Demographic features and outcomes in critically ill mechanically ventilated COVID-19 patients with respiratory failure in a resource limited ICU setting Report from a tertiary care center in Karachi

Background: Studies done on severe COVID-19 have revealed a wide heterogeneity in intensive care clinical outcomes across various countries. We aimed to identify the demographic features and outcomes of mechanically ventilated COVID-19 patients with respiratory failure in Pakistan in resource limited settings. Methods: This was a cross-sectional study conducted at the COVID-19 Intensive care unit (ICU) of Jinnah postgraduate medical center in Karachi, Pakistan. 86 patients who received mechanical ventilation in a period of five months from 1/2/2021 till 30/6/2021 were included in the study. Patient demographic characteristics, comorbidities, clinical manifestations of COVID-19 infection, laboratory values at the time of presentation (hemoglobin, Neutrophil lymphocyte ratio, platelets, glomerular filtration rate, C-reactive protein, D-dimers, Ferritin, liver function tests and electrolytes) and mode and duration of ventilation, final outcome (survivor vs. non-survivor) and cause of death in non-survivors were recorded. Data was analysed using SPSS 26. Patient characteristics were compared among those who died early before 7 days with those who survived for more than 7 days using P sample t-test. Results: 86 patients, who required mechanical ventilation because of severe respiratory distress not alleviated by non-invasive methods of ventilation, were included in the study. 66.3% (n=57) were males and 33.7% (n=29) were females. Mean age was 59 (SD 12). The most common comorbidities were diabetes mellitus and hypertension 44.2% (n=38) each. Only 3 (3.4%) of mechanically ventilated patients were extubated and 1 patient was eventually discharged home on room air. The mortality rate was 98.8% and only one patient survived. The most common causes of death were respiratory failure (86%, n=74), renal failure (48.8%, n=42) and sepsis (18.6%, n=16). Conclusion: Mortality in COVID-19 patients who require mechanical ventilation is very high in resource limited settings because of the lack of essential medications, specialized teams and established protocols of ICU management and is not related to the demographic characteristics and comorbidities of patients and severity of disease at presentation. © 2022 Authors.

C3 Glomerulonephritis After Vector COVID-19 Vaccination: A Case Report

Introduction: Mass vaccinations for coronavirus (COVID-19) are being administered worldwide. Even though vaccine is safe and effective, rare adverse events like thrombosis with thrombocytopenia, myocarditis, Guillain barre syndrome have been reported. Renal adverse events such as IgA nephropathy and minimal change disease are reported as well. We report a case of C3 glomerulonephritis (C3 GN) after Johnson & Johnson (J&J) vector COVID-19 vaccine. Case Description: 84-year-old female with history of hypertension, diabetes, and CKD stage 3 presented with fatigue, shortness of breath, leg swelling and poor oral intake. She had received J&J vector vaccine few weeks prior to presentation. Her baseline creatinine was 1.8. Home medications included amlodipine, aspirin, clonidine, coreg, hydralazine, insulin and protonix. In the emergency department, vitals were normal. She had bilateral lower extremities edema. Her labs showed creatinine 5.4 mg/dl, BUN 42 mg/dl, and CPK 167 IU/L. Urine analysis positive for dysmorphic RBCs. 24-hour urine protein was 820 mg. Hepatitis serologies, Anti-dsDNA, SPEP, UPEP, C-ANCA and PR-3 were negative. Her ANA, P-ANCA and MPO titers were positive. Her C3 was low. C4 was normal. Renal biopsy revealed C3 dominant glomerulonephritis with crescents and moderate interstitial fibrosis. C4d was negative. Hydralazine was discontinued. With worsening renal parameters, she was initiated on hemodialysis. Trial of Steroids and CellCept did not show any response and she remains on hemodialysis. Discussion(s): The C3 glomerulopathies are a group of rare kidney diseases characterized by complement dysregulation occurring in the glomerular microenvironment, which results in prominent complement C3 deposition. Most patients are treated with steroids in combination with either cyclophosphamide or Mycophenolate mofetil. Rituximab has been used in some case reports. To our knowledge, this is the first reported case of C3 GN after receiving the COVID-19 vaccine. In our case, the temporal association suggests an immune response to vaccine as a potential trigger. 1. Lebedev L. and Wechsler A. Minimal change disease following the Pfizer-BioNTech COVID-19 vaccine. Am J Kidney Dis. 2021;78:142-145. 2. Peggy Perrin and Nicolas Bouvier. Gross hematuria following SARS-CoV-2 vaccination in patients with IgA nephropathy, Kidney Int. 2021 Aug;100(2): 466-468.

Decreased mortality in coronavirus disease 2019 associated mucormycosis with aspirin use: a retrospective cohort study.

OBJECTIVE: Rhino-orbito-cerebral mucormycosis is a rapidly progressive disease with high mortality rates of about 60 per cent. The increasing incidence of rhino-orbito-cerebral mucormycosis in coronavirus disease 2019 patients in India and worldwide has become a matter of concern owing to the case fatality rate. This study explored the use of low dose aspirin in decreasing the mortality rate of coronavirus disease 2019 associated mucormycosis. METHOD: This was a retrospective observational study. Patients suffering from post-coronavirus disease 2019 mucormycosis were included in the study. Each patient was treated with surgical debridement and systemic amphotericin B. Low dose aspirin was added, and mortality rates were compared with the patients who did not receive aspirin. RESULTS: The demographic data and rhino-orbito-cerebral mucormycosis staging between the two groups were not significantly different. There was a statistically significant difference in mortality outcomes between the two groups (p = 0.029) and a 1.77 times higher risk of dying for patients not receiving aspirin. Kaplan-Meier survival indicated that patients receiving aspirin had better survival rates (p = 0.04). CONCLUSION: Low dose aspirin improves survival rates in coronavirus disease 2019 associated mucormycosis.

A Comparative Study of Topical Antifungal Therapy in COVID-19-Associated Mucormycosis (CAM): A New Hope?

Introduction: COVID-19-associated mucormycosis (CAM) is an ongoing epidemic that adds to COVID-19 woes in several countries. Mucormycosis is a fulminant angioinvasive fungal disease for which surgical debridement with systemic antifungal therapy is advocated. The efficacy of using topical antifungal therapy in the form of lipid-based amphotericin B gel and povidone-iodine is compared in the trial. Method(s): This is a multiarm, parallel randomized control trial. Microbiologically and histologically proven cases of mucormycosis in patients who underwent open or endoscopic surgical debridement were included in the study. The trial was conducted in the in-patient ear, nose, throat department of a tertiary care referral hospital in eastern India, All India Institute of Medical Sciences, Bhubaneswar, from May to December 2021. The postoperative cavity was treated according to the intervention arm in the form of lipid-based amphotericin B gel, povidone-iodine ointment, or saline nasal douching according to the allotted group. The aim was (1) to compare the efficacy of 0.1% w/w liposomal amphotericin B gel with 10% w/w povidone-iodine and saline nasal douching in preventing revision surgery in patients with CAM and (2) to develop the AIIMS Bhubaneswar Endoscopic Scoring System (AMESS) to quantify response to treatment. The requirement of revision surgery in postoperative cases of CAM was assessed. Result(s): Fifteen participants were analyzed in each group. The control arm's risk of revision surgery was 4.50 (95% CI, 1.16-17.44) times than the lipid-based amphotericin B gel arm and 1.50 (95% CI, 0.71-3.16) times than povidone-iodine arm. The difference was statistically significant (P=.02) for amphotericin but not for povidone-iodine. The absolute risk reduction of applying amphotericin gel is 46.7%, and number needed to treat is 2.14. Conclusion(s): Topical amphotericin B gel application in the postoperative cavity can decrease the need for revision surgery and help in early recovery. However, long-term studies with greater sample size are required to confirm our findings.

COVID-Associated Mucormycosis in Case of Fibrous Dysplasia of Maxilla: Freeing 2 Birds With 1 Key

Introduction: India is one of the countries most affected by COVID-19. COVID-19-associated mucormycosis (CAM) has added to the woes of the already devastating effects of the virus. About 97.6% of cases in India presented with rhino-orbito-cerebral disease. Fibrous dysplasia (FD) is characterized by abnormal mixtures of fibrous and osseous elements leading to bony deformities and pathological fractures. Monostotic and polyostotic varieties have been described, with the latter being more common in children. The monostotic type of FD accounts for about 70% to 80% of FD, affecting the second and third decade. Method(s): We present a case of 44-year-old man with fibrous dysplasia of left maxilla with CAM, an angioinvasive fungal disease associated with high morbidity and mortality. As India and the entire world is struck by the COVID-19 pandemic, the use of corticosteroids has proven somewhat helpful in managing severe COVID infection. Evidence shows it has also led to CAM. Our patient was treated with radical surgical treatment of lesion with gross removal of all necrotic tissues from the sinuses along with antifungal treatment with amphotericin B. FD is a benign disorder characterized by replacement of normal bone with cellular fibrous connective tissue. Result(s): Our case presented with CAM of maxilla with palatal involvement requiring urgent surgical intervention and antifungal therapy. It incidentally happened to be a case of FD. Maxillectomy took care of the patient's FD as well. Conclusion(s): FD is a disorder characterized by dystrophy and bony metaplasia, and treatment depends on the zone of involvement. Early diagnosis and surgical intervention, with good antifungal therapy with strict glycemic control, are critical features to prevent its onslaught. Sometimes treatment of one condition can cure the others as well.

The Threshold Effect of Covid19 on Shariah Indices:an Empirical Analysis of GCC Countries

This paper examines the volatility of Shariah indices of the gulf cooperative council due to coronavirus. Do GCC Shariah indices that are affected by the bad news of coronavirus? and attempts to analyze the impact of (Cov-NC) and (Cov-DC) on the movements of Shariah indices. The study used the GCC Shariah Indices viz., S&P Domestic Shariah of each country separately. New corona cases (Cov-NC) and new death cases (Cov-DC) are the dependent and independent variables used from Jan 1, 2020, to Dec. 31, 2020. The threshold-GARCH model is used to make the study more significant in terms of volatility in stock index prices due to the outbreak of the pandemic. The analysis shows that there is a negative leverage effect of bad news has more than the impact on conditional variance than good news. Here, GCC Shariah Indices are impacted due to coronavirus (Covid- New cases, Covid death cases) news spread in the market. Diagnostic analysis is based on AIC, SIC, and HQC criteria. Bahrain, Kuwait, Oman Shariah indices are lower values in comparison to the higher values of Qatar, Saudi Arabia and UAE Shariah indices. At-last T-GARCH model is more suitable for Bahrain, Oman, and Kuwait Islamic indices. © 2022, Statistical Economic and Social Research and. All rights reserved.

Multi-Modality and Feature Fusion-Based COVID-19 Detection Through Long Short-Term Memory

The Coronavirus Disease 2019 (COVID-19) pandemic poses the worldwide challenges surpassing the boundaries of country, religion, race, and economy. The current benchmark method for the detection of COVID-19 is the reverse transcription polymerase chain reaction (RT-PCR) testing. Nevertheless, this testing method is accurate enough for the diagnosis of COVID-19. However, it is time-consuming, expensive, expert-dependent, and violates social distancing. In this paper, this research proposed an effective multi-modality-based and feature fusion-based (MMFF) COVID-19 detection technique through deep neural networks. In multi-modality, we have utilized the cough samples, breathe samples and sound samples of healthy as well as COVID-19 patients from publicly available COSWARA dataset. Extensive set of experimental analyses were performed to evaluate the performance of our proposed approach. Several useful features were extracted from the aforementioned modalities that were then fed as an input to long short-term memory recurrent neural network algorithms for the classification purpose. Extensive set of experimental analyses were performed to evaluate the performance of our proposed approach. The experimental results showed that our proposed approach outperformed compared to four baseline approaches published recently. We believe that our proposed technique will assists potential users to diagnose the COVID-19 without the intervention of any expert in minimum amount of time. © 2022 Tech Science Press. All rights reserved.

Applicability of vitamins in the management of COVID-19: An overview

The pandemic situation due to COVID-19 has crippled the lives of the whole world population and has affected almost every individual in one way or the other. Researchers have been intrigued due to the increasing number of strains and symptoms. Several approaches have been used to control the spread of this highly infectious disease: early detection of the infected individual, development of a suitable drug and containment of the spread of this virus. Although, several vaccines have been developed, they have shown to have their own limitations and side-effects. One of the measures which has been adopted by the global health agencies is to educate people (infected or uninfected) regarding the maintenance of strong immune system to prevent the infection and lessen the health complications. There are several important factors which determine the immunity of an individual. Eating balanced diet and maintaining the proper supplication of nutritional components are being suggested by health experts to keep the immunity strong. Minerals and vitamins must be maintained in the diet for proper health and immunity. Vitamins have various roles in human physiology. In this review, the relevance of vitamins in the maintenance of immunity has been discussed and reviewed in prevention of adverse health effects of COVID-19.

Anxiety among COVID-19 Physicians during the Pandemic in the Health Care Center of the Rural Region

Introduction: The COVID-19 pandemic is likely to put healthcare professionals in critical circumstances globally, having to make intolerable assessments and work under extreme pressures. It is very difficult to provide care for all severely sick patients with reserved resources. This may affect a physician's mental health. Healthcare professionals are at greater risk of mental health concerns because they are allocating with tasks of the COVID-19 pandemic situation especially in rural areas where it is difficult to deal with uneducated attendants and patients. This study aims to assess the work pattern of doctors who are performing duties with COVID-19 patients. Results: A total of 33 doctors participated in this survey out of which the majority of the age group was found to be 27. In this survey 23 males (70%) and 1.0 females (30%) participated. 7 doctors (21.2%) were normal and they were not having anxiety, 12 of doctors (36.4%) were mild anxious, 8 doctors (24.2%) were moderate anxious, 6 doctors (18.2%) were having severe anxiety. Five males were normal. 6 males were mild anxious,7 males were moderate anxious and 5 males were severely anxious, and 2 females were normal, 6 females were mild anxious, 1 female was moderate anxious and 1 female was severely anxious. Conclusion: In this study, we found that those doctors who performed duty with COVID-19 patients were more worried when assessed with the GAD-7 scale.

Determine the frequency of corona virus and examine the demographics and clinical profile of coronavirus patients

Aim: To exam ine the frequency, dem ographics, clinical profile and outcom es of corona virus in patients with s ym ptom s of corona virus s uch as fever, s ore throat, res piratory problem, d iarrhea, cough and abdom inal pain. Study Design: Cros s -s ectional s tudy Place and Duration of Study: Departm ent of Medicine, Chandka Medical College Hos pital Larkana from 1st March 2020 to 31st May 2020. Methodology: Four hundred patients of both genders with ages 20 to 80 years s us pected to have corona virus were enrolled in this s tudy. Patients detailed dem ographics including age, s ex, res idence and co -m orbidities were recorded after taking written cons ent. Real tim e PCR was done to confirm the cas es. Com plete clinical profile of corona virus patients was exam ined. Results: There were 115 (28.75%) diagnos ed to have corona virus while 285 (71.25%) had negative for corona virus. Out of 115 patients, 82 (71.30%) were m ale while 33 (2 8.70%) were fem ales. Mean age of patients was 56.45±10.85 years. Majority of patients 100 (86.96%) were as ym ptom atic, 8 (6.96%) patients were critically ill and 7 (6.09%) patients were s ym ptom atic. Mean tim e to recovery was 12.42±2.76 days. Mortality found in 3 (2.61%) patients and all were critically ill. Conclusion: Majority of corona virus patients were m ale, older age group and as ym ptom atic. Only 6.96% patients were critically ill. Majority of patients were recovered while only 2.61% patients were died. © 2020 Lahore Medical And Dental College. All rights reserved.