolic syndrome as a prognostic factor for morbidity and mortality in COVID-19. Anaesth. pain intensive care 2023;27(3):343−350. DOI: 10.35975/apic.v27i3.2225 Received: February 14, 2023; Reviewed: March 08, 2023; Accepted: March 16, 2023

Clinical Features and Treatment Outcomes of COVID-19 Admissions in the Can Tho City Hospital of Tuberculosis and Respiratory Diseases, Vietnam: A Hospital-Based Observational Study.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, is among the top global health crises. As confirmed by the Vietnam Ministry of Health on 25th January 2023, Vietnam had a cumulative total of more than 11.52 million COVID-19 patients, including 10.61 million recoveries and 43,186 deaths. This study aimed to describe the clinical and subclinical characteristics, treatment progress, and outcomes of 310 cases of SARS-CoV-2 infection. A total of 310 patients with medical records of SARS-CoV-2 were admitted to Can Tho City Hospital of Tuberculosis and Lung Diseases, Can Tho city, Vietnam, between July 2021 and December 2021. Demographic and clinical data, including laboratory examinations, of all the patients were collected and analyzed. The median duration of hospital stay was 16.4 ± 5.3 days. There were 243 (78.4%) patients with clinical symptoms of COVID-19 and 67 (21.6%) patients without clinical symptoms. The common symptoms included cough (71.6% of 310 patients), fever (35.4%), shortness of breath (22.6%), sore throat (21.4%), loss of smell/taste (15.6%), and diarrhea (14.4%). Regarding treatment outcomes, 92.3% of the patients were discharged from the hospital, 1.9% of the patients suffered a more severe illness and were transferred to a higher-level hospital, and 5.8% of the patients died. The RT-PCR results were negative in 55.2% of the patients, and 37.1% of the patients had positive RT-PCR results with Ct values of >30 on the discharge/transfer day. Multivariate logistic regression analyses showed that comorbidity and decreased blood pH were statistically significantly related to the treatment outcomes of the patients with COVID-19 (p < 0.05). This study provides useful information (i.e., the clinical characteristics and treatment outcomes) on the COVID-19 pandemic in Vietnam during its biggest outbreak; the information may be used for reference and for making improvements in the handling of future health crises.

Comparison of ID NOW COVID-19 with RT-PCR for Diagnosis and Management of COVID-19 Cases

ABSTRACT Introduction: Rapid diagnosis of SARS-CoV-2 is a challenging issue for healthcare personnel. Abbott’s ID NOW COVID-19 assay is a rapid instrument based on isothermal nucleic acid amplification method for qualitative estimation of SARS-CoV-2 in nasal, nasopharyngeal, and throat swabs. Aim and objective: The performance of ID NOW was compared with standard reference RT-PCR in 609 patients. Results and discussion: The two methods agreed in 90.6% of the cases and disagreed in 9.4% of the cases, and this agreement was statistically significant (Cohen’s Kappa = 0.727, P &lt; 0.001). The diagnostic performance of ID NOW in predicting RT-PCR positivity was as follows: sensitivity of 78%; specificity of 94%; positive predictive value (PPV) of 80%; negative predictive value (NPV) of 94%; and diagnostic accuracy of 91%. Conclusion: Hence ID NOW can be used as point-of-care testing in the diagnosis of SARS-CoV-2 and thereby immediately isolate positive cases from negative cases.

Acil Serviste COVID-19 Hastalarının Prognozunu Tahmin Etmek İçin Erken Uyarı Puanlama Sistemlerinin Kullanımı

Aim: Increased emergency department (ED) admissions and the need for intensive care unit (ICU) brought with the pandemic has led to the need to make fast and accurate decisions. Early warning scores (EWS) may be useful in ED in this regard. This study was performed to evaluate the effectiveness of EWS in predicting mortality and need for ICU of patients with COVID-19.&#x0D; Materials and methods: This retrospective observational study was performed with subjects presented to the ED and were later admitted to a general ward or to the ICU because of COVID-19. Subjects aged ≥18 years with positive RT-PCR were included in the study. Subjects experienced a cardiac or respiratory arrest or intubated at the time of presentation to the ED and pregnant women were excluded from the study. MEWS, NEWS, NEWS-2, REMS, and qSOFA scores were calculated using patients’ data on first presentation. We examined the association of these scoring systems with mortality and need for ICU.&#x0D; Results: While 60(10%) of the 600 patients participating in the study were admitted to the ICU, 222(37%) patients died. The scoring systems’ negative predictive values for predicting ICU admission were 0.95, 0.98, 0.97, 0.96, and 0.96 respectively and for predicting mortality were 0.61, 0.67, 0.67, 0.66, and 0.61 respectively. All scorings assessed were significant predictors of the need for ICU and mortality in patients with COVID-19.&#x0D; Conclusions: All evaluated scoring systems were successful; however, NEWS and NEWS-2 had the highest predictive value both for the need for ICU and mortality.

Analyzing Trends in Demographic, Laboratory, Imaging, and Clinical Outcomes of ICU-Hospitalized COVID-19 Patients.

COVID-19 has led to significant hospitalization and intensive care unit admission rates. The demographic parameters of COVID-19 patients, such as age, underlying illnesses, and clinical symptoms, substantially influence the incidence and mortality of these individuals. The current study examined the clinical and demographic characteristics of COVID-19 intensive care unit (ICU) patients in Yazd, Iran. The descriptive-analytical cross-sectional study was conducted on ICU patients with a positive RT-PCR test for coronavirus, admitted to the ICU in Yazd province, Iran, over 18 months. To this end, demographic, clinical, laboratory, and imaging data were collected. Moreover, patients were divided into good and worse clinical outcome groups based on their clinical outcomes. Subsequently, data analysis was performed at a 95% confidence interval (CI) using SPSS 26 software. 391 patients with positive PCR were analyzed. The average age of the patients in the study was 63.59 ± 17.76, where 57.3% were male. On the high-resolution computed tomography (HRCT) scan, the mean lung involvement score was 14.03 ± 6.04, where alveolar consolidation (34%) and ground-glass opacity (25.6%) were the most prevalent type of lung involvement. The most common underlying illnesses in the study participants were hypertension (HTN) (41.4%), diabetes mellitus (DM) (39.9%), ischemic heart disease (IHD) (21%), and chronic kidney disease (CKD) (20.7%). In hospitalized patients, the rates of endotracheal intubation and mortality were 38.9% and 38.1%, respectively. Age, DM, HTN, dyslipidemia, CKD, cerebral vascular accident (CVA), cerebral hemorrhage, and cancer were reported to be significantly different between these two groups of patients, indicating an increase in the rate of intubation and mortality among these patients. Furthermore, the multivariate logistic regression analysis revealed that DM, HTN, CKD, CVA, neutrophil-to-lymphocyte ratio (NLR), the percentage of lung involvement, and initial O2 saturation significantly increase the mortality of ICU patients. Several features of COVID-19 patients influence the mortality in these individuals. According to the findings, early detection of this disease in people at high risk of death can prevent its progression and lower mortality rates.

Auditory function in symptomatic patients recovered from SARS-CoV-2 and unexposed patients: An analytical cross-sectional study

ObjectiveTo describe audiological symptoms, audiometric profile, and distortion product otoacoustic emission in symptomatic patients recovering from SARS-CoV-2 infection (positive RT-PCR test) and asymptomatic patients (negative RT-PCR test). MethodsAn analytical cross-sectional study was conducted using data obtained from clinical charts, physical examination, audiometry, and distortion product otoacoustic emission on 40 patients [case patients (CP)] recovering from SARS-CoV-2 infection diagnosed by a positive RT-PCR test and 22 asymptomatic participants with a negative RT-PCR test [non-case (NC)]. ResultsSixty-two patients (mean age: 31.1 and 28.2 years in the CP and NC groups, respectively) were included. All participants were young without significant comorbidities, risk factors for hearing loss or otological history. Vertigo (5%), tinnitus (17.5%) and aural fullness/hearing loss (35%) were found in the CP group. A statistically significant difference was found in specific frequencies (1000, 4000, and 8000 Hz) and pure tone average (low and high conversational frequencies with increased threshold in the PC group compared with the NC group), which was not found in distortion product otoacoustic emission. ConclusionAudiovestibular symptoms are frequent in symptomatic patients recovering from SARS-CoV-2 infection. SARS-CoV-2 infection was consistently associated with an increased audiometric hearing threshold at specific frequencies and low tone average.

Evaluation of Prolonged Rt-Pcr Positivity and Viral Load in COVID-19 Patients

Aim: Real-time reverse transcription polymerase chain reaction (RT-PCR) test is used in the diagnosis of COVID-19. It was aimed to evaluate the factors affecting the viral conversion time, to examine the relationship between viral load, and to determine other factors that may be associated with viral load. Material and Methods: Patients were hospitalized between 15.03.2020-01.08.2020, and viral conversion detected were evaluated retrospectively. Patients were divided into two according to viral conversion time (0-14 days vs &amp;gt;14 days). Results: 349 patients were included in the study (284 vs 65 patients). The age and gender characteristics were similar. Prolonged PCR positivity group had more death (p=0.036) and lower cycle-threshold (CT) value (p=0.017). In the examination of CT values of 246 patients, 228 patients with viral conversion and 18 patients without viral conversion due to death, the CT value was found to be lower, therefore the viral load was higher in patients over 60 years of age (p=0.006), in the presence of cardiovascular system disease (p&amp;lt;0.001) and in patients who died (p&amp;lt;0.001). Conclusion: Prolonged PCR positivity may indicate excess viral load and adverse outcomes. An evaluation including the patient's age, CT value, comorbid conditions, and viral conversion time can give an idea about the prognosis.

Virus variant-specific clinical performance of a SARS-CoV-2 rapid antigen test with focus on Omicron variants of concern

ObjectivesAntigen rapid diagnostic tests (Ag-RDTs) play an important role in the diagnosis of SARS-CoV-2. They are easier, quicker, and less expensive than the ‘reference standard’ RT-PCR and therefore widely in use. Reliable clinical data with respect to Ag-RDT performance in SARS-CoV-2 Omicron variants of concern (VOCs) are limited. Consequently, the objective of this study was to determine the impact different VOCs—especially Omicron—have on the clinical performance of an Ag-RDT. MethodsWe compared the clinical performance of the Sofia SARS-CoV-2 Ag-RDT to RT-PCR in a real-world, single-centre study in a clinical point-of-care setting in patients admitted to a large hospital via the emergency department from 2 November 2020 to 4 September 2022. ResultsAmong 38 434 Ag-RDT/RT-PCR tandems taken, 1528 yielded a SARS-CoV-2 positive RT-PCR test result, with a prevalence of 4.0% (95% CI, 3.8–4.2). Overall sensitivity of the Ag-RDT was 63.7% (95% CI, 61.3–66.1) and overall specificity was 99.6% (95% CI, 99.5–99.6). Ag-RDT sensitivity was dependent on viral load (VL), because the sensitivity increased to 93.2% (95% CI, 91.5–94.6) in samples with a VL > 106 SARS-CoV-2 copies/mL. Furthermore, the Ag-RDT was more sensitive in men, and older patients. Variant-dependent sensitivity assessment showed that the sensitivity was significantly lower in Omicron-VOC (64.1%; 95% CI, 60.5–67.6) compared with SARS-CoV-2 wild-type samples (70.0%; 95% CI, 59,8–78,6) (binomial test; p value < 0.001). Analysing the limits of detection showed a 27 times higher 95% limit of detection for the Omicron-VOC BA.5 compared with the SARS-CoV-2 wild-type. DiscussionAg-RDT sensitivity for detection of patients with lower VLs and with Omicron-VOC is reduced, limiting the effectiveness of Ag-RDTs. However, Ag-RDTs are still an unreplaceable tool for widely available, quick, and inexpensive point-of-care SARS-CoV-2 diagnostics.

Prevalence, risk factors, and vaccine effectiveness of COVID-19 infection in thai children, adolescents, and young adults in the omicron era.

The study of prevalence, risk factors, and vaccine effectiveness (VE) in children, adolescents, and young adults during the Omicron era has been limited, making this the objectives of the study. A prospective, test-negative case-control study was conducted on patients aged 0-24 years old classified as patients under investigation (PUI) from January to May 2022. PUI with positive RT-PCR within 14 days were classified as cases, whilst PUI with negative RT-PCR in 14 days were controls. Univariate and multivariate analyses determined risk factors; VE was calculated using [1-adjusted odds ratio (OR)] × 100. The final analyses included 3,490 patients with a PUI infection rate of 45.6%. Heterologous vaccination regimens, including inactivated vaccines, viral vectors, and mRNA were utilized during the study period. A total of 2,563 patients (73.5%) had received at least 2 vaccine doses, regardless of regimen. Male gender and household infections were independent risk factors for the development of infection, with an adjusted OR of 1.55 and 1.45, respectively. Underlying comorbidities and obesity were not significantly associated with the development of infection. Patients with underlying comorbidities were more likely to have at least moderate severity of infection with the adjusted OR of 3.07. Age older than 11 years was associated with lower infection risk and development of at least moderate infection with adjusted OR of 0.4 and 0.34, respectively. Vaccinated participants also had a lower risk of developing at least moderate infection: adjusted OR of 0.40. The adjusted VE of any vaccination regimen for infection prevention for one, two, three, or more than four doses was 21.8%, 30.6%, 53.5%, and 81.2%, respectively. The adjusted VE of any vaccination regimen for prevention of at least moderate severity of the disease for one, two, three, or more than four doses was 5.7%, 24.3% 62.9%, and 90.6%, respectively. Disease prevalence among PUI was substantially high during the Omicron wave. A two-dose vaccination regimen does not appear sufficient to ensure protection against infection.

Postnatal SARSCOV2 Infection in Neonates, Characteristics and Outcomes: An Observational Study

Background: Many aspects of the severe acute respiratory syndrome coronavirus 2 (SARSCoV2) pandemic in 2019 have been unclear, especially in newborns, and reports of neonatal diseases are usually associated with perinatal infection. Objectives: The purpose of this study was to evaluate clinical and para-clinical manifestations in newborns that contracted the infection after birth. Methods: This observational research was conducted from October 2020 to March 2022 to examine postnatal SARSCoV2 infection in infants admitted to the NICU or neonatal ward at the Children’s Medical Center in Tehran, Iran. Inclusion in the study was open to neonates who had positive RT-PCR results postnatally. Results: In total, 55 newborns were confirmed to have postnatal SARSCOV2. Fever was the most frequently observed symptom, with 35 (61%). Necrotizing enterocolitis was seen in 18% of neonates, and 30% of them were preterm. Neutropenia was seen in 34% of cases, with five cases having severe neutropenia. All neonates had a normal platelet count. Twenty percent of patients showed C - reactive protein higher than 6 mg/L. Two newborns had co-existing bacterial urinary tract infections. Our neonates didn't require antiviral, anticoagulant, or corticosteroid medications, and they recovered while receiving only supportive care. Everyone in the group of newborns was discharged without complications, and there were no deaths. Conclusions: The high rate of fever, high C- reactive protein, and neutropenia in SARSCoV2 neonates suggests that more observational research is needed to compare these symptoms to bacterial sepsis to avoid the overuse of antibiotics in these patients.

Epidemiology, Phenotypic and Genotypic Characterization of Carbapenem-Resistant Gram-Negative Bacteria from a Libyan Hospital.

Antimicrobial resistance, particularly resistance to carbapenems, has become one of the major threats to public health. Seventy-two isolates were collected from patients and hospital environment of Ibn Sina Hospital, Sirte, Libya. Antibiotic susceptibility tests, using the disc diffusion method and E-Test strips, were performed to select carbapenem-resistant strains. The colistin (CT) resistance was also tested by determining the minimum inhibitory concentration (MIC). RT-PCR was conducted to identify the presence of carbapenemase encoding genes and plasmid-mediated mcr CT resistance genes. Standard PCR was performed for positive RT-PCR and the chromosome-mediated CT resistance genes (mgrB, pmrA, pmrB, phoP, phoQ). Gram-negative bacteria showed a low susceptibility to carbapenems. Molecular investigations indicated that the metallo-β-lactamase New Delhi metallo-beta-lactamases-1 was the most prevalent (n = 13), followed by Verona integron-encoded metallo-beta-lactamase (VIM) enzyme (VIM-2 [n = 6], VIM-1 [n = 1], and VIM-4 [n = 1]) that mainly detected among Pseudomonas spp. The oxacillinase enzyme OXA-23 was detected among six Acinetobacter baumannii, and OXA-48 was detected among one Citrobacter freundii and three Klebsiella pneumoniae, in which one coharbored the Klebsiella pneumoniae carbapenemase enzyme and showed resistance to CT (MIC = 64 μg/mL) by modification in pmrB genes. In this study, we report for the first time the emergence of Pseudomonas aeruginosa carrying the blaNDM-1 gene and belonging to sequence type773 in Libya. Our study reported also for the first time CT resistance by mutation in the pmrB gene among Enterobacteriaceae isolates in Libya.