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The COVID-19 vaccines provide a high degree of protection against severe disease, hospitalisation, and death. However, no vaccine claimed 100% effectiveness and it is expected that a small proportion of vaccinated individuals may develop a breakthrough infection due to individual differences, virus variants and other factors. We conducted an epidemiological investigation and analysis of an imported case who had finished four doses of vaccination, and in order to provide a relevant reference for regular epidemic prevention and control in the post-pandemic era.
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Patients on maintenance hemodialysis (MHD) are highly susceptible to SARS-CoV-2 and with high mortality rates due to Coronavirus disease 2019, mainly because of the older age in this group of patients, comorbidities, compromised immune status due to uremia, as well as inability to keep social isolation because of the necessity for regular physical presence in dialysis facility. Several retrospective studies of patients on MHD in Europe, America and Asia, show high susceptibility to SARS-CoV-2 in this group of patients with very high rates of critical course of the disease and high mortality rates, reaching more than 40% The aim of this retrospective observational study was to identify risk factors among patients on intermittent hemodialysis for infection with SARS-CoV-2 as well as predictors of severe COVID-19 and fatal outcome. Materials and methods. We analyzed 69 patients receiving intermittent dialysis in Aleksandrovska University Hospital - Hemodialysis Unit. 34 of them have been tested positive for SARS-CoV-2 in the period from September 2020 (when the first case of the disease was registered for our dialysis center) up to March 2022, and are compared with a control group of 35 dialysis-dependent patients without COVID-19. Data about comorbidities, main laboratory and radiologic findings, need of hospitalization and treatment in ICU, as well as data for conducted treatment, are collected from electronic medical records. To identify predictors of severe COVID and poor outcome we compared the group of survivors with the one of non-survivors. Results. There are no significant differences between patients on MHD with and without COVID-19 except higher frequency of COPD and hypoproteinemia in the positive group. Older age, female gender, history of smoking, lymphopenia with neutrophilia, treatment in ICU and need of mechanical ventilation, signs of malnutrition - hypoproteinemia and lower levels of serum creatinine, are risk factors for severe disease and fatal outcomes. Conclusions. The course of COVID infection in dialysis-dependent patients is severe and with high mortality rate, in line with other studies worldwide. Malnutrition is the main risk factor for COVID and also main predictor for poor outcomes.
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Background: A significant portion of individuals with SARS-CoV-2 infection have persistent COVID-19 symptoms after recovery. Symptoms may be new or persistent from the initial illness, which could cause both psychological and physical difficulty to the patients. These symptoms are collectively known as "long COVID-19 syndrome". There is limited information about this syndrome in the Thai population. Objectives: We aimed to describe and evaluate the risk for post COVID-19 symptoms among hospitalized COVID-19 patients in a university hospital. Methods: A prospective descriptive study was conducted on symptomatic COVID-19 patients admitted in Ramathibodi Hospital from July 1 to September 10, 2021. All surviving COVID-19 patients received a telephone assessment every month until 3 months after discharge and electronic medical records were reviewed. Information collected included symptoms, severity, treatment, duration of symptom, complication of COVID-19 and treatment. The New York Heart Association (NYHA) functional classification was used to categorized severity of dyspnea. Results: Among 253 evaluable patients, 57.3% were female and the mean age was 59.3 years old. Of these, 66% and 24.1% had moderate (pneumonia and SpO2 90%) and severe COVID-19 (pneumonia with severe respiratory distress and SpO2 90%), respectively. Almost all patients were inadequately vaccinated (unvaccinated 53.3%, partially vaccinated 41.9%). Overall, complete resolution of symptoms before 1 month after onset were noted in 47 patients (18.5%) and 72 (28.5%) patients had at least one persistent symptom at three months. The most common symptom is sleep disturbance (11.9%);29.2% remain in NYHA II and 0.8% in NYHA III and IV each. Female gender (OR 1.94;[95% CI 1.09-3.48], p=0.024), history of receiving dexamethasone (OR 1.04;[95% CI 1.01-1.08], p=0.004) and length of hospitalization (OR 1.04;[95% CI 1.00-1.08], p=0.034) were associated with being in NYHA II. Additionally, 5.9% had bacterial infection, and most were urinary tract infection and pneumonia, respectively. The risk factor associated with post-COVID-19 bacterial infection is bed ridden status (OR 23.3;[95% CI 5.79-93.72], p=<0.001). Conclusions: A significant number of COVID-19 patients had residual COVID-19 symptoms and still not fully functional at least 3 months after recovery. A major limitation of this study is obtaining information by telephone interview since hospital visit were not encouraged to limit mobility of people during pandemic, which may have led to a recall bias.
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Introduction : Understanding the epidemiological and clinical profile of COVID-19 cases and pattern of disease is very much required for future preparedness. Objective : To assess the epidemiological and clinical profile of cases of COVID 19 Method : Cross sectional descriptive study was carried out at a Rural Health Training Centre (RHTC). All cases reported in the month of January 2022were included in the study. The information about the epidemiological and clinical profile was collected from RHTC records by conducting telephonic interview. Results : Total 83 cases were reported. Among them, 43 (54.4%) cases were in age group 20-39 years. Male: Female ratiowas 1.37:1. Therewas one death and patient had ovarian cancer as co-morbidity. Total 71 patients could be contacted for telephonic interview. Fever was most common symptom andwas presenting symptom on first day followed by cough/cold and sore throat. None had shortness of breath or chest pain. Hospitalization rate was 5.63% and none required oxygen supplementation or intensive care. Recovery period was 3-5 days. Out of total, 90% cases were fully vaccinated and 95.8% had knowledge of CAB. Diabetes and hypertension were most common comorbidities andwere statistically significantlymore in age > 40 years. Conclusions : The COVID-19 cases in the beginning of year 2022 had clinical presentation different than the earlier waves. Periodic situational analysis can guide in policymaking for handling this pandemic in future.
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Canine parvovirus (CPV), canine coronavirus (CCoV) and canine rotavirus (CRV) are the three main causative viruses of diarrhea in dogs with similar clinical symptoms;thereby it is necessary to establish a high effective molecular detection method for differentiating the above pathogens. By optimizing the primer concentration and annealing temperature, a triple PCR method was established for simultaneous detection of CPV, CCoV and CRV, and then the specificity, sensitivity and repeatability of the method were tested. The results showed that the target fragments of CPV VP2 gene (253 bp), CCoV ORF-1b gene (379 bp) and CRV VP6 gene (852 bp) could be accurately amplified by the triple PCR method with high specificity, the detection limits of CPV, CCOV and CRV were 6.44x10-1 pg/L, 8.72x10-1 pg/L and 8.35x10-1 pg/L respectively with high sensitivity, and the method had good stability. Using this triple PCR method, 135 canine diarrhea fecal samples collected in Chengdu region from 2019 to 2020 were detected, and compared with those of single PCR method. The detection rates of CPV, CCoV and CRV were 16.30%, 20.74% and 4.44%, respectively, and the total infection rate was 51.11% (65/135) with 20.00% (13/65) co-infection rate. The detection results were consistent with three single PCR methods. In conclusion, CPV/CCoV/CRV triple PCR method successfully established in this paper can be applied as an effective molecular method to detection of related pathogens and to the epidemiological investigation.
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Currently, there is no availability of any proven specific treatment or prevention strategy to fight against COVID-19. Convalescent plasma (CP) therapy is expected to increase survival rates in COVID-19 as in the case of emerging viral infection (SARS-CoV and MERS-CoV). To collect all the studies relevant to CP therapy in critically ill or severe COVID-19 patients and summarize the findings. The systematic review was conducted according to the PRISMA consensus statement. A systematic search was performed in PubMed, Scopus, Web of Science, and Cochrane databases on April 25, 2020. A total of six studies (28 patients) relevant to CP therapy in severe or critical COVID-19 are considered for inclusion. Two authors extracted the data about study characteristics, demographics, symptoms, co-morbidities, clinical classification of COVID-19, drug therapies, oxygen therapy, laboratory results, chest CT, neutralizing antibody titer, SARS-CoV-2 RNA load, aal outcome. The review findings revealed that CP therapy increases lymphocyte count, reduced s serum inflammatory markers (CRP, IL-6, Procalcitonin) and liver enzyme levels (AST or ALT). There was a rise in serum neutralizing antibody titers in 10 of 14 patients after CP transfusion. In 4 of 14 patients, the titer levels remain unchanged after CP transfusion. All 28 cases (100%) achieved negative to the SARS-CoV-2 RNA after CP transfusion. The convalescent plasma transfusion can improve neutralizing antibody titers and reduces the viral load in severe/critical COVID-19 patients. The review recommends a well-controlled trial design is required to give a definite statement on the safety and efficacy of convalescent plasma therapy in severe/critical COVID-19.
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The coronavirus pandemic is a global health emergency which has had widespread unforeseen mental health consequences. Those with borderline personality disorder are predisposed to poor coping strategies to manage such stress and require intense psychological input which was not widely available during the peak of the pandemic. It is likely that the coronavirus outbreak has had a significant impact on the mental stability of such patients aggravating deliberate self-harm behaviours. A 20-year old psychiatric in-patient with borderline personality disorder, held under Section III of the mental health act, presented to the adult plastic surgery team in Bristol with localised infection of her right forearm. Foreign bodies were easily palpable and imaging revealed linear metal objects. The patient reported that she had removed metal strips from her collection of face masks and inserted them into her forearm as an act of deliberate self-harm. The patient was taken to operating theatre for removal of these foreign bodies under general anaesthetic. After twenty-four hours of antibiotics she was discharged safely back to the psychiatric ward. Despite the epilogue of the COVID-19 pandemic facemasks are still mandatory within the hospital setting. Clinicians need to be aware of these unusual circumstances where a form of protective equipment was deconstructed to cause actual bodily harm. The purpose of this report is to promote awareness of this type of injury especially in those suffering from mental illness. The authors would suggest an alternative mask without any form of metal.
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Oesophageal involvement due to tuberculosis (TB) and coinfection with HTLV-1 is rare and can be complicated by the presence of other infections that affect the mucosa of the upper respiratory tract, such as COVID-19. We present the case of a 27-year-old male patient, with 3 months of illness, weight loss, dysphagia, and ulcers in the oral cavity. Tomography showed oesophageal perforation and after oesophageal ulcer biopsy, TB was diagnosed, in addition to infection by HTLV-1 and severe acute respiratory syndrome coronavirus 2 (SARS-COV-2). The patient responded satisfactorily to antituberculous treatment and corticosteroids. Considering the association between rare extrapulmonary tuberculosis and other immunosuppressive pathologies, it is crucial to identify these pathologies in such patients.
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Background and Aim: Coronavirus disease 2019 (COVID-19) is a respiratory disorder that can affect many body systems, including the hemostatic system. In this study, we aim to investigate the role of hemostatic system and the blood coagulation in COVID-19. Methods & Materials In this review study, the articles were searched using the keywords COVID-19, Respiratory infection, and Coagulopathy in Google Scholar, PubMed, Google Springer and Science Direct databases. Ethical Considerations: Ethical principles in writing this article were observed in accordance with the guidelines of the National Ethics Committee and the Committee on Publication Ethics (COPE). Results Many changes in the coagulation profile of infected patients were reported, including changes in the platelet count, fibrinogen/fibrin degradation product, D-Dimer, fibrinogen, prothrombin time, and activated partial thromboplastin time. With the increase in the number of patients with COVID-19, several studies found out the occurrence of thrombosis and coagulopathy in patients. Conclusion: Due to the increase in the occurrence of coagulation disorders in patients with COVID-19, the administration of anticoagulants is needed for their treatment;it can play an effective role in improving the prognosis of patients.
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Variant Omicron was discovered as a newest severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The first emergence of the omicron variant was detected in November 2021. In this study, we investigated the clinical manifestation, laboratory and radiological findings and responding to treatment of 70 pediatric patients with positive RT- PCR COVID-19 in Omicron peak. We described 20 criteria associated with efficacy, such as demographic data, clinical manifestation, laboratory and radiological findings. All of the patients received Remdesivir that 5.7% of patients responded to the treatment. No patients were given Intravenous Immunoglobulin (IVIG). This is the first study aimed at assessing symptoms clinical manifestation among hospitalization pediatrics patients in pediatric Hospital of Amir kola, Babol. The findings of this study can be effective in preventing and controlling disease transmission among children.
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In recent years, a number of complications have been observed as a result of uncontrolled antibiotic treatment. One of them is gastrointestinal dysbiosis. Not infrequently it is the cause of pseudomembranous colitis, a disease with a remarkably high associated mortality. It can be severe and requires serious medical care. This report presents a clinical case of a patient who developed the disease pseudomembranous colitis after antibiotic treatment for a Covid infection. The aim of the report is to define and present in a systematized manner the nursing care provided in the specific case. The daily analysis of the patient's condition allows to offer complex, adequate and individual nursing care, which, in addition to meeting her needs, also aims to alleviate her condition.
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Various Slovenian hospitals were recruited to treat COVID-19 patients in Slovenia during the COVID-19 epidemic. Centrally coordinated hospital utilisation - depending on the needs, available hospital bed capacity, and considering the professional orientation of individual hospitals - left these facilities with different experiences. We present our experience and COVID-19 treatment management during the fourth epidemic wave in our peripheral, pulmonary-oriented hospital, representing the first treatment quality analysis of these patients in Slovenia. The basic hospitalization characteristics were analysed using integrated Birpis information system solutions and the electronic temperature-therapeutic charts (eTTL) review. The quality of management was assessed through adherence to professional recommendations. The analysis was carried out with the in-built statistical functions of Microsoft Excel software. 99 patients (58 women, 41 men) aged 67.9 years were hospitalised for an average of 8.1 days. The majority were residents of our region (61%), unvaccinated (61.6%), and experienced a severe form of the disease with the need for oxygen supplementation (88.9%). The majority received steroids (73.7%), antibiotics (68.7%) and vitamin D (71.7%), to a lesser extent specific therapy (remdesivir 25.3%, combination casirivimab/imdevimab 2%, tocilizumab 1%). No adverse reactions were noted. 17 people died (total mortality rate 17.2%). There was no infection transmission among the COVID department staff. Results show successful treatment of patients with COVID-19 in Topolsica Hospital. They also suggest the possibility of further improvements, particularly in prescribing antibiotic therapy.
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Introduction: Faced with the pandemic produced by SARS-CoV-2, the Peruvian government implemented several measures such as the temporary closure of primary care facilities and the health system implemented various policies and strategies;one of them was to create and implement the Drug Delivery System for Chronic Patients (SIENMECRO) project. Background: To describe the creation and implementation process of SIENMECRO project. Methods: Qualitative case study that involved reviewing existing documentation such as texts and videos and conducting in-depth interviews with officials and collaborators involved since the preparation of SIENMECRO proposal. Results: SIENMECRO project emerges as a positive initiative with the aspiration of promoting an integrated health system that addresses the health reality from the social determinants of health, due to patients' difficulties to go to their controls and to receive their treatment. Although there was no comprehensive plan for the implementation and control of the project, it was essential to cover the need for health care for a vulnerable segment of the population, avoiding their transfer and preserving the health of the people most likely to suffer complications from COVID-19 infection. Conclusions: It is an initiative where the health system takes a more proactive role for the benefit of the population, implementing the use of technology of the information and communication in health care, articulating with the various providers and bringing services closer to the most vulnerable citizens.
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Objective: To describe the clinical features, causal agent and transmission mode of a fever outbreak in a school in Shanghai. Methods: Field epidemiological approaches including case definition development, searching for contacts, distribution of diseases description, environmental sampling and laboratory testing. Results: A total of 16 influenza-like cases were included, all concentrated in the one class of grade two, including 15 students and 1 teacher. Among student cases, the incidence rate was 36.59%(15/41), the average age was 7.4 years, the incidence rate was 36.84%(7/19) for boys, 36.36%(8/22) for girls. The clinical course was 5-15 days, with the median of 9 days, and 18.75%(3/16) of the cases stayed studying while sick. The nasopharyngeal swab specimens in 16 cases all tested positive for influenza B, of which 11 tested positive for mycoplasma pneumoniae and 1 case also tested positive for coronavirus OC43. Body temperature, number of mononuclear cells, and treatment time of patients infected with Influenza B and mycoplasma pneumoniae were higher than those of patients infected with influenza B alone(P < 0.05). The outbreak lasted for 12 days, all sick students were treated and discharged from hospital, with no severe cases or death, and the outbreak was effectively controlled. Conclusion: This campus cluster outbreak caused by influenza B and mycoplasma pneumoniae. Patients with influenza B with mycoplasma pneumoniae have severe symptoms and a long course of illness, suggesting the importance of early management of the epidemic.
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Introduction: The new pandemic of coronavirus disease 2019 (COVID-19) has evolved certain neurologic syndromes as a presentation of this disease that should be integrated into the whole disease process. Case Presentations: We present cases of neurologic involvement in adult patients with documented bronchopulmonary COVID-19. Certain signs and symptoms are introduced, including new onset seizures, ischemic stroke, and altered mental status in otherwise minimal clinical signs and symptoms of COVID-19. Conclusions: Many neurologic presentations are diagnosed in resolving COVID respiratory infections or in an otherwise asymptomatic individual.
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Background and Objectives: The COVID-19 epidemic and its subsequent effects have become a significant global challenge. In addition to being affected by this crisis, Iran is also facing many other problems, including sanctions and economic problems. So, there is a concern that it will suffer more severe consequences. Methods: Scenario planning is one of the ways to recognize future changes and environmental uncertainties. This study used the so-called global business network (GBN) method, also known as the scenario matrix method. This method is based on two key uncertainties and six steps have been taken to examine variables related to health and socio-economic factors and use the opinions of relevant experts. Results: To be expected, Iran's health system will be able to manage the epidemic in the face of various conditions with severity and weakness, and only in the pessimistic scenario or in Worst-case scenario with the default assumption of the continuation of sanctions and the spread of the epidemic. It leads to global restrictions, loss of foreign exchange reserves, loss of performance or collapse of the health system, increasing the number of deaths and diminishing the quality of life. Conclusion: Regarding the COVID-19 epidemic and the existing background factors, scenarios of Iran's health and economic conditions were narrated. Given the ability of the scenarios to understand the complexity and help in decision-making, it is considered a useful tool for policy makers to have a broader, comprehensive and reasonable look to achieve a correct consensus. This situation leads to the preservation and continuation of society health and conventional economic decisions.
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Introduction: Information on the cardiac manifestations of coronavirus disease 2019 (COVID-19) is scarce. In this study we assessed the echocardiogram of consecutive patients with COVID-19 infection to assess the frequency of cardiac abnormalities. Materials and Methods: This retrospective descriptive study examined the echocardiographic study of 43 patients with severe and critical COVID-19 infection admitted at the ICU of Chitwan Medical College from May 16, 2021 to June 05, 2021. The study focused on left ventricle (LV) and right ventricle (RV) function. The results were then compared between severe and critical infections to examine if any differences exist between them. Results: The mean age of the study population was 54 years and predominately males. One-third were classified as critical COVID-19 while the remaining were severe COVID-19. Majority(83.7%) had a normal echocardiogram. Among the patients with abnormal reports, the distribution of echocardiographic pattern were biventricular dilation with biventricular dysfunction in two patients (4.6%), LV dialtion with LV dysfunction in two patients (4.6%) and isolated LV dysfunction (diastolic and systolic) in three patients (6.9%). None of the echocardiographic parameters were significantly different between the severe and the critical infection. Conclusion: COVID-19 in primarily a respiratory disease and the cardiac complications is largely attributed to the critical nature of the illness than the specific infection. Considering the risk of infection spread, routine echocardiography for all patients with COVID-19 infection is not advisable.
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Objective: We aimed to find the parameters that can change during herpes zoster infection and observe the relationship of these parameters throughout the disease. Material and Methods: We compared 40 herpes zoster patients and 2 separate control groups, who were healthy and had comorbidities similar in age and gender. Patient files were retrospectively analyzed, and laboratory parameters were compared between groups. The laboratory values of the patient group with herpes zoster were evaluated among themselves according to the duration of the symptoms. Results: Fasting glucose, creatinine, aspartate aminotransferase values, the percentage and the absolute number of monocytes, red blood cell distribution width-coefficient of variation, and C-reactive protein levels of the patients with herpes zoster were significantly higher, and the absolute number of lymphocytes, mean corpuscular volume and platelet distribution width levels were lower than the control groups. The percentage of monocytes in the first 5 days was significantly higher than in the following days, and hematocrit values were lower in the last days. Conclusion: Examining routine laboratory values during diseases may help diagnose the disease, especially in patients with faint clinical signs and zoster sine zoster. In addition, it may be useful to question patients with herpes zoster for renal dysfunction, rheumatological diseases, and malignancy.
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Asthma and COPD comorbidities are expected to exacerbate the clinical manifestations of COVID-19. However, many reported studies show that asthmatic patients infected with COVID-19 do not show severe clinical manifestations, and some are asymptomatic. This literature review aimed to describe COVID-19 in asthmatic patients along with the hypothesis that asthma is a protective factor against COVID-19 infection. Systemic corticosteroids have been shown to reduce the death/mortality rate in patients who are hospitalized due to COVID-19 infection. This is possibly due to the suppression of the immune system against a hyperinflammatory state which can result in further damage from SARS-CoV-2 infection. Mucus hypersecretion, which is one of the hallmarks of asthma, can prevent the SARS-CoV-2 virus from reaching the distal lung and can protect the lungs from pathological processes. The secreted mucus is rich in glycoproteins, such as MUC5AC, which act as the first line of defense against infection. Mucus hypersecretion in asthmatic patients may prevent SARS-CoV-2 from penetrating far enough to gain access to type-2 alveolar cells, which are the cells that predominantly express ACE2 in the lungs. In conclusion, comorbid asthma in patients infected with COVID-19 does not cause adverse clinical manifestations to appear, but on the contrary, it will have a protective effect on patients.
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Objective: To explore the clinical characteristics of nucleic acid negative newborns delivered by pregnant women infected with SARS-CoV-2 (Omicron variant BA. 5.1.3) in Sanya area, and to provide evidence for understanding its clinical characteristics. Methods: A retrospective analysis was performed on 14 neonates with negative nucleic acid delivered by pregnant women who tested positive for SARS-CoV-2 (Omicron variant BA.5.1.3) in Sanya Central Hospital (the Third People's Hospital of Hainan Province) from June 2022 to September 2022 (observation group, n=14). The corresponding nucleic acid-negative newborns delivered by pregnant women detected negative with SARS-CoV-2 (Omicronon variant strain BA.5.1.3) were set as the control group (n=56), and the general data and clinical characteristics of neonates in the two groups were compared. Results: There was no significant difference between the observation group and the control group in pregnancy diabetes, pregnancy induced hypertension, gestational pre-eclampsia, fetal intrauterine distress, premature rupture of membranes (P > 0.05);there was no significant difference between the observation group and the control group in terms of sex, gestational age, birth weight, age, mode of delivery, birth Apgar score, heart screening, pulmonary disease, glucose 6-phosphate dehydrogenase (G6PD) deficiency, thalassemia, breast milk jaundice, hemolytic jaundice (P > 0.05). The bilirubin level, blue light irradiation cases and the duration of blue light irradiation of the newborns in the observation group at 7 days after birth were higher than those in the control group (P < 0.05);the ratio of blood oxygen saturation 90% in the observation group was lower than that in the control group (21.43% vs 89.29%, P < 0.05), and the ratio of blood oxygen saturation occasionally<90% was higher than that in the control group (57.14% vs 10.71%, P < 0.05). The ratio of blood oxygen saturation<90% had no significant difference compared with that in the control group (7.14% vs 0, P > 0.05), and the ratio of blood oxygen saturation reduced to the required oxygen uptake was higher than that in the control group (14.29% vs 0, P < 0.05). Conclusions: The jaundice manifestation of the nucleic acid-negative newborns delivered by pregnant women infected with SARS-CoV-2 (Omicronon variant strain BA.5.1.3) in Sanya area is relatively obvious, with blood oxygen saturation easily lower than 90% and even requiring oxygen inhalation in severe cases.