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1.
Int J Infect Dis ; 2022 Jul 26.
Article in English | MEDLINE | ID: covidwho-2015444

ABSTRACT

OBJECTIVE: Indigenous populations have been disproportionately affected during pandemics. We investigated COVID-19 mortality estimates among Indigenous and non-Indigenous populations at national and sub-national levels in Mexico. METHODS: We obtained data from the Ministry of Health of Mexico on 2,173,036 laboratory-confirmed RT-PCR positive COVID-19 cases and 238,803 deaths. We estimated mortality per 1000-person weeks, mortality rate ratio among Indigenous vs. non-Indigenous groups (RR), and hazard ratio (HR) for COVID-19 deaths across four waves from February 2020 to March 2022. We also assessed differences in the reproduction number (Rt). RESULTS: The mortality rate among Indigenous populations of Mexico was 68% higher than that of non-Indigenous groups. Out of 32 federal entities, 23 exhibited higher mortality rates among Indigenous groups (P<0.05 in 13 entities). The fourth wave showed the highest RR (2.40). The crude HR was 1.67 (95% CI: 1.62, 1.72), which decreased to 1.08 (95% CI: 1.04, 1.11) after controlling for other covariates. During the intense fourth wave, the Rt among the two groups was comparable. CONCLUSION: Indigenous status is a significant risk factor for COVID-19 mortality in Mexico. Our findings may reflect disparities in non-pharmaceutical (e.g., handwashing and using facemasks) and COVID-19 vaccination interventions among Indigenous and non-Indigenous populations in Mexico.

2.
6th International Conference on Inventive Systems and Control, ICISC 2022 ; 436:775-788, 2022.
Article in English | Scopus | ID: covidwho-2014003

ABSTRACT

This study is divided into risk factor analysis (RFA) and proposed system architecture (PSA). The light gradient boosting machine (LightGBM) algorithm in the RFA will work with the PSA to predict the risk factors. The results, efficacy, and performance will be validated via a ROC-AUC curve. Therefore, a system usability scale (SUS) procedure will be implemented to increase the performance. If the SUS score reaches 85–99 and 100 thresholds, it will be classified as appropriate for use and robust. The prediction score thresholds will be 0–100. If the score is below 25, it will be classified as normal, 26–50 as moderate, 51–70 risk, and 71–100 as severe. Due to a shortage of experienced staff and intelligent technology, it is becoming progressively difficult to reduce COVID-19 fatality rates. In this research, a lightweight mobile application has been suggested from which the significant patterns and factors can be recognised. Furthermore, it will assist both doctors and patients become aware of COVID-19 risk factors and take the required steps to mitigate them. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

3.
Public Health Reports ; : 1, 2022.
Article in English | Academic Search Complete | ID: covidwho-2002026

ABSTRACT

Understanding COVID-19–related mortality among the large population of people experiencing homelessness (PEH) in Los Angeles County (LA County) may inform public health policies to protect this vulnerable group. We investigated the impact of COVID-19 on PEH compared with the general population in LA County.We calculated crude COVID-19 mortality rates per 100 000 population and mortality rates adjusted for age, race, and sex/gender among PEH and compared them with the general population in LA County from March 1, 2020, through February 28, 2021.Among adults aged ≥18 years, the crude mortality rate per 100 000 population among PEH was 20% higher than among the general LA County population (348.7 vs 287.6). After adjusting for age, the mortality rate among PEH was 570.7 per 100 000 population. PEH had nearly twice the risk of dying from COVID-19 as people in the general LA County population;PEH aged 18-29 years had almost 8 times the risk of dying compared with their peers in the general LA County population. PEH had a higher risk of mortality than the general population after adjusting for race (standardized mortality ratio [SMR] = 1.4;95% CI, 1.2-1.6) and sex/gender (SMR = 1.3;95% CI, 1.1-1.5).A higher risk of COVID-19–related death among PEH compared with the general population indicates the need for public health policies and interventions to protect this vulnerable group. [ FROM AUTHOR] Copyright of Public Health Reports is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

4.
Cureus ; 14(7): e27067, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1988453

ABSTRACT

INTRODUCTION: Other entities besides deep vein thrombosis (DVT) affecting the venous system, such as superficial vein phlebitis (SVP) and superficial vein thrombophlebitis (SVT), receive poor attention in the literature. However, both entities may propagate proximally into the deep venous system and progress to a DVT. To our knowledge, the relevance of other venous findings such as SVP or SVT in coronavirus disease 2019 (COVID-19) patients has not been evaluated. This work aimed to assess the clinical, biochemical, and hematological variables associated with the incidence of acute venous diseases, such as DVT, SVP, and SVT, in a cohort of 74 critically ill COVID-19 patients and their association with mortality. METHODS: Given the high thrombotic risk, all patients underwent venous imaging with bedside ultrasound. Clinical variables were obtained from medical records. Comparisons were made by the chi-square test or Fisher's exact test. We constructed Kaplan-Meier curves and used Cox proportional hazard models to calculate hazard ratios for dichotomized risk factors to identify predictors of mortality. SPSS version 21.0 (IBM Corp., Armonk, NY) was used for statistical analysis. RESULTS:  SVP occurred in 28 patients (37.8%), DVT in 22 patients (29.7%), and 28 patients died (37.8%). Elevated D-dimer was associated with DVT but not with SVP. Neither SVP nor DVT was associated with mortality. After adjusting for age, elevated troponins (OR: 2.4, 95% CI: 1.1-5.4), platelets < 244 cell/mm3 (2.4, 1.1-5.6), and IMPROVE (International Medical Prevention Registry on Venous Thromboembolism) bleeding score > 7 (2.8, 1.3-6.3) were predictors of mortality. CONCLUSIONS: Acute venous findings such as SVP and DVT are highly prevalent and independent of mortality in critically ill COVID-19 patients. These entities are not related, although they may occur synchronically. DVT is frequently presented as an asymptomatic distal bilateral finding associated with elevated D-dimer, decreased ferritin, and higher vasoactive drug use but independent from chronic venous disease. Interestingly, elevated troponins, decreased platelets, and a prognostic value > 7 of the IMPROVE bleeding score were predictors of mortality in this group of critically ill COVID-19 patients.

5.
Expert Syst Appl ; 209: 118377, 2022 Dec 15.
Article in English | MEDLINE | ID: covidwho-1977260

ABSTRACT

Many factors significantly influence the outcomes of infectious diseases such as COVID-19. A significant focus needs to be put on dietary habits as environmental factors since it has been deemed that imbalanced diets contribute to chronic diseases. However, not enough effort has been made in order to assess these relations. So far, studies in the field have shown that comorbid conditions influence the severity of COVID-19 symptoms in infected patients. Furthermore, COVID-19 has exhibited seasonal patterns in its spread; therefore, considering weather-related factors in the analysis of the mortality rates might introduce a more relevant explanation of the disease's progression. In this work, we provide an explainable analysis of the global risk factors for COVID-19 mortality on a national scale, considering dietary habits fused with data on past comorbidity prevalence and environmental factors such as seasonally averaged temperature geolocation, economic and development indices, undernourished and obesity rates. The innovation in this paper lies in the explainability of the obtained results and is equally essential in the data fusion methods and the broad context considered in the analysis. Apart from a country's age and gender distribution, which has already been proven to influence COVID-19 mortality rates, our empirical analysis shows that countries with imbalanced dietary habits generally tend to have higher COVID-19 mortality predictions. Ultimately, we show that the fusion of the dietary data set with the geo-economic variables provides more accurate modeling of the country-wise COVID-19 mortality rates with respect to considering only dietary habits, proving the hypothesis that fusing factors from different contexts contribute to a better descriptive analysis of the COVID-19 mortality rates.

6.
Sci Total Environ ; 848: 157579, 2022 Jul 25.
Article in English | MEDLINE | ID: covidwho-1956329

ABSTRACT

The ambient air pollution by particulate matter (PM) has strong negative effects on human health. Recent studies have found correlations between pollution and mortality due to Covid-19. We present here an analysis of such correlation for 32 locations in 6 countries of the Western Europe (France, Germany, Italy, Netherlands, Spain, United Kingdom), for the 2020-2022 period. The data are weekly averaged, and the mortality values were normalized considering the population of the locations. A correlation is qualitatively found for the time-series of PM2.5 pollution and Covid-19 mortality. The higher mortality values occurred during the pollutions peaks, as presented for the city of Paris (France) and the Lombardy regions (Italia), one of the more polluted locations in Western Europe. An almost linear trend with a factor 5.5 ± 1.0 increase in mortality when the pollution increases to ~45 µg.m-3 is found when considering all data. This leads to an increase of 10.5 ± 2.5 % of mortality per 1 µg.m-3. More precisely, the trend depends on the period of the analysis and decreases with time (first spread of the pandemic in Spring 2020, mid-2020 - mid 2021 period where the pandemic was better managed, and vaccinal race after mid-2021). Finally, although the initial conditions could differ from one country to another, the relative trend of increase was similar for the countries here considered. Such results can have some implication on the management of the Covid-19 pandemic and other cardiopulmonary diseases during PM pollution events. They also show the importance of reducing the PM pollution in the major cities.

7.
Indian J Crit Care Med ; 26(4): 416-418, 2022.
Article in English | MEDLINE | ID: covidwho-1954528

ABSTRACT

How to cite this article: Siddiqui SS, Patnaik R, Kulkarni AP. General Severity of Illness Scoring Systems and COVID-19 Mortality Predictions: Is "Old Still Gold?" Indian J Crit Care Med 2022;26(4):416-418.

8.
Gondwana Res ; 2022 Jun 06.
Article in English | MEDLINE | ID: covidwho-1945037

ABSTRACT

Environmental selenium (Se) distribution in the US is uneven, yet US residents appear to have a relatively narrow range of serum Se concentrations, according to the NHANES III survey data; this is probably due to the modern food-distribution system. In the US, Se concentration in alfalfa leaves has been used as a proxy for regional Se exposure (low, medium or high, corresponding to ≤ 0.05, 0.06-0.10 and ≥ 0.11 ppm respectively). Se in plants, soil, water, and bacteria can be transformed into volatile dimethyldiselenide, which can be inhaled and excreted via the lung. Hence, pulmonary Se exposure may be different in states with different atmospheric Se levels. We found a significantly higher death rate from COVID-19 in low-Se states than in medium-Se or high-Se states, though the case densities of these states were not significantly different. Because inhaled dimethyldiselenide is a potent inducer of nuclear-factor erythroid 2 p45-related factor 2 (Nrf2), exposure to higher atmospheric dimethyldiselenide may increase Nrf2-dependent antioxidant defences, reducing the activation of NFκB by SARS-CoV-2 in the lung, thereby decreasing cytokine activation and COVID-19 severity. Atmospheric dimethyldiselenide may thereby play a role in COVID-19 mortality, although the extent of its involvement is unclear. Synopsis Loss of pulmonary dimethydiselenide via exhalation may help explain a significantly higher death rate from COVID-19 in states with low environmental (atmospheric) Se concentrations.

9.
Annals of Actuarial Science ; : 1-20, 2022.
Article in English | Web of Science | ID: covidwho-1937388

ABSTRACT

The Covid- I9 pandemic caused an alarming mortality stress. The evidence shows that a significant proportion of people who die from Covid-19 are in a frail state. According to this consideration, we assume that the mortality shocks are related to a group of the individuals with some co-morbidities at Covid-19 diagnosis. In other words, the mortality shocks present a specific characterisation, which consists of a causal connection with pre-existing conditions, and the phenomenon could be described as a mortality acceleration. In this paper, an Accelerated Mortality Model is proposed in order to capture the different effects on mortality that depend on the evolution of the pandemic and the presence of co-morbidities at diagnosis. Furthermore, we assess the impact of Covid-19 mortality acceleration on a set of traditional life insurance contracts. We observe that, although mortality acceleration by Covid-19 affects more markedly the elderly and unhealthy sub-populations, it could be considered as a temporary shock with a limited impact on the life insurance market.

10.
Journal of Obstetric, Gynecologic & Neonatal Nursing ; 51(4, Supplement):S1-S2, 2022.
Article in English | ScienceDirect | ID: covidwho-1914707
11.
PeerJ ; 10: e13227, 2022.
Article in English | MEDLINE | ID: covidwho-1884664

ABSTRACT

COVID-19 can be life-threatening to individuals with chronic diseases. To prevent severe outcomes, it is critical that we comprehend pre-existing molecular abnormalities found in common health conditions that predispose patients to poor prognoses. In this study, we focused on 14 pre-existing health conditions for which increased hazard ratios of COVID-19 mortality have been documented. We hypothesized that dysregulated gene expression in these pre-existing health conditions were risk factors of COVID-19 related death, and the magnitude of dysregulation (measured by fold change) were correlated with the severity of COVID-19 outcome (measured by hazard ratio). To test this hypothesis, we analyzed transcriptomics data sets archived before the pandemic in which no sample had COVID-19. For a given pre-existing health condition, we identified differentially expressed genes by comparing individuals affected by this health condition with those unaffected. Among genes differentially expressed in multiple health conditions, the fold changes of 70 upregulated genes and 181 downregulated genes were correlated with hazard ratios of COVID-19 mortality. These pre-existing dysregulations were molecular risk factors of severe COVID-19 outcomes. These genes were enriched with endoplasmic reticulum and mitochondria function, proinflammatory reaction, interferon production, and programmed cell death that participate in viral replication and innate immune responses to viral infections. Our results suggest that impaired innate immunity in pre-existing health conditions is associated with increased hazard of COVID-19 mortality. The discovered molecular risk factors are potential prognostic biomarkers and targets for therapeutic intervention.

12.
Indian J Crit Care Med ; 26(5): 626-631, 2022 May.
Article in English | MEDLINE | ID: covidwho-1884586

ABSTRACT

Introduction: We researched blood urea nitrogen (BUN), albumin and their ratio (BAR), and compared them with C-reactive protein (CRP), D-dimer, and computed tomography severity scores (CT-SS), to predict in-hospital mortality. Methods: One-hundred and thirty-one coronavirus disease-2019 (COVID-19) confirmed patients brought to the emergency department (ED) were dispensed to the survivor or non-survivor group, in light of in-hospital mortality. Information on age, gender, complaints, comorbidities, laboratory parameters, and outcome were gathered from the patient's record files. Results: The median BUN, mean total protein, mean albumin, median BAR, median creatinine, median CRP, and median D-dimer were recorded. CT-SS were utilized in categorizing the patient as mild, moderate, and severe. In-hospital mortality occurred in 42 (32.06%) patients (non-survivor group) and did not occur in 89 (67.94%) patients (survivor group). The median BUN (mg/dL) and BAR (mg/gm) values were significantly raised in the non-survivor group than in the survivor group [BUN: 23.48 (7.51-62.75) and 20.66 (4.07-74.67), respectively (p = 0.009); BAR: 8.33 mg/g (2.07-21.86) and 6.11 mg/g (1.26-23.33); (p = 0.0003)]. The mean albumin levels (gm/dL) in the non-survivor group were significantly lower than in the survivor group [2.96 ± 0.35 and 3.27 ± 0.35, respectively (p <0.0001)]. Albumin with an odd's ratio of 6.14 performed the best in predicting in-hospital mortality, followed by D-dimer (4.98). BAR and CRP had similar outcome of 3.75; BUN showed an OR of 3.13 at the selected cutoff value. Conclusion: The BUN, albumin, and BAR were found to be dependable predictors of in-hospital mortality in COVID-19 patients, with albumin (hypoalbuminemia) performing even better. How to cite this article: Singh S, Singh K. Blood Urea Nitrogen/Albumin Ratio and Mortality Risk in Patients with COVID-19. Indian J Crit Care Med 2022;26(5):626-631.

13.
Isr J Health Policy Res ; 11(1): 24, 2022 May 31.
Article in English | MEDLINE | ID: covidwho-1883542

ABSTRACT

BACKGROUND: The COVID-19 pandemic caused four waves of infection in Israel until October 2021. Israel was the first country to offer vaccinations to all the adult population followed by boosters. This study addresses how mortality rates reflect the effects of the pandemic. METHODS: Total mortality rates and rates of mortality without COVID-19 deaths (non-COVID-19 mortality) between March 2020 and October 2021 were compared with the average pre-COVID-19 rates in 2017-2019 by month, population group and by age group. In addition, a cohort vaccinated at least once by 31 March 2021 was followed up for mortality in the following seven months compared to the corresponding months in 2017-2019. RESULTS: A small number of excess deaths was found in the first wave and a greater excess in the following waves. The monthly mortality rate ratio was highest in October 2020, 23% higher than the average in 2017-2019, followed by August 2021 (22%), September 2021 (20%) and September 2020 (19%). Excess mortality in the Arab population was greater than for Jews and Others, and they had 65% and 43% higher mortality in September and October, 2020, 20-44% higher mortality between December 2020 and April 2021 and 33%, 45% and 22% higher mortality in August, September and October 2021, respectively. In most months of the pandemic, the non-COVID-19 mortality rates were not significantly different from those in 2017-2019. However, between November 2020 and March 2021, they were significantly lower for the total population and Jews and Others. They were significantly higher for the total population only in August 2021, and particularly for the Arab population. Non-COVID-19 mortality was also lower for most sex/age groups over the total study period. In a cohort of 5.07 million Israeli citizens vaccinated at least once by 31 March, 2021, age adjusted and age specific mortality rates for the following 7 months were lower than the average rates in 2017-2019 for these months, CONCLUSION: Israel has seen significant excess mortality during the COVID-19 pandemic, particularly in the Arab sector. Following lockdowns and administration of vaccinations excess mortality was reduced, and no excess mortality was seen amongst the vaccinated in the months after the vaccination campaign. These findings highlight the importance of public health measures such as mandating mask wearing and population vaccinations to control infection and reduce mortality.


Subject(s)
COVID-19 , Influenza, Human , Adult , COVID-19/epidemiology , Communicable Disease Control , Humans , Infant , Israel/epidemiology , Pandemics
15.
J Hosp Infect ; 126: 29-36, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1878270

ABSTRACT

BACKGROUND: Tocilizumab is an interleukin-6 inhibitor that reduces mortality and the need for invasive mechanical ventilation, while increasing the possibility of successful hospital discharge for hyperinflammatory patients with severe coronavirus disease 2019 (COVID-19). No increase in adverse events or serious infections has been reported previously. AIM: To describe the characteristics and outcomes of patients with severe COVID-19 in critical care who received tocilizumab, and to compare mortality and length of hospital stay for patients who received tocilizumab (N=41) with those who did not (N=33). METHODS: Retrospective review of data related to patients with COVID-19 who received tocilizumab in a critical care setting from 1st January to 31st December 2021. FINDINGS: Amongst COVID-19 survivors, those who had received tocilizumab had longer intensive care unit (ICU) stays (median length 21 vs 9 days) and hospital stays (45 vs 34 days) compared with those who had not received tocilizumab. Thirty-day mortality (29% vs 36%; P=0.5196) and 60-day mortality (37% and 42%; P=0.6138) were not significantly lower in patients who received tocilizumab. Serious bacterial and fungal infections occurred at higher frequency amongst patients who received tocilizumab [odds ratio (OR) 2.67, 95% confidence interval (CI) 1.04-6.86; P=0.042], and at significantly higher frequency than in non-COVID-19 ICU admissions (OR 5.26, 95% CI 3.08-9.00; P<0.0001). CONCLUSIONS: In this single-centre study, patients in critical care with severe COVID-19 who received tocilizumab had a greater number of serious bacterial and fungal infections, but this may not have been a direct effect of tocilizumab treatment.


Subject(s)
COVID-19 , Invasive Fungal Infections , Antibodies, Monoclonal, Humanized , COVID-19/drug therapy , Critical Care , Hospitals , Humans , Incidence , Respiration, Artificial , SARS-CoV-2 , Treatment Outcome
16.
Soc Sci Med ; 305: 115072, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1867786

ABSTRACT

The Covid-19 pandemic has affected countries and regions to varying degrees. In this paper, I examine the socioeconomic determinants of Covid-19 mortality and study whether vaccinations have affected the relationship between those determinants and Covid-19 mortality rates across local areas in England. I use monthly data for 6791 Middle Layer Super Output Areas for the period from March 2020 to April 2021 and estimate a spatial correlations model with local authority and time fixed effects. To study whether vaccinations have affected the relationship between socioeconomic determinants and Covid-19 mortality, I extend the model to include interactions between socioeconomic variables and the lagged cumulative vaccination rate. I find that Covid-19 mortality is higher in areas that have an older population, a larger share of Asian population, higher population density, lower income, poorer pre-existing health and a larger share of employment in health and social care occupations. Vaccinations have weakened the links between mortality and these socioeconomic characteristics. These findings highlight the importance of making vaccines widely available and encouraging take-up, to reduce inequality in Covid-19 mortality across socioeconomic groups.


Subject(s)
COVID-19 , COVID-19/prevention & control , England/epidemiology , Humans , Mortality , Pandemics , Socioeconomic Factors , Vaccination
17.
Exp Ther Med ; 23(6): 418, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1862973

ABSTRACT

The recent coronavirus outbreak from Wuhan China in late 2019 caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) resulted in a global pandemic of coronavirus-19 disease (COVID-19). Understating the underlying mechanism of the pathogenesis of coronavirus infection is important not only because it will help in accurate diagnosis and treatment of the infection but also in the production of effective vaccines. The infection begins when SARS-CoV-2 enters the cells through binding of its envelope glycoprotein to angiotensin-converting enzyme2 (ACE2). Gene variations of ACE2 and microRNA (miR)-196 are associated with viral infection and other diseases. The present study investigated the association of the ACE2 rs4343 G>A and miR-196a2 rs11614913 C>T gene polymorphisms with severity and mortality of COVID-19 using amplification refractory mutation system PCR in 117 COVID-19 patients and 103 healthy controls from three regions of Saudi Arabia. The results showed that ACE2 rs4343 GA genotype was associated with severity of COVID-19 (OR=2.10, P-value 0.0028) and ACE2 rs4343 GA was associated with increased mortality with OR=3.44, P-value 0.0028. A strong correlation between the ACE2 rs4343 G>A genotype distribution among COVID-19 patients was reported with respect to their comorbid conditions including sex (P<0.023), coronary artery disease (P<0.0001), oxygen saturation <60 mm Hg (P<0.0009) and antiviral therapy (0.003). The results also showed that the CT genotype and T allele of the miR-196a2 rs11614913 C>T were associated with decreased risk to COVID-19 with OR=0.76, P=0.006 and OR=0.54, P=0.005, respectively. These results need to be validated with future molecular genetic studies in a larger sample size and different populations.

18.
International Journal of Advanced and Applied Sciences ; 9(5):18-31, 2022.
Article in English | Scopus | ID: covidwho-1863536

ABSTRACT

The objective of our study was to explore the influence of the current vaccination program and other relevant government factors to explain the variation in COVID-19 mortality in the world. The study involves a cross-sectional survey of COVID-19 related and government factors from 161 countries. We retrieved and processed publically available coronavirus pandemic data (July 17, 2021) from several online databases, excluding countries' data violating correlation and regression analysis assumptions. In addition, partial correlations studies and multivariate analysis were performed to explore the influence current vaccination program and other relevant government factors on the relationship between the explanatory variable and the total deaths due to COVID-19. The partial-correlation studies revealed that controlling for a complete dosage of COVID-19 vaccine per 100 people in the population had a significant (P<0.001) impact on the strength of the relationship between some explanatory variables and the response variable (total COVID-19 mortality). Furthermore, the Stepwise Linear Regression (SLR) model shows that the covariates, namely total_cases, hospital patients per million, hospital beds per thousand, male smokers, and people fully vaccinated per hundred, added significantly (P<0.001) to the prediction of the response variable. Our SLR model validation study revealed that the observed total COVID-19 mortality was highly correlated with the predicted total COVID-19 mortality in various countries (r = 0.977, P<0.001). Our Stepwise Linear Regression model performs significantly better with an R-squared value of 0.958 and adjusted R-squared value of 0.956 than other related regression models built to predict COVID-19 mortality. Based on our current findings, we conclude that governments with better hospital infrastructure and people with complete dosages of the COVID-19 vaccine will have minimal COVID-19 fatalities. © 2022 The Authors.

19.
Cureus ; 14(4): e24281, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1856258

ABSTRACT

OBJECTIVE:  Pregnancy is a transient state of immunosuppression. The objective of this study was to ascertain whether pregnant women are more susceptible to coronavirus disease 2019 (COVID-19) than non-pregnant women and the impact of pregnancy on the severity of COVID-19 and associated morbidity and mortality. METHODS:  A prospective observational study was performed at All India Institute of Medical Sciences (AIIMS) Rishikesh for a period of two months. A total of 42 and 33 COVID-19 positive women were included in the obstetric and non-obstetric cohorts respectively. RESULTS:  Baseline characteristics were similar in both groups. Approximately 48% of the obstetric cohort had no COVID-19-related symptoms. Whereas, 100% of the non-obstetric cohort was symptomatic and had a significantly higher number of patients presenting with fever, cough, and breathlessness. The obstetric cohort had a significantly higher incidence of mild disease (p=0.009). In the obstetric cohort, the mean gestational age was 32.59 ± 2.57 weeks, with patients spread across all trimesters. Most of the patients with severe disease were in their second trimester. There was no difference in intensive care unit (ICU) admission, duration of ICU stay, duration of hospital stay, and mortality among both groups. A significantly smaller number of patients in the obstetric cohort required ventilatory support (p=0.0002). The maternal mortality rate was 16.67%. All of them had severe diseases requiring ICU admission. The cause of death was attributed to severe COVID pneumonia with septic shock in all cases. The mortality rate was comparatively higher (27.27%) in the non-obstetric group. CONCLUSION:  Pregnancy, unlike other immunocompromised conditions, does not seem to affect the prognosis of COVID-19 in terms of disease severity or mortality.

20.
Journal of Liver Transplantation ; : 100099, 2022.
Article in English | ScienceDirect | ID: covidwho-1851729

ABSTRACT

Background : Since its declaration as a global pandemic on March11th 2020, COVID-19 has had a significant effect on solid-organ transplantation. Aim of this study was to analyze the impact of COVID-19 on Liver transplantation (LT) in United States. Methods : We retrospectively analyzed the United Network for Organ Sharing database regarding characteristics of donors, adult-LT recipients, and transplant outcomes during early-COVID period (March 11- September 11, 2020) and compared them to pre-COVID period (March 11 - September 11, 2019). Results : Overall, 4% fewer LTs were performed during early-COVID period (4107 vs 4277). Compared to pre-COVID period, transplants performed in early-COVID period were associated with: increase in alcoholic liver disease as most common primary diagnosis (1315 vs 1187, P< 0.01), higher MELD score in the recipients (25 vs 23, P<0.01), lower time on wait-list (52 vs 84 days, P<0.01), higher need for hemodialysis at transplant (9.4 vs 11.1%, P=0.012), longer distance from recipient hospital (131 vs 64 miles, P<0.01) and higher donor risk index (1.65 vs 1.55, P<0.01). Early-COVID period saw increase in rejection episodes before discharge (4.6 vs 3.4%, P=0.023) and lower 90-day graft/patient survival (92.2 vs 96.5 %, P<0.01;90.2 vs 95.1 %, P<0.01). In multivariable cox-regression analysis, early-COVID period was the independent risk factor for graft failure at 90-days post-transplant (HR 1.77, P<0.01). Conclusions : During early-COVID period in United States, overall LT decreased, alcoholic liver disease was primary diagnosis for LT, rate of rejection episodes before discharge was higher and 90-days post-transplant graft survival was lower.

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