The impact of the Beirut blast on the COVID-19 situation in Lebanon.

AIM: On August 4, 2020, a massive explosion hit Lebanon's capital city, Beirut. The aim of this study was to explore the effect of the Beirut blast on the COVID-19 situation in the country. SUBJECT AND METHODS: Data on COVID-19 were retrieved from the Lebanese Ministry of Public Health (LMOPH), where all the COVID-19 positive cases were reported. The study was divided into two periods, considering the incubation period of the COVID-19 virus: (July 27-August 9, 2020) and (August 10-23, 2020). Information obtained included daily number of cases, tests, deaths, hospitalized patients, intensive care unit (ICU) patients, and mode of acquisition (local vs. expat). Daily positivity rates were reported per 100 tests. An independent sample t-test and a Joinpoint regression analysis were used to determine significance. A p value less than 0.05 was considered significant. RESULTS: A total of 201,010 tests were conducted during our studied period, with 8993 positive cases, constituting a total positivity rate of 4.5 per 100 tests. Case fatality rate over the studied period was 0.8%. The positivity rate of the period prior to August 10, 2020, was 2.7 per 100 tests, significantly less than that of the period following the explosion, which was 6.4 per 100 tests (p < 0.001). During our studied period, daily positivity rates were significantly increasing at a slope of 0.29 (p < 0.001). A significant increase in slope was noted on August 13, 2020 (p < 0.001). The number of hospitalized patients increased from 139 patients on July 27 to 266 on August 23, 2020, and that of ICU patients increased from 36 to 75. CONCLUSION: The port of Beirut explosion resulted in a significant increase in the daily number of positive COVID-19 cases. The aftermath of the explosion, the damage to healthcare facilities, and the overcrowding due to emergency efforts were contributing factors to that increase.

Emerging Health Disparities during the COVID-19 Pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has underscored social and racial discrimination in global health, showing that health equity is still a goal to be achieved. Understanding the impact of COVID-19 on public health potential is vital to present a fair opportunity for people of different backgrounds to be as healthy as possible. As such, this communication discusses the emerging health disparities in light of the COVID-19 pandemic and analyzes their implications. Original research, effective health communication, and promotion strategies ought to be leveraged to step closer toward national and international health equity.

COVID-19 in Patients with Cancer: Insights from a Tertiary Care Intensive Care Unit (preprint)

Background & Aim: Since The emergence of the COVID-19, patients with cancer have been among the most vulnerable patients, as this infection can be severe and mostly requires intensive care therapy. Literature discussing the risk factors and the outcome of these patients in intensive care units (ICU) is accumulating. Our study aims to search for the incidence of COVID-19 infection in cancer patients and analyses their associated comorbidities, possible risk factor for infections, and their outcomes. Methods: Patients with active cancer under treatment and those recently diagnosed with cancer and had confirmed COVID-19 infection requiring ICU admission were included in our study over 8 months, from March to October 2022. Patient demographic data, comorbidities, ICU stay, duration of hospital stay, oxygenation/ventilatory requirements, treatment, secondary bacterial infection, and outcome were collected from the COVID-19 patients' registry in the ICU. Data were entered into the SPSS program version 23, and results were considered statistically significant at p ≤ 0.05. Results:  A total of 24 patients with cancer and COVID-19 infection required intensive care therapy. The most common type of malignancy in those patients was solid organ tumor (13 vs. 11 patients), and most of the study sample were males (20/ 83.3%). Seventy-five percent (18 patients) required intubation and invasive ventilation. Twenty-nine percent (7 patients) had secondary bacterial pneumonia and bacteremia. In addition, 70% had septic shock and required vasopressors. Acute kidney injury (AKI) due to rhabdomyolysis (P<0.001), secondary bacterial infection (P<0.006), bacteremia and pneumonia (P<0.02), invasive ventilation (P<0.02) and requiring muscle relaxant (P<0.02), the requirement for High flow nasal cannula and prone position (P<0.03 and 0.01) respectively, shock (P<0.004) were significantly associated with increased mortality. Patients with cancer and COVID-19 had higher severity scores (P<0.003), longer ventilation duration (P<0.002), and ICU stay (P<0.002). Overall mortality was 45%.8, there was no significant difference in mortality rate between patients with solid organ tumors and hematological malignancy with COVID-19 infection requiring intensive care therapy (P<0.68). Conclusion: Cancer patients requiring ICU were more prone to develop AKI, rhabdomyolysis, secondary infection, requiring ventilation and prone position, and septic shock. These patients had a significantly high mortality rate and were severely ill, requiring prolonged ventilation and ICU stays.

Neutrophil-to-lymphocyte ratio as a predictor of clinical outcomes in critically ill COVID-19 patients: A retrospective observational study.

Background: Timely identification of patients at risk of worse clinical outcomes is vital in managing coronavirus disease 2019 (COVID-19). The neutrophil-to-lymphocyte ratio (NLR) calculated from complete blood count can predict the degree of systemic inflammation and guide therapy accordingly. Hence, we did a study to investigate the role of NLR value on intensive care unit (ICU) admission in predicting clinical outcomes of critically ill COVID-19 patients. Methods: We conducted a retrospective analysis of electronic health records of COVID-19 patients admitted to ICUs at Hazm Mebaireek General Hospital, Qatar, from March 7, 2020 to July 18, 2020. Patients with an NLR equal to or higher than the cut-off value derived from the receiver operating characteristic curve were compared to those with an NLR value below the cut-off. The primary outcome studied was all-cause ICU mortality. The secondary outcomes evaluated were the requirement of mechanical ventilation and ICU length of stay (LOS). Results: Five hundred and nineteen patients were admitted to ICUs with severe COVID-19 infection during the study period. Overall, ICU mortality in the study population was 14.6% (76/519). NLR on ICU admission of ≥6.55 was obtained using Youden's index to predict ICU mortality, with a sensitivity of 81% and specificity of 41%. Mortality was significantly higher in patients with age ≥60 years (p < 0.001), chronic kidney disease (p = 0.03), malignancy (p < 0.002), and NLR ≥ 6.55 (p < 0.003). There was also a significant association between the requirement of mechanical ventilation (34.7% vs. 51.8%, p < 0.001) and increased ICU LOS (8 vs. 10 days, p < 0.01) in patients with ICU admission NLR ≥ 6.55. Conclusion: Higher NLR values on ICU admission are associated with worse clinical outcomes in critically ill COVID-19 patients.

Right Ventricular Assessment in Critically Ill COVID-19 Patients and its Prognostic Importance

BACKGROUND: Cardiac injury is a prevalent complication and is associated with worse prognosis in COVID-19 patients. The increased cardiac workload resulting from respiratory failure and hypoxemia is a common mechanism of cardiac injury, and the right ventricle may bear the brunt of its impact. AIM: The present study aimed to determine the incidence and prognostic value of right ventricular (RV) dysfunction in COVID-19 patients admitted to the intensive care unit using conventional echocardiography parameters. METHODS: Patients were subjected to full history taking and clinical examination, computed tomography (CT) of the chest was done for all patients to assess the severity of lung infiltration, all patients received standard treatment according to Ministry of Health and Population COVID-19 treatment protocol recommendations. The echocardiographic assessment was done on all patients. RESULTS: The mean age of the patients was 61.10 ± 9.64 years (range 42–80 years). There were 36 (60%) males and 24 (40%) females. The nonsurvivor group consisted of 28 patients (46.7%), and the survivors consisted of 32 patients (53.3%). There was a statistically significant association between mortality and RV function regarding tricuspid plane systolic excursion, fractional area change %, RV basal diameter, and expiratory positive airway pressure. CONCLUSION: We concluded that in COVID-19 patients, RV function must be assessed and its prognostic importance recognized. RV dysfunction is not only a symptom of high pulmonary pressures, but it also contributes to cardiac insufficiency.

Prognostic tools and candidate drugs based on plasma proteomics of patients with severe COVID-19 complications.

COVID-19 complications still present a huge burden on healthcare systems and warrant predictive risk models to triage patients and inform early intervention. Here, we profile 893 plasma proteins from 50 severe and 50 mild-moderate COVID-19 patients, and 50 healthy controls, and show that 375 proteins are differentially expressed in the plasma of severe COVID-19 patients. These differentially expressed plasma proteins are implicated in the pathogenesis of COVID-19 and present targets for candidate drugs to prevent or treat severe complications. Based on the plasma proteomics and clinical lab tests, we also report a 12-plasma protein signature and a model of seven routine clinical tests that validate in an independent cohort as early risk predictors of COVID-19 severity and patient survival. The risk predictors and candidate drugs described in our study can be used and developed for personalized management of SARS-CoV-2 infected patients.

Characteristics and clinical outcomes of COVID-19 patients with pulmonary disorders: A single-center, retrospective observational study.

INTRODUCTION: Mortality rates and clinical characteristics of patients with coronavirus disease 2019 (COVID-19) admitted to the intensive care unit (ICU) vary significantly. OBJECTIVES: To describe the data of patients with pulmonary comorbidities who were admitted to the ICU with COVID-19 in Qatar in terms of demographic characteristics, coexisting conditions, imaging findings, and outcomes. METHODS: We conducted a retrospective study of the outcomes with regard to mortality and requirement of invasive ventilation, demographic characteristics, coexisting conditions, secondary infections, and imaging findings for critical care patients with COVID-19 in Qatar who had pulmonary comorbidities between March and June 2020. RESULTS: A total of 923 patients were included, 29 (3.14%) were found to have pulmonary disease. All these 29 patients' respiratory disease was noted to be asthma. Among these, three patients (10.3%) died in the ICU within 28 days of ICU admission. They were all above 50 years old. Nineteen (66%) patients required intubation and mechanical ventilation. Twenty-one (72.4%) patients were males. The most common comorbidities included diabetes mellitus (55.1%) and hypertension (62%). Eighteen (62%) patients developed secondary infections in the ICU. Five (17.24%) patients developed renal impairment. Twenty (69%) patients received tocilizumab as part of their COVID-19 management, and out of these 16 (80%) patients developed a coinfection. CONCLUSION: Patients with pulmonary disorders had higher mortality rates than other patients admitted to ICU during the same time frame with similar comorbidities; these patients require extra consideration and care to avoid disease progression and death.

Ocular manifestations of COVID-19: facts and figures from a tertiary care center.

INTRODUCTION: COVID-19 patients presenting with ocular manifestations are from 0.8% to 32% of patients seen in the ED. The available literature is scarce regarding COVID-19 patients presenting with ocular manifestations from the Middle Eastern region. PURPOSE: This study aims to report the incidence of ocular signs and symptoms in COVID-19 patients and find any correlation between the occurrence of ocular manifestations and patients' comorbidities. METHODS: All patients having the primary diagnosis of COVID-19 infection and concurrent ocular manifestations on admission to our tertiary COVID-19 health care centre were included in the study. The patient's demographic data, comorbidities, and type of ocular manifestations were recorded from the patients' health records retrospectively. RESULTS: In our study, 39 (7.8%) patients presented with ocular manifestations. The majority of COVID-19 patients were male, and 200 (20%) patients had a history of other comorbidities. The majority of our patients had hyperaemia (13 [33.3%]), followed by eye pain (9 [23.1%]), epiphora (8 [20.5%]), burning sensation (4 [10.3%]), and photophobia (2 [5.1%]) patients. There was no statistically significant difference in the occurrence of ocular manifestations and patients' gender or comorbidities (p > .05). CONCLUSION: The occurrence of ocular manifestations was lower compared to the present literature. There was no significant association between the occurrence of ocular manifestations and the patient's gender or comorbidities.

Cytomegalovirus meningoencephalitis in a case of severe COVID-19 Pneumonia. A case report.

The use of steroids and other immune modulatory therapies in the treatment of severe COVID-19 pneumonia predisposes patients to the reemergence of opportunistic infections. Cytomegalovirus (CMV) reactivation can be one of them. A 55-year-old gentleman with severe COVID-19 pneumonia and hypoxic respiratory failure who was ventilated and received steroids but no other immunomodulatory drugs; had altered sensorium and multiple episodes of seizures in the later course of his illness. Brain MRI showed leptomeningeal enhancement and encephalopathy changes, electroencephalography (EEG) was suggestive of diffuse encephalopathy and his cerebrospinal fluid (CSF) analysis revealed high Cytomegalovirus PCR DNA titers (103,614). The patient made a complete recovery after treatment with Ganciclovir. Altered sensorium in cases of COVID-19 can be multifactorial. High index of suspicion for reactivation of dormant infections is warranted. CMV meningoencephalitis is one of the differential diagnoses. We believe this is the first case reported of CMV meningoencephalitis in the setting of severe COVID-19 infection.

Which qualities should built environment possess to ensure satisfaction of higher-education students with remote education during pandemics?

The COVID-19 pandemic has suddenly switched most education processes from face-to-face to remote mode, obliging millions of students to utilize their residences as study spaces. However, the characteristics of their residential built environments differ in terms of regional, social, cultural, and technological aspects. These differences should impact the students' performance and satisfaction which needs to be measured and studied. The present study aims to identify the effect of the residential built environment on students' satisfaction and academic performance during the COVID-19 pandemic. It was conducted in two countries, Kazakhstan (KZ) and Norway (NO), using a comprehensive online survey to gather data. An empirical assessment based on the structural equation model was employed to identify links between health, safety, and comfort of students' facilities and academic performance and satisfaction. We conclude that the built environment affects both satisfaction for remote education and their learning performance. Significant differences in readiness for remote education have been observed between urban and non-urban living areas: (1) The role of health-and-safety convenience seems to increase with the urbanization level of the respondents' living spaces; (2) in contrast, for non-urban residents, the provision of comfort facilities is dominant. In the meantime, an analysis "by regions" revealed that health-and-safety-related facilities in residences are more critical for remote education in Central Asia (KZ). In contrast, the comfort features of residences being more important for the students studying remotely in Northern Europe (NO). These results provide an understanding that would assist in improving remote education and preparing pandemic-ready living areas.

Clinical outcomes of post-renal transplant patients with COVID-19 infection in the ICU: A single-center case series.

Most of the post-renal transplant patients are taking immunosuppressive medications, including calcineurin inhibitors, anti-proliferative agents, and steroids. This case series highlights the clinical characteristics and outcomes of eight post-renal transplant patients with severe COVID-19 infection admitted to the intensive care unit.

Clinical outcomes of intravenous immunoglobulin therapy in COVID-19 related acute respiratory distress syndrome: a retrospective cohort study.

BACKGROUND: Intravenous immunoglobulin (IVIG) has been used as an immunomodulatory therapy to counteract severe systemic inflammation in coronavirus disease 2019 (COVID-19). But its use in COVID-19 related acute respiratory distress syndrome (ARDS) is not well established. METHODS: We conducted a retrospective analysis of electronic health records of COVID-19 patients admitted to intensive care units (ICUs) at Hazm Mebaireek General Hospital, Qatar, between March 7, 2020 and September 9, 2020. Patients receiving invasive mechanical ventilation for moderate-to-severe ARDS were divided into two groups based on whether they received IVIG therapy or not. The primary outcome was all-cause ICU mortality. Secondary outcomes studied were ventilator-free days and ICU-free days at day-28, and incidence of acute kidney injury (AKI). Propensity score matching was used to adjust for confounders, and the primary outcome was compared using competing-risks survival analysis. RESULTS: Among 590 patients included in the study, 400 received routine care, and 190 received IVIG therapy in addition to routine care. One hundred eighteen pairs were created after propensity score matching with no statistically significant differences between the groups. Overall ICU mortality in the study population was 27.1%, and in the matched cohort, it was 25.8%. Mortality was higher among IVIG-treated patients (36.4% vs. 15.3%; sHR 3.5; 95% CI 1.98-6.19; P < 0.001). Ventilator-free days and ICU-free days at day-28 were lower (P < 0.001 for both), and incidence of AKI was significantly higher (85.6% vs. 67.8%; P = 0.001) in the IVIG group. CONCLUSION: IVIG therapy in mechanically ventilated patients with COVID-19 related moderate-to-severe ARDS was associated with higher ICU mortality. A randomized clinical trial is needed to confirm this observation further.

Tension Pneumomediastinum: A life-threatening condition in patients with COVID-19.

Tension pneumomediastinum (TPM) is a rare but potentially fatal clinical entity. TPM leads to the leakage of air into the mediastinal cavity and increased pressure in thoracic vessels, respiratory tract, and the heart. Herein, this report presents a series of five cases of coronavirus disease-2019 (COVID-19) that caused acute respiratory distress syndrome (ARDS) and TPM. All patients were male who had severe ARDS with a secondary lung infection that required invasive ventilation and had moderate positive-end expiratory pressure. All patients required vasopressors to maintain hemodynamics, and two patients needed decompression with chest drains. One patient received extracorporeal membrane oxygenation therapy. Three patients had cardiac arrest, and two patients died; thus, the mortality rate was 40%. Patients with COVID-19 pneumonia with ARDS required invasive ventilation and prone positioning. Secondary lung infection can cause TPM, and TPM may cause cardiac arrest. Management should be prompt recognition and decompression with the insertion of drains, and conservative treatment is required in stable cases. Protocols for the management of pneumomediastinum and TPM may enable early detection, earlier management, and prevention of TPM.

Loneliness in adults awaiting liver transplantation at 7 u.s. transplant centers during the COVID-19 pandemic

Purpose: Loneliness, defined by the National Academy of Medicine as “a subjective feeling of being isolated”, has recently emerged as a strong predictor of adverse health effects and is of increasing concern given the COVID-19 pandemic. We aimed to characterize loneliness in patients with end-stage liver disease (ESLD) awaiting liver transplantation (LT). Methods: We surveyed adult ambulatory cirrhosis patients awaiting LT at 7 U.S. sites during the COVID-19 pandemic (May2020-Jan2021) using the validated UCLA Three-Item Loneliness Scale by phone or video. Participants were asked to report if they felt: 1) they lack companionship, 2) left out, or 3) isolated using a 3-point scale (1=hardly ever, 2=some of the time, or 3=often). Participants were classified as “lonely” if they reported a score of ≥2 in at least 1 category. Frailty was assessed with the Liver Frailty Index (LFI);“frail”=LFI≥4.4. Logistic regression was used to associate loneliness and other factors. Results: Of 454 participants, 36% were female, median age was 60 years (IQR 53-64), median MELDNa was 14 (IQR 10-19), and 14% were frail. 181 (40%) met criteria for “lonely” in at least 1 category;49 (11%) met criteria for “lonely” in all 3 categories. Compared to those who were not lonely, those who reported feeling lonely were younger (58 v. 61y) and more likely to be female (46% v. 29%), frail (19 v. 11%), or have hepatic encephalopathy (62 v. 50%). There were no differences by race/ethnicity, disease etiology, ascites, or MELDNa score. In univariable analysis, age (OR 0.97, 95% CI 0.96-0.99), female sex (OR 2.16, 95% CI 1.46-3.21), frailty (OR 1.88, 95% CI 1.09-3.2), and hepatic encephalopathy (OR 1.60, 95% CI 1.09- 2.35) were associated with loneliness. After multivariable adjustment, younger age (OR 0.97, 95% CI 0.95-0.99), female sex (OR 1.95, 95% 1.30-2.90), and frailty (OR 1.5, 95% CI 1.2-1.96), remained significantly associated with loneliness. Conclusions: During the COVID-19 pandemic, loneliness was prevalent in patients with ESLD awaiting LT (40%). This is similar to rates reported in the general population (20-50%) during the pandemic, despite LT candidates being a select subgroup in which social support is a criterion for listing. In our cohort, younger age, female sex, and frailty were independently associated with loneliness. These data lay the foundation for future work investigating the extent to which loneliness impacts health outcomes in LT patients, as it does in the general population, and how targeting loneliness in interventions may facilitate improvements in frailty.

Spontaneous pneumomediastinum and pneumothorax in COVID-19 patients: A tertiary care experience.

INTRODUCTION: COVID-19 can occasionally complicate into spontaneous pneumothorax (SP) and/or spontaneous pneumomediastinum (SM). This study aims at exploring the occurrence of SP and or SM, risk factors, and outcomes in COVID-19 patients. MATERIALS AND METHODS: All patients with COVID-19, which complicated into SP and/or SM at Hamad Medical Corporation (the principal public healthcare provider in Qatar) from March to September 2020, were retrospectively enrolled. The clinical diagnosis was confirmed by CXR and CT. Between-group comparisons were performed by using Chi-square and t-test. Differences were considered statistically significant at P ≤ .05. RESULTS: A total of 1100 patients were admitted, and 43 patients developed SP, SP + SM, or SM. Most patients were males (42/97.9%), and the most common comorbidity was diabetes mellitus (13/30.2%). All patients had acute respiratory distress syndrome (ARDS), and most patients had low lung compliance at the time of developing SP or SM. Twenty-two of the patients developed SP (51.2%), 11 patients had both SP and SM (25.6%), and 10 patients had SM only (23.3%). There was no significant difference in the development of SP or SM and patients' gender or blood group or whether patients were on invasive or noninvasive ventilation or even the mortality (P > .05). Lung compliance was significantly (P < .05) lower in patients complicated with SP and or SM. Patients with SP required significantly higher (P < .001) chest drain insertion. CONCLUSION: Patients with severe COVID-19 pneumonia can complicate into SP and SM. These complications are more common in male diabetic patients. Patients with ARDS and having low lung compliance are at a higher risk of developing SP, SP + SM, or SM.

Comparison of the clinical outcomes of non-invasive ventilation by helmet vs facemask in patients with acute respiratory distress syndrome.

ABSTRACT: The main aim of this study is to compare the use of non-invasive ventilation (NIV) via helmet versus face mask where different interfaces and masks can apply NIV. However, some of the limitations of the NIV face mask were air leak, face mask intolerance, and requirement of high positive end expiratory pressure, which could be resolved with the use of the helmet NIV. NIV facemask will be applied as per the facial contour of the patient. NIV helmet is a transparent hood and size will be measured as per the head size. Both groups will have a standard protocol for titration of NIV.Patients aged more than 18 years old and diagnosed with acute respiratory distress syndrome as per Berlin definition will be enrolled in the study after signing the informed consent. Subjects who met the inclusion criteria will receive 1 of the 2 interventions; blood gases, oxygenation status [Po2/Fio2] will be monitored in both groups. The time of intubation will be the main comparison factor among the 2 groups. The primary and secondary outcomes will be measured by the number of patients requiring endotracheal intubation after application of helmet device, Improvement of oxygenation defined as PaO2/FiO2 ≥ 200 or increase from baseline by 100, duration of mechanical ventilation via an endotracheal tube, intensive care unit length of stay, death from any cause during hospitalization at the time of enrolment, need for proning during the hospital stay, intensive care unit mortality, and the degree to which overt adverse effects of a drug can be tolerated by a patient including feeding tolerance. TRIAL REGISTRATION NUMBER: NCT04507802. PROTOCOL VERSION: May 2020.

Right atrial mass in a patient with COVID-19 pneumonia: A case report.

Lipomatous hypertrophy of the interatrial septum can have an atypical appearance by transthoracic echocardiography. The authors emphasize on the importance of the multimodality imaging approach to reach the appropriate diagnosis in such cases.

Clinical outcomes of intravenous immunoglobulin therapy in COVID-19 related acute respiratory distress syndrome: a retrospective cohort study (preprint)

Background: Immunomodulatory property of intravenous immunoglobulin (IVIG) has been used to counteract severe systemic inflammation in coronavirus disease 2019 (COVID-19). However, its use in acute respiratory distress syndrome (ARDS) due to COVID-19 pneumonia is not well established.Methods: In this retrospective study, we analyzed electronic health records of COVID-19 patients admitted to intensive care units (ICUs) at Hazm Mebaireek General Hospital, Qatar, between March 7, 2020, and September 9, 2020. Patients receiving invasive mechanical ventilation for moderate-to-severe ARDS were divided into two groups based on whether they received IVIG therapy. The primary outcome was all-cause ICU mortality. Secondary outcomes studied were ventilator-free days and ICU-free days at day-28 and incidence of acute kidney injury (AKI). Propensity score matching was used to adjust for confounders, and the primary outcome was compared using competing-risks survival analysis.Results: Among 590 patients included in the study, 400 received routine care, and 190 received IVIG therapy in addition to routine care. One hundred eighteen pairs were created after propensity score matching with no statistically significant differences between the groups. Overall ICU mortality in the study population was 27.1%, and in the matched cohort, it was 25.8%. Mortality was higher among IVIG-treated patients (36.4% vs. 15.3%; sHR 3.5; 95% CI 1.98- 6.19; P<0.001). Ventilator-free days and ICU-free days at day-28 were lower (P<0.001 for both), and the incidence of AKI was significantly higher (85.6% vs. 67.8%; P=0.001) in the IVIG group.Conclusion: IVIG therapy in mechanically ventilated patients with COVID-19 related moderate-to-severe ARDS was associated with higher ICU mortality. A randomized controlled study is required to confirm this observation further.

Managing a patient with bipolar disorder associated with COVID-19: A case report from Qatar.

This case highlights an atypical presentation of a patient with unknown history of mental disease who has been diagnosed with a bipolar disorder associated with severe COVID-19 symptoms. Neuroimaging was only positive for subtle white matter changes; he was treated with antipsychotics and mood-stabilizing agents until he reached partial remission. The authors urge clinicians to consider the impact of the COVID-19 pandemic on patients with mental illness and the urgent need for vigilant monitoring of presenting signs and symptoms.

Management considerations for a critically ill 26-gestational week patient with COVID-19: A case report.

Pregnant women are potentially more susceptible to respiratory tract infections making them a high-risk group. We describe the successful management of a 35-year-old pregnant woman, G3, P1, with a history of a cesarean section who tested positive for COVID-19 at 26 weeks and required critical care support.