Sars-CoV-2 in critical immunocompromised patients. Evolution and prognosis

Introduction: In this study, we share the results of immunosuppressed patients who suffered from acute respiratory distress syndrome (ARDS) secondary to COVID-19 pneumonia managed in our ICU. Method(s): We tracked all patients admitted to ICU of a Tertiary Hospital diagnosed with severe SARS-COV2 pneumonia from March 1, 2020 to January 31, 2022. The definition of Immunocompromised patient is based on history of transplantation, active neoplasia, autoimmune diseases or HIV. Collected data includes: sex, age, type of immunosuppression, vaccination, mechanical ventilation, ECMO VV, incidence of superinfections and mortality. Result(s): From a cohort of 425 patients, 55 met the inclusion criteria. 33% were women and 67% male. The average age was 58 years for women and 62 years for men. Out of these patients, 27% had solid organ transplants. 40% suffered from neoplasic disease. 27% had autoimmune diseases and were under treatment with immunosuppressants. 3 had HIV. Only the 29% had received at least 1 dose of COVID 19 vaccine. 80% required orotracheal intubation. 3.64% (2) required Veno-Venous ECMO. 61% presented bacterial superinfection, with the most frequent germs being Pseudomonas aeruginosa and Enterococcus. 36% had viral superinfection, being cytomegalovirus the most frequent one. 32% had fungal superinfection, mainly by Aspergillus fumigatus. 27% did not suffer any superinfection. 40% of the total sample died. After logistic regression, in our model (AUC 83,4% (Se 57.1%, Sp 87.9%), we identified need of intubation as independent variable of mortality (OR 27,06 IC95% 1.76-415.55, p = 0.018). Conclusion(s): Immunocompromised patients with ARDS secondary to COVID-19 pneumonia present high mortality, with statistically significant difference when mechanical ventilation is needed. The most frequently isolated germs causing superinfection in this group of patients are bacterias. We believe that this group of patients require special care in our ICU units and an in-depth analysis and study to optimize their prognosis.

COVID-19 vaccination perceptions and attitudes among Egyptian medical students

Background: This study aimed to assess perceptions and attitudes toward COVID-19 vaccines among medical students. Methods: A consecutive convenient sample of 2100 university students representing the student's union network were included using an electronic self-administered questionnaire. About 12 items were used to assess attitudes and acceptance of COVID-19 vaccines. Results: A total of 2100 volunteers responded to the survey. All ages ranged from 18 to 25 years, 69% were females, and 57.3% were from urban residences. According to their willingness to receive the COVID-19 vaccine, 49.7% accepted, 38.5% hesitated, and 11.8% refused vaccination. Out of 60 scales measuring their attitudes, a median total score of 46.0 (42.0-49.0) differed significantly in relation to genders, residence, and vaccine decision-making groups. Logistic regression analysis showed that participants who consented that COVID-19 mass vaccination could prevent the spread of infection in the community and stop the pandemic have 1.9 higher odds of accepting vaccination (p= 0.003). Additionally, the participants who believed that the vaccine had no severe infection or side effects were 3.1 and 2.8 higher folds for vaccine acceptance, respectively (p= 0.001). Moreover, participants who thought it was not too early for clinical trials were 4.3 times more likely to take the vaccine (p = 0.001). Individuals who agreed that information about vaccine side effects better to discuss openly with the authorities were 2.8 times more likely to accept vaccination than other hesitating/ refusing groups, p-value < 0.001. Conclusions: Understanding students' perspectives of the COVID-19 vaccine and supporting their health engagement and awareness may help plan an adequate response.

Predicting COVID-19 Outbreak in Algeria Using Long Short-Term Memory Networks

From late November 2019 until today, the Coronavirus (COVID19) has been circulating worldwide on a broad scale. The World Health Organization agrees that this is the world's most serious outbreak in the last twenty years. Algeria is no exception;although the relatively early precautions taken by the Algerian government, especially the national lockdown, the spread of Coronavirus has attained all cities. This study aims at clarifying how COVID-19 has spread in Algeria so fast in a short time and perform an intelligent system to predict confirmed, deaths, recovered, and active cases. This paper presents firstly a comprehensive analytics study on the spread of the pandemic to understand the COVID19 evolution in Algeria. Secondly, a predictive model based on a Long Short Term Memory Network is proposed and studied to estimate the future number of confirmed, deaths, recovered, and Active cases. © 2022 IEEE.

Combined cardiac risk factors predict COVID-19 related mortality and the need for mechanical ventilation in Coptic Clergy

Background and aims: The clinical adverse events of COVID-19 among clergy worldwide have been found higher than among ordinary communities, probably because of the nature of their work. The aim of this study, was to assess the impact of cardiac risk factors on COVID-19-related mortality and the need for mechanical ventilation in Coptic clergy. Methods: Of 1576 Coptic clergy participating in the COVID-19-Clergy study, serving in Egypt, USA and Europe, 213 had the infection and were included in this analysis. Based on the presence of systemic arterial hypertension (AH), participants were divided into two groups: Group- I, Clergy with AH (n=77) and Group-II, without AH (n=136).Participants' demographic indices, cardiovascular risk factors, COVID-19 management details and related mortality were assessed. Results: Clergy with AH were older (p<0.001), more obese (p=0.04), had frequent type 2 diabetes (DM) (p=0.001), dyslipidemia (p=0.001) and coronary heart disease (CHD) (p=0.04) compared to those without AH. COVID- 19 treatment at home, hospital or in intensive care did not differ between the patient groups (p>0.05 for all). Clergy serving in Northern and Southern Egypt had a higher mortality rate compared to those from Europe and the USA combined (5.22%, 6.38%, 0%;p=0.001). The impact of AH on mortality was significant only in Southern Egypt (10% vs. 3.7%;p=0.01) but not in Northern Egypt (4.88% vs. 5.81%;p=0.43). In multivariate analysis, CHD OR 1.607 [(0.982 to 3.051);p=0.02] and obesity, OR 3.403 [(1.902 to 4.694);p=0.04]predicted COVID-19 related mortality. A model combining cardiac risk factors (systolic blood pressure (SBP) ≥160 mmHg, DM, obesity, dyslipidemia and history of CHD), was the most powerful independent predictor of COVID-19-related mortality, OR 4.813 [(2.011 to 7.017);p=0.008]. The same model also proved the best independent multivariate predictor of mechanical ventilation OR 1.444 [(0.949 to 11.88);p=0.001]. Conclusion: In Coptic clergy, the cumulative impact of risk factors is the most powerful predictor of mortality and the need for mechanical ventilation in Coptic clergy.

Obesity strongly predicts COVID-19-related major clinical adverse events in Coptic Clergy

Background and aims: The Coptic Clergy, due to their specific work involving interaction with many people, could be subjected to increased risk of infection from COVID-19. The aim of this study, a sub-study of the COVID-19-CVD international study of the impact of the pandemic on the cardiovascular system, was to assess the prevalence of COVID-19 among Coptic priests and identify predictors of clinical adverse events. Methods: Participants were geographically divided into three groups: Group-I: Europe and USA, Group II: Northern Egypt and Group III: Southern Egypt. Participants' demographic indices, cardiovascular risk factors, possible source of infection, number of liturgies, infection management and major adverse events (MAEs), comprising death, re-infection or mechanical ventilation, were assessed. Results: Out of the 1,570 clergy serving in 25 dioceses, 226 (14.39%) were infected. Their mean age was 49.5±12 years and mean weekly number of liturgies was 3.44±1.0. The overall prevalence rate was 14.7% and did not differ between Egypt as a whole and overseas (p=0.23). Disease prevalence was higher in Northern Egypt clergy compared to Europe and USA combined (18.4% vs 12.1%, p=0.03) and tended to be higher than in Southern Egypt (18.4% vs. 13.6%, p=0.09). Ten priests (4.42%) died of COVID-19 related complications, 2 (0.9%) had re-infection and 27 (11.9%) suffered a MAE. The clergy from Southern Egypt were more obese but the remaining risk factors were less prevalent compared to those in Europe and USA (p=0.01). In multivariate analysis, obesity OR 4.184 (2.483 to 12.14;p=0.01);age OR 1.070 (0.014 to 1.130;p=0.02), and systemic hypertension OR 0.932 (0.874 to 0.994;p=0.007) predicted MAEs. Obesity was the most powerful independent predictor of MAE in Southern Egypt and systemic hypertension in Northern Egypt (p<0.05 for both). Conclusion: Obesity is very prevalent among Coptic clergy and seems to be the most powerful independent predictor of major COVID-19-related adverse events. (Figure Presented).

The Impact of COVID-19 on In-Hospital Outcomes of ST-Segment Elevation Myocardial Infarction Patients

Background: Primary percutaneous coronary intervention (PPCI) is one of the important clinical procedures that have been affected by the COVID-19 pandemic. In this study, we aimed to assess the incidence and impact of COVID-19 on the in-hospital outcomes of ST-elevation myocardial infarction (STEMI) patients managed with PPCI. Methods: This observational retrospective study was conducted on consecutive STEMI patients who presented to International Cardiac Center (ICC) Hospital, Alexandria, Egypt between February 1 and October 31, 2020. A group of STEMI patients who presented during the same period in 2019 was also assessed (control), and the data were used for comparison. The inclusion criterion was established diagnosis of STEMI requiring PPCI. A total of 634 patients were included in the study. Results: During the COVID-19 period, the number of PPCI procedures was 25.7% lower than previous year (average 30 cases/month 30.0±4.01 compared to 40 cases/month 40.4±5.3), and the time from first medical contact to needle (FMC-to-N) was longer (125.0±53.6 min vs 52.6±22.8 min, p=0.001). Also during the COVID-19 period, the in-hospital mortality rate was higher (7.4% vs 4.6%, p=0.036), as was the incidence of re-infarction (12.2% vs. 7.7%, p=0.041) and the need for revascularization (15.9% vs 10.7%, p=0.046). The incidence of heart failure, stroke and bleeding was not different between groups, but the length of hospital stay was longer during COVID-19 (6.85±4.22 days versus 3.5±2.3 days, p=0.0025). Conclusion: At the ICC, the COVID-19 pandemic contributed significantly to the PPCI management of STEMI, with a decreased number and delayed procedures. COVID-19 was also associated with higher in-hospital mortality, rate of re-infarction, need for revascularization, and longer hospital stay.

Medical waste management during COVID-19 pandemic, a review study

Medical waste management problems are rising due to the crisis brought upon by the coronavirus disease 2019 (COVID-19) as a worldwide pandemic. The security management of medical care worldwide increases their attention due to the high risk of COVID-19 medical waste. This paper gives a review of medical waste management during the COVID-19 pandemic around the world. Furthermore, an effort has been made to prepare a review of the characteristics, generation, collection, transportation, disposal, and treatment technologies of solid waste management worldwide. Detailed data on medical waste management practices, including collection, recovery, and disposal, have been presented. The poor medical waste management in Iraq before and during COVID-19 causes a huge environmental risk and can be a possible reappearing infection source. Hence, the study also points out some recommendations for handling COVID-19 pandemic medical waste properly to reduce possible secondary effects on health and the environment and manage any possible pandemics in the future.

COVID-19-induced pancytopenia in a major molecular response CML patient on dasatinib: A case report and review of the literature

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19), has caused a global health crisis. COVID-19 can have a multifaceted presentation, and a wide range of complications and outcomes may emerge based on the severity and comorbidities of the infected patient. We report the case of a 42-year-old man with a history of chronic myeloid leukaemia (CML) on dasatinib (in major molecular response) who was diagnosed with COVID-19 and developed pancytopenia. Our case report and review of available publications add to the limited literature available regarding COVID-19 in CML.