The Aftermath of COVID-19: Exploring Long-Term Effects on the Organ Systems (preprint)

Background: Post-acute sequelae of SARS-CoV-2 infection (PASC) is a complicated disease that affects millions of people all over the world. Previous studies have shown that PASC impacts 10% of SARS-CoV-2 infected patients of which 50-70% are hospitalized. It has also been shown that 10-12% of those vaccinated against COVID-19 were affected with PASC and its complications. The severity and the later development of PASC symptoms is positively associated with the early intensity of the infection. Results: The generated health complications caused by PASC involve a vast variety of organ systems. Patients affected by PASC have been diagnosed with neuropsychiatric and neurological symptoms. Cardiovascular system also has been involved and several diseases such as myocarditis, pericarditis, and coronary artery diseases were reported. Chronic hematological problems such as thrombotic endothelialitis and hypercoagulability were described as a condition that could increase the risk of clotting disorders and coagulopathy in PASC patients. Chest pain, breathlessness, and cough in PASC patients were associated with respiratory system in long COVID-19 causing respiratory distress syndrome. The observed immune complications were notable, involving several diseases. Renal system also was impacted and result in raising the risk of diseases such as thrombotic issues, fibrosis, and sepsis. Endocrine gland malfunction can lead to diabetes, thyroiditis, and male infertility. Symptoms such as diarrhea, nausea, loss of appetite and taste were also among reported observations due to several gastrointestinal disorders. Skin abnormalities might be an indication of infection and long-term implications such as persistent cutaneous complaints were linked to PASC. Conclusions: Long COVID is a multidimensional syndrome with considerable public health implications, affecting several physiological systems and demanding thorough medical therapy as well as more study to address its underlying causes and long-term effects.

Clinical Characteristics of COVID-19 Reinfection: A Retrospective Study in China (preprint)

Purpose The number of patients with COVID-19 reinfection is gradually increasing.In this study, we aimed to investigate the clinical characteristics of individuals who experienced COVID-19 reinfection.Methods A retrospective data analysis was conducted involving patients diagnosed with COVID-19 between April 1, 2023, and June 20, 2023. The patients were categorized into two groups: the observation group, consisting of individuals with reinfection, and the control group, comprising those with primary infection.Results A Total 905(905/1025) patients were included in the study,with 407 in the observation group and 498 in the control group. The top three clinical symptoms in both groups were fever, cough with expectoration, and dizziness with fatigue (p < 0.001). The clinical classification of patients in the observation group primarily consisted of non-severe cases, (p<0.001). The proportion of hospitalized patients was lower in the observation group than in the control group (p < 0.001). The observation group exhibited a shorter clinical symptom recovery time than that of the control group (median, 5 d vs. 7 d,p < 0.001).Conclusion Patients experiencing COVID-19 reinfection were primarily classified as non-severe cases, with lower proportions of occurrence of severe and rare critical conditions. The severity was milder compared to that in patients with primary COVID-19 infections.

Tracking Persistent Symptoms in Scotland (TraPSS): A Longitudinal Prospective Cohort Study of COVID-19 Recovery After Mild Acute Infection (preprint)

Background: COVID-19 disease results in disparate responses between individuals and has led to the emergence of Long-COVID, characterized by persistent and cyclical symptomology. To understand the complexity of Long-COVID, the importance of symptom surveillance and prospective longitudinal studies is evident. Methods: A 9-month longitudinal prospective cohort study was conducted within Scotland (n=287), using a mobile app to determine the proportion of recovered individuals, those with persistent symptoms, common symptoms, and associations with gender and age. Results: 3.1% of participants experienced symptoms at month 9, meeting the criteria for Long-COVID, as defined by the NICE terminology. Fatigue, cough, and muscle pain were the most common symptoms at baseline, with fatigue persisting the longest, while symptoms like cough improved rapidly. Older age increased the likelihood of reporting pain and cognitive impairment. Female gender increased the likelihood of headaches and post-exertional malaise (PEM), and increased recovery time from fatigue and PEM. Conclusions: The majority of people fully recover from acute COVID-19, albeit often slowly. Age and gender play a role in symptom burden and recovery rates, emphasizing the need for tailored approaches to Long-COVID management. Further analysis is required to determine the characteristics of the individuals still reporting ongoing symptoms months after initial infection to identify risk factors and potential predictors for the development of Long-COVID.

Signature Inflammatory Cytokine panel: IL-10, IL-6, VEGF and IL-8 in Covid-19 (preprint)

Objective We aimed to assess a battery of inflammatory cytokines in SARS-CoV-2 patients to determine the cytokines of prognostic and/ predictive relevance in Covid-19.Methods In a cohort of total 100 SARS-CoV-2 patients (RT-PCR confirmed) hospitalized in associated SMHS hospital of GMC Srinagar, Kashmir (North India), the level of a battery of cytokines IL-6, IL-8, IL-10, IL-1α and VEGF, TNF-α and ferritin, were estimated by Enzyme Linked Immunosorbent Assay ( ELISA) on Multimode Microplate reader.Result The deranged levels of these cytokines were mostly found in patients > 60 years of age with cough and pneumonia as the most common symptoms. Correlation analysis revealed significant association between interleukin's IL-6, IL-8 and disease severity (p = 0.002) (p = 0.007) and poor disease outcome (p = 0.04), (p = 0.009) respectively. Similar association was also found between decreased levels of VEGF and poor disease outcome (p = 0.02). Further ROC analysis, univariant and multivariant (after adjusting for age, gender and other inflammatory markers), revealed increased IL-10 (AUC = 0.72) and IL-6 (AUC = 0.70) as independent markers of both disease severity(p = 0.02) (p = 0.01) and disease outcome (P = 0.03) (p = 0.02) and decreased VEGF (AUC = 0.69) as independent marker of disease outcome only (p = 0.03). Significant association of cough with IL-8 levels (p = 0.01) and of diabetes with raised ferritin levels (p = 0.01) with very high ferritin levels (> 1500ng/ml) as indicator of those that are likely to develop hyperinflammatory phenotype was found in SARS-CoV-2 patients.Conclusion We conclude ‘IL-6, IL10, VEGF and IL-8’ as the signature inflammatory cytokine panel in Covid-19. An increased IL-10, IL-6 levels proved to be equally significant independent prognosticators of Covid − 19 severity and predictors of poor disease outcome and decreased VEGF level as predictors of poor disease outcome in SARS-CoV-2 patients. Testing of the signature inflammatory cytokine panel is, therefore, recommended for optimal clinical decision making in Covid-19.

Characteristics and Determinants of Pulmonary Long COVID (preprint)

RATIONALE: Persistent cough and dyspnea are prominent features of post-acute sequelae of SARS-CoV-2 (termed 'Long COVID'); however, physiologic measures and clinical features associated with these pulmonary symptoms remain poorly defined. OBJECTIVES: Using longitudinal pulmonary function testing (PFTs) and CT imaging, this study aimed to identify the characteristics and determinants of pulmonary Long COVID. METHODS: The University of Alabama at Birmingham Pulmonary Long COVID cohort was utilized to characterize lung defects in patients with persistent pulmonary symptoms after resolution primary COVID infection. Longitudinal PFTs including total lung capacity (TLC) and diffusion limitation of carbon monoxide (DLCO) were used to evaluate restriction and diffusion impairment over time in this cohort. Analysis of chest CT imaging was used to phenotype the pulmonary Long COVID pathology. Risk factors linked to development of pulmonary Long COVID were estimated using univariate and multivariate logistic regression models. MEASUREMENTS AND MAIN RESULTS: Longitudinal evaluation 929 patients with post-COVID pulmonary symptoms revealed diffusion impairment (DLCO ≤80%) and restriction (TLC ≤80%) in 51% of the cohort (n=479). In multivariable logistic regression analysis (adjusted odds ratio; aOR, 95% confidence interval [CI]), invasive mechanical ventilation during primary infection conferred the greatest increased odds of developing pulmonary Long COVID with diffusion impaired restriction (aOR=10.9 [4.09-28.6]). Finally, a sub-analysis of CT imaging identified evidence of fibrosis in this population. CONCLUSIONS: Persistent diffusion impaired restriction was identified as a key feature of pulmonary Long COVID. Subsequent clinical trials should leverage combined symptomatic and quantitative PFT measurements for more targeted enrollment of pulmonary Long COVID patients.

Coronavirus Disease 2019 Combined with T. marneffei Infection Complicated by Undiagnosed HIV：A case report and literature review (preprint)

Background: Talaromycosis(TSM) commonly occurs in immunodeficient or immunosuppressed individuals, but it can also occur in healthy populations. The present case reports the COVID-19 together with human immunodeficiency virus(HIV) and TSM. Case Presentation: This report describes a 26-year-old male who presented with a fever and cough for 20 days. He was diagnosed with COVID-19 and viral pneumonia through a real-time RT-PCR assay and chest CT scan. However, his symptoms failed to improve significantly despite being treated with high-flow oxygen, levofloxacin antibiotic, and dexamethasone for 5 days. The presence of white streaks in his oral cavity, combined with the patient's history of multiple antibiotics, raised the possibility of a fungal infection. The results of the oral pharyngeal swabs indicated that he was infected with T. marnefii, which led to testing for HIV and eventually confirmed the diagnosis. Conclusion: This case demonstrates the importance of being alert to concurrent fungal infections when infecting with COVID-19 and using multiple antimicrobial agents. Additionally, when infecting with T. marnefii, it is crucial to focus on the presence of HIV infection.

Clinical features and outcomes in kidney transplant recipients with COVID-19 pneumonia: a single center retrospective cohort study (preprint)

Objective This retrospective cohort study aimed to assess the clinical characteristics, treatment outcomes, and short-term prognosis of kidney transplant recipients (KTRs) with concurrent coronavirus disease 2019 (COVID-19) pneumonia.Methods KTRs with COVID-19 pneumonia who were admitted to our hospital from December 28, 2022, to March 28, 2023 were included in the study, and their clinical symptoms, response to antiviral medications, and short-term prognosis were analyzed.Results A total of 64 KTRs with initial diagnosis of COVID-19 pneumonia were included in this study. The primary symptoms were fever, cough, and myalgia, with an incidence of 79.7%, 89.1%, and 46.9%, respectively. The administration of antiviral drugs (paxlovid or molnupiravir) within 1–5 days and for over 5 days demonstrated a statistically significant reduction in viral shedding time compared to the group without antiviral medication (P = 0.002). Both the paxlovid and molnupiravir treatment groups exhibited a significantly shorter duration of viral shedding time in comparison to the group without antiviral drugs (P = 0.002). After 6 months of recovery, there was no significantly negative impact on transplant kidney function (P = 0.294).Conclusion Fever, cough, and myalgia remain common initial symptoms of concurrent COVID-19 pneumonia in KTRs. The earlier use of antiviral drugs (the paxlovid or molnupiravir) is associated with better therapeutic outcomes. severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had limited impact on short-term renal function of the KTRs with concurrent moderate or severe COVID-19 pneumonia.

Characterization of severe and critical COVID-19 infected individuals outside of Wuhan, China (preprint)

BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is highly transmissible among people，and the critical cases are still tough to treat, even leading to death. METHODS We retrospectively collected the clinical data of all the critical patients admitted to the Three Gorges Hospital(Chongqing, China) from Jan 20, 2020 to Feb 16, 2020 , whom were divided into improved group and worsen group. At last, we analyzed and compared the differences in laboratory indexes and length of hospital stay of the two groups. RESULT 46 cases were enrolled in the study. Comorbid conditions were present in 25 cases (54.3%). Most cases had symptoms, such as fever, cough, sputum, shortness of breath and dyspnea. The worsen group had a higher APACHE II score of 14(range from 5 to 23) than improved group(5, range from 3 to 7)(p<0.05). 32(69.6%) cases had low level lymphocyte counts (<1.0×109/L), including 8(66.7%) worsen group patients and 24(70.6%) improved group patients. The worsen group was 14.3(range from 8.21 to 18) with the ratio of neutrophil counts to lymphocyte counts, higher than that in improved group((7.33, range from 4.71 to 14.35)(p<0.05). There were faster respiratory frequencies in worsen group(23, range from 20 to 24.75) (p<0.05). And the worsen group had a lower OI(156.5, range from 74.25 to 233) than the other group(206, range from 177.5 to 242.75)(p<0.05). CONCLUSIONS Initial lower lymphocytes and higher APACHE II scores might be relative to the poor prognosis. And most of severe or critical patients had underlying diseases.

Convalescent Plasma for Critically-ill Covid-19 Patients (preprint)

Background and aim: Convalescent plasma (CP) was early and successfully used in management of covid-19 infection. This report aimed to document our experience with use of CP in two critically-ill covid-19 patients.Main findings: Patients presented with fever, dry cough and difficulty of breathing with reduced oxygen saturation, massive radiological lung involvement and deteriorated Sequential Organ Failure Assessment (SOFA) Score. Use of two sessions of CP resulted in marked improvement of radiological and/or pulmonary findings. Both patients died of septic shock or thromboembolic events.Conclusions Use of CP may be associated with radiological and clinical improvement in critically-ill patients. However, it’s not related to better survival if used in late stages of the disease.

Genomic surveillance of SARS-CoV-2 and emergence of XBB.1.16 variant in Rajasthan (preprint)

Background & objectivesGenomic surveillance of positive SARS-CoV-2 samples is important to monitor the genetic changes occurring in virus, this was enhanced after the WHO designation of XBB.1.16 as a variant under monitoring in March 2023. From 5th February till 6th May 2023 all positive SARS-CoV-2 samples were monitored for genetic changes. MethodsA total of 1757 samples having Ct value <25 (for E and ORF gene) from different districts of Rajasthan were processed for Next Generation sequencing (NGS). The FASTA files obtained on sequencing were used for lineage determination using Nextclade and phylogenetic tree construction. Results and discussionSequencing and lineage identification was done in 1624 samples. XBB.1.16 was the predominant lineage in 1413(87.0%) cases while rest was other XBB (207, 12.74%) and other lineages (4, 0.2%). Of the 1413 XBB.1.16 cases, 57.47% were males and 42.53% were females. Majority (66.53%) belonged to 19-59 year age. 84.15% of XBB.1.16 cases were infected for the first time. Hospitalization was required in only 2.2% cases and death was reported in 5 (0.35%) patients. Most of the cases were symptomatic and the commonest symptoms were fever, cough and rhinorrhoea. Co-morbidities were present in 414 (29.3%) cases. Enhanced genomic surveillance helped to rapidly identify the spread of XBB variant in Rajasthan. This in turn helped to take control measures to prevent spread of virus and estimate public health risks of the new variant relative to the previously circulating lineages. XBB variant was found to spread rapidly but produced milder disease.

Symptoms of children and adolescents infected with SARS-CoV-2 variants alpha, delta or omicron (preprint)

Symptoms experienced by children and adolescents with SARS-CoV-2 infections in the alpha, delta and omicron variant dominated phases were investigated using an online survey, and the frequencies of reported symptoms and changes over time were analyzed. The most prevalent symptoms were fever above 38 {degrees}C, tiredness, headache, runny or blocked nose, sneezing and dry cough. Lethargy and nausea were reported significantly more frequently in the omicron variant dominated phase than in the earlier phases of the pandemic. Compared to symptoms reported by adults, fever and gastrointestinal symptoms were reported more frequently for children, especially in the omicron variant dominated phase, whereas the frequency of loss of smell and loss of taste was significantly lower in children than in adults.

Clinical, laboratory, and imaging findings of stage 3-5 chronic kidney disease patients suffering from COVID-19 in Bangladesh: a prospective cross-sectional study (preprint)

Background: Chronic kidney disease (CKD) patients were susceptible to morbidity and mortality once they affected by COVID-19. These patients were more likely to develop severe disease, requiring dialysis, admission to intensive care unit. The aim of this study was to evaluate the presentations and outcomes of COVID-19 in stage 3-5 CKD patients not on dialysis. Methods This prospective observational study was conducted in the COVID-19 unit, at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from September 2020 to August 2021. Hospitalized RT-PCR positive COVID-19 patients with pre-existing CKD having eGFR <60 ml/min/1.73 m 2 but not yet on dialysis were enrolled. Clinical and laboratory parameters were recorded. Outcomes were observed till discharge from the hospital and followed up after 3 months of survived patients. Results Out of 109 patients, the mean age was 58.1(SD: 15.4) years where 61.5% were male. Common co-morbid conditions were hypertension (89.0%), diabetes mellitus (58.7%) and ischemic heart disease (24.8%). Fever, cough, shortness of breath and fatigue were common presenting features. Most of the patients had moderate (41.3%) and severe (41.3%) COVID-19. Sixty-six patients (60.6%) developed AKI on CKD. Twenty patients (30.3%) required dialysis. Death occurred in 16 patients (14.7%) and 12 patients (11%) required ICU admission and 6 patients (9.1%) achieved baseline renal function at discharge. We identified risk factors like low haemoglobin, lymphopenia, high CRP, high procalcitonin, high LDH and low SpO 2 in patients who did not survive. Seventy-six patients were followed up at 3rd month where 17 patients were lost. Ten patients (27.0%) achieved baseline renal function who had persistent AKI at discharge and 34 patients (87.1%) remained stable who had stable renal function at discharge. Conclusion The stage 3-5 chronic kidney patients with COVID-19 are vulnerable to severe to critical morbidity and mortality with higher incidence of AKI which demands a special attention to this group of patients.

COVID-19 Caused by the Omicron Variant in Lung Transplant Recipients: A Single Center Case Series (preprint)

Background: Limited data from the Chinese experience are available regarding the infection status, clinical characteristics, treatments and early outcomes of lung transplant recipients (LTRs) afflicted with coronavirus disease 2019 (COVID-19) caused by the SARS-CoV-2 Omicron Variant. Methods: We conducted a study on LTRs with COVID-19 caused by the Omicron Variant from November 17, 2022, to May 1, 2023. Clinical information was gathered through electronic medical records, questionnaires, or follow-up telephone calls. To identify potential risk factors for severe disease progression, a multivariate logistic analysis was performed. Results: 178 LTRs with COVID-19 were included, with 50% (89/178) requiring hospitalization for an average stay of 16 days (IQR: 9.5-25.5 days). The most common symptoms were fever (79.8%), dry cough (75.3%) and fatigue (61.8%). Ultimately, 17 recipients succumbed to COVID-19-related respiratory failure or secondary multiple organ dysfunction, resulting in an overall mortality rate of 9.6%. Of the 89 hospitalized patients, 41.6% (37/89) eventually progressed to severe or critical disease, forming the Severe/Critical Group (S/C group), while the remaining 58.4% (52/89) had mild to moderate disease (M/M group). In comparison to the M/M group, the S/C group had higher CRP (59.6 vs. 16.8 mg/L, P＜0.01), ESR (45.5 vs. 22.5mm/h, P＜0.01) and D-dimer (1.09 vs. 0.65 mg/L, P＜0.05), but lower CD3+ T lymphocytes (577 vs. 962 cells/ul, P＜0.01) and CD4+ T lymphocytes (217 vs. 427 cells/ul, P＜0.01). The S/C group had significantly higher rates of combined pulmonary bacterial infection (67.6% vs. 38.5%, P＜0.01) and pulmonary fungal infection (73.0% vs. 38.5%, P＜0.01) during the course of COVID-19, nearly double that of the M/M group. In a multivariate logistic analysis, elevated CRP (>41.8mg/L), combined pulmonary fungal infection, and interstitial lung disease(ILD) as primary disease emerged as high-risk factors for developing the severe disease phenotype following Omicron variant infection in LTRs, with respective OR values of 4.23 (95% CI: 1.68-11.23), 4.76 (95% CI: 1.59-15.64), and 5.13 (95% CI: 1.19-29.17). Conclusions: LTRs displayed an increased vulnerability to combined lung bacterial or fungal infections following Omicron infection. CRP> 41.8mg/L, ILD as primary disease, and combined pulmonary fungal infection are high-risk factors for developing severe disease.

Clinical Features and Vaccine Efficacy Analysis of COVID-19 patients in a Chongqing Shelter hospital in 2022 (preprint)

BackgroundThe long-term impact of coronavirus disease 2019 (COVID-19) on many aspects of society emphasizes the necessity of vaccination and nucleic acid conversion time as markers of prevention and diagnosis. However, little research has been conducted on the immunological effects of vaccines and the influencing factors of virus clearance. Epidemiological characteristics and factors related to disease prognosis and nucleic acid conversion time need to be explored. Design and participantsWe reviewed published documentation to create an initial draft. The data were then statistically evaluated to determine their link. Given that a Chongqing shelter hospital is typical in terms of COVID-19 patients receiving hospital management and treatment effects, a retrospective analysis was conducted on 4,557 cases of COVID-19 infection in a shelter hospital in Chongqing in December 2022, which comprised 2,291 males and 2,266 females. The variables included age, medical history, nucleic acid conversion time, vaccination status, and clinical symptoms. ResultsUnivariate survival analysis using the Log-rank test (P < 0.05) showed that factors such as age significantly affected nucleic acid conversion time. COX regression analysis indicated a significant association between a history of hypertension and nucleic acid conversion time, which had a hazard ratio of 0.897 (95% CI: 0.811-0.992). A statistically significant difference was observed between vaccinated and unvaccinated infected individuals in terms of the presence of symptoms such as cough and sensory system manifestations (P < 0.05). ConclusionThe effect of vaccination against COVID-19 on symptoms such as coughing, nasal congestion, muscle aches, runny nose, and sensory system symptoms in COVID-19 patients was determined. Typical symptoms, such as runny nose, were generally higher in vaccinated than in unvaccinated ones; previous hypertension was an influential factor in nucleic acid conversion time in patients with COVID-19 infection. STRENGTHS AND LIMITATIONSThis study clarifies the advantages of vaccination by comparing the symptom development between patients who had received vaccinations and those who had not. This research suggests potential future study directions, such as investigating the impact of pre-existing diseases like hypertension on viral clearance time and assessing vaccine efficacy and safety in certain demographic groups. This work investigated data from 4,557 coronavirus disease 2019 patients admitted to a shelter hospital, which offered significant insights into patients clinical features and outcomes over a defined time span. This study has several flaws because a retrospective analysis method was used and not all confounding variables that might have affected the results were appropriately controlled. The overall research sample may not be representative of other communities because it was drawn from a shelter hospital in Chongqing, and the types of immunizations used were not disclosed. These factors might have had an impact on the precision and extent of the research findings.

Prevalence and pattern of Post Covid-19 symptoms in recovered patients of Delhi: A Population-Based study (preprint)

Background: Post-coronavirus disease (COVID) is widely reported but the data of Post COVID-19 after infection with the Omicron variant is limited. This prospective study was conducted to determine the prevalence, pattern, and duration of symptoms related to Covid-19 recovered patients. Methods: Adults (>18 years old) in 11 districts of Delhi who had recovered from Covid-19 were followed up at 3 months and 6 months post-recovery. Results: The study found that the participants had a mean age of 42.07 years, with a standard deviation of 14.89. Additionally, a significant proportion of the participants (79.7%) experienced post-Covid symptoms. The participants elicited a history of Joint Pain (36%), Persistent dry cough (35.7%), anxiousness (28.4%) and shortness of breath (27.1%). The other symptoms reported were persistent fatigue (21.6%), persistent headache (20%), forgetfulness (19.7%) and weakness in limbs (18.6%). The longest duration of symptom was observed in participants reporting anxiousness (138.75 +54.14) followed by fatigue (137.57+48.33), shortness of breath (131.89+60.21) and joint pain/swelling (131.59+58.76). During the first follow-up, 2.2% of participants had an abnormal ECG reading, while no abnormalities were reported during the second follow-up. Additionally, 4.06% of participants had abnormal chest X-ray findings during the first follow-up, with this number decreasing to 2.16% during the second follow-up. Conclusion: Our study concluded that the clinical symptoms persist in participants until 6 months and a multi-system involvement is seen in the post-COVID period. Thus, the findings necessitate long-term, regular follow-ups.

OUTCOME OF COVID-19 PATIENTS ON STEROID THERAPY: A LONGITUDINAL STUDY (preprint)

ABSTRACT: Introduction: SARS-CoV-2 is responsible for global pandemic that originates from Wuhan, China (1). Patients presentation van be varied from asymptomatic to severe ARDS and multiorgan dysfunction likely due the dysregulated systemic inflammation (2). Glucocorticoids inhibits the inflammation by down streaming of cytokine receptor and promote resolution (3). The role of corticosteroid in COVID-19 still remains controversial. Corticosteroids associated with many long terms side effects. Previous MARS outbreak had experienced avascular necrosis with corticosteroid use (4). Objectives: The aim of the study was to evaluate the outcome of covid-19 patients on the corticosteroid therapy and estimate mortality rate with corticosteroid therapy and investigate potential long-term adverse events associated with its use. Methods: We did a longitudinal follow up study at the AIIMS Rishikesh to assess the side effects of corticosteroids in COVID-19 patients. Patients with moderate to severe COVID-19 pneumonia requiring the oxygen support were included in the study. According to the institutional protocol patients received conventional dose steroids versus pulse dose steroids. (Based on CT/ X-ray findings). Patients were followed up in the hospital till discharge/death for assessment of adverse events due to corticosteroids and all other biochemical parameters (Inflammatory markers) and SOFA score were obtained during hospitalisation till discharge. And at the 6 month follow up patient was assessed for infection and avascular necrosis of the femur. Results: A total of 600 patients were screened out of which 541 patients who received corticosteroids were included in this study. 71.3% were male and 26.6 % were females. Most prevalent comorbidity was systemic hypertension (38.8%) followed by diabetes mellitus (38%). Most common presenting symptoms was dyspnoea followed by fever and cough. Majority patients received dexamethasone (95%). 65.8 % patients received conventional dose while 34.2% of patients received pulse dose. Mortality was more associated with pulse dose (44%) then a conventional dose (30%) (p-value 0.0015). the median duration of the corticosteroids was 10 days with an IQR of 7-13 days. During the hospitalisation 142 patients (26.2%) develops hyperglycaemia. Hyperglycaemia was more prevalent in the pulse dose steroid group (16.8% versus 9.4%). One patient develops pancreatitis. There was a significant reduction in the levels of inflammatory markers (p<0.005) after steroid initiation. At the 6th month of follow patients were assessed for AVN and suspected infection. 25 patients (8.25%) had infection out of which 19 received pulse dose. Out of 25 patients cultures was available for 7 patients and 2 patients grows pathogenic organism in the urine (pseudomonas and E. coli). 02 patients develop non-specific joint pain at 6 months. No patient had AVN during the follow up.

Radiological and Functional Pulmonary Evolution in Post-COVID-19 Patients: An Observational Study (preprint)

COVID-19 generated a scenario for global health with multiple systemic impairments. This retrospective study evaluated the clinical, radiological, and pulmonary functional evolution in 302 post-COVID-19 patients. Regarding post-COVID-19 pulmonary symptoms, dry cough, dyspnea, and chest pain were the most frequent. Of the associated comorbidities, asthma was more frequent (23.5%). Chest Tomography (CT) initially showed a mean pulmonary involvement of 69.7%, and the evaluation in the subsequent months showed an improvement in the evolutionary image, and with less than six months post-pathology, there was a commitment of 37 .7%, from six to twelve months, 20% and after 12 months, 9.9%. And as for most of the sample, 50.3% of the patients presented CT normalization in less than six months after infection, 23% normalized between six and twelve months, and 5.2% normalized the images after twelve months, with one remaining. Percentage of 17.3% who maintained post-COVID-19 pulmonary residual sequelae. Regarding spirometry, in less than six months after the pathology, 59.3% of the patients already showed a regular exam; 12.3% normalized their function within six to twelve months, and 6.3% concluded a normal exam after twelve months of post-pathology evaluation. Only 3.6% of the patients still showed some alteration in this period.

High seroprevalence after the second wave of SARS-COV2 respiratory infection in a small settlement in the northern coastal of Peru. (preprint)

Background. Due to more infections from variations that could escape vaccination and immunity by asymptomatic to uninfected transmission, COVID-19's second wave had higher seroprevalence globally. Public health constraints and herd immunity may not work against these novel variations' infectivity. This population-based study in Peru's Tumbes Region during the second wave of COVID-19 seeks to determine seroprevalence and demographic changes from the first wave. Methodology/Principal findings. In Dec 2021-Jan 2022, a study in Tumbes' informal settlement sampled individuals over 2 years old from one in every four households. Finger-prick blood samples and symptom surveys were collected. On the second wave, there was a substantial rise in adjusted seroprevalence (50.15%, 95% CI [45.92 - 54.40]) compared with the first wave (24.82 %, 95%CI [22.49 - 27.25]), with females maintaining a higher seroprevalence (53.89; 95% CI [48.48-59.23]) vs. 45.49; 95% CI [38.98-52.12], p=0.042) compare to males. Those under 18 years of age had the highest IgG seropositivity: the 12-17 age group during the second wave (85.14%) and the 2-11 age group (25.25%) during the first wave. Nasal congestion and cough were symptoms associated with seropositivity, unlike the first wave. Conclusions/Significance. In Tumbes, the seroprevalence of COVID-19 increased by twofold compared to the initial wave. Inadequate infrastructure and limitations in human resources and supplies in healthcare facilities made the Peruvian health system collapse. We must include in epidemiological surveillance mHealth tools that enable real-time reporting of new cases. Working alongside the community is the only way to improve any new intervention strategy to prevent or control a new pandemic.

Clinical manifestations and mortality among hospitalized COVID-19 patients in Tanzania, 2021-2022. (preprint)

Abstract Background There have been differential mortality rates from Corona Virus Disease of 2019 (COVID-19) in different parts of the world. It is not clear whether the clinical presentation does also differ, thus the need for this study in a Sub-Saharan African country. The aim of this study was to describe clinical manifestations and outcome of patients diagnosed with COVID-19 in selected tertiary hospitals in Tanzania. Methods and Findings A retrospective analysis of archived data from 26th March, 2021 to 30th September, 2022 was done for adults aged ≥18 years who were admitted in five tertiary-level   hospitals in Tanzania.  Information collected included socio-demographic, radiological and clinical characteristics of the patients as well as outcome of the admission (discharge vs death). Categorical variables were presented as frequencies and proportions and compared using Chi square test. Logistic regression was used to assess the relationship between COVID-19 mortality and the collected variables. Out of 1387 COVID-19 patients, approximately 52% were males.  The median age was 60 years [ (IQR)= (19-102)). The most common symptoms were dyspnea (943,68%), cough (889, 64%), fever (597,43%) and fatigue (570, 41%). In-hospital mortality was (476, 34%). Mortality significantly increased with increasing age, being the most in age >90 years [aOR (95% CI) =6.72 (1.94-20.81), P<0.001. Other predictors of death were not possessing a health insurance, [aOR (95% CI) = 2.78 (2.09-3.70), P<0. 001],  dyspnea [aOR (95% CI) = 1.40(1.02-2.06), P=0.03]; chest pain, [aOR (95% CI) = 1.78 (1.12-3.21), P=0.03]; HIV positivity, [aOR (95% CI) = 4.62 (2.51-8.73), P<0.001]; neutrophilia, [aOR (95% CI) = 1.02 (1.01 – 1.03), P=0.02]; none use of ivermectin, [aOR (95% CI) = 1.46 (1.09 – 2.22), P=0.02] and non-use of steroid, [aOR (95% CI) = 1.40 (1.2 – 2.5), P=0.04]. Retrospective nature of this study which based on documented patients records, with a large number of patients left out of the analysis due to missed data, this might in a way affect the results of the present study. Conclusions The most common presenting symptoms were dyspnea, cough and fever, just as what was common elsewhere in the world.  Mortality increased significantly with age, in HIV-infected patients, in those without a health insurance, those presenting with dyspnea, chest pain, or neutrophilia and those who did not use steroid or ivermectin. Clinicians should actively look for the predictors of mortality and take appropriate management to reduce mortality.