Metabolic Disease and The Risk of Post-COVID Conditions: A Retrospective Cohort Study (preprint)

Objective: To examine the influence of having a baseline metabolic disorder (diabetes, hypertension, and/or obesity) on the risk of developing new clinical sequelae potentially related to SARS-CoV-2 in a large sample of commercially insured adults in the US. Design, setting, and participants Deidentified data were collected from the IBM/Watson MarketScan Commercial Claims and Encounters (CCAE) Databases and Medicare Supplemental and Coordination of Benefits (MDCR) Databases from 2019 to 2021. A total of 839,344 adults aged 18 and above with continuous enrollment in the health plan were included in the analyses. Participants were grouped into four categories based on their COVID-19 diagnosis and whether they had at least one of the three common metabolic disorders at baseline (diabetes, obesity, or hypertension). Measures and methods ICD-10-CM codes were used to determine new symptoms and conditions after the acute phase of SARS-CoV-2 infection, defined as ending 21 days after initial diagnosis date, or index period for those who did not have a COVID-19 diagnosis. Propensity score matching (PSM) was used to create comparable reference groups. Cox proportional hazard models were conducted to estimate hazard ratios and 95% confidence intervals. Results Among the 772,377 individuals included in the analyses, 36,742 (4.8%) without and 20,912 (2.7%) with a baseline metabolic disorder were diagnosed with COVID-19. On average, COVID-19 patients with baseline metabolic disorders had more 2.4 more baseline comorbidities compared to those without baseline metabolic disorders. Compared to adults with no baseline metabolic condition, the risks of developing new clinical sequelae were highest among COVID-19 patients with a baseline metabolic condition (HRs ranging from 1.51 to 3.33), followed by those who had a baseline metabolic condition but with no COVID-19 infection (HRs ranging from 1.33 to 2.35), and those who had COVID-19 but no baseline metabolic condition (HRs ranging from 1.34 to 2.85). Conclusions In a large national cohort of commercially insured adults, COVID-19 patients with a baseline metabolic condition had the highest risk of developing new clinical sequelae post-acute infection phase, followed by those who had baseline metabolic condition but no COVID-19 infection and those who had COVID-19 but no baseline metabolic disorder.

Differences in COVID-19 Vaccination and Experiences among Patients with Hypertension in Colombia and Jamaica during the COVID-19 Pandemic (preprint)

Background: COVID-19 vaccination and shielding targeted hypertensive patients in low and middle income countries. We describe the COVID-19 experiences of hypertensive patients in Colombia and Jamaica and discuss factors associated with vaccine acceptance. Methods: A cross-sectional study was conducted between December 2021 and February 2022 in 4 randomly selected primary care clinics in Colombia and 10 primary care clinics in Jamaica. Participants in Colombia were randomly selected from an electronic medical record. In Jamaica consecutive participants were selected on clinic days for non-communicable diseases. Interviewer-administered questionnaires were conducted by telephone. Results: 576 participants were recruited (50% Jamaica; 68.5% female). Jamaica participants were younger (36% vs 23% <60 years) and had a lower proportion of persons with more than high school education (17.2% vs 30.3%, p=0.011). Colombia participants more commonly tested positive for COVID-19 (24.2% vs 6.3%, p<0.001), had a family member or close friend test positive for COVID-19 (54.5% vs, 21.6%; p<0.001), experienced loss of a family member or friend due to COVID-19 (21.5% vs 7.8%, p<0.001) and had vaccination against COVID-19 (90.6% vs 46.7%, p<0.001). Fear of COVID-19 (AOR 2.71, 95% CI 1.20-6.13) and residence in Colombia (AOR 5.88 (95% CI 2.38-14.56) were associated with COVID-19 vaccination. Disruption in health services affecting prescription of medication or access to doctors was low (<10%) for both countries. Conclusion: Health services disruption was low but COVID-19 experiences such as fear of COVID-19 and vaccine acceptance differed significantly between Colombia and Jamaica. Addressing reasons for these differences are important for future pandemic responses.

Impact of Comorbidity on Mortality in COVID-19 Patients: A Single- Center Retrospective Study (preprint)

The global spread of COVID-19 has had a profound impact on human health, with millions of people infected and a significant death. Comorbidities play a pivotal role in the prognosis of COVID-19 patients. The aim of this study was to assess the impact of the comorbidity on mortality in COVID-19 patients in a Single-Centre Retrospective Study. The characteristics and results of patients with COVID-19 admitted to KLE's Hospital in Belgaum, Karnataka, India, were examined through retrospective research. 642 participants having COVID-19 diagnoses between October 1, 2020, and September 30, 2021 were enrolled in the research. Data such as, patients' clinical features, vital signs, demographic information and patients' outcomes (survived or deceased) were collected. The findings of this study showed that out of 642 patients, 256 patients had co morbidities, 62.8% of them had poly morbidity and most prevalent underlying medical conditions were hypertension, diabetes, and heart disease which affected 30.7%, 29.1, and 7.9%, respectively. Only diabetes and renal disease reported strong associations (P.value: 0.011, aOR: 1.852 95% CI: 1.148–2.988), (p.value: 0.000, aOR: 6.491 (95% CI: 2.613–16.124), respectively. Furthermore, Comorbidities such kidney disease, and diabetes mellitus can lead to more serious complications and death in COVID-19 patients. Understanding the impact of these comorbidities on COVID-19 mortality is essential for more effective patient care and resource allocation.

Optimal prevention strategies for chronic diseases in a compartmental disease trajectory model (preprint)

In countries with growing elderly populations, multimorbidity poses a significant healthcare challenge. The trajectories along which diseases accumulate as patients age and how they can be targeted by prevention efforts are still not fully understood. We propose a compartmental model, traditionally used in infectious diseases, describing chronic disease trajectories across 132 distinct multimorbidity patterns (compartments). Leveraging a comprehensive dataset from approximately 45 million hospital stays spanning 17 years in Austria, our compartmental disease trajectory model (CDTM) forecasts changes in the incidence of 131 diagnostic groups and their combinations until 2030, highlighting patterns involving hypertensive diseases with cardiovascular diseases and metabolic disorders. We pinpoint specific diagnoses with the greatest potential for preventive interventions to promote healthy aging. According to our model, a reduction of new onsets by 5% of hypertensive diseases (I10-I15) leads to a reduction in all-cause mortality over a period of 15 years by 0.57 (0.06)% and for malignant neoplasms (C00-C97) mortality is reduced by 0.57 (0.07)%. Furthermore, we use the model to assess the long-term consequences of the Covid-19 pandemic on hospitalizations, revealing earlier and more frequent hospitalizations across multiple diagnoses. Our fully data-driven approach identifies leverage points for proactive preparation by physicians and policymakers to reduce the overall disease burden in the population, emphasizing a shift towards patient-centered care.

MULTIMORBIDITY, MORBIDITIES, AND LONG COVID – findings of the Sulcovid longitudinal study (preprint)

Background The aim of this study was to evaluate the association between long COVID, morbidities, and multimorbidity in adults and older adults six to nine months after infection with the SARS-CoV-2 virus in Southern Brazil.Methods Baseline data were obtained from the longitudinal study, Sulcovid, conducted on individuals diagnosed with COVID-19 through RT-PCR testing from December 2020 to March 2021, who were symptomatic and living in a city in southern Brazil. Long COVID was assessed based on the affirmative response to at least one of the 18 symptoms investigated and categorized as musculoskeletal, neurological, respiratory, sensory, or digestive. Morbidities were assessed based on the presence of at least one of nine self-reported diseases. Data were analyzed using the Stata 15.0 statistical package. Crude and adjusted analyses were performed using Poisson regression to assess the relationships between morbidity, multimorbidity, and long COVID.Results In total, 2,919 people were interviewed. The most prevalent morbidities were anxiety (26.3%), hypertension (25.3%), and depression (19.4%). In addition, 17.8% reported two previous morbidities and 22.6% had three or more comorbidities. Individuals with depression (PR = 1.17 95% CI 1.05–1.30), anxiety (PR = 1.33 95% CI 1.21–1.47), two or more morbidities (PR = 1.22 95% CI 1.07–1.39), and three or more morbidities (PR = 1.40; 95% CI 1.24–1.57) were more likely to have long COVID. A linear trend was observed, where individuals with two and three or more morbidities were 1.22 (95% CI 1.07–1.39) and 1.40 (95% CI 1.24–1.57) times more likely to develop long COVID than those with no or one morbidity.Conclusions The findings of this study reinforce that individuals with morbidities and multimorbidities prior to infection had greater vulnerability to long COVID.

Preoperative COVID-19 Vaccination is Associated with Decreased Perioperative Mortality after Major Vascular Surgery (preprint)

Background: The objective of this study was to examine the effect of COVID-19 vaccination on perioperative outcomes after major vascular surgery. Methods: This is a multicenter retrospective study of patients who underwent major vascular surgery between December 2021 through August 2023. The primary outcome was all-cause mortality within 30 days of index operation or prior to hospital discharge. Multivariable models were used to examine the association between vaccination status and the primary outcome. Results: Of the total 85,424 patients included, 19161 (22.4%) were unvaccinated. Unvaccinated patients were younger compared to vaccinated patients (mean age 68.44 +/- 10.37 years vs 72.11 +/- 9.20 years, p <.001) and less likely to have comorbid conditions, including hypertension (87.2% vs 89.7%, p <.001), congestive heart failure (14.5% vs 15.9%, p <.001), chronic obstructive pulmonary disease (35.7% vs 36.3, p <.001) and renal failure requiring hemodialysis (1.4% vs 1.7%, p = .005). After risk factor adjustment, vaccination was associated with decreased mortality (OR 0.7, 95% CI 0.62 - 0.81, p <.0001). Stratification by procedure type demonstrated that vaccinated patients had decreased odds of mortality after open AAA (OR 0.6, 95% CI 0.42-0.97, p = 0.03), EVAR (OR 0.6, 95% CI 0.43-0.83, p 0.002), CAS (OR 0.7, 95% CI 0.51-0.88, p = 0.004) and infra-inguinal lower extremity interventions (OR 0.7, 95% CI 0.48-0.96, p = 0.03). Conclusions: COVID-19 vaccination is associated with reduced perioperative mortality in patients undergoing vascular surgery. This association is most pronounced for patients undergoing aortic aneurysm repair, carotid stenting and infrainguinal bypass.

Faith-based leaders’ perceptions on the implementation of programs to promote healthy lifestyles in churches in Barbados- a mixed-methods analysis (preprint)

Background: There is a high burden of chronic diseases such as hypertension and diabetes in small island developing states (SIDS). SIDS governments have committed to a range of public health, healthcare, and fiscal measures to reduce this burden including community-based health education in collaboration with civil society organizations. We sought to explore perceived acceptability, appropriateness, and feasibility of implementing self-management health programs in 20 faith-based organizations in the small island developing state of Barbados. Methods: This was a concurrent mixed methods study - a quantitative online survey and a qualitative inquiry using semi-structured interviews. Acceptability, appropriateness and feasibility of the intervention were assessed using the following quantitative assessment tools: Acceptability of Intervention Measure (AIM), Intervention Appropriateness Measure (IAM) and Feasibility of Intervention Measure (FIM). Thirteen in-depth interviews were conducted virtually, recorded and transcribed verbatim. Transcripts were analyzed using thematic analysis based on deductive codes from Proctor’s implementation outcomes definitions. Results: From the 52 respondents of the survey, the median and interquartile ranges for the AIM, IAM and FIM scales were 16 (15-20), 16 (16-20) and 16 (15-17) (out of 20), respectively. We found high levels of acceptability, 82% (95% CI (69%, 95%)) of leaders indicating that health programs in churches met with their approval; and high levels of appropriateness- 90% (95% CI (80%, 100%)) indicating health programs in churches were “fitting” and “a good match”. Feasibility scores were lower, with 60% (95% CI (44%, 76%)) indicating that health programs in churches would be easy to use.  In interviews, leaders expressed acceptance of healthy lifestyle programs in churches and described their appropriateness through alignment with church doctrines stating, “the body is the temple of God”. They felt that economic impacts from COVID-19 were likely to be a barrier to the success of programs. Leaders expressed the need for support from healthcare providers who are sensitive and respectful of church culture. Conclusion: We found that health-based programs in churches align well with church doctrines, but the success of these programs will depend on establishing trust through the engagement of church-based champions, tailoring programming to include a biblical perspective and engaging entire households.

Prospective Clinical Surveillance for Severe Acute Respiratory Illness in Kenyan Hospitals during the COVID-19 pandemic (preprint)

There are limited data from sub-Saharan Africa describing the pattern of admissions to public hospitals with severe acute respiratory infections during the COVID-19 pandemic. We conducted a prospective longitudinal hospital-based sentinel surveillance between May 2020 and December 2022 at 16 public hospitals in Kenya. All patients aged above 18 years admitted to adult medical wards in the participating hospitals were included. Demographic and clinical characteristics, COVID-19 infection and vaccination status and outcome data were collected. Of the 52,714 patients included in the study, 18,001 (35%) were admitted with severe acute respiratory illness (SARI). The mean age was 51 years. Patients were equally distributed across sexes. Pneumonia was the most common diagnosis at discharge. Hypertension, HIV and diabetes mellitus were the most common comorbidities. COVID-19 test results were positive in 2,370 (28%) of the 8,517 (47%) patients that underwent testing. Overall inpatient case fatality for SARI was 21% (n=3,828). After adjusting for age, sex and presence of a comorbidity, SARI patients had higher inpatient mortality compared to non-SARI patients regardless of their COVID-19 status (aHR 1.31, 95% CI 1.19 - 1.46). COVID-19 positive SARI patients had a higher inpatient mortality rate compared to their negative counterparts (aHR 1.31, 95% CI 1.12 - 1.54, p value < 0.0001). COVID-19 vaccine effectiveness against mortality due to SARI after adjusting for age, sex and presence of a comorbidity was 34% (95% CI 11% - 51%). We have provided a comprehensive description of the pattern of admissions with respiratory illnesses in Kenyan hospitals during the COVID-19 pandemic period. We have demonstrated the utility of routine surveillance activities within public hospitals in low-income settings which if strengthened can enhance the response to emerging health threats.

Modeling the relative influence of socio-demographic variables on post-acute COVID-19 quality of life: an application to settings in Europe, Asia, Africa, and South America (preprint)

Long-term COVID-19 complications are a globally pervasive threat, but their plausible social drivers are often not prioritized. Here, we use data from a multinational consortium to quantify the relative contributions of social and clinical factors to differences in quality of life among participants experiencing long COVID and measure the extent to which social variables impacts can be attributed to clinical intermediates, across diverse contexts. In addition to age, neuropsychological and rheumatological comorbidities, educational attainment, employment status, and female sex were identified as important predictors of long COVID-associated quality of life days (long COVID QALDs). Furthermore, a great majority of their impacts on long COVID QALDs could not be tied to key long COVID-predicting comorbidities, such as asthma, diabetes, hypertension, psychological disorder, and obesity. In Norway, 90% (95% CI: 77%, 100%) of the effect of belonging to the highest versus lowest educational attainment quintile was not attributed to intermediate comorbidity impacts. The same was true for 86% (73%, 100%) of the protective effects of full-time employment versus all other employment status categories (excluding retirement) in the UK and 74% (46%,100%) of the protective effects of full-time employment versus all other employment status categories in a cohort of four middle-income countries (MIC). Of the effects of female sex on long COVID QALDs in Norway, UK, and the MIC cohort, 77% (46%,100%), 73% (52%, 94%), and 84% (62%, 100%) were unexplained by the clinical mediators, respectively. Our findings highlight that socio-economic proxies and sex may be as predictive of long COVID QALDs as commonly emphasized comorbidities and that broader structural determinants likely drive their impacts. Importantly, we outline a multi-method, adaptable causal machine learning approach for evaluating the isolated contributions of social disparities to long COVID quality of life experiences.

The prevalence of pre-diabetes and diabetes in people with and without past history of COVID-19 in northeastern Nigeria (preprint)

Background An increased risk of diabetes mellitus (DM) after COVID-19 has been reported in the United States, Europe, and Asia. The burden of COVID-related DM has not been described in Africa, where the overall risk of DM has been increasing rapidly. Our objective was to compare the prevalence of pre-DM and DM in Nigerian individuals with a history of COVID-19 to individuals without known COVID-19 infection.Methods We identified 256 individuals with a past medical history of COVID-19 with no history of pre-DM or DM and 256 individuals without a history of COVID-19 or pre-DM/DM. Participants were categorized as pre-DM (fasting capillary glucose 100–125 mg/dL) or DM (fasting capillary glucose ≥ 126 mg/dL). We used multivariate multinomial logistic regression to determine the odds of pre-DM and DM in those with and without a history of COVID-19 after adjustment for age, gender, the presence of hypertension, physical activity, central adiposity, and family history of DM.Results Compared to the control group, those with a history of COVID-19 had a similar median age (38 vs 40 years, p = 0.84), had a higher proportion of men (63% vs 49%), and had a lower prevalence of central adiposity (waist: hip ratio ≥ 0.90 for males and WHR ≥ 0.85 for females) (48% vs 56.3%, p = 0.06). Of the 256 with a history of COVID-19, 44 (17%) required inpatient care. The median (interquartile range) time interval between COVID-19 diagnosis and the glycaemic assessment was 19 (14, 24) months. Pre-DM prevalence was 27% in the post-COVID-19 group and 4% in the control group, whereas the prevalence of DM was 7% in the post-COVID-19 group and 2% in the control group. After multivariable adjustment, the odds of pre-DM were 8.12 (95% confidence interval (CI): 33.98, 16.58; p < 0.001) higher, and the odds of DM were 3.97 (95% CI: 1.16, 13.63) higher in those with a history of COVID-19 compared to controls.Conclusion Previous COVID-19 was found to be a risk factor for prevalent pre-diabetes and diabetes mellitus in Nigeria. More intensive screening for DM in those with a history of COVID-19 should be considered.

Clinical characteristics and analysis of risk factors for disease progression in patients on maintenance hemodialysis infected with SARS-CoV-2 omicron variant (preprint)

Objective:To summarize the clinical characteristics of patients on maintenance hemodialysis (MHD) with the novel coronavirus omicron variant and explore the risk factors for severe cases. Methods:We retrospectively analyzed the data of 158 patients on MHD from Zhongnan Hospital of Wuhan University between December 7, 2022 and January 31, 2023. We collected clinical data, described clinical characteristics, and analyzed the relationships between these factors and critical illness using univariate and multivariate logistic regression analyses. Results: The median age of the 158 patients was 63 (interquartile range: 52–71) years, and 128 (63.7%) were men. Fever (62.7%) and cough (60.1%) were the two most common symptoms. Hypertension (80.4%) was the most common comorbidity, followed by diabetes (31.0%), cardiovascular disease (22.8%), and cerebrovascular disease (15.2%). Unvaccinated patients constituted the majority of the enrolled patients (88.6%, 140/158), whereas only a small proportion (11.4%, 18/158) had been vaccinated (including fully vaccinated and partially vaccinated patients). Multivariate logistic regression analysis indicated that an elevated C-reactive protein (CRP) level (odds ratio [OR]: 1.03, 95% confidence interval [CI], 1.014–1.046], p<0.001) and a decreased platelet count (OR: 0.986, 95% CI, 0.986 (0.976–0.997), p=0.013) during hospitalization were risk factors for the severe group. Conclusions:This study demonstrated a high mortality rate among patients on MHD infected with omicron variant. Furthermore, advanced age, increased CRP levels, and decreased platelet count were predictors of critical illness.

COVID-19 severity and corticosteroid treatment have minimal effect on specific antibody production (preprint)

Background Dexamethasone is currently administered for Coronavirus disease 2019(COVID-19); however, there are concerns about its effect on specific antibodies’ production. The aim of this study was to evaluate whether specific antibodies were affected by COVID-19 severity and corticosteroid treatment.Methods Of 251 confirmed COVID-19 patients admitted to our hospital between January 26 and August 10, 2020, the early period of the pandemic, 75 patients with sera within 1 month of onset and 1month or longer were included in the research. A total of 253 serum samples from these patients were collected. The levels of specific antibodies for severe acute respiratory syndrome coronavirus 2(SARS-CoV-2), immunoglobulin G (IgG) and M (IgM), were measured retrospectively. The results were compared separately of each COVID-19 severity, and with or without corticosteroid treatment.Results Among the 75 patients, 47, 18, and 10 had mild, moderate, and severe disease, respectively. The median age was 53.0 years and 22 (29%) were women. The most common comorbidities were hypertension and dyslipidemia. Corticosteroids were administered to 20 (27%) and 10 (53%), patients with moderate and severe disease, respectively. The positivity rates IgM increased first, and IgG was almost always positive after day 16, regardless of the severity of COVID-19. On days 6–10, both IgG and IgM positivity rates were higher in patients with moderate disease than in those with mild or severe disease. In patients with moderate disease, IgG positivity was similar over time, regardless of corticosteroid treatment.Conclusions In COVID-19 patients, specific IgG is positive and maintained for a long period of time, even after corticosteroid treatment. The effect of corticosteroid treatment in a COVID-19 epidemiological study using specific IgG antibodies was considered minor. COVID-19 patients were more likely to receive oxygen if IgM was positive 1 week after onset, but not mechanical ventilation. IgM measurement 1 week after onset may predict COVID-19 severity.

Post-COVID-19 Condition Patients’ Utilisation of Healthcare Resources after Implementation of an Integrated Care Unit: A Retrospective and Case-Control Observational Study (preprint)

Background: While the clinical factors of the post-COVID-19 condition (PCC) are becoming clearer, the economic implications remain uncertain, posing a challenge to healthcare professionals in terms of understanding and managing this emerging phenomenon. This article aims to investigate the demographic and clinical characteristics of PCC patients and quantify the economic impact of their healthcare resource utilisation. Methods: A retrospective and case-control observational study was conducted, comparing the case group of PCC population before and after diagnosis with a control group. Demographic and clinical variables were analysed with the objective of describing the population. Economic analysis was performed to evaluate the resource costs in procedures and primary, secondary (both outpatient and inpatient) and emergency care. Findings: PCC patients (N=341) exhibited older age and elevated cardiovascular risk factors compared to controls (N=49,078). There were differences in the socio-economic distribution between male and female patients in the PCC patients. Hypertension and diabetes mellitus type 2 were the most common chronic diseases observed among the case patients. Economic analysis revealed that PCC patients were approximately four times as costly as control patients, with increased utilisation of healthcare resources. However, post-diagnosis PCC patients showed a reduction in costs, primarily driven by decreased primary care visits and hospitalisations. Conclusion: Coordinated care management for PCC patients is associated with reduced costs and improved healthcare resource utilisation. Further research is warranted to investigate long-term health outcomes and establish causal relationships between COVID-19 sequelae and healthcare resource utilisation.

COVID-19 VACCINATION-INFECTION STATUS AND IMMUNOLOGICAL PROFILE: IDENTIFICATION OF HIGH RISK POPULATION FOR TARGETED BOOSTER IMMUNIZATION IN INDIA (preprint)

Background: The COVID-19 pandemic's global impact was mitigated through rapid vaccine development, leading to a mix of natural and vaccination-derived immunity. Immunological profile in hybrid immunity remains less studies, especially in regions where non-mRNA vaccines were used. This study focuses on the immunological profiles and predictors of immune response in one such population. Methods: This was a cross-sectional study to assess their humoral and cellular immune responses based on vaccination and infection history. Immunological assays were performed to measure anti-spike protein and neutralizing antibodies as well as interferon-γ release assay. Multivariable linear regression model was used to estimate predictors of immune response. Results: The study revealed significant differences in immune response among participants based on their hybrid immunity status, vaccination, and infection history. Higher antibody titres and cellular responses were observed in individuals with hybrid immunity, especially those with dual pre-Omicron and Omicron infections (3326 BAU/ml, IQR: 770.25-5678.25 and 4.92 IU of IFN-γ/mL, IQR:3.74-16.98 respectively, p <0.001). Age and comorbidities such as diabetes and hypertension were associated with lower antibody levels and cellular response, while vaccination and hybrid immunity correlated with higher immune responses. Conclusion: The prevalence of hybrid immunity was high, yet a substantial portion of the population lacks it, indicating the necessity for targeted immunization strategies. The findings underscore the importance of prioritizing high-risk individuals, such as elderly and individuals with comorbidities, for booster vaccinations to enhance community-level protection against COVID-19.

Impact of COVID-19 on the Management of Hypertension: A Perspective on Disease Severity, Service Use Patterns and Expenditures from Ghana’s Health Insurance Claims Data (preprint)

Hypertension is a leading cause of death and morbidity in Ghana and other sub-Saharan African countries, but management has historically suffered from the fragility of health systems in these countries. This has been exacerbated by the COVID-19 pandemic and its associated measures. Our study examines and quantifies the effect of the pandemic on the management of hypertension in Ghana by determining changes in disease severity and presentation, as well as changes in service use patterns and expenditures. We used cross-sectional data to perform an impact evaluation of COVID-19 on hypertension management before and during the pandemic. We employed statistical tests to analyse medical claims data from Ghana’s National Health Insurance Authority database. The study duration includes a 12-month reference/pre-pandemic period (March 2019- February 2020) relative to the target/pandemic period (March 2020 - February 2021). We observed significant changes in health services use for hypertension during the pandemic. While there was a 20% reduction in the number of hypertension claimants in the pandemic year, there was an increase in hypertension severity as measured by the number of hypertension episodes per claimant (a 17.6% increase (95% CI. 15.0% – 20.3%; p = 0.031)). There was also an 18.64% or $22.88 (95% CI:$12 – $25, p = 0.01042) increase in the average cost per hypertension claimant in the pandemic year. The increase in episodes per claimant had the largest financial impact on the average cost per claimant. The findings from our studies are relevant for future policymaking and strategy implementation for hypertension control in Ghana.

Acute kidney injury outcomes of COVID-19 confirmed patients in a Philippine tertiary hospital: A retrospective study (preprint)

The novel coronavirus (COVID-19) is known to be the fifth pandemic causing massive deaths worldwide. This virus has not only been deeply associated with acute respiratory distress, but also acute kidney injury (AKI). This study describes the baseline characteristics and various outcomes of AKI based on the KDIGO 2012 Clinical Practice Guidelines in patients hospitalized with COVID-19 at a Philippine tertiary hospital. A total of 195 patient records were retrospectively reviewed for the study. Of the 195 patients, 81(42%) patients developed AKI. Significant baseline characteristics included older age (56.28 + 14.12), presence of hypertension (p=0.004), diabetes mellitus (p=0.002), and cardiovascular disease (p=0.003). Also, the use of diuretics, inotropes and antibiotics were more prevalent in patients who developed AKI. Most of the patients who had AKI were categorized as stage 1 (49.38%).  Mechanical ventilation was significantly (p<0.001) more prevalent in patients with AKI (20.99%) compared to patients without AKI (5.26%). There was significantly higher rates (p<0.001) of renal replacement therapy in patients with AKI (30.86%). Lastly, higher mortality rates were observed in patients with AKI (50.62%) versus patients without AKI (12.28%). Our study demonstrated that patients with COVID-19 can develop AKI and tend to have a poorer prognosis.

Comparison of Clinical Characteristics in Adult Patients Under 65 years of age with and without Covid 19 pneumonia (preprint)

Background: Coronavirus disease-2019 (COVID-19) can cause asymptomatic, mild upper respiratory tract symptoms, pneumonia in young persons. How the disease will progress in each patient is still unknown. Therefore, we aimed to investigate the prognostic markers of the development of pneumonia and the clinical characteristics of patients under 65 years with COVID-19 confirmed by a positive reverse transcriptase polymerase chain reaction (RT-PCR) test. Method: In this retrospective study, a total of 271 patients admitted in our unit were included. The patients were divided into two groups, those who did or did not develop pneumonia. Their clinical features, treatment protocols and laboratory parameters were recorded retrospectively. Results: Pneumonia developed in 67.9% (n = 184) of the cases. Age in the pneumonia group was higher than in the non-pneumonia group (p < 0.001). In the logistic regression analysis, when symptom and comorbidity status were examined according to the presence of pneumonia; HT (OR: 4,525 95% CL: 1,494–13,708) were the most important risk factor for pneumonia. When age and laboratory values were examined according to the presence of pneumonia, advanced age (OR: 1.042 95% CL: 1.01–1.073), low albumin (OR: 0.917 95% CL: 0.854–0.986) and high troponin (OR: 1.291 95% CL: 1.044–1.596) were identified as risk factors for pneumonia. Conclusion: HT, older age, low albumin, high troponin were important factors for predicting COVID-19 pneumonia in patients under 65 years of age. Young patients with these predictive factors should be more carefully evaluated by further diagnostic procedures, such as thoracic CT. Key Words: COVID-19, pneumonia, young adults

How phytocannabinoids affect cardiovascular health? An update on the most common cardiovascular diseases. (preprint)

Cardiovascular diseases (CVDs) remain the cause of millions of deaths in the world annually. Despite the great progress in therapies, which are available for patients with CVDs, some limitations including drug complications still exist. Hence, the endocannabinoid system (ECS) was proposed as a new avenue for CVDs treatment. The cardiovascular action of cannabinoids is complex as they not only affect vasculature and myocardium directly via specific receptors but also exert indirect effects through the central and peripheral nervous system. The growing interest in phytocannabinoid studies has been broadened the knowledge about their molecular targets as well as therapeutical properties, nonetheless, some areas of their actions are not yet fully recognized. The purpose of this review is to summarize and update the cardiovascular actions of the most potent phytocannabinoids and the potential therapeutic role of ECS in CVDs, including ischemic reperfusion injury, arrhythmia, heart failure, hypertension as well as cardiac complications associated with the novel coronavirus SARS-CoV-2 infections.

Inflammation Patterns in Omicron Variant-Linked COVID-19: Assessing Biomarkers for Predicting Disease Severity (preprint)

The ongoing COVID-19 pandemic necessitates the identification of effective biomarkers to gauge disease severity. C-reactive protein (CRP), D-Dimer, and White Blood Cell counts (WBCs) have emerged as potential indicators of COVID-19 severity and prognosis. This research, conducted at Qalla Hospital, enrolled 112 confirmed COVID-19 patients and 35 healthy controls, employing comprehensive clinical and laboratory evaluations that included CRP, D-Dimer, and WBC measurements. The diagnosis of COVID-19 adhered to established clinical criteria and was confirmed through SARS-CoV-2 testing, with stringent assessments to ensure precise participant classification. The results unveiled significantly elevated CRP (p-value=0.0001), D-Dimer (p-value=0.0001), and WBCs in COVID-19 patients compared to healthy controls. Elevated CRP levels, indicative of inflammation, increased D-Dimer levels associated with coagulation abnormalities, and raised WBCs within the CRP level (0.943), indicative of an immune response, were prevalent in COVID-19 patients. Gender distribution was balanced, while comorbidities such as diabetes mellitus (25%), hypertension (34.8%), kidney disease (6.2%), and multiple concurrent diseases (34%) were prevalent in the COVID-19 cohort. The discussion underscores the substantial differences in CRP, D-Dimer, and WBCs, emphasizing their potential as valuable biomarkers for diagnosing and monitoring COVID-19 severity. These biomarkers could serve as critical tools in evaluating disease progression, predicting complications, and guiding tailored therapeutic interventions. In conclusion, CRP, D-Dimer, and WBCs exhibited marked disparities between healthy individuals and COVID-19 patients, indicating their potential as diagnostic and prognostic indicators. Continued investigation into the utility of these biomarkers may refine risk stratification and treatment strategies, ultimately enhancing patient outcomes in COVID-19 management. A deeper understanding of the clinical implications of CRP, D-Dimer, and WBC levels could profoundly impact disease management and patient care strategies.

Multimorbidity characteristics in elderly inpatients and their associated factors in complex networks: a cross-sectional study (preprint)

Background Multimorbidity of chronic diseases has become an increasingly serious public health problem. However, the research on the current situation of multimorbidity in the elderly in Jiangsu, China is relatively lacking. Methods We surveyed a total of 229,926 inpatients aged above 60 and with two or more chronic diseases in the First Affiliated Hospital with Nanjing Medical University from January 1, 2015 to December 31, 2021. The Apriori algorithm was used to analyze the association rules of the multimorbidity patternsin old adults. Results The mean age of these patients was 72.0±8.7 years, and the male-to-female ratio was 1:1.53. These patients during the COVID-19 period(from 2020 to 2021) displayed younger, higher male rate, shorter median length of hospital stay, higher ≥6 multimorbidities rate and lower median cost than those not during the COVID-19 period (from 2015 to 2019). In all of these patients, the top 5 chronic diseases were "Hypertensive diseases(I10-I15)", "Other forms of heart disease(I30-I52)", "Diabetes mellitus(E10-E14)", "lschaemic heart diseases(I20-I25)" and "Cerebrovascular diseases(I60-I69)". The complex networks of multimorbidity showed that Hypertensive diseases had a higher probability of co-occurrence with multiple diseases in all these patients, followed by Diabetes mellitus, Other forms of heart disease, and lschaemic heart diseases(I20-I25). Conclusion In conclusion, the patterns of multimorbidity among the aged varied by COVID-19. Our results highlighted the importance of control of hypertensive diseases, diabetes, and heart disease in gerontal patients. More efforts to improve the understanding of multimorbidity patterns would help us develop new clinical and family care models.