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Background: COVID rapidly became a multisystemic infection with varied cardiovascular complications including Acute Coronary Syndrome. Current literature is limited on the impact of COVID on ACS patients. Methods: We queried the national inpatient sample (NIS) from 2020 to identify patients who were admitted for ACS and stratified them based on the presence or absence of COVID. The adjusted odds ratios (aOR) of in-hospital outcomes and resource utilization were calculated using chi-square statistics in the software STATA v.17. Results: Out of 883940 patients analyzed, who were admitted for ACS, 3900 patients had COVID. On adjusted analysis, patients with COVID had significantly elevated In-Hospital mortality (aOR, 2.91 CI 2.25-3.79), MACCE (aOR 2.53, CI 1.90-3.10), cardiac arrest (aOR 3.34, CI 1.1-10.1) with longer length of stay (6.34 ± 0.39 vs 4.48 ± 0.02). Interestingly, the outcome PCA (aOR, 0.39 CI 0.33-0.46) showed significant improvement. Interestingly, mean costs were elevated in patients without COVID at $105,550.8 vs $98597.7 in patients without COVID. In terms of trends, as exposure increased through the year with the highest levels in December, the mortality also increased (April 18.52% vs 25.64%). Interestingly, the cardiac arrest percentage decreased from April 2020 (7.4%) to Dec 2020 (1.98%) as well as MCS in April 202 (11.11%)vs December 2020 (3.47%) in patients exposed to COVID. Conclusions: In patients admitted for ACS, the presence of COVID significantly increases the risk of MACCE, in-hospital mortality, and cardiac arrest. Prospective trials are necessary for the identification of risk factors to improve clinical outcomes in these patients. Key words: COVID, Sars-2 coronavirus. Coronavirus. ACS. Acute Coronary Syndrome. [Formula presented]
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Objective: To determine risk factors associated with development of AKI with regards to mortality rate among covid-19 patients taking in consideration risk factors such as age, sex and chronic diseases like diabetics considering renal function to outcome. Design and method: This is a retrospective cohort study using de-identified data retrieved from clinical records of patients from two COVID 19 isolation centers. Medical history, demographic data, symptoms, disease complications and laboratory investigations were extracted from clinical records of 406 confirmed COVID 19 hospitalized patients in the period between Feb 2020 and July 2021. Continuous variables were presented as means ± standard deviation (SD) while categorical variables were presented as percent proportions. Logistic regression was used to determine risk factors associated with development of AKI with regards to mortality factors rate among covid 19 hypertensive patients. Result: Out of 406 hospitalized COVID-19 patients, 59.6% had a history of hypertension. Logistic regression was used to analyze risk factors associated with AKI among hypertensive and non hypertensive patients of covid-19. Age factor is highly significant factor for development of AKI for hypertensive (odd ratio [OR]: 4.89, 95% confidence interval [CI]: (1.93-1.36, P = 0.001) and non-hypertensive patients (odd ratio [OR]: 4.73, 95% confidence interval [CI]: (1.58-4.18, P = 0.001). Urea (odd ratio [OR]: 3.06, 95% confidence interval [CI]: (1.63-5.76, P = 0.001), creatinine (odd ratio [OR]: 3.39, 95% confidence interval [CI]: (1.82-6.32, P > 0.001) and potassium[K] (odd ratio [OR]: 2.17, 95% confidence interval [CI]: (2.23-3.83, P = 0.035) are highly significantly increased for hypertensive covid- 19 patients, whereas urea, creatinine and K are not significantly changed for non-hypertensive covid-19 patients Gender and morbidity factor (diabetes mellitus) has no significant effect for AKI development for hypertensive and non-hypertensive covid-19 patients. AKI is considered as a risk factor death among COVID-19 patients (OR:284, CI:1.56-5.15, p = 0.001). Conclusion: The present study indicates that 71% of patients with AKI are hypertensive. The results also highlight the alarming high incidents of hypertension in the studied population. On conclusion hypertension is considered as highly morbidity factor for development of AKI.
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Background: Early identification of COVID-19-associated pulmonary aspergillosis (CAPA) is particularly challenging in low- middle-income countries where diagnostic capabilities are limited, and risk factors for CAPA have not been identified. It is also essential to recognise CAPA patients who are likely to have a poorer outcome to decide on aggressive management approaches. Therefore, this study aimed to identify risk factors and outcomes for CAPA among admitted moderate to critical COVID-19 patients at our centre in Pakistan. Methods: An unmatched case–control study with ratio of 1:2 was conducted on hospitalised adult patients with COVID-19 from March 2020–July 2021. Cases were defined according to European Confederation of Medical Mycology and the International Society for Human and Animal Mycology consensus criteria. Controls were defined as patients hospitalised with moderate, severe or critical COVID-19 without CAPA. Results: A total of 100 CAPA cases (27 probable CAPA;73 possible CAPA) were compared with 237 controls. Critical disease at presentation (aOR 5.04;95% CI 2.18–11.63), age ≥ 60 years (aOR 2.00;95% CI 1.20–3.35) and underlying co-morbid of chronic kidney disease (CKD) (aOR 3.78;95% CI 1.57–9.08) were identified as risk factors for CAPA. Patients with CAPA had a significantly greater proportion of complications and longer length of hospital stay (p-value <.001). Mortality was higher in patients with CAPA (48%) as compared to those without CAPA (13.5%) [OR = 6.36(95% CI 3.6–11)]. Conclusions: CAPA was significantly associated with advanced age, CKD and critical illness at presentation, along with a greater frequency of complications and higher mortality. © 2022 Wiley-VCH GmbH.
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Purpose: Since the coronavirus disease 2019 (COVID-19) pandemic began, new variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have emerged, and distinct epidemic waves of COVID-19 have occurred for an extended period. This study aimed to analyze the clinical and epidemiological characteristics of children with COVID-19 from the third wave to the middle of the fourth epidemic wave in Korea. Methods: We retrospectively reviewed the medical records of hospitalized patients aged ≤18 years with laboratory-confirmed COVID-19. The study periods were divided into the third wave (from November 13, 2020 to July 6, 2021) and the fourth wave (from July 7 to October 31, 2021). Results: Ninety-three patients were included in the analysis (33 in the third and 60 in the fourth waves). Compared with the third wave, the median age of patients was significantly older during the fourth wave (6.7 vs. 2.8 years, P=0.014). Household contacts was reported in 60.2% of total patients, similar in both periods (69.7 vs. 55.0%, P=0.190). Eighty-one (87.1%) had symptomatic SARS-CoV-2 infection. Among these, 10 (12.3%) had no respiratory symptoms. Anosmia or ageusia were more commonly observed in the fourth epidemic wave (10.7 vs. 34.0%, P=0.032). Most respiratory illness were upper respiratory tract infections (94.4%, 67/71), 4 had pneumonia. The median cycle threshold values (detection threshold, 40) for RNA-dependent RNA polymerase (RdRp) and envelope (E) genes of SARS-CoV-2 were 21.3 and 19.3, respectively. There was no significant difference in viral load during 2 epidemic waves. Conclusions: There were different characteristics during the two epidemic waves of COVID-19.
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Objective: There is little data concerning the impact of arterial hypertension (HTN) on the cardiopulmonary status and right ventricle (RV) function of patients with SARS-Cov-2 infection. The purpose of our study was to investigate whether HTN affects the functional status of hospitalized for SARS-Cov-2 patients, using cardiopulmonary test and echocardiographic parameters, 3 months after the first day of infection. Design and Method: Subjects who were hospitalized and survived Covid-19 infection were divided into two groups according to history of HTN. All subjects underwent cardiorespiratory exercise using Bruce or modified Bruce protocol evaluating all parameters. Echocardiographic findings including right ventricle strain were analyzed using an offline program. Results and Conclusion: A total population of 52 hospitalized Sars-Cov-2 patients with a mean age of 57 ± 11.5 years were evaluated 3 months after the symptoms onset. Males amounted to 51.9 %. History of coronary artery disease was recorded in 15.4% of them. In hypertensive subjects, age (63 ± 8 vs. 52 ± 11 years, p < 0.001), BMI (29.9 ± 4.6 vs. 27.1 ± 5.8 kg/m2, p:0.03) and BSA (2.1 ± 0.25 vs. 2 ± 0.9 m2, p:0.04) were significantly higher. When analyzing cardiopulmonary test parameters, only maximum systolic blood pressure ((SBP, mmHg), 190 ± 21 vs.171 ± 26, p: 0.02) at peak and during the 1st minute of recovery (180 ± 23 vs. 157 ± 27 mmHg, p: 0.005) were higher comparing to normotensive subjects. Furthermore, diameter of left atrium ((LA, mm), 42 ± 6 vs.38 ± 6 p: 0.009), left ventricle ejection fraction ((LVEF,%), 48 ± 11 vs. 57 ± 6, p:0.004) and the absolute mean value of right ventricle strain ((RVLS, %), 9.1 ± 4 vs. 12.7 ± 5.4, p:0.04) differed significantly between two groups. Using linear regression analysis adjusted for age, gender, HTN, coronary heart disease and LVEF, HTN (p: 0.01) proved to be independent predictive factor for RVLS in hospitalized patients. To conclude our study highlighted negative impact of HTN both in right and left ventricle functionality, implying HTN as a negative independent predictive factor for right ventricle strain in patients hospitalized for SARS-Cov-2.
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Arterial thrombosis encountered during sars-cov2 infections is a rare complication with a poor prognosis compared to venous ones. They generally occur in severe and critical clinical forms of covid19 [1,2]. The physiopathology of arterial thrombosis, even if not completely understood highlights hypercoagulability and excessive inflammation as risk factors with a major role of the endothelial lesions in their occurrence. The presence of cardiovascular risk factors in patients infected with covid19 is also discussed as a predisposing factor for arterial thrombosis [2,3]. We report the case of a North African male patient hospitalized for acute respiratory distress syndrome (ARDS) secondary to covid19 pneumonia, complicated by the occurrence of multiple arterial thrombosis of the aorto-iliac axis with the rare finding of two free floating thrombus in the aorta and the right common iliac artery. Clinically, the patient had developed acute bilateral lower limb ischemia and multi-organ failure and the evolution was dramatic with rapid worsening of the patient…s health and eventually his death. Thromboembolic complications are frequent during covid19 infection but the aortic localization is very rare. Its diagnosis is difficult and it has a poor prognosis. Our objective through this case report is to increase knowledge about arterial thromboembolic events while discussing their link to the sars-cov2 viral infection. © 2022
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Objective: To study the association of calcium channel blockers (CCBs), the renin-angiotensin-aldosterone system (RAAS) inhibitors or their combination as antihypertensive medications and the clinical outcome of COVID-19 infection. Design and method: This is a retrospective cohort study using de-identified data retrieved from clinical records of COVID-19 patients in two isolation centers. Medical history, demographic data, symptoms, complications and laboratory investigations were extracted from clinical records of 406 confirmed COVID-19 hospitalized patients between Feb 2020 and July 2021. Hypertension and antihypertensive treatments were confirmed by medical history and clinical records. Continuous variables were presented as means ± standard deviation (SD) while categorical variables were presented as percent proportions. Logistic regression was used to assess the impact of antihypertensive drugs (RAAS inhibitors, CCBs, combination of RAAS inhibitors and CCBs and those not receiving medication) on the prognosis of COVID-19 patients and to explore the risk factors associated with mortality. Result: Out of 406 hospitalized COVID-19 patients, 242 (59.6%) had a history of hypertension. Hypertensive patients under the age of 65 years and receiving RAAS inhibitors or the combination of both RAAS inhibitors and CCBs were at higher risk of mortality than those on CCBs only (odds ratio [OR]: 4.45, 95% confidence interval [CI]: 1.56-12.56, P = 0.005 and OR:3.57, CI: 1.03-12.36, P = 0.045 respectively). Antihypertensive medications did not seem to influence mortality rates among hypertensive patients above 65 years. Routine laboratory investigations were not significantly different between the subgroups receiving different antihypertensive medications regardless of age. Cough was the only symptom associated with mortality among patients under 65 years (OR:2.34, CI:1.24-4.41, P = 0.009). Type II respiratory failure was significantly associated with death among hypertensives under 65 years (OR:5.43, CI:1.08-28.07, P = 0.044) whereas acute kidney injury and septic shocks are the common complications related to death among hypertensives above 65 years (OR:3.59, CI:1.54-8.36, P = 0.003 and OR:7.87, CI: 1.68-36.78, P = 0.009 respectively). Conclusion: Administration of CCBs may improve the outcome of COVID-19 hypertensive patients under 65 years of age. Antihypertensive treatment does not seem to influence the prognosis of COVID-19 patients above 65 years. Such results may affect management strategy of COVID-19 hypertensive patients. Type-II respiratory failure among patients under 65 years of age, acute kidney injury and septic shock among those above 65 years are the most serious complications that can lead to death regardless of blood pressure.
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The impact of the COVID-19 pandemic on the incidence of microbial infections and other metrics related to antimicrobial resistance (AMR) has not yet been fully described. Using data from Japan Surveillance for Infection Prevention and Healthcare Epidemiology (J-SIPHE), a national surveillance database system that routinely collects clinical and epidemiological data on microbial infections, infection control practices, antimicrobial use, and AMR emergence from participating institutions in Japan, we assessed the temporal changes in AMR-related metrics before and after the start of the COVID-19 pandemic. We found that an apparent decrease in the incidence of microbial infections in 2020 compared with 2019 may have been driven primarily by a reduction in bed occupancy, although the incidence showed a constant or even slightly increasing trend after adjusting for bed occupancy. Meanwhile, we found that the incidence of Streptococcus pneumoniae dramatically decreased from April 2020 onward, probably due to stringent non-pharmaceutical interventions against COVID-19. Antimicrobial use showed a weak increasing trend, while the use of hand sanitiser at the included medical institutions increased by about 50% in 2020 compared with 2019. © 2022 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases
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Objective: To explore the prevalence of hypertension and the common risk factors associated with increased death rate among (Covid-19) patients. Design and method: This is a retrospective cohort study using de-identified data retrieved from clinical records of patients from two COVID 19 isolation centers. Medical history, demographic data, self-reported comorbidities, symptoms, disease complications and laboratory investigations were extracted from clinical records of 406 confirmed COVID 19 hospitalized patients between Feb 2020 and July 2021. The outcomes of interest were death or discharge from the hospital. Logistic regression analysis was used to assess the impact of age, gender, associated comorbidities and some laboratory abnormalities on increased death rate among in-hospital (Covid-19) patients. Results: The prevalence of hypertension, was 59.6%, followed by diabetes (47.3%). COVID-19 patients with hypertension were older (67.0 ± 10.7vs 65.0 ± 13.0 P = 0.001). 70.4% were males. Undiagnosed high blood pressure was detected among 14.5%. Overall mortality was 46.2%, while mortality among normotensives, known hypertensives and undiagnosed hypertension was 47.7%, 54.7% and 37.6%, respectively (p < 0.005). Death was significantly higher among the age group > 65 years compared to ≦ 65 years old (53.6% % vs 39.0% (P = 0.005) irrespective of their blood pressure. Severe respiratory and gastrointestinal symptoms were significantly higher among hypertensives. Type I Respiratory failure 22.1%, and acute kidney injury 11.8% were the most typical complications among hypertensives. Leucocytosis (24.2%), Lymphopenia (56.8%) and higher levels of D-Dimer (47.7%) and C-reactive protein (49.7%) were mainly observed among hypertensive patients. Logistic Regression analysis after adjusting for age significantly showed age OR: 1.81, 95% CI: (1.12: 2.73, p = 0.01), undiagnosed HTN OR: 5.65, 95% CI: (2.04:15.67, p = 0.00), low platelets count OR: 6.53, 95% CI, (1.23:35.23, p = 0.02), higher levels of urea OR:1.67, 95% CI, (1.04:2.63, p = 0.03) and creatinine OR:1.71, 95% CI, (1.063:2.70, p = 0.02), were associated with worse prognosis and in-hospital death among Covid- 19 patients. Conclusion: The age group, more than 65 years with undiagnosed BP of more than 140/90, is significantly associated with higher in-hospital death. Thrombocytopenia and elevated urea and creatinine levels were the most prominent laboratory markers and may be used as a potential indicator for prognosis and outcome among Covid 19 hypertensives. (Table Presented).
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Introduction: A clinically significant variant of SARS-CoV-2 was identified in the UK in December 2020 and was designated VOC‐202012/01 (lineage B.1.1.7) on 14 December 2020. Our study aimed to evaluate the lineage B.1.1.7 prevalence over time and demographic, hematological, coagulation, inflammation characteristics in hospitalized patients with B.1.1.7 during February-March 2021. Materials and Methods: Between 5 February and 20 March 2021, 182 inpatients with B.1.1.7 were included in this study. Bio-Speedy, SARS-CoV-2 Double Gene RT-qPCR (Bioeksen, Ístanbul, Türkiye) kit was used to diagnose COVID-19. Cycle threshold< 27 samples were taken into mutation study with Bio-Speedy SARS-CoV-2 Variant Plus kit. Results: Of the 5187 SARS-CoV-2 positive cases, 2288 (69.65%) were evaluated as variant B.1.1.7 positive. Throughout the study, the case number's daily increase rate was 8.78% in SARS CoV-2, 13.16% in B.1.1.7;the case number's doubling time was calculated as 7.9 days in SARS CoV-2 and 5.27 days in B.1.1.7. In ICU patients, hemoglobin (p< 0.001), platelet (p= 0.034) and lymphocyte (p< 0.001) levels were lower but neutrophil (p= 0.025), monocyte/lymphocyte ratio (MLR) (p= 0.002), neutrophil/lymphocyte (NLR) (p< 0.001) ratio and D-dimer (p= 0.008) levels were dedected higher than non-ICU patients. Conclusion: Our study demonstrated that the infectiousness of B.1.1.7 was higher than previous variants and became the dominant SARS-CoV-2 in six weeks in our region. Therefore, urgent and decisive measures should be taken to minimize morbidity and mortality associated with COVID-19. In addition, our findings indicate that first hematologic markers of the patients can be an important biomarker for the prognosis of COVID-19 disease.
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Background and purpose: There are limited studies on co-infection of COVID-19 and tuberculosis (TB). This study aimed to describe the clinical, radiological, laboratory characteristics, treatment and outcome of patients admitted with tuberculosis and COVID 19 co-infection. Materials and methods: In this retrospective study, we investigated all patients with either active TB or old TB and COVID-19 admitted to Qaemshahr Razi Teaching Hospital between 2020 and 2022. Results: A total of 9251 patients with COVID-19 were admitted to our hospital between February 2020 and May 2022. There were eight patients with pulmonary tuberculosis and COVID-19 co-infection, including five (62.5%) male patients. The mean age of these patients was 61.13±22.63 years old. The mean time of symptom onset to hospital admission was 15.13±30.56 days and 50% were diagnosed with active TB and other half had old TB. Four patients were admitted to the ICU, three of whom required ventilation. Finally, four (50%) patients deceased. In this study, among factors that influence patients' outcomes, only underlying diseases were significantly associated with death. Conclusion: Tuberculosis is assumed to cause a higher mortality risk in COVID-19 patients, especially in those with chronic underlying diseases.
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Objective: The role of angiotensin converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARB) in the pandemic context of coronavirus disease 2019 (COVID-19) continues to be debated. Patients with hypertension, diabetes mellitus, chronic renal failure, cerebro-cardiovascular disease, or chronic obstructive pulmonary disease (COPD), who often use ACEi/ARB, may affect risk of severe COVID-19. However, there are no data available on the association of ACEi/ARB use with COVID-19 severity in this population. Design and method: This study is an observational study of patients with a positive SARS-CoV-2 test and inpatient treatment at a healthcare facility, using the registry information of COVIREGI-JP. Our primary outcomes were consisting of in-hospital death, ventilator support, extracorporeal membrane oxygenation support, and ICU admission. Out of the 6,055 patients, 1,921 patients with preexisting hypertension, diabetes mellitus, chronic renal failure, cerebro-cardiovascular disease, or COPD were enrolled. We also evaluated 1,097 patients with hypertension. Results: Factors associated with an increased risk of the primary outcomes were aging, male sex, COPD, severe renal impairment, and diabetes mellitus. No correlations were observed with ACEi/ARB, cerebro-cardiovascular diseases, or hypertension. Associated factors in male patients were aging, renal impairment, hypertension, and diabetes. In female patients, factors associated with an increased risk were aging, ACEi/ARB, renal impairment, and diabetes, whereas hypertension was associated with a lower risk of the primary outcomes. In patients with hypertension, factors associated with an increased risk of the primary outcomes were aging, male sex, severe renal impairment, and diabetes mellitus, but not ACEi/ ARB, cerebro-cardiovascular diseases, or COPD. Conclusions: Independent factors for the primary outcomes were aging, male sex, COPD, severe renal impairment, and diabetes, but not ACEi/ARB, in the COVID-19 patients with preexisting hypertension, diabetes mellitus, chronic renal failure, cerebro-cardiovascular disease or COPD. Based on this registry data analysis, more detailed data collection and analysis is needed with the cooperation of multiple healthcare facilities.
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Background: We sought to use existing in-patient surveillance data to investigate the risk of hospital-acquired antimicrobial-resistant organisms (ARO) among patients with COVID-19 infection. Methods: Prospective case capture was done for patients admitted with COVID-19, as well as those admitted with ARO and Clostridioides difficile infections (CDI). Odds ratios (OR) were used to measure the strength of association between COVID-19 infection and the risk of acquiring hospital-acquired ARO and CDI. Results: The odds of acquiring ARO/CDI were statistically higher among patients with hospital-acquired and community-acquired COVID-19 infections (OR=2.68 and 1.79 respectively) compared to persons without COVID-19 (OR=0.53). Conclusions: Our results show an association between COVID-19 infection and the acquisition of ARO/CDI in the in-patient setting. This finding suggests that prolonged hospitalization may expose patients to hospital-acquired infections, and this may have relevance in the management of patients requiring hospitalization for extended periods of time.
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Objective The havoc caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic could not have been predicted, with children being affected worldwide. Testing for SARS-CoV-2 infection helped to define the interventions against the spread of the disease. A polymerase chain reaction (PCR) test has been the mainstay of diagnostic testing. Cycle threshold (Ct) is a semiquantitative value that indicates approximately how much viral genetic material was in the sample. The aim of this study was to evaluate the impact of Ct values among children with SARS-CoV-2 infection. Methods Between May 3, 2020 and August 3, 2020, clinical laboratory input and the data of patients with positive SARS-CoV-2 PCR tests were retrospectively studied. Results There was no statistical significance between Ct values and the patient's status, symptoms other than fever, or other laboratory findings. However, the Ct value of patients who had symptoms at the time of admission to the hospital was significantly lower. Conclusion In this study, symptomatic patients had lower Ct than asymptomatic patients that reflected higher viral loads. In evidence-based medicine applications, it might be useful to correlate the clinical history with laboratory test results. Even symptomatic patients with high Ct value coinfections, or an alternative acute infection, should be considered. © 2022. Thieme. All rights reserved.
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Clinical presentation is an undependable prognostic indicator of COVID-19 (COronaVIrus Disease 2019). So, a more objective predictor is needed to precisely evaluate and classify the prognosis. Immune dysregulation to lymphocytes, mainly T-lymphocytes, have been noticed between COVID-19 patients. The aim. This study was planned to determine the role of platelet-to-lymphocyte count ratio and neutrophil-to-lymphocyte ratio in assessment of COVID-19 prognosis. Methods. 70 hospitalized patients with confirmed COVID-19 were included in this study. All included patients underwent a consistent clinical, radiological and blood examination. Laboratory analysis was made by means of a commercially accessible kit. Blood cells ratios were computed by dividing their absolute counts. Results. Non-significant association was found between laboratory data and COVID-19 clinical severity. A significant association between CT classification and platelet-to-lymphocyte count ratio (higher value in L type;p = 0.001) was detected. Platelet-to-lymphocyte count ratio was significantly higher among intubated cases. However, Non-significant association was found between neutrophil-to-lymphocyte ratio and need of endotracheal intubation. Conclusion. Routine blood values are abnormal in patients with COVID-19. Platelet-to-lymphocyte count ratio ratios could be used as more meaningful biomarker than other values in predicting the prognosis of COVID-19. LMR helpful in COVID-19 severity.
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Objective: Primary preventive nonpharmaceutical interventions were introduced to reduce viral transmission and disease spread at the beginning of the COVID-19 pandemic. Therefore, herein, we aimed to determine and assess the impact of the nonpharmaceutical interventions on bronchiolitis and varicella infection rates in the pediatric population during the pandemic compared to the previous four years. We also aimed to evaluate which viruses cause viral respiratory tract infections during the pandemic period. Material(s) and Method(s): Diagnosis and laboratory data of the patients who were one month to 18 years of age were retrospectively retrieved from hospital records. The distribution of the number of patients with bronchiolitis and chickenpox diagnoses was shown monthly between January 2016 and December 2020. Viral agents detected by polymerase chain reaction (PCR) in the nasopharyngeal aspirate samples obtained at the first application of the patients during the pandemic period were investigated. Result(s): The data of 2.254.877 pediatric patients admitted to our hospital from January 2016 to December 2020 were examined. There were 38.458 bronchiolitis and 954 chickenpox cases reported both as inpatients and outpatients. There was a 85.6% decrease in the rate of bronchiolitis compared to previous years, and chickenpox peak was not observed in the pandemic period. Rhinovirus was found to be the most common etiologic agent of bronchiolitis during the pandemic period and Respiratory Syncytial Virus (RSV) came second. A significant decrease in the frequency of influenza was also observed. Conclusion(s): Our study reveals that the measures which curtail social life and prioritize social distancing prevent the spread of viral infections. It has also shown that there is an increase in the frequency of Rhinovirus infection during the pandemic period. Copyright © 2022 Ankara Pediatric Hematology Oncology Training and Research Hospital. All rights reserved.
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Background: The long-term cardiovascular outcomes in COVID-19 survivors remain largely unclear. The aim of this study was to investigate the long-term cardiovascular outcomes in COVID-19 survivors. Method(s): This study used the data from the US Collaborative Network in TriNetX. From a cohort of more than 42 million records between January 1, 2019 and March 31, 2022, a total of 4 131 717 participants who underwent SARS-CoV- 2 testing were recruited. Study population then divided into two groups based on COVID-19 test results. To avoid reverse causality, the follow-up initiated 30 days after the test, and continued until 12 months. Hazard ratios (HRs) and 95% Confidence intervals (CIs) of the incidental cardiovascular outcomes were calculated between propensity score-matched patients with versus without SARS-CoV- 2 infection. Subgroup analyses on sex, and age group were also conducted. Sensitivity analyses were performed using different network, or stratified by hospitalization to explore the difference of geography and severity of COVID-19 infection. Result(s): The COVID-19 survivors were associated with increased risks of cerebrovascular diseases, such as stroke (HR [95% CI] = 1.618 [1.545-1.694]), arrhythmia related disorders, such as atrial fibrillation (HR [95% CI] = 2.407 [2.296-2.523]), inflammatory heart disease, such as myocarditis (HR [95% CI] = 4.406 [2.890-6.716]), ischemic heart disease (IHD), like ischemic cardiomyopathy (HR [95% CI] = 2.811 [2.477-3.190]), other cardiac disorders, such as heart failure (HR [95% CI] = 2.296 [2.200-2.396]) and thromboembolic disorders (e.g. pulmonary embolism: HR [95% CI] = 2.648 [2.443-2.870]). The risks of two composite endpoints, major adverse cardiovascular event (HR [95% CI] = 1.871 [1.816-1.927]) and any cardiovascular outcome (HR [95% CI] = 1.552 [1.526-1.578]), were also higher in the COVID-19 survivors than in the controls. Moreover, the survival probability of the COVID-19 survivors dramatically decreased in all the cardiovascular outcomes. The risks of cardiovascular outcomes were evident in both male and female COVID-19 survivors. Furthermore, the risk of mortality was higher in the elderly COVID-19 survivors (age >= 65 years) than in the young ones. Sensitivity analyses presented roughly similar results globally. Furthermore, the impact of COVID-19 on cardio-related outcomes appeared to be more pronounced in inpatients than in outpatients. Conclusion(s): The 12-month risk of incidental cardiovascular diseases is substantially higher in the COVID-19 survivors than the non-COVID- 19 controls. Clinicians and patients with a history of COVID-19 should pay attention to their cardiovascular health in long term.
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Objectives: This study was conducted to describe the use of tofacitinib in severe and critical Coronavirus disease -2019 (COVID-19), and to explore the association of drug initiation time with survival. Method(s): This was a retrospective chart review of inpatients with severe or critical COVID-19 at a tertiary care hospital, who received generic tofacitinib for at least 48 hours. The baseline demographics, comorbidities, treatment, adverse effects and outcomes (i.e. mortality at day 28) were analysed. The severity of COVID-19 was categorised as per WHO classification. Patients were further grouped based on median duration of symptomatic illness prior to tofacitinib administration, as early or late initiation groups. Result(s): Forty-one patients [(85.4% males), mean age 52.9 +/- 12.5 years], were studied. 65.9% (n = 27) of patients had severe COVID-19, while 34.1% (n = 14) were critically ill. Death occurred in 36.6% patients (n = 15). The median time to prescription of tofacitinib was 13 (9.50, 16.0) days of symptom onset. Tofacitinib was initiated early (8-13 days) in 56.1% of patients (n = 23), while the remaining received it beyond day 14 of symptom onset (late initiation group). The proportion of survivors was significantly higher in the early initiation group (21/23, 91.3%) compared to the late group (5/18, 27.8%) (P < 0.0001). Among severe COVID-19 patients, 100% and 62.5% of the patients were survivors among early and late initiation groups respectively (P < 0.01). In the critical COVID-19 patients, 50% were alive on day 28 in the early group while all died in the hospital in the late initiation group (P = 0.06). Multivariate logistic regression adjusted for age, presence of diabetes mellitus (DM) and illness duration prior to hospitalisation demonstrated higher odds of survival (AOR-19.3, 95% C.I. 2.57, 145.2) in the early initiation group, compared to the late initiation group. Conclusion(s): Early initiation of tofacitinib in severe and critical COVID-19 has potential to improve survival odds. (Table Presented).
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Background: Various studies have established a relationship between coronavirus infection (COVID-19) and diabetes mellitus (DM) as a factor of poor prognosis. Purpose(s): To determine the influence of DM on the evolution of patients hospitalised by COVID-19. Method(s): Retrospective observational study. All hospitalised patients with COVID-19 infection treated with Lopinavir/Ritonavir and Hydroxychloroquine during March and April 2020 were included. Two cohorts were performed: patients with DM and patients without DM. Patients who were not discharged or exited until April 30th 2020, were excluded. The treatment guidelines used were: Lopinavir/Ritonavir 200/50 every 12 hours mg for 14 days and Hydroxychloroquine 400 mg every 12 hours on the first day, followed by 200 mg every 12 hours during four days. Data were obtained through the Athos-Prisma inpatient prescription programme and review of medical records at Diraya. The chi-square test of comparison between data series of the two patient subgroups was performed. Result(s): Fifty-six (56) patients, 40 men and 16 women were included. The cohort of patients with DM (n=15) presented a mean of 66.7 years (53.8-79.6) vs 65.8 years (52.4-75.7) in the cohort of patients without DM (n=41). Mortality in the group with DM was 46.6% vs. 29.2% in the group without DM. After performing the chi-square test, a p>0.05 was obtained, so the differences between the two subgroups were not statistically significant. Conclusion(s): Our results do not associate DM with a poor prognostic factor in COVID-19 infection, although they are conditioned to the small sample size available. New studies with a larger number of patients will be necessary.