Severe Form Of COVID-19 Research Articles

The functional consequences in severe and critical covid-19 survivors – A pilot study

PurposeTo perform pulmonary function tests (PFT) in severe COVID-19 survivors one and five months after hospital discharge in order to assess the lung function, as well to identify clinical characteristics and PFT parameters associated with worse cardiopulmonary exercise testing (CPET). Material and methodsA prospective study included 75 patients with severe form of COVID-19. PFT was conducted one and five months after hospital discharge, in addition to CPET in a second assessment. Patients with a previous history of chronic respiratory diseases were excluded from our study. ResultsOne month after hospital discharge, all examined patients had diffusion lung capacity for carbon-monoxide(DLco%) below the 80% of predicted values (in mean 58%), with 40% of patients having a restrictive pattern (total lung capacity(TLC) < 80%). In a repeated assessment after five months, pathological DLco% persisted in 40% of patients, while all other PFT parameters were normal. CPET showed reduced maximum oxygen consumption during exercise testing (VO2peak%) values in 80% of patients (in mean 69%), and exercise ventilatory inefficiency in 60%. Patients with VO2peak < 60% had significantly lower values of examined PFT parameters, both one and five months after hospital discharge. Patients with VO2peak% ≥ 60% had a significantly higher increase after the second assessment for Forced expiratory volume in 1st second (FEV1%), Forced expiratory volume in 1st second and forced vital capacity ratio (FEV1/FVC), DLco% and Diffusion lung capacity for carbon monoxide corrected for alveolar volume (DLco/VA). ConclusionSignificant functional abnormalities, according to PFT and CPET, was present both one and five months in severe COVID-19 survivors, thus emphasizing the importance of a comprehensive follow-up including both resting and dynamic functional assessment in these patients.

Virulence potential of multidrug-resistant Acinetobacter baumannii isolates from COVID-19 patients on mechanical ventilation: The first report from Serbia.

Since the WHO declared the COVID-19 pandemic in March 2020, the disease has spread rapidly leading to overload of the health system and many of the patients infected with SARS-CoV-2 needed to be admitted to the intensive care unit (ICU). Around 10% of patients with the severe manifestation of COVID-19 need noninvasive or invasive mechanical ventilation, which represent a risk factor for Acinetobacter baumannii superinfection. The 64 A. baumannii isolates were recovered from COVID-19 patients admitted to ICU at General Hospital "Dr Laza K. Lazarević" Šabac, Serbia, during the period from December 2020 to February 2021. All patients required mechanical ventilation and mortality rate was 100%. The goal of this study was to evaluate antibiotic resistance profiles and virulence potential of A. baumannii isolates recovered from patients with severe form of COVID-19 who had a need for mechanical ventilation. All tested A. baumannii isolates (n = 64) were sensitive to colistin, while resistant to meropenem, imipenem, gentamicin, tobramycin, and levofloxacin according to the broth microdilution method and MDR phenotype was confirmed. In all tested isolates, representatives of international clone 2 (IC2) classified by multiplex PCR for clonal lineage identification, bla AmpC, bla OXA-51, and bla OXA-23 genes were present, as well as ISAba1 insertion sequence upstream of bla OXA-23. Clonal distribution of one dominant strain was found, but individual strains showed phenotypic differences in the level of antibiotic resistance, biofilm formation, and binding to mucin and motility. According to PFGE, four isolates were sequenced and antibiotic resistance genes as well as virulence factors genes were analyzed in these genomes. The results of this study represent the first report on virulence potential of MDR A. baumannii from hospital in Serbia.

Interplay between lymphocyte subpopulation, inflammatory cytokines and their correlation with oxidative stress parameters in COVID-19

Our objective was to investigate the inflammatory and oxidative stress markers in patients with moderate and severe form of COVID-19. In addition, we show the correlation between changes in lymphocyte subsets and markers of oxidative stress as a tool for patient classification. IL-6 and VEGF were analysed by utilizing a High Sensitivity Evidence Investigator™ Biochip Array technology. The total antioxidant capacity (PAT) and the free radical concentrations (d-ROM) were measured in serum utilizing analytical photometric system FRAS5. Peripheral blood was used to determine CD45 + mononuclear, B, T, and NK cells using a multi-parameter flow cytometric immunophenotypic test.&#x0D; Statistically significant differences in IL-6 and VEGF levels were observed between the two patient groups. Decreased values of the absolute number of lymphocytes and their CD4 + and CD8 + positive T cells, NK cells, and CD8 were obtained. In the moderate group, good correlations were found between IL-6 and VEGF and NK cells (r = 0.6973, p &lt;0.05; for IL6 and r = 0.6498, p &lt;0, for VEGF. 05). Cytokines were correlated with CD45+ (r = 0.5610, p &lt;0.05; for IL-6 and r = 0.5462, p &lt;0.05 for VEGF). The oxidative stress index can be used as a cheaper alternative and as a triage tool between severe and moderate illnesses, after showing good correlation with more expensive patient classification analysis.

The Clinical Form of COVID-19 and the Impact on the Course and Outcome of the Disease: Experiences from Tuzla Canton, Bosnia and Herzegovina.

Covid-19 primarily manifests itself as a respiratory disease, but also with numerous extrapulmonary symptoms and complications. The clinical form of the disease before hospitalization, has a great influence on the further course and occurrence of complications of the disease. To analyze the clinical and laboratory characteristics of patients with moderate and severe clinical form of the disease, the complications that developed in these patients during hospitalization and the outcome of the disease. The retrospective study included 520 patients from the Tuzla Canton, treated in the COVID-19 Hospital at University Clinical Center Tuzla in the period from March 27 to October 1, 2020. The source of data were the medical records of hospitalized patients. The clinical and laboratory characteristics of patients with moderate and severe clinical form of the disease. and the complications that developed in these patients during hospitalization were analyzed. The number of hospitalized men was statistically significantly higher, p=0.000. Most patients were in the age group of 60-69 years: 152 (29.3%), then in the age group of 50-59 years: 119 (22.9%). Women <70 years had more often a moderate, and women >70 years more often a severe clinical form of the disease, p<0.01. Patients with hypertension, diabetes mellitus, chronic lung diseases, cardiovascular diseases, hematological diseases and tumors of solid organs, with leukopenia and lymphopenia, elevated LDH, CRP, transaminases and serum ferritin, significantly more often had a clinically severe form of the disease (p<0.01). Patients with a severe clinical form of the disease on admission to the hospital had more frequent complications and death as outcome (p<0.01). Patients who were hospitalized with a severe form of COVID-19 had significantly more frequent disease complications and death as outcome.

Role of Inflammatory Markers and Computed Tomography Severity Score in Predicting the Severity and Clinical Outcome in Patients with COVID-19

Background and objective Several inflammatory markers such as C-reactive protein CRP lactic dehydrogenase LDH serum ferritin D- dimer and interleukin IL-6 have been linked to play a role in the causation of severe disease and mortality of patients with COVID-19. The present study was carried out to correlate the clinical severity with inflammatory markers and CT Computed tomography severity score CTSS in both survivors and non-survivors.Methods It was a hospital-based retrospective study conducted based on data obtained from the records of 100 patients with a laboratory-confirmed COVID-19 for a period of two months 15th April to 14th June 2021. All patients aged over 18 years were included for the study. The pregnant women or breast-feeding mothers and patients suffering from other inflammatory conditions were excluded from the study. Inflammatory markers used were serum CRP serum ferritin LDH D-dimer and IL-6. High resolution computed tomography HRCT of thorax was used for assessing disease severity score.Results In our study 100 patients were grouped as survivors 67 and non-survivors 33 and there was a male predominance 60 over female 40. Among survivors the mean age of the patients was 50.33 years while in non-survivors it was 52.78 years. All non-survivors had comorbidities compared to survivors in whom 41 patients did not have any comorbidities. In both hypertension 24 was the most common comorbidity followed by diabetes 14. The mean C- reactive protein was 60.22plusmn45.1mgdL among survivors and 144.8plusmn94.7 mgdL among non- survivors. The mean ferritin level among survivors was 376plusmn578 ngmL and that among non-survivors was 738.8plusmn581.4 ngmL. The LDH among survivors and non-survivors was 462.4plusmn276 and 819.5plusmn503.6 UL respectively. The mean IL-6 of survivors was 103.3plusmn278.7 and non-survivors was 145.1plusmn179.2 pgmL. The mean D-dimer was 604.3 plusmn 508.8 ngmL in the survivor group and 1346plusmn1002 ngmL in non-survivors. The CTSS was 12.3plusmn4.9 among survivors and 15.96plusmn6.5 among non-survivors with p value 0.0037. All the inflammatory markers were elevated in both survivors and non-survivors but were markedly elevated in non-survivors. C- reactive protein and D-dimer elevation were highly significant with p value lt0.0001.Conclusion The disease severity of COVID-19 correlated with D-dimer and CRP levels. CTSS was also significant in diagnosing severity of the disease. They had the diagnostic accuracy in predicting the severity of disease and mortality. The patients with severe form of COVID-19 also had raised levels of IL-6 LDH and ferritin. Patients with co-morbidities had higher levels of inflammatory markers which exhibited more severe disease. D-dimer CRP and CTSS are recommended to predict the severity and mortality in patients with COVID-19 infection.nbsp

The Clinical Form of COVID-19 and the Impact on the Course and Outcome of the Disease: Experiences from Tuzla Canton, Bosnia and Herzegovina.

Covid-19 primarily manifests itself as a respiratory disease, but also with numerous extrapulmonary symptoms and complications. The clinical form of the disease before hospitalization, has a great influence on the further course and occurrence of complications of the disease. To analyze the clinical and laboratory characteristics of patients with moderate and severe clinical form of the disease, the complications that developed in these patients during hospitalization and the outcome of the disease. The retrospective study included 520 patients from the Tuzla Canton, treated in the COVID-19 Hospital at University Clinical Center Tuzla in the period from March 27 to October 1, 2020. The source of data were the medical records of hospitalized patients. The clinical and laboratory characteristics of patients with moderate and severe clinical form of the disease. and the complications that developed in these patients during hospitalization were analyzed. The number of hospitalized men was statistically significantly higher, p=0.000. Most patients were in the age group of 60-69 years: 152 (29.3%), then in the age group of 50-59 years: 119 (22.9%). Women <70 years had more often a moderate, and women >70 years more often a severe clinical form of the disease, p<0.01. Patients with hypertension, diabetes mellitus, chronic lung diseases, cardiovascular diseases, hematological diseases and tumors of solid organs, with leukopenia and lymphopenia, elevated LDH, CRP, transaminases and serum ferritin, significantly more often had a clinically severe form of the disease (p<0.01). Patients with a severe clinical form of the disease on admission to the hospital had more frequent complications and death as outcome (p<0.01). Patients who were hospitalized with a severe form of COVID-19 had significantly more frequent disease complications and death as outcome.

Perfil clínico e epidemiológico de pacientes pediátricos diagnosticados com COVID-19 em um hospital público de referência na Amazônia brasileira

INTRODUCTION: The disease caused by SARS-CoV-2 called COVID-19 has high transmissibility and broad clinical spectrum. OBJECTIVE: To describe the epidemiological profile and clinical manifestations of children infected with the SARS-CoV-2 virus in a referral pediatric hospital. METHODS: This is a descriptive retrospective study, approved by the Research Ethics Council. RESULTS: 139 medical records of children diagnosed with COVID-19 were analyzed. By correlating the clinical outcome of the disease with its classification, the result was that 13% of patients who died had the severe form of COVID-19. 20% of children with mild clinical form and 19% of moderate clinical form were discharged home. When analyzing each of the symptoms with the clinical outcome, there was a statistically significant relationship between myalgia and dry cough symptoms and the discharge home outcome. And when the complications were analyzed: acute respiratory distress syndrome, multiple organ dysfunction and sepsis, they presented significant statistics with the clinical outcome of death and with the severe and critical clinical forms. When symptoms and complications were related to the clinical classification, they found a significant association between symptoms of productive cough and sore throat and the clinical forms: mild and moderate. CONCLUSION: It is necessary to encourage research in order to characterize the various clinical manifestations of this pathology, which may have different forms of presentation and spread knowledge about it, to establish measures for early diagnosis and adequate treatment, with restoration of health. of affected children.

Clinical, demographic and oxidative profile of patients with COVID-19 and disease severity

This study aimed to profile the clinical progression, demographics, and oxidative status of COVID-19 patients, correlating with disease severity. The study included 143 participants: 93 patients with COVID-19 (28 outpatients, 65 inpatients), and 50 control participants. Thiobarbituric acid reactive substance (TBARS) was used as an oxidative damage marker. Antioxidant activity was assessed via quantification of Vitamin C, sulfhydryl groups, ferric reduction ability of plasma (FRAP), Uric acid (UA), and evaluation of delta-aminolevulinate dehydratase (δ-ALA-D) enzymatic activity. Geriatric patients, especially men, with comorbidities such as obesity and/or chronic diseases were more likely to develop the most severe form of COVID-19. The activity of the δ-ALA-D was lower in inpatients, and there was no significant difference with the outpatient. Antioxidants decreased in COVID-19 groups, while lipid peroxidation increased. FRAP and Vitamin C decreased with evolution of the disease. Oxidative stress could be used as a predictor of worsening clinical condition.

An artificial neural network classification method employing longitudinally monitored immune biomarkers to predict the clinical outcome of critically ill COVID-19 patients.

The severe form of COVID-19 can cause a dysregulated host immune syndrome that might lead patients to death. To understand the underlying immune mechanisms that contribute to COVID-19 disease we have examined 28 different biomarkers in two cohorts of COVID-19 patients, aiming to systematically capture, quantify, and algorithmize how immune signals might be associated to the clinical outcome of COVID-19 patients. The longitudinal concentration of 28 biomarkers of 95 COVID-19 patients was measured. We performed a dimensionality reduction analysis to determine meaningful biomarkers for explaining the data variability. The biomarkers were used as input of artificial neural network, random forest, classification and regression trees, k-nearest neighbors and support vector machines. Two different clinical cohorts were used to grant validity to the findings. We benchmarked the classification capacity of two COVID-19 clinicals studies with different models and found that artificial neural networks was the best classifier. From it, we could employ different sets of biomarkers to predict the clinical outcome of COVID-19 patients. First, all the biomarkers available yielded a satisfactory classification. Next, we assessed the prediction capacity of each protein separated. With a reduced set of biomarkers, our model presented 94% accuracy, 96.6% precision, 91.6% recall, and 95% of specificity upon the testing data. We used the same model to predict 83% and 87% (recovered and deceased) of unseen data, granting validity to the results obtained. In this work, using state-of-the-art computational techniques, we systematically identified an optimal set of biomarkers that are related to a prediction capacity of COVID-19 patients. The screening of such biomarkers might assist in understanding the underlying immune response towards inflammatory diseases.

Clinical outcomes of COVID-19 caused by the Alpha variant compared with one by wild type in Kobe, Japan. A multi-center nested case-control study

ObjectivesThe emergence of the Alpha variant of novel coronavirus 2019 (SARS-CoV-2) is a concerning issue but their clinical implications have not been investigated fully. MethodsWe conducted a nested case-control study to compare severity and mortality caused by the Alpha variant (B.1.1.7) with the one caused by the wild type as a control from December 2020 to March 2021, using whole-genome sequencing. 28-day mortality and other clinically important outcomes were evaluated. ResultsInfections caused by the Alpha variant were associated with an increase in the use of oxygen (43.4% vs 26.3%. p = 0.017), high flow nasal cannula (21.2% vs 4.0%, p = 0.0007), mechanical ventilation (16.2% vs 6.1%, p = 0.049), ICU care (30.3% vs 14.1%, p = 0.01) and the length of hospital stay (17 vs 10 days, p = 0.031). More patients with the Alpha variant received medications such as dexamethasone. However, the duration of each modality did not differ between the 2 groups. Likewise, there was no difference in 28-day mortality between the 2 groups (12% vs 8%, p = 0.48), even after multiple sensitivity analyses, including propensity score analysis. ConclusionThe Alpha variant was associated with a severe form of COVID-19, compared with the non-Alpha wild type, but might not be associated with higher mortality.

The Relationship between Nrf2 and HO-1 with the Severity of COVID-19 Disease.

Nuclear factor erythroid 2-related factor 2 (Nrf2) and heme oxygenase-1 (HO-1) have significant roles in the development of a hyperinflammatory state in infectious diseases. We aimed to investigate the association of the serum concentrations of Nrf2 and HO-1 with the severity of COVID-19 disease. The study included 40 subjects with mild and moderately severe forms of the disease (MEWS scoring system ≤2). Twenty of the subjects had MEWS scores of 3 or 4, which indicate a severe form of the disease, and twenty subjects had a MEWS score of ≥5, which indicates a critical form of the disease. HO-1 and Nrf2 were measured using the commercially available Enzyme-Linked Immunosorbent Assay (ELISA). Subjects with the most severe form of COVID-19 (critically ill) had a lower concentration of Nrf2 that negatively correlated with the markers of hyperinflammatory response (CRP, IL-6, ferritin). This observation was not made for HO-1, and the correlation between Nrf2 and HO-1 values was not established. In the mild/moderate form of COVID-19 disease, Nrf2 was associated with an increased 1,25 dihydroxy vitamin D concentration. The results of this study show that Nrf2 has a role in the body's anti-inflammatory response to COVID-19 disease, which makes it a potential therapeutic target.

Determining factors of a personalized approach to patients with HIV during the COVID-19 pandemic

Objective. To study the epidemiological, medical, social and clinical factors that affect the manifestations and treatment of diseases — infections caused by the immunodeficiency virus (HIV) and the new coronavirus (SARS-CoV-2), which underlie the formation of a personalized approach to the management and treatment of people living with HIV (PLHIV).Materials and methods. Epidemiological analysis of morbidity and mortality from COVID-19 in the Leningrad region for 2021–2022 was carried out. The research team conducted a questionnaire and analysis of medical documentation of 122 HIVpositive patients registered at the Leningrad Regional Center for the Prevention and Control of AIDS and Infectious Diseases who suffered a novel coronavirus infection (COVID-19) in the period from 2020 to 2022. An assessment was made of the psychological and social characteristics of patients affecting adherence to antiretroviral therapy (ART), the clinical picture of the course of HIV infection, including in combination with COVID-19. The fact of SARS-CoV-2 disease was confirmed by polymerase chain reaction (PCR) smears from the mouth and nasopharynx. Additionally, a group of 59 PLHIV hospitalized in hospitals in St. Petersburg and the Leningrad region with a severe form of COVID-19 was isolated for analysis.Results and discussion. Number of COVID-19 cases in 2020–2021 in the Leningrad region amounted to 15.553 people, of which 1.553 had a history of HIV infection (13.5% of patients registered at the dispensary). The mortality rate among PLHIV who underwent COVID-19 was 5.1%. An equal ratio of women and men was observed among 122 surveyed patients, the average age of respondents was 41 years. When assessing the social status of the respondents, it was found that 25.4% had higher education, 56.5% had specialized secondary education. 72.9% had a permanent job. 61.4% of respondents considered themselves to be in the category of material well-being of «average level», 24.6% — to «below average». The sexual route of HIV infection was established in 50.8% of patients, injectable was 29.5%, in other cases it was not unknown. The average level of CD4 lymphocytes in the blood was 544 cl/mcl, most patients (90.2%) had an undetectable indicator of HIV viral load (VL). The average duration of the disease with the new coronavirus in HIV patients was 15.6 days. At the same time, 108 (88.5%) people noted a mild course of COVID-19 and did not need hospitalization. Coverage of COVID-19 vaccination among the surveyed PLHIV was 40.9%. According to data from 59 case histories of PLHIV hospitalized as a result of the severe course of COVID-19, 55 people died, a pathoanatomic autopsy was performed in 26 cases. The autopsy revealed the following complications and concomitant diseases: miliary tuberculosis (7.7%), purulent endocarditis (11.5%), sepsis (19.2%). Improvement in the dynamics was observed only in 4 PLHIV, whose further fate is unknown.Conclusion. The study showed that the incidence of SARS-CoV-2 among PLHIV in the Leningrad region is comparable to the general population, however, the total mortality among HIV-infected patients is higher than in the region and across the country. As a result of the analysis, we came to the conclusion that HIV infection and COVID-19 are independent in terms of co-infection at the outpatient stage. The exception is severe and aggravated comorbid cases, which required a more detailed assessment of the condition, the involvement of a larger number of specialists, as well as laboratory and instrumental research methods. The results obtained determined the need for a comprehensive interdisciplinary approach to patients with HIV infection, taking into account their personal needs. Medical personnel providing care to PLHIV should take into account not only the clinical picture of the disease, but also the psychosocial status of the patient, in order to improve the outcomes of COVID-19 and HIV infection.

Association between Brain Injury Markers and Testosterone in Critically-Ill COVID-19 Male Patients.

Accumulating data suggest that various neurologic manifestations are reported in critically-ill COVID-19 patients. Although low testosterone levels were associated with poor outcomes, the relationship between testosterone levels and indices of brain injury are still poorly understood. Therefore, we aimed to explore whether testosterone levels are associated with glial fibrillary acidic protein (GFAP) and ubiquitin carboxy-terminal hydrolase L1 (UCH-L1), biomarkers of brain injury, in patients with a severe form of COVID-19. The present study was conducted on 65 male patients aged 18-65 with severe COVID-19. Blood samples were collected at three time points: upon admission to ICU, 7 days after, and 14 days after. In patients with neurological sequels (n = 20), UCH-L1 serum concentrations at admission were markedly higher than in patients without them (240.0 (155.4-366.4) vs. 146.4 (92.5-243.9) pg/mL, p = 0.022). GFAP concentrations on admission did not differ between the groups (32.2 (24.2-40.1) vs. 29.8 (21.8-39.4) pg/mL, p = 0.372). Unlike GFAP, UCH-L1 serum concentrations exhibited a negative correlation with serum testosterone in all three time points (r = -0.452, p &lt; 0.001; r = -0.430, p &lt; 0.001 and r = -0.476, p = 0.001, respectively). The present study suggests that the traumatic brain injury biomarker UCH-L1 may be associated with neurological impairments seen in severe COVID-19. Moreover, a negative correlation between UCH-L1 and serum testosterone concentrations implies that testosterone may have a role in the development of neurological sequels in critically-ill COVID-19 patients.

The association of chronic liver disorders with exacerbation of symptoms and complications related to COVID-19: A systematic review and meta-analysis of cohort studies.

The aim of this review was to combine the results of published cohort studies to determine the exact association between chronic liver disorders, and the severe form of COVID-19, and its associated complications. This meta-analysis employed a keyword search (COVID-19 and chronic liver disorders) using PubMed (Medline), Scopus, Web of Sciences, and Embase (Elsevier). All articles related from January 2019 to May 2022 were reviewed. The STATA software was used for analysis. The risk of death in COVID-19 patients with chronic liver disorders was higher than in ones without the chronic liver disease (RR: 1.52; CI 95%: 1.46-1.57; I2 : 86.14%). Also, the risk of acute respiratory distress syndrome (ARDS) and hospitalization in COVID-19 patients with chronic liver disorders was higher than in ones without the chronic liver disease ([RR: 1.65; CI 95%: 1.09-2.50; I2 : 0.00%] and [RR: 1.39; CI 95%: 1.23-1.58; I2 : 0.20%]). Also, the meta-analysis showed cough, headache, myalgia, nausea, diarrhea, and fatigue were 1.37 (CI 95%: 1.20-1.55), 1.23 (CI 95%: 1.09-1.38), 1.25 (CI 95%: 1.04-1.50), 1.19 (CI 95%: 1.02-1.40), 1.89 (CI 95%: 1.30-2.75), 1.49 (CI 95%: 1.07-2.09), and 1.14 (CI 95%: 0.98-1.33), respectively, whereas the risk of all these symptoms was higher in COVID-19 patients with chronic liver diseases than ones without chronic liver disorders. The mortality and complications due to COVID-19 were significantly different between patients with the chronic liver disease and the general population.

Role of serum metalloproteinases 2 and 9 to assess the severity of COVID-19 in pregnant women: a prospective cross-sectional study.

To investigate the relationship between blood matrix metalloproteinases -2 and -9 levels and disease severity in pregnant women with COVID-19 infection. A prospective cohort study was conducted at the Kanuni Sultan Suleyman Education and Research Hospital in Istanbul, Turkey. We measured serum MMPs-2 and-9 levels of the healthy pregnant controls and pregnant women with COVID-19 and sought to assess the status of these MMPs in pregnant women with COVID-19, especially in women with a severe form of COVID-19 as diagnosed by abnormal computed tomography (CT) findings in addition to severe clinical and laboratory findings. Of the healthy pregnant controls and pregnant women with COVID-19, the serum MMP-2 levels were comparable, but the MMP-9 level was lower in the pregnant women with COVID-19. Although the serum MMP2 level was somewhat lower in the women with COVID-19 with abnormal CT findings. The serum MMP-9 level of pregnant women with COVID-19 with abnormal CT was meaningfully lower. In the pregnant women, COVID-19 decreases the serum MMP-9 but does not change the serum MMP-2. COVID-19 with abnormal CT findings causes minimal decrease in the serum MMP-2 but decreases the serum MMP-9 with abnormal CT findings. Considering the study variables of current study, the probability of LMWH-related MMP alterations needs to be a study topic to clarify the possible contribution of LMWH to the status of serum MMPs in pregnant women with COVİD-19 especially in the women with COVID-19 with abnormal CT findings.

Investigation of the Factors Related to Mortality and Length of Hospitalization among COVID-19 Patients in East Azerbaijan Hospitals, Iran.

It is of utmost importance to identify populations with an elevated risk for COVID-19 and the factors influencing its outcomes. The present study aimed to investigate factors affecting mortality and length of stay (LOS) among COVID-19 patients in the hospitals of East Azerbaijan province, Iran, during 15 months of this pandemic. The present study followed a retrospective cohort design. This retrospective study was conducted using data in the integrated syndromic surveillance system (ISSS) on patients admitted to the hospitals from February 21, 2020, to April 11, 2021. The association between variables of interest and death, as well as LOS, was investigated via multiple logistic regression and multiple linear regression analyses. In total, 24 293 inpatients with a mean age of 54.0 ± 19.4 years were included in this study. About 15% of them lost their lives, whose mean age was 69.0 ± 14.6 years, significantly higher than the recovered ones (P < 0.001). Factors, such as above 49 years of age (P < 0.001), male gender (OR = 1.17; 95% CI: 1.08-1.26), and having chronic diseases (OR = 1.32; 95% CI: 1.22-1.42), were correlated with patient mortality. In addition, having chronic diseases (Beta = 0.06; 95% CI: 0.03-0.08) was associated with higher LOS in hospitals. In conclusion, older patients were at a higher risk of mortality and prolonged hospitalization. Furthermore, patients' underlying diseases could cause a severe form of COVID-19, which can lead to death and increase patients' LOS.

Evaluation of myocardial work in patients recovered from the severe form of COVID-19

Abstract Background/Introduction The impact of COVID-19 goes beyond its acute form, and can lead to the persistence of symptoms and the emergence of systemic disorders, defined as Post-Covid or Long-Covid. Purpose Assess the late impact on the cardiorespiratory system of patients recovered from severe Covid. Methods We performed cross-sectional study that included patients over 18 years of age who recovered from the severe form of COVID-19 after at least 60 days of their discharge. Patients and healthy controls were enrolled to perform transthoracic echocardiography (TTE) and cardiopulmonary exercise testing (CPET). Results A total of 52 patients and 24 controls were enrolled. The standard TTE parameters (end diastolic diameters, left ventricular ejection fraction, diastolic function and right ventricular systolic function) showed no difference when compared to the control group. When analyzing the myocardial work, there was a higher Wasted MW (GWW): 135 mmHg% vs 84.5 mmHg% (p=0.002), with lower MW Efficiency (GWE): 94 vs. 96 (p=0.003); as well as lower values of global strain: cases = 18.6% vs. 20.1% (p=0.009). No differences were found in the Constructive MW (GWC) and MW Global Index (GWI). In the CPET data we found lower peak values for the VO2: 24 ml/kg/min vs. 32.75 ml/kg/min (p&amp;lt;0.001); for the Heart Rate: 162 bpm vs. 175 bpm (p&amp;lt;0.001); for the Ventilation: 79.3 L/min vs. 109.85 L/min (p&amp;lt;0.001) and Respiratory Exchange Ratio: 1.12 vs. 1.19 (p=0.004). There was no difference in the maximum load reached, neither in the oxygen pulse values and in the Ve/CO2 slope. In relation to the oxygen kinetics, there was a significant reduction in OUES%: 85% vs. 98% (p=0.03); as well as an extended T½: 112 s vs. 88.5 s (p&amp;lt;0.001); and a slowing of the fall in heart rate in recovery time, as measured by the Heart Rate decay: −17.32 bpm vs. −22.08 bpm (p=0.005). Conclusion Patients recovered from the severe form of COVID-19 had higher GWW with lower efficiency (GWE). Such findings, added to changes in oxygen kinetics during exercise, may point to a possible cardiocirculatory mechanism associated with decreased aerobic capacity. Funding Acknowledgement Type of funding sources: None.

P334 Fungal infections in patients with COVID-19 in 1-year pandemic 2020-2021 from Cote d'Ivoire

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PMBackground and Objectives: The COVID-19 pandemic has caused significant public health problems both in Côte d'Ivoire and around the world. Among the different causes of morbidity and mortality in COVID-19 patients, the frequency and impact of co-infections are still little studied, especially in patients with acute respiratory distress syndrome (ARDS).However, people with severe COVID-19 infection are particularly vulnerable to bacterial and fungal infections. This study aims to determine the frequency and susceptibility profile of isolated fungi in severe COVID-19 patients living in west Africa.Methodology: We conducted a retrospective observational study of COVID-19 patients who were tested for invasive fungal infections (IFI) between 2020 and 2021 in the laboratory of mycology at Pasteur Institute of Cote d'Ivoire.ResultsWe received a total of 77 samples (from superficial specimens, deep sites, urine) collected from 35 patients admitted for severe COVID-19. The patients were predominantly female (n = 21, 60%) and had a median age of 54,5 years (range16-79 years).The mycological analysis for IFI diagnosis showed 20% of samples positive only for yeasts, 66.7% of which were Candida albicans and responsible for 90% of invasive infections in COVID-19 patients. No difference in fungal species was found regarding of the sex, age of the patients, and waves of the pandemic. Antifungal susceptibility testing revealed no resistance to antifungals (fluconazole, voriconazole, itraconazole, amphotericin B, and flucytosine) among Candida isolates.ConclusionThese data show significant Candidiasis infection associated with the severe form of COVID-19. Given this prevalence of 20%, it is important for clinicians to remain vigilant and take proactive measures to prevent candidemia in patients with COVID-19. The widespread surveillance for fungal co-infections is still essential to reduce mortality associated with COVID-19.

Impact clinique de l'infection par le SARS-CoV2 chez les footballeurs professionnels de la première ligue Tunisienne

Aim of the studyThe aim of our work, developed within the Tunisian Football Federation (TFF), was to study the clinical manifestations and the possible cardiac complications in professional footballers of the first league having contracted an infection by SARS-CoV2. Patients and methodsThis is a retrospective, descriptive, and analytical study. Professional Premier League football players who contracted COVID-19 from the onset of the pandemic through June 2021 were included. ResultsAmong the 1388 players of the Tunisian first professional league, 102 players (7.35%) had COVID-19. Three were excluded for lack of clinical data. The average age of the subjects included was 26 ± 4 years with extremes ranging from 19 to 37 years. The most frequent clinical manifestations were anosmia, agueusia and muscle fatigue. The clinical examination was normal in all the subjects included except for the presence of fever among 37 (37.9%) subjects. All subjects’ electrocardiogram did not show any unusual abnormality. As for the imaging data, two players presented a pericardial effusion without signs of severity. In the other players, echocardiography was normal. Cardiac magnetic resonance imaging did not reveal any abnormality. ConclusionThe results of our study showed that there was no severe form of COVID-19 among professional soccer players. Larger scale studies integrating other leagues and different sport categories may provide more information on the clinical impact of this disease in high level athletes.

COVID-19 Severity and Mortality Among Chronic Liver Disease Patients: A Systematic Review and Meta-Analysis.

IntroductionPre-existing comorbid conditions in COVID-19 patients are risk factors for developing severe disease and death. We aimed to determine the association of chronic liver disease (CLD), a comorbid condition, with severity of disease and death among COVID-19 patients.MethodsWe searched for studies reporting COVID-19 outcomes among CLD and non-CLD patients in databases including Medline, EMBASE, ScienceDirect, Google Scholar, and Cochrane Library from inception of the pandemic until February 2022. Risk of bias assessment was conducted by using the Newcastle-Ottawa Scale for assessing the quality of nonrandomized studies in meta-analyses. We conducted a meta-analysis with a random-effects model and reported pooled odds ratios (ORs) with 95% CIs.ResultsWe included 40 studies with 908,032 participants. Most studies were conducted in China and the US. COVID-19 patients with CLD had significantly higher odds of having a severe form of COVID-19 (pooled OR = 2.44; 95% CI, 1.89–3.16) and death (pooled OR = 2.35; 95% CI, 1.85–3.00) when compared with COVID-19 patients without CLD.ConclusionThe presence of CLD is significantly related to adverse clinical outcomes among COVID-19 patients in terms of severity and mortality. Clinicians should develop a comprehensive intervention plan to manage these high-risk patients and reduce COVID-19–related deaths.