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Introduction: COVID-19 infection can be complicated by coagulation derangement and a high risk of thromboembolic episodes. Our study aimedto investigate coagulation parameters in COVID-19 patients and their correlation with clinical severity. Methods: We analyzed coagulation parameters PT, APTT, D-Dimer, and Fibrinogen in 98 RT-PCR-confirmed COVID-19 patients admitted to the Government Institute of Medical Sciences, Gautam Buddha Nagar, Uttar Pradesh, India. Results: This study involved 69 males (70.50%), and 29 (29.5%) were females. The mortality rate was 6.12% (n= 06). Forty-six patients (46.94%) had comorbidities. Thirty-four patients had elevated PT, and 7 had high APTT, whereas D-dimer and fibrinogen levels were raised in 68 and 61 patients, respectively. Among all four parameters, D-Dimer levels were significantly associated with disease severity. Conclusion: Derangement of D-dimer levels is significantly associated with disease severity in COVID-19 infection.
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Background & Aims: Epidemics of human viruses began during the period of Neolithic around 12,000 years ago. Humans developed more densely population which allowed viruses to spread rapidly among communities. Also, plant and livestock viruses increased along with human viruses (2). At the January 2020, the coronavirus disease (COVID-19 7th human coronavirus) was discovered in Wuhan, Hubei province of China. COVID-19 virus caused six million deads in the world to date and cussed infection of more than seven million of cases in Iran (1). This infectious disease caused by the SARS-CoV-2 virus. This virus was contagious and fast-spread. Despite the aquarantine politics, SARS-CoV-2 virus caused many permanent economic and health damages in most countries. Coronaviruses are positive-sense, single- stranded enveloped RNA viruses with helical capsids that infect a wide range of hosts including humans, bats, other mammals, and birds (2). Coronaviruses are belonging to Nidovirales order, Coronaviridae family, Coronovirinae subfamily and four genera of alpha, beta, delta, and gamma. Alpha and beta coronaviruses are known as human infection agents. SARS-COV-2 virus abilities are including: high mortality number, short period of incubation, widespread transmission protocols, asymptomatic infection and affecting on most vital organs (heart, brain, lungs and ...) which have attracted the health system attention and caused neglect to the other chronic and non-communicable diseases (4). Therefore, the disease incidence, prevalence and prioritization around the world may change in the future. From the beginning of COVID-19 pandemic, some symptoms and risk-factors have been introduced to the world as the increase elements of morbidity and mortality. Studies have shown that having any kind of underlying diseases and risk factors will be effective in the COVID-19 disease severity and mortality (6). Some of these important risk factors are including of chronic kidney disease, hypertension, age, gender, obesity, obstructive pulmonary diseases, diabetes, lung diseases, cardiovascular diseases, cancer, and liver disease. Also, each risk factors have different impact in different geographic areas (7). Some factors, such as different viral load kinetics in each individual person, epidemiological history, therapeutic or pharmacological effects and immune response have some major impacts on the laboratory diagnostic results. Due to the successive mutations of the SARS-CoV-2 virus and the high incidence disease, it seems that the vaccination alone cannot prevent the COVID-19 (9). On the other hand, the World Health Organization has warned about the vaccination as the only pandemic control protocol. Therefore, the prevalence of morbidity and mortality have become the public health concerns in the world since the beginning of the COVID-19 epidemic and the vaccination. Recognizing of the risk-factors and symptoms on COVID-19 in different geographic areas can be a helpful source to prevent the mortality. Understanding risk factors can help the world to control of the coronaviruses pandemic period and similar situations in the future. Therefore, the aim of this study was to determine the risk-factors of mortality of COVID-19 patients in three cities of Khuzestan province, Iran. Methods: This research was an analytical cross-sectional study. Some details of 27963 COVID-19 patients such as clinical symptoms, individual characteristics and underlying diseases were gathered from hospitals in Abadan, Shadegan and Khorramshahr cities in Khuzestan province, Iran, from 20 February 2020 to November 2020. All the under-study population was previously investigated in terms of COVID-19 infection by the medical examinations and laboratory methods. This under-study population was categorized into three different groups such as hospitalized, outpatients and dead patients. Hospitalized patients have admitted in general or ICU (Intensive Care Unit) sector. Obtained database of COVID-19 patients was analyzed by IBM SPSS version 22.0 under regression, logistic model (u
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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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The outbreak of a new coronavirus infection was officially recognized by the World Health Organization as a global pandemic since March 11, 2020. The pandemic is currently gradually receding, the number of patients is also steadily decreasing. However, these circumstances are not grounds to believe that the virus has been definitively and irrevocably defeated. For this reason, the world medical community is still concerned about the coronavirus' impact on the course and outcome of various chronic bronchopulmonary diseases. Bronchial asthma has been recognized as one of the leading forms of human somatic pathology throughout the history of mankind and medicine. It is quite natural that the focus of the researchers' attention turned out to be questions about the SARS-CoV-2 virus' impact on patients suffering from bronchial asthma, starting with the peculiarities of the course of combined pathology and ending with the peculiarities of therapy and subsequent rehabilitation. The issues of coronavirus infection and bronchial asthma pathogenesis were considered. The research data on some features of the development and course of a new coronavirus infection in patients with this profile were analyzed and summarized. The low coronavirus infection prevalence among patients with an allergic bronchial asthma form compared with other phenotypes is shown among such features, data on the effect of eosinophilia on the course of infection are presented, and the basic therapy's positive effect using inhaled glucocorticosteroids and/or monoclonal antibodies (biological therapy) in severe asthma, is shown in the form of a protective effect that provides a lighter coronavirus infection course. The main features of patient management suffering from bronchial asthma in the conditions of a pandemic are the organization of stable medical control in online telemedicine once monthly, regular examinations in accordance with the severity of the course of the disease and the correction of basic therapy to achieve complete control over the course of asthma.
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Background: There has been a tremendous increase in number of cases of rhino-orbitocerebral involvement with mucor in the COVID era, as reported from India. It is well established that management of ROCM involves early clinical and radiological diagnosis, reversal of underlying risk factors, prompt antifungal therapy and surgical debridement when indicated. Materials &Methods: Multiplanar MR imaging and CT scan were performed for brain, orbit and paranasal sinuses. All the cases were assessed for involvement of the paranasal sinuses, nasal cavities, orbits and brain. Results: 25 cases with ROCM were identified over 8 months. The mean age of the cases was 56.1 years. 18 of the 25 cases had a positive RT-PCR test result at the time of diagnosis with ROCM. 20 cases had poorly controlled diabetes mellitus, 2 had a hematological malignancy, 2 had chronic kidney disease and 1 had ischemic heart disease. There was involvement of the paranasal sinuses, nasal cavities, orbits and brain inclusing necrosis in most of the cases. The number of cases identified during the interval is much higher than the numbers presenting in the prior 2 years during equivalent intervals than those reported in the literature in different settings in the pre-pandemic era. Conclusions: Rhino-orbito mucormycosis can have aggressive necrosis of the involved paranasal sinuses and orbits with or without cerebral extension. Hence, the correct diagnosis is imperative as prompt antifungal drugs and surgical debridement can significantly reduce mortality and morbidity.
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The COVID-19 pandemic due to SARS-CoV-2 has proven to be a tremendous challenge to the medical community. The greatest challenge since the turn of the century. The authors summarized the main cardiovascular (CV) complications and mechanisms of COVID-19 and its vaccines. COVID-19 has lung tropism, but it has been reported to affect the CV system as well. The presence of comorbidities such as hypertension, CV disease, diabetes, and chronic obstructive pulmonary disease increased the risk of developing serious complications and in turn mortality significantly. The common CV complications include cardiac arrhythmia, myocardial infarction, myocarditis, and cardiac failure, which occurred in around 20% of all COVID-19 patients. The present difficulty in the diagnosis of CV complications were that COVID-19 symptoms often mimic CV events. Furthermore, the rapid diagnosis and management of serious CV events are sometimes overlooked due to COVID-19. Access to medical treatments were sometimes restricted due to the limited healthcare resources during the pandemic. The advent of various covid vaccines have reduced the number of these complications. However, CV events following mRNA vaccines or adenoviral vector vaccines are recognized as well as myocarditis and vaccine-induced immune thrombotic thrombocytopenia. With increasing experience in managing covid patients with CV complications, physicians are becoming better equipped in preventing, detecting, and treating these complications.
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Objective. To know the intrinsic and extrinsic factors associated with anemia in post-cesarean women treated in the COVID-19 and non-COVID-19 obstetric area of the Alberto Sabogal Hospital. Methods. The study was observational, retrospective and cross-sectional, quantitative approach, explanatory level, casecontrol model, applied to 358 puerperal women;of which 179 were the cases, that is, those puerperal women with postpartum anemia and 179 were controls, taken from both areas. The data were processed with the SPSS 25 statistic. Results. The intrinsic factors: diet without variation, overweight or morbid obesity, parity of 4 or more, number of cesarean sections of 3 or more, and the intergenetic period of less than 2 years, were conditions that represented a double risk of producing anemia in the puerperium among women in the study, in relation to those who did not have these characteristics. Also, the intrinsic factor or condition of having had anemia during pregnancy, resulted in a 5 times greater probability of producing anemia in the puerperium among the women in the study (Odds Ratio 5.156), compared to the women who did not have anemia. Folic acid intake was 3.4 times less likely (Odds Ratio of 3.408) to develop anemia compared to those who did not, and complications in the immediate puerperium (Odds Ratio of 3.397) were associated with anemia in puerperal women. Conclusions. Intrinsic factors such as the diagnosis of anemia during pregnancy and extrinsic factors such as folic acid not ingest and complications in the immediate puerperium were associated with anemia in puerperal women in the COVID-19 and non-COVID-19 obstetric area of Hospital Alberto Sabogal.
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Introduction: Temporary disability due to COVID-19 was expressly regulated, through various rules and instructions, covering both isolation by contact, by infection or for sensitive workers. It involved the integration of preventive labor protection covered by its protection in a financial benefit with the highest amount. Analyzing the consequences of the pandemic in the first wave, confinement, de-escalation and return to normality, months from March to October, the ..collapsing.. impact of COVID-19 on the health system led to the paralysis and increase of waiting lists for tests, operations and non-urgent consultations of the rest of pathologies, and consequently a high increase in the average duration of sick leave for all processes, in confinement and de-escalation in 84.48% and in 25.27% the prolonged casualties that reached more than 365 days. Consequently, COVID-19 as a collateral effect led to a poor evolution of the rest of the processes, prolonging the duration of temporary disabilities, which implies a worsening of occupational health, a greater risk of not returning to work that occurs during sick leave long, higher risk of unemployment, higher spending on benefits and economic decline for companies and the self-employed. Temporary disability due to COVID-19 accounted for 38.73% of all casualties at the end of October 2020. Conclusions: The pandemic forced to prioritize resources around COVID-19, collapsing the care of the rest of pathologies, except for emergencies or vital treatments. This meant an increase in waiting lists for non-urgent consultations, tests or surgical interventions, as well as the cancellation or postponement of consultations or treatments and therefore an increase in the longer duration of sick leave and also the worsening of occupational health, consequently, by not being able to have treatment in a timely manner. In confinement and de-escalation, the average duration of casualties increased by 84.48%;by processes, the increase was 503.58% in respiratory diseases, 215.88%, in infectious diseases, 60.73% in endocrine diseases, 45;42% of blood diseases, 45 09% for digestive diseases, 35.63% for osteomyoarticular disorders, 34.12% for neoplasms, 33.37% for circulatory diseases, 31.94% for ..procedures.., and 29.56% of mental disorders. Long-term sick leave (PIT) that reached 365 days increased by 25.27%, compared to the month of October of the previous year. Prolonged sick leave due to endocrine and nutritional diseases increased by 28.50, from mental disorders by 28.20%, from musculoskeletal disorders by 26.70, from neoplasms by 26.49%, from respiratory diseases in 24.27%, for diseases of the nervous system in 22.79%, for cardiovascular diseases in 20.48%, and for digestive diseases in 19.24%. As a consequence of COVID-19, the working population was exposed to an added and new risk;health and social health workers suffered the disease as a direct consequence of their work due to illness of an undoubted professional nature. The effects of COVID-19 on the delay of tests, surgeries or treatments in ..No COVID-19.. processes and the difficulties of contact with care worsened occupational health, prolonging disability situations and increasing the risk of prolonged non-COVID-19 disabilities, return to work due to the expected poor evolution of any process when it cannot be treated and attended to early.
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The COVID-19 pandemic has created unprecedented obstacles to the delivery of care to patients with cancer. Patients with hematologic malignancies appear to have a greater risk of SARS-CoV-2 infection and severe disease due to myelosuppression and lymphopenia. The first challenge, therefore, is how to continue to deliver effective therapy to vulnerable patients and at the same time to avoid exposing them, and their health care teams (HCT), to SARS-CoV-2. An additional challenge is the timely completion of the procedures required for diagnosis and staging to formulate appropriate treatment plans. Deferred procedures and avoidance of multiple trips to the surgical wards, diagnostic units, and laboratories require same day consolidation of all procedures. With laboratory medicine absorbed by the need to deploy large scale COVID-testing, the availability of routine molecular tests is seriously affected. Finally, we are increasingly faced with the challenge of making complex treatment decisions in SARS-CoV-2 positive patients with aggressive but potentially curable blood cancers. When to treat, how to treat, when to wait, how long to wait, how to predict and manage toxicities, and how to avoid compromising cure rates remains unknown. In this article, we attempt to provide some practical suggestions on the management of patients with hematologic malignancies during the COVID-19 pandemic. The manuscript briefly covers practical issues such as delays in diagnosis, deferral of chemotherapy, impact on the clinical trials, utilization of SCT, modifications of maintenance treatments, access to and utilization of supportive measures, role and safety of targeted therapies.
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Purpose: Recommendations and guidelines consider cancer patients a high-priority population for COVID-19 immunization. Vaccination process in Serbia began in January 2021 with four available vaccines. We have conducted a cross-sectional study investigating cancer patients' acceptability of anti SARS-COV2 vaccines.
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SARS-CoV-2 infection in patients with hematological malignancies and hematopoietic stem cell transplants (HSCT) can be severe and with significant mortality. We carried out a prospective and observational study to describe the clinical and epidemiological characteristics and outcome of SARS-CoV-2 infection in patients with hematological malignancies and HSCT. Twenty adult patients were included with a median age of 58 years and a median Charlson score of 3. Infections were community-acquired and nosocomial in 60% and 40%, respectively, and 30% of the patients had a history of contact with a SARS-CoV-2 infected person. Sixty-five percent had pulmonary infiltrates, mostly with a ground-glass pattern on CT scan. Almost half of the patients had a severe and critical illness, and a high proportion received convalescent plasma as treatment. Twenty percent and 15% had complications and hospital infections, respectively, and had prolonged hospitalization expressed as median days of it. The 30-day mortality was 10%. SARS-CoV-2 infection in our population had a considerable clinical and epidemiological impact.