Incidence and factors associated with pulmonary embolism among RT-PCR confirmed Covid-19 patients with upfront CT pulmonary angiography in Ethiopia: A nested case-control study

Introduction: Pulmonary embolism is one of the complications of COVID-19, with reported incidence ranging from 3 to 33 % in non-ICU patients to as high as 40% among ICU patients. Since the clinical presentations of COVID-19 and Pulmonary embolism overlap, it is difficult to differentiate between these cases. This study aimed to assess the incidence of pulmonary embolism and associated factors among confirmed Covid-19 Patients in Ethiopia. Methods: A nested case control study was conducted among 131 patients with COVID-19 (40 COVID-19 patients with Pulmonary embolism and 91 COVID-19 patients with no PE) who were on follow up from May, 2021 to May, 2022. Data was summarized using frequencies with percentages. A chi-square test/ Fisher's exact test was run to determine the presence of a significant difference between the exposure variables and the development of PE. To identify factors associated with the development of Pulmonary embolism, a multivariable Binary Logistic Regression model with sensitivity analysis was run. Results: The incidence of PE was 30.5% (95% CI, 22.9% - 37.4%) in the cohort of patients for whom upfront CTPA was performed. The Chi-square/ Fisher's exact test results showed a significantly higher proportion of patients with PE tend to present with shortness of breath, chest pain and anosmia/ageusia than those with no PE. However, in a subsequent regression analysis, only chest pain was found to be significantly associated with the development of PE in COVID-19 patients (AOR= 3.24, 95% CI= 1.10, 9.54, p-value=0.033). Conclusion: The incidence of PE among COVID-19 patients was found to be relatively lower than reports from other countries. Having chest pain was found to be a significant factor that indicates the development of PE, implying that in a setting where performing upfront CTPA is not practical, detailed symptom inquiry could serve as an important clinical criteria.

Delayed SARS-COV-2 clearance in infected persons in Ghana

Objective: This study aimed to determine the duration of SARS-CoV-2 clearance in persons in Ghana. The research question was whether the duration of virus clearance in Ghana matched the 14 days recommended by the World Health Organization (WHO); this had direct implications for transmission, which was key in managing the COVID-19 pandemic. Design: This was a retrospective analytical study. Setting: All facilities that submitted clinical specimens to Noguchi Memorial Institute for Medical Research (NMIMR) for SARS-CoV-2 diagnosis between March to June 2020 were included in the study. Interventions: Samples from 480 persons who tested positive for SARS-CoV-2 by RT-PCR from March to June 2020 at NMIMR and submitted at least two follow-up samples were retrospectively analysed. Individuals with two consecutive negative RT-PCR retesting results were considered to have cleared SARS-CoV-2. Results: The median time from the initial positive test to virus clearance was 20 days (IQR: 5-56 days). This was six days longer than the WHO-recommended 14 days, after which infected persons could be de-isolated. Sputum and nasopharyngeal swabs proved more sensitive for detecting viral RNA as the infection progressed. At a significance level of 0.05, age and sex did not seem to influence the time to SARS-CoV-2 clearance. Conclusions: The median time to SARS-CoV-2 clearance in this study was 20 days, suggesting that SARS-CoV-2 infected persons in Ghana take longer to clear the virus. This finding calls for further investigations into whether patients who remain PCR positive continue to be infectious and inform isolation practices in Ghana.

Prolonged SARS-CoV-2 RNA shedding in a young man recovering from traumatic pneumothorax

We describe a case of prolonged SARS-CoV-2 RNA shedding in an HIV-negative 21-year-old man recovering from abdominal and thoracic trauma. Nasopharyngeal (NP) swabs collected at 12 time points over a 95-day span all tested positive for SARS-CoV-2 by reverse transcription polymerase chain reaction (RT-PCR). Genotyping revealed canonical beta-variant E484K and N501Y mutations at earlier time points. Human rhinovirus, coronavirus NL63 and respiratory syncytial virus B were detected at different time points by RT-PCR. Full blood analysis at time point 9 (day 82) showed leukopenia with lymphocytosis. The patient's NP swab tested negative for SARS-CoV-2 by RT-PCR 101 days after the first positive test. The prolonged duration of SARS-CoV-2 RNA shedding in the context of trauma presented here is unique and has important implications for COVID-19 diagnosis, management and policy guidelines

SARS CoV2 RT-PCR cycle threshold (Ct) values and the risk of developing acute respiratory distress syndrome in patients with Covid19

Background. SARS-CoV-2 viral loads may aid in the risk stratification of patients with COVID-19. Methods. 486 patients tested positive for SARS Cov2 by real time RT-PCR were included in this study. All the tests were performed on nasopharyngeal swabs during the first week after symptom onset using Sansure Biotech™ SARS Cov2 real time RT-PCR kits. Patient's condition was monitored over a period of one month after the onset of symptoms. Results. The mean Ct value in the group of patients who developed acute respiratory distress syndrome (ARDS +) was 18.27 (95% CI: 17.43-19.10) while for the ARDS group it was 33.06 (95% CI: 32.77-33.34). Discussion. The Ct values in the group of patients who developed ARDS (ARDS +) were significantly lower than those observed in the ARDS- group. By setting a cut-off value, the determination Ct values (on a qualitative technique) from nasopharyngeal swabs performed during the first week after symptom onset will assist clinicians in risk-stratifying patients. Conclusion. Our data show that the determination of SARS CoV2 RTPCR cycle threshold values from nasopharyngeal swabs performed during the first week after symptom onset may aid in the risk stratification of patients with COVID-19

Profil clinique et évolutif des patients atteints du COVID-19 à Libreville étude rétrospective et mono-centrique / Clinical and evolutionary profile of patients with COVID-19 in Libreville: A Retrospective Cohort study

Introduction : L'étude clinique des patients infectés par le SARS-CoV2 est nécessaire pour la mise en œuvre des mesures préventives de lutte contre la COVID-19. L'objectif de l'étude a été de déterminer le profil clinique et évolutif des patients Covid-19 au CHU de Libreville.Méthodes : Il s'agit d'une étude rétrospective à viser analytique menée en secteur d'infectiologie COVID du SICOV du CHU de Libreville sur une période d'activité allant du 15 mars au 30 juin. La régression logistique univariée et multivariée pour explorer les facteurs de risque associés à la mortalité au SICOV a été utilisée. Résultats : Au total 441 patients COVID-19 étaient inclus dans l'étude, parmi lesquels 398 survivants (90,2%) et 43 décédés (9,8%). La population de moins de 65 ans représentait 88,0% de l'effectif. Le sex-ratio était de 1,34. Par rapport aux 398 survivants, les 43 patients décédés étaient significativement plus âgés (âge médian, 59 ans vs 48 ans ; p <0,001). Les lésions pulmonaires avec atteinte critique > 75% étaient plus importantes chez les patients décédés (29,2% vs 3,0% ; p=0,001). Cependant, après ajustement en analyse multivariée, l'âge supérieur à 65 ans était le seul facteur de risque indépendant de décès (p<0,001 ; OR=4,632 IC95% [2,243 ­ 9,565]).Conclusion : L'âge supérieur à 65 ans était le facteur de risque indépendant de décès, nécessitant un renforcement de mesure de contrôle de l'infection dans cette population

Introduction: The study of the prognostic factors of death of patients infected with SARS-CoV2 is necessary for the implementation of preventive measures against COVID-19. Methods: This is a retrospective study conducted in the COVID infectious disease sector of the SICOV of the University Hospital of Libreville over a period of activity from March 15 to June 30. The clinical course of the survivors and the deceased were compared. Univariate and multivariate logistic regression to explore risk factors associated with SICOV deaths were used.Results: A total of 441 COVID-19 patients were included in the study, of which 398 survivors (90.2%) and 43 died (9.8%). The population under 65 represented 88.0% of the workforce. The sex ratio was 1.34. Compared to the 398 survivors, the 43 patients who died were significantly older (median age, 59 years vs 48 years; p <0.001). Lung lesions with critical impairment > 75% were greater in deceased patients (29.2% vs. 3.0%; p = 0.001). On multivariate analysis, age over 65 was the main independent risk factor for death (p <0.001; OR = 4.632 95% CI [2.243 - 9.565]).Conclusion: Age over 65 was the independent risk factor for death, requiring increased infection control measures in this population

The SARS-COV2 (COVID-19) Pandemic: What Clinicians should Know

In late 2019, a novel coronavirus, now designated SARS-CoV-2, emerged and was identified as the cause of an outbreak of acute respiratory illness in Wuhan, a city in China, named as COVID-19. Since then the waves of the virus exponentially hit many countries around the globe with high rates of spread associated with variable degrees of morbidity and mortality. The WHO announced the pandemic state of the infection in March 2020 and by June 1st 2020 more than 6 million individuals and more than 370 thousands case fatalities were documented worldwide. In this article, we discussed many aspects regarding this emerged infection based on the available evidence aiming to help clinician to improve not only their knowledge but also their practices toward this infection.

Perceived accessibility, and adequacy of COVID-19 related information in Nigeria

Information on COVID-19 has evolved and blended with fake news, which the public, unfortunately, has to make an individual decision on how to use. As a result, access to authentic and adequate health information on COVID-19 is crucial for curbing the ongoing pandemic. The study was aimed at identifying sources of information on COVID-19 commonly used by adult Nigerian residents; determine the adequacy of information received; determine the accessibility of information on COVID-19 among Nigerians, and explore the relationship between location and access to information. An adapted version of the World Health Organization's (WHO) COVID-19 behavioral insight questionnaire was used to collect data from 1,039 adult residents in Nigeria across the geopolitical zones through an online survey. Analysis was done using SPSS version 24. Logistic regression was used to examine if location predicts access to information. Social media was identified as the major source of information among Nigerians. The top three accessible sources included social media 807(77.7%), television 546 (52.6%), and WHO websites 340 (32.7%). It was also found that they perceived information received on COVID-19 as adequate. The logistic regression model of the location did not predict access to COVID-19 information (p<0.05; 95% CI). Health authorities like the WHO, the ministry of health, CDC should optimize social media for better health information coverage.

A pandemic guided by the SARS-CoV-2 PCR test: What should the clinician know?

Amidst an ever-evolving pandemic, the demand for timely and accurate diagnosis of coronavirus disease 2019 (COVID-19) continues to increase. Critically, managing and containing the spread of the disease requires expedient testing of infected individuals. Presently, the gold standard for the diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection remains the polymerase chain reaction (PCR) test. Potential vulnerabilities of this testing methodology can range from preanalytical variables to laboratory-related analytical factors and, ultimately, to the interpretation of results.

Profil épidémiologique de la COVID-19 dans la région de Tombouctou au Mali / Epidemiological profile of COVID-19 in Tombouctou region in Mali

Introduction : L'objectif de notre étude était d'établir le profil épidémiologique de la COVID-19 à Tombouctou. Matériel et méthodes : Il s'agissait d'une étude transversale descriptive des données de surveillance de la COVID-19 de la Région de Tombouctou du 3 avril au 1er octobre 2020. Nos variables d'intérêts ont été extraites de la base de données de surveillance et analysées sur Excel 2013. Les fréquences, taux et ratio ont été calculés. Résultats :Au total 1851 cas suspects en provenance de tous les districts de la région ont été testés à la RT-PCR dont 572 confirmés soit un taux de positivité de 30,90%. La tranche d'âge de 15-34 ans était la plus représentée avec une proportion de 48% de l'effectif des confirmés. Le sex ratio (homme/femme) des cas confirmés était de 2,67. La ville de Tombouctou était l'épicentre de la COVID-19. La région de Tombouctou avait un taux de dépistage d'environ 2‰ (1851/928.000) et a connu son pic entre les semaines 22 et 23 avec une létalité de 2,8%. Conclusion : Les jeunes et les hommes seraient les plus susceptibles d'être infectés par la COVID-19. Nous recommandons le renforcement de la sensibilisation pour le respect des mesures barrières

Introduction: The objective of our study was to establish the epidemiological profile of COVID-19 in Tombouctou. Material and methods: This was a descriptive cross-sectional study of COVID-19 surveillance data from Tombouctou from April 3 to October 1, 2020. Our variables of interest were extracted from the surveillance database and analyzed with Excel 2013. The frequencies, rate, and ratio were computed. Results: Overall, 1851 suspects from all districts of the region were screened by RT-PCR, including 572 confirmed, which indicate a positivity rate of 30.90%. The 15-34 age group was the most represented with 48% of the confirmed cases. The sex ratio (male / female) of confirmed cases was 2.67. The city of Tombouctou was the epicenter of COVID-19. The Tombouctou region had a detection rate of around 2‰ (1851/928,000) and peaked between weeks 22 and 23 with a case fatality of 2.8%. Conclusion: Young people and men were most likely to be infected with COVID-19. We recommend increasing awareness of compliance with barrier measures.

Covid-19 et système cardiovasculaire / Covid-19 and cardiovascular system

L'expansion planétaire du covid19 représente une crise sans précèdent ; cette pandémie a fait plus d'un million de mort en une année. En plus de l'atteinte pulmonaire, le virus a des implications majeures sur le système cardiovasculaire : les maladies cardiovasculaires pré existantes représentent un facteur de risque d'infection sévère avec augmentation de la mortalité, d'autre part l'infection entraine des complications cardiovasculaires qui aggravent le pronostic. Le lien entre le Covid19 et le système cardiovasculaire découle principalement de la voie d'entrée cellulaire du virus qui est assurée par sa liaison à une protéine membranaire l'enzyme de conversion de l'angiotensine (ECA), qui joue un rôle clé dans la régulation neurohumorale ; cette protéine est très présente au niveau du cœur et du poumon, d'où le tropisme du virus qui entraine la dysrégulation de cette voie cellulaire avec des répercussion sur la fonction cardiaque et respiratoire. Une polémique a déferlé concernant les traitements anti hypertenseurs et notamment les inhibiteurs du système rénine angiotensine aldostérone mais après évaluation des données actuelles, il est de consensus de ne pas arrêter ou changer les traitements anti hypertenseurs. L'augmentation des troponines cardiaques est un facteur de mauvais pronostic qui aggrave le tableau. La myocardite est définie par une inflammation myocardique, Les tableaux cliniques sont variables de la forme légère à la forme grave ; les biomarqueurs myocardiques restent un test incontournable en cas de suspicion clinique, le pronostic est incertain avec des formes fulminantes qui peuvent régresser et enfin pour le traitement les corticoïdes semblent être efficaces. Une autre complication du virus sont les accidents thrombo-emboliques et le dilemme occasionné par le risque accru aux thromboses et la thrombopénie induite par l'utilisation de l'héparine (TIH). On note une augmentation de l'incidence des syndromes coronaires aigus chez les sujets atteints du covid19.

The global expansion of covid19 represents a global crisis; this pandemic killed more than a million people in one year. In addition to pulmonary involvement, the virus has major implications on the cardiovascular system: pre-existing cardiovascular diseases represent a risk factor for severe infection with increased mortality, on the other hand the infection causes cardiovascular complications which worsen the prognosis. The link between the Covid19 and the cardiovascular system stems primarily from the virus's cellular entry pathway, which is provided by its binding to a membrane protein, the angiotensin converting enzyme (ACE) wich plays a key role in neurohumoral regulation; this protein is very present in the heart and lungs, hence the tropism of the virus which causes the dysregulation of this cellular pathway with repercussions on cardiac and respiratory function. A controversy broke out concerning the antihypertensive treatments and in particular the inhibitors of the renin angiotensin aldosterone system but after evaluation of the current data, there is a consensus not to withhold or change the treatments. The increase in cardiac troponins is a factor of poor prognosis which worsens the picture. Myocarditis is defined by myocardial inflammation, its clinical form ranges from the mild form to the severe one; the myocardial biomarkers remain an essential when the clinical suspicion rise, the prognosis is uncertain with fulminant forms which can regress; for treatment corticosteroids seem to be effective. Another complication of the virus are thromboembolic events and the dilemma caused by the increased risk of thrombosis and thrombocytopenia induced by the use of heparin (TIH), and there is an increase in the incidence of acute coronary syndromes in patients affected by covid19.