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2.
SSM - Population Health ; : 101118, 2022.
Article in English | ScienceDirect | ID: covidwho-1821485

ABSTRACT

Excess mortality has been used to measure the impact of COVID-19 over time and across countries. But what baseline should be chosen? We propose two novel approaches: an alternative retrospective baseline derived from the lowest weekly death rates achieved in previous years and a within-year baseline based on the average of the 13 lowest weekly death rates within the same year. These baselines express normative levels of the lowest feasible target death rates. The excess death rates calculated from these baselines are not distorted by past mortality peaks and do not treat non-pandemic winter mortality excesses as inevitable. We obtained weekly series for 35 industrialized countries from the Human Mortality Database in 2000–2020. Observed, baseline and excess mortalities were measured by age-standardized death rates. We assessed weekly and annual excess death rates driven by the COVID-19 pandemic in 2020 and those related to seasonal (predominantly) respiratory infections in earlier years. There was a distinct geographic pattern with high excess death rates in Eastern Europe followed by parts of the UK, and countries of Southern and Western Europe. Some Asia-Pacific and Scandinavian countries experienced lower excess mortality. In 2020 and earlier years, the alternative retrospective and the within-year excess mortality figures were higher than estimates based on conventional metrics. While the latter were typically negative or close to zero in “normal” years without extraordinary epidemics, the alternative estimates were substantial. Cumulation of this usual excess over 2–3 years results in human losses comparable to those caused by COVID-19. Challenging the view that non-pandemic seasonal winter mortality is inevitable would focus attention on reducing premature mortality in many countries. As SARS-CoV-2 is unlikely to be the last respiratory pathogen with the potential to cause a pandemic, such measures would also strengthen global resilience in the face of similar threats in the future.

3.
Public Health ; 207:28-30, 2022.
Article in English | EMBASE | ID: covidwho-1821459

ABSTRACT

Objectives: This study aimed to identify and quantify the role that social and economic determinants play in the probability of dying from COVID-19, in the case of Mexico. Study design: This was a cross-sectional study based on secondary data. Methods: In this study, COVID-19 contagion and mortality data were used, as well as socio-economic variables, from public databases and open access, with which an econometric model was estimated. Results: It shows that the number of deaths can rise when variables related to vulnerable groups increase, such as poverty, lack of services, gender, and age. In addition, having pre-existing medical conditions or lacking access to water can be a significant factor in the increase in deaths. Conclusions: Therefore, this study suggests more policies be developed for vulnerable groups to reduce gaps in inequality, particularly given the current situation in which greater inequality can exacerbate the impact of a disease or an unforeseen situation, as is the case of COVID-19.

4.
The Lancet Regional Health - Americas ; 12:100269, 2022.
Article in English | ScienceDirect | ID: covidwho-1821404

ABSTRACT

Summary Background This study aimed to describe the clinical characteristics of maternal deaths associated with COVID-19 registered in a collaborative Latin-American multi-country database. Methods This was an observational study implemented from March 1st 2020 to November 29th 2021 in eight Latin American countries. Information was based on the Perinatal Information System from the Latin American Center for Perinatology, Women and Reproductive Health. We summarized categorical variables as frequencies and percentages and continuous variables into median with interquartile ranges. Findings We identified a total of 447 deaths. The median maternal age was 31 years. 86·4% of women were infected antepartum, with most of the cases (60·3%) detected in the third trimester of pregnancy. The most frequent symptoms at first consultation and admission were dyspnea (73·0%), fever (69·0%), and cough (59·0%). Organ dysfunction was reported in 90·4% of women during admission. A total of 64·8% women were admitted to critical care for a median length of eight days. In most cases, the death occurred during the puerperium, with a median of seven days between delivery and death. Preterm delivery was the most common perinatal complication (76·9%) and 59·9% were low birth weight. Interpretation This study describes the characteristics of maternal deaths in a comprehensive multi-country database in Latin America during the COVID-19 pandemic. Barriers faced by Latin American pregnant women to access intensive care services when required were also revealed. Decision-makers should strengthen severity awareness, and referral strategies to avoid potential delays. Funding Latin American Center for Perinatology, Women and Reproductive Health. Resumen Antecedentes Este estudio tuvo el objetivo de describir las características clínicas de las muertes maternas asociadas a COVID-19 registradas en una base de datos latinoamericana multipaís. Métodos Se implementó un estudio observacional descriptivo en el que participaron ochos países Latinoamericanos desde el 1ero de marzo 2020 al 29 de noviembre 2021. La información se obtuvo del Sistema Informático Perinatal del Centro Latino Americano de Perinatología, Salud de la Mujer y Reproductiva. Presentamos las variables categóricas como frecuencias y porcentajes y las variables continuas en medianas con rangos inter cuartiles. Resultados Identificamos un total de 447 muertes. La mediana de edad materna fue de 31 años. 86·4% de las mujeres se infectaron ante del parto, siendo la mayoría de los casos detectados en el tercer trimestre del embarazo (60·3%). Los síntomas más frecuentes en la primera consulta y la admisión fueron disnea (73·0%), fiebre (69·0%), y tos (59·0%). Se reportaron disfunciones orgánicas en 90·4% de las mujeres durante la admisión. Un total de 64·8% de las mujeres fueron ingresadas a cuidados críticos por una mediana de ocho días de estadía. En la mayoría de los casos la muerte ocurrió durante el puerperio, con una media de siete días entre el parto y su ocurrencia. El parto prematuro fue la complicación perinatal más frecuente (76·9%) y 59·9% tuvo bajo peso al nacer. Interpretación Este estudio describe las características de las muertes maternas durante la pandemia por COVID-19 a partir de una base colaborativa multipaís. Se observaron barreras para el acceso a cuidados intensivos. Los tomadores de decisión deberían trabajar en el fortalecimiento de la conciencia de gravedad, y en estrategias de referencia para evitar potenciales demoras. Financiamiento Centro Latino Americano de Perinatología, Salud de la Mujer y Reproductiva.

5.
The Brazilian Journal of Infectious Diseases ; : 102365, 2022.
Article in English | ScienceDirect | ID: covidwho-1821152

ABSTRACT

Background : Patients infected with SARS-CoV-2 can develop acute kidney injury (AKI), associated with adverse clinical outcomes. In Mexico, an AKI incidence of 60.7% was reported in patients with COVID-19. Serum cystatin C is a well-known marker for AKI. It has been postulated as a marker for mortality in Chinese patients with COVID-19. Information regarding levels of cystatin C in COVID-19-infected patients is nonexistent among Mexican or Latin American populations. Aim : This work aimed to assess the level of cystatin C as an indicator of AKI and mortality among COVID-19 patients from Mexico. Methods : A cross-sectional study among 38 adults was performed in the Regional High Specialty Hospital of the Yucatan Peninsula in Merida, Yucatan, Mexico. Baseline characteristics and clinical and biomechanical parameters were collected, and serum levels of cystatin C were measured by ELISA. Results : A total of 71% (27 patients) with COVID-19 developed AKI;78% were men, and 22% were women. In addition, 60% of individuals (16 men;7 women) died due to COVID-19 complications. Serum levels of cystatin C were higher in those individuals who developed AKI (p = 0.001). A logistic regression model indicated that individuals with serum levels of cystatin C above 0.84 ng/mL had a 23-fold increased risk of developing AKI (OR, 23.7, 95% CI, 2.59-217.00, p = 0.005). However, increased cystatin C was not independently associated with mortality in the Mexican population (HR, 1.01, 95% CI, 0.66-1.56, p = 0.959). Conclusion : The results suggest that serum levels of cystatin C indicate AKI in COVID-19 patients. Although we recommend caution when using serum cystatin C levels as an indicator of mortality among the Mexican population, it is essential to note that cystatin C elevates earlier than creatinine, which is an advantage for timely clinical interventions.

6.
Annals of Thoracic Surgery ; 113(5):1401-1404, 2022.
Article in English | EMBASE | ID: covidwho-1821141
7.
Journal of Epidemiology and Global Health ; 2022.
Article in English | EMBASE | ID: covidwho-1821089

ABSTRACT

Introduction: Following the first year of the COVID-19 pandemic, a complete analysis of the characteristics of the deceased hospitalized patients was performed, to identify factors related to premature mortality and to compare patient profiles according to the epidemic periods. Methods: Retrospective analysis of 1104 deceased patients in two University Hospitals in South-eastern France, between March 1, 2020 and March 12, 2021 from Hospital’s electronic medical records was performed. Results: Mean age was 80 years (± 11.1) and 10% of the deceased were younger than 65 years with specific comorbidities, e.g., genetic conditions, metastatic cancer, or massive obesity. Among the three clusters identified, two clusters (75% of deceased patients) include very elderly patients with numerous comorbidities, and differ by their proportion of dependent institutionalized patients. The third cluster is made up of younger patients with fewer but severe comorbidities. Deceased patients’ profiles varied according to the epidemic periods: during the first period (March–June 2020), more patients were institutionalized. The second period (September–December2020) coincided with a higher mortality rate. Conclusions: This study confirmed that most patients hospitalized and dying from COVID-19 were frail, i.e., elderly and/or highly comorbid and that the small proportion of young patients had severe comorbidities.

8.
Journal of Nephrology ; 35(3):715-716, 2022.
Article in English | EMBASE | ID: covidwho-1821076
9.
Current Tropical Medicine Reports ; 9(1), 2022.
Article in English | EMBASE | ID: covidwho-1821070

ABSTRACT

Purpose of Review: Cryptococcosis of the central nervous system due to Cryptococcus gattii species complex is a serious mycosis with worldwide distribution but of great importance in the tropics. This article aims to review the progress made in these regions in the knowledge of this disease and its etiological agent. Recent Findings: They can be summarized in the presence in apparently immunocompetent patients of autoantibodies against granulocyte-macrophage colony-stimulating factor (GM-CSF), which is a hidden risk factor for acquiring C. gattii infection;this finding strengthens the concept that C. gattii is an opportunistic pathogen. A greater knowledge of the clinical and molecular epidemiology of C. gattii infection and of the different environmental niches of this fungus in the tropics. The discovery of a new lineage of C. gattii, VGV, in environmental samples from Africa. Until now, the COVID-19 pandemic has not meant an increase in cryptococcosis cases. Summary: Advances have been made in the identification of risk factors for cryptococcosis due to C. gattii as well as in the knowledge of its etiological agent and its relationship with the environment. Remarkably, there have been no significant achievements in diagnosis and treatment notwithstanding the documented importance.

10.
Current Infectious Disease Reports ; 2022.
Article in English | EMBASE | ID: covidwho-1820991

ABSTRACT

Purpose of Review: Without effective antimicrobials, patients cannot undergo transplant surgery safely or sustain immunosuppressive therapy. This review examines the burden of antimicrobial resistance in solid organ transplant recipients and identifies opportunities for antimicrobial stewardship. Recent Findings: Antimicrobial resistance has been identified to be the leading cause of death globally. Multidrug-resistant pathogens are associated with significant morbidity and mortality in transplant recipients. Methicillin-resistant S. aureus affects liver and lung recipients, causing bacteremia, pneumonia, and surgical site infections. Vancomycin-resistant enterococci is a nosocomial pathogen primarily causing bacteremia in liver recipients. Multidrug-resistant Gram-negative pathogens present urgent and serious threats to transplant recipients. Extended-spectrum beta-lactamase-producing E. coli and K. pneumoniae commonly cause bacteremia and intra-abdominal infections in liver and kidney recipients. Carbapenemase-producing Enterobacterales, mainly K. pneumoniae, are responsible for infections early-post transplant in liver, lung, kidney, and heart recipients. P. aeruginosa and A. baumannii continue to be critical threats. While there are new antimicrobial agents targeting resistant pathogens, judicious prescribing is crucial to minimize emerging resistance. The full implications of the COVID-19 global pandemic on antimicrobial resistance in transplant recipients remain to be understood. Currently, there are no established standards on the implementation of antimicrobial stewardship interventions, but strategies that leverage existing antimicrobial stewardship program structure while tailoring to the needs of transplant recipients may help to optimize antimicrobial use. Summary: Clinicians caring for transplant recipients face unique challenges tackling emerging antimcirobial resistance. Coordinated antimicrobial stewardship interventions in collaboration with appropriate expertise in transplant and infectious diseases may mitigate against such threats.

11.
Journal of Thrombosis and Thrombolysis ; 2022.
Article in English | EMBASE | ID: covidwho-1820966

ABSTRACT

This study describes demographics, thrombotic and bleeding events, mortality, and anticoagulant use among hospitalized patients with COVID-19 in the United States. Premier Healthcare Database data were analyzed to identify inpatients with a discharge diagnosis for COVID-19 (ICD-10-CM code: U07.1) from April 1, 2020 to March 31, 2021, and matched historical controls without COVID-19 (inpatients discharged between April 1, 2018 and March 31, 2019). Thrombotic [including venous thromboembolism (VTE)] and bleeding events were based on ICD-10-CM discharge diagnosis codes. Of the 546,656 patients hospitalized with COVID-19, 20.1% were admitted to the ICU, 62.8% were aged ≥ 60 years, 51.5% were male, and 31.0% were non-white. Any thrombotic event was diagnosed in 10.0% of hospitalized and 20.8% of ICU patients with COVID-19 versus (vs) 11.5% and 24.4% for historical controls, respectively. More VTE events were observed in hospitalized and ICU patients with COVID-19 than historical controls (hospitalized: 4.4% vs 2.7%, respectively;ICU: 8.3% vs 5.2%, respectively;both P < 0.0001). Bleeding events were diagnosed in 10.2% of hospitalized and 21.8% of ICU patients with COVID-19 vs 16.0% and 33.2% for historical controls, respectively. Mortality among hospitalized (12.4%) and ICU (38.5%) patients with COVID-19 was higher vs historical controls (2.4%, P < 0.0001 and 9.4%, P < 0.0001, respectively) and higher in hospitalized patients with COVID-19 who had thrombotic events (29.4%) vs those without thrombotic events (10.8%, P < 0.0001). VTE and mortality were higher in hospitalized and ICU patients with COVID-19 vs historical controls. The presence of thrombotic events was associated with worse outcomes.

12.
Pediatric Nephrology ; 2022.
Article in English | EMBASE | ID: covidwho-1820930

ABSTRACT

Background: Patients with kidney diseases (KD) appear to be at particularly high risk for severe COVID-19. This study aimed to characterize the clinical outcomes and risk factors for COVID-19-related death in a large cohort of hospitalized pediatric patients with KD. Methods: We performed an analysis of all pediatric patients with KD and COVID-19 registered in SIVEP-Gripe, a Brazilian nationwide surveillance database, between February 16, 2020, and May 29, 2021. The primary outcome was time to death, which was evaluated considering discharge as a competitive risk by using cumulative incidence function. Results: Among 21,591 hospitalized patients with COVID-19, 290 cases (1.3%) had KD. Of these, 59 (20.8%) had a fatal outcome compared with 7.5% of the non-KD cohort (P < 0.001). Pediatric patients with KD had an increased hazard of death compared with the non-KD cohort (Hazard ratio [HR] = 2.85, 95% CI 2.21–3.68, P < 0.0001). After adjustment, the factors associated with the death among KD patients were living in Northeast (HR 2.16, 95% CI 1.13–4.31) or North regions (HR 3.50, 95% CI 1.57–7.80), oxygen saturation < 95% at presentation (HR 2.31, 95% CI 1.30–4.10), and presence of two or more associated comorbidities (HR 2.10, 95% CI 1.08–4.04). Conclusions: Children and adolescents with KD had a higher risk of death compared with the non-KD cohort. The higher risk was associated with low oxygen saturation at admission, living in socioeconomically disadvantaged regions, and presence of other pre-existing comorbidities. Graphical : A higher resolution version of the Graphical is available as Supplementary information [Figure not available: see fulltext.].

13.
European Journal of Molecular and Clinical Medicine ; 9(3):2809-2818, 2022.
Article in English | EMBASE | ID: covidwho-1820648

ABSTRACT

Aim: To evaluate neutrophilic lymphocyte ratio and lymphocyte monocyte ratio as prognostic markers in COVID 19. Material and method: The present retrospective observational studyconducted in the department of Medicine, Government Medical College, Jammu for a period of one year. The study comprised of 100 Covid 19 RT PCR positive cases admitted patient in ICU as well as Ward, in covid care centre of Government Medical College, Jammu. Patients characteristics were obtained from the hospital covid care centre satisfying inclusion criteria from electronic medical records and demographic, clinical, laboratory data were extracted included age, sex clinical features, signs and symptoms, comorbidities, exposure history, oxygen support during hospitalization, duration of oxygen support during hospitalization,imaging features of the chest (CT scoring), laboratory findings (Hemogram, Total leucocyte count, differential counts, NLR and LMR. Complete blood count including NLR and LMR collected at day of admission and day 3 of admission and documented on a standardized proforma. Two outcomes were evaluated: “discharge” or “died.” Results:In majority (53%) of patients, ventilation given was high flow followed by bipap (21%), ventimask (19%) and ventilator (5%). Ventilation given was room air in only 2 out of 100 patients (2%). In present study, only 10 out of 100 patients (10.00%) died.Discriminatory power of neutrophil lymphocyte ratio (AUC 0.865;95% CI: 0.781 to 0.925) was excellent and discriminatory power of lymphocyte monocyte ratio (AUC 0.791;95% CI: 0.698 to 0.867) was acceptable. Among both the parameters, neutrophil lymphocyte ratio was the best predictor of CTSI severity at cut off point of >3.57 with 86.50% chances of correctly predicting CTSI severity. Conclusion: It can be concluded from the results that NLR may be a rapid, widely available, useful prognostic factor in the early screening of critical illness in patients with confirmed COVID-19.

14.
Clinical Osteology ; 26(4):186-190, 2021.
Article in Czech | EMBASE | ID: covidwho-1820623

ABSTRACT

COVID-19 is an emerging infectious disease that has specific characteristics that interfere with the care of patients with osteoporosis. This article discusses the interfaces between osteological issues and COVID-19. A prevalent fracture very modestly increases the risk of death from COVID-19 but in hospitalized patients, the prevalence of vertebral fracture can be considered another aspect of polymorbidity increasing the likelihood of an adverse course of infection. Vitamin D deficiency correlates with worse outcomes in COVID-19, and sufficient vitamin D saturation is very likely protective in relation to COVID-19. Containment measures at the peak of the pandemic may result in muscle loss and increased risk of falls in the elderly. Densitometry and majority of laboratory tests can be easily delayed in patients with osteoporosis. This also applies to parenteral administration of bisphosphonates, whereas continuation of oral bisphosphonate therapy can be ensured by electronic prescription. Teriparatide should not be discontinued for more than 2–3 months, and the interval between denosumab administrations should not exceed 7 months.

15.
Anesthesia and Analgesia ; 134(4 SUPPL):25-26, 2022.
Article in English | EMBASE | ID: covidwho-1820598

ABSTRACT

Background High-risk surgeries account for 12% of the cases performed but represent 80% of the postoperative mortality [1]. The ASA (American Society of Anesthesiology) score, used since 1941, categorizes risk based on patient's comorbidities [2]. Such stratification is of utmost importance, enabling therapeutic decision making, distribution of resources, decision sharing with patients, and billing. By exploiting clinical databases, risk scores could become automatically extracted from medical records, personalized for different populations, and quickly provide insights on several outcomes. By clustering a population with unsupervised artificial intelligence (AI) algorithms, we can create subgroups without specifying how to subdivide them. By identifying discriminative features, the AI creates subgroups from which we extract the typical profile, or phenotype, before describing the associated outcomes [3]. This recent approach identified subgroups among covid-19 and septic patients [3, 4]. The objective of this project is to export this concept for the first time to a surgical population and, considering the democratization of “Enhanced Recovery after Surgery” protocol, to identify phenotypes and associated outcomes in a population undergoing colectomy [5]. Methods Using the patient data warehouse (PDW) from University of California in Los Angeles (UCLA), we retrospectively extracted all surgical cases containing “colectomy” in the procedure name, which occurred between 2013, inception of the database, and November 2021 [6]. Institutional Review Board of UCLA waived the need for patient's consent. We selected 56 relevant variables, including demographic data, comorbidities, and medication. Unsupervised K-means clustering was applied to the data, and the optimal number of phenotypes was determined based on discrimination of significant binary outcomes, including mortality, intensive care unit (ICU) length of stay (LOS) over 10 days, and hospital LOS over 20 days. Continuous data, including age and preoperative vitals were normalized with a min-max algorithm before clustering. A random forest plot algorithm was used to identify the 15 most relevant features linked to mortality and compare the clustering results in a restricted set. Results We identified three major phenotypes in the population (N=2273) based on the major characteristics described in Table 1, with an overall mortality of 0.08%. Despite being younger (average age: 52), phenotype 1 had the highest in-hospital mortality risk with 3.4% (15/437) and had longer ICU LOS (10.1% stayed > 10d), and hospital LOS (26.7% stayed >20d). This subgroup mostly contained patients undergoing urgent surgery (90%) with intestine obstruction (26%). While phenotypes 2 and 3 both were elective and included most cancer cases, mortality and LOS varied significantly between groups (mortality: 0.06% vs 2.1%;ICU>10d: 0.5% vs 7.2%;hospital LOS>20d: 2.4% vs 11.3% ). Phenotype 2 was generally younger (57 vs 62 years old) and presented less comorbidities (see Figure 1). Cases lengths were similar across all groups, and phenotype 3 received more intravenous fluids. In this cohort, phenotype 1 (19.5% of procedures) accounted for 83.3% of deaths, 74,5% of prolonged ICU LOS, and 68,4% of prolonged hospital LOS. Clustering on the restricted feature built after random forest plot algorithm provided similar results. Discussion and conclusion By identifying 3 phenotypes in the colectomy population, we could discriminate patients' outcome and trajectory of care. We confirmed that despite having few comorbidities, the highest risk of complication and prolonged ICU/hospital LOS correlates with urgent surgeries. In other words, urgency seems more correlated to adverse outcomes than comorbidities or ASA score. These results confirm the effectiveness of clustering the surgical population for risk stratification. While these analyses were limited by the low number of deaths, LOS insights were of great interest. Accumulating more data will be interesting to further phenotype patients undergo ng urgent colectomy, or to personalize risk stratification for other surgeries. (Table Presented).

16.
European Journal of Molecular and Clinical Medicine ; 9(3):2605-2612, 2022.
Article in English | EMBASE | ID: covidwho-1820595

ABSTRACT

Introduction: Mortality rates for COVID-19-related mucormycosis vary greatly in reported studies. A systematic evaluation of 101 cases revealed a fatality rate of 30.7 percent. However, research on the determinants of death in COVID-19 associated mucormycosis is insufficient. The purpose of this study was to find out what factors contributed to in-hospital mortality in patients with COVID-19-related mucormycosis. Objectives: To study the the Clinical profile, Haematological,Biochemical and Radiological changes associated with mortality in patients with covid-19 associated mucormycosis. Methodology: In this single-center, observational study, 130 patients diagnosed with COVID-19 associated mucormycosis were recruited from a tertiary level intensive care unit from Bowring and Lady Curzon hospital, Bangalore, India. Results: Proportion of HTN, IHD, CKD and HIV was significantly more in non survivors compared to survivors. ICU admission and Oxygen requirement was scientifically higher in Non Survivors and had significant association with the outcome.. There was no significant difference in the levels of Hb, Neutrophils, Lymphocytes, Monocytes, Eosinophils, and Platelets as p>0.05. Total count (17191±7764), ESR (57.6±12.4), CRP levels (199.0±69.5), and S.Ferritin (624.6±268.0) were significantly higher among the Non survivors. S.LDH (355.7±108.9), S.Free Iron (51.7±13.3), HBA1C (11.4±2.4), and S.Urea (36.9±35.3) were also found to be significantly higher among the non survivors. Conclusion: The current study highlights that a multidisciplinary approach in COVID-19 associated mucormycosis patients that includes timely and effective surgical debridement coupled with appropriate antifungal therapy and diligent sugar monitoring with intrahospital glycemic control may help to lower mortality.

17.
European Journal of Molecular and Clinical Medicine ; 9(3):2360-2374, 2022.
Article in English | EMBASE | ID: covidwho-1820591

ABSTRACT

Coronavirus outbreak has challenged the medical, public health infrastructure and economic status of nearly all countries across the World. The main issue of concern with SARS-CoV-2 has been the high infectivity rate and the high mortality rate especially, observed during the wave 2 of COVID-19. The symptoms associated with SARS-CoV-2 are often misleading with influenza and another respiratory tract seasonal viral infection as, majority of the patients report common constitutional symptoms. Hence, correct diagnosis for COVID-19 may play a key role in early detection, management and curtailment in the transmission rate.Therefore, apart from limiting this outbreak, efforts need to be made to plan comprehensive and stringent measures to develop diagnostic tools to prevent future outbreaks of this zoonotic disease. The present manuscript provides a detailed description of various indices and parameters which are currently being used for easier, rapid, accurate diagnosis, medical managementand prognosis assessment of COVID-19 patients in various stages of the disease.

18.
European Journal of Molecular and Clinical Medicine ; 9(3):2673-2681, 2022.
Article in English | EMBASE | ID: covidwho-1820578

ABSTRACT

Background- For successful management of Covid-19 pregnancy, adequate information and understanding of its clinical presentation and impact of the disease on pregnant mothers and their newborns is required. Aim- To describe the clinical manifestations of COVID -19 infection in pregnant women during peripartum period and to study the clinical outcomes of neonates born to these mothers. Methods- This prospective study was conducted at a COVID-19 Hospital of North India, from May 2021 to July 2021.All Covid-19 positive pregnant women who presented at the time of labor (symptomatic or asymptomatic) were included in the study. Follow up of these women and their newborns was done till discharge and neonates were further followed up till 28 days of life. Results-Total 70 patients were included in the study (24.2% symptomatic and 75.7% asymptomatic). Eighteen (25.7%) were NVD and 52(74.2%) were LSCS. LSCS was done more in symptomatic subjects (p<0.05). Frequency of AFD is higher in symptomatic subjects(p value< 0.05).Co morbidities noted were PIH, GDM, hypothyroidism and anemia in 15(21.4%), 2(2.8%), 11(15.7%) and 22(31.4%) respectively. All study women were successfully discharged. There were 69 live births(53(76.8%) term and 16(23.1%) preterms)and 1 IUD. Two (2.8%) babies were tested positive for COVID19. Both remained asymptomatic and discharged. Total 11 neonates required NICU admission due to non covid reasons. Number of deaths among neonates were 2 (2.8%). During followup visits 5(9.09%) neonates required readmission in NICU. Inadequate weight gain was seen in 3(5.4%) babies. None developed COVID related symptoms. Conclusion- COVID 19 infection during pregnancy is not associated with severe clinical presentation, high mortality and morbidity. There may be an association between symptomatic COVID19 pregnant women and AFD. There is high incidence of prematurity and LBW in neonates born to COVID positive mothers.

19.
European Journal of Molecular and Clinical Medicine ; 9(3):2682-2693, 2022.
Article in English | EMBASE | ID: covidwho-1820559

ABSTRACT

The availability of different vaccines plays a crucial role in bringing the COVID-19 pandemic to a standstill. All the vaccines with two initial and a booster dose have reduced the mortality rate and do not elicit serious symptoms or illness. However, the clinical trials on different vulnerable populations are still not reliable. In particular, COVID-19 patients belonging to the diabetic population exhibited higher morbidity and mortality. Therefore, the prioritization of vaccination for these populations may reduce further complications. Yet, the hesitancy toward vaccines hinders the process of vaccination campaigns. Hence, this review focuses on the availability of different vaccines against COVID-19 and their role in eradicating previous epidemics. The effect of this vaccination on the diabetic group and the management of chronic illness have been emphasized.

20.
Biomedicines ; 10(4):16, 2022.
Article in English | Web of Science | ID: covidwho-1820167

ABSTRACT

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) generated a worldwide emergency, until the declaration of the pandemic in March 2020. SARS-CoV-2 could be responsible for coronavirus disease 2019 (COVID-19), which goes from a flu-like illness to a potentially fatal condition that needs intensive care. Furthermore, the persistence of functional disability and long-term cardiovascular sequelae in COVID-19 survivors suggests that convalescent patients may suffer from post-acute COVID-19 syndrome, requiring long-term care and personalized rehabilitation. However, the pathophysiology of acute and post-acute manifestations of COVID-19 is still under study, as a better comprehension of these mechanisms would ensure more effective personalized therapies. To date, mounting evidence suggests a crucial endothelial contribution to the clinical manifestations of COVID-19, as endothelial cells appear to be a direct or indirect preferential target of the virus. Thus, the dysregulation of many of the homeostatic pathways of the endothelium has emerged as a hallmark of severity in COVID-19. The aim of this review is to summarize the pathophysiology of endothelial dysfunction in COVID-19, with a focus on personalized pharmacological and rehabilitation strategies targeting endothelial dysfunction as an attractive therapeutic option in this clinical setting.

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