Survival Evaluation of Hospitalized COVID-19 Patients with Cox Frailty Approach.

INTRODUCTION: The survival cox analysis is becoming more popular in time-to-event data analysis. When there are unobserved /unmeasured individual factors, then the results of this model may not be dependable. Hence, this study aimed to determine the factors associated with Covid-19 patients' survival time with considering frailty factor. METHODS: This study was conducted at 1 of the hospitals in Iran, so that hospitalized patients with COVID-19 were included. Epidemiological, clinical, laboratory, and outcome data on admission were extracted from electronic medical records. Gamma-frailty Cox model was used to identify the effects of the risk factors. RESULTS: A total of 360 patients with COVID-19 enrolled in the study. The median age was 74 years (IQR 61 - 83), 903 (57·7%) were men, and 661 (42·3%) were women; the mortality rate was 17%. The Cox frailty model showed that there is at least a latent factor in the model (P = 0.005). Age and platelet count were negatively associated with the length of stay, while red blood cell count was positively associated with the length of stay of patients. CONCLUSION: The Cox frailty model indicates that in addition to age, the frailty factor is a useful predictor of survival in Covid-19 patients.

SARS-COV-2 IgG specific antibodies persistence in recovered COVID-19 individuals and its association with severity and time of illness.

In order to accurately interpret the immune response to COVID-19, it is critical to know how long serum antibodies to COVID-2 persist. This study aimed to describe the serum IgG responses to SARS-CoV-2 in patients with mild, moderate, and severe COVID-19 infection in Birjand, South Khorasan province, Iran. The study was performed on individuals whose COVID-19 disease was confirmed by RT-PCR and recovered from the disease. After completing the questionnaire, blood samples were collected from 4 different groups based on the time of the test at two, four, six, and eight months' post-recovery. Then, SARS-COV-2 virus-specific IgG nucleocapsid antibody level in patients was measured using the enzyme-linked immunosorbent assay (ELISA). In total, 206 patients (mean age 44.19 ± 14.9, 51% man) were included in the survey. Serum prevalence of specific IgG antibodies in patients with mild, moderate, and severe COVID-19 disease was 51.5%, 64% and 78.9%, respectively. Furthermore, serum prevalence of COVID-19 specific IgG antibody level in two, four, six, and eight months after recovery were 80.8, 69.1, 43.2 and 41.8%, respectively (p < 0.05). The multiple logistic regression model showed that the variables of age and the time elapsed after recovery had a significant relationship with the positive antibody test of recovered COVID-19 patients (P < 0.05). But other variables had no significant relationship with the result of antibody test (P > 0.05). In the present report, we attempted to characterize the antibody response against SARS-CoV-2 in patients with mild, moderate, and severe COVID-19, with the aim of better elucidating the humoral immune response after recovery from SARS-CoV-2 infection.

SARS-COV-2 IgG specific antibodies persistence in recovered COVID-19 individuals and its association with severity and time of illness

In order to accurately interpret the immune response to COVID-19, it is critical to know how long serum antibodies to COVID-2 persist. This study aimed to describe the serum IgG responses to SARS-CoV-2 in patients with mild, moderate, and severe COVID-19 infection in Birjand, South Khorasan province, Iran. The study was performed on individuals whose COVID-19 disease was confirmed by RT-PCR and recovered from the disease. After completing the questionnaire, blood samples were collected from 4 different groups based on the time of the test at two, four, six, and eight months' post-recovery. Then, SARS-COV-2 virus-specific IgG nucleocapsid antibody level in patients was measured using the enzyme-linked immunosorbent assay (ELISA). In total, 206 patients (mean age 44.19 ± 14.9, 51% man) were included in the survey. Serum prevalence of specific IgG antibodies in patients with mild, moderate, and severe COVID-19 disease was 51.5%, 64% and 78.9%, respectively. Furthermore, serum prevalence of COVID-19 specific IgG antibody level in two, four, six, and eight months after recovery were 80.8, 69.1, 43.2 and 41.8%, respectively (p < 0.05). The multiple logistic regression model showed that the variables of age and the time elapsed after recovery had a significant relationship with the positive antibody test of recovered COVID-19 patients (P < 0.05). But other variables had no significant relationship with the result of antibody test (P > 0.05). In the present report, we attempted to characterize the antibody response against SARS-CoV-2 in patients with mild, moderate, and severe COVID-19, with the aim of better elucidating the humoral immune response after recovery from SARS-CoV-2 infection.

Seroprevalence of SARS-COV-2 antibodies among health-care workers exposed to COVID-19 patients in a large reference hospital, Iran.

Background and Objectives: Health care workers (HCWs) are a high-risk group for acquiring and transmitting severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Aim of the study was the evaluation of seroprevalence of SARS-CoV-2 in a random sample of HCWs at a large acute care hospital in Iran. Materials and Methods: We collected blood samples of 180 medical staffs from September 22, 2020 to January 26, 2021. The enzyme linked immunosorbent assays (ELISA) tests were used for evaluation of the presence of IgG antibodies. Participants completed a self-report questionnaire, comprising demographics, occupational, the work area, and personal protection data. Results: Of the 180 HCWs who participated in this study, 44 (24.4%) were seropositive for anti-SARS-CoV-2 IgG. The percentage of IgG positivity was higher in males than females (P<0.05). Also, there was statistically significant difference between presence of the antibodies and the occupation, location, and infecting family members with Covid -1 (P<0.05). Other factors did not associate significantly to antibody presence against SARS-CoV-2 (P>0.05). Conclusion: According to this point that the number of COVID-19 cases is still growing rapidly among HCWs. So, the epidemiological estimate of SARS-CoV-2 infection remains a major challenge that is needed to prevent the spread of infection in the hospitals.

Evaluation of the effect of sofosbuvir and daclatasvir in hospitalized COVID-19 patients: a randomized double-blind clinical trial (DISCOVER).

BACKGROUND: The combination of sofosbuvir and daclatasvir has shown preliminary efficacy for hospitalized patients with COVID-19 in four open-label studies with small sample sizes. This larger trial aimed to assess if the addition of sofosbuvir/daclatasvir to standard care improved clinical outcomes in hospitalized patients with COVID-19. METHODS: This was a placebo-controlled, double-blind, randomized clinical trial in adults hospitalized with COVID-19 at 19 hospitals in Iran. Patients were randomized to oral sofosbuvir/daclatasvir 400/60 mg once-daily or placebo in addition to standard of care. Patients were included if they had positive PCR or diagnostic chest CT, O2 saturation <95% and compatible symptoms. The primary outcome was hospital discharge within 10 days of randomization. Secondary outcomes included mortality and time to clinical events. The trial is registered on the Iran Registry of Clinical Trials under IRCT20200624047908N1. RESULTS: Between July and October 2020, 1083 patients were randomized to either the sofosbuvir/daclatasvir arm (n = 541) or the placebo arm (n = 542). No significant difference was observed in the primary outcome of hospital discharge within 10 days, which was achieved by 415/541 (77%) in the sofosbuvir/daclatasvir arm and 411/542 (76%) in the placebo arm [risk ratio (RR) 1.01, 95% CI 0.95-1.08, P = 0.734]. In-hospital mortality was 60/541 (11%) in the sofosbuvir/daclatasvir arm versus 55/542 (10%) in the placebo arm (RR 1.09, 95% CI 0.77-1.54, P = 0.615). No differences were observed in time to hospital discharge or time to in-hospital mortality. CONCLUSIONS: We observed no significant effect of sofosbuvir/daclatasvir versus placebo on hospital discharge or survival in hospitalized COVID-19 patients.

Role of fatty liver in coronavirus disease 2019 patients' disease severity and hospitalization length: a case-control study.

BACKGROUND AND PURPOSE: Fatty liver is one of the most common pre-existing illnesses; it can cause liver injury, leading to further complications in coronavirus disease 2019 patients. Our goal is to determine if pre-existing fatty liver is more prevalent in hospitalized COVID-19 patients compared to patients admitted before the SARS-CoV-2 pandemic and determine the disease severity among fatty liver patients. EXPERIMENTAL APPROACH: This retrospective study involves a case and a control group consisting of 1162 patients; the case group contains hospitalized COVID-19 patients with positive PCR tests and available chest CT-scan; the control group contains patients with available chest CT-scan previous to the COVID-19 pandemic. Patients' data such as liver Hounsfield unit, hospitalization length, number of affected lobes, and total lungs involvement score were extracted and compared between the patients. RESULTS: The findings indicate that 37.9% of hospitalized COVID-19 patients have a pre-existing fatty liver, which is significantly higher (P < 0.001) than the prevalence of pre-existing fatty liver in control group patients (9.02%). In comparison to hospitalized non-fatty liver COVID-19 patients, data from hospitalized COVID-19 patients with fatty liver indicate a longer hospitalization length (6.81 ± 4.76 P = 0.02), a higher total lungs involvement score (8.73 ± 5.28 P < 0.001), and an increased number of affected lobes (4.42 ± 1.2 P < 0.001). CONCLUSION: The statistical analysis shows fatty liver is significantly more prevalent among COVID-19 against non-COVID-19 patients, and they develop more severe disease and tend to be hospitalized for more extended periods.

The effect of low serum calcium level on the severity and mortality of Covid patients: A systematic review and meta-analysis.

INTRODUCTION: Imbalances of various electrolytes, including calcium, are associated with the prognosis of Covid disease. This study investigated the relationship between serum calcium and clinical outcomes in patients with COVID-19. METHOD: This study is a systematic review and meta-analysis by searching PubMed, Scopus, web of sciences until August 2021 using the keywords COVID-19, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), COVID, coronavirus disease, SARS-COV-infection. 2, SARS-COV-2, COVID19, calcium, calcium isotopes, calcium radioisotopes, hypercalcemia, and hypocalcemia were performed. Heterogeneity of studies was investigated using I2 index, data were analyzed using meta-analysis (random effects model) with Comprehensive Meta-Analysis Software software. RESULTS: Finally, 25 articles were included in the study. Clinical data from 12 articles showed that 59% (95% confidence interval [CI]: 0.49-0.68) of people with COVID-19 have hypocalcemia. The results of meta-analysis showed that hypocalcemia was significantly associated with severity of the disease (p = .002), mortality in patients with COVID-19 (odds ratio [OR] = 6.99, 95% CI: 2.71-17.99), number of hospitalization days (p < .001) and admission to the intensive care unit (OR = 5.09, 95% CI: 2.14-12.10). The results also showed that there is a direct relationship between low serum calcium levels with increasing D-dimer levels (p = .02) and decreasing lymphocyte counts (p = .007). CONCLUSION: Based on the results of meta-analysis in people with lower calcium, mortality and complications are higher, therefore, serum calcium is a prognostic factor in determining the severity of the disease. Consequently, it is suggested that serum calcium levels should be considered in initial assessments.

SARS-CoV-2 outbreak in Iran: The dynamics of the epidemic and evidence on two independent introductions.

The SARS-CoV-2 virus has been rapidly spreading globally since December 2019, triggering a pandemic, soon after its emergence. While Iran was among the first countries confronted with rapid spread of virus in February 2020, no real-time SARS-CoV-2 whole-genome tracking in early phase of outbreak was performed in the country. To address this issue, we provided 50 whole-genome sequences of viral isolates ascertained from different geographical locations in Iran during March-July 2020. The corresponding analysis on origins, transmission dynamics and genetic diversity of SARS-CoV-2 virus, represented at least two introductions of the virus into the country, constructing two major clusters defined as B.4 and B.1*. The first entry of the virus might have occurred around very late 2019/early 2020, as suggested by the time to the most recent common ancestor, followed by a rapid community transmission that led to dominancy of B.4 lineage in early epidemic till the end of June. Gradually, reduction in dominancy of B.4 occurred possibly as a result of other entries of the virus, followed by surge of B.1* lineages, as of mid-May. Remarkably, variation tracking of the virus indicated the increase in frequency of D614G mutation, along with B.1* lineages, which showed continuity till October 2020. The increase in frequency of D614G mutation and B.1* lineages from mid-May onwards predicts a rapid viral transmission that may push the country into a critical health situation followed by a considerable change in composition of viral lineages circulating in the country.

Uncovering psychobehavioural implications of SARS-CoV-2 infection in Iran.

Iran is the country in Western Asia most impacted by the COVID-19 outbreak. A survey was conducted among the general public in Iran aimed at investigating psychobehavioural issues related to the COVID-19 outbreak, namely (a) barriers to preventive measures against SARS-CoV-2 infection; (b) negative emotions towards SARS-CoV-2 infection; and (c) anxiety levels among the general public in Iran. A cross-sectional, web-based survey using an online questionnaire was carried out between 16 March and 1 April 2020. The six-item version of the State-Trait Anxiety Inventory (STAI-6) was used to assess anxiety levels. A total of 1,789 complete responses were received. Nearly 60% reported having difficulty in wearing a face mask to protect against SARS-CoV-2 infection. The mean and standard deviation (SD) for the total prevention barrier score was 35.8 (SD ± 7.1; range 18-68) out of a possible score of 72. Male respondents [odds ratio (OR) = 1.25; 95% confidence interval (CI) 1.03-1.51] and respondents who perceived their health status as poor/fair (OR = 1.49; 95% CI 1.31-1.82) were predictors of high prevention barriers. Negative emotions such as fear (74.6%) followed by depression (43.4%) and stigma (23.0%) associated with SARS-CoV-2 infection were reported. Respondents who perceived their health as poor/fair (OR = 2.19; 95% CI 1.57-3.04) reported a higher likelihood of having higher negative emotions. Findings on anxiety level revealed 68.0% (95% CI 65.8-70.1) reported moderate to severe anxiety. Respondents who perceived their health as poor/fair (OR = 3.46; 95% CI 12.22-5.40) and who were females (OR = 1.91; 95% CI 1.55-2.36) were predictors of moderate to severe anxiety. In conclusion, psychobehavioural interventions are needed to facilitate management and control of the COVID-19 outbreak.