Clinical, laboratory, and imaging findings of stage 3-5 chronic kidney disease patients suffering from COVID-19 in Bangladesh: a prospective cross-sectional study (preprint)

Background: Chronic kidney disease (CKD) patients were susceptible to morbidity and mortality once they affected by COVID-19. These patients were more likely to develop severe disease, requiring dialysis, admission to intensive care unit. The aim of this study was to evaluate the presentations and outcomes of COVID-19 in stage 3-5 CKD patients not on dialysis. Methods This prospective observational study was conducted in the COVID-19 unit, at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from September 2020 to August 2021. Hospitalized RT-PCR positive COVID-19 patients with pre-existing CKD having eGFR <60 ml/min/1.73 m 2 but not yet on dialysis were enrolled. Clinical and laboratory parameters were recorded. Outcomes were observed till discharge from the hospital and followed up after 3 months of survived patients. Results Out of 109 patients, the mean age was 58.1(SD: 15.4) years where 61.5% were male. Common co-morbid conditions were hypertension (89.0%), diabetes mellitus (58.7%) and ischemic heart disease (24.8%). Fever, cough, shortness of breath and fatigue were common presenting features. Most of the patients had moderate (41.3%) and severe (41.3%) COVID-19. Sixty-six patients (60.6%) developed AKI on CKD. Twenty patients (30.3%) required dialysis. Death occurred in 16 patients (14.7%) and 12 patients (11%) required ICU admission and 6 patients (9.1%) achieved baseline renal function at discharge. We identified risk factors like low haemoglobin, lymphopenia, high CRP, high procalcitonin, high LDH and low SpO 2 in patients who did not survive. Seventy-six patients were followed up at 3rd month where 17 patients were lost. Ten patients (27.0%) achieved baseline renal function who had persistent AKI at discharge and 34 patients (87.1%) remained stable who had stable renal function at discharge. Conclusion The stage 3-5 chronic kidney patients with COVID-19 are vulnerable to severe to critical morbidity and mortality with higher incidence of AKI which demands a special attention to this group of patients.

Efficacy of ultra-short, response-guided sofosbuvir and daclatasvir therapy for Hepatitis C: a single arm mechanistic pilot study (preprint)

ABSTRACT Background WHO has called for research into predictive factors for selecting persons who could be successfully treated with shorter durations of direct acting antiviral (DAA) therapy for Hepatitis C. We evaluated early virological response as a means of shortening treatment and explored host, viral and pharmacokinetic contributors to treatment outcome. Methods Duration of sofosbuvir and daclatasvir (SOF/DCV) was determined according to day 2 (D2) virologic response for HCV genotype (gt) 1- or 6-infected adults in Vietnam with mild liver disease. Participants received 4 or 8 weeks treatment according to whether D2 HCV RNA was above or below 500 IU/ml (standard duration is 12 weeks). Primary endpoint was sustained virological response (SVR12). Those failing therapy were retreated with 12 weeks SOF/DCV. Host IFNL4 genotype and viral sequencing was performed at baseline, with repeat viral sequencing if virological rebound was observed. Levels of SOF, its inactive metabolite GS-331007 and DCV were measured on day 0 and 28. Results Of 52 adults enrolled, 34 received 4 weeks SOF/DCV, 17 got 8 weeks and one withdrew. SVR12 was achieved in 21/34 (62%) treated for 4 weeks, and 17/17 (100%) treated for 8 weeks. Overall 38/51 (75%) were cured with first-line treatment (mean duration 37 days). Despite a high prevalence of putative NS5A-inhibitor resistance associated substitutions (RAS), all first-line treatment failures cured after retreatment (13/13). We found no evidence treatment failure was associated with host IFNL4 genotype, viral subtype, baseline RAS or DCV levels. SOF metabolite levels were higher in those failing 4-week therapy. Conclusions Shortened SOF/DCV therapy, with retreatment if needed, reduces DAA use while maintaining high cure rates. D2 virologic response alone does not adequately predict SVR12 with 4 weeks treatment. Funding Funded by the Medical Research Council (grant MR/P025064/1) and The Global Challenges Research Fund (Wellcome Trust Grant 206/296/Z/17/Z).) Clinical trial number ISRCTN17100273

Covid-19 Detection in Chest X-ray Through Random Forest Classifier using a Hybridization of Deep CNN and DWT Optimized Features

Chest X-ray image contains sufficient information that finds wide-spread applications in diverse disease diagnosis and decision making to assist the medical experts. This paper has proposed an intelligent approach to detect Covid-19 from the chest X-ray image using the hybridization of deep convolutional neural network (CNN) and discrete wavelet transform (DWT) features. At first, the X-ray image is enhanced and segmented through preprocessing tasks, and then deep CNN and DWT features are extracted. The optimum features are extracted from these hybridized features through minimum redundancy and maximum relevance (mRMR) along with recursive feature elimination (RFE). Finally, the random forest-based bagging approach is used for doing the detection task. An extensive experiment is performed, and the results confirm that our approach gives satisfactory performance compare to the existing methods with an overall accuracy of more than 98.5%.

Preventing laboratory-associated infections in the COVID-19 era: experience from a tertiary care infectious disease hospital in Southern Vietnam (preprint)

Objectives: Laboratory staff is at higher risk of coronavirus disease 2019 (COVID-19) infection owing to the handling of patient samples. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) focus risk assessment and risk management are essential for preventing laboratory acquired infections (LAIs). We present herein the steps taken to prevent LAIs related to SARS-CoV-2 testing from February 1, 2020 to September 17, 2020 in a tertiary care hospital in Vietnam. Results: A SARS-CoV-2-focused risk assessment was conducted for laboratory processes. Risk management strategies, including engineering, administrative and operations control procedures, were established. This includes the use of dedicated facility, instrument, and cold chain units for testing; SOPs; training (testing, decontamination and cleaning staff); the introduction of biosafety level 2+ laboratory practices; COVID-19 symptom reporting; enhanced cleaning protocols; and the assigning of additional staff for testing and safety system implementation. In total, 38,377 (daily mean and range: 166; 3 – 2,377) samples were received and tested. The turnaround time (median ± standard deviation (SD)) was 3.54 ± 2.97 days. Altogether, 32 staff members were involved with SARS-CoV-2 testing and biosafety management, and there were no reports of COVID-19 symptoms among them.