ABSTRACT
Background/study objective: The effect of the COVID-19 pandemic affected health care delivery, as it led to variable outcomes in different disease states including cardiovascular diseases. In this study, we evaluated the impact of coexisting COVID-19 on Acute Myocardial Infarction (AMI). Design/setting: We analyzed discharge records of AMI patients from the National Inpatient Sample (NIS) in the year 2020. Main outcome measures: Using propensity score matching, we assessed the impact of COVID-19 infection on the in-hospital outcomes of patients presenting with AMI. Results: There were 1154 patients with concomitant COVID-19 infection and AMI who were matched with 109,990 patients with AMI and without COVID-19. We found that patients with COVID-19 who had AMI were less likely to have dyslipidemia (64.6 % vs. 70.4 %, p < 0.001), peripheral vascular disease (2.4 % vs. 3.8 % p = 0.0017), smoking history (23.5 % vs. 28.2 % p < 0.0001) and hypertension (37.1 % vs. 40.1 % p = 0.004).COVID-19 was associated with higher hospital mortality rates (Adjusted odds ratio aOR: 2.72, CI: 2.23-3.30, p < 0.001), cardiac arrest (aOR: 1.65, 95 % CI: 1.26-2.15, p < 0.001), cardiogenic shock (aOR:1.36,95 % CI: 1.10-1.68, p = 0.004) and respiratory failure (aOR:1.81, 95 % CI: 1.55-2.11 p < 0.001) compared to AMI patients without COVID-19. There was also a significant association between coexisting COVID-19 and longer duration of hospital stay (Adjusted mean differences:1.40, 95 % CI: 1.31-1.59 p < 0.0001) in AMI patients. Conclusion: COVID-19 infection is associated with worse in-hospital mortality and cardiorespiratory complications in patients with AMI.
ABSTRACT
The COVID-19 pandemic has exposed the frontline physicians to a greater risk of getting infected, tremendous workload, and drastic changes in their work environment, leading to an increased prevalence of depression among doctors from many countries, including Bangladesh. The aim of this study was to examine the association of various personal, professional and psychosocial factors with different degrees of depressive symptoms among the frontline doctors of Bangladesh working during the COVID-19 pandemic. An online, cross-sectional survey was conducted for that purpose and data were collected from 312 doctors working in Bangladeshi hospitals using a self-administered survey questionnaire inclusive of a validated tool (Patient Health Questionnaire-9). Among the participants, around half were of age 30-34 years (51.3%), 81.8% worked in public hospitals and 70.5% did not have any comorbidity. Regarding workplace conditions, 77% of the doctors reported a perceived shortage of healthcare providers at their workplace, while 95% reported a perceived shortage of equipment, most commonly N95 masks (49%), gowns (35%), eye-protective shields (35%). A total of 199 (63.8%) participants received formal training since the beginning of the pandemic. According to the response from PHQ-9 questionnaire, 17 (5%) participants reported having no depression, while 18 (6%), 18 (6%), 25 (8%), and 234 (75%) reported having mild, moderate, moderately severe, and severe depression. Findings from multiple logistic regression showed the odds of moderate-to-severe depression to be higher among physicians with comorbidities (OR:7.47, CI: 1.27-43.89, P: 0.026) and those who felt extremely worried from looking at negative news on social/mass media (aOR: 15.180, CI:1.98-116.683, P: 0.009). To preserve and promote the psychological well-being of Bangladeshi doctors, it is, therefore, crucial to take these identified sources and risk factors of depression under sincere consideration by the responsible authorities and appropriate measures should be designed to remove these sources of depression to better support the physicians of the country. © 2023, Mahidol University - ASEAN Institute for Health Development. All rights reserved.
ABSTRACT
Background: To curb the threat of COVID-19, vaccines of different forms and shape have been developed and assessed for their efficacy in the last one and a half year. Amongst those Inactivated viral vaccines developed in China, Sinopharm and Sinovac are the most frequently employed vaccines in Pakistan. It has been established that natural infection and certain forms of SARS-CoV- 2 vaccine alters the clinical picture of blood. Aim(s): In this study we have compared the levels of three inflammatory biomarkers namely PAI-1, D-Dimer and HAI-IgG in the sera collected from SARS-CoV- 2 Vaccinated and unvaccinated Subjects. Method(s): Briefly, 80 individuals, each as a cohort of SARS-CoV- 2 vaccinated and unvaccinated were recruited with written consent after ethical approval for the study. From each subject 2 ml blood was drawn and plasma was separated to assess inflammatory biomarkers like PAI-1, D-Dimer and HIA IgG by ELISA. Additionally, platelets count were also monitored using automated counter. Result(s): Our data show difference in the level of PAI-1, D-Dimer and HIA-IgG between SARS-CoV- 2 Vaccinated and unvaccinated subjects. However, the difference was found statistically in significant. Nevertheless, segregating the data based on the nature of vaccination, age and gender of the subjects shows interesting pattern that could be insightful in relation to the clinical outcome of the vaccine efficacy. Conclusion(s): The findings in this regard could well be of clinical value, especially when the data is stratified with reference to different variables. Therefore, large scale studies are warranted with same, and few additional biomarkers would be of more resolving in relation to the host response against SARS-CoV- 2 vaccination.
ABSTRACT
Background: The advance pathology of SARS-CoV- 2 infection entails engagement of blood related ailment including thrombosis as secondary clinical manifestation. SARS-CoV- 2- Human protein-protein interactome has been explored. Dysregulation of the several proteins and mutations in the genes have been linked with the incidence and progression of thrombosis. Aim(s): Aim of the investigation is to develop and functionally analyze a combine molecular network of SARS-CoV- 2- Human and Thrombosis to delineate candidate molecule that could later be used for the prognosis and therapeutic intervention. Method(s): Briefly, two separate system networks were developed, one for over 500 humans protein that have shown to interact with the viral genome and 26 different proteins encoded by SARS-CoV- 2 genome. The second network is based on the genes tagged for being aberrated genetically and/or in terms of expression in thrombosis. Both networks were combined as a singular entity after removing the redundant repetition and orphans' nodes and edges by selective enrichment. The network then be dissected in different modules primarily based on the promiscuity of the nodes. Complete network and each module were assessed for in betweenness and shortest path length of edges. Result(s): The data shown over 700 genes could be coalesced as a single network providing a molecular interplay that may underpin SARS-CoV- 2 associated thrombosis. Over 16 modules were observed in the network with important candidate genes of thrombosis have been identified as hub due to the inter modular abridging potential. Identification of hub genes was further substantiated with the pathlength distance, lack of orphan edges and partner protein promiscuity. Biological functions and KEGG analysis of the holistic network and modular compartment further strengthen the predicted candidate gene status as central to the disease biology. Conclusion(s): Candidate genes identified in the study could later be used as markers for prognosis of the pathology of COVID-19 for thrombosis and/or developing therapeutic intervention.
ABSTRACT
Background: COVID-19 is an ongoing public health issue across the world. Several risk factors associated with mortality in COVID-19 have been reported. The present study aims to describe clinical and epidemiological characteristics and predictors of mortality in hospitalized patients from Khyber Pakhtunkhwa, a province in Pakistan with highest COVID-19 associated case fatality rate. Methods: This multicentre, retrospective study was conducted in hospitalized COVID-19 patients who died or discharged alive until 1st May 2020. Data about sociodemographic characteristics, clinical and laboratory findings, treatment and outcome were obtained from hospital records and compared between survivors and non-survivors. Statistical tests were applied to determine the risk factors associated with mortality in hospitalized patients. Results: Of the total 179 patients from the 10 designated hospitals, 127 (70.9%) were discharged alive while 52 (29.1%) died in the hospital. Overall, 109 (60.9%) patients had an underlying comorbidity with hypertension being the commonest. Multivariate logistics regression analysis showed significantly higher odds of in-hospital death from COVID-19 in patients with multiple morbidities (OR 3.2, 95% CI 1.1, 9.1, p-value=0.03), length of hospital stay (OR 0.8, 95% CI 0.7, 0.9, p-value <0.001), those presenting with dyspnoea (OR 4.0, 95% CI 1.1, 14.0, p-value=0.03) and oxygen saturation below 90 (OR 9.6, 95% CI: 3.1, 29.2, p-value <0.001). Conclusion: Comorbidity, oxygen saturation and dyspnoea on arrival and length of stay in hospital (late admission) are associated with COVID-19 mortality. The demographic, clinical and lab characteristics could potentially help clinician and policy makers before potential second wave in the country.