Incidence and Outcomes of Pulmonary embolism among hospitalized COVID-19 patients (preprint)

BackgroundPatients with COVID-19 may be at high risk for thrombotic complications due to excess inflammatory response and stasis of blood flow. This study aims to assess the incidence of pulmonary embolism among hospitalized patients with COVID-19, risk factors and the impact on survival. MethodA retrospective case-control study was conducted at Al-Noor Specialist Hospital in, Saudi Arabia between March 15, 2020, and June 15, 2020. Patients with confirmed COVID-19 diagnosis by a real-time polymerase chain reaction (PCR) and confirmed diagnosis of pulmonary embolism by Computed Tomography pulmonary angiogram (CTPA) formed the case group. Patients with confirmed COVID-19 diagnosis by a real-time polymerase chain reaction (PCR) and without confirmed diagnose of pulmonary embolism formed the control group. Logistic regression analysis was used to identify predictors of pulmonary embolism and its survival. ResultsA total of 159 patients participated were included in the study, of which 51 were the cases (patients with pulmonary embolism) and 108 patients formed the control group (patients without pulmonary embolism). The incidence of PE among hospitalized was around 32%. Smoking history, low level of oxygen saturation and higher D-dimer values were important risk factors that were associated with a higher risk of developing PE (p< 0.05). Higher respiratory rate was associated with higher odds of death, and decrease the possibility of survival among hospitalised patients with PE. ConclusionPulmonary embolism is common among hospitalized patients with COVID-19. Preventive measures should be considered for hospitalized patients with smoking history, low level of oxygen saturation, high D-dimer values, and high respiratory rate.

Circulatory Cytokines and Chemokines Profile in Human Coronaviruses: A systematic review and meta-analysis (preprint)

Background SARS, MERS, and COVID-19 share similar characteristics as the genetic homology of SARS-CoV-2 compared to SARS-CoV and MERS-CoV is 80% and 50% respectively and cause similar clinical features. Uncontrolled release of proinflammatory mediators (cytokine storm) by activated immune cells in SARS, MERS, and COVID-19 leads to severe phenotype development. Aim This systematic review and meta-analysis aimed to evaluate the inflammatory cytokines profile associated with severe human coronavirus diseases, including three stains: MERS-CoV, SARS-CoV SARS-CoV-2, in severe patients. Method PubMed, Embase, and Cochrane Library databases were searched up to July 2020. Randomized and Observational studies reporting the inflammatory cytokines associated with severe and non-severe human coronavirus diseases, including MERS-CoV, SARS-CoV SARS-CoV-2 were included. Two reviewers independently screened articles, extracted data, and assessed the quality of included studies. Meta-analysis was performed using a random-effects model with a 95% confidence interval (CI) to estimate the pooled mean of inflammatory biomarkers. Results A high level of circulating IL-6 could be associated with the severity of the three strains of coronaviruses infection. TNF, IL-10, and IL-8 is associated with the severity of COVID-19. Increased circulating levels of CXCL10/IP10 and CCL2/MCP-1 might also be related to the severity of MERS. Conclusion This study suggests that the immune response and immunopathology in the three severe human coronavirus strains are similar to some extent. These findings highlight that nearly all studies reporting severe cases of SARS, MERS, and COVID-19 have been associated with elevated levels of IL-6, which could be used as a potential therapeutic target to improve patients’ outcomes in severe cases.

Clinical, Radiological and Therapeutic Characteristics of Patients with COVID-19 in Saudi Arabia (preprint)

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a rapidly spreading global pandemic. The clinical characteristics of COVID-19 has been reported; however, there are limited researches that investigated the clinical characteristics of COVID-19 in the Middle East. The aim of this study is to investigate the clinical, radiological and therapeutic characteristics of patients diagnosed with COVID19 in Saudi Arabia. METHODS: This study is a retrospective single-centre case series study. We extracted data for patients who were admitted to the Al-Noor Specialist hospital with a PCR confirmed SARS-COV-2 between 12th and 31st of March 2020. Descriptive statistics were used to describe patients characteristics. Continuous data were reported as mean (SD). Chi-squared test/Fisher test were used as appropriate to compare proportions for categorical variables. RESULTS: A total of 150 patients were hospitalised for COVID-19 during the study period. The mean age was 46.1 years (SD: 15.3 years). Around 61.0% (n= 90) were males and six patients (3.9%) reported working in the healthcare sector. The most common comorbidities were hypertension (28.8%, n= 42) and diabetes mellitus (26.0%, n= 38). The majority of the patients, 64.4% (n = 96) had a recent contact history with a COVID patient. Regarding the severity of the hospitalised patients, 105 patients (70.0%) were mild, 29 (19.3%) were moderate, and 16 patients (10.7%) were severe or required ICU care. From the 105 mild patients, around 31.3% (n= 47) were asymptomatic. CONCLUSION: This case series provides clinical, radiological and therapeutic characteristics of hospitalised patients with confirmed COVID-19 in Saudi Arabia.

Negative nasopharyngeal SARS-CoV-2 PCR conversion in Response to different therapeutic interventions (preprint)

BACKGROUND: Despite lack of convincing evidence of the efficacy of hydroxychloroquine, it has been suggested to be used for the treatment of SARS CoV 2 to accelerate the negative virus conversion. We aimed to explore the association between negative nasopharyngeal SARS CoV 2 PCR clearance and different therapeutic interventions. METHODOLOGY: This was a retrospective cohort study of 93 patients who were admitted to medical ward with a PCR confirmed diagnosis of COVID 19 and met the inclusion criteria in a tertiary hospital in Mecca, Saudi Arabia. There were three interventional subgroups (group A (n=45): who received antimalarial drug only classified as (A1), combined with azithromycin (A2) or combined with antiviral drugs (A3)), and one supportive care group (group B) (n=48). The primary and secondary endpoints of the study were achieving negative SARS_CoV_2 nasopharyngeal PCR sample within five days or less from the start of the intervention and 12 days or less from the diagnose, respectively. RESULTS: The mean age of the patients was 43.9 years (SD:15.9). A median time of 3.00 days (IQR:2.00 to 6.50) needed from the time of starting the intervention/supportive care to the first negative PCR sample. There was no statistically significant difference neither between the percentage of patients in the interventional group and the supportive care group who achieved the primary or the secondary endpoint, nor in the median time needed to achieve the first negative PCR sample (p>0.05). CONCLUSION: Prescribing antimalarial medications was not shown to shorten the disease course nor to accelerate the negative PCR conversion rate.

Knowledge and practices towards COVID-19 during its outbreak: a multinational cross-sectional study (preprint)

Background: The emergence of COVID-19 globally coupled with its unknown aetiology and its high transmission rate has created an unprecedented state of emergency worldwide. Public knowledge and awareness about COVID-19 are essential in suppressing its pandemic status. Method: A cross-sectional study using an online survey was conducted between 19th of March and 6th of April 2020 in three Middle Eastern countries (Jordan, Saudi Arabia and Kuwait) to explore the knowledge and practices of Middle Eastern population towards COVID-19. A previously developed questionnaire was used. Multiple linear regression analysis was used to identify predictors of COVID-19 knowledge. Results: A total of 1,208 participants were involved in this study from the three countries (Jordan = 389, Saudi Arabia = 433, and Kuwait = 386). The majority of participants (n = 810, 67.2%) were females and aged 30 to 49 years (n = 501, 41.5%). Participants had moderate overall COVID-19 knowledge with a mean score of 7.93 (SD = 1.72) out of 12, 66.1%. Participants had better knowledge about disease prevention and control with 83.0%, whereas the lowest sub-scale scores were for questions about disease transmission routes (43.3%). High education level was an important predictor of greater COVID-19 knowledge scores (p<0.01). Conclusion: Middle Eastern participants are of a relatively low level of knowledge about COVID-19, particularly regarding its transmission routes. Policymakers are recommended to develop informative COVID-19 related campaigns targeted specifically towards university students, unemployed individuals and those with lower levels of education.

Mental health status of the general population, healthcare professionals, and university students during 2019 coronavirus disease outbreak in Jordan: a cross-sectional study (preprint)

Background: The emergence of COVID-19 global pandemic coupled with high transmission rate and mortality has created an unprecedented state of emergency worldwide. This global situation may have a negative impact on the psychological well-being of individuals which in turn impacts individuals performance. Methods: A cross-sectional study using an online survey was conducted in Jordan between 22nd and 28th of March 2020 to explore the mental health status (depression and anxiety) of the general population, healthcare professionals, and university students during the COVID-19 outbreak. The Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) were used to assess depression and anxiety among the study participants. Logistic regression analysis was used to identify predictors of depression and anxiety. Results: The prevalence of depression and anxiety among the entire study participants was 23.8% and 13.1%, respectively. Anxiety was most prevalent across university students 21.5%, followed by healthcare professionals 11.3%, and general population 8.8%. Females among healthcare professionals and university students, divorced healthcare professionals, pulmonologists, and university students with history of chronic disease were at higher risk of developing depression. Females, divorced participants among the general population, and university students with history of chronic disease and those with high income ([≥]1500 JD) were at higher risk of developing anxiety. Conclusions: During outbreaks, individuals are put under extreme stressful condition resulting in higher risk of developing anxiety and depression particularly for students and healthcare professionals. Policymakers and mental healthcare providers are advised to provide further mental support to these vulnerable groups during this pandemic.