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1.
Pakistan Journal of Medical and Health Sciences ; 16(3):393-395, 2022.
Article in English | EMBASE | ID: covidwho-1819184

ABSTRACT

Background: In covid-19 related ARDS patients, early approach to proper health care facility and non-invasive ventilation lead to better outcome. Objective: To determine the outcome of covid-19 related ARDS patients at a tertiary care hospital, Rahim Yar Khan. Methodology: This retrospective study was carried out at department of ICU & anesthesiology in collaboration with department of Pulmonology, Sheikh Zayed Medical College/Hospital, Rahim Yar Khan. A total of 74 (confirmed positive PCR) covid-19 ARDS patients with age of 18-90 years of either sex were admitted in covid ICU from June – December 2020. Patients with negative PCR for covid-19 or who presented in gasping condition or received dead were excluded from the study. Outcomes were labelled as recovered (survivors) or died (non-survivors) and treatment outcome was observed in both groups those who were on non-invasive ventilation (NIV) and on invasive mechanical ventilation (IMV). Data was analyzed by using SPSS version 23.0 Results: Out of 74 patients, 60 (81.08%) were male and 14 (18.02%) were female. Middle and old age patients were more affected as compared to young age group (p-value 0.01) and more than half 41 (55.40%) patients went in to severe ARDS. Regarding treatment outcome 44 (59.5%) patients received NIV and 30 (40.5%) patients received IMV. Survival rate better (35.4%) among the patients on NIV as compared to those on IMV (6.7%) respectively. Conclusion: Survival was better among the covid-19 ARDS patients who received NIV as compared to those on IMV. Keeping an eye on respiratory rate and SpO2 is the main factor for the early recognition of ARDS development and severity.

2.
Pakistan Journal of Medical and Health Sciences ; 16(3):289-291, 2022.
Article in English | EMBASE | ID: covidwho-1819182

ABSTRACT

Introduction: Corona virus disease 2019 (COVID-19) is currently diagnosed mainly using reverse transcriptase polymerase chain reaction (RT-PCR). Yet a significant proportion of patients have negative RT-PCR result. A comparative study of RT-PCR negative patients with RT-PCR positive patients will help understand clinical characteristic and differences of this diseased population. Objective: To compare the clinical and laboratory features of RT-PCR Positive and RT-PCR negative patients admitted in high dependency unit. Patients and methods: In this retrospective cohort study, the data of 128 patients (59 patients with RT-PCR positive result and 69 patients with RT-PCR negative results) was obtained. These patients had been admitted in high dependency unit of a community hospital. Demographics, clinical characteristics and laboratory abnormalities were noted and a comparison was done using statistical analysis. Results: In our study-total 128 patients were enrolled out of which 68 (53.1%) were males and 60 (46.9%) were females. 59 (46.1%) patients were RT-PCR positive and 69 (53.9%) patients were RT-PCR negative. Median age was 55.34 years (18 to 95). No significant difference was noted in most of clinical symptoms (fever, sputum production, rhinorrhea, dyspnea, myalgia, nasal congestion, vomiting, diarrhea, urinary symptoms, altered level of consciousness), comorbidities (diabetes mellitus, hypertension, prior lung disease, prior ischemic heart disease, prior kidney disease), laboratory abnormalities (elevated creatinine, elevated liver enzymes, elevated ferritin, elevated C-reactive protein, elevated d-dimers, elevated procalcitonin, abnormal electrocardiogram). Cough was significantly found to be more prevalent in RT-PCR positive patients (p=0.042) and severe disease was also more prevalent in these patients significantly (p=0.000). Conclusion: Our study shows that patients admitted and diagnosed to be suffering from COVID-19 infection had remarkable similarities in clinical features and laboratory parameters regardless of RT-PCR status, however RT-PCR positive patients suffered from more severe pneumonia as compared to RT-PCR negative patients.

3.
Andes Pediatrica ; 93(2):174-183, 2022.
Article in Spanish | EMBASE | ID: covidwho-1819098

ABSTRACT

Objective: To describe a cohort of critically ill adult patients suffering from COVID-19, admitted to a pediatric intensive care unit managed by a pediatric intensive care team (ICU-MP). Patients and Method: Retrospective observational study of adults admitted to the ICU-MP due to COVID-19 from May 11 to July 26, 2020. Demographic, clinical, biochemical, ventilatory support characteris-tics, and complications were recorded. Disease severity was characterized by Acute Physiology and Chronic Health Evaluation II score (APACHE II) using data from the first 24 hours of admission to the ICU-MP. Results: Ninety-three patients over 18 years with suspected or confirmed COVID-19 were admitted to the ICU-MP. The median age was 60.3 years (SD 13.9), and 59 (63.4%) patients were male. Eighty-two (88.1%) patients had at least 1 medical comorbidity. The median APACHE II score was 9.4 points (SD 5.6). Fifty-one (54.8%) patients were invasively ventilated, for a median of 13.7 days (SD 17.9). Inotropic support was used in 45 (48%) patients. Thirty-three (35.5%) patients presented acute kidney injury (AKI) and 14 (15.1%) patients received continuous renal replacement therapy. Twenty-nine (31.2%) patients had healthcare-associated infections. The median ICU-MP stay was 10.8 days (SD 11.8). 25 (26.9%) patients died, ten of them (40%) had adequacy of thera-peutic effort. Conclusions: The mortality rate of critically ill patients with COVID-19 is high. Older patients (> 70 years), those who require invasive mechanical ventilation and who develop AKI are at increased risk of death. Although this is not a comparative study, our mortality rate and complications seem to be similar to those reported in adult case series.

4.
Iranian Red Crescent Medical Journal ; 23(9), 2021.
Article in English | EMBASE | ID: covidwho-1819086

ABSTRACT

Background: Convalescent plasma (CP) transfusion is one of the suggested treatments for Coronavirus disease 2019 (COVID-19) especially in critically ill patients. Objectives: This study aimed to investigate the efficacy and safety of CP transfusion were investigated in severe/critically ill COVID-19 patients. Methods: This study was performed on 50 consecutive COVID-19 patients with severe/critically ill disease. Severe disease was defined as having at least one of the following symptoms: shortness of breath, respiratory frequency ≥ 20/min, blood oxygen saturation ≥ 93%, partial pressure of arterial oxygen to fraction of inspired oxygen ratio < 300, lung infiltrates > 50% within the last 24-48 h. Critically ill disease was identified by intensive care unit admission, respiratory failure, septic shock, or multiple organ dysfunction or failure. Primary outcomes included the safety of CP transfusion, 14-day and 30-day survival rate, and change in lung computed tomography (CT) scan score. Several other clinical and laboratory features were evaluated as the secondary outcomes. Results: Based on the results, 21 out of 50 consecutive patients were on mechanical ventilation at the time of CP transfusion. In total, 32 patients (64%) survived 30 days after CP transfusion. The survival rates were 74% and 44% in patients who received CP < 7 and ≥ 7 days after admission, respectively. While 92% of patients without mechanical ventilation survived, the survival rate of patients on mechanical ventilation was 29%. Moreover, the CT scan score and some other clinical features were improved in the group that received CP transfusion, and no adverse effects were observed. Conclusion: The CP transfusion is a safe and effective treatment in severe/critically ill COVID-19 patients. The best outcome can be achieved in patients who are not on mechanical ventilation, especially early in the disease course.

5.
Asian Journal of Pharmaceutical and Clinical Research ; 15(4):118-121, 2022.
Article in English | EMBASE | ID: covidwho-1818973

ABSTRACT

Objective: The studies describing the clinicoepidemiological features of coronavirus disease-2019 (COVID-19) patients of first wave are available but about second wave, very few studies have documented. This study was aimed to describe the clinicoepidemiological features and the causes of mortality of COVID-19 patients of second wave admitted in our center. Methods: This retrospective, observational, and cross-sectional study was carried out among 200 randomly selected and confirmed COVID-19 indoor patients admitted between April 7, 2021 and July 3, 2021 in Dr. N. D. Desai Hospital, Nadiad. The demographic profile, clinical features, comorbidities, inflammatory markers, and causes of mortality in these patients were analyzed. Results: A total 200 patients of COVID-19 of second wave were analyzed. Majority of them were males (64.5%) and the patients between 18 and 60 years of age constituted 60%. Hypertension (70.93%) and diabetes mellitus (46.51%) were common comorbidities followed by ischemic heart diseases and chronic kidney disease. The most common presenting features were fever (75.7%), cough (68.8%), and shortness of breath (60%). The median duration of hospital stay was 7 days [interquartile range, 4-12]. The patients needed any kind of mode of oxygen therapy were 82.5%. The most common cause of death was cardiac arrest (70.58%) followed by severe acute respiratory distress syndrome (ARDS) (35.29%). Conclusions: In this retrospective study, most patients were young males with the age <60 years. The patients had one or more comorbidities, hypertension being the most common. Inflammatory markers were significantly higher in patients who died in our hospital.

6.
Pneumon ; 35(1), 2022.
Article in English | EMBASE | ID: covidwho-1818859

ABSTRACT

INTRODUCTION In Greece, higher morbidity and mortality due to COVID-19 pandemic were recorded during the third pandemic wave. Only a small percentage of the population was fully vaccinated at the beginning of the third pandemic wave. Our effort was multi-level, from the emergency room department to the ward. The aim of this article is to communicate a single secondary center’s experience during the third pandemic wave in Greece. METHODS A retrospective cohort study was conducted at the regional Agios Andreas General Hospital of Patra, Greece, including 360 hospitalized COVID-19 patients. A standard of care protocol was applied in all cases and its outcomes are examined. RESULTS The median age of the patients was 64.2 years (IQR: 18–100) and the median duration of hospitalization was 8 days. The overall case fatality rate was 8.1%. Of the 360 patients, 12 (3.3%) needed to be intubated. Most of the hospitalized patients (n=316;87.8%) were treated with nasal canula or Venturi mask. Twenty-six patients (7.2%) were supported with HFNC and 18 (5%) received any available type of non-invasive mechanical ventilation. CONCLUSIONS An articulate protocol and coordinated collaboration among specialists were the cornerstone of proper, immediate, and individualized treatment. The international recommendations in force at that time proved to be efficient in reducing progress to SRF and intubation. Full vaccination of the medical staff ensured long and dedicated presence in the patients’ rooms.

7.
Revista de Saude Publica ; 55, 2021.
Article in English | EMBASE | ID: covidwho-1818710

ABSTRACT

This study aimed to verify socio-demographic and baseline clinical factors associated with death in a hospital cohort of patients with COVID-19. A retrospective cohort study was conducted between February and December 2020 in a university hospital in the city of São Paulo, using Hospital Epidemiology Center data. RT-PCR-positive patients were selected to compose the sample (n = 1,034). At the end of the study, 362 (32%) patients died. In this cohort, age equal to or greater than sixty years (HR = 1.49) and liver disease (HR = 1.81) were independent risk factors for death from COVID-19 associated with higher in-hospital mortality

8.
Journal of Clinical and Diagnostic Research ; 16(4):DC01-DC05, 2022.
Article in English | EMBASE | ID: covidwho-1818679

ABSTRACT

Introduction: Ever since the Coronavirus Disease 2019 (COVID-19) pandemic hit, there have been constant efforts to develop rapid, sensitive and specific diagnostic methods to detect the virus in order to curb the further spread of the disease. There is an array of tests available for the detection of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). Time being a very crucial factor, Rapid Antigen Testing (RAT) is very helpful in detecting the virus. Aim: To discuss the importance of rapid testing among symptomatic and asymptomatic cases in different age groups and gender with association to infection. Materials and Methods: This retrospective study was conducted in Department of Microbiology, Autonomous State Medical College and SNM Hospital, Firozabad, Uttar Pradesh, India, from April 2020-August 2021. A total of 16,258 samples were collected from symptomatic patients having Influenza Like Illness (ILI), Severe Acute Respiratory Illness (SARI), those seeking hospitalisation, contacts (symptomatic and asymptomatic) and travellers were subjected to antigen detection by the Standard Q COVID-19 antigen kit following proper precautions. The cases were divided into Group A of patients who presented with symptoms ≤7 days, Group B of patients who presented with signs and symptoms >7 days and group C comprised of asymptomatic patients. The Chi-square test was done to test the statistical significance of association of symptomatic patients with outcome of the antigen test. Results: Of the total 16,258 samples tested, the maximum number of positive cases were found in the age group 30-39 years (p-value <0.05) followed by 20-29 years. The least number of positive cases (six) was found in the higher (90 years) and lower (below 9 years) age groups. No significant impact was found on the positivity rates on the basis of gender. The percentage positivity as detected by rapid antigen was 2% and maximum patients were found in the group having symptoms <7 days (p<0.05). Conclusion: Rapid Antigen Detection Test (RADT) for SARS-CoV-2 is a simple, portable, fast and easy to perform test. It could be easily used in rural areas as it does not require special laboratory set up. It could be used for mass testing and helped as a good epidemiological tool. However, few symptomatic cases which could not be detected by rapid testing had to be cross checked with Real Time-Reverse Transcriptase Polymerase Chain Reaction (RT-PCR). Thus, when used in conjunction with molecular methods, the sensitivity of the test increased.

9.
Journal of Clinical and Diagnostic Research ; 16(4):LC10-LC15, 2022.
Article in English | EMBASE | ID: covidwho-1818678

ABSTRACT

Introduction: Coronavirus Disease 2019 (COVID-19), the new contagious novel coronavirus, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), pandemic in 2020-21 has had a devastating impact on human race. The most common cause of death among hospitalised patient was COVID-19 pneumonia or lung injury. Various studies have shown diurnal variation in human mortality due to all causes with or without intervention. Aim: To identify existence of diurnal variations for mortality among the hospitalised patients with COVID-19 pneumonia. Materials and Methods: This hospital-record based, retrospective study was conducted in a tertiary referral centre of north east India (Assam Medical College, Dibrugarh, Assam, India) which was a dedicated COVID-19 hospital during the pandemic. The study was conducted from September 2021 to December 2021 and the data was collected and recorded from the Cadaver slips issued to families of patient dying of COVID-19 pneumonia during the period January 2021 to August 2021. The data were generated by plotting the number of deaths of COVID-19 cases for each two hour interval as a percent of the mean number of deaths per two-hour interval and as a percentage of cumulative deaths per two-hour interval on a 24 hour scale. The deaths were sub grouped according to gender, age, and reported co-morbid causes of death along with pneumonia. Comparisons of data i.e., mean deaths/2 hour interval (mean±SD) were performed by one-way Analysis of Variance (ANOVA), followed by Bartlett's test for equal variances. The p-value <0.05 was considered as statistically significant. Results: Total 743 deaths, with 537 males and 206 females were included in the study. Mean age of the deaths was 56.39 years. There was rise of deaths during 4 PM to 6 PM (16:00 to 18:00) interval for all deaths due to COVID-19 pneumonia. The increase in deaths during this period was mainly due to deaths among males equal or above 65 years and females below age 65 years. However, the deaths of females equal or above the age of 65 years did not show significant diurnal variation. Only 26.51% (n=197) of pneumonia deaths were without co-morbidity. Conclusion: There exists a diurnal variation in mortality among COVID-19 pneumonia patients with evening rise of deaths. Diurnal variation is significantly more among males rather than females above 65 years.

10.
Journal of Clinical and Diagnostic Research ; 16(4):OC24-OC27, 2022.
Article in English | EMBASE | ID: covidwho-1818677

ABSTRACT

Introduction: The portable Chest Radiograph (CXR) has an indispensable role in large scale screening and diagnosis of Coronavirus Disease 2019 (COVID-19), especially in developing countries with limited resources. It can help in predicting the severity of lung involvement in the patients infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, especially in areas where the Computed Tomography (CT) is unavailable. Aim: To determine the prognostic value of CXR at clinical presentation in assessing the disease severity and its correlation with inflammatory markers in COVID-19 hospitalised patients. Materials and Methods: This was a single-centre retrospective study, conducted at Sri Ramachandra Institute of Higher Education and Research, from October 2020 to December 2020, on hospitalised COVID-19 patients. Clinically, the patients were categorised as mild, moderate and severe, based on their peripheral oxygen saturation- more than 94%, between 90-93%, and less than or equal to 89%, respectively. Blood samples, drawn at presentation to the hospital tested for various inflammatory markers proven to be predictive of disease severity, were documented for the analysis purpose. The CXRs, done at the presentation, were scored based on the number of zones involved and type of abnormality present (ground glassing, consolidation and septal thickening). The CXRs were scored a minimum '0' to a maximum of '9'. Correlation between the radiograph score and inflammatory markers was further analysed. Results: Among the 456 study patients, 71% had mild, 15% had moderate and 14% had severe COVID-19 infection. The mean CXR score in each category was 1, 3 and 4, respectively (p-value <0.001). The study groups were grouped as mild and non mild (included the moderate and severe categories). A criterion CXR score of 2 was able to differentiate mild and non mild cases (sensitivity was 78.29%, specificity was 77.98%, positive predictive values was 58.38%, negative predictive values was 90.11%), with an accuracy of 78.1%. The inflammatory markers like Neutrophil Lymphocyte Ratio (NLR), Absolute Lymphocyte Counts (ALC), eosinophil%, D-dimer, Lactate Dehydrogenas (LDH), Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP), and ferritin showed statistically significant difference between the two groups (p-value<0.001). Conclusion: The CXR can be used as a screening and predictive tool for disease severity in developing countries where access to Computed Tomography (CT) is limited. Given the possibility of subsequent waves of the COVID-19 pandemic and the risk of excessive radiation exposure from CT, CXR may be used as a reliable alternative.

11.
Journal of Clinical and Diagnostic Research ; 16(4):IC01-IC04, 2022.
Article in English | EMBASE | ID: covidwho-1818676

ABSTRACT

Introduction: Delhi, India’s capital, witnessed the first Coronavirus Disease 2019 (COVID-19) case on February 10, 2020, and subsequently three waves of the pandemic due to which the government had to impose lockdown starting March 25. It led to a decrease in patients seeking health care services for non emergency problems. Janakpuri Super Speciality Hospital (JSSH), a three hundred bedded autonomous institute under Delhi Government, also encountered a decrease in patient footfall. Aim: To identify the changes in trend in Outpatient Department (OPD) registrations and Inpatient Department (IPD) admissions during one year (January 1, 2020 to December 31, 2020) of COVID-19 pandemic in comparison to 2019 and also to analyse the collected data with the publicly available data on daily COVID-19 incidence in Delhi. Materials and Methods: A retrospective study was done by collecting data from the Janakpuri Super Speciality Hospital, Medical Record Department from 1st January 2019 to 31s December 2020, for daily OPD visits and IPD admissions. The collected data was analysed with the publicly available data on daily COVID-19 incidence in Delhi. Statistical analysis was performed using Microsoft Excel 2017. The non parametric exponential smoothening technique (dampening factor= 0.9) was applied over the dot plot graphs. Results: In 2020, compared to 2019, the daily OPD visits decreased by 37%. After an initial fall with March lockdown, there was a gradual increase in daily load. The OPD load peaked near middle of August 2020, The second big fall in OPD footfall occurred near second wave in September 2020, After that, OPD volume remained low till the 31st December 2020. Similarly, IPD admission volume peaked near the first wave in June 2020. The 2020 IPD admission volume also witnessed a massive decrease of 40.67% compared to 2019 and was maximum in gastroenterology admissions (65.63%). Conclusion: The study’s findings suggest that temporal associations between COVID-19 pandemic and hospital OPD and IPD admissions during 2020. The possibility of increased morbidity and mortality amongst non COVID-19 patients due to the unavailability of timely health care cannot be ruled out. The government should do capacity building to guide patients to identify the best doctor, clinic and hospital nearest to them in case of future pandemics.

12.
Asia Pacific Allergy ; 12, 2022.
Article in English | EMBASE | ID: covidwho-1818572

ABSTRACT

Background: Allergen-specific immunotherapy (AIT) is accepted as the only disease-modifying therapy for IgE-mediated allergic airway diseases and hymenoptera venom allergy. AIT requires repeated contact between patient and physician or nurse in the hospital. Because it is a long-term treatment, compliance is essential issue to obtain maximal efficacy. Coronavirus disease 2019 (COVID-19) pandemic reshaped doctor-patient interaction and pattern of hospital admissions. Objective: We aimed to determine the possible changes in the administration of AIT and associated factors, in addition to the characteristics of patients diagnosed with COVID-19 infection. Methods: Adult patients who underwent AIT for hymenoptera venom allergy, allergic rhinitis or allergic asthma between 11 March 2020 and 31 January 2021 were included in our retrospective study. Perennial and preseasonal AIT practices were evaluated. We identified patients with COVID-19 infection among the ones who received AIT. Results: The mean age of 215 patients was 37.8±11.9 years and 52.1% of the patients were female. In our study, 35.4% of perennial AIT patients did not continue treatment after the COVID-19 pandemic, and the cause was patient-related in 66.7% of the cases. Compliance was 70.7% in patients receiving perennial AIT. The highest compliance rate for AIT was for venom allergy (86.5%). Thirty-four patients (15.8%) were diagnosed with COVID-19 infection. No mortality due to COVID-19 infection was observed in those who underwent AIT. Conclusion: COVID-19 pandemic has reduced compliance to AIT. Compliance was higher in venom immunotherapy than in aeroallergens. Severe COVID-19 infection and COVID-19 related death were not observed in patients receiving AIT.

13.
Neurological Sciences and Neurophysiology ; 39(1):40-47, 2022.
Article in English | EMBASE | ID: covidwho-1818461

ABSTRACT

Introduction: Coronavirus disease 2019 (COVID-19) is known to have higher morbidity and mortality rates, parallel to the increased risk factors in the elderly. We aimed to define the risk factors related to mortality and morbidity in older patients hospitalized with COVID-19 disease in this study. Materials and Methods: This retrospective cross-sectional study included patients aged ≥65 years who were hospitalized with a confirmed diagnosis of COVID-19. We analyzed their demographic data, clinical findings, comorbidities, laboratory and radiologic findings, treatment protocols, and outcomes. Results: A total of 58 patients were included in the study. A total of eight (13.8%) patients died during the clinical follow-up and treatment, and 50 (86.2%) patients were discharged. The most common comorbidities among all patients were hypertension (HT) (69%) and diabetes mellitus (39.7%). The most common symptoms include fever (51.7%), cough (44.8%), and dyspnea (43.1%), and the most common neurologic findings were headache (27.6%) and impaired consciousness (27.6%). Intensive care unit admission was significantly higher among patients with comorbidities of HT, cerebrovascular disease, atrial fibrillation (AF), and chronic obstructive pulmonary disease. The rate of death was significantly higher in patients with a history of smoking, cerebrovascular disease, AF, and HT. Although there was a statistically significant positive correlation between the death rate and leukocyte, neutrophil, C-reactive protein, lactate dehydrogenase, D-dimer, interleukin-6, and procalcitonin levels, a negative correlation was observed in lymphocyte levels. Conclusion: Age-related comorbid conditions, especially HT, cerebrovascular disease, and AF, caused increased morbidity and mortality rates in older patients with COVID-19.

14.
Vaccines ; 10(3), 2022.
Article in English | EMBASE | ID: covidwho-1818229

ABSTRACT

Introduction: Onset of oral lichenoid lesions (OLL) or oral lichen planus (OLP) can be rare adverse reactions to vaccines. Recently, the first solitary cases were reported after COVID-19 vaccination. The aim of the present study was to assess if an increased frequency of OLL/OLP can be found after COVID-19 vaccination within a large real-world cohort. It was assumed that the incidence of OLL/OLP was significantly higher in subjects who received COVID-19 vaccine (cohort I) compared to individuals who were not vaccinated (cohort II). Patients and Methods: Initial cohorts of 274,481 vaccinated and 9,429,892 not vaccinated patients were retrieved from the TriNetX database (TriNetX, Cambridge, Massachusetts, USA), and matched for age, gender and the frequency of use of non-steroidal anti-inflammatory drugs, beta blockers, and angiotensin-converting enzyme inhibitors. Results: After matching each cohort, we accounted for 217,863 patients. Among cohort I, 146 individuals had developed OLL/OLP within 6 days after COVID-19 vaccination (88 and 58 subjects had received mRNA-and adenovirus vector-based vaccines), whereas in cohort II, 59 patients were newly diagnosed with OLL/OLP within 6 days after having visited the clinic for any other reason. The risk of developing OLL/OLP was calculated as 0.067% vs. 0.027%, for cohorts I and II, whereby the risk difference was highly significant (p < 0.001;log-rank test). RR and OR were 2.475 (95% CI = 1.829;3.348) and 2.476 (95% CI = 1.830;3.350), respectively. Discussion: The hypothesis was confirmed. Accordingly, the obtained results suggest that the onset of OLL/OLP is a rare adverse drug reaction to COVID-19 vaccines, especially to mRNA vaccines. Thus far, it remains unknown if specific components of the formulations cause a type IV hypersensitive reaction corresponding to OLL, or if the immune response post vaccination triggers a T cell-driven autoimmune reaction directed against the basal layer of keratinocytes of the oral mucosa in terms of OLP. Although OLL and OLP are both classified as premalignant lesions, spontaneous remission may be expected over time, at least in the case of OLL. Therefore, the presented findings should not place any limitation toward the use of COVID-19-vaccines in broad levels of the population.

15.
Vaccines ; 10(3), 2022.
Article in English | EMBASE | ID: covidwho-1818226

ABSTRACT

The COVID-19 vaccination has been the subject of unprecedented misinformation, false news, and public concerns. This study presents a unique analysis comprising persons who were not vaccinated and became ill. It investigates reasons for not vaccinating and evaluates how the personal experience of COVID-19 affected further attitudes and decisions related to health. The study included 730 consecutive unvaccinated patients hospitalized in 12 centers in Poland during the autumn 2021 pandemic wave. The most frequent reason behind the refusal to receive the vaccine was concern over the adverse effects, disbelief that the vaccine was sufficiently tested, and one’s conviction that COVID-19 will not affect a patient. Online information, friends, spouse, children/grandchildren, and other family members were most often the source of discouragement from vaccination. Most individuals regretted their decision not to receive a vaccine (66.0%), declared to promote COVID-19 vaccination after discharge (64.0%), and to receive a COVID-19 vaccine in the time recommended for convalescents (69.5%). Individuals expressing no regrets of vaccine refusal more frequently revealed conspiracy beliefs. The study shows that personal experience with severe COVID-19 can influence the perception of vaccination, but approximately one-third of unvaccinated hospitalized patients still appear to express vaccine hesitancy.

16.
Journal of Clinical Medicine ; 11(9), 2022.
Article in English | EMBASE | ID: covidwho-1818163

ABSTRACT

Hyperglycemia is among the main risk factors for severe COVID-19. We evaluated the association of glycated albumin (GA) and GA/HbA1c ratio with progression of COVID-19 from mild to severe disease in patients with type 2 diabetes mellitus (T2DM). Our retrospective study included 129 patients aged over 18 years with COVID-19 and T2DM who did not have any need of oxygen supplement. Of these, 59 patients whose COVID-19 was aggravated and required oxygen supplementation eventually were classified as having severe disease. Clinical and laboratory data were compared between mild and severe cases. The median of GA (18.4% vs. 20.95%, p = 0.0013) and GA/HbA1c (2.55 vs. 2.68, p = 0.0145) were higher in severe disease than in mild disease and positively correlated with C-reactive protein (Kendal Tau coefficient 0.200 and 0.126, respectively;all p < 0.05). Multiple logistic regression analysis showed that GA (odds ratio (OR), 1.151;95% confidence interval (CI), 1.024–1.294) and GA/HbA1c (OR, 8.330;95% CI, 1.786–38.842) increased the risk of severe disease. Patients with GA 20% or higher were 4.03 times more likely to progress from mild to severe disease. GA and GA/HbA1c ratio predicted progression of COVID-19 from mild to severe disease in patients with T2DM.

17.
Journal of Clinical Medicine ; 11(9), 2022.
Article in English | EMBASE | ID: covidwho-1818161

ABSTRACT

This study estimated the outcome of delayed intravitreal anti-vascular endothelial growth factor (VEGF) therapy due to the coronavirus (COVID-19) disease pandemic on the prognosis of patients with neovascular age-related macular degeneration (nAMD). This study retrospectively enrolled 57 nAMD patients whose intravitreal anti-VEGF injections were delayed for >2 weeks between February and June 2020. Best-corrected visual acuity (BCVA), central subfield thickness (CST), and anatomical characteristics were evaluated before (baseline), on the day, and at 2, 4, and 6 months after the delayed injection, and risk factors were identified. The average injection interval before and after treatment delay was 3.05 ± 1.45 and 2.41 ± 1.46 months, respectively (p = 0.002). The CST at baseline and on the day of delayed injection was 227.82 ± 62.46 and 267.26 ± 77.74 µm, respectively (p < 0.001). The average BCVA decreased from 0.29 ± 0.29 logMAR (baseline) to 0.38 ± 0.31 logMAR (6 months) (p = 0.001). The maximum subretinal fluid (SRF) height increased from 84.32 ± 89.33 µm (baseline) to 121.38 ± 103.36 µm (6 months) (p = 0.027). A higher baseline maximum SRF height was associated with less SRF height deterioration 6 months later (p < 0.001). Delayed intravitreal anti-VEGF therapy caused by the COVID-19 pandemic has worsened BCVA and residual SRF in nAMD patients after a temporary recovery. The baseline SRF reduce the degree of SRF height deterioration.

18.
Frontiers in Medicine ; 9, 2022.
Article in English | EMBASE | ID: covidwho-1817974

ABSTRACT

Background: Severe COVID-19 pneumonia requiring intensive care treatment remains a clinical challenge to date. Dexamethasone was reported as a promising treatment option, leading to a reduction of mortality rates in severe COVID-19 disease. However, the effect of dexamethasone treatment on cardiac injury and pulmonary embolism remains largely elusive. Methods: In total 178 critically ill COVID-19 patients requiring intensive care treatment and mechanical ventilation were recruited in three European medical centres and included in the present retrospective study. One hundred thirteen patients (63.5%) were treated with dexamethasone for a median duration of 10 days (IQR 9–10). Sixty five patients (36.5%) constituted the non-dexamethasone control group. Results: While peak inflammatory markers were reduced by dexamethasone treatment, the therapy also led to a significant reduction in peak troponin levels (231 vs. 700% indicated as relative to cut off value, p = 0.001). Similar, dexamethasone resulted in significantly decreased peak D-Dimer levels (2.16 mg/l vs. 6.14 mg/l, p = 0.002) reflected by a significant reduction in pulmonary embolism rate (4.4 vs. 20.0%, p = 0.001). The antithrombotic effect of dexamethasone treatment was also evident in the presence of therapeutic anticoagulation (pulmonary embolism rate: 6 vs. 34.4%, p < 0.001). Of note, no significant changes in baseline characteristics were observed between the dexamethasone and non-dexamethasone group. Conclusion: In severe COVID-19, anti-inflammatory effects of dexamethasone treatment seem to be associated with a significant reduction in myocardial injury. Similar, a significant decrease in pulmonary embolism, independent of anticoagulation, was evident, emphasizing the beneficial effect of dexamethasone treatment in severe COVID-19.

19.
British Journal of Biomedical Science ; 79, 2022.
Article in English | EMBASE | ID: covidwho-1817927

ABSTRACT

Objectives: This study aims to investigate hemostatic changes in patients with coronavirus disease (COVID-19) and their relationship to disease severity and survival. Methods: This study included 284 patients with COVID-19 who attended the Security Forces Hospital, Makkah, Saudi Arabia between October 2020 and March 2021, and retrospectively reviewed their demographic, radiological, and laboratory findings. The coagulation profile was assayed at the time of diagnosis for platelet counts using an automated hematology analyzer;Sysmex XN2000 while international normalized ratio (INR), activated partial thromboplastin time (aPTT), fibrinogen, D-dimer, factor VIII, ristocetin cofactor (RiCoF), and von Willebrand factor antigen (VWF-Ag) were measured by Stago kits on a Stago automated coagulation analyzer (STA Compact Max®). Results: In this study, 32.3% of the cases had severe disease, while 8.8% of the cases died. D-dimer, factor VIII, and RiCoF were the only independent predictors of disease severity, with factor VIII and RiCoF having significantly higher areas under the curve (AUCs) than D-dimer (all p < 0.001). Furthermore, age, aPTT, and factor VIII were associated with an increased risk of mortality in multivariate Cox regression analysis, with factor VIII having a higher AUC of 0.98 than aPTT with an optimal cut-off value of >314 IU/dl in predicting mortality. Cases with factor VIII levels >314 IU/dl, compared to those with factor VIII levels <314 IU/dl, were associated with a significantly shorter mean overall survival time (20.08 vs. 31.35 days, p < 0.001), a lower survival rate (30.3% vs. 99.2%, p < 0.001), and a 16.62-fold increased mortality risk. Conclusion: RiCoF is a novel predictor of disease severity in COVID-19, while factor VIII is confirmed as a predictor of severity and mortality in COVID-19 patients and is associated with lower overall survival and increased mortality risk.

20.
Insights into Imaging ; 13(SUPPL 1):8, 2022.
Article in English | EMBASE | ID: covidwho-1817265

ABSTRACT

An artificial intelligence (AI) tool designed to detect COVID-19 on chest CT can be used as a screening tool with high sensitivity but with low specificity. Additional training with supplementary artifact datasets should further improve diagnostic accuracy. Purpose/objectives: To evaluate the performance of an AI tool, for Covid-19 detection and lung injury quantification, on chest CT during a real-time clinical workflow. Materials & methods: We retrospectively collected a consecutive dataset of 264 Chest CTs performed to screen for Covid-19 at hospital admission. All axial images were pseudo-anonymized and sent to the AI tool Quibim Precision platform (QUIBIM S.L) to be analyzed by the Imaging COVID-19 Analyzer. The AI tool provided a probability score for COVID-19 infection. RT-PCR was considered the gold standard for COVID-19 diagnosis. Results: When the COVID-19 probability score cut-off value is set at 0.41 there is a sensitivity of 90.48% (95%CI: 82.09% to 95.80%), specificity of 30.00% (95%CI: 23.42% to 37.26%), PPV of 13.65% (95%CI: 12.32% to 15.11%) and NPV of 96.26 (95%CI: 92.77% to 98.10%) and an AUC of 0.75. Regarding the probabilities we suggest the following ranges with 95% sensitivity to exclude the disease and 95% specificity to include the disease: < 0.38: almost certain negative;0.39 - 0.62: indeterminate;> 0.63: almost certain positive. We chose a relatively low cut-off value in order to have a high sensitivity so it could be used as a screening test. However, this reduced the specificity and diagnostic accuracy. When using the suggested probability ranges, a substantial number of cases (69%) were labeled as indeterminate. False positive cases were partly explained by mislabeling of breathing artifacts, hypoventilation in dependent lung areas or linear atelectasis as ground glass opacities. Also, some clear-cut diagnoses for the radiologists (e.g., heart failure, bacterial pneumonia, interstitial lung disease, .) were often given a high probability by the AI tool. Conclusion: The AI tool can be used as a screening tool with a sensitivity of 90% when the cut-off value is set relatively low. Due to low specificity the AI tool on its own cannot be used as a diagnostic test but has the potential to serve as an adjunct for COVID-19 detection. Training with supplementary artifact datasets should further improve the AI accuracy.

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