Disseminated tuberculosis and diagnosis delay during the COVID-19 era in a Western European country: a case series analysis.

Background: Disseminated tuberculosis is frequently associated with delayed diagnosis and a poorer prognosis. Objectives: To describe case series of disseminated TB and diagnosis delay in a low TB burden country during the COVID-19 period. Methodology: We consecutively included all patients with of disseminated TB reported from 2019 to 2021 in the reference hospital of the Northern Crown of the Metropolitan Area of Barcelona. We collected socio-demographic information, clinical, laboratory and radiological findings. Results: We included all 30 patients reported during the study period-5, 9, and 16 in 2019, 2020, and 2021 respectively-20 (66.7%) of whom were male and whose mean age was 41 years. Twenty-five (83.3%) were of non-EU origin. The most frequent system involvement was central nervous system (N = 8; 26.7%) followed by visceral (N = 7; 23.3%), gastro-intestinal (N = 6, 20.0%), musculoskeletal (N = 5; 16.7%), and pulmonary (N = 4; 13.3%). Hypoalbuminemia and anemia were highly prevalent (72 and 77%). The median of diagnostic delay was 6.5 months (IQR 1.8-30), which was higher among women (36.0 vs. 3.5 months; p = 0.002). Central nervous system involvement and pulmonary involvement were associated with diagnostic delay among women. We recorded 24 cured patients, two deaths, three patients with post-treatment sequelae, and one lost-to-follow up. We observed a clustering effect of patients in low-income neighborhoods (p < 0.001). Conclusion: There was a substantial delay in the diagnosis of disseminated TB in our study region, which might impacted the prognosis with women affected more negatively. Our results suggest that an increase in the occurrence of disseminated TB set in motion by diagnosis delay may have been a secondary effect of the COVID-19 pandemic.

COVID-19 and Mucormycosis of Orofacial Region: A Scoping Review.

During the second wave of coronavirus disease, or COVID-19, infection due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus in the year 2021 around the globe, there is a surge in the number of cases of mucormycosis or "Black Fungus" that is directly/indirectly associated with COVID-19. In this review article, mucormycosis of the orofacial region has gained importance from the maximum published literature (45 articles) from various databases like PubMed, Google Scholar, Scopus, Web of Science, and Embase. Rhino-orbital cerebral mucormycosis (ROCM) is a fatal condition associated with COVID-19 among categories of mucormycosis such as pulmonary, oral, gastrointestinal, cutaneous, and disseminated. ROCM targets the maxillary sinus, also involving teeth of the maxilla, orbits, and ethmoidal sinus. These are of particular interest to dentists and oral pathologists for proper diagnosis and identification. Co-morbid conditions, especially diabetes mellitus type II, have to be monitored carefully in COVID-19 patients as they have a higher risk of developing mucormycosis. In this review article, various presentations of COVID-19-linked mucormycosis are mentioned having particular emphasis on pathogenesis, signs and symptoms, clinical presentation, various diagnostic modalities including histopathology, radiology like CT and MRI, serology, tissue culture, various laboratory investigations, treatment protocols, management with prognosis, and so on. Any suspected case of mucormycosis needs quick detection and treatment since it progresses quickly due to the destructive course of infection. Long-term follow-up along with proper care is a must to detect any kind of recurrence.

Laboratory markers and radiological signs of mild versus severe COVID-19 patients

Background Coronavirus disease 2019 (COVID-19), a global pandemic that has spread worldwide in a dramatic manner since its first emergence in December 2019 from Wuhan, China. To date, there is still lack of an appropriate protocol that predicts cases who are impending to develop severe COVID-19. Hence, this work was an attempt to determine the potential association of the clinical, laboratory, and radiological parameters with the severity of COVID-19 and the ability of these parameters to predict the severe cases. Patients and methods This is a retrospective study that was based on recruiting the data from the files of patients who attended the chest outpatient clinic, or admitted to the chest department or the ICU of our institution. The study included adult patients who were diagnosed with COVID-19. Patients were categorized into two groups: severe/critical cases and mild/moderate disease cases. Data concerning the patient history, clinical picture, and radiological data were obtained and analyzed. Results Eighty adult patients with COVID-19 were included in this study. They were classified into severe/critical (40 patients) or mild/moderate disease (40 patients). Patients with severe/critical COVID-19 disease were significantly older in age and had higher comorbidities, prevalence, higher incidence of cough, dyspnea, gastrointestinal tract symptoms and fatigue, elevated total leukocyte count, lower relative lymphocytes, lower absolute lymphocytes and higher neutrophils, higher blood glucose levels, higher alanine transaminase, higher aspartate aminotransferase and lower serum albumin, reduced Ca levels, elevated lactate dehydrogenase, serum ferritin, D-dimer, and C-reactive protein levels. They had significantly higher computed tomographic (CT) scores and CT chest with greater than 50% lesions or progressive lesions. The mortality rate was 10%, all of which were from the severe disease group. Conclusion The current study is confirming an overall substantial association between severe COVID-19 and older age, chronic diseases, CT imaging pattern, and severity score, leukocyte count, lymphopenia, blood glucose, serum albumin, alanine transaminase, aspartate aminotransferase, calcium levels, C-reactive protein, D-dimer, lactate dehydrogenase, and ferritin. These results highlighted the importance of using clinical, laboratory, and radiological features for monitoring of COVID-19 patients.Copyright © 2023 The Egyptian Journal of Chest Diseases and Tuberculosis.

A snapshot of pediatric inpatients and outpatients with COVID-19: a point prevalence study from Turkey.

This multi-center point prevalence study evaluated children who were diagnosed as having coronavirus disease 2019 (COVID-19). On February 2nd, 2022, inpatients and outpatients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were included in the study from 12 cities and 24 centers in Turkey. Of 8605 patients on February 2nd, 2022, in participating centers, 706 (8.2%) had COVID-19. The median age of the 706 patients was 92.50 months, 53.4% were female, and 76.7% were inpatients. The three most common symptoms of the patients with COVID-19 were fever (56.6%), cough (41.3%), and fatigue (27.5%). The three most common underlying chronic diseases (UCDs) were asthma (3.4%), neurologic disorders (3.3%), and obesity (2.6%). The SARS-CoV-2-related pneumoniae rate was 10.7%. The COVID-19 vaccination rate was 12.5% in all patients. Among patients aged over 12 years with access to the vaccine given by the Republic of Turkey Ministry of Health, the vaccination rate was 38.7%. Patients with UCDs presented with dyspnea and pneumoniae more frequently than those without UCDs (p < 0.001 for both). The rates of fever, diarrhea, and pneumoniae were higher in patients without COVID-19 vaccinations (p = 0.001, p = 0.012, and p = 0.027).  Conclusion: To lessen the effects of the disease, all eligible children should receive the COVID-19 vaccine. The illness may specifically endanger children with UCDs. What is Known: • Children with COVID-19 mainly present with fever and cough, as in adults. • COVID-19 may specifically threaten children with underlying chronic diseases. What is New: • Children with obesity have a higher vaccination rate against COVID-19 than children without obesity. • Among unvaccinated children, fever and pneumoniae might be seen at a higher ratio than among vaccinated children.

The prevalence of adjustment disorder and predisposing factors in infertile women.

BACKGROUND: Infertility is a stressful life event that increases the risk of developing mental disorders, particularly adjustment disorder (AD). Given the paucity of data on the prevalence of AD symptoms in infertility, the purpose of this study was to ascertain the prevalence, clinical presentation, and risk factors for AD symptoms in infertile women. METHOD: In a cross-sectional study, 386 infertile women completed questionnaires including the Adjustment Disorder New Module-20 (ADNM), the Fertility Problem Inventory (FPI), the Coronavirus Anxiety Scale (CAS), and the Primary Care Posttraumatic Stress Disorder (PC-PTSD-5) at an infertility center between September 2020 and January 2022. RESULT: The results indicated that 60.1% of infertile women exhibited AD symptoms (based on ADNM > 47.5). In terms of clinical presentation, impulsive behavior was more common. No significant relationship was observed between prevalence and women's age or duration of infertility. Infertility stress (ß = 0.27, p < 0.001), coronavirus anxiety (ß = 0.59, p = 0.13), and a history of unsuccessful assisted reproductive therapies (ß = 2.72, p = 0.008) were several predisposing factors for AD symptoms in infertile women. CONCLUSIONS: The findings suggest that all infertile women be screened from the start of infertility treatment. Additionally, the study suggests that infertility specialists should focus on combining medical and psychological treatments for individuals predisposed to AD, particularly infertile women who exhibit impulsive behaviors.

The comparison of clinical, laboratory, and radiological findings in immunocompromised and immunocompetent patients with COVID-19: A case-control study.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19) with significant morbidity and mortality. We reported and compared the clinical and para-clinical findings of immunocompromised and immunocompetent COVID-19 patients in a case-control study at the Imam Khomeini hospital in Tehran, Iran. METHODS: In this study, 107 immunocompromised COVID-19 patients were recruited as the case group, and 107 immunocompetent COVID-19 patients as the control group. The participants were matched based on age and sex. The patients' information was retrieved from the hospital records in an information sheet. Associations between clinical and para-clinical findings with the immune status were assessed using bivariate and multivariate analyses. RESULTS: The initial pulse rate and recovery time were significantly higher in immunocompromised patients (p < .05). Myalgia, nausea/vomiting, loss of appetite, headache, and dizziness were more frequently reported by the control group (p < .05). Regarding the prescribed medications' duration, Sofosbovir was used longer in the case group, while Ribavirin was used longer in the control groups (p < .05). The most common complication in the case group was acute respiratory distress syndrome, although no major complications were observed in the control group. According to the multivariate analysis, recovery time and Lopinavir/Ritonavir (Kaletra) prescription were significantly higher in the immunocompromised compared to the immunocompetent group. CONCLUSION: Recovery time was significantly longer in the immunocompromised compared to the immunocompetent group, which emphasizes the necessity of prolonged care in these high-risk patients. Also, it is recommended to investigate the effect of novel therapeutic interventions to reduce the recovery time in addition to improving the prognosis of immunodeficient patients with COVID-19.

Epidemiology and Clinical Presentation of COVID-19 in Older Adults.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection remains asymptomatic in 33% to 90% of older adults depending on their immune status from prior infection, vaccination, and circulating strain. Older adults symptomatic with SARS-CoV-2 often both present atypically, such as with a blunted fever response, and develop more severe disease. Early and late reports showed that older adults have increased severity of coronavirus disease 2019 (COVID-19) with higher case fatality rates and higher intensive care needs compared with younger adults. Infection and vaccine-induced antibody response and long-term effects of COVID-19 also differ in older adults.

How Different Predominant SARS-CoV-2 Variants of Concern Affected Clinical Patterns and Performances of Infected Professional Players during Two Soccer Seasons: An Observational Study from Split, Croatia.

There are limited data describing clinical patterns and match running performance (MRP) among players with COVID-19 infection before and after infection, particularly related to different predominant SARS-CoV-2 variants, as well as in comparison to uninfected players. This observational study was conducted during two consecutive soccer seasons in one professional club in Split, Croatia. There were four clusters of mild, self-limited, or asymptomatic infection characterised by low adherence to preventive measures. Infected players had significantly more symptoms (t-test = 3.24; p = 0.002), a longer period of physical inactivity (χ2 = 10.000; p = 0.006) and a longer period of self-assessment for achieving full fitness (χ2 = 6.744; p = 0.034) in the 2020-2021 season (Wuhan wild strain and Alpha variant) than in the 2021-2022 season (Omicron variant). It was also found that, despite the milder clinical presentation of the infection in the 2021-2022 season, the players had significantly more abnormal laboratory findings (χ2 = 9.069240; p = 0.002), although without clinical significance at the time of the study. As for the MRP, player performance in the 2021-2022 season was not negatively affected by the Omicron variant, while there was an improvement in MRP in scores for a sample of all players. The RTP protocol was correctly applied because it helped the athletes to recover their pre-infection physical capacities relatively quickly. This study advances the understanding that an optimally and individually planned RTP protocol is crucial for the MRP of infected players. Future research needs to replicate the findings of abnormal laboratory results and extend the study focusing on their potential long-term clinical significance.

The Age-Related Course of COVID-19 in Pediatric Patients-1405 Cases in a Single Center.

Since the beginning of the pandemic, many reports have pointed to age as the most important risk factor for severe COVID-19 in adults, but this relationship is less clear in children. Between March 2020 and April 2022, 1405 pediatric COVID-19 patients were included in our prospective study, which aimed to analyze the disease's characteristics in three age groups: infants, toddlers (1-5 years), and children (5-18 years). We observed male prevalence of the disease in infants and toddlers compared to female prevalence in children. Comorbidities appeared most often in children. In the first pandemic wave, the vast majority of pediatric patients were children, but later, the percentage of infant and toddler patients increased significantly. A total of 74% of hospitalized children were younger than five years. Upper respiratory tract symptoms were most common in infants and toddlers, and lower respiratory tract symptoms and gastroenterocolitis were more common in children. Neurological symptoms appeared similarly in all age groups. The activities of ALT, CK, and LDH were the most elevated in infants, along with D-dimers. The median length of hospitalization fluctuated between three and four days and was highest in infants. Severe courses were more common in adolescents.

Characteristics of Hospitalized Pediatric Patients in the First Five Waves of the COVID-19 Pandemic in a Single Center in Poland-1407 Cases.

This is a single-center, prospective study that compared the clinical presentation and laboratory findings of hospitalized children during the first five waves of the COVID-19 pandemic. Data were collected, according to a standardized questionnaire, from 1407 children from 23 March 2020 to 30 April 2022. Significant differences in clinical courses were found among the five waves probably due to different SARS-CoV-2 variants. The median age was 95.8 months in the first wave versus 14.6-23 months in the others. The number of patients with upper respiratory infection was the highest in the fifth wave (74.4% versus 43.8-56.9% in the others) and for lower respiratory infection in the first wave (50.0% versus 16.4-32.5%). Gastroenterocolitis was more common in the fifth wave (24.4% versus 8.9-16.5%); neurological diagnoses appeared more frequently in the fourth wave (16.6% versus 0.6-9.9%), while anosmia and ageusia were higher in the fifth wave (13% versus 1.5-4%). Life-threatening courses were relatively rare. However, children with pneumonia, dehydration from high fever, gastrointestinal symptoms, loss of smell and taste, and neurological symptoms required hospitalization.

Features of the post-COVID course of psoriasis

Background. Psoriasis is one of the most common dermatoses. The adverse impact of COVID-19 on psoriasis course is now increasingly be-ing reported. Objective. To study clinical and epidemiological features of psoriasis course after COVID-19. Material and methods. We reviewed outpatient records and case histories of 159 psoriasis patients (84 males and 75 females) who recov-ered from COVID-19. Results. The mean age of the patients was 49.9+/-1.9 years. The majority (55.3%) of patients were aged 50 to 60 years or older. The mean duration of illness was 4.74+/-0.69 years. The most common comorbidities were diabetes mellitus and obesity. Psoriasis vulgaris was diagnosed in 56% of patients, and different types of pustular psoriasis accounted for 4.4%. Psoriasis guttata was detected in 9 (5.7%) patients, arthropath-ic psoriasis in 13 (8.2%), exudative psoriasis in 15 (9.4%), psoriatic erythroderma in 14 (8.8%), and psoriatic onychodystrophy in 26 (16.3%) patients. The disease was mild in 12 (7.5%) patients, moderate in 55 (34.6%), and severe in 92 (57.9%) patients. The dermatological quality of life index was 26.6+/-3.2 points. Conclusion. Diabetes mellitus and obesity were the most common comorbidities. A significant part of the patients had pustular psoriasis, psoriasis guttata, and psoriatic erythroderma. In the post-COVID period, a moderate to severe course of psoriasis was observed in 78% of cas-es. A high DLQI value indicated an adverse impact of COVID-19 and psoriasis on patients' quality of life. The features of the psoriasis course in the post-COVID period should be considered when prescribing therapy and medical rehabilitation measures. Copyright © 2022, Media Sphera Publishing Group. All rights reserved.

Clinical presentation and pulmonary function tests in post-acute COVID-19 patients.

AIMS: The study analysed post-acute COVID-19 symptoms and the pulmonary function test (PFT) results in patients surviving the native strain of the virus. METHODS: The study was prospective; the inclusion criteria were positive PCR test for SARS-CoV-2 and age 18-100. Exclusion criteria were active respiratory infection, known or suspicious pre-existing pulmonary disease, cardiac failure, recent or acute pulmonary embolism, anaemia, and neuromuscular diseases. The recruitment period was 1st March 2020 - 25th December 2020. The initial examination was performed 4-12 weeks after the disease onset. All subjects underwent physical examination, anamnesis, chest x-ray and PFT. RESULTS: The study involved 785 subjects (345 male) mean age 53.8 (SD 14.6). The disease severity groups were: mild (G1), moderate (G2) and severe/critical (G3). Anosmia was present in the acute disease phase in 45.2% of G1 patients, but only in 4.5% of G3 patients. Dyspnoea occurred frequently in more severe groups (40%, 51.8% and 63.7% for G1, G2 and G3 respectively), while cough and fatigue showed no relationship to disease severity. Females were more likely to experience persistent symptoms. PFT results were significantly decreased in more severe groups compared to the mild COVID-19 patients, diffusing capacity was 86.3%, 79% and 68% of predicted values in G1, G2 and G3 respectively. CONCLUSION: Anosmia during the acute phase was associated with mild disease, persisting dyspnoea was more frequent after more severe COVID-19. Females tended to have persisting symptoms in post-acute phase more frequently. PFT results showed decrease with disease severity.

The clinical presentation and clinical severity of COVID-19 in pediatric age group in Iraq: Cross sectional study

Background: In general there is susceptibility for the disease in pediatric age group (12). It has been shown that 2 % of affected individuals are children in certain parts of the world (13). Development of severe disease in children has been linked to comorbidities such as malnutrition, asthma, neuropsychiatric disorders, epilepsy, congenital abnormalities and type 1 diabetes mellitus) (14, 15). In Iraq, reports about clinical presentation and severity of disease in pediatric age group are scanty;therefore. Aim of the study: The aim of the current study was to highlight the main clinical features and clinical severity of COVID-19 in children. Patients and methods: The current cross-sectional research was conducted in Iraq's Al-Diwaniyah Province's Children and Maternity Teaching Hospital. The study included 400 children who tested positive for COVDI-19 using RT-PCR after nasopharyngeal swabs. The study included 220 males and 180 females ranging in age from 1 month to 15 years. The severity of disease was considered according to medication required so that children required no oxygen therapy were regarded as mild cases, children required oxygen therapy were regarded as moderate cases while those requiring mechanical ventilation or Continuous positive airway pressure were considered severe cases. Results: out of 400 children 244 cases (61.0 %) were considered as mild cases whereas, moderate cases were recorded in 156 cases (39.0 %). In addition, no severe presentation was reported. Mild case had higher mean age in comparison with moderate cases, 3.62 ±3.56 years versus 2.77 ±2.88 years, respectively (p = 0.013). The frequency distribution according to gender revealed no significant association between severity of disease and gender of patients (p = 0.650). Fever was the most common symptom accounting for 230 (57.5 %), followed by gastrointestinal symptoms (GIT symptoms) accounting for 192 (48.0 %), followed by cough which was reported in 156 (39.0 %), followed by sore throat which was observed in 74 (18.5 %) and finally followed by rhinorrhea that was reported in 66 (16.5 %). Sore throat and GIT symptoms were significantly associated with moderate disease (p < 0.05). Conclusion: The disease is often mild or moderate and the main clinical features were fever, upper respiratory tract manifestation and GIT manifestations. © International Journal of Health Sciences.All right reserved.

Epidemiological characteristics and initial clinical presentation of patients with laboratory-confirmed MERS-CoV infection in an emergency department

Emergency departments have been implicated as a source of index cases of the Middle East Respiratory Syndrome (MERS) coronavirus infection. We describe the epidemiological characteristics and initial clinical presentation of patients with Middle East respiratory syndrome coronavirus infection in an emergency department at a hospital in Riyadh, in the Kingdom of Saudi Arabia. The records of all patients presenting to the emergency department who tested positive for Middle East respiratory syndrome coronavirus infection on real-time reverse transcriptase polymerase chain reaction testing from April 2014 to November 2019 were reviewed, and the outcomes were assessed. The clinical presentations and outcomes were compared according to sex. A total of 68 patients with Middle East respiratory syndrome coronavirus infection were identified, of whom 40 (58.8%) were female, and 28 (41.2%) were male. The mean age was 50.7 (standard deviation: 16.4) years, and female patients were younger (44.7±13.1 years) than male patients (59.4 ± 16.9 years). Nineteen of the 68 patients (27.9%) were asymptomatic of whom the majority (16/19, 84%) were female (p = 0.012). The most common symptoms were fever (n = 29, 42.6%), cough (n = 25, 36.8%), upper respiratory tract infection (n = 23, 33.8%), and pneumonia (n = 15, 22.1%). Pneumonia, diarrhea, dyspnea, and vomiting/diarrhea were more common among male patients. Male patients were more likely than female patients to require hospital admission (78.6% vs. 30.0%), intensive care unit admission (64.3% vs. 15.0%), and invasive mechanical ventilation (32.1% vs. 10.0%). The most common presentation of Middle East respiratory syndrome coronavirus infection in this cohort was asymptomatic infection. A high proportion of asymptomatic infections has not been reported previously. The study did not identify typical clinical features of MERS patients. Male patients tended to develop more severe disease than female patients. A larger study is needed to confirm these findings. © 2022 The Author(s). Published by MRE Press.

Sex-Based Medicine Meets Psoriatic Arthritis: Lessons Learned and to Learn.

Humorally associated autoimmune diseases generally show a female predominance whereas ankylosing spondylitis, a disease that overlaps with psoriatic arthritis (PsA), shows a male predominance. The present review ascertains the current knowledge of sex-specific differences related to psoriatic arthritis (PsA), a chronic, inflammatory condition associated with psoriasis. Sex differences may have important implications for clinical research in PsA and in terms of epidemiology (incidence, prevalence, lifetime risk, survival, and mortality), clinical, radiological, and laboratory features, and response to treatment. While nationwide surveys and large-scale databases and registries show no sex-specific differences, varying male/female ratios have been reported, ranging from 0.42 to 2.75 (comparable with those reported for psoriasis vulgaris: ranging from 0.28 to 2.38). This may reflect subtle, complex, nonlinear interactions between the biological make-up of the individual (genetic and epigenetic differences), hormonal components including menopausal status, environmental exposures including skeletal physical stressing, and psychological variables. There exists methodological heterogeneity and paucity of data concerning sex-specific differences, in terms of the specific population studied, study design, and the diagnostic criteria utilized. Harmonizing and reconciling these discrepancies would be of crucial importance in achieving the ambitious goals of personalized/individualized medicine and further standardized meta-data and Big Data could help disentangle and elucidate the precise mechanisms of underlying potential PsA sex-specific differences.

A comparative review of the current SARS-CoV-2 strains and the updated COVID management

SARS-CoV-2, like other RNA viruses, is susceptible to genetic evolution, with mutations forming over time, resulting in mutant strains with differing characteristics from the original strains. With so many variants discovered the CDC and WHO created its own classification system for SARS-CoV-2 variants, dividing them into variants of concern (VOCs) and variants of interest (VOIs). Convalescent plasma, antiviral medicines, dexamethasone, monoclonal antibodies, and immuno modulators, which are currently available to treat SARS-CoV-2 infection, could help manage SARS-CoV-2 infection, although their effectiveness is limited. COVID-19 vaccines have been created in a variety of techniques, all of which are briefly discussed in this article. The development of affordable and effective oral anti-COVID-19 drugs along with increased vaccination uptake, will go a long way toward not just reducing COVID-19's progression but also bringing hope for the end of this devastating pandemic caused by Covid 19. The rationale of this study is to give a comparison of the many Covid strains that exist around the world.

COVID-19 Clinical Presentation Among HIV-Infected Persons in China: A Systematic Review.

PURPOSE OF REVIEW: The impact of HIV infection on the natural history of COVID-19 is unknown, given the recency of the human spread of SARS-CoV-2 (CoV). We reviewed published case series/reports of CoV-HIV coinfections to clarify epidemiologic and clinical features in China, the first nation with pandemic experience. RECENT FINDINGS: Assuming that HIV-infected persons were at average risk of CoV infection in Wuhan, we estimated HIV-CoV coinfected persons to number 412 (95%CI: 381-442); our review encompassed an estimated 16.7% (69/412) of Wuhan. Men (many of whom reported sex with other men) accounted for 71.1% (54/76) of the cases reported in China. The median age was 48.0 years old (range 24-77, interquartile:37-57). The median CD4+ cell count at the last clinical visit was 421 cells/µL; 83.0% had an undetectable viral load. Among 31 patients with clinical details reported, fatigue (41.9%), respiratory distress (41.9%), and gastrointestinal symptoms (26.7%) were most common. Among the 52 cases reporting COVID-19 clinical severity, 46.2% were severe, 44.2% mild, and 9.6% asymptomatic COVID-19. Late antiretroviral therapy (ART) was reported by 30.4% (7/23) among whom 57.1% (4/7) were confirmed as severe COVID-19. The case fatality rate was 9.1% (3/33). Severe disease and death were less common among persons who took ART prior to the COVID-19 diagnosis. Of 16 reported IL-6 results, 68.7% were within the normal range. Earlier use of ART was associated with a better COVID-19 prognosis with CoV-HIV co-infection reported from China through early 2021, but small sample sizes limit definitive conclusions.

Length of Hospital Stay of COVID-19 Patients managed at the Lagos State Isolation Centres during the First Wave of the Pandemic

BACKGROUND: Lagos State has the highest number of COVID-19 cases in Nigeria. We assessed the factors predicting the length of hospital stay of COVID-19 patients admitted in 15 isolation centres across the state. METHODS: We reviewed the electronic medical records of all COVID-19 patients admitted and discharged between February 27, 2020, and September 30, 2020. Logistic and linear regressions were used to assess factors predicting the length of hospital stay. RESULTS: A total of 3153 records were reviewed, of which 2623 (83.2%) met the inclusion criteria. The mean age of patients admitted was 40.5 (Sd 14.8) years. The age range was four days-97 years. A total of 1258 (48.0%) were symptomatic, while 2056 (78.4%) and 567 (21.6%) presented with mild and severe disease, respectively. Cough (22.0%), fever (17.3%) and breathlessness (12.3%) were the most common symptoms at presentation. Generally, the median length of hospital stay was 11 (IQR 9, 14) days. A total of 1609 (61.3%) had a prolonged length of hospital stay. The odds for prolonged hospital stay was higher among elderly patients (AOR 12.1 95%CI 7.6-19.4, p<0.001), male (AOR 1.2 95%CI 1.0-1.4, p=0.031) and patients with severe disease (AOR 1.3 95% CI 1.0-1.7, p=0.042). Age, hypertension and shortness of breath made the most significant contribution to predicting the length of hospital stay (P<0.05). CONCLUSION: Age, gender, hypertension and breathlessness predicted the length of hospital stay. Proactive measures should be instituted in managing COVID-19 patients.

Clinical Characteristics of Patients with Acute Ischemic Stroke Previously Vaccinated Against COVID-19.

OBJECTIVES: The aim of this study was to examine the clinical characteristics of patients with acute ischemic stroke which were previously vaccinated against Coronavirus Disease 2019 (COVID-19) and determine whether the vaccine had impact on outcome. MATERIALS AND METHODS: In this observational cohort study we analyzed the clinical characteristics of 58 patients with ischemic stroke, previously vaccinated against COVID-19. We analyzed demographic characteristics, risk factors, type of stroke and outcome. We also compared outcome of those patients with outcome in stroke patients hospitalized in the same period but not vaccinated, patients hospitalized during the pandemic, before vaccination began, and stroke patients hospitalized before the pandemic. Further, we compared mortality rate with mortality rate in patients who had acute ischemic stroke and COVID-19 simultaneously. RESULTS: The mean age of the patients was 71.0 years, most were male (58.6%), mostly with risk factors for stroke. In the largest number of patients, 17 (29.3%), the etiopathogenetic mechanism of stroke was atherosclerosis of the large arteries. Mortality in vaccinated patients was identical to mortality in stroke patients before pandemic, without significant difference from mortality in unvaccinated patients (13.8% versus 8.6%; p= 0.23). The mean NIHSS and mRS score at discharge for all examined groups were without significant difference. A significant difference in mortality was found between COVID-19 positive and COVID-19 negative stroke patients (37.8% versus 18.1%; p=0.001). CONCLUSIONS: There are no significant differences in clinical characteristics of stroke in vaccinated compared to unvaccinated patients. We did not find a connection between vaccination and stroke.

Obsessive-Compulsive Disorder and the Corona Virus Pandemic – Doctors, Am I Still Diagnosed?

Obsessive-compulsive disorder (OCD) was considered one of the less common mental disorders, but in fact about 2-3% of people in the population have obsessive-compulsive disorder. OCD belongs to the group of anxiety disorders, and is characterized by the appearance of obsessive thoughts and compulsive actions. People who suffer from this disorder understand the irrationality of their actions and find them uncomfortable, but cannot prevent them. Consequently, all aspects of life can be affected (work, school, interpersonal relationships), and many activities limited. The changes in daily routines caused by the pandemic cause's anxiety in everyone, it can be especially disturbing for people who suffer from mental disorders. Social structures and relationships are components of mental and physical health, and their sudden disappearance is especially difficult for those who use them to maintain balance in the fight against mental difficulties. An additional problem is the fear of many unknowns and an uncertain future. In this paper we aim to present the main characteristics of OCD and also changes in the way it is observed during the pandemic of corona virus. © 2021, Opca Bolnica Zadar. All rights reserved.