Indian food habit & food ingredients may have a role in lowering the severity & high death rate from COVID-19 in Indians: findings from the first nutrigenomic analysis.

Background & objectives: During the COVID-19 pandemic, the death rate was reportedly 5-8 fold lower in India which is densely populated as compared to less populated western countries. The aim of this study was to investigate whether dietary habits were associated with the variations in COVID-19 severity and deaths between western and Indian population at the nutrigenomics level. Methods: In this study nutrigenomics approach was applied. Blood transcriptome of severe COVID-19 patients from three western countries (showing high fatality) and two datasets from Indian patients were used. Gene set enrichment analyses were performed for pathways, metabolites, nutrients, etc., and compared for western and Indian samples to identify the food- and nutrient-related factors, which may be associated with COVID-19 severity. Data on the daily consumption of twelve key food components across four countries were collected and a correlation between nutrigenomics analyses and per capita daily dietary intake was investigated. Results: Distinct dietary habits of Indians were observed, which may be associated with low death rate from COVID-19. Increased consumption of red meat, dairy products and processed foods by western populations may increase the severity and death rate by activating cytokine storm-related pathways, intussusceptive angiogenesis, hypercapnia and enhancing blood glucose levels due to high contents of sphingolipids, palmitic acid and byproducts such as CO2 and lipopolysaccharide (LPS). Palmitic acid also induces ACE2 expression and increases the infection rate. Coffee and alcohol that are highly consumed in western countries may increase the severity and death rates from COVID-19 by deregulating blood iron, zinc and triglyceride levels. The components of Indian diets maintain high iron and zinc concentrations in blood and rich fibre in their foods may prevent CO2 and LPS-mediated COVID-19 severity. Regular consumption of tea by Indians maintains high high-density lipoprotein (HDL) and low triglyceride in blood as catechins in tea act as natural atorvastatin. Importantly, regular consumption of turmeric in daily food by Indians maintains strong immunity and curcumin in turmeric may prevent pathways and mechanisms associated with SARS-CoV-2 infection and COVID-19 severity and lowered the death rate. Interpretation & conclusions: Our results suggest that Indian food components suppress cytokine storm and various other severity related pathways of COVID-19 and may have a role in lowering severity and death rates from COVID-19 in India as compared to western populations. However, large multi-centered case-control studies are required to support our current findings.

Healthcare Providers' Adherence to Recommended Pneumococcal and Influenza Vaccination in Patients Discharged with Respiratory Diseases from General Medical Wards.

The periodic assessment of adherence to vaccination recommendations is an essential component of any vaccination process. This study aimed to investigate the adherence of healthcare providers to the international recommendations on influenza and pneumococcal vaccine in patients discharged from the internal medicine department with respiratory diseases. All medical records of adult patients who are 18 years of age and older with respiratory illnesses and who were discharged in January-February, May-June, and October-November of 2018 were retrospectively analyzed. A total of 264 discharge summaries from 190 patients were included in this analysis. The mean age was 55.5 years, with 54.7% of them being males. Pneumonia was the leading cause of hospitalization (63.7%), followed by asthma or chronic obstructive pulmonary disease (COPD) exacerbation (27.4%). None of the discharged patients had immunization recommendations at discharge or a documented immunization request within 6 months of discharge from the hospital. The findings of this study demonstrated that healthcare providers need to pay more attention to adhering to the global recommendations on influenza and pneumococcal vaccine among patient who were recently discharged with respiratory disease. Additional measures are needed to improve adherence to routinely recommended vaccines among adults with respiratory diseases.

Epidemiological and molecular description of nosocomial outbreak of COVID-19 Alpha (B.1.1.7) variant in Saudi Arabia.

BACKGROUND: Nosocomial outbreaks frequently occurred during the Coronavirus disease 2019 (COVID-19) pandemic; however, sharing experiences on outbreak containment is vital to reduce the related burden in different locations. OBJECTIVES: This article aims at sharing a practical experience on COVID-19 outbreak containment, including contact tracing, screening of target population, testing including molecular analysis, and preventive modalities. It also provides an epidemiological and molecular analysis of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS­CoV­2) infection outbreak in a tertiary care hospital in Saudi Arabia. METHODS: The outbreak occurred in a non-COVID medical ward at a tertiary care hospital in Jeddah, Saudi Arabia, from 22nd March and 15th April 2021. The multidisciplinary outbreak response team performed clinical and epidemiological investigations. Whole-Genome Sequencing (WGS) was implemented on selected isolates for further molecular characterization. RESULTS: A total of eight nurses (20 % of the assigned ward nurses) and six patients (16.2 % of the ward admitted patients at the time of the outbreak) tested positive for the SARS-CoV-2 virus based on PCR testing. The outbreak investigation identified strong evidence of an epidemiologic link between the affected cases. WGS revealed a set of spike mutations and deletions specific to the Alpha variant (B.1.1.7 lineage). All the nurses had mild symptoms, and the fatality among the patients was 50 % (three out of the six patients). CONCLUSIONS: The current nosocomial COVID-19 outbreak, caused by the Alpha variant, revealed multiple breaches in the adherence to the hospital infection control recommended measures. Containment strategies were successful in controlling the outbreak and limiting infection spread. Molecular analysis and genome sequencing are essential tools besides epidemiological investigation to inform appropriate actions, especially with emerging pathogens.

Detection of erythroid progenitors and erythrocytopathies in patients with severe COVID-19 disease.

OBJECTIVES: To assess the effect of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection on erythropoiesis and red blood cells (RBC) surface markers by evaluating erythroid progenitor cells (CD [cluster of differentiation]71+/CD235a+) and RBC surface markers (CD235a and CD36), together with various hematological parameters. METHODS: This case-control study includes 47 participants recruited in the study: 30 patients with coronavirus disease 2019 (COVID-19) and 17 healthy individuals. The COVID-19 patients were recruited from the intensive care unit (ICU) of various hospitals in Makkah, Saudi Arabia. Blood samples were collected during July and September 2021. Red blood cells indices were measured using a CBC analyzer. The expression of CD235a, CD71, and CD36 was obtained using flow cytometry technique. The unpaired t-test was conducted to evaluate the differences in these markers in COVID-19 patients and healthy individuals. RESULTS: The data showed that more than half of the COVID-19 patients were anemic (64%). Expansion of erythroid progenitors (CD71+/CD235a+) was detected in the COVID-19 patients. Analysis of the expression of RBC surface markers, such as CD235a and CD36, showed that SARS-CoV-2 was associated with significantly higher expression of these markers in COVID-19 patients. CONCLUSION: Severe acute respiratory syndrome coronavirus-2 promoted the expansion of erythroid progenitors in the peripheral blood of COVID-19 patients. In addition, the expression of RBC surface markers was higher in COVID-19 patients. The expansion of erythroid progenitors and alteration of RBC surface markers can contribute to erythrocytopathies observed in severe COVID-19 patients and can therefore be used as prognostic factors.

The prevalence of pulmonary embolism among COVID-19 patients underwent CT pulmonary angiography

Background Pulmonary embolism (PE) is a common and fatal complication of COVID-19 infection. COVID-19's main clinical manifestations are not only pneumonia but also coagulation disorders. This study evaluates the prevalence of pulmonary embolism at CT pulmonary angiography (CTA) for positive coronavirus patients as well as the factors associated with PE severity. Materials and methods This is a retrospective cross-sectional study that was conducted at King Faisal Medical Complex (KFMC) in Taif city of Saudi Arabia from June 2020 to June 2021. Data was collected from the picture archiving and communication system (PACs) for a total of 445 positive patients who underwent CT pulmonary angiography and analyzed using SPSS. Results The mean age and gender of the male were 57.3 ± 15.8 years and 64.5%, respectively. The prevalence of pulmonary embolism at CTA among patients with COVID-19 was found to be 8.1%. Bilateral segmental and bilateral subsegmental pulmonary embolism were found to be the most common sites for PE (16.7% for each). Furthermore, shortness of breath (SOB) was found to be the most common reported symptom among the respondents. Lastly, shortness of breath, chest pain, loss of taste or smell, D-dimer, and cardiac troponin were found to be significantly associated with PE (P-value = < 0.001, <0.001, 0.001, <0.001 and 0.037 respectively). Conclusion Present results show that the prevalence of pulmonary embolism among COVID19 patients with CT Pulmonary Angiography at KFMC is relatively low (8.1%) and most of the patients were from the ICU department. Early detection and treatment of COVID-19 patients with PE and APE complications are critical for lowering the mortality rate.

Epidemiology, clinical characteristics and risk factors of COVID-19 among children in Saudi Arabia: a multicenter chart review study.

BACKGROUND: The Coronavirus Disease 2019 (COVID-19) has affected over 100 million cases worldwide. Children accounted for 1-5% of all cases with less reported symptoms and better prognosis compared to adults. This study aimed to describe the epidemiological characteristics and outcomes of pediatric COVID-19 cases in Saudi Arabia in addition to identifying risk factors associated with disease severity. METHODS: This was a multicenter, cross-sectional retrospective study that included confirmed SARS-CoV-2 infection among pediatric patients (< 14 years) from the time of initial identification in March 2020 to the end of July 2020 in 6 centers across the country. Patients were classified based on clinical severity. Study outcomes included time to recovery, need for invasive ventilation, and mortality. Multivariate logistic regression analysis was conducted to explore factors associated with increased disease severity. RESULTS: The study enrolled 567 children with (51.5%) were males, and (44.6%) aged from 6 to 14 years old. Asymptomatic patients accounted for 38.98% of the cases: while 319 patients (56%) had mild disease, and 27 patients (4.76%) had moderate-to-severe disease. Only 10 patients (1.76%) required Pediatric Intensive Care Unit admission. The calculated case-fatality was 0.7%. After performing multivariate regression analysis, chronic lung conditions [adjusted OR = 12.73, 95% CI (2.05-79.12)] and decreased red blood cells (RBCs) count [adjusted OR = 2.43, 95% CI (1.09-5.41] were found to be significant predictors for moderate-to-severe disease (p = 0.006 and 0.030, respectively). CONCLUSION: Most COVID-19 cases in the current study had a benign course of illness and carried an excellent prognosis. Children with chronic lung conditions or low RBCs count are at higher risk to develop moderate-to-severe COVID-19 disease.

The Impact of the COVID-19 Pandemic on Medical Imaging Case Volumes in Aseer Region: A Retrospective Study.

COVID-19 has had a significant impact on global health systems. The aim of this study was to evaluate how imaging volumes and imaging types in radiology departments have been affected by the COVID-19 pandemic across different locations. METHODS: Imaging volumes in the Aseer region (in the south of Saudi Arabia) across main hospitals were reviewed retrospectively including all cases referred from different locations (outpatient, inpatient and emergency departments). Data for years 2019 and 2020 were compared. The mean monthly cases were compared using a t-test. RESULTS: The total imaging volumes in 2019 were 205,805 compared to 159,107 in 2020 with a 22.7% overall reduction. A substantial decline was observed in both the April to June and the July to September periods of approximately 42.9% and 44.4%, respectively. With respect to location, between April and June, the greatest decline was observed in outpatient departments (76% decline), followed by emergency departments (25% decline), and the least impact was observed in inpatient departments, with only 6.8% decline over the same period. According to modality type, the greatest decreases were reported in nuclear medicine, ultrasound, MRI, and mammography, by 100%, 76%, 74%, and 66%, respectively. Our results show a statistically significant (p-value ≤ 0.05) decrease of cases in 2020 compared to 2019, except for mammography procedures. CONCLUSION: There has been a significant decline in radiology volumes due to COVID-19. The overall reduction in radiology volumes was dependent on the stage/period of lockdown, location, and imaging modality.

Predictors of Length of Hospital Stay, Mortality, and Outcomes Among Hospitalised COVID-19 Patients in Saudi Arabia: A Cross-Sectional Study.

BACKGROUND: COVID-19 pandemic is a major strain on health and economic systems, with rapidly increasing demand for in patients' facilities. Disease diagnosis and estimating patients at higher risk is important for the optimal management during the pandemic. This study aimed to identify the predictors of mortality and length of hospital stay in COVID-19 patients. METHODS: A retrospective cross-sectional study was conducted between March 2020 and August 2020 at Al-Noor Specialist Hospital in Mecca, Saudi Arabia. All patients who were admitted and had a confirmed COVID-19 diagnosis by a real-time polymerase chain reaction (PCR) were included in the study. Descriptive statistics were used to describe patients' demographic characteristics, laboratory findings, and clinical outcomes. Multiple logistic/linear regression analysis was used to identify predictors of death and length of stay at the hospital. RESULTS: A total of 706 patients were hospitalised for COVID-19. The mean age was 48.0 years (SD: 15.6 years). More than half of the patients (68.5%; n= 292) were males. The median duration of stay at the hospital was 6.0 days (IQR: 300-10:00). The prevalence rate of venous thromboembolism (VTE) among the patients was 3.0% (n= 21). In the multivariate logistic regression analysis, age (AOR: 1.05; 1.02-1.09), patients with end-stage renal disease (AOR: 6.44; 2.20-18.87), low Oxygen saturation SPO2 (AOR: 9.92; 4.19-23.50), D.dimer >0.5 (AOR: 13.31; 5.45-32.49), ESR>10 mm/h (AOR: 4.08; 1.72-9.68), Ferritin>400mcg/L (AOR: 18.55; 6.89-49.96), and Procalcitonin>0.5ug/L (AOR: 8.23; 1.81- 37.40) were associated with a higher risk of death among patients with COVID-19. Patients with VTE (AOR: 12.86; 3.07- 53.92) were at higher risk of death due to COVID-19. CONCLUSION: Hospitalised COVID-19 patients have multiple negative consequences in terms of their laboratory findings, signs and symptoms. Age and end-stage renal diseases have a significant impact on the mortality rate and the length of hospital stay among COVID-19 patients.

Potential Predictors of Poor Prognosis among Severe COVID-19 Patients: A Single-Center Study.

BACKGROUND: Timely detection of the progression of the highly contagious coronavirus disease (COVID-19) is of utmost importance for management and intervention for patients in intensive care (ICU). AIM: This study aims to better understand this new infection and report the changes in the various laboratory tests identified in critically ill patients and associated with poor prognosis among COVID-19 patients admitted to the ICU. METHODS: This was a retrospective study that included 160 confirmed SARS-CoV-2-positive patients. RESULTS: Elevated serum ferritin, D-dimer, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and nonconjugated bilirubin levels were present in 139 (96%), 131 (96%), 107 (68%), 52 (34%), and 89 (70%) patients, respectively. Renal parameters were abnormal in a significant number of cases with elevated creatinine and blood urea nitrogen in 93 (62%) and 102 (68%) cases, respectively. Hematological profiles revealed lower red blood cell count, hemoglobin, eosinophils, basophils, monocytes, and lymphocytes in 90 (57%), 103 (65%), 89 (62%), 105 (73%), 35 (24%), and 119 (83%) cases, respectively. The neutrophil count was found to increase in 71.3% of the cases. There was significantly higher mortality (83%) among patients older than 60 years (p=0.001) and in female patients (75%) (p=0.012). Patients with lung diseases had a poor outcome compared to patients with other comorbidities (p=0.002). There was a significant association between elevated D-dimer levels and increased mortality (p=0.003). Elevated levels of AST, creatinine, blood urea nitrogen, and bilirubin were significantly associated with unfavorable outcomes. CONCLUSION: Different parameters can be used to predict disease prognosis, especially the risk of poor prognosis. Accurate diagnosis and monitoring of disease progression from the early stages will help in reducing mortality and unfavorable outcomes.

Measuring Awareness of Infection Control Guidelines for Patients with COVID-19 in Radiology Departments in Saudi Arabia.

Due to the contagious nature of the COVID-19 virus, healthcare workers are at a great risk of infection. Since medical imaging plays a significant part in the healthcare system and is often used in the diagnosis of potential COVID-19 patients, the radiology personnel are at a very high risk of becoming infected. PURPOSE: This study aims to assess the enforcement of infection control guidelines for patients with COVID-19 during medical imaging procedures and raise awareness of infection control in different hospitals in Saudi Arabia. METHODS: A total of 128 responses were collected from four hospitals across Saudi Arabia using a new structured questionnaire, which was created for health workers by the WHO specifically for this purpose. Data were collected during the COVID-19 pandemic in April 2020. RESULTS: Most participants correctly followed the guidelines of the WHO and Centers for Disease Control and Prevention (CDC) on infection control in the X-ray and general radiology departments. Guideline awareness was higher among magnetic resonance imaging (MRI) and computerised tomography (CT) radiographers, which reduced the risk of future infections. Out of the total respondents, 98.4% stated that they had received formal training in hand hygiene. Only 40.6% of participants, however, knew that respiratory droplets are the primary mode of transmission of the virus from person to person. CONCLUSION: The knowledge of healthcare professionals in the radiology department regarding infection control needs to be continually assessed. A focus on educational interventions on infection control is required in order to maintain well-informed medical staff.