ABSTRACT
Objective: To determine the seroprevalence of SARS-CoV2 antibodies in patients and healthy individuals presenting to a tertiary care hospital in Lahore. Study Design: Cross-sectional study Place and Duration of Study: Pathology Department of Surayya Azeem Hospital, Lahore Pakistan, from May to Jul 2020. Methodology: The study included clinically suspected patients of COVID-19 referred by clinicians and healthy individuals presenting to the hospital for the SARS-CoV-2 antibody test, irrespective of age and gender. Results: The SARS-CoV-2 antibody positivity was 704(59.4%) in our study. Out of 1184 individuals tested, 690 patients had a positive clinical history of COVID-19 infection, and 517(74.9%) were positive for COVID-19 antibodies. Out of 494 asymptomatic healthy individuals, positivity for COVID-19 antibodies was 187(37.8%). It was observed that positivity was significantly higher 169(44.0%) in contacts of COVID-19 infection patients compared to asymptomatic healthy individuals 18(16.3%). Conclusion: Our study shows that the seroprevalence of SARS-CoV-2 antibodies in the general public in Pakistan has greatly increased. © 2023, Army Medical College. All rights reserved.
ABSTRACT
Introduction: Initial reports during the first wave of the pandemic in the United Kingdom have shown that diabetic patients with COVID-19 often had a more severe infection with co-morbidities such as Hypertension (HTN) leading to a poorer prognosis. Males could also be at higher risk of death from COVID-19 as was demonstrated in one study. [1] SARS-CoV-2 has been theorised to trigger the increased secretion of glucocorticoids and catecholamine's due to stress conditions- increasing the frequency of acute hyperglycaemic events such as diabetic ketoacidosis in COVID-19 patients with diabetes. It has been suggested that SARS-CoV-2 enters into islets in the pancreas via angiotensin converting enzyme 2 as its receptor leading to acute beta-cell dysfunction. [2] There is also some evidence to suggest that increased Body Mass Index (BMI) in diabetic patients with COVID-19 is linked with severity of the infection. Objectives: We aim to investigate the impact of diabetes on mortality in patients with COVID-19, and to identify potential prognostic factors therein including body mass index (BMI), co-morbidities and gender. Methods: We undertook a retrospective study of all patients aged ≥ 18 years during the first wave of the pandemic. All patients who had a confirmed diagnosis of COVID-19, via radiological and polymerase chain reaction testing, were included in the study. Data was collected using electronic patient records. Statistical analysis was performed using the Chi Squared Test for impendence. Results: 445 COVID-19 positive patients were included in the study, out of whom 127 (29%) were diabetic. Mortality in diabetic patients (61%) was found to be significantly higher than non-diabetics (48%) (p=0.01). There were no significant differences in mortality between diabetic and non-diabetic patient when grouped for BMI ≥25 (p=0.4), Male (p=0.06), Female (0.19) and hypertension (p=0.12). Conclusion: Our study demonstrated how diabetic patients with COVID-19 had a significantly higher mortality rate compared to non-diabetics. This prompts the need to educate diabetic patients about hyperglycaemia arising from infection, the importance of sick day rules and compliance with social isolation measures. Further research is required to investigate the causes behind the raised mortality rate in diabetics.
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Introduction Due to the novelty of COVID-19, uncertainty about the factors contributing to mortality, unavailability of definitive treatment options, limited access to medical, social support and rehabilitation in the community during the COVID-19 peak;compounded with anxiety and reluctance to seek medical help in timely manner, it was anticipated that vulnerable patients would be affected the worst. We report post-discharge mortality and the associated risk factors. Method This is a retrospective study of all the patients admitted at a busy district general hospital during the peak period of the COVID-19 pandemic i.e. 1st March to 20 June 2020. We included all patients aged 18 and above in data analysis. Results A total of 628 patients were admitted during the study period with 481 having positive swab PCR. Of these, 389 (62%) patients had two or more comorbidities, 311 (49.5%) hypertensive and 166 (26.4%) diabetic. In-hospital mortality: 226/628 (35.9%) patient died in hospital, of which 194 (85.8%) had a positive Coronavirus nasopharyngeal swab. This was statistically significant with p-value of 0.001. Post-discharge mortality of patients: 54/402 (13.4%) of those patients discharged home following hospitalisation died within 28 days of discharge. 42/54 (77.7%) were swab positive. Swab positive patients 42/54 (77.8%) had a higher risk of death. Two thirds of swab positive patient were older than 75 years and 81% had two or more pre-existing comorbidities. There was no difference in length of stay between the survivors and non-survivors. Conclusion As expected, age, male gender, COVID-19 PCRpositivity, multiple comorbidities, high BMI and raised CRP were associated with higher in-hospital and post-discharge mortality. It is unsurprising that antibiotic treatment without bacterial infection was associated with higher but statistically insignificant mortality rate, while therapeutic anticoagulation and steroids were associated with better outcomes. There is an urgent need for further analysis of root cause to mitigate the modifiable factors and devise a robust post-discharge management plan in collaboration with all stakeholders.
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Introduction Hypoxemia, acute respiratory distress syndrome and coagulopathy are common issues experiences by pts with severe COVID-19 disease.1 The aim of this study was to evaluate the efficacy of anticoagulation therapy in COVID-19 patients. Methods This is a retrospective observational study for patients admitted to a busy district hospital during the peak period of the COVID-19 pandemic. All patients aged >18 with suspected or confirmed RT-PCR COVID-19 and raised D-Dimer were included in this study. Data including demographics, comorbidities, and effects of anticoagulation on mortality were examined. Results A total of 628 pts with more males (n = 365;58.1%), and 48.7% >75 years were included in the study. 27.9% were obese (BMI-30);and 25% were overweight (BMI 25-29.9). 448/628 (71.3%) had a positive swab for coronavirus and a further 70 patients (11.1%) had probable infection based on clinic-radiological suspicion. Nearly half (n = 311;49.5%) of the patients had hypertension and a quarter (n = 166;26.4%) had diabetes. A total of 226 (36%) pts died of which 85.8% (n = 194) had a positive swab compared to 12.8% (n = 29) with negative swab. This was statistically significant with a p-value of 0.001. Patients with a raised D-dimer 150/628 (23.8%) received therapeutic dose anticoagulation and 408/628 (64.9%) received prophylaxis or no anticoagulation. 53 patients (22.5%) of those who received treatment dose died compared to 183 (77.5%) who received prophylactic dose or no anticoagulation due to comorbidities. This was statistically significant (p value 0.02). Conclusion Therapeutic anticoagulation significantly reduces mortality in COVID-19 patients with a high D-dimer.
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S99 Table 1Association of swab PCR with Anticoagulants, D-Dimer in MortalityVariablesMortality with SWABp-valuePositive (n=236)Negative (n=41) n%n% AnticoagulantYes20687.33892.70.32No3012.737.3Treatment Dose AnticoagulantYes5322.51639.00.02*No18377.52561.0ConclusionTherapeutic anticoagulation significantly reduces mortality in COVID-19 patients with a high D-dimer.ReferenceKlok F, Kruip M, van der Meer N, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res 2020 Apr 10. [Epub ahead of print]