Clinical features, laboratory characteristics and risk factors for mortality of COVID-19 patients in a secondary hospital in Oman during the first wave of the SARS-CoV-2 pandemic

BackgroundThe changing epidemiological profile of the COVID-19 pandemic and the uncertain clinical picture of patients characterise this ongoing and most challenging health event.ObjectivesTo report clinical features, laboratory characteristics, and mortality risk factors among COVID-19 patients admitted to a secondary hospital in Oman.MethodsA retrospective study for the first 455 patients admitted with COVID-19 to Rustaq hospital from 12th April, 2020 to 27th September, 2020. A predesigned questionnaire collected data from the hospital medical electronic system.ResultsThe mean age was 42.84 (SD = 19.86) years, and the majority of patients were aged 30 to 59 and 60 or above;207 (45.5%) and 189 (41.5%), respectively. Male patients constituted approximately two-thirds of the subjects. Fever, dyspnea and cough were the most common presenting symptoms (69%, 66%, and 62%, respectively), while comorbidities with diabetes mellitus and hypertension were 47% and 44%, respectively. Bacterial growth was identified at approximately 10%. Bivariate analysis turned out to be significant with a number of factors. However, multivariate analysis showed significance with patients aged over 60 (OR = 7.15, 95% CI 1.99–25.63), dyspnea (OR = 2.83, 95% CI 1.5–5.33), dyslipidemia (OR = 1.93, 95% CI 1.02–3.66) and being bed-ridden (OR = 5.01, 95% CI 1.73–14.44). Durations from onset of symptoms to admission and respiratory distress were lower among patients who died;p = 0.024 and p = 0.001, respectively. Urea, Troponin and LDH may act as potential diagnostic biomarkers for severity or mortality.ConclusionsThis study identified groups of patients with a higher risk of mortality, with severe disturbance in the laboratory markers while some could act as potential diagnostic biomarkers.

A new interventional home care model for COVID management: Virtual Covid IP.

AIM: Amidst COVID-19 pandemic, the health care delivery in India faces major challenges owing to the overwhelming hospitals, exhausted healthcare workers, and shortage of crucial medical supplies such as ventilators and oxygen. The study aims to propose a novel successful interventional home care model, the Virtual COVID In-Patient (VCIP) care for effective COVID management. METHODS: The Covid-19 positive patients enrolled in VCIP were chosen for the study. A 24/7 active multidisciplinary WhatsApp group was created for each patient, for remote monitoring of temperature, blood pressure, blood glucose, respiratory and pulse rate along with the symptoms. Advice on sleep and exercises were given along with the medication via video-audio consultations. Lab facility was provided at the doorstep. Training on various devices, medications including steroids, delivering subcutaneous injections etc were given via video platforms. RESULTS: Among the 220 patients who availed the VCIP facility, only two were hospitalized, yielding a 99.5 % success rate in preventing hospitalizations and patients enrolled have been immensely satisfied with their experience. CONCLUSIONS: With similar pandemics anticipated in near future, VCIP model may be considered for successful domiciliary treatment and overcoming the challenges.

Post COVID-19 Syndrome ("Long COVID") and Diabetes: Challenges in Diagnosis and Management.

BACKGROUND AND AIMS: Post Covid-19 syndrome (PCS) is a major cause of morbidity. In this article we intend to review the association and consequences of PCS and diabetes. METHODS: We reviewed all studies on "Long Covid", "Post COVID-19 Syndrome" and diabetes in PubMed and Google Scholar. RESULTS: The symptoms of PCS can be due to organ dysfunction, effects of hospitalisation and drugs, or unrelated to these. Type 2 diabetes mellitus has a bidirectional relationship with COVID-19. Presence of diabetes also influences PCS via various pathophysiological mechanisms. COVID-19 can add to or exacerbate tachycardia, sarcopenia (and muscle fatigue), and microvascular dysfunction (and organ damage) in patients with diabetes. CONCLUSION: PCS in patients with diabetes could be detrimental in multiple ways. Strict control of diabetes and other comorbidities, supervised rehabilitation and physical exercise, and optimal nutrition could help in reducing and managing PCS.

Management Strategies for Dealing With Surges of the COVID-19 Pandemic.

The spread of COVID-19 (coronavirus disease 2019) across the world has resulted in widespread morbidity and mortality. An explosive increase in the number of cases during the surge phase of the pandemic can result in a management crisis. Therefore, we propose a simple model to manage the surges of the pandemic.

Long COVID: An overview.

BACKGROUND AND AIMS: Long COVID is the collective term to denote persistence of symptoms in those who have recovered from SARS-CoV-2 infection. METHODS: WE searched the pubmed and scopus databases for original articles and reviews. Based on the search result, in this review article we are analyzing various aspects of Long COVID. RESULTS: Fatigue, cough, chest tightness, breathlessness, palpitations, myalgia and difficulty to focus are symptoms reported in long COVID. It could be related to organ damage, post viral syndrome, post-critical care syndrome and others. Clinical evaluation should focus on identifying the pathophysiology, followed by appropriate remedial measures. In people with symptoms suggestive of long COVID but without known history of previous SARS-CoV-2 infection, serology may help confirm the diagnosis. CONCLUSIONS: This review will helps the clinicians to manage various aspects of Long COVID.

Remdesivir and favipiravir for COVID -19: An update

COVID-19 pandemic due to SARS-CoV-2 infection has already resulted in more than 6 lakhs death worldwide. Various drugs like hydroxychloroquine, lopinavir/ritonavir, dexamethasone, ivermectin etc are examples of drugs currently used to treat COVID-19 with varying results. Remdesivir is a broad spectrum anti-viral agent, which is active against Middle East respiratory syndrome coronavirus (MERS-CoV), SARS-CoV-1, Ebola virus etc. Favipiravir had been widely used for treating influenza pandemics in Japan in 2014 .Studies showed that it was effective for treating many RNA viruses like arenavirus, bunyavirus, flavivirus, and filoviruses causing hemorrhagic fever and Ebola virus. Remdesivir and favipiravir are anti-viral agents tried in patients with COVID-19 with varying results. Currently Remdesivir is recommended in hospitalized patients with COVID-19 requiring supplemental oxygen and favipiravir in patients with mild to moderate disease. In this article we are reviewing the pharmacological features and clinical use of Remdesivir and favipiravir in COVID-19.

Does a younger host make the virus weaker? Presenting a new hypothesis.

BACKGROUND: COVID-19 is a pandemic, resulting in large number of deaths all over the world. METHODS: The risk factors for mortality are not clearly understood. We are presenting a new hypothesis. RESULTS: Virus become more virulent as it passes through weaker hosts and vice versa. CONCLUSIONS: Viruses become more virulent when it passes through weaker and older hosts. It will be worth analysing the transmission chain of COVID-19 from this perspective.

Reverse quarantine and COVID-19.

BACKGROUND: COVID-19 is a pandemic, resulting in large number of deaths all over the world. Lack of effective antiviral agents and vaccines pose a major challenge to control this pandemic. METHODS: Review the role of reverse quarantine in the control of COVID-19. RESULTS: Public health measures like social distancing, wearing face mask and hand hygiene along with quarantine measures form important steps to control the disease. Reverses quarantine is a useful strategy to reduce morbidity and mortality associated with COVID-19. CONCLUSIONS: Reverse quarantine is a promising public health measure to reduce the morbidity and mortality associated with COVID-19.