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BackgroundPatients with autoimmune rheumatic disease (AIRD) are at risk of severe COVID-19 infection and vaccine has been demonstrated to be able to reduce the severity of infection. Malaysia has a low flu vaccination coverage rate (approximately 3%) and hence it is important to assess the perception and hesitancy of COVID-19 vaccine especially among the vulnerable group.ObjectivesTo study the perception of COVID-19 vaccine and to determine the prevalence of vaccine hesitancy among AIRD patients in Malaysia.MethodsThis was a cross-sectional survey using online Google Forms® that was conducted among adult AIRD patients (18 years and older) from August 2021 until February 2022. Patients were recruited from the outpatient clinics as well as distribution of the survey through social medias. The survey was in English and Malay language. The survey collected data on the socio-demographic background, prior history of other vaccination after the age of 18 and COVID-19 vaccination with reasons of hesitancy, defined as being unsure or unwilling to be vaccinated. The survey also assessed the patients' perception by specifying the level of agreement to COVID-19 vaccine statements using the Likert response scale: 1-Strongly disagree;2- Disagree;3-Neither agree nor disagree;4-Agree;5-Strongly agree.ResultsA total of 162 patients participated in the survey and majority of them were females (87.7%). Our multi-racial cohort consisted of Malay (n=103, 63.5%), followed by Chinese (n=38, 23.5%), Sabahan Bumiputra (n=12, 7.4%) and Indian (n=7, 4.3%). More than half (n=107,66.6%) have not had any history of other vaccination after the age of 18. Only 16.7% (n=27) agreed/strongly agreed that COVID-19 vaccine can be given to patients with co-morbidities and 24.1 (n=39) agreed/strongly agreed that COVID-19 vaccine can be given to patients who have history of allergy to other drugs or food. At the time of the survey, vast majority of the respondents have received at least the 1st dose of Covid-19 vaccine (n=148, 91.4%). A total of 9 (5.6%) patients were hesitant to be vaccinated (6 were unsure and 3 patients were not willing to be vaccinated). The commonest reasons of being unsure or not willing to be vaccinated was worried of the vaccine's adverse effects (66.7%), worried of the blood clot complication (33,3%), worried of disease flare post-vaccine (33,3%), worried of allergic reaction (22.2%), lack of information on the safety of the vaccine in patients with AIRD from government and media (22.2%), face mask and social distancing measures were adequate (22.2%). Statistical analysis revealed that more patients who had vaccine hesitancy were from the lower socioeconomic status (income <1066 Euro/month), 88.9% vs 11.1%, p=0.03 but no association with ethnicity, education status, marital status or place of residence (urban vs rural).ConclusionCOVID-19 vaccine hesitancy is low in Malaysian patients with AIRD but patients with a low socioeconomic status are prone to have vaccine hesitancy. More education on the vaccine's efficacy and safety especially among patients with co-morbidities are warranted.Reference[1]Knowledge, acceptance and perception on COVID-19 vaccine among Malaysians: A web-based survey. Mohamed NA, Solehan HM, Mohd Rani MD, Ithnin M, Che Isahak CI (2021) Knowledge, acceptance and perception on COVID-19 vaccine among Malaysians: A web-based survey. PLOS ONE 16(8): e0256110.Acknowledgements:NIL.Disclosure of InterestsSyahrul Sazliyana Shaharir Speakers bureau: Pfizer,Novartis, Lydia Kamaruzaman: None declared, Theepa Nesam Mariamutu: None declared, Mohd Shahrir Mohamed Said: None declared, Azmawati Mohammed Nawi: None declared, Wan Syamimee Wan Ghazali: None declared, Malehah Mohd Noh: None declared.
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Intro: The spike protein of the SARS-CoV-2 virus targets the human cell receptor of angiotensin-converting enzyme (ACE2), including the myocardium and heart's conduction system. Patients diagnosed with COVID-19 have also been found to exhibit cardiac arrhythmia. Here, a whole-genome sequencing analysis using long-read sequencing was proposed to evaluate the virus genome in a patient who presented with AVNRT as a main presentation of COVID-19. Method(s): The sample was recovered from nasopharyngeal and oropharyngeal swab specimens of a 46-year-old female with no comorbidities who presented with palpitation, and ECG showed typical AVNRT features. The RT-qPCR of SARS- CoV-2 was confirmed positive with a CT-value of 15.82. The total RNAs were extracted and proceeded for RT-qPCR and proceeded with Oxford Nanopore Flongle sequencing. The genomics data of the virus was deposited in GISAID (EPI_ISL_3241561) and further analysed using online bioinformatics tools such as Nextclade CLI 2.3.0. Ethical approval (IREC 2021-080) for the study was obtained from IIUM Research Ethics Committee. Finding(s): Here, we reported a total of 29,775 bp near-complete whole-genome belonging to clade 21J (Delta) of AY.79 lineage (also known as B.1.617.2.79), which formed a dominant variant in Malaysia during the time of sampling. Discussion(s): While a previous study showed an association between Delta variant infection with fulminant myocarditis, the present study reported the benign AVNRT as the main presentation of SARS-CoV-2 infection. Furthermore, we observed the presence of the C3037T mutation previously described in the endomyocardial biopsy of a patient with persistent arrhythmia. Conclusion(s): Even though SARS-CoV-2 targets the respiratory tract, the present study supports the evidence that the ACE2 receptors are present in the heart. In addition, COVID19 is causing more and more damage to heart tissue, and viral transcription has been confirmed on cardiomyocytes. Further functional studies are needed to explore the associated mutations and their relation to cardiac manifestation.Copyright © 2023
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Acute pancreatic pseudocysts are increasingly recognized as complications in patients with coronavirus disease 2019 (COVID-19). There-fore, it is important for healthcare providers to be aware of this phenomenon to ensure proper diagnosis and treatment. Up to 17% of patients with severe acute respiratory syndrome corona-virus 2 (SARS-CoV-2) infection have been shown to develop pancreatic lesions. These pancreatic lesions can be caused directly by the cytopathic effects of the viral infection or indirectly by systemic responses to inflammation or respiratory failure. Several studies have shown that angio-tensin-converting enzyme 2 (ACE2) is the functional receptor used by SARS-CoV-2 to gain access to target cells, while ACE2 receptors are expressed in significant amounts in the pancreas. In this article, we present 2 cases of COVID-19. patients that presented with similar pancreatic lesions. The first case was a 47-year-old lady who presented to the emergency department (ED) with flu-like symptoms for ten days. Incidental findings on computed tomography (CT) scan showed a large, multiloculated cystic mass in the pancreatic tail. The second case was an 81-year-old Caucasian lady who presented to the outpatient clinic with multiple chronic complaints after an acute COVID-19 infection four months prior. Abdominal CT scan with oral contrast revealed multiple hypodense masses on the pancreas measuring 0.3 cm in diameter. The cases we reported in this article showed the degree of COVID-19's effect on the gastrointestinal system, with pancreatic injury occurring during the early phases of the acute phase of the infection and lasting up to 4 months post-resolution of the infection.Copyright © 2023, The Indonesian Foundation of Critical Care Medicine. All rights reserved.
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In recent years, the excessive use of electronic cigarettes (e-cigarettes), and vaping, as a re-placement for traditional tobacco cigarettes, have highlighted potential health risks for users. One such risk is the development of "electronic cigarette (vaping) product use-associated lung injury" (EVALI). This type of lung injury has an unclear cause that may be related to the various components found in e-cigarette fluids. The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection (coronavirus disease . 2019 or COVID-19) may worsen EVALI symptoms in individuals with both conditions. This could be due to the increased oxidative stress and inflammation caused by e-cigarette use, as re-search shows increased levels of reactive oxygen species (ROS) and decreased glutathione. In this paper, we present two critical cases of COVID-19 patients with a history of chronic e-cigarette smoking and describe their clinical progression during hospitalization. The findings suggest that their prolonged use of e-cigarettes may have sig-nificantly impacted the severity of the disease.Copyright © 2023, The Indonesian Foundation of Critical Care Medicine. All rights reserved.
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Background: The recent pandemic of COVID-19 has left a wide range of after-effects on the health of older adults. The effects of the pandemic have been particularly felt in the areas of physical strength, fatigue, and functional performance. Material(s) and Method(s): Fifty-four participants were allocated into three groups: Tai Chi (TC) attended 4 sessions of 60-min TC training per week for consecutive 12 weeks, Aerobic Training (AT) attended 4 sessions of 60-min aerobic training per week for 12 weeks, and Control (CON) instructed to maintain a daily routine. Hand grip strength (HGS) and Fatigue Severity Scale (FSS) were used to evaluate the participants. Functional performance outcomes were determined The functional performance outcome was determined by The 30-second Chair Stand Test (CST), The 30-second Arm Curl Test (ACT), The 8-feet Up-and-Go test (TUG), and The 2 min steps. Pre-post comparisons of all outcomes in each group and comparisons between groups were analyzed using the ANOVA test with SPSS software. Result(s): After the intervention, TC and AT groups both experienced significant improvements in HGS, fatigue levels, CST, ACT, TUG, and 2-minute steps compared to baseline (all P < 0.001). The Tai Chi group also experienced significantly improved hand grip strength (p =0.0435, mean difference of-2.5), and ACT (p =0.0235, mean difference of 1) compared to the AT group. Conclusion(s): Tai Chi is an integrated rehabilitation program that had a positive effect on hand grip strength, fatigue levels, and functional performance compared to aerobic training in the elderly post-COVID-19.Copyright © 2023, Codon Publications. All rights reserved.
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The COVID-19 pandemic has forced almost all countries in the world to implement lockdowns. The impact of the COVID-19 pandemic is work from home. This study examines employee preferences and organizational support directly and indirectly through virtual teamwork communication on employee task performance and Financial Well-being. This study used the descriptive qualitative method. The study involved 156 employees working in education, telecommunications, transportation and health in South Kalimantan, Indonesia. Sampling was carried out randomly among employees in the research department. The reliability of the research tool is above the acceptable level with Cronbach's alpha above 0.70. The data analysis used is path analysis. The results showed that employee preferences and organizational support had a direct effect on Financial Well-being and task performance. Virtual team communication can mediate influence in enhancing the relationship between employee preferences and organizational support. The research implication shows that well-functioning virtual team communication can contribute to improved work performance as well as Financial Well-being. Therefore, collaborative support is needed, both individual and organizational support. © 2022 Institute of Society Transformation. All rights reserved.
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Background At the time of conducting this study, we were at the peak of the influenza season, and influenza vaccinations were not readily accessible throughout the country. Thus, predisposing many high-risk individuals to influenza infections in a time when coronavirus disease 2019 (COVID-19) was also highly circulating, and the emerging Omicron variant of concern was peaking in many countries worldwide.Methods We conducted a brief survey to prospectively estimate the frequency of influenza A and B and severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) in samples received at our laboratories at Libyan Biotechnology Research Center, Tripoli, Libya, between December 1, 2021, and January 31, 2022, for patients complaining of respiratory symptoms using a multiplex reverse transcription-polymerase chain reaction test for SARS-COV-2, influenza A and B, and RSV.Results We analyzed nasopharyngeal swabs in viral transport media from 2,186 samples. About 27% (589/2186) of study patients tested positive for SARS-COV-2, 2.8% (61/2186) were positive for influenza A virus, 0.18% (4/2186) for influenza B virus, and 1.4% (31/2186) tested positive for RSV.Conclusions These results revealed that along with COVID-19, influenza infections were also rising. As the COVID-19 pandemic continues, the most significant concern is the development of an influenza outbreak in the upcoming months. Therefore, continuing annual influenza vaccination is critical to increasing population immunity. National influenza surveillance and testing should also be conducted. Furthermore, sequencing and antigenic characterization should be performed regularly. There is a need for continuous monitoring in national laboratories to detect any zoonotic cases and substantial viral evolution.
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This study evaluates whether social media plays a role as the main source of information and, at the same time, as information sharing. Research on information-seeking behaviour, information needs, and information sharing has received increasing attention from various scientific communities since COVID-19 was declared a global epidemic. However, efforts have not been made to compare the capabilities of digital and interpersonal channels in both aspects of seeking and sharing information in Indonesia. Among the siege of information sources, identifying the primary sources of information used by students is important if the government is to intervene in health policies to overcome the pandemic. With an online survey conducted on 624 students, this study revealed that social media, which appears to be dominant as a source of COVID-19 information, cannot influence the behaviour of sharing information with others. The ETA correlation test confirms no correlation between the information source and information sharing behaviour. Indonesian students are moved to pass on information from interpersonal communication. In the two-stage communication model, individuals obtain information from the media and then discuss the information with others, which emerged in the conventional era and is still valid in today's digital era. The issue of trust is still inherent in social media, which makes it difficult to confirm the information on social media to be shared with others. The study explains that although communication technology has developed into the digital era, it does not necessarily eliminate the role of conventional technology. © 2023, Penerbit Universiti Kebangsaan Malaysia. All rights reserved.
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Abstract: PhOMe-salophen (1b) (salophen is N,N-bis(salycilidene)-1,2-phenylenediamine with two tert-butyl on each ring) and Cu(II) complex with PhOMe-salophen (1c) have been synthesized and characterized using various tools, including X-ray diffraction for the Cu(II)-complex (1c, C43H52CuN2O3)). The copper complex has been obtained by Cu2+ templated approach using 1b. PhOMe-salophen (1b) has been obtained in reasonably high yield using a mixture of the Schiff-base, 1a, Pd(OAc)2, PPh3, Na2CO3, 4-methoxyphenylboronic acid in benzene. We focus in this research work on the electronic and structural properties of the Cu–Schiff base complex. The tetra-coordinate τ4 index was calculated, indicating almost a perfect square planner in agreement with X-ray diffraction results. MEP reveals the maximum positive regions in 1/-associated with the azomethine and methoxyphenyl C–H bonds with an average value of 0.03 a.u. Hirshfeld surface analysis (HSA) was also studied to highlight the significant inter-atomic contacts and their percentage contribution through 2D Fingerprint plot. In a fair comparative molecular docking study, 1b and 1c were docked together with N-[{(5-methylisoxazol-3-yl)-carbonyl}alanyl}-l-valyl]-N1-((1R,2Z)-4-(benzyloxy)-4-oxo-1-[{(3R)-2-oxopyrrolidin-3-yl}methyl]but-2-enyl)-l-leucinamide, N3 against main protease Mpro, (PDB code 7BQY) using the same parameters and conditions. Interesting here to use the free energy, in silico, molecular docking approach, which aims to rank our molecules with respect to the well-known inhibitor, N3. The binding scores of 1b, 1c, N3 are –7.8, –9.0, and –8.4 kcal/mol, respectively. These preliminary results propose that ligands deserve additional study in the context of possible remedial agents for COVID-19. © 2022, Pleiades Publishing, Ltd.
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Small-scale business owners are among those who were very affected when the COVID-19 pandemic hit the country. This group supports their families solely through daily sales profits. However, when the country began implementing the Movement Control Order (MCO) from March 2020 to May 2020, it was difficult for this group to survive. Some of them were unable to do business at all, while the majority experienced a significant decline in sales. This study aims to measure the ability of small-scale business owners to survive before and after the COVID-19 period. GIS software (ArcMap 10.4.1) was used to map the ability of small-scale business owners to survive before and after the pandemic. Data were obtained through face-to-face questionnaires conducted throughout the state of Kedah. Findings indicated that several districts have successfully managed the pandemic for economic survival. This was achieved through a well-collaborated effort by the government and NGOs to strengthen certain aspects of these small-scale business and revive their growth. Future work should focus on studying the actions taken by successful business owners in coping with the pandemic environment. © 2023 by the authors.
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The Covid-19 pandemic has forced almost all countries in the world to implement lockdowns. The impact of the Covid-19 pandemic is work from home. This study examines employee preferences and organizational support directly and indirectly through virtual teamwork communication on employee task performance in environmental management sector. This study used the descriptive qualitative method. The study involved 156 employees working in environmental management sector, education, telecommunications, and transportation in South Kalimantan, Indonesia. Sampling was carried out randomly among employees in the research department. The reliability of the research tool is above the acceptable level with Cronbach's Alpha above 0.70. The data analysis used is path analysis. The results showed that employee preferences and organizational support had a direct effect on task performance in environmental management sector. Virtual team communication can mediate influence in enhancing the relationship between employee preferences and organizational support. The research implication shows that well-functioning virtual team communication can contribute to improved work performance in environmental management sector. Therefore, collaborative support is needed, both individual and organizational support. © 2022, Procedia Environmental Science, Engineering and Management. All Rights Reserved.
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Background At the time of conducting this study, we were at the peak of the influenza season, and influenza vaccinations were not readily accessible throughout the country. Thus, predisposing many high-risk individuals to influenza infections in a time when coronavirus disease 2019 (COVID-19) was also highly circulating, and the emerging Omicron variant of concern was peaking in many countries worldwide.Methods We conducted a brief survey to prospectively estimate the frequency of influenza A and B and severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) in samples received at our laboratories at Libyan Biotechnology Research Center, Tripoli, Libya, between December 1, 2021, and January 31, 2022, for patients complaining of respiratory symptoms using a multiplex reverse transcription-polymerase chain reaction test for SARS-COV-2, influenza A and B, and RSV.Results We analyzed nasopharyngeal swabs in viral transport media from 2,186 samples. About 27% (589/2186) of study patients tested positive for SARS-COV-2, 2.8% (61/2186) were positive for influenza A virus, 0.18% (4/2186) for influenza B virus, and 1.4% (31/2186) tested positive for RSV.Conclusions These results revealed that along with COVID-19, influenza infections were also rising. As the COVID-19 pandemic continues, the most significant concern is the development of an influenza outbreak in the upcoming months. Therefore, continuing annual influenza vaccination is critical to increasing population immunity. National influenza surveillance and testing should also be conducted. Furthermore, sequencing and antigenic characterization should be performed regularly. There is a need for continuous monitoring in national laboratories to detect any zoonotic cases and substantial viral evolution.
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Synthesis of a new fluorinated nucleoside of 6,7-difluoro-2-methyl-4-quinazolinone was described. 2-Amino-4,5-difluorobenzoic acid 1 reacts with (CH3CO)2O followed by ammonia to form (1H)-6,7-difluoro-2-methyl-4-quinazolinone 3a. Ribosylation of a silylated 4 with l-O-acety1-2,3-5-tri-O-benzoyl-α-D-ribofuranose 5 forms a protected nucleoside 6 then unprotected from 6 to give a free nucleoside 7. Greener pasture biological docking of the cystine protease of COVID-19 [Mpro, code 7BQY, PDB] by novel nucleoside and fluoroquinazoline compounds is presented. LIGPLOT (2D) representations calculated for the same ligands are shown. A superposition of remdesivir approved medicine, N3 inhibitor, and our ligands docked together into the binding protein of 7BQY is also given for a fair comparison. The binding affinities of remdesivir, N3 inhibitor, the nucleoside 7, and fluoroquinazoline 3a, 3b compounds with 7BQY calculated under the same conditions are –7.7, –7.4, –7.6, –6.1, and –6.1 kcal mol–1, respectively. The high values were due to the existence of many hydrophobic interactions and hydrogen bonds between the ligands and the active amino acid residues of the receptor, indicating a promising candidate as a COVID-19 inhibitor. Pro Tox -II server showed that compound 7 has a similar feature to the approved antiviral drug remdesivir for COVID-19. Additionally, a fascinating molecular modeling investigation showed that our nucleoside demonstrated good binding inhibition of AChE enzyme towards advancing an efficient medication against Alzheimer's disease. Finally, DFT has been conducted to illustrate the MD results in terms of the molecular descriptor-based structural activity relationship calculated from FMOs. © TÜBÍTAK.
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INTRODUCTION: Advanced age is frequently cited as a prognostic indicator in critically ill patients. This study aimed to assess the association between outcomes in three age subgroups of older adults with COVID 19 patients. METHOD(S): Retrospective analysis of 994 adult patients admitted to our hospital between March 2020 and February 2022 with COVID-19. Patients with ages on admission >= 65 years were included and classified as young-old (65- 74 years), middle old (75-84 years), and oldest old (>= 85 years). Primary endpoints were survival, hospital length of stay (LOS), and need for mechanical ventilation. Secondary assessments included code status, ICHIKADO score, and the highest value of IL-6. Descriptive statistics, Pearson Chisquare, and Mann-Whitney-U methods were used. A p value <= 0.05 was considered statistically significant. RESULT(S): 293 patients with age on admission >= 65 years were included in this analysis. 183 (68.5%) were young old patients, 81(27.6%) middle old patients, and 29(9.9%) oldest old patients. The median age for non-survivors was 73[69- 78.2] years vs 72[68-78] years for survivors. 56(30.6%) patients from young old group died, 28 (34.6%) died in middle old group and 10(34.5%) in the oldest old (X2(2) =0.491, p=0.78). 22(12%) of the young old group were do not resuscitate (DNR), 11(13.6%) in the middle old group, and 7(24%) in the oldest old group(X2(2) =3.118, p=0.21). LOS for young old patients was 9[4-15] days, 10[5-16] days for middle old, and 8[5-13] days for oldest-old (H(2)=1.070 p=0.58). A total of 25(13.7%) young old patients required mechanical ventilation, 11(13.6%) middle old patients and 5(17.2%) oldest old patients (X2(2) =0.282, p= 0.86). ICHIKADO score was 160[121-200] in the young old group, 150 [110-230] in the middle old and 145[119.2-176.2] in the oldest old group (H(2) =1.426,p= 0.49). Regarding inflammatory markers, IL-6 wasn't different between the groups. In the young old IL-6 was 40.9[8.9-176.5]pg/ mL, 74.45[12-374.3]pg/mL in the middle old and 51.85 [14.25-812.2]pg/mL in the oldest old group (H(2) =3.336, p=0.189). CONCLUSION(S): Oldest old patients were not found to have increased IL6, worse computed tomography findings, increased risk of death, length of stay, or need for mechanical ventilation than their younger counterparts.
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INTRODUCTION: Coronavirus disease 2019 (COVID-19) infection has been associated with the development of acute kidney injury (AKI) in some patients. The purpose of this study was to assess the mortality rates among different ethnicity of COVID-19 patients who developed AKI. METHOD(S): A retrospective study of adult patients admitted to our hospital with COVID-19 from March 2020 to February 2022 was performed. Patients were divided into three groups based increased creatinine levels compared to their baseline creatinine, according to the KDIGO Guidelines for AKI: Stage 1 (S1;1.5 -1.9 times baseline creatinine), Stage 2 (S2;2.0-2.9 times baseline creatinine), and Stage 3 (S3;>3.0 times baseline creatinine). Survival to hospital discharge was assessed for each individual. Descriptive statistics, Chisquare, and Mann-Whitney tests were utilized. A p value <= 0.05 was considered statistically significant. RESULT(S): 192 patients with AKI admitted to our hospital with COVID-19 were included in this study. The median age was 61 [18-95]. 75 (39.1%) were female.101 (52.6%) patients survived. 111 (57.8%) were Hispanic, 22 (11.5%) were African-American, 48 (25.0%) were Caucasian, and 8 (4.2%) had other ethnicities. 45 (23.4%) patients were classified in S1, 52 (27.1%) were in S2, and 95 (49.5%) were in S3. In S1, 15 (33.3%) patients died and 30 (66.7%) survived. In S2, 24 (46.2%) died and 28 (53.8%) survived. In S3, 52 (54.7%) died and 43 (45.3%) survived. There was no correlation between mortality and AKI staging. (chi2(2) = 5.655, p = 0.059). Of 48 Caucasians, 10 (20.8%) had S1 on admission, 14 (29.2%) S2, and 24 (50.0%) S3. Of 111 Hispanics, 25 (22.5%) had S1, 31 (27.9%) S2, and 55 (49.5%) S3. Of 22 African-Americans, 7 (31.8%) had S1, 5 (22.7%) had S2, and 10 (45.5%) S3. Of 8 in other ethnicities, 1 (12.5%) had S1, 2 (25.0%) S2, and 5 (62.5%) S3. There was no statistical significance between AKI staging on admission and race. (chi2(6) = 1.845, p = 0.933). CONCLUSION(S): The development of AKI is not associated with increased mortality for any specific ethnicity.
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INTRODUCTION: Elevated D-dimer levels are common in hospitalized COVID-19 patients. We aimed to investigate the correlation between D-dimer levels and survival, as well as ICHIKADO, APACHE II, and SOFA scores. METHOD(S): Retrospective study of adult patients with COVID-19 admitted to the hospital between March 2020 and February 2022. Patients were divided into three groups according to D-dimer levels: group 1 (G1) had levels less than 0.5 mg/L, group 2 (G2) had 0.5 to 3.99 mg/L and group 3 (G3) was above 4 mg/L. The primary outcome was survival to hospital discharge. Descriptive statistics, Chi-square, and Kruskal-Wallis tests were used. A p value <= 0.05 was considered statistically significant. RESULT(S): 830 patients were included in the study. 464 (55.9%) patients were men. Median age was 56 [45-66] years. There was a statistically significant association between D-dimer levels and survival rate. A total of 677 (81.6%) patients survived. 401 (89.3%), 235 (74.8%), and 41 (61.2%) patients survived in G1, G2, and G3 respectively, p < 0.001. There was also a statistically significant association between D-dimer levels and different severity scores. Median ICHIKADO scores across D-dimer levels;G1 had a median score of 140.00 [115-180]], G2 had a score of 157.50 [120-205], and G3 had a score of 200.00 [160- 245] (H (2) = 55.345, p < 0.001). APACHE II scores across the groups;G1 had a median score of 7.00 [5-11], G2 had a score of 10.50 [7-16], and G3 had a score of 12.00 [8-19] (H (2) = 76.817, p < 0.001). For SOFA scores, G1 had a median score of 2.00 [1-2], G2 had a score of 2.00 [1-3.25], and G3 had a score of 4.00 [2-6] (H(2)= 81.309, p < 0.001). CONCLUSION(S): In this cohort, elevation of D-dimer levels was associated with decreased survival rates as well as with increased ICHIKADO, APACHE II, and SOFA scores.
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INTRODUCTION: Increased mortality due to COVID-19 in the intensive care unit (ICU) raised questions about the best way and time to use invasive mechanical ventilation (IMV). The purpose of this study is to analyze effectiveness of IMV in COVID-19 patients. METHOD(S): We performed a retrospective analysis of adult patients admitted to our hospital with COVID-19 infection from May 2020 to December 2021. We reviewed the need of IMV in patients admitted to the ICU with APACHE II scores higher than 12.5. Outcomes from the IMV-receiving patients were compared to outcomes from patients on non-invasive mechanical ventilation (NIMV). The second analysis of IMV aimed to determine the best initiation time for IMV. Patients were divided into Group1: early intubation (IMV within the first 24hrs of admission) and Group2: late intubation (IMV later than 24hrs after admission). Primary outcomes included mortality and length of stay (LOS) in the ICU. Descriptive statistics, Mann-Whitney-U and Chi-square methods were used. RESULT(S): For the first part of the analysis, 82 patients were included. They were divided into 2 groups (IMV and NIMV) of 41 patients each. Median age in IMV group was 67 [51.5- 75.5] vs 64 [47.5-73.5]. 21 (51.2%) patients died in the IMV group vs 22 (53.7%) X2(1, N=82)=0.049, p=0.5. Median LOS in the IMV group was 10 [6-16] days vs 11 [5-19.5] days U(NIMV group=41, NNIMV group=41)=819, z=-0.2, p=0.84. For the second analysis, 68 patients were included. They were divided into 2 groups (Group1 and 2) of 34 patients each. Median age in group1 was 53.5 [25-90] vs 53.5 [37.75-65.25]. 19 (55.9%) patients in group1 were male vs. 26 (76.5%). The median APACHE II, SOFA and ICHIKADO scores on admission in group1 were 8 [6-10.5], 1.5 [1-2], 120 [110-165] points respectively vs 9.5 [6-16.5], 2 [1-4], 150 [132.5-200] points. 3 (8.8%) patients died in group1 vs 11 (32.4%) X2(1, N=68)=5.76,p=0.033. Median LOS in group1 was 4.5 [3-8.5] days vs 6 [3.75-10.5] days U(NGroup1=34, NGroup2=34)=450, z=-1.59, p=0.113. CONCLUSION(S): In COVID-19 patients admitted to the ICU with APACHE II score higher than 12.5, mortality and LOS were not significantly different in patients that received IMV vs those that received NIMV. Early intubation correlated with improved mortality, but not with length of ICU stay.
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INTRODUCTION: The antiviral efficacy of remdesivir is still controversial. We aimed to evaluate the impact of remdesivir use in patients admitted to our intensive care unit (ICU) with COVID-19. METHOD(S): A retrospective study of adult patients admitted to our hospital with COVID-19 infection from March 2020 to September 2021 was performed. Patients were divided into 2 groups;Group1 received remdesivir while Group2 did not. The primary outcomes studied were mortality rate, length of stay (LOS) in the ICU and the need of invasive mechanical ventilation (IMV). Additional outcomes assessed were highest APACHE II during stay and inflammatory markers (Ferritin, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)). Descriptive statistics, Mann-Whitney-U and Chisquare methods were used. RESULT(S): 227 patients were included, median age was 57 years [46-68]. 122 (53.7%) were male. 113 patients were in Group1 vs 114 in Group2. Median age in Group1 is 58 years [45.75-68] vs 57 years [46.5-68] in Group2. In Group1, 64 (56.1%) were male vs 58 (51.3%). The median APACHE II score on admission for group1 was 8 [5-12] vs 9 [6-12]. The median SOFA score on admission for group1 was 2 [2-3] vs 2 [1-2.75]. The median ICHIKADO score on admission for group1 was 160 [120-200] vs 140 [110-180]. 24 (21.1%) patients died in group1 vs 21 (18.6%) in group2 x2(1, 227) = 0.218, p = 0.74. The median LOS of group1 was 7 [4-10] vs 7 [5-11] U(NGroup1=114, NGroup2=113)=6400, z=- 0.083, p=0.934. 16 (14%) patients in group1 needed IMV vs 22 (19.5%) in group 2, x2(1, 227) = 0.273, p = 0.291. The median of the highest APACHE II score in group1 was 10 [6- 17.5] vs 11 [7-15] U(NGroup1=114, NGroup2=112)=6163, z=-0.45, p=0.652. In group1, median ferritin, CRP and ESR were 486.6 [246.75-1184.5] ng/ml, 90.35 [39.48-135] mg/L, 85 [60-106.5] mm/hr, respectively vs. 493.3 [174.6- 1025.5] ng/ml, 69.6 [35.25-116.75] mg/L, 77 [47.5-110] mm/hr, U(NGroup1=114, NGroup2=107)=5614.5, z=- 1.022, p=0.307, U(NGroup1=56, NGroup2=34)=854, z=- 0.816, p=0.415, U(NGroup1=113, NGroup2=110)=5644.5, z=-1.185, p=0.236, respectively. CONCLUSION(S): There is no difference in mortality, severity scales nor inflammatory markers in patients that were treated with remdesivir compared to those who were not.
ABSTRACT
INTRODUCTION: Thrombocytopenia (TCP) can be caused by Epstein-Barr Virus (EBV), Cytomegalovirus (CMV), and Coronavirus Disease 2019 (COVID-19). This study aimed to evaluate the degree of TCP in COVID-19 patients with coinfection with EBV and/or CMV. METHOD(S): Retrospective study of adult patients admitted to our hospital with COVID-19 infection from March 2020 to February 2022 was conducted. Patients were divided into two groups. Group 1 (G1) had viral co-infection with EBV and/or CMV and group (G2) did not. These groups were analyzed based on the degree of TCP. Thrombocytopenia was classified into mild (100-150x103/uL), moderate (50- 99x103/uL), and severe (< 50x103/uL). Primary outcomes were mortality, need for ventilation (NFV), and length of stay (LOS). Descriptive statistics, crosstabulation, Chi-square, and Mann-Whitney tests were used. RESULT(S): Of 994 patients, 445 with a median age of 57 [45-68] years were tested for viral co-infection. 262 (58.9%) were male and 327 (73.5%) survived. There was a statistically significant association between co-infection and TCP, X2(3)= 22.335, p= <.001. Of 218 patients in G1, 98 (45.0%) had normal platelet count (NPC), 44 (20.2%) had mild TCP, 47 (21.6%) had moderate, and 29 (13.3%) had severe. Of 227 patients in G2, 132 (58.1%) had NPC, 59 (26.0%) had mild TCP, 26 (11.5%) had moderate, and 10 (4.4%) had severe. There was a statistically significant association between coinfection and mortality, X2(1)= 36.682, p= <.001. In G1, 86 (39.4%) died and 132 (60.6%) survived. In G2, 32 (14.1%) died and 195 (85.9%) survived. There was a significant difference in LOS between the groups, [U= 16935.50, p= <.001]. G1 had a median LOS of 12 [6-19] days and G2 had a median of 7 [4-11] days. There was no statistically significant association between co-infection and NFV, X2(1)= .033, p= .856. In G1, 34 (15.6%) patients were mechanically ventilated and 184 (84.4%) were not. In G2, 34 (15.0%) were ventilated and 193 (85.0%) were not. CONCLUSION(S): COVID-19 and viral co-infection with EBV and/or CMV is associated with the presence of thrombocytopenia, mortality, and longer LOS in hospitalized patients. The presence of co-infection is associated with moderate and severe TCP.