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Background: There exists a treatment dilemma regarding the optimal and effective use of therapeutic drugs (hydroxychloroquine/chloroquine/azithromycin) for COVID-19. Furthermore, with changing guidelines, the data on drug utilization patterns across India are limited. Hence, this study was conducted to assess the prescription pattern and drug utilization trends in COVID-19 patients with the aim to study the drug utilization pattern in patients affected with COVID-19 in a dedicated COVID-19 hospital. Aims and Objectives: The objectives of the study are as follows: (1) To study drug utilization patterns according to the severity of the disease. (2) To study the prevalence of adverse drug reactions (ADRs). Materials and Methods: Data were collected retrospectively from 100 medical records of patients 18 years irrespective of sex admitted in the COVID ward and ICU of a dedicated COVID hospital from May to August 2020. Pregnant and lactating women were excluded from the study. ADRs reported were also analyzed. Results: About 71% were mild in this study, 18% were moderate, and 11% were severe COVID-19 patients. Overall, the most common drugs prescribed were multivitamins, followed by pantoprazole, paracetamol, and azithromycin. Hydroxychloroquine was prescribed in 22%, favipiravir in 7%, and remdesivir in 3% of cases. The majority of moderate COVID patients received injectables piperacillin-tazobactam, methylprednisolone, and enoxaparin. The mean number of medications, duration of admission, and number of days on oxygen were higher and significant in moderate compared to mild and severe COVID patients. Overall, ADRs were encountered in 9% of cases. Conclusion: The prescribed pattern of drugs was by the national standard guidelines. Multivitamins, followed by pantoprazole, paracetamol, and azithromycin dominated the prescription pattern. Polypharmacy was encountered, which needs to be addressed for the rational use of drugs.
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These proceedings comprise 85 articles spanning diverse fields such as bacteriology, molecular biology, biotechnology, dermatology, infectious and parasitic diseases, epidemiology, physiotherapy, immunology, mycology, parasitology, pathology, collective health, and virology. The articles delve into a wide range of research topics, from repurposing drugs for Mycobacterium abscessus complex infections to utilising artificial intelligence for SARS-CoV-2 diagnosis. In bacteriology, investigations explore the correlation between smoking and Helicobacter pylori infection in gastric adenocarcinoma patients, as well as the resistance profiles of Staphylococcus aureus and Pseudomonas aeruginosa in tracheostomised children. Molecular biology studies focus on gene polymorphisms related to diseases like paracoccidioidomycosis. Biotechnology research emphasises bioactive molecules in species like Croton urucurana and the development of computational models for cytotoxicity prediction. Dermatology articles address stability characterisation in vegetable oil-based nanoemulsions. The section on infectious and parasitic diseases encompasses studies on COVID-19 vaccine response in pregnant women and the impact of infection prevention measures in rehabilitation hospitals. Epidemiology investigations analyse trends in premature mortality, tuberculosis in diabetic patients, and public adherence to non-pharmacological COVID-19 measures. Physiotherapy research covers topics such as telerehabilitation through a developed game and the prevalence of congenital anomalies. Immunology studies explore immune responses in HIV and Leishmaniasis, whilst mycology investigates the biotechnological potential of fungi from the cerrado biome. Parasitology research evaluates treatment efficacy against vectors parasites such as Aedes aegypti and Toxoplasma gondii. Pathology articles discuss intentional intoxication in cattle and the influence of curcumin on acute kidney injury therapy. Collective health studies focus on intervention plan development in healthcare settings and pesticide use in horticulture. Lastly, virology research investigates parvovirus occurrence in hospitalised children during the COVID-19 pandemic, hidden hepatitis B virus infection in inmates, and the prevalence of HPV and HTLV-1/2 infections in specific populations.
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Background and Objectives: Statins, which are primarily used for controlling blood cholesterol levels, have a well-known role in inhibiting the inflammatory process and reducing mortality rate of infectious diseases. This study aims to evaluate the effect of atorvastatin along with standard treatment protocol in hospitalized adults with COVID-19. Methods: This randomized controlled clinical trial was conducted on adults hospitalized due to COVID-19 infection at Shahid Beheshti Hospital in Qom, Iran from April to September 2020. They were randomly divided into groups of treatment (n=37, receiving atorvastatin 40 mg daily for 30 days plus standard treatment protocol) and control (n=37, receiving standard treatment protocol alone). The data were analyzed in SPSS v.22 software using chi-square, paired t-test, and ANOVA. P < 0.05 was statistically significant. Results: The CRP level in the atorvastatin-treated group decreased significantly such that there was a significant difference between the two groups after 30 days (P=0.01). There was no significant difference in Spo2 level on the discharge day. The length of hospitalization in the atorvastatin-treated group was significantly reduced compared to the control group (P < 0.05). Conclusion: The use of atorvastatin as an adjunctive treatment method, can significantly reduce the length of hospitalization and CRP level after 30 days in hospitalized patients.
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In present manuscript describes synthesis of silver nanoparticles using turmeric leaves extract, traditional turmeric is a common spice that comes from the root of Curcuma longa, chemical called curcumin. Turmeric has a warm, bitter taste and is frequently used to flavor or color curry powders, mustards, butters, and cheeses. People commonly use turmeric for osteoarthritis, hay fever, depression, high cholesterol, liver disease, itching. There is also no good evidence to support using turmeric for COVID-19. Synthesis of silver nanoparticles AgNO powder was dissolved in distilled water to prepare 10 mM AgNO stock 3 3 solution from which different composition prepared. The AgNO solutions were mixed with urmeric plants 3 t leaves extract in equal proportion in flask. The flask was wrapped with an aluminum foil and was then heated in a water bath at 50-60 C for 2 hours. The synthesis of nanoparticles, which was confirmed by UVSpectra and TEM. UV-Vis spectra and visual observation showed that the color of the fresh leaf extractsof Vinca rosea turned into brownish yellow, respectively, after treatment with silver. In addition, TEM analysis confirmed that AgNO solutions for all concentrations produced ilver nanoparticles and their average size 3 s was less than 20 nm. Turmeric plants extract of fresh leaves can be used as bioreducing agents, drug resistant strains, toxic nature towards microbial agents, play an important role in nanoscience and nanotechnology, particularly in nanomedicine and potential applications in cancer diagnosis and therapy.
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Background: Patients with COVID-19 infection are liable to develop coagulopathies and bleeding. An increase in the use of anticoagulants among this group of patients may be associated with an increase in the risk of developing GI bleeding. We aimed to evaluate the endoscopic characteristics of patients with COVID-19 that developed a GI bleed. Methods: A retrospective analysis of patients admitted to Rashid hospital with Upper GI bleeding, and COVID was done. We collected details on patient demographics, comorbid conditions, the severity of COVID infection, use of antiplatelet/anticoagulants, and their endoscopic findings. Results: 14 cases of Upper GI bleeding were included, half of which were on antiplatelet/anticoagulant. Endoscopic findings included peptic ulcer disease, Mallory Weis, gastritis, dieulafouy lesion, esophageal varices, and small gastric erosions. Peptic ulcer disease was the most common finding on endoscopy. Conclusion: Coagulopathy and bleeding risk remains a challenge in patients with COVID-19. Although peptic ulcer disease was the commonest etiology, it is still unclear whether the risk of bleeding was secondary to COVID-19 infection itself or the use of anticoagulants. We recommend physicians to be cognizant of the possible endoscopic features that may be encountered in COVID-19 infected patients presenting with GI bleeding so as to provide optimal management.
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Background: Diabetes Mellitus is one of the major non-communicable diseases among patients suffering from COVID-19, which increases the likelihood of hospital admission mortality. While Metformin has been found effective in reducing the mortality associated with COVID-19, there is a need to update the existing meta-analyses and quantitively synthesize the findings regarding the effect of Metformin in reducing mortality. Methods: We undertook a meta-analysis of 21 studies after searching for epidemiological studies systematically in PubMed/Medline, EMBASE, and Science Direct. We used odds ratios and their respective 95% confidence interval (CI) for a binary outcome, which was mortality, to examine the effect of Metformin on mortality. Heterogeneity was assessed using the I2 statistic and Q-test statistics. We evaluated the publication bias using a funnel plot, which was further confirmed by eager test statistics. A p-value of < 0.05 was considered statistically significant. Results: Overall, the findings revealed that Metformin reduced mortality by about 35%, and the results were statistically significant (OR= 0.66;95% CI 0.62 to 0.69;p < 0.05). This revealed that patients who took Metformin had improved survival by more than one-third than those who were not given Metformin. We found a relatively higher heterogeneity with an I2 value of 85.60% (Chi-squared = 138.85). The inverted funnel plot for the findings for the effect of Metformin on mortality was asymmetrical with test statistics for an eager test of -3.64 and a P-value of 0.002. Conclusion: The present updated meta-analysis revealed a positive effect of Metformin in reducing mortality among diabetic patients suffering from COVID-19. However, before implementing Metformin at a larger scale, clinicians and endocrinologists need to assess the risks versus benefits associated with Metformin for diabetic patients of COVID-19. Also, future studies are warranted to investigate the effects of Metformin for non-diabetic patients.
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Introduction: the daily increase in cases and deaths, the economic losses in the millions suffered by affected nations and the consequent strain on the human resources involved in reversing this situation have made the COVID-19 pandemic an unprecedented international challenge. Background: to describe the orchestrated immune response following SARS-CoV-2 infection. Methods: an up-to-date bibliometric study was conducted on the type of articles stated in the objective, using a total of 30 bibliographies. Documentary review and analysis-synthesis methods were used to prepare the final report. Resources available on the Infomed network were used to select the information, specifically: PubMed and SciELO, through the databases: Medline, Search Premier and Scopus. Development: the core elements in the immunopathology of COVID-19 involve innate immunity, with the sustained increase of pro-inflammatory interleukins associated with failures in the interferon system, which can trigger a potentially fatal cytokine storm. In terms of elements linked to adaptive immunity, there is evidence of marked lymphopenia which, depending on the degree, may indicate the severity of the disease. Conclusions: understanding the orchestrated immune response following SARS-CoV-2 infection and its temporal sequence allows us to choose timely and effective therapies, specifically when selecting anti-inflammatory drugs and the time of their application, as it is difficult to determine when they will be clearly beneficial, that they do not impair the response and that it is not too late, given the irreversibility of the process.
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Objective To observe the clinical efficacy and safety of Qingke Pingchuan Granules in treatment of light and common type of novel coronavirus infection(phlegm heat stagnating lung syndrome). Methods Sixty patients with novel coronavirus infection(phlegm heat stagnating lung syndrome) hospitalized in the Novel Coronavirus Unit of Shanghai Public Health Clinical Center from March 2022to June 2022 were selected and divided into control group and treatment group according to different therapeutic drugs, with 30 cases in each group. Patients in the control group were given conventional treatment. Patients in the treatment group were po administered with Qingke Pingchuan Granules on the basis of conventional treatment, 10 g/time, 3 times daily. The efficacy of TCM syndromes, inflammatory indexes and adverse reactions were observed before and after treatment. Results After treatment, the total effective rate in the treatment group(86.7%) was significantly higher than that in the control group(66.7%)(P < 0.05). After treatment, daytime and nighttime cough scores in 2 groups were lower than before treatment(P < 0.05), and daytime and nighttime cough scores in the treatment group were lower than those in the control group(P < 0.05). There was no significant difference in the levels of peripheral blood leukocytes and procalcitonin between the two groups before and after treatment. After treatment, the level of C-reactive protein(CRP) in the two groups was significantly lower than that before treatment(P < 0.05), and the CRP level in the treatment group was lower than that in the control group(P < 0.05). There was no significant difference in the incidence of adverse reactions between the two groups. Conclusion Qingke Pingchuan Granules has good clinical efficacy in treatment of light and common type of novel coronavirus infection(phlegm heat stagnating lung syndrome), and can relieve the clinical symptoms of patients, which has good safety.
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The use of alternative medicine helps to prevent the symptoms generated by Covid-19, among the methods is phytotherapy or herbal therapy, homeopathy acupuncture, among others, all with different functions such as moxibustion, for coughs, flu, lungs, pain body, breathing, etc. Although some people do not use it due to the few results in improving their health. In this article, the use of alternative medicine to treat symptoms of Covid-19 was analyzed through a quantitative exploratory approach, the population was taken through a simple random non-probabilistic sampling of 40 people from the Banos parish of Ulba between 30 At 60 years as results it was obtained that, among the most frequently used methods was phytotherapy with 65%, followed by homeopathy with 15% and acupuncture with 12,5%. It was concluded that it is important to know the benefits that contributes to health using alternative medicine such as medicinal plants to improve health and in this case to a virus that has affected and caused the death of countless people.
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Background and purpose: Violet is a plant that has received interest in complementary medicine due to its anti-inflammatory, antipyretic, and antimicrobial effects. Fever is one of the major symptoms of COVID-19. This study was conducted to determine the effect of violet extract in the form of syrup on fever in patients with COVID-19. Materials and methods: In this randomized clinical trial, 52 patients with COVID-19 were studied in Intensive Care Unit in Amol Imam Khomeini Hospital (2021). In intervention group in addition to an injection of acetaminophen, 5 cc of violet extract syrup prepared from the aqueous extract of the plant was taken. The temperature was recorded after 30 and 60 minutes and four hours. The follow-up of the patients continued for three days and the temperature was recorded every six hours. Results: There was a significant difference between the intervention group (36.84..0.37) and control group (37.13..0.62) in mean temperature at second time in second day of follow-up (P=0.04). Also, the mean temperature was found to be significantly different between the two groups at 30 (P=0.001) and 60 minutes (P=0.05) after the intervention. At other groups, there was no significant difference between the intervention and control groups. Conclusion: The aqueous extract of violet plant in the form of syrup reduces fever in patients with COVID-19 causing no complication. Due to the ease of access to this herbal product, it can be used to prevent problems caused by fever.
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Background: WHO has declared Coronavirus 2019 (COVID-19) as pandemic on 11th March 2020. Hydroxychloroquine (HCQ) chemoprophylaxis has been approved by the Indian Council of Medical Research (ICMR) for asymptomatic healthcare workers treating suspected or confirmed COVID-19 cases and asymptomatic household contacts of confirmed patients. However, there is a scarcity of data regarding the efficacy and safety of HCQ for COVID-19 prophylaxis and treatment. Background: The present study was designed to evaluate the adverse drug reaction (ADR) profile of HCQ prophylaxis among healthcare workers in a tertiary care teaching hospital in India. Methods: A Descriptive cross-sectional study was conducted in Kalpana Chawla Medical College and Hospital, Karnal for duration of 3 months (April-June 2020). The study was performed on the reported ADRs due to HCQ prophylaxis by the healthcare workers to the ADR monitoring centre of the institute during this period. Results: Gastrointestinal disturbance such as loose stool (16.4%) and hyperacidity (14.9%) were the most commonly reported ADRs during the study period. The incident rate of adverse drug reactions was 23.7%. The number of ADRs was found to be significantly (p<0.01) more in female as compared to male. We have observed that most of the reactions were reported following the 1st day loading dose. Conclusions: Our results showed that gastrointestinal system was most commonly affected. Loose stool and hyperacidity were most frequently reported ADRs due to HCQ prophylaxis. Larger studies are required to ensure the safety of the use of HCQ as prophylaxis for COVID 19.
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Background: Anxiety is common among university students and previous research has highlighted the association between the COVID-19 pandemic and higher anxiety scores in the public. Objectives: In this regard, this study aimed to evaluate the effect of the COVID-19 pandemic on the anxiety status of pharmacy students studying in Northern Cyprus and analyze the role of some parameters on the observed anxiety scores. Methods: Anxiety scores of 185 pharmacy students studying at two universities in Northern Cyprus were evaluated using Beck Anxiety Inventory (BAI) and Generalized Anxiety Disorder-7 (GAD-7) assessments. Additionally, the information of participants was recorded in terms of sociodemographic and educational characteristics, antidepressants and anxiolytic use, and consumption of vitamin-mineral supplements. The questionnaires were distributed during the COVID-19 pandemic from December 11, 2020, to January 4, 2021, online via the Microsoft TeamsR platform. It should be mentioned that responses were anonymous. Results: The mean BAI and GAD-7 scores of pharmacy students were 13.1+or-11.2 and 10+or-6.7, respectively. Based on the results, 6% of the students (n=11) revealed potentially concerning levels of anxiety in their BAI responses. Moreover, 31.9% of the pharmacy students (n=59) demonstrated severe anxiety scores on the GAD-7. Positive COVID-19 cases in the family led to statistically significant increases in anxiety on both instruments. Pharmacy students with five years of education (B. Pharm/M. Pharm) showed significantly higher anxiety scores on the BAI. Besides, age correlated negatively with anxiety scores on the GAD-7. Neither antidepressant and anxiolytic use nor vitamin/mineral supplement use were not related to the anxiety scores of participants. Conclusion: Results of this study demonstrated an alarming anxiety status among pharmacy students during the COVID-19 pandemic period. Diagnosis of a family member with COVID-19 was observed to be critical in triggering the anxiety of pharmacy students. Data from this study should raise awareness to take action plans for the mental well-being of pharmacy students during pandemics.
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Objective This article summarizes the clinical characteristics and diagnosis and treatment experience of an elderly patient infected with Omicron variant BA.5.1.3 of COVID-19 in Hainan Province. Methods The clinical data and treatment of an elderly patient infected with Omicron variant BA.5.1.3 of COVID-19 admitted to Haikou designated hospital on August 15, 2022 were retrospectively analyzed. Results A 107-year-old female patient was admitted to the hospital with "fever and cough for 1 day". Two of her family members have infected with COVID-19. The patient initially developed fever, accompanied by cough, expectoration, a little white sticky sputum, accompanied by sore throat, muscle pain, fatigue. Nucleic acid test was positive in throat swab, indicating Omicron variant BA.5.1.3 infection. The patient was diagnosed as mild COVID-19 and treated with antiviral therapy, Chinese medicine conditioning, anticoagulation, electrolyte disorder regulation and symptomatic treatment for 9 days. The patient's clinical symptoms were relieved, and she was cured and discharged after two negative nucleic acid tests. One week later, the patient recovered well. Conclusions Omicron variant BA.5.1.3 is highly infectious, and comprehensive treatment such as antiviral treatment and traditional Chinese medicine treatment has achieved good efficacy. For elderly patients, attention should be paid to maintaining the stability of organ function and internal environment, which is helpful to improve the prognosis of patients.
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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) provokes the host immune responses and induces severe respiratory syndrome by overreaction of immune cells. IL-1beta is a pro-inflammatory cytokine highly associated with the related inflammation and cytokine storm, and several IL-1beta antagonists are being used to treat cytokine release syndrome (CRS). Accordingly, some studies and clinical trials are investigating the effects of IL-1beta antagonists for controlling Coronavirus disease 2019 (COVID-19) associated CRS. Here, we will review any interaction and association between IL-1beta and SARS-CoV-2 infection.
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Introduction: The global coronavirus disease 2019 (COVID-19) pandemic has made the provision of cancer care services a challenging task all over the world, even in developed countries. Multiple studies have already reported increased rate of diagnostic delays, interruptions in radiotherapy and chemotherapy administration, and shortage of health care personnel to deliver these services. Background: The aim of this study was to analyze the impact of strategies used to deliver uninterrupted childhood cancer services at our center during the COVID-19 pandemic. Materials and Methods: This is a cross-sectional study of the children less than 18 years of age admitted at our center between March 2020 and September 2021 to assess the effect of strategies adopted to provide uninterrupted cancer services during the COVID-19 pandemic. All the children with cancer who were managed during the study period were included in the study. The children who had treatment interruptions/lost to follow-up prior to onset of COVID-19 were excluded from the study. The primary outcome was to measure the effect of COVID-19 on delivery of cancer care services. The secondary outcome was to assess whether the strategies followed at our center helped to reduce diagnostic delays or loss to follow-up during the COVID-19 pandemic. Results: Out of total 1,490 admissions, 199 children were managed during the study period. Among the 199 children managed, 124 of them were newly diagnosed, 75 had ongoing treatment, 16 children relapsed, 13 children received palliative care, and 6 families were lost to follow-up. Out of 1,471 tests done, only 16 children and 6 caregivers tested COVID-19 positive during routine screening. Thirty-five underwent surgery and 23 received radiotherapy during this period. Among 199 children, 143 (71.8%) received financial support for hospital expenses, 23 (11.5%) received travel support, 20 (10%) were provided free accommodation, and 15 (7.5%) received home delivery of oral chemotherapy and pain medications. A total of $86,989.05 was supported for diagnostic investigations, COVID-19 testing, chemotherapy, and supportive care;$1,144.90 for travel support;and $17,010.94 was waived off by hospital administration to support the poor families. Conclusion: The shared care model, support from nongovernmental organizations and hospital administration, and utilization of local resources productively and effectively helped to avoid diagnostic delays and treatment interruptions, and provide uninterrupted pediatric cancer care services at our center.
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Coronavirus disease 2019 (COVID-19) is an emerging worldwide issue, that has affected a large number of people around the world. So far, many studies have aimed to develop a therapeutic approach against COVID-19. Montelukast (MK) is a safe asthma controller drug, which is considered as a potential antiviral drug for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This review has a systematic approach to investigate the reports on the use of MK as a part of treatment or a prophylactic agent in COVID-19. The search was conducted in PubMed, Web of Science, and Scopus databases and yielded 35 studies containing the influence of MK on SARS-CoV-2. Ultimately, MK appears to be worth being used as an adjuvant therapeutic and prophylactic drug against SARS-CoV-2. Nevertheless, more clinical trials are required to accurately investigate its effectiveness.
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No effective antiviral drugs and vaccines are available for the treatment of patients with severe coronavirus 2019 (COVID-19). Therefore, available, safe, and inexpensive drugs and supplements such as melatonin are among the proposed options for controlling inflammation. We did a randomized, single-blind study in Imam Khomeini Hospital between June 30, 2020, and August 5, 2020. Mild to moderate COVID-19 patients aged 25-65 years were eligible to enter the study based on chest CT scan, clinical symptoms, and physician diagnosis. The intervention group was prescribed 6 mg of oral melatonin for 2 weeks, which consumed half an hour before bedtime every night in low light conditions. Clinical symptoms and C-reactive protein (CRP) were measured before and after treatment in the melatonin received and control(regular medications)groups. Among screened patients with COVID-19, 14 patients were assigned to receive melatonin, and 17 patients were considered as controls. A significant difference (p=0.005) between CRP 1 and CRP 2 levels (before and after using melatonin) was found in the melatonin group while this difference (p=0.069) was not significant in the control group. Also, the percentage of recovery (based on symptoms) in patients who took melatonin was higher than that of patients in the control group (85.7%VS 47.1%). The result of this study confirmed the effectiveness of melatonin in mild to moderate outpatients with COVID-19. More clinical trials on elderly, diabetic, obese patients and severe cases are suggested in future studies.
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Background and Design: Systemic retinoids are commonly used medications in dermatology and indicated in various skin disorders such as acne vulgaris and psoriasis. Data about the risk of Coronavirus disease-2019 (COVID-19) in patients using systemic retinoids are limited. Thus, this study aimed to investigate the risk of COVID-19 in patients undergoing systemic retinoid therapy. Materials and Methods: A total of 186 patients who have undergone systemic isotretinoin and acitretin therapy were recruited. Patients who presented to the dermatology clinic for various skin diseases, such as eczema, vitiligo, tinea, etc., who were not on systemic retinoid therapy, and who received topical medications comprised the control group. The development of COVID-19 in the retinoid therapy group and the control group was retrospectively reviewed using hospital database. Results: The mean age of the patients in the retinoid therapy group was 25.72+or-0.67 and that in the control group was 25.4+or-0.62. Moreover,165 patients received isotretinoin, and 21 patients received acitretin treatment. The isotretinoin dosage ranged from 0.5 to 0.8 mg/kg wheras the acitretin dosage ranged between 10 and 25 mg/day. Two patients (1.07%) in the retinoid therapy group and 8 (4.3%) patients in the control group were diagnosed with COVID-19. None of the patients receiving acitretin was diagnosed with COVID-19. COVID-19 diagnosis was established in the 2nd and 3rd months of isotretinoin treatment, and lung involvement was not observed. No significant difference regarding the number of COVID-19 cases and disease severity was found between the two groups (p=0.105;p=0.258, respectively). Conclusion: Isotretinoin and acitretin use was not associated with increased COVID-19 risk or disease severity. Systemic retinoids appear to be a safe treatment modality in the COVID-19 era.
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Background: Coronavirus disease 2019 (COVID-19) involves multiple organs, including the gastrointestinal tract. It also causes frequent thromboembolic events because of its thrombogenicity. This study reports a COVID-19 case of extensive bowel necrosis despite using warfarin. Case Presentation: A 52-year-old homeless addict male was brought via Emergency Medical Services with a chief complaint of abdominal pain for two days and loss of consciousness since the day before. He had a history of cough and dyspnea for seven days and had been using warfarin after mitral valve replacement three years earlier. On admission, he had low oxygen saturation, tachycardia, and fever. Because of his respiratory signs and symptoms, a chest CT scan was performed, and evidence of COVID-19 infection was detected. He had nausea, and on abdominal examination, there was generalized tenderness, rebound tenderness, and guarding. Following physical examination and abnormal laboratory test results, he underwent an emergent laparotomy. Extensive necrosis made surgical intervention impossible, and he died shortly after the surgery. Conclusion: COVID-19-associated coagulopathy raises many challenges nowadays, and according to the present case, even using anticoagulants may not prevent it.
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Aim: The mortality from Coronavirus Disease 2019 (COVID-19) has remained a significant medical challenge. Internationally, patient demographics and pre-existing co-morbidities are significant determinants of mortality from COVID-19. The mortality-risk in a local population is difficult to determine. The objective of our study is to examine the risk posed by epidemiological and demographic variables, and co-morbidities in our local population. Method: A retrospective, observational study was conducted on confirmed COVID-19 patients, identified from the local microbiology database. A search of the electronic patient records was performed to collect demographic details and co-morbidities. Chi-square test and logistic regression analysis of the demographic variables and co-morbidities were utilised to calculate the predictive-risk for in-hospital mortality of adult COVID-19 patients. Results: Final analysis included 263 samples. Univariate logistic regression analysis was performed using age as an independent categorical predictor with two cohorts - those <60 and those 60 years old. Age (X2 =17.12, p<0.001) was found to be an independent predictor of mortality - this was independent of sex (X2 =1.784, p<0.182). Charlson Comorbidity Index (CCI) score was found to be a significant predictor of adverse outcome. The odds of death for patients with CCI scores 0-4 was less than half (44.8%) of those with CCI scores 5 (p=0.005). Patients with no pre-existing medical conditions had a lower mortality-risk (OR=0.181, p=0.022) than those with known medical conditions. Pre-existing renal disease predicted a poor outcome (OR=1.996, p=0.027). The odds of death for the patients coming from their own-home was only 26% of the odds for those from a longterm care-home. Long-term care facility, advanced age (OR=1.058, p <0.001), and long-term oral steroid (OR=3.412, p=0.016) use were all associated with a poor prognosis. Conclusion: People aged 60 years, residence in a long-term care-home, pre-existing renal diseases, a high CCI score and long-term oral steroids use were associated with an increased mortality-risk.