SARS-CoV-2 Infection Related Hyperglycemia during hospitalization and three months post-discharge (preprint)

Hyperglycemia or diabetes mellitus during COVID-19 has always been a great concern and heralds severe forms of the disease, we also don’t know whether this condition will continue as diabetes mellitus even after convalescence. For this purpose we conducted a study to investigate this condition and factors related to it in hospitalized patients and even three months post-discharge we followed them up. We gathered data from 202 patients that fulfilled our inclusion criteria, among them 100 patients were hyperglycemic. Patients in hyperglycemic status experienced significantly longer duration of hospitalization than normoglycemic patients and significantly showed more severe forms of the disease. During their follow up three months post-discharge for the investigation of glycemic status, 46 out of 97 patients were diagnosed with diabetes mellitus and have been taking anti-diabetic drugs while 29 patients only had normal glycemic status.

Bilateral spontaneous pneumothorax as a late complication of COVID-19, a case report (preprint)

The first case of sever pneumonia caused by coronavirus (COVID-19) was detected in Wuhan, China in December 2019 and spread rapidly around the world. Pneumothorax has been reported as an uncommon complication following COVID-19 infection which caused by alveolar rupture, air leakage and interstitial emphysema after alveolar damages. Bilateral pneumothorax is also an uncommon life threatening complication induced by COVID-19 which has to be considered in patients present with late sudden dyspnea after Coronavirus infection. In this case report, we are presenting a patient with mild COVID-19 pneumonia with a left massive pneumothorax following a late sudden dyspnea in third week of the disease, during the hospitalization, in addition to aggravating the respiratory condition, right pneumothorax was also added.

Outcome of using Intravenous Immunoglobulin (IVIG) in critically ill COVID-19 patients’: a ‎retrospective, ‏multi-centric cohort study (preprint)

Abstract Background: To access the effect of Intravenous immunoglobulin ‎‎(IVIG) in critically ill corona virus disease 2019 (COVID-19) patients. Method: In this retrospective matched cohort study, records of three tertiary centers with large number of COVID-19 admissions were evaluated and used. Based on treatment options, ‎patients were divided into two groups, standard COVID-19 treatment (109 patients) and IVIG treatment (74 patients) patients. Also, the effect of IVIG in different dosages was evaluated. Patients with IVIG treatment were divided into three groups of ‎low (0.25 gr/kg), medium (0.5 gr/kg), and high (1 gr/kg) dose. Data analysis was performed using independent t-test and ‎One-way analysis of variance (ANOVA) to compare the ‎outcomes between two groups, including duration of hospitalization, intensive care unit (ICU) length of stay, and mortality rate.‎ Result: The duration of hospitalization in the IVIG group ‎were significantly longer than standard treatment (13.74 days vs. 11.10 days, p<0.05). There was not a significant difference between the two groups in ICU length of stay, number of intubated patients and duration of mechanical ventilation (P>0.05).‎ Also initial ‎outcomes in IVIG subgroups were compared separately with the standard ‎treatment group. The results indicated that only the duration of hospitalization ‎in the IVIG subgroup with medium dose is significantly longer than the standard ‎treatment group (P<0.01). Conclusion: Using IVIG is not beneficial for COVID-19 patients based on no remarkable differences in duration of hospitalization, ICU length of stay, duration of mechanical ventilation and even mortality rate.

Bilateral spontaneous pneumothorax as a late complication of COVID-19, a clinical case report (preprint)

Bilateral spontaneous pneumothorax can occur as a late complication in patients with COVID-19 even without any history of mechanical ventilation. Here, we are presenting a patient with mild COVID-19 pneumonia with a left massive pneumothorax in the third week of the hospitalization, and the addition of right pneumothorax as well.

Recurrent culture-negative endocarditis and osteomyelitis caused by Q fever in Iran, a case report (preprint)

Background: Endocarditis is an infection of the endocardial layer of the heart known as fatal infection. Gold standard diagnosis of infectious endocarditis is blood culture, which in some cases can be negative. In blood culture-negative endocarditis, the early diagnosis, and treatment are much harder, which can increase morbidities and also mortality. Case presentation: In this case report we are presenting a patient with intermittent fever for three months with a history of aortic and pulmonary valve replacement and also recurrent blood culture-negative endocarditis. According to the pandemic situation, we checked the Covid-19 PCR and also performed a chest computed tomography (CT) -scan, which both were negative and did not represent any pathologic conditions. Other examinations such as transesophageal echocardiography (TEE) and blood cultures were all normal and the only abnormal finding we had was a positron emission tomography (PET) - CT scan with endocarditis and sternum osteomyelitis evidence. Conclusion: After several evaluations based on endemic epidemiology, the Real-time PCR and IFA (IgG phase I; 1:16384, IgG phase II; 1:16384) were positive for Q fever and the patient responded to the proper doxycycline and hydroxychloroquine treatment.

The Comparison of Clinical, Laboratory, and Radiological Findings in Immunocompromised and Immunocompetent Patients with COVID-19: A Case-Control Study (preprint)

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19) with significant morbidity and mortality. We reported and compared the clinical and para-clinical findings of immunocompromised and immunocompetent COVID-19 patients in a case-control study at the Imam Khomeini hospital in Tehran, Iran.Methods: A total of 107 immunocompromised COIVD patients as the case group and 107 immunocompetent COVID patients as the control group was recruited in the study. The participants were matched based on age, and sex. The patients’ information was retrieved from the hospital records in an information sheet. Associations between clinical and para-clinical findings with the immune status were assessed using bivariate and multivariate analyses. The clinical trial registration number is not applicable.Results: The initial pulse rate and recovery time were significantly higher in immunocompromised patients (P <0.05). Myalgia, nausea/vomiting, loss of appetite, headache, and vertigo were more frequently reported by the control group (P <0.05). In terms of the duration of prescribed medications, Sofosbovir time was longer in the case group; while Ribavirin time was longer in the control groups (P <0.05). The most common complication in the case group was ARDS although no major complications were observed in the control group. In the multivariate analysis, recovery time and Kaletra prescription were significantly higher in immunocompromised compared to the immunocompetent group. Conclusions: Recovery time was significantly higher in the immunocompromised compared to the immunocompetent group. This informs the current practice of dominant COVID-19 clinical course in immunocompromised patients and communicates the related implications.

Does the Rubella Immunoglobulin G affect the severity of COVID- 19? Rubella Immunoglobulin G and COVID- 19 (preprint)

Objective &Aim: The coronavirus disease, so far (COVID-19) has brought about millions of infections and fatalities throughout the world. Our aim was to determine whether rubella IGG titers are inversely correlated with severity COVID-19 patients.Materials & Methods: This study was conducted among COVID-19 confirmed patients over 18 years of age. The disease severity levels were categorized by WHO interim guidance. The rubella-specific IgG antibody-titer spectrum was measured (within first 48 hours of hospitalization) by enzyme-linked immunosorbent assay (ELISA). Result: in a study of 46 inpatients with varying COVID-19 disease severity (mild, moderate, severe, and critical), we observed a negative correlation between rubella IgG antibody titers and COVID‐19 severity (P-Value=0.03), There was an interaction between COVID-19 vaccination history and rubella IGG on severity COVID-19 (P-Value=0.0015). There was an interaction between age group under 44 years (including national measles- rubella (MR) vaccination in Iran) and rubella IGG titers on severity COVID-19 too (p-value=0.014).Conclusion: In conclusion, MR vaccination seems to have a positive effect in reducing the severity of the disease, emphasizing that, the important and separate effect of the IGG rubella (due to natural or extrinsic immunity) titers is determining.

Outcome of Using Intravenous Immunoglobulin (IVIG) in Critically Ill COVID-19 Patients’: A ‎Retrospective, ‏Multi-Centric Cohort Study (preprint)

Background: To access the effect of Intravenous immunoglobulin ‎‎(IVIG) in critically ill corona virus disease 2019 (COVID-19) patients. Method: In this retrospective matched cohort study, records of three tertiary centers with large number of COVID-19 admissions were evaluated and used. Based on treatment options, ‎patients were divided into two groups, standard COVID-19 treatment (109 patients) and IVIG treatment (74 patients) patients. Also, the effect of IVIG in different dosages was evaluated. Patients with IVIG treatment were divided into three groups of ‎low (0.25 gr/kg), medium (0.5 gr/kg), and high (1 gr/kg) dose. Data analysis was performed using independent t-test and ‎One-way analysis of variance (ANOVA) to compare the ‎outcomes between two groups, including duration of hospitalization, intensive care unit (ICU) length of stay, and mortality rate.‎ Result: The duration of hospitalization in the IVIG group ‎were significantly longer than standard treatment (13.74 days vs. 11.10 days, p< 0.05). There was not a significant difference between the two groups in ICU length of stay, number of intubated patients and duration of mechanical ventilation (P>0.05).‎ Also initial ‎outcomes in IVIG subgroups were compared separately with the standard ‎treatment group. The results indicated that only the duration of hospitalization ‎in the IVIG subgroup with medium dose is significantly longer than the standard ‎treatment group (P<0.01). Conclusion: Using IVIG is not beneficial for COVID-19 patients based on no remarkable differences in duration of hospitalization, ICU length of stay, duration of mechanical ventilation and even mortality rate.

SARS-CoV-2 re-positivity within the first 3 months of COVID-19 recovery; probable re-infection (preprint)

Objectives: Possibility of reinfection with SARS-CoV-2 changes our view on herd immunity and vaccination, and can impact worldwide quarantine policies. We performed RT-PCR follow-up studies on recovered patients to assess possible development of reinfections and re-positivity. Method During a 6-month period, 202 PCR-confirmed recovering COVID-19 patients entered this study. Follow-up RT-PCR tests and symptoms assessment were performed one month after the initial Positive results. patients who tested negative were tested again one and three months later. The Serum IgG and IgM levels were measured in the last follow-up session. Results In the first two follow-up sessions, 82 patients continued their participation, of which four patients tasted positive. In the second follow-up 44 patients participated, three of whom tested positive. None of the patients who tested positive in the first and second follow-up session were symptomatic. In the last session, 32 patients were tested and four patients were positive, three of them were mildly symptomatic and all of them were positive for IgG. Conclusion A positive RT-PCR in a recovering patient may represent reinfection. While we did not have the resources to prove reinfection by genetic sequencing of the infective viruses, we believe presence of mild symptoms in the three patients who tested positive over 100 days after becoming asymptomatic, can be diagnosed as reinfection. The IgG may have abated the symptoms of the reinfection, without providing complete protection.

SARS-CoV-2 Reinfection within the first 3 months of COVID-19 Recovery in A Referral Hospital, Tehran, Iran (preprint)

ObjectivesPossibility of reinfection with SARS-CoV-2 changes our view on herd immunity and vaccination, and can impact quarantine policies. We performed follow-up studies on recovered patients to assess possible development of reinfections.MethodDuring a 6-month period, 202 PCR-confirmed recovering COVID-19 patients entered this study. Follow-up RT-PCR tests and symptoms assessment were performed one month after the initial Positive results. patients who tested negative were tested again one and three months later. The Serum IgG and IgM levels were measured in the last follow-up session.ResultsIn the first two follow-up sessions, 82 (out of 202) and 44 patients participated with four and three asymptomatic patients testing positive. In the last session, 32 patients were tested and four were positive, three of them were mildly symptomatic and all of them were positive for IgG.ConclusionA positive RT-PCR in a recovering patient may represent reinfection. While we did not have the resources to prove reinfection by genetic sequencing of the infective viruses, we believe presence of mild symptoms in the three patients who tested positive over 100 days after becoming asymptomatic, can be diagnosed as reinfection. The IgG may have abated the symptoms of the reinfection, without providing complete protection.

Safety and Effectiveness of High-Dose Vitamin C in Patients with COVID-19; A Randomized Controlled open-label Clinical Trial ‎ (preprint)

Background: To assess the effectiveness of vitamin C treatment against coronavirus disease 2019 (COVID-19) Methods: An open-label, randomized, and controlled trial was conducted on patients with severe COVID-19 infection. The case and control treatment groups each consisted of 30 patients. The control group received lopinavir/ritonavir and hydroxychloroquine and the case group received high-dose of vitamin C (six gr daily) added to the same regimen. Results: There were no statistically significant differences between two groups with respect to age and gender, laboratory results, and underlying diseases. On the 3 rd day of hospitalization, the mean core body temperatures was significantly lower and SpO2 was higher In the case group (p value = 0.001, and 0.014, respectively). The median length of hospitalization in case group which was significantly longer than the control group (8.5 days vs. 6.5 days) (p value = 0.0280). There was no significant difference in SpO2 levels at discharge time, the length of ICU stay, and mortality between the two groups. Conclusions: : We did not find significantly better outcomes in the group who were treated with high-dose vitamin C in addition to the main treatment regimen at discharge. Trial registration: The project was registered by Iranian Registry of Clinical Trials.IRCT20200411047025N1