Clinical outcomes following major trauma for patients with a diagnosis of depression: a large UK database analysis.

BACKGROUND: More than a quarter of the UK population are affected by depression during their lifetime. For major trauma patients, postinjury depression can result in poorer long-term outcomes, but there is limited evidence regarding outcomes for patients with pre-existing depression. This study investigated the relationship between a diagnosis of depression prior to hospital admission and clinical outcomes after major trauma. METHODS: Trauma patients at a UK major trauma center were identified during a 6.5-year period using the Trauma Audit and Research Network database. Patients with Injury Severity Score >15 who did not die in the emergency department (ED) were included. Logistic regression models were used to compare in-hospital mortality (excluding ED), requirement for surgery, and length of stay (LOS) between those with depression and those without. RESULTS: There were 4602 patients included in the study and 6.45% had a diagnosis of depression. Depression was associated with a significant reduction in mortality (OR 0.54, 95% CI 0.30 to 0.91; p=0.026). However, patients with depression were more likely to have longer LOS (OR 124, 95% CI 8.5 to 1831; p<0.001) and intensive care unit LOS (OR 9.69, 95% CI 3.14 to 29.9; p<0.001). Patients with depression were also more likely to undergo surgery (OR 1.36, 95% CI 1.06 to 1.75; p=0.016). DISCUSSION: A pre-existing diagnosis of depression has complex association with clinical outcomes after major trauma, with reduced mortality but longer LOS and higher likelihood of surgical intervention. Further prospective investigations are warranted to inform optimal management strategies for major trauma patients with pre-existing depression. LEVEL OF EVIDENCE: III.

Outcome of early short-course corticosteroids in hospitalized patients with coronavirus disease-2019 (COVID-19): A report from a Saudi Arabian hospital.

BACKGROUND: The efficacy of corticosteroid use in patients with acute respiratory illness due to coronavirus disease-2019 (COVID-19) is unclear. In this study, we describe the clinical course of COVID-19 patients who received early course of corticosteroid treatment in patients with severe respiratory distress secondary to COVID-19. MATERIALS AND METHODS: The clinical course of 30 COVID-19 patients admitted to King Fahad Military Medical Complex in Dhahran from the period of late March 2020 till June 2020 was assessed and described. All the 30 patients received steroids. Data on demographics, medical history, laboratory findings, chest radiology, medication use, and clinical outcomes were extracted from patients' records. Data was entered and analyzed with SPSS software. RESULTS: A total of 30 patients admitted with COVID-19 were included. The mean age 52.53 years (SD=16.31) with a range from 22-98 years; 73.3% were males. About two-thirds of the patients at least had comorbidities; most common were diabetes (46.7%) and hypertension (46.7%), and chronic heart disease (16.7%). About 57% patients had fever, cough, and shortness of breath. The median C-reactive protein (CRP) level was 87.5 mg/dL (IQR 45.0 - 165.65); 46.7% had CRP levels >120 mg/dL. The median white blood cell, lymphocytes, and platelet counts were 4.39, 1.05, and 212 K/µL, respectively. All the patients received corticosteroids; 17 (56.7%) patients were given IV methylprednisolone and 13 (43.3%) received dexamethasone tablets. Of the total patients, 13 (43.3%) patients developed acute respiratory distress syndrome (ARDS); 17 (56.7%) required oxygen, 10 (33.3%) were admitted to Intensive Care Unit (ICU), and 7 (23.3%) required mechanical ventilation. All the patients improved and were discharged home well. CONCLUSION: Early use of oral corticosteroids in patients with higher CRP levels may lead to better outcomes and may lower risk of transfer to ICU and use of mechanical ventilation.

In-silico network-based analysis of drugs used against COVID-19: Human well-being study.

INTRODUCTION: Researchers worldwide with great endeavor searching and repurpose drugs might be potentially useful in fighting newly emerged coronavirus. These drugs show inhibition but also show side effects and complications too. On December 27, 2020, 80,926,235 cases have been reported worldwide. Specifically, in Pakistan, 471,335 has been reported with inconsiderable deaths. PROBLEM STATEMENT: Identification of COVID-19 drugs pathway through drug-gene and gene-gene interaction to find out the most important genes involved in the pathway to deal with the actual cause of side effects beyond the beneficent effects of the drugs. METHODOLOGY: The medicines used to treat COVID-19 are retrieved from the Drug Bank. The drug-gene interaction was performed using the Drug Gene Interaction Database to check the relation between the genes and the drugs. The networks of genes are developed by Gene MANIA, while Cytoscape is used to check the active functional association of the targeted gene. The developed systems cross-validated using the EnrichNet tool and identify drug genes' concerned pathways using Reactome and STRING. RESULTS: Five drugs Azithromycin, Bevacizumab, CQ, HCQ, and Lopinavir, are retrieved. The drug-gene interaction shows several genes that are targeted by the drug. Gene MANIA interaction network shows the functional association of the genes like co-expression, physical interaction, predicted, genetic interaction, co-localization, and shared protein domains. CONCLUSION: Our study suggests the pathways for each drug in which targeted genes and medicines play a crucial role, which will help experts in-vitro overcome and deal with the side effects of these drugs, as we find out the in-silico gene analysis for the COVID-19 drugs.

Imaging trend and disease course in admitted COVID-19 patients.

OBJECTIVES: To describe radiographic imaging findings and disease course in admitted Coronavirus disease 2019 (COVID-19) patients. METHODS: This retrospective study was carried in the Radiology Department, King Fahad Military Medical Complex, Dhahran between March to August 2020 (6 months). All laboratory confirmed COVID-19 admitted cases were evaluated for their symptoms, duration of hospital stays (in a ward or intensive care unit [ICU]), and imaging findings (ground-glass opacity [GGO], air-space shadowing/consolidation, and others such as atelectasis, reticulation, peribronchovascular thickening, lymphadenopathy and pleural effusion) on chest radiograph (CXR) and computed tomography (CT) studies. Cavitation, nodularity, bronchiectasis, and embolism detected on CT scans were considered as complications. Disease course in terms of recovery (radiographic regression or resolution of findings), worsening (shifting from ward to ICU), and unfavorable outcome (persistent ICU stay or death) were recorded. Imaging findings were interpreted by 2 experienced radiologists and consensus reporting was made. Chi-square test was used to determine association. Results: Out of 106 patients, majority were males (n=82, 77.4%). Forty-six patients (43.3%) had abnormal imaging with mostly peripheral GGO (56.5%), followed by consolidations (34.7%), and others (26%). Complications were detected in 6 ICU patients. All patients with unfavorable outcomes were above 60 years having comorbidities or complications (p less than 0.0005). Fatality rate was calculated as 2.8. Conclusion: Coronavirus disease 2019 is seen mostly affecting males, with peripheral opacities as common imaging findings. Elderly patients with co-morbidities may show unfavorable outcomes.

Evaluating antibody response pattern in asymptomatic virus infected pregnant females: Human well-being study.

The ongoing SARS-CoV-2 pandemic infecting millions of people globally has given rise to serious public health threats. The need for early detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in asymptomatic pregnant women is compelling to detect vertical transmission timely. Here, 11 SARS-CoV-2 asymptomatic pregnant cases from Wuhan China were investigated. All the patients were initially tested negative for SARS-CoV-2 on RT-PCR, so a chest CT scan was performed. Also, serum antibody (IgM and IgG) titers were estimated. CT scan of patients revealed typical abnormalities related to SARS-CoV-2, indicating ground-glass opacity and infection lesions suggesting viral pneumonia. Elevated IgM and IgG antibodies levels (p < 0.001) were also noticed in infected patients. Hence, CT imaging and serum antibody response are valuable in the early detection of SARS-CoV-2 in asymptomatic pregnant patients. These might serve as prognostic markers for healthcare professionals, in RT-PCR negative patients, to assess the effect of given treatment by chest CT.