Overview Of Proteinuria Among Hospitalized Patients With COVID-19

COVID-19 was thought to be primarily a respiratory disease, progressing in some patients to serious respiratory symptoms, pneumonia, severe respiratory distress syndrome and even death.Patients infected with SARS-CoV-2 might have a variety of clinical presentations, ranging from no symptoms to life-threatening sickness. Later analysis revealed entire systems were compromised, affecting other vital organs, including the kidneys, and a correlation was observed between chronic kidney disease (CKD) and COVID-19 severity. A large percentage of affected patients present with acute kidney injury. However, specific phenotypic aspects of acute kidney injury or other renal manifestations of COVID-19 remain sparsely characterized. Urine proteincreatinine ratio (UPCR) in single-voided urine samples correlates well with measurements of 24-hour urinary protein when properly interpreted by taking into consideration the different rates of creatinine excretion. Arguably, knowing the baseline status of proteinuria can be equally important in the assessment of AKI in a hospitalized patient. Many reports indicate that proteinuria can be detected in acute kidney injury associated with COVID-19 despite being largely described as a form of acute tubular injury. Therefore, this study aimed to review acute kidney injury among hospitalized patients with COVID 19.Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

Prospective Observational Cohort Study of Serological Responses to COVID-19 Vaccines in Pediatric Kidney Transplant Recipients at a Single Institution

Background. Pediatric kidney transplant recipients (PKTR) are at risk of poor outcomes from COVID-19. Data on serologic responses to COVID-19 vaccines in PKTR remain sparse. We characterized the magnitude, breadth, and longevity of SARS-CoV-2 spike protein binding antibody responses in PKTR. Methods. This single institution, prospective observational study enrolled PKTR presenting to a transplant clinic for routine care who had received or were eligible to receive a COVID-19 vaccine. Demographic data, history of prior COVID-19, and vaccination details were collected. Plasma samples obtained from standard-of-care residual specimens were analyzed for SARS-CoV-2 spike variant IgG using the MesoScale Discovery V-PLEX platform, which quantitatively measures antibodies to SARS-CoV-2 full-length spike wild-type (Wuhan-hu-1), Alpha (B.1.1.7), Beta (B.1.351), Delta (B.1.617.2), Gamma (P.1), and Omicron (B.1.1.529;BA.1) variants. Vaccine time points with > 5 samples available were analyzed. Geometric mean titers (GMTs) were calculated and log-transformed titers were compared using one-way ANOVA with Tukey's post-hoc comparisons test. Results. 61 PKTR enrolled (Table1);47 (77%) received at least 1 dose of COVID-19 vaccine in transplant clinic. 47 (77%) PKTR had at least one sample available for analysis, but serial specimens were lacking for many. By 6 months post-dose 2 of COVID-19 mRNA vaccination, spike (Wuhan-hu-1) IgG titers had waned to prevaccination levels (GMT 24 vs 47 binding antibody units (BAU)/mL, P=0.988). Administration of a 3rd dose of mRNA vaccine significantly boosted IgG antibodies (GMT 492 BAU/mL, P=0.007), and titers were maintained at 3 months (GMT 656 BAU/mL, P=0.001) but gradually waned by 6 months (GMT 223 BAU/mL, P=0.070). Administration of a 4th dose elicited a non-significant increase in titers (GMT 905 BAU/mL, P=0.870). Binding IgG antibodies to SARS-CoV-2 variant spike proteins post-vaccination were not significantly different from Wuhan spike. Conclusion. In this cohort of PKTR, a 3rd dose of COVID-19 mRNA vaccine significantly boosted broadly cross-reactive binding IgG antibodies to SARS-CoV-2 spike variants, including Omicron. Decreasing titers at 6 months post-dose 3 raise concern for waning protective immunity and support 4th dose vaccination.

Effect of Insulin Injection Techniques on Glycemic Control Among Patients with Diabetes.

Objective: Previous studies have shown that healthcare professionals rarely instruct patients about proper insulin injection techniques. This study aimed to assess the practices of insulin injection techniques among patients with diabetes treated and assess the effect of these practices on glycemic control. Patients and Methods: This cross-sectional study was conducted between November 2020 and February 2021. A random systematic sampling technique was used to recruit study subjects at specialist outpatient clinics. Subjects with type 1 or 2 diabetes mellitus who had been using insulin injections for at least a year were included in this study. Results: A total of 298 subjects with type 1 diabetes and 553 with type 2 diabetes participated in this study. The mean age of patients with type 1 diabetes was 20.1 ± 10.4 years. The mean age of patients with type 2 diabetes was 58.6 ± 9.5 years. The median type 1 diabetes duration was 6.0 years, and median type 2 diabetes duration was 15.0 years. About 66.8% of patients with type 1 diabetes and 69.4% of patients with type 2 diabetes were rotating insulin injection sites. Almost 36.6% of patients with type 1 diabetes and 50.5% of patients with type 2 diabetes reported using the same insulin needle more than three times. The prevalence of lipohypertrophy was 57.0% among patients with type 1 diabetes and 55.5% among patients with type 2 diabetes. The absence of lipohypertrophy, rotation of insulin injection site, and total daily insulin dose ≤50 units were all independently significantly associated with better glycemic control. Conclusion: Insulin injection techniques were suboptimal among significant proportion of patients with diabetes in Jordan. Improper insulin injection technique, especially the rotation of injection sites and lipohypertrophy formation, was associated with uncontrolled blood glucose levels. Educational interventions that focus on insulin injection techniques among Jordanian patients with diabetes are strongly recommended.

Coding-complete genome sequences of two SARS-CoV-2 isolates from Egypt

This report announces the complete genome sequences of two severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) isolates detected in Egypt. The isolates were obtained from oropharyngeal swab specimens from two Egyptians in Upper and Lower Egypt. Sequence analysis showed mutations that differentiate Egyptian strains from the reference strain 2019-nCoV WHU01.

Healthcare Workers and Exposure to COVID-19: Survey and Training in Kuwait

Many healthcare workers received inadequate infection prevention and control training while facing shortages of personal protective equipment. Community exposure, however, is often overlooked when exposure assessment of infection risk is applied. The overall level of exposure of healthcare workers in Kuwait remains understudied. This study aimed at identifying and quantifying the risks of COVID-19 exposure to healthcare workers using the WHO-developed risk assessment tool before an in-house online training. A cross-sectional survey was conducted in July 2020. Healthcare workers from governmental hospitals in Kuwait were recruited by convenience due to lockdowns. The recruited individuals were offered in-house comprehensive online training. Out of 115 healthcare workers, 68.7% were female, 47.8% were aged 31-40 and 44.4% were doctors. Community exposure was identified in 53% of participants. About 80.8% were considered highly exposed to COVID-19. During interactions with patients, 95.5% wore N95 masks and 59.5% wore face shields ‘always as recommended’ and only 11.8% wore gloves ‘most of the time’. Removal of PPEs according to IPC protocol was reported by 72.2% of healthcare workers. Healthcare workers in Kuwait face an extra risk of exposure to COVID-19 from the community, not only from healthcare facilities. The causes of the suboptimal level of adherence to PPEs warrants further investigation. The COVID-19 pandemic has illuminated the significant additive biohazard risk healthcare workers face from the community. Many countries including Kuwait are following through on the International Labor Organization and the World Health Organization recommendation to establish an occupational health and safety program for healthcare workers. © 2021 Teikyo University School of Medicine. All rights reserved.

Perception of online learning among undergraduate students at suez canal medical school during the covid-19 pandemic: A cross-sectional study

Background: Many adaptations to medical education have been made in response to the new emergent COVID-19 pandemic and its enormous global effects including the teaching and learning strategies to assure the educational process's safety and advancement. Accordingly, it was necessary to implement new online instructional approaches at the Faculty of Medicine, Suez Canal University in Egypt. Objective: To assess online learning advantages and disadvantages as perceived by medical students in addition to their preference regarding online vs face-to-face learning, Subjects and methods: This study was conducted as a cross-sectional study that included 340 students who filled an online survey consisting of 16 questions and was conducted on the Google Forms platform. Target population: years 1, 2 and 3 undergraduate medical students at Faculty of Medicine, Suez Canal University who experienced online learning during the COVID-19 pandemic. Results: The mean age of students was 19.57±1.02, ranged from 17 to 23 years, 61% of them were females. About 63.8% of students had no previous experience with online learning. The main perceived advantages were the ability to stay home (63.8%), comfortable surrounding (52.1%) and access to online materials (47.1%), while the main perceived disadvantages were technical problems (67.6%), lack of interaction with patients (58.8%), and reduced interaction with teachers (48.5%). Most of the students found face-to-face learning is superior to online learning in improving the knowledge (p=0.005), clinical skills (p<0.001) and social competence (p<0.001). Though 77% of them rated online learning as enjoyable. Conclusion: Most of our participants preferred traditional face-to-face learning over the online learning. Stakeholders should take the required steps to improve learning by reducing the disadvantages and increasing advantages of online learning as perceived by students during this study. © 2021, Ain Shams University Faculty of Medicine. All rights reserved.

Efficient Classification Approach Based on COVID-19 CT Images Analysis with Deep Features

Currently, a new coronavirus(COVID-19) has affected millions of people worldwide. For this reason, it's not sufficient that radiologists can slow down the virus spreading manually. Convolutional Neural Networks (CNNs) can be utilized as a tool to aid radiologists in diagnosing COVID-19 images, which consequently can save efforts and time. In this work, a dataset of CT images of confirmed and negative COVID-19 was used for the screening of COVID-19. Some preprocessing operations were applied to enhance the COVID-19 CT images which aim at including only the Area of Interest (AOI). This was accomplished in three stages. First, a conversion of the CT images to the binary scale was performed by applying a global threshold algorithm. Then, the median filter algorithm was applied to remove random noise. Then, we include only the ROI (the lung) and exclude other parts of the images. Finally, we applied VGGNet 19 to extract features from the preprocessed CT images, which is a popular CNN architecture, trained previously on ImageNet. The proposed pipeline showed high performance by achieving 98.31%, 100%, 98.19% and 98.64% of accuracy, recall, precision and f1-score, respectively. To the best of our knowledge, these results are the best published on this dataset when compared to a set of recently published works. Also, the proposed model overcomes several popular CNNs architectures.

Epidemiologic features and clinical course of COVID-19: a retrospective analysis of 19 patients in Germany

Background: SARS-coronavirus-2 causes coronavirus disease-19 (COVID-19). Materials & methods: We here report epidemiology;clinical, radiological and laboratory characteristics;and outcomes of COVID-19 in 19 patients confirmed by reverse-transcriptase-PCR. Results: In 19 PCR-confirmed cases (median age 69 years;63% males), the most common presentations were fever (79%), cough (79%) and fatigue (79%). The most common comorbidities were hypertension (47%), hypothyroidism (32%) and cardiac diseases (32%). All patients received symptomatic treatment. Ampicillin/sulbactam was prescribed for 50% of cases. Also, 13 (68.4%) recovered and discharged, 9 (47.3%) needed intensive care unit admission and 4 (21.1%) cases died Conclusion: The included cases had variable clinical outcomes following supportive and antibiotic treatments. These findings may contribute to development of more effective strategies for infection control.

The transCampus Metabolic Training Programme Explores the Link of SARS-CoV-2 Virus to Metabolic Disease.

Currently, we are experiencing a true pandemic of a communicable disease by the virus SARS-CoV-2 holding the whole world firmly in its grasp. Amazingly and unfortunately, this virus uses a metabolic and endocrine pathway via ACE2 to enter our cells causing damage and disease. Our international research training programme funded by the German Research Foundation has a clear mission to train the best students wherever they may come from to learn to tackle the enormous challenges of diabetes and its complications for our society. A modern training programme in diabetes and metabolism does not only involve a thorough understanding of classical physiology, biology and clinical diabetology but has to bring together an interdisciplinary team. With the arrival of the coronavirus pandemic, this prestigious and unique metabolic training programme is facing new challenges but also new opportunities. The consortium of the training programme has recognized early on the need for a guidance and for practical recommendations to cope with the COVID-19 pandemic for the community of patients with metabolic disease, obesity and diabetes. This involves the optimal management from surgical obesity programmes to medications and insulin replacement. We also established a global registry analyzing the dimension and role of metabolic disease including new onset diabetes potentially triggered by the virus. We have involved experts of infectious disease and virology to our faculty with this metabolic training programme to offer the full breadth and scope of expertise needed to meet these scientific challenges. We have all learned that this pandemic does not respect or heed any national borders and that we have to work together as a global community. We believe that this transCampus metabolic training programme provides a prime example how an international team of established experts in the field of metabolism can work together with students from all over the world to address a new pandemic.

In silicodomain structural model analysis of coronavirus orf1ab polyprotein

The world today is battling with a coronavirus infection which is considered a global pandemic. Coronavirus infection is mainly attributed to the varying technique of the replication and releaseof different genomic components of the virus. In this study, the aim is to establish the physical and chemical features, as well as the basic structural and functional properties of Coronavirus ORF1ab domain. A molecular approach was adopted in this study using the Swiss Model & Phyre2 server while the prediction of the active ligand binding sites was done using Phyre2.The analysis of the structure of the protein showed that it has good structural and heat stability, as well as better hydrophilic features and acidic in nature. Based on the Homology modelling, only 2 binding active sites were noted with catalytic function being mediated by Zn2+ as the metallic heterogen ligand for binding sites prediction. The proteins mostly exhibited helical secondary configurations. This study can help in predicting and understanding the role of this domain protein in active coronavirus infection.

Measuring operational efficiency of isolation hospitals during COVID-19 pandemic using data envelopment analysis: a case of Egypt

Purpose: This study used Data Envelopment Analysis (DEA) to measure and evaluate the operational efficiency of 26 isolation hospitals in Egypt during the COVID-19 pandemic, as well as identifying the most important inputs affecting their efficiency. Design/methodology/approach: To measure the operational efficiency of isolation hospitals, this paper combined three interrelated methodologies including DEA, sensitivity analysis and Tobit regression, as well as three inputs (number of physicians, number of nurses and number of beds) and three outputs (number of infections, number of recoveries and number of deaths). Available data were analyzed through R v.4.0.1 software to achieve the study purpose. Findings: Based on DEA analysis, out of 26 isolation hospitals, only 4 were found efficient according to CCR model and 12 out of 26 hospitals achieved efficiency under the BCC model, Tobit regression results confirmed that the number of nurses and the number of beds are common factors impacted the operational efficiency of isolation hospitals, while the number of physicians had no significant effect on efficiency. Research limitations/implications: The limits of this study related to measuring the operational efficiency of isolation hospitals in Egypt considering the available data for the period from February to August 2020. DEA analysis can also be an important benchmarking tool for measuring the operational efficiency of isolation hospitals, for identifying their ability to utilize and allocate their resources in an optimal manner (Demand vs Capacity Dilemma), which in turn, encountering this pandemic and protect citizens' health. Originality/value: Despite the intensity of studies that dealt with measuring hospital efficiency, this study to the best of our knowledge is one of the first attempts to measure the efficiency of hospitals in Egypt in times of health' crisis, especially, during the COVID-19 pandemic, to identify the best allocation of resources to achieve the highest level of efficiency during this pandemic. © 2020, Emerald Publishing Limited.

Gastrointestinal and hepatic manifestations of COVID-19: A case series of 711 patients

INTRODUCTION: Gastrointestinal (GI) symptoms and liver function test (LFT) abnormalities are increasingly being reported in patients with COVID-19 but there is no reliable data on the real magnitude of GI tract involvement. We present the results of our study of 711 patients for GI and liver manifestations of COVID-19. METHODS: We performed a retrospective chart review of the 711 adult patients who visited the Richmond University Medical Center and/or its ambulatory centers in New York City up until May 13, 2020, and tested positive for COVID-19. We analyzed the reported incidence of dysgeusia, anorexia, nausea, vomiting, diarrhea, abdominal pain, and GI bleeding as well as LFT abnormalities. In case of deranged LFTs, we looked for preexisting liver disease, alcohol abuse, and anti-retroviral medication use. RESULTS: A total of 711 patients were studied using inpatient charts, and laboratory data to identify abnormal findings. The mean age of patients was 60.5 years with slight male predominance (n = 395 vs 316). 27.1% (n = 193) reported GI symptom and an additional 56.9% (n = 405) had at least one liver enzyme abnormality. Diarrhea was the most common with a frequency of 17.3% (n = 86), nausea 16.2% (n = 80), anorexia/vomiting 13.7% (n = 68), and abdominal pain 5.6% (n = 28). The least reported symptoms were dysgeusia 3.2% (n = 16) and GI bleeding 2.2% (n = 11). Lipase level was elevated in 27.8% patients (n = 138). Among LFTs, AST alone was elevated in 16.6% (n = 118), ALT alone in 15.0% (n = 6), both AST/ALT 15.7% (n = 112), alkaline phosphatase 23% (n = 164), and bilirubin 10% (n = 71). Potential confounders were preexisting liver disease (n = 8), patients taking HIV medications (n = 9) and alcohol abuse. However, the enzyme levels in these patients were elevated above their baseline. PT/ INR was elevated in 13.4% (n = 95) of patients while only 27 of them were on oral anticoagulant. 88.6% (n = 630) of patients were admitted with respiratory failure, and 28.5% (n = 203) died. CONCLUSION: GI symptoms were experienced by 27% and hepatic dysfunction was at 57% in this study of 711 COVID-19 patients. This reflects a fairly high burden of GI involvement. As the covid- 19 pandemic continues its rampage, our understanding of its GI and hepatobiliary aspects is growing. This will improve our diagnostic, therapeutic, and preventive armamentarium. Other implications for gastroenterlogists include prolonged viral shedding in stools, potential for fecal-oral transmission and risk of exposure during endocsopy. (Table Presented).

Circuit clotting on continuous venovenous hemofiltration in COVID-19 patients at new england's largest health safety-net hospital

Background: The pandemic of COVID19 led to a surge in critically ill patients with severe kidney failure requiring continuous renal replacement therapy (CRRT). Primary reports rapidly showed a hypercoagulable state associated with cytokine storm representing a challenge to conduct CRRT. We report our experience to face clotting on continuous venovenous hemofiltration (CVVH) with COVID19 patients. Methods: We reviewed data on all admitted patients with COVID19 diagnosis and requiring CVVH at Boston Medical Center between March, 15th and May 7th, 2020. The study was approved by the institutional IRB. Results: Twenty six patients were admitted to ICU with COVID19 disease and developed acute kidney injury requiring CRRT. The majority of patients were males (73%), and mean age was 64.3 (+/ 9.4) years. At dialysis initiation, patients showed marked inflammatory state with a median CRP of 239mg/dl (IQR 123-391.5), fibrinogen 609mg/dl (431-693), d-dimer 4,036 ng/ml (1,777-15,558). CVVH was conducted in predilution mode, with a median therapy rate of 3L/h (2.5-3.1) and a mean blood flow of 280 mL/min. The median cartridge half-life from CVVH initiation was 11.8 hours (3.5-20). Twelve patients (46%) experienced CVVH circuit clotting within the first 24 hours, including 6 patients (23%) with severe recurring clotting. Curative systemic anticoagulation by heparin was used in 12 patients (46%) based on hospital protocol. Its use was associated with mild improvement in cartridge half-life: 15h with curative heparin dosing compare to 11.25h with no/ low dose preventive anticoagulation (nonsignificant). Of note, heparin was held prior to CRRT initiation for dialysis catheter placement and was reinitiated without bolus, which could lead to early coagulation of the filter in patients with hypercoagulable state. The fatality rate was 76.9% with a median time from CVVH initiation to death of 2.5 days (1 - 8.75). Conclusions: Conducting CRRT in patients with multiorgan failure secondary to COVID19 is challenging. Our experience suggests only a mild non significant improvement of clotting prevention with heparin anticoagulation at the time of cvvh initiation. Further studies are warrantied to determine the optimal anticoagulation regimen.

A view of the health services after COVID-19: an Egyptian perspective

Introduction: Humankind is now facing a global crisis. Perhaps the biggest crisis of our generation. However, national and international health systems failed to avoid millions of morbidities and hundred thousands of mortalities. The decisions people and governments take in the next few weeks will probably shape the world for years to come. They will shape not just our healthcare systems but also our economy, politics, and culture. Aim(s): The overall aim of this report is just to present an outline skeleton of the main elements of a health plan that may be adopted to achieve a high quality medical care services in the near future. Approach: The approach that will be adopted to present the main elements of the health plan will be through a time frame that includes short term (about one year) and long-term measures (five to ten years). Copyright © 2020, © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.