Suspected Coronavirus Disease 2019 Patients Research Articles

Incidence of Long COVID-19 at 12-18 Months Following Delta Wave of Coronavirus Disease 2019: Hospital-based Prospective Registry.

Long coronavirus disease 2019 (COVID-19) has emerged as an important consequence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). To identify its incidence 12-18 months following hospitalization in patients with COVID-19, we performed a prospective study. Virologically confirmed successive patients with moderate-to-severe COVID-19, hospitalized during the delta wave in India, were recruited. Data on clinical features, investigations, and outcomes were obtained. Long COVID-19 was diagnosed using the European quality of life questionnaire (EQ-5D) and Birmingham symptom burden questionnaire (SBQ) at 12-18-month follow-up. During the study period (January-July 2021), we evaluated 8,680 suspected COVID-19 patients, of whom 1,641 were confirmed virologically and 388 were hospitalized. Men accounted for 64.4%, individuals aged >60 years for 41.5%, hypertension for 42.8%, diabetes for 38.4%, and cardiovascular disease for 17.3%. At admission, there was a high prevalence of cough (71.1%), fever (86.6%), and oxygen requirement (38.6%). Proning was deployed in 89.2% of cases, nasal cannula in 36.3%, nonrebreather masks in 15.7%, noninvasive ventilation in 14.4%, and invasive ventilation in 16.2%. In-hospital deaths totaled 75 (19.3%), with 310 discharged for home care and eligible for follow-up. At a median follow-up of 15 months, 9 patients had died, 40 were lost to follow-up, and 264 were evaluated. The incidence of Long COVID-19 was 45 [17.0%, 95% confidence of interval (CI) 12.6-21.9%]. The median EQ-5D score was 5.0, with >5 observed in only 11 patients (0.6%). Using the SBQ, new-onset dyspnea on exertion was noted in 13 (4.9%), rest dyspnea in 7 (2.6%), fatigue in 31 (11.7%), feverishness in 18 (6.8%), and low energy in 16 (6.1%). Long COVID-19 was significantly more prevalent in women and older individuals. In Long COVID-19 compared to controls, the mean duration of oxygen requirement (5.46 ± 9.8 vs 2.46 ± 4.5 days, p = 0.002), use of nonrebreather masks (17.8 vs 7.3%, p = 0.026), noninvasive ventilation (11.1 vs 3.2%, p = 0.020), and duration of intensive care unit (ICU) stay (13.5, 8.7-17.3 vs 8.0, 5.0-11.0 days, p = 0.028) were significantly higher. The incidence of Long COVID-19 at 12-18 months follow-up is 17.0%. It is significantly higher in women, older age groups, and patients requiring longer oxygenation, nonrebreather oxygen masks, noninvasive respiratory support, and extended stays in the ICU.

Sp110 Gene Polymorphisms Associated with Increased Susceptibility to COVID-19 Severity among the Hillah Population

Abstract Background: The new coronavirus causes many respiratory illnesses in Wuhan, China, under the name severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), from December 2019. The illness of coronavirus disease 2019 (COVID-19) was brought on by this virus. At least three isoforms of the SP110 nuclear body protein are encoded by the SP110 gene. These include the SP110a, b, and c isoforms, which are the most abundant and are thought to come from alternative mRNA splicing. Aim: This study attempted to evaluate the impact of Sp110 gene variation on COVID-19 susceptibility in the province of Babylon. Materials and Methods: In this study, of 113 cases, 63 cases have clinical symptoms of COVID-19 patients and 50 blood samples were collected from healthy people as a control group in this study from November 2021 to February 2022 at Al-Morgan Hospital. There were many demographic data included in the present study such as age distribution, sex distribution, and geographic distribution of COVID patients. Samples (63) from suspected COVID-19 patients from different age groups ranging from 20 to 80 years old were considered. Results: The Sp110 rs7580900 AA genotype was the most frequent in both COVID-19 (28.32%) and control (21.24%) groups. This indicates that the Sp110 Rs7580900 single-nucleotide polymorphisms are not related to susceptibility to COVID-19 in patients (P ≤ 0.05). Conclusion: Significant results were seen in SP110 gene polymorphism between COVID patients and vaccinated persons at P ≤ 0.05. This may be the of Sp110in mediating SARS-CoV-2 infection as a novel route for SARS-CoV-2 entry.

Retinal vascular occlusion risks during the COVID-19 pandemic and after SARS-CoV-2 infection

The coronavirus disease 2019 (COVID-19) has been reported to affect vascular networks including the eye. However, evidence on the causal relationship between COVID-19 infection and retinal vascular occlusions remains limited. This study aimed to determine the change in retinal vascular occlusion incidence during COVID-19 era and whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection induces retinal vascular occlusion. Retinal vein occlusion (RVO) and retinal artery occlusion (RAO) incidences during 2018–2019 and 2020–July 2021 were compared, those in confirmed and suspected COVID-19 patients diagnosed from 2020 to January 2021 were calculated, and those in COVID-19 patients during 180 days prior and 180 days after diagnosis were assessed. Additionally, the standardized incidence ratio of RVOs in COVID-19 patients was analyzed. Incidence rates per 100,000 people/year of RVO during 2018–2019 and 2020–2021 was 102.0 and 98.8, respectively. RAO incidence rates during 2018–2019 and 2020–2021 were 11.7 and 12.0, respectively. In both confirmed and suspected COVID-19 patients, the incidence of RVO and RAO did not change significantly from 180 days before to after diagnosis in the adjusted model. RVO incidence slightly decreased while RAO incidence increased during the COVID-19 pandemic. SARS-CoV-2 infection did not significantly increase RVO or RAO incidence.

Experience with the safe admission of breast and thyroid cancer patients in non-endemic areas during an epidemic outbreak.

The outbreaks of infectious diseases, such as coronavirus disease 2019 (COVID-19), have seriously affected the normal work and life of the public, as well as the normal diagnosis and treatment of other diseases due to their strong infectivity, high population susceptibility, and diverse clinical manifestations. Breast and thyroid specialists in non-hotspot epidemic areas of COVID-19 must consider factors, including epidemic prevention and control, breast and thyroid cancers and diseases diagnosis and treatment, and access to medical resources to make a reasonable treatment choice and optimize the treatment process. A cohort study was designed under our center's epidemic prevention and control strategy. The study was conducted between February 3 and April 19, 2020, to explore the safety of clinical diagnosis and treatment of breast and thyroid cancer patients during the epidemic. All the outpatients, inpatients, day-time chemotherapy patients, targeted therapy patients, and relevant medical staff in the observation period in the Department of Breast and Thyroid Surgery in Southwest Hospital in Chongqing municipality, China, were included to investigate the detection and infection rate of COVID-19 and suspected patients. During the observation period, 27,117 patients were admitted to the outpatient unit. We performed 394 inpatient surgeries and 411 day-time surgeries. In our center, 1,046 and 663 patients received day-time chemotherapy and targeted therapy, respectively. All the patients were diagnosed and treated promptly and safely. Three suspected COVID-19 patients were identified in the outpatient unit. Healthcare staff achieved a "zero" infection of COVID-19. The spread and cross-infection of COVID-19 can be avoided in non-hotspot epidemic areas based on scientific prevention and control, and cancer patients can be diagnosed and treated on time. The prevention and control measure implemented in the COVID-19 epidemic for diagnosing and treating cancer patients was effective and can be referenced for other infectious disease outbreaks.

A Retrospective Study on Prevalence and Profile of Reverse Transcriptase Polymerase Chain Reaction Positive Severe Acute Respiratory Syndrome Corona Virus 2 Samples Tested in a Tertiary Care Hospital, South India

Introduction: In December 2019, the first outbreak of severe acute respiratory syndrome coronavirus 2 disease was reported in Wuhan, China, which was later re-named by the World Health Organization (WHO) as coronavirus disease 2019 (COVID-19). Severe illness was seen in approximately 20%–30% of patients needing intensive care unit intervention. Some of them presented with acute respiratory distress syndrome, Shock, acute cardiac injury, organ dysfunction, and acute renal injury. Aim: This study aims to estimate the prevalence of reverse transcriptase polymerase chain reaction (RT-PCR)-positive COVID-19 samples among the total samples tested and their profile among the positive COVID-19 samples at a tertiary care hospital, south India, and will also highlight the comorbid conditions associated with increased morbidity and mortality. Materials and Methods: Nasopharyngeal and oropharyngeal samples from suspected COVID-19 patients were collected and tested by real-time RT-PCR and the targeted genes were identified. Results: In our study, the prevalence of COVID-19 RT-PCR positivity was found to be 3.1%. Among the positive samples, males were found to be 58.2% and females were 41.8%. Symptomatic patients were less of which 17.65% were male and 7.98% were female. Among the positive patients, 83 patients had severe symptoms that needed intensive care and died of complications. The patients with comorbid conditions had diabetes as the leading cause of death. Conclusion: The present study concluded that mortality was found to be more among COVID-positive males, elderly people above 60 years of age with comorbid conditions.

Lactate Dehydrogenase Levels as A Marker of COVID-19 Severity

Coronavirus Disease 2019 (COVID-19) is an infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). Knowing the severity of COVID-19 is important during a pandemic. Measurement of Lactate Dehydrogenase (LDH) levels is a simple, quick, and widely available laboratory test in most health facilities. Lactate dehydrogenase levels change significantly in patients with tissue damage including COVID-19 disease. The purpose of this study was to analyze the LDH levels as a marker of the severity of COVID-19. The research method used was a cross-sectional approach using primary data from 70 suspected COVID-19 patients from June to July 2021 at Labuang Baji Hospital, Hasanuddin University Hospital, and Makassar City Hospital. Samples were grouped into mild, moderate, and severe COVID-19. The LDH levels at the time of hospital admission were measured using an Architect device. Chi-Square, Kruskal-Wallis, and ROC curve statistical tests were used to obtain the LDH value with a significant value of p<0.05. The sample consisted of 24 mild COVID-19, 23 moderate COVID-19, and 23 severe COVID-19. The LDH levels in mild COVID-19 were 101.00 U/L (74.00-156.00 U/L) significantly different from moderate COVID-19 was 143.00 U/L (126.00-253.00 U/L) and COVID-19 were 291.00 U/L (177.00-655.00 U/L) (p<0.001) and had a very strong positive correlation (r=0.914). The ROC curve showed that LDH had a sensitivity of 91.3%, specificity of 94.7% with the cut-off >250.5 U/L, NPV of 96.4%, PPV of 87.5%, and accuracy of 91.3%. LDH levels increase along with the increasing severity of COVID-19 caused by tissue damage due to increased inflammatory response. LDH can be used as a marker of COVID-19 severity.

Comparison of the performance of two real-time fluorescent quantitative PCR kits for the detection of SARS-CoV-2 nucleic acid: a study based on large real clinical samples

BackgroundThe global pandemic of coronavirus disease 2019 (COVID-19) has led to the development of multiple detection kits by national manufacturers for severe acute respiratory syndrome coronavirus 2 viral nucleic acid testing. The purpose of this study is to evaluate the performance of different kits (i.e., Maccura kit and Sansure kit) in real clinical work using clinical samples, which will help with the optimization of the test kits.MethodDuring the past three months (March–May 2022), 1399 pharyngeal swabs from suspected COVID-19 patients have been initially screened using the Maccura kit in Jilin, China, and the test results were verified using the Sansure kit. The cycle threshold (Ct) values generated by the two kits were compared at different viral load levels. Correlation and consistency of the Ct values were investigated using Spearman correlation, Deming regression, and Bland–Altman plots. The cut-off Ct values of the Maccura kit were recalculated by referencing the result of the Sansure kit as a standard. Furthermore, another 163 pharyngeal swabs from suspected COVID-19 patients were collected to verify the new cut-off values.ResultsAs a result of the Maccura kit testing, 1192 positive cases and 207 suspected COVID-19 cases were verified. After re-examination by the Sansure kit, 1118 positive cases were confirmed. The difference between the Ct values provided by the two kits was statistically significant, except for the N gene at high viral load. The Ct values obtained from the two kits presented a linear positive correlation. The Maccura kit used new cut-off Ct values of 35.00 (ORF1ab gene) and 35.07 (N gene). Based on that, the validation pass rate for the new cut-off Ct values was 91.41%.ConclusionSince the Maccura kit is found to have false positives in actual clinical work, recalculation of the cut-off values can reduce this occurrence. In order to improve the accuracy of the testing, laboratories should use two kits for COVID-19 testing, and the adjusting and optimizing of the kits for their situation are needed.

Ethical challenges in clinical practice during the COVID-19 pandemic in an academic healthcare institution in Malaysia: A qualitative study

BackgroundHealthcare professionals (HCPs) face a myriad of ethical challenges during the coronavirus disease 2019 (COVID-19) pandemic. However, there is limited literature examining the ethical challenges faced by HCPs in low- and medium-income countries. The research was designed to explore the ethical challenges experienced by HCPs in a Malaysian hospital setting during the pandemic.MethodsSemistructured interviews were conducted via video calls with 10 Malaysian HCPs across different clinical disciplines involved in managing patients diagnosed with COVID-19 infections. The calls were audio-recorded, transcribed verbatim and checked. Thematic analysis with constant comparison across transcripts was carried out to identify categories and themes.ResultsThree main themes emerged. Firstly, there was deprioritisation of care for non-COVID-19 patients resulting from resource limitations. HCPs raised concerns that there was curtailed access to various healthcare services by non-COVID-19 patients. There was also a trade-off between protecting individual patient safety and public health interests. Secondly, patients were disempowered from decision-making; the decision to segregate suspected COVID-19 patients to high-risk areas without seeking patients’ approval may result in an increased risk of infection. Lastly, HCPs expressed internal conflicts when balancing the professional duty of care against concerns about contracting COVID-19 and spreading it to their family members.ConclusionThe study highlighted ethical issues faced by HCPs in Malaysia during the pandemic. It underscores the need for clinical ethics consultation services in hospitals to navigate the various ethical dilemmas.

Clinical and laboratory comparison between End-Stage Kidney Disease patients with and without COVID-19: a cross-sectional study in a top referred hospital of West Nusa Tenggara

Background: The initial presentation of hospitalized End-Stage Kidney Disease (ESKD) patients with and without coronavirus disease 2019 (COVID-19) is similar and can overlap. We aimed to compare clinical dan laboratory characteristics of the COVID-19 positive and negative patients to help clinicians screen and differentiate hospitalized ESKD patients. Methods: We reviewed data from the medical record of ESKD patients hospitalized between May 1, 2020, and April 30, 2021. The study comprised all suspected COVID-19 patients. The COVID-19 positive was based on results from RT-PCR for SARS-CoV-2. The bivariate analysis was used to compare the positive and negative groups. The association of all characteristics and diagnosis of COVID-19 were then evaluated by multivariable analysis. Results: There was twenty-nine percent of confirmed COVID-19 in 176 ESKD patients. The proportion of dyspnea, pulmonary edema, pleural effusion, and cardiomegaly were lower in the COVID-19 positive group. Diastolic blood pressure, pulse rate, white blood cell differential counts, and potassium were lower in the COVID-19 positive group. Using a multivariate analysis, eosinophil count <0.04 x103µl (P<0.001, OR 3.50, 95%CI:0.123-0.665), monocyte count <0.69 x103µl (P=0.004, OR 2.54, 95%CI:0.166-0.931), and neutrophil-to-lymphocyte ratio (NLR) <3.13 (P=0.044, OR 3.18, 95%CI:0.102-0.968) were associated with the presence of COVID-19. Conclusions: Leukocyte differential count and chest x-ray should be evaluated as an initial screening of COVID-19 in hospitalized ESKD. Low levels of monocyte and eosinophil count and mild elevation of NLR were associated with COVID-19 in ESKD patients.

A Newly Developed Interprofessional In-Situ Simulation-Based Training for Airway Management of COVID-19 Patients: Identification of Challenges and Safety Gaps, and Assessment of the Participants' Reaction.

BackgroundHealthcare providers performing aerosol-generating procedures like airway management are at the highest risk for contamination with coronavirus disease 2019 (COVID-19). We developed an in-situ simulation (ISS) airway management training in confirmed or suspected COVID-19 patients for emergency and anesthesiology staff, evaluated participants’ reactions, and identified perceived challenges.MethodsWe used a cross-sectional study design incorporating a quantitative questionnaire to describe participants’ reaction to the ISS and a qualitative group interview using the plus-delta debriefing modality to explore participants’ challenges in acquiring the knowledge and skills required for each learning objective. Data were analyzed using descriptive statistics and deductive content analysis.ResultsTwo hundred and ninety-nine healthcare providers participated in 62 ISS training sessions. Over 90% of our study participants agreed or strongly agreed that: they understood the learning objectives; the training material appropriately challenged them; the course content was relevant, easy to navigate, and essential; the facilitators’ knowledge, teaching, and style were appropriate; the simulation facilities were suitable; and they had ample opportunities to practice the learned skills. The main challenges identified were anticipating difficult airways, preparing intubation equipment, minimizing the number of personnel inside the room, adhering to the proper doffing sequence, preparing needed equipment outside the intubation room, speaking up, and ensuring closed-loop communication.ConclusionThe newly developed ISS training was feasible for busy healthcare practitioners to safely perform airway management procedures for suspected or confirmed COVID-19 patients without affecting bedside care. Anticipation of difficult airways and speaking up were the most frequent challenges identified across all specialties in this study.

VDR gene polymorphisms are associated with the increased susceptibility to COVID-19 among iranian population: A case-control study.

Coronavirus disease 2019 (COVID‐19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), but the pathogenesis is unclear. Host genetic background is one of the main factors influencing the patients' susceptibility to several viral infectious diseases. This study aimed to investigate the association between host genetic polymorphisms of two genes, including vitamin D receptor (VDR) and vitamin D binding protein (DBP), and susceptibility to COVID‐19 in a sample of the Iranian population. This case‐control study enrolled 188 hospitalized COVID‐19 patients as the case group and 218 suspected COVID‐19 patients with mild signs as the control group. The VDR (rs7975232, rs731236 and rs2228570) and DBP (rs7041) gene single nucleotide polymorphisms (SNPs) were genotyped by Polymerase Chain Reaction Restriction – Fragment Length Polymorphism (PCR‐RFLP) method. A significant association between rs2228570 SNP in the VDR gene and the susceptibility of COVID‐19 was found between case and control groups. The CT genotype (Heterozygous) of rs2228570 C > T polymorphism showed significant association with a 3.088 fold increased odds of COVID‐19 (p < .0001; adjusted OR: 3.088; 95% CI: 1.902–5.012). In addition, a significant association between CC genotype of rs2228570 CT polymorphism and increased odds of COVID‐19 in male and female groups (p = .001; adjusted OR: 3.125; 95% CI: 1.630–5.991 and p = .002; adjusted OR: 3.071; 95% CI: 1.485–6.354 respectively) were determined. Our results revealed no significant differences in the frequency of genotype and allele of VDR (rs7975232 and rs731236) and DBP (rs7041) between SARS‐CoV‐2‐infected patients and controls (p > .05). Our results showed that polymorphism of VDR (rs2228570) probably could influence individual susceptibility to COVID‐19. The polymorphisms of VDR (rs7975232 and rs731236) and DBP (rs7041) were not associated with SARS‐CoV‐2 infection susceptibility.

Routine laboratory tests: Potential practical parameters to detect coronavirus disease-2019 in resource-limited settings.

The diagnosis of Coronavirus Disease-2019 (COVID-19), an ongoing global pandemic with more than 3 million cases worldwide both in developed and developing countries, requires molecular or serological tests that are not available in some settings. This systematic review provides further evidence to assess the diagnostic accuracy of routine laboratory tests to detect COVID-19 in suspected COVID-19 patients in resource-limited point of care and mobile laboratory. Comprehensive and systematic literature search in electronic databases (PubMed, Cochrane, and Online Wiley Library) was conducted to retrieve studies published between December 2019 and April 2020 reporting the diagnostic value of routine laboratory tests in the diagnosis of COVID-19. The quality of each study was assessed using QUADAS2. Literature search and study selection were depicted in PRISMA 2009 Flow Diagram. Three studies were included in this review. Two studies reported poor accuracy (AUC 0.075 and 0.624) of lymphopenia to detect COVID-19. One study reports good accuracy (AUC 0.858) of neutrophilia to detect COVID-19 amongst suspected cases. One multi-gated cross-sectional study reports poor discriminatory ability (AUC 0.65) of neutrophilia to discriminate between COVID-19 and CAP. Because of its big variability between patients and poor diagnostic accuracy (AUC 0.112 and 0.624), leukocyte count should not be a single parameter to determine COVID-19 patient status. Neutrophil percentage might be helpful to determine COVID-19 status for suspected patients at the primary point of care or even in a mobile laboratory for countries with limited resources, but further study is needed to support this statement.

The COVID-19 pandemic and maritime telemedicine: 18-month report.

The onset of the coronavirus disease 2019 (COVID-19) pandemic has greatly impacted maritime telemedicine services. The aim of this study is to describe the impact of the pandemic, both quantitatively and qualitatively, by analysing the teleconsultations by doctors from the French Tele-Medical Assistance Service (TMAS). We carried out a descriptive observational study of retrospective data from the TMAS files. The main inclusion criterion for the files was a diagnosis of "influenza due to an unidentified virus". We extracted the following data: type of ship, gender, age, nationality, role on board, reason for the call and symptoms, number of calls, navigation zone, severity, medical decision, whether or not a COVID-19 test had been carried out, and treatments prescribed on board. One hundred and ninety-nine files were included of which 39 (20%) were clusters. We were able to analyse data from 384 patients. The study population comprised 376 suspected COVID-19 patients, of whom 334 (87%) were symptomatic and 42 (10.9%) asymptomatic. Eight (2.1%) patients were not thought to have COVID-19 but their call was related to the pandemic. Of the symptoms presented by the patients, fever was the most frequent (n = 196; 59%), while 129 (39%) presented a cough, 60 (18%) a headache, 41 (12%) non-specific ear, nose, throat signs, and 40 (12%) dyspnoea. Two hundred fifty-two (75%) patients stayed on board, 55 (17%) were disembarked, for 14 (4%) a ship diversion was arranged, and 13 were evacuated including 4 medical evacuations. The most important problem encountered related to managing asymptomatic or pauci-symptomatic patients at sea, which was the subject of the majority of calls. The TMAS doctors played an important role in managing the pandemic by emphasising the need for social distancing and quarantine procedures at sea to limit the spread of the virus, while adapting to the sometimes difficult implementation conditions and logistics for medical decision and quarantine.

Prediction of Patients with COVID-19 Requiring Intensive Care: A Cross-sectional Study Based on Machine-learning Approach from Iran.

BackgroundPrioritizing the patients requiring intensive care may decrease the fatality of coronavirus disease-2019 (COVID-19).Aims and objectivesTo develop, validate, and compare two models based on machine-learning methods for predicting patients with COVID-19 requiring intensive care.Materials and methodsIn 2021, 506 suspected COVID-19 patients, with clinical presentations along with radiographic findings, were laboratory confirmed and included in the study. The primary end-point was patients with COVID-19 requiring intensive care, defined as actual admission to the intensive care unit (ICU). The data were randomly partitioned into training and testing sets (70% and 30%, respectively) without overlapping. A decision-tree algorithm and multivariate logistic regression were performed to develop the models for predicting the cases based on their first 24 hours data. The predictive performance of the models was compared based on the area under the receiver operating characteristic curve (AUC), sensitivity, and accuracy of the models.ResultsA 10-fold cross-validation decision-tree model predicted cases requiring intensive care with the AUC, accuracy, and sensitivity of 97%, 98%, and 94.74%, respectively. The same values in the machine-learning logistic regression model were 75%, 85.62%, and 55.26%, respectively. Creatinine, smoking, neutrophil/lymphocyte ratio, temperature, respiratory rate, partial thromboplastin time, white blood cell, Glasgow Coma Scale (GCS), dizziness, international normalized ratio, O2 saturation, C-reactive protein, diastolic blood pressure (DBP), and dry cough were the most important predictors.ConclusionIn an Iranian population, our decision-based machine-learning method offered an advantage over logistic regression for predicting patients requiring intensive care. This method can support clinicians in decision-making, using patients’ early data, particularly in low- and middle-income countries where their resources are as limited as Iran.How to cite this articleSabetian G, Azimi A, Kazemi A, Hoseini B, Asmarian N, Khaloo V, et al. Prediction of Patients with COVID-19 Requiring Intensive Care: A Cross-sectional Study based on Machine-learning Approach from Iran. Indian J Crit Care Med 2022;26(6):688–695.Ethics approvalThis study was approved by the Ethical Committee of Shiraz University of Medical Sciences (IR.SUMS.REC.1399.018).

Airborne or Droplet Precautions for Health Workers Treating Coronavirus Disease 2019?

Cases of coronavirus disease 2019 (COVID-19) have been reported in more than 200 countries. Thousands of health workers have been infected, and outbreaks have occurred in hospitals, aged care facilities, and prisons. The World Health Organization (WHO) has issued guidelines for contact and droplet precautions for healthcare workers caring for suspected COVID-19 patients, whereas the US Centers for Disease Control and Prevention (CDC) has initially recommended airborne precautions. The 1- to 2-meter (≈3–6 feet) rule of spatial separation is central to droplet precautions and assumes that large droplets do not travel further than 2 meters (≈6 feet). We aimed to review the evidence for horizontal distance traveled by droplets and the guidelines issued by the WHO, CDC, and European Centre for Disease Prevention and Control on respiratory protection for COVID-19. We found that the evidence base for current guidelines is sparse, and the available data do not support the 1- to 2-meter (≈3–6 feet) rule of spatial separation. Of 10 studies on horizontal droplet distance, 8 showed droplets travel more than 2 meters (≈6 feet), in some cases up to 8 meters (≈26 feet). Several studies of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) support aerosol transmission, and 1 study documented virus at a distance of 4 meters (≈13 feet) from the patient. Moreover, evidence suggests that infections cannot neatly be separated into the dichotomy of droplet versus airborne transmission routes. Available studies also show that SARS-CoV-2 can be detected in the air, and remain viable 3 hours after aerosolization. The weight of combined evidence supports airborne precautions for the occupational health and safety of health workers treating patients with COVID-19.

Implementation and findings on a one-minute sit-stand test for prehospital triage in patients with suspected COVID-19\u2014a pilot project

IntroductionDuring the initial Coronavirus Disease 2019 (COVID-19) pandemic wave, sparse personal protection equipment made telephone triage of suscpeted COVID-19 patients for ambulance transport necessary. To spare resources, stable patients were often treated and released on-scene, but reports from Italy suggested that some later detoriated. We implemented a prehospital sit-stand test to identify patients in risk for detoriation.MethodsThe test was implemented as part of a new guideline in stable suspected COVID-19 patients younger than 70 years with no risk factors for serious disease triaged by general practitioners to ambulance response in the Central Denmark Region. Data were collected from April 6th to July 6th 2020. The primary outcome for this study was the proportion of patients treated with oxygen within 7 days among patients decompensating vs patients not decompensating during the test.ResultsData on 156 patients triaged to ambulance response by general practioners were analysed. In total 86/156 (55%) were tested with the sit-stand test. Due to off-guideline use of the test, 30/86 (34.8%) were either older than 70 or had risk factors for serious disease. 10/156 (6%) of patients had a positive COVID-19-test. In total, 17/86 (20%) decompensated during the test and of these, 9/17 (53%) were treated with oxygen compared to 2/69 (3%) in patients who did not decompensate (p < 0.001).ConclusionIn a population suspected of COVID-19 but with a low COVD-19 prevalence, decompensation with the sit-stand test was observed in 20% of patients and was associated with oxygen treatment within 7 days. These findings are hypotheses-generating and suggest that physical exercise testing may be usefull for decision making in emergency settings.

COVID-19 EXPERIENCE AT A NON-COVID REMOTE MULTI-SPECIALITY HEALTH CENTRE

Background- Coronavirus disease 2019 (COVID-19) pandemic has affected all emergency branches, and likewise, its incidental diagnosis, as well as a varied neurological presentation, presented as a new war for health centers situated at resource constraint remote peripheries. Objectiveon the basis of a set admission protocols we tried to identify circulating and radiological indicators in the suspected COVID-19 patient population, to triage them, till the conrmation of their COVID-19 status. Methods and Material- We did a retrospective analysis of hemogram, other blood th th investigations and chest X ray of all patients who were admitted in Lifeline hospital Azamgarh from 5 May 2020 to 11 September 2020 and diagnosed later on as COVID-19 positive. Results- The most signicant ndings were Lymphopenia (absolute lymphocyte count [ALC] &lt;2 9 9/ 9 ×10 /L) in 52.9% patients with 4 having mild (ALC 1-2 ×10 L), and ve with moderate lymphopenia (ALC0.5-1 ×10 /L). Another nding 9 was Monocytopenia (&lt;0.2 ×10 /L) present in 9 (52.9%) patients and eosinopenia in one patient. Platelet count were almost normal, with only 3 9 (17.6%) patients having mild to moderate (50-150 × 10 /L) thrombocytopenia. Raised levels of C- reactive protein (CRP) was present in 5 (29.4%) patients. Chest X Ray was abnormal in 2 (11.8%) patients with bilateral ground glass opacities (GGO). Conclusions- We found almost same ndings on chest X-ray and in blood investigation like raised haemoglobin level, leukopenia, lymphopenia, eosinopenia and raised CRPlevel in this highly specialized small patient population like other studies, hence their presence have the potential to indicate SARS-CoV-2 infection, during the covid pandemic irrespect

Association of Chest Xray (CXR) findings with outcomes in COVID-19 Patients.

To investigate chest radiography findings in suspected coronavirus disease-2019 patients in a tertiary care setting. The retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised data of coronavirus disease-2019 cases admitted to the tertiary care centre from March 1 to March 30, 2020. A predesigned proforma was used to gather data, including demographics, like age and gender, co-morbidities, presenting symptoms and chest radiography findings during the admission. Length of stay and mortality were the outcome measures. Data was analysed using SPSS 22. Of the 154 suspected cases, 46(29.8%) tested positive for coronavirus disease-2019; 29(63%) males and 17(37%) females with a mean age of 50.7±19.1 years. Abnormal chest radiography was noted in 25(54.3%) cases, with bilateral pulmonary infiltrates being the most common finding 19(41.3%). Mortality was the outcome in 7(28%) of these cases, and the mean length of hospital stay was 9.3±7.3 days. Abnormal chest radiography findings were associated with an increased risk of mortality (p=0.009) and a longer hospital stay (p=0.017). Abnormal chest radiography findings were frequently seen in coronavirus disease-2019 patients and were also associated with increased risk of mortality and prolonged hospital stay.

Integrated Infection Control in the Maxillofacial Operation Theatre Considering COVID-19 Pandemic

AbstractThe pandemic of coronavirus disease 2019 (COVID-19) has influenced all services of life, including dentistry and oral and maxillofacial surgery. COVID-19 is primarily spread through contact with infected person, mucosal/respiratory droplets, fomites/contaminated surfaces/objects, and aerosol. Oral and maxillofacial surgeons are particularly at a high risk of transmission of COVID-19 due to proximity with patient during treatment. All cases should be assumed COVID-19 positive till proven otherwise because now asymptomatic patients also report to be COVID-19 positive. Such patients act as a carrier, shedding virus to expose the oral and maxillofacial surgeons. All elective procedures can be postponed. Only emergency cases that require immediate treatment should be done with proper standard precautions and sound infection control practice. During surgery, we require a maxillofacial operation theater (OT), which is divergent from other OTs due to the use of high-powered aerosol-generating instruments during surgery that increase the chances of spreading infection in the OTs. The aim of this paper is to integrate infection control in the OT for the management of confirmed or suspected COVID-19 patients throughout emergency treatment in oral and maxillofacial surgery.

Simultaneous Detection of Multiple Respiratory Viruses Among SARS-CoV-2-Positive and Negative Patients by Multiplex TaqMan One-Step Real-Time PCR

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has clinical manifestations similar to other common respiratory viral infections. There are limited data on the frequency of viral respiratory coinfection among patients infected with SARS-CoV-2 in Iran. Objectives: This cross-sectional study investigated the prevalence of multiple respiratory viruses among SARS-CoV-2-positive and negative patients during the coronavirus disease 2019 (COVID-19) pandemic in Iran. Methods: We included oropharyngeal/nasopharyngeal swab specimens of patients suspected of COVID-19 from December 2020 to March 2021. A reliable multiplex TaqMan one-step real-time PCR method was employed to detect 17 viral respiratory pathogens simultaneously. Descriptive analyses were performed to characterize the specimens concerning age, gender, clinical manifestations, and underlying disease. Results: Multiple respiratory viruses with a frequency of 18.78% were detected in 197 studied patients. Human metapneumovirus was the most prevalent pathogen detected in both SARS-CoV-2-positive (n = 7, 7.7%) and negative (n = 7, 6.6%) patients. Moreover, the frequency rate of viral infection was almost the same in both SARS-CoV-2-positive (18.68%) and negative (18.86%) patients. Altogether, there were no differences in baseline demographic characteristics such as age, sex, clinical symptoms, and comorbidities between the two groups (P &gt; 0.05). Conclusions: The data presented here expand our understanding of the epidemiology of multiple types of viral respiratory pathogens in suspected COVID-19 patients. Therefore, simultaneous screening of other viral respiratory pathogens will be helpful for clinicians and researchers interested in the control of viral respiratory tract infections.