Assessment of positive airway pressure treatment adherence and sleep quality in sleep apnea patients during COVID-19 pandemic: multi-center cross-sectional study results

Background: Patients with obstructive sleep apnea (OSA), related to their disease consequences and treatment modalities, are physically and mentally vulnerable during the outbreak. Objectives: To investigate the association between pandemic-related changes and positive airway pressure (PAP) adherence and sleep quality in OSA patients. Methods: This was a multi-center cross-sectional study, and the necessary data were collected prospectively. A total of 221 patients were included in the study, who were invited from four different centers from June 1 - December 1, 2020. Pittsburgh Sleep Quality Index (PSQI) was administered to evaluate sleep quality. Information on demographics positive airway pressure (PAP) device use, Coronavirus disease (COVID-19) a questionnaire collected related changes. Patients >18 years with a diagnosis of OSA and prescribed PAP treatment before the pandemic period were included in the study. Lack of cooperation with the questionnaires and incompliant with PAP treatment for longer than one year were the exclusion criteria. Results: Of the 221 participants, 79.2% were men. The mean apnea-hypopnea index was obtained at 40.8+or-24.3. A positive COVID-19 test was reported in nine cases, and three patients had hospitalization. During the pandemic, 102 (46.2%) subjects were retired, 26 (11.8%) lost their jobs, and 34 (15.3%) reported home office work or on-call or on leave. Poor sleep quality was found in 54 (24.4%) individuals. It was also reported that poor sleep quality was more common in those who reported mask use difficulty (38.7% vs. 18.9%;P=0.004) and increased or decreased PAP use (increased, decreased, no change in PAP use: 45.5%, 36.0%, 19.4%, respectively;P=0.01). The good sleep quality group had higher PAP use than the poor sleep quality group (6.2+or-1.5 vs. 5.3+or-2.4 night/week;P=0.002;6.2+or-1.5 vs. 5.5+or-2.2 hour/night;P=0.01). Conclusions: Pandemic period had several negative effects on sleep apnea patients regarding sleep quality and social lives which also influenced PAP adherence in OSA patients. Most patients did not change their regular PAP use attitudes during this period. Similar to the pre-COVID-19 disease period, PAP adherence and compliance positively influenced sleep quality;people who were "good sleepers" were the ones who were the "good PAP device users".

The influence of post-COVID syndrome on cognitive functions of students

A survey of senior students of the Faculty of General Medicine of the NAO MUK who had recovered from Covid-19 was conducted. The disease in all respondents proceeded in a mild form or moderate severity. Post-covid syndrome developed in students who had a coronavirus infection in the form of moderate severity. The most frequent complications were loss of smell and taste, cough and shortness of breath, as well as cognitive dysfunction in the form of impaired attention, memory and thinking. The decline in performance is associated with the above violations of the central nervous system.

Effectiveness of exercise training on the dyspnoea of individuals with long COVID: A randomised controlled multicentre trial.

BACKGROUND: COVID-19-related acute respiratory distress syndrome (CARDS) is a severe evolution of the Sars-Cov-2 infection and necessitates intensive care. COVID-19 may subsequently be associated with long COVID, whose symptoms can include persistent respiratory symptoms up to 1 year later. Rehabilitation is currently recommended by most guidelines for people with this condition. OBJECTIVES: To evaluate the effects of exercise training rehabilitation (ETR) on dyspnoea and health-related quality of life measures in people with continuing respiratory discomfort following CARDS. METHODS: In this multicentre, two-arm, parallel, open, assessor-blinded, randomised controlled trial, we enroled adults previously admitted with CARDS to 3 French intensive care units who had been discharged at least 3 months earlier and who presented with an mMRC dyspnoea scale score > 1. Participants received either ETR or standard physiotherapy (SP) for 90 days. The primary outcome was dyspnoea, as measured by the Multidimensional Dyspnoea Profile (MDP), at day 0 (inclusion) and after 90 days of physiotherapy. Secondary outcomes were the mMRC and 12-item Short-Form Survey scores. RESULTS: Between August 7, 2020, and January 26, 2022, 487 participants with CARDS were screened for inclusion, of whom 60 were randomly assigned to receive either ETR (n = 27) or SP (n = 33). Mean MDP following ETR was 42% lower than after SP (26.15 vs. 44.76); a difference of -18.61 (95% CI -27.78 to -9.44; p<10-4). CONCLUSION: People who were still suffering from breathlessness three months after being discharged from hospital with CARDS had significantly improved dyspnoea scores when treated with ETR therapy for 90 days unlike those who only received SP. Study registered 29/09/2020 on Clinicaltrials.gov (NCT04569266).

Spontaneous pneumomediastinum secondary to COVID-19 in Iran: a case series study: SPM secondary to COVID-19

BACKGROUND: Pneumomediastinum is defined as open-air in the mediastinum. Spontaneous pneumomediastinum (SPM) occurs when air leaks into the surrounding vascular sheath through small alveolar ruptures. CASE REPORT: We want to introduce 4 different cases with different outcomes. The first case was a 60-year-old man with a history of psychological disorders, the second case was a 41-year-old man with a history of hypertension (HTN) and asthma, the third case was a 50-year-old heavy smoker with no history of an underlying disease, and the fourth case was a 60-year-old man with a history of schizophrenia. They suddenly developed an exacerbation of cough, dyspnea, chest pain, and a severe decrease in oxygen saturation during hospitalization. Antibiotic therapy, corticosteroids, and high-dose oxygen therapy were administered to the patients. One of these patients died. CONCLUSION: All patients can potentially be at risk for this complication and have a good prognosis if diagnosed early and treated properly overall.

Surveillance of SARS CoV-2 and other respiratory viruses in 2020-2021 winter season

Aim: The global COVID-19 pandemic and new variants continue to seriously threaten society. In this study;It was aimed to investigate surveillance of SARS CoV-2 and other respiratory viruses in respiratory tract samples in the winter season of 2020-2021 in Sakarya province. Material and Method: The study was carried out at Sakarya Training and Research Hospital between 2020-2021. e study was carried out with respiratory tract samples (Nasopharyngeal swab) stored in the laboratory. Clinical samples included in study were stored in a Bio-SpeedyRvNATRtransfer tube (Bioeksen,Turkey) and no extraction was performed in accordance with manufacturer's instructions. All analyzes were recorded on BIO-RAD CFX-96C1000 Touch Real-time system device using Diagnovital influenza A/B, SARS CoV-2, RSV multiplex Real Time PCR amplification kit. Results: Of the 200 patients diagnosed with URTI/LRTI, 54.5% were male and 45.5% female. e most common clinical symptoms;sore throat 74%, cough 73.5%, fatigue 71%, fever 57%, runny nose 56%, headache 48.5%, sneezing 41.5%, loss of smell / taste 39.5%, diarrhea 36%, dyspnea was 31.5% and myalgia was 23.5%. PCR positivity rates of samples were analyzed as 28.5% for SARS COV-2 and 1.5% for RSV, respectively. PCR positivity for influenza A/B was not defined in the study. Considering the statistical significance between PCR results and COVID-19 symptoms in patients;symptoms of dyspnea (n=63), fever(n= 62) and sneezing(n=56), respectively, were statistically significant(p<0.05). Conclusion: Due to the circumstances, only three main viral agents could be investigated in the study. RSV was frequently identified as an important factor in pediatric patients, whereas influenza-which may be related to social and individual measures (mask,distance,hygiene)- was not detected in any sample. More comprehensive scientific studies are needed to support the data.

Determinants of recovery from post-COVID-19 dyspnoea: analysis of UK prospective cohorts of hospitalised COVID-19 patients and community-based controls.

Background: The risk factors for recovery from COVID-19 dyspnoea are poorly understood. We investigated determinants of recovery from dyspnoea in adults with COVID-19 and compared these to determinants of recovery from non-COVID-19 dyspnoea. Methods: We used data from two prospective cohort studies: PHOSP-COVID (patients hospitalised between March 2020 and April 2021 with COVID-19) and COVIDENCE UK (community cohort studied over the same time period). PHOSP-COVID data were collected during hospitalisation and at 5-month and 1-year follow-up visits. COVIDENCE UK data were obtained through baseline and monthly online questionnaires. Dyspnoea was measured in both cohorts with the Medical Research Council Dyspnoea Scale. We used multivariable logistic regression to identify determinants associated with a reduction in dyspnoea between 5-month and 1-year follow-up. Findings: We included 990 PHOSP-COVID and 3309 COVIDENCE UK participants. We observed higher odds of improvement between 5-month and 1-year follow-up among PHOSP-COVID participants who were younger (odds ratio 1.02 per year, 95% CI 1.01-1.03), male (1.54, 1.16-2.04), neither obese nor severely obese (1.82, 1.06-3.13 and 4.19, 2.14-8.19, respectively), had no pre-existing anxiety or depression (1.56, 1.09-2.22) or cardiovascular disease (1.33, 1.00-1.79), and shorter hospital admission (1.01 per day, 1.00-1.02). Similar associations were found in those recovering from non-COVID-19 dyspnoea, excluding age (and length of hospital admission). Interpretation: Factors associated with dyspnoea recovery at 1-year post-discharge among patients hospitalised with COVID-19 were similar to those among community controls without COVID-19. Funding: PHOSP-COVID is supported by a grant from the MRC-UK Research and Innovation and the Department of Health and Social Care through the National Institute for Health Research (NIHR) rapid response panel to tackle COVID-19. The views expressed in the publication are those of the author(s) and not necessarily those of the National Health Service (NHS), the NIHR or the Department of Health and Social Care.COVIDENCE UK is supported by the UK Research and Innovation, the National Institute for Health Research, and Barts Charity. The views expressed are those of the authors and not necessarily those of the funders.

Silent Hypoxemia in COVID-19 Pneumonia.

In patients suffering from Coronavirus Disease 2019 (COVID-19), dyspnoea is less likely to occur despite hypoxemia. Even if the patient develops severe hypoxemia, it cannot be detected from subjective symptoms. In other words, it becomes more serious without the person or the surroundings noticing it. Initially less talked about, hypoxemia without dyspnoea (silent hypoxemia or happy hypoxia: hypoxemia that does not coincide with dyspnoea) is now experienced in many institutions. Dyspnoea is defined as "the unpleasant sensation that accompanies breathing." Dyspnoea occurs when afferent information is transmitted to the sensory area. Receptors involved in the development of dyspnoea include central and peripheral chemoreceptors, chest wall receptors, lung receptors, upper respiratory tract receptors and corollary discharge receptors. In the present study, we considered mechanisms mediating the silent hypoxemia through three cases experienced at our hospital as a dedicated coronavirus treatment hospital. We have treated about 600 people infected with COVID-19, of which about 10% were severe cases. In the present study, the patients' condition was retrospectively extracted and analysed. We investigated three typical cases of COVID-19 pneumonia admitted to our hospital (men and women between the ages of 58 and 86 with hypoxemia and tachypnoea). Silent hypoxemia is not entirely without dyspnoea, but hypoxemia does not cause dyspnoea commensurate with its severity. The virus may have specific effects on the respiratory control system. In our cases, respiratory rate significantly increased with hypoxemia, and hyperventilation occurred. Therefore, information about hypoxemia is transmitted from the carotid body. Since hyperventilation occurs, it is suggested that information is transmitted to effectors such as respiratory muscles. The fact that these patients did not feel the unpleasant sensation indicates that information is not accurately transmitted to the sensory area of the cerebral cortex. These cases suggest that there may be a problem somewhere in the path from the respiratory centre to the sensory area.

Clinical-epidemiological behavior of post-COVID-19 syndrome in patients at Andres Ortiz Polyclinic, 2021

Introduction: post-COVID-19 syndrome is the set of signs and symptoms that develop during or after an infection compatible with COVID-19, that persist for more than 12 weeks and are not explained by an alternative diagnosis. Background: to characterize the clinical-epidemiological behavior of the post-COVID-19 syndrome in patients at the Andres Ortiz Polyclinic. Method: a descriptive and cross-sectional observational study was carried out from October to December 2021, in a population of 51 subjects that was studied in its entirety. The analysis was descriptive. Results: patients with 50-59 years (n = 20;39.2%), female (n = 32;62.7%) predominated. The most frequently affected organ system was the respiratory (n = 19;37.2%), while the symptoms were: chronic fatigue (n = 15;29.4%), shortness of breath (n = 11;21.5%) and cough (n = 8, 15.6%). Among the patients with respiratory (n = 30), cardiovascular (n = 24) and neurological (n = 10) diseases, the most frequent were, respectively: pulmonary fibrosis (n = 17;56.7%), cardiac arrhythmias (n = 11;45.8%) and peripheral neuropathies (n = 5;50%). Conclusions: post-COVID-19 syndrome occurred mainly between the ages of 50 and 59, in female patients, with symptoms of chronic fatigue, shortness of breath and cough, as well as pulmonary fibrosis, cardiac arrhythmias and peripheral neuropathies as main comorbidities.

A Bilateral Diaphragmatic Paralysis Post-COVID-19 Infection: A Case Report and a Review of the Literature.

The diaphragm is the essential respiratory muscle, and damage can significantly impede a human's capacity for blood oxygenation. During inspiration, the diaphragm domes permit the pleural cavity to expand. Whenever this process is disrupted, it results in decreased thoracic expansion and, as a result, hypoventilation. The phrenic nerve innervates the diaphragmatic muscle via the cervical nerve roots C3, C4, and C5. Diaphragmatic paralysis is a multifactorial consequence caused by trauma, neurogenic diseases, infections, inflammatory responses, and chest operative surgery, with the last being the most prevalent causative factor. Here, we are describing the case of a 52-year-old male patient who has had ongoing dyspnea for months after contracting COVID-19 in December 2021, despite the remission of his previous COVID-19 pneumonia in 2020. An X-ray of the chest revealed no diaphragm elevation, whereas electromyography verified diaphragm impairment. On the conservative treatment plan, he reported persistent dyspnea following a period of pulmonary rehabilitation. To a lesser extent, it is advised to wait at least one year to see if there is any reinnervation, which could benefit his lung capacity. COVID-19 has been linked to many systematic diseases. As a result, COVID-19 will not be restricted to its inflammatory effect on the lungs. In other words, it is a multi-organ systematic syndrome. One of these effects is diaphragm paralysis, which should be considered a post-COVID-19 disease. However, there is a need for more literature to support physicians as guidelines for neurological conditions related to COVID-19 infection.

Successful intrapericardial fibrinolysis on acute recurrent purulent pericarditis with impending cardiac tamponade during pandemic situation: a rare case report

Introduction: Acute recurrent purulent pericarditis is an uncommon pericardium infection that can be life-threatening due to pus production, leading to cardiac tamponade. Case presentation: We report a 36-year-old man referring to our hospital with impending cardiac tamponade who needed urgent pericardiocentesis. The patient's complaints were worsening dyspnea and palpitations in the last two days. The patient had been hospitalized for the same complaint and had pericardiocentesis due to cardiac tamponade approximately three weeks earlier. Physical exam, ECG, and CXR suggest impending cardiac tamponade. Echocardiography indicated massive right and left pericardial effusion and right atrial collapse. The Covid-19 screening test was positive;however, RT-PCR revealed a negative result. The patient was diagnosed with recurrent acute purulent pericarditis with impending cardiac tamponade requiring urgent pericardiocentesis. After the procedure, 1.5 million units of intrapericardial fibrinolytic were administered to patients. His improved hemodynamic and clinical symptoms indicate a successful procedure. Conclusion: This case highlights the challenges of managing an acute recurrent purulent pericarditis patient due to Staphylococcus A. infection in the current pandemic era, including distinguishing it from other contagious diseases due to nonspecific dyspnea, limited therapeutic options, and the effectiveness of intrapericardial fibrinolytic in improving the overall patient conditions, and reducing the mortality rate.

Anti-fibrotic agents could be the game-changer for post-COVID-19 pulmonary fibrosis treatment

More than 220 countries and territories are globally affected by the recent pandemic COVID-19 which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). There is possibility of third wave of this pandemic as per epidemiological and public health experts. Besides that post-COVID-19 complications are alarming matter to look upon. Post-COVID-19 complications include several symptoms like as persistent fever;cough;fatigue;headache;attention disorder;dyspnea;anosmia;ageusia;chest pain discomfort;various respiratory illness;acute respiratory distress syndrome (ARDS) etc., and here the things to worry about is the development of pulmonary fibrosis after COVID-19. In some COVID-19 patients, hyper-inflammation in the form of 'cytokine storm' along with dysregulated immune response, alveolar epithelial tissue injury and wound repair collectively cause this secondary pulmonary fibrosis. Therefore, using anti-fibrotic agents e.g. pirfenidone, nintedanib and other natural compounds could be meaningful in these circumstances although their efficacy in treating COVID-19 is subject to more detailed laboratory research works. In this review article, we have discussed the progression of pulmonary fibrosis development which is triggered by COVID-19;probable solutions with anti-fibrotic agents including anti-fibrotic drugs, some well-known natural compounds, combined anti-fibrotic therapies;and the current challenges of this field.

Clinical presentation of Iranian patients affected with COVID-19: a thousand faces disease

The coronavirus disease 2019 (COVID-19) pandemic in Iran is part of the worldwide pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The present study aimed to demonstrate the clinical characteristics of patients affected by COVID-19, in our tertiary teaching hospital. Medical records and compiled data of 668 patients with suspected COVID-19 were obtained retrospectively between January to April 2020. The present study outcomes included demographic features of infected patients, underlying diseases and conditions, the relationship between the results of reverse transcription-polymerase chain reaction (RT-PCR) or CT-scan with the manifestations of the disease, mortality rate, and age distribution of fatalities among men and women. The median age of hospitalized patients was 63 years old (from 18 to 94). The patients' chief complaints in the admission time were cough, dyspnea, fever, and gastrointestinal problems, respectively. Hospitalized patients' common comorbidities were hypertension (HTN), and cardiovascular disease (CVD) (24%), diabetes mellitus (DM) (21.5%), asthma, or chronic obstructive pulmonary disease (COPD) (6%), or other underlying diseases (15.5%). One-third of patients had no comorbidity according to the data of medical records. In hospitalized patients, 169 (84.5%) had positive RT-PCR, and 156 (78%) had positive chest CT findings. The mortality rate of males was higher than females (66.3% vs. 33.3%) and in patients with positive RT-PCR compared to patients with positive chest CT-scan findings. The majority of deaths had a history of DM or HTN/CVD in their medical records. The chief complaint of patients was cough. DM and HTN or CVD were the common underlying disease related to death in hospitalized cases. Besides, the hospitalization and mortality rate in males was higher than in females. About 87% of dead hospitalized cases had positive RT-PCR results, and this rate was 82% for chest CT results.

Clinical and epidemiological profile of SARS-CoV-2 in patients with severe acute respiratory illness (SARI) at a tertiary care hospital of north India

Background: Severe acute respiratory illness due to SARS-CoV-2 represents great global public health concern. The spectrum of disease ranges from mild to life-threatening. Surveillance of hospitalized patients with severe acute respiratory infections (SARI) is an important public health tool used to identify etiologies to understand the disease, track changes in circulating viruses and as an alert mechanism for potential pandemic viruses. We aim to find out the rate of SARS-CoV-2 positivity in SARI cases and further study the epidemiological and clinical characteristics of patients. Material & Methods: A Prospective study was conducted on 200 Severe Acute Respiratory Illness patients admitted at tertiary care hospital. The clinical, demographic, epidemiological, risk factors / co-morbidities of all the patients were recorded. Oropharyngeal and nasopharyngeal samples were collected and tested for SARS-CoV-2 by real time reverse transcriptase (RT-PCR) test. Results: Out of 200 SARI patients, 51 (25.5%) were tested positive for SARS-CoV-2. Maximum cases (54.90%) were in the age group of 41-60 years;males were infected predominantly (52.94%). The most common symptoms of presentation were fever (100%), cough (86.27%), dyspnoea (82.35%) and sore throat (56.86%). Comorbidities associated with COVID-19 were Hypertension (56.86%), Diabetes Mellitus (33.33%), Chronic Obstructive Pulmonary Disease (13.72%) and Coronary Artery disease (9.8%). More than 30% of the patients were admitted in ICU and 9.80% received mechanical ventilation. Conclusions: Evaluation of clinical and epidemiological profiles of SARI patients can help in understanding and managing the outbreak more efficiently. Close monitoring and quarantine will be required to prevent extensive transmission within the community.

Clinical, laboratory and radiological parameters of COVID 19 pneumonia: a single-centered retrospective observational study in Pune, India

Background: The severe acute respiratory syndrome coronavirus called the novel coronavirus caused the pandemic coronavirus disease 19 (COVID-19). All over the world, SARS-CoV-2 pneumonia is causing significant short-term morbidity and mortality, but the medium-term impact on lung function and quality of life of affected patients is still unknown. Aims: To assess clinical, laboratory, and radiological parameters of COVID-19 Patients and to correlate radiological findings and disease severity among patients. Methodology: In this retrospective observational study a total of 630 patients with radiologically confirmed pneumonia and COVID-19 RT PCR positive were included from a tertiary care centre in Pune, Maharashtra, following their voluntary informed consent. Patients underwent clinical, laboratory, and radiological investigations. Results: It was observed that the majority 174 (27.6%) were in the age group of 31 to 40 years and male predominance was observed compared to female. The majority of the patients 314 (49.8%) had mild, 232 (36.8%) were moderate and 84 (13.3%) had severe illness as per CT scores (HRCT Chest score). Mean BSL levels were 181 +or- 81.44, mean pulse rate was 94.03 +or- 14.93 bpm, mean respiratory rate was 22.84 +or- 3.71cpm, systolic blood pressure was 129.09 +or- 13.18 mmHg, diastolic blood pressure was 82.80 +or- 9.67 mmHg and mean temperature was 98.56 +or- 1.67 degrees F. The mean ferritin levels were 181 +or- 81.44, the mean LDH level was 94.03 +or- 14.93, mean HbA1C was 7.45 +or- 1.68. The mean NLR was 5.51 +or- 2.41, the mean WBC count was 7238.38 +or- 4942.23 and the mean hematocrit was 39.69 +or- 4.80. The mean D dimer level was 402.29 +or- 424.70, median levels were 260 (170-450). 503 (79.8%) had CRP levels more than 5 and 127 (20.2%) had levels less than 5. The mean duration of hospital stay was 9.18 days +or- 4.34 days. Majority 570 (90.5%) had fever, 493 (78.3%) had cough, 286 (45.4%) had breathlessness, 66 (10.5%) had sore throat. Other symptoms include vomiting, and loose motion in 17 (2.7%). Among 630 subjects included in the present study, the majority 584 (92.7%) have recovered/were discharged from the hospital and 46 (7.3%) succumbed to the illness. The mean SGOT and SGPT levels were 44.86+or- 31.29 and 43.60 +or- 31.25 respectively. Mean serum creatinine and BUN levels were 0.87+or- 0.80 and 13.96 +or- 9.46 respectively. The mean values of pulse rate, systolic blood pressure, diastolic blood pressure, respiratory rate and temperature showed an increasing trend across the grades of severity. Conclusion: We concluded that age, gender, blood sugar level, blood pressure, clinical symptoms, comorbidities, inflammatory biomarkers and CT severity score were independently associated with the severity and mortality based on our findings.

Laboratory and clinical findings in hospitalized pregnant women with COVID-19 based on disease outcome during the outbreak of Delta variant in Ardabil (summer and autumn 2021)

Introduction: Due to the high risk of Covid-19 disease, especially delta variant in pregnant women, as well as the novelty of this epidemic in the world and the lack of similar studies in Iran and the region, it seems necessary to perform a study on mortality rate and laboratory and clinical findings of the disease in pregnant women. Therefore, this study was performed aimed to determine the laboratory and clinical findings in hospitalized pregnant women with Covid -19 based on disease outcome during the outbreak of Delta variant (summer and autumn 2021) in Ardabil province. Methods: In this cross-sectional and descriptive study, all pregnant women with Covid-19 admitted to the hospitals of Ardabil province in summer and autumn 2021 at the time of delta outbreak were included. Finally, 187 infected pregnant mothers were studied. Demographic information, clinical signs and laboratory findings were studied in all mothers. Data were analyzed by SPSS (version 24) and Fisher Exact test and Pearson Correlation. P<0.05 was considered statistically significant. Results: Of the 187 infected pregnant women, 8 mothers died. Comorbidity was observed in 41 pregnant women. The most common clinical finding was shortness of breath (Dyspnea) and cough, and the most common laboratory finding was lymphopenia. Comparing the cured and dead mothers according to laboratory findings using Fisher's exact test showed that the difference between ALT (p <0.05), lactate dehydrogenase (p <0.001), AST (p <0.001), BS (P <0.05), creatinine (p <0.05) and total bilirubin (p <0.05) were statistically significant between the two groups. Conclusion: Infection to delta variant of Covid-19 disease resulted in 187 hospitalizations and 8 deaths of pregnant mothers in Ardabil province. Shortness of breath (Dyspnea) and cough were the most common clinical findings and lymphopenia was the most common laboratory finding.

C-reactive protein (CRP) medium and severe symptoms levels of COVID-19

Coronavirus Disease 2019 (COVID-19) is a disease caused by SARS-CoV-2 and has caused a global pandemic. Patients with COVID-19 can experience symptoms such as fever, dry cough, headache, and shortness of breath which can lead to pneumonia. Excessive inflammation is considered a leading cause of critical illness and death in COVID-19 patients. C-Reactive Protein is a sensitive indicator as an early marker of infection and inflammation. This study presents an overview of the difference in the average CRP levels between patients with moderate and severe confirmed COVID-19 symptoms at UKI Hospital for June-September 2021. The study design was cross-sectional with descriptive and analytical data presentation obtained from medical record documents at UKI Hospital. The average CRP level of COVID-19 patients with moderate symptoms is 63,705 mg/L, totaling 139 patients. The average CRP level of COVID-19 patients with severe symptoms is 132,050 mg/L, totaling 57 patients. The results obtained from the Mann-Whitney test between groups of patients with moderate and severe COVID-19 showed a significant difference between CRP levels with moderate and severe symptoms with p <0.05.

Fenofibrate and statins in patients with COVID-19

Statins, which are widely used to treat hypercholesterolemia, have anti-inflammatory and antioxidant effects, upregulate angiotensin-converting enzyme 2 (ACE2) receptors, which happen to be SARS-CoV-2's gateway into cells. This study aims to analyse the effects of Fenofibrate in comparison to Statins and a control group in patients with COVID-19. This is a retrospective open blind observational study of cohort of 300 patients experienced COVID-19 (symptoms' severity varied between patients). The participants were divided into three cohorts;a control group received standard COVID-19 treatment (n=100);a second group (n=100) of patients who were on Statins, in addition they received the standard treatment;and a third cohort for patients who were already taking Fenofibrate (TRICORR) as a medication to treat hyperlipidemia (n=100). Most symptoms (including cough, exertional dyspnoea, SOB, sore throat, sneezing, headache, tiredness, agitation, diarrhoea, joint pain, insomnia, myalgia, and fatigue) were less prevalent for patients who administered antihyperlipidemic drugs compared to the control group. Patients who were already taking Cholesterol-lowering medication presented with symptoms varied between mild to severe. Patients on Statins or Fenofibrate also showed less tachycardia and tachypnoea compared to those who were not on antihyperlipidemic drugs, and also the need for oxygen and ICU admission were less frequent. The length of stay in hospital was shorter in patients who were already on Statins or Fenofibrate. Both Statins and Fenofibrate have improved the outcome and the severity of symptoms for patients with Covid 19 infection.

Post-COVID symptoms and health-related quality of life in extended postpartum period

Background: COVID-19 pandemic has remarkable effect not just on physical health, but also on psychological state and overall quality of life (QoL). It affected all the section of community including vulnerable section of pregnant females and children. Aims and Objective: The aim of the study was to assess health-related QoL in recovered COVID-19 positive pregnant females in their extended postpartum period along with insight into prevailing post-COVID symptoms in this population. This was a cross-sectional and questionnaire-based study conducted in Kota, Rajasthan, India. Materials and Methods: This study was conducted on 173 admitted females between March 1, 2021 and June 30, 2021 who were pregnant and contacted COVID-19 infection at any point of their antenatal/intrapartum period. The questionnaire included details related to demographics, symptomatology, hospitalization, oxygen requirement, and ventilator use during the acute disease as well as any symptoms after recovery from acute COVID-19 disease. Patients were contacted during their extended postpartum period and systematically asked about a list of post-COVID-19 symptoms (dyspnea, myalgia, fatigue, anosmia, ageusia, chest pain, cough, mood disturbances, etc.), but they were also free to report any other symptoms that they considered relevant. The health-related QoL was evaluated using the EuroQoL five-dimension five-level questionnaire telephone interview version. In-person interview and telephonic interview methods were arranged for collection of data. Descriptive statistical analysis was done. Results: Among the 173 consented participants, the mean age was 26.3 (..6.6) years, most of them were primiparous (45.66%), admitted with gestational age between 37 and 40 weeks (68.21%), asymptomatic (85.54%) or mildly symptomatic. For symptomatic cases, the most common clinical presentations included fever, cough, and dyspnea. Only 1.16% of symptomatic subjects required ventilator support. For 58.96% patients, hospital stay was less than a week. Mean duration of stay was 5.86 days. However, 87.28% patients required antiviral medications. About 23.70% have various comorbidities among which anemia 7.51% and preeclampsia 6.35% predominated. About 85.55% did not experienced any persistent symptoms after discharge but some of the subjects shown persistent symptoms such as cough, fever, and breathlessness among which persistent cough predominates (7.51%). In relation to post-COVID effects, 82.56% were found asymptomatic while rest 17.44% showed effects such as body ache, insomnia, cough, and loss of taste and smell and depression. Conclusion: COVID-19 pandemic left its sequels both in the form of physical as well as psychological symptoms in extended postpartum period although health-related QoL does not significantly affected by COVID-19 disease during this period.

COVID-19, Chronic Obstructive Pulmonary Disease and Pneumothorax: A Frightening Triad.

We describe the case of a male patient admitted to our emergency department during the Italian COVID-19 epidemic, for progressive worsening dyspnoea. A diagnosis of pneumothorax and diffuse interstitial lung involvement was promptly made by lung ultrasound and confirmed by an HRCT scan. A chest CT scan also showed diffuse emphysema, as observed in chronic obstructive pulmonary disease (COPD), and small consolidations in the lower lobes, suggestive for COVID-19 pneumonia. A chest tube was immediately inserted in the emergency room with complete resolution of the dyspnoea. A nasopharyngeal swab for 2019-nCoV was positive. Unfortunately, the patient died from COVID-19-related acute respiratory distress syndrome after 48 days of hospitalization. LEARNING POINTS: Coronavirus disease (COVID-19) can cause death from severe acute respiratory distress syndrome (ARDS).Pneumothorax is a common complication of chronic obstructive pulmonary disease (COPD).The combination of COVID-19, COPD and pneumothorax can prove fatal.

Interpretation of chest CT scan of patients with COVID-19 in imam Khomeini Hospital of Jiroft University of Medical Sciences from December to March 2019

Background & Aims: Along with laboratory testing, chest CT scans may be helpful to diagnose COVID-19 in individuals with a high clinical suspicion of infection. Due to their availability and rapid turnaround time, the role of chest computed tomography (CT) scan is growing for early diagnosis of patients with COVID-19. However, due to the low efficiency of viral nucleic acid detection as well as low specificity of chest CT scan for detecting COVID-19 pneumonia, this method shows incomplete clinical performance for proper COVID-19 disease diagnosis. Due to the highly contagious nature of the Coronavirus 2019 and the importance of early detection of the disease, a limited number of nucleic acid test kits, such as rRT-PCR and the possibility of false-negative rRT-PCR results, chest CT scan as a non-invasive method, it can be a highly accurate tool for early detection of suspected COVID-19 cases. The purpose of this study was the Interpretation of chest CT scan of patints with COVID-19 in Imam Khomeini Hospital of Jiroft University of Medical Sciences from December to March 2019 Methods: This research is a retrospective study that was conducted with the aim of interpreting CT scans of the chest in patients with covid-19 in Imam Khomeini Hospital, Jiroft University of Medical Sciences from March 2018 to June 2019. After obtaining permission from the ethics committee of the university, the researcher appeared in the research environment according to the pre-determined schedule for sampling. The desired data were extracted from the patients' files and recorded in a questionnaire form that was designed for this purpose. The criteria for entering the study included cases whose demographic information, clinical and laboratory data were complete and the positive PCR test along with chest CT imaging findings were available in the file, the exclusion criterion was the presence of low quality chest images. The data were extracted from the hospital information system based on clinical electronic medical records. including demographic information including age, sex, level of education and data related to the underlying disease, disease symptoms (cough, fever, phlegm, shortness of breath, chest pain, etc.) and the frequency of imaging findings in the chest CT scan that They were examined and evaluated according to age, gender, level of education, clinical symptoms, underlying disease and based on lymphopenia and lymphocytosis. and chest CT scan report of patients with COVID-19, which was available in the PACS system of this hospital, were evaluated. In this way, all the CT images of the chest by a radiologist as well as a lung specialist who were not aware of the clinical and laboratory data of the patients, in terms of the types of findings include, Patchy ground glass opcification, diffuse ground glass opacification, Air space opacity, Consolidation, pleural effusion, Atelectasis, Bronchiectasis, Fibrotic change, Cavitation, Lymphadenopathy. And the distribution of conflict was investigated as peripheral, central, bilateral, and unilateral. Results: The highest number of people with Covid-19 were in the age range of 30 to 59 years and men. In CT scan findings, the highest CT scan imaging findings as well as the highest mortality rate in patients were PGGO view (63.3%) and peripheral and bilateral involvement and the lowest frequency was related to Cavitation findings. In the examination of CT scan findings, PGGO and peripheral and bilateral involvement were the most frequent and Cavitation was the least frequent. Also, the findings of PGGO, Peripheral and Bilateral in the CT scan of the people who died had the highest frequency. In none of the imaging findings of the chest scan, there was no statistically significant relationship with the level of education, the level of education and death of patients due to COVID-19. There was no significant difference between gender and the findings of PGGO and Cavitation and peripheral involvement and Bilateral, but between the findings of DGGO and gender and there was a significant relationsh