Liver injury at admission and outcomes in patients with COVID-19 disease: a prospective cohort study.

The liver is one of the common extrapulmonary organs involved in the coronavirus disease 2019 (COVID-19) infection. We aimed to find the prevalence of liver injury at hospital admission and its effects on outcomes. Methods: This is a single-center prospective observational study. All consecutive patients with COVID-19 admitted during the months of May to August 2021 were included in the study. Liver injury was defined as at least 2 times elevation of aspartate transaminase, alanine transaminase, alkaline phosphatase, and bilirubin above the upper limits on normal. The predictive efficacy of liver injury was measured as its effects on outcome variables, that is duration of hospital stay, requirement of ICU admission, mechanical ventilation, and mortality. Presence of liver injury compared with existing biomarkers markers of severe disease, that is lactate dehydrogenase, D-dimer, and C-reactive protein. Results: A total of 245 consecutive adult patients with COVID-19 infection were included in the study. Liver injury was present in 102 (41.63%) of patients. There was a significant association between the presence of liver injury and duration of hospital stay (10.74 vs. 8.9 days; P=0.013), the requirement of ICU admission (12.7 vs. 10.2%; P=0.018), mechanical ventilation (10.6% vs. 6.5%; P=0.003), and mortality (13.1% vs. 6.1%; P<0.001). Liver injury was significantly associated (P<0.001) with the corresponding elevation of serum biomarkers of severity. Conclusion: The presence of liver injury in patients with COVID-19 infection at the time of hospital admission is the independent predictor of poor outcomes and can also be used as the marker of disease severity.

Knowledge, attitude and reported practice regarding donning and doffing of personal protective equipment among frontline healthcare workers against COVID-19 in Nepal: A cross-sectional study

Background Coronavirus Disease 2019 (COVID-19) is a respiratory infection with a high rate of transmission primarily via airborne route and direct contact. Proper use of personal protective equipment (PPE) is a proven and effective way to prevent COVID-19 spread in healthcare settings. This study was done aiming to assess the knowledge, attitude, and reported practice, and identify the associated factors regarding donning and doffing of PPE among frontline healthcare workers in Nepal. Methods A cross-sectional study was conducted from 25th April to 30th July 2021 among 205 frontline healthcare workers of Nepal selected randomly from among the contacts of the investigators. A structured self-administered questionnaire prepared in google form was used as a study tool and shared via social media to the participants to obtain information on socio-demographic and workplace characteristics along with their knowledge, attitude, and reported practice regarding donning and doffing of PPE. Result A total of 79.5% of participants had satisfactory knowledge while 75.6% had satisfactory practice scores regarding donning and doffing of PPE. Factors such as the profession of the participants (p-value = 0.048), their workplace (p-value = 0.005), provision of PPE at workplace (p-value = 0 .009), and availability of designated space at workplace for methodical donning and doffing of PPE (p-value = 0.010) were significantly associated with satisfactory knowledge score whereas availability of designated space at workplace for donning and doffing of PPE was significantly associated with good practice score (p-value = 0.009). Conclusion This study demonstrated an overall good knowledge, attitude, and reported practice regarding donning and doffing of PPE among frontline healthcare workers in Nepal. However, the reported shortcomings like poor knowledge regarding the sequence of donning and doffing and corresponding flawed practice behaviors need to be addressed.

Social and mental health impact of COVID-19 pandemic among health professionals of Gandaki Province, Nepal: A mixed method study.

BACKGROUND: The frontline health workers are the key players in the fight against the COVID-19 pandemic, however, several incidences of attacks, stigmatization, and discrimination towards them have been reported throughout the world during the peak of infection. The social impact experienced by health professionals can alter their efficiency and also lead to mental distress. This study aimed to examine the extent of social impact experienced by health professionals currently working in Gandaki Province, Nepal along with the factors associated with their depression status. METHODS: This was a mixed-method study where a cross-sectional online survey was executed among 418 health professionals followed by in-depth interviews with 14 health professionals of Gandaki Province. The bivariate analysis and multivariate logistic regression were performed to identify the factors associated with depression at 5% level of significance. The information collected from the in-depth interviews was clustered into themes by the researchers. RESULTS: Out of 418 health professionals, 304 (72.7%) expressed that COVID-19 has impacted their family relationships, whereas 293 (70.1%) expressed that it impacted their relationships with friends and relatives, and 282 (68.1%) expressed it impacted their relationships with community people. The prevalence of depression among health professionals was noted at 39.0%. Being a female (aOR:1.425,95% CI:1.220-2.410), job dissatisfaction (aOR:1.826, 95% CI:1.105-3.016), COVID-19 impact on family relation (aOR:2.080, 95% CI:1.081-4.002), COVID-19 impact on relationship with friends and relatives (aOR:3.765, 95% CI:1.989-7.177), being badly treated (aOR:2.169, 95% CI:1.303-3.610) and experiencing moderate (aOR:1.655, 95% CI:1.036-2.645) and severe fear (aOR:2.395, 95% CI:1.116-5.137) of COVID-19 were found to the independent predictors of depression. It was noted that the pandemic has an effect on the social relations of health professionals in multiple ways. CONCLUSION: This study noted that there is a significant impact of COVID-19 on health professionals in terms of their social and mental health aspects. The social impact experienced by health professionals is an important predictor of their mental health. The mental health and well-being of these vital workforces can be enhanced by focusing on the social aspect during the pandemic.

Cardiac Implications of COVID-19 in Deceased and Recovered Patients: A Systematic Review.

Background: Patients infected with coronavirus disease 2019 (COVID-19) present with various clinical presentations with majority of them developing pulmonary complications. This study focuses on cardiac implications of COVID-19 which are less discussed and thus will help to address cardiac implications of COVID-19. Methods: PubMed, PubMed Central, and Google Scholar were screened for articles which mentioned cardiac implications of COVID-19. NHLBI Study Quality Assessment Tools for the observational cohort and cross-sectional studies was used for assessing the risk of bias of our studies. Results: All 14 studies selected were good and had score of ≥9 by NHLBI Study Quality Assessment Tools. Cardiac complications of COVID-19 are common. They are associated with significant mortality. Also, people infected with COVID-19 with premorbid conditions such as cardiovascular diseases and diabetes mellitus have poor prognosis as compared to those without premorbid conditions. Cardiac biomarkers such as highly sensitive troponin I, creatinine, and creatinine kinase-MB on admission are good prognostic markers. Conclusions: Cardiac complications such as heart failure, myocardial injury, and arrhythmias are common among patients infected with COVID-19. Elevated cardiac markers and patients with cardiac complications require utmost care and continuous cardiac monitoring.

Impact of COVID­19 infection in patients with neurodegenerative diseases with particular focus on Alzheimer's and Parkinson's disease.

Neurodegenerative disorders (NDD) are chronic neurological diseases characterized by loss and/or damage to neurons along with the myelin sheath, and patients are at higher risk of severe infection with the SARS­CoV­2. A comprehensive literature search was performed using relevant terms and inclusion­exclusion criteria. Recent articles, subjects older than 50 years, and articles written in the English language were included, whereas letters to the editor and articles related to pregnant women were excluded from the review study. COVID­19 appears to damage angiotensin­II receptors which cause natural killer cells to lose the ability to clear virus­infected cells, owing to worse outcomes in patients with NDD. COVID­19 can worsen the symptoms of Alzheimer's disease. In addition, COVID­19 worsens drug­responsive motor symptoms in Parkinson's disease (PD) and other symptoms like fatigue and urinary complaints. Vitamin D is essential in decreasing pro­inflammatory and increasing anti­inflammatory cytokines in ongoing COVID­19 infections and reducing angiotensin receptors and, hence, decreasing COVID­19 infection severity. Telemedicine shows promise for patients with NDD but is yet to overcome legal issues and personal barriers. COVID­19 has a significant effect on neurodegenerative conditions, which appears partly to the nature of the NDD and the neuro­invasive capabilities of the SARS­CoV­2. The protective role of vitamin D in patients with NDD further supports this hypothesis. Modifications in current health care, like the telemedicine platform, are required to address the increased risk of serious infection in this population. Further studies will be required to clarify conflicting reports in many fields.

Knowledge, attitude and reported practice regarding donning and doffing of personal protective equipment among frontline healthcare workers against COVID-19 in Nepal: A cross-sectional study.

BACKGROUND: Coronavirus Disease 2019 (COVID-19) is a respiratory infection with a high rate of transmission primarily via airborne route and direct contact. Proper use of personal protective equipment (PPE) is a proven and effective way to prevent COVID-19 spread in healthcare settings. This study was done aiming to assess the knowledge, attitude, and reported practice, and identify the associated factors regarding donning and doffing of PPE among frontline healthcare workers in Nepal. METHODS: A cross-sectional study was conducted from 25th April to 30th July 2021 among 205 frontline healthcare workers of Nepal selected randomly from among the contacts of the investigators. A structured self-administered questionnaire prepared in google form was used as a study tool and shared via social media to the participants to obtain information on socio-demographic and workplace characteristics along with their knowledge, attitude, and reported practice regarding donning and doffing of PPE. RESULT: A total of 79.5% of participants had satisfactory knowledge while 75.6% had satisfactory practice scores regarding donning and doffing of PPE. Factors such as the profession of the participants (p-value = 0.048), their workplace (p-value = 0.005), provision of PPE at workplace (p-value = 0 .009), and availability of designated space at workplace for methodical donning and doffing of PPE (p-value = 0.010) were significantly associated with satisfactory knowledge score whereas availability of designated space at workplace for donning and doffing of PPE was significantly associated with good practice score (p-value = 0.009). CONCLUSION: This study demonstrated an overall good knowledge, attitude, and reported practice regarding donning and doffing of PPE among frontline healthcare workers in Nepal. However, the reported shortcomings like poor knowledge regarding the sequence of donning and doffing and corresponding flawed practice behaviors need to be addressed.

Post-COVID syndrome: A prospective study in a tertiary hospital of Nepal.

INTRODUCTION: The post-coronavirus disease 2019 (COVID-19) syndrome is defined as the persistence of symptoms after viral clearance and the emergence of new symptoms after a few months following recovery from COVID-19. This study aimed to assess the prevalence of post-COVID-19 syndrome and the risk factors that contribute to its development. METHODS: This study was conducted prospectively in Tribhuvan University Teaching Hospital (TUTH), located in Maharajgunj, Kathmandu. The patients were followed up for three months. RESULTS: The post-COVID status of 300 patients admitted to the COVID emergency of TUTH was studied. The mean age of the patients was 46.6±15.7 years, and the proportion of male (56%) was slightly higher than female (44%). Most of the patients (81.7%) had fever on their presentation to the emergency which was followed by fatigue (81.3%) and cough (78.3%). During the post-COVID phase, fatigue was the most common persistent symptom, with 34% experiencing fatigue after 60 days and 28.3% even after 90 days from the onset of symptoms. Univariate logistic regression showed sore throat (OR 4.6; 95% CI (2.8-7.6)), rhinitis (OR 3.6; 95% CI (2.1-5.9)), fatigue (OR 3.7; 95% CI (1.8-7.6)), diarrhea (OR 4.1; 95% CI (2.4-6.9)), anosmia (OR 6.7; 95% CI (3.9-11.3)), ageusia (OR 7.8; 95% CI (4.5-13.4)) and shortness of breath (OR 14.9; 95% CI (1.8-119.6)) at admission were all predictors of post-COVID syndrome after three months. CONCLUSION: Even after recovering from COVID-19, people with COVID-19 may develop symptoms. As a result, COVID-19's long-term consequences should not be neglected, as they may lead to increased morbidity among patients, consumption of financial resources, and added burden on the health system.

Characteristics of COVID-19 Breakthrough Infections among Vaccinated Individuals and Associated Risk Factors: A Systematic Review.

We sought to assess breakthrough SARS-CoV-2 infections in vaccinated individuals by variant distribution and to identify the common risk associations. The PubMed, Web of Science, ProQuest, and Embase databases were searched from 2019 to 30 January 2022. The outcome of interest was breakthrough infections (BTIs) in individuals who had completed a primary COVID-19 vaccination series. Thirty-three papers were included in the review. BTIs were more common among variants of concern (VOC) of which Delta accounted for the largest number of BTIs (96%), followed by Alpha (0.94%). In addition, 90% of patients with BTIs recovered, 11.6% were hospitalized with mechanical ventilation, and 0.6% resulted in mortality. BTIs were more common in healthcare workers (HCWs) and immunodeficient individuals with a small percentage found in fully vaccinated healthy individuals. VOC mutations were the primary cause of BTIs. Continued mitigation approaches (e.g., wearing masks and social distancing) are warranted even in fully vaccinated individuals to prevent transmission. Further studies utilizing genomic surveillance and heterologous vaccine regimens to boost the immune response are needed to better understand and control BTIs.

Usefulness of Electoral Models for COVID-19 Vaccine Distribution.

Purpose of Review: In response to the COVID-19 pandemic, there has been a remarkably accelerated development of vaccines worldwide. However, an effective distribution system is crucial for vaccination at a national level. Ecuador was one of the first Latin American countries to be most severely affected by the pandemic. It has been struggling to expand its vaccination drive and requires a strategy that provides an achievable vaccination rate and maintains its primary care services. This study aims to provide an efficient vaccination model to achieve herd immunity by utilizing the country's existing infrastructure (the centralized electoral system) for mass vaccination. Recent Findings: The national electoral data from 2017 and 2021 were used to create estimates for the proposed vaccination model. Two model variations, total personnel, needed, and the number of days needed to vaccinate 50%, 75%, and 100% of the population were considered. The numbers of vaccines needed, and vaccination sites were estimated based on the current number of registered voters and polling stations. The results from the proposed model show that 17,892,353 people can be vaccinated, at 40,093 polling stations, by 90,209 personnel if one vaccinator was available per polling station. Summary: Based on this model, even a conservative estimate shows that 12.56 days are needed to achieve herd immunity, and 16.74 days are needed to vaccinate the entire population of Ecuador. Additionally, we propose that this vaccination model can be used as a blueprint for any country to address similar catastrophes in the future. Supplementary Information: The online version contains supplementary material available at 10.1007/s40475-022-00251-y.

Bell's palsy as a possible complication of mRNA-1273 (Moderna) vaccine against COVID-19.

Introduction: Vero Cell, AstraZeneca, Janssen, mRNA-1273 (Moderna), and Pfizer COVID-19 vaccines have been authorized for emergency use in Nepal. These vacines have been linked to some adverse effects, including fever, myalgia, and headache. Furthermore Bell's Palsy a rare adverse effect was also reported to be associated with the use of mRNA-1273 (Moderna) vaccine in some patients. Case presentation: In this case report we present a 17-year-old female who acquired Bell's Palsy following the administration of mRNA-1273 (Moderna) COVID-19 vaccination. Discussion: The possible etiology of BP that has been suggested is infection by reactivated viruses, such as the varicella-zoster virus (VZV), herpes simplex virus type 1 (HSV-1), human herpesvirus 6, and the Usutu virus, [1] the most accepted hypothesis is the one with reactivation of latent Herpes Simplex Virus type 1 in the geniculate ganglia of the facial nerves, an autoimmune mechanism through the mimicry of host molecules by the antigens of the vaccines. Conclusion: Though the extent of association between the mRNA vaccination and the development of Bell's Palsy has yet to be confirmed, this example highlights the need to closely monitor side effects and repercussions after receiving a new vaccine.

Characteristics of COVID-19 Breakthrough Infections among Vaccinated Individuals and Associated Risk Factors: A Systematic Review

We sought to assess breakthrough SARS-CoV-2 infections in vaccinated individuals by variant distribution and to identify the common risk associations. The PubMed, Web of Science, ProQuest, and Embase databases were searched from 2019 to 30 January 2022. The outcome of interest was breakthrough infections (BTIs) in individuals who had completed a primary COVID-19 vaccination series. Thirty-three papers were included in the review. BTIs were more common among variants of concern (VOC) of which Delta accounted for the largest number of BTIs (96%), followed by Alpha (0.94%). In addition, 90% of patients with BTIs recovered, 11.6% were hospitalized with mechanical ventilation, and 0.6% resulted in mortality. BTIs were more common in healthcare workers (HCWs) and immunodeficient individuals with a small percentage found in fully vaccinated healthy individuals. VOC mutations were the primary cause of BTIs. Continued mitigation approaches (e.g., wearing masks and social distancing) are warranted even in fully vaccinated individuals to prevent transmission. Further studies utilizing genomic surveillance and heterologous vaccine regimens to boost the immune response are needed to better understand and control BTIs.

The Past, Present and Future of COVID-19 Associated Mucormycosis: A Rapid Review.

Coronavirus disease 2019 (COVID-19) is caused by SARS-CoV-2, which is known for the multiple mutations and forms that have rapidly spread across the world. With the imminent challenges faced by low- and middle-income countries in curbing the public health fallbacks due to limited resources, mucormycosis emerged as a fungal infection associated with high mortality. In this rapid review, we explored MEDLINE, Cochrane, Web of Science, WHO Global Database, and the search engine-Google Scholar for articles listed until July 2021 and presented a narrative synthesis of findings from 39 articles. The epidemiology, causative factors, incidence parameters, pharmacological treatment, and recommendations for low- and middle-income countries are enlisted. This study concludes that a majority of the globally reported COVID-19 associated mucormycosis cases stemmed from India. Individuals receiving systemic corticosteroids or who have a history of diabetes mellitus are more prone to contracting the disease. Public health authorities in LMIC are recommended to strengthen antifungal therapies for COVID-19 associated mucormycosis and to strategize reduction in diabetes mellitus prevalence.