Comorbidities and outcomes among patients hospitalized with COVID-19 in Upper Egypt.

Background: The coronavirus disease 19 (COVID-19) pandemic has spread rapidly around the globe with considerable morbidity and mortality. Coexistence of comorbidities with COVID-19 had consistently been reported as risk factors for unfavorable outcome. We aimed to evaluate the impact of comorbidities in COVID-19 patients on the outcome and determine predictors of prolonged hospital stay, requisite for intensive care unit (ICU) admission. Four hundred and thirty-nine adult patients who are admitted through (June and July 2020) in our University Hospitals were included in the study. All participants were diagnosed with COVID-19 according to Egyptian Ministry of Health guidance as definite case or probable case. Results: Patients with comorbidities represented 61.7% of all cases. Constitutional symptoms especially myalgia and lower respiratory tract (LRT) symptoms such as dyspnea were significantly higher in patients with comorbidities (P < 0.05). Patients with comorbidities had significantly worse laboratory parameters. ICU admission was higher in patients with comorbidities (35.8%). Among different comorbidities 45.4% of cardiovascular diseases (CVD) cases were admitted in ICU followed by diabetes mellitus (DM) cases (40.8%). Also, patients with comorbidities needed invasive mechanical ventilation more than those without comorbidity (31 versus 10.7%, P < 0.001). Significant lower frequency of recovery was found in COVID-19 patients with comorbidities (59% versus 81%, P < 0.001) and death rate was significantly higher in cases with comorbidities (P < 0.001) . The survival rates in cases with pre-existing CVD and neurological diseases were lower than those without disease (P < 0.002 and 0.001, respectively). Conclusions: Association of cardiovascular comorbid conditions including hypertension or neurological diseases including old cerebrovascular strokes together with COVID-19 infections carries higher risks of mortality. However, other comorbidities such as diabetes mellitus, chronic pulmonary or kidney diseases may also contribute to increased COVID-19 severity.

Impact of comorbidities on COVID-19 outcome.

BACKGROUND AND AIMS: The coronavirus disease 19 (COVID-19) pandemic has spread rapidly around the globe with considerable morbidity and mortality. Coexistence of comorbidities with COVID-19 have consistently been reported as risk factors for unfavorable prognosis. We aim at this study to evaluate the impact of comorbidities in COVID-19 patients on the outcome and determine predictors of prolonged hospital stay, requisite for ICU admission or decease. METHODS: Four hundreds and thirty nine adult patients who are admitted through (June and July 2020) in Assiut and Aswan University Hospitals were included in the study. All participants were diagnosed with COVID-19 according to Egyptian Ministry of Health guidance as definite case or Probable case. Detection of SARS-CoV-2 RNA was done by (TaqManâ"¢ 2019-nCoV Control Kit v1 (Cat. No. A47532) supplied by QIAGEN, Germany on the Applied Biosystem 7500 Fast RT PCR System, USA. RESULTS: Patients with comorbidities represented 61.7% of all cases. Constitutional symptoms especially myalgia and LRT symptoms such as dyspnea were significantly higher in patients with comorbidities (P < 0.05). Patients with comorbidities had significantly worse laboratory parameters. ICU admission was higher in patients with comorbidities (35.8%). Among different comorbidities 45.4% of CVD cases were admitted in ICU followed by DM cases (40.8%). Also, patients with comorbidities needed invasive mechanical ventilation more than those without comorbidity (31 vs. 10.7%, P<0.001). Significant lower frequency of recovery was found in COVID-19 patients with comorbidities (59% vs. 81%, P<0.001) and death rate was significantly higher in cases with comorbidities (P< 0.001). The survival rates in cases with pre-existing CVD and neurological diseases were lower than those without disease (P<0.002 and 0.001 respectively). CONCLUSION: Association of cardiovascular comorbid conditions including hypertension or neurological diseases together with COVID-19 infections carries higher risks of mortality. However, other comorbidities such as diabetes mellitus, chronic pulmonary or kidney diseases may also contribute to increased COVID-19 severity.

Intrathecal dexmedetomidine versus magnesium sulphate for postoperative analgesia and stress response after caesarean delivery; randomized controlled double-blind study.

BACKGROUND: Various adjuvants were added to intrathecal anaesthetics to improve quality of the block and postoperative analgesia. We hypothesized that intrathecal dexmedetomidine and magnesium sulphate (MgSO4 ) may add similar effects. Our objectives were to compare their effects as adjuvants to intrathecal bupivacaine on postoperative analgesia, stress hormones, sedative properties and the neonatal outcome after caesarean section. METHODS: A randomized double-blind controlled study; 90 parturients were divided into three groups. All patients received intrathecal hyperbaric bupivacaine 12.5 mg. NaCl 0.9% was added to intrathecal block in group C, 5 µg dexmedetomidine in the group D and 50 mg MgSO4 in group M. Visual analogue scale (VAS) score, stress hormones were assessed within the first 12 postoperative hours, sensory block, and neonatal outcome were also assessed. RESULTS: VAS scores were significantly lower in groups D and M. Onset of postoperative pain was significantly prolonged in group D. Time to peak sensory level was shorter in group D. Sedation score was significantly higher in group D only after 30 min of intrathecal block. Although stress hormones increased in all groups during intraoperative and postoperative periods, their levels were significantly lower in group D compared to other groups. No differences were noted regarding neonatal outcomes. CONCLUSION: Intrathecal dexmedetomidine is superior to intrathecal MgSO4 during caesarean section with regard to duration of analgesia, pain severity and stress hormone levels. Dexmedetomidine has a rapid onset and longer duration of sensory block compared to MgSO4 . No significant adverse effects to the parturients or newborns.

Does occupational exposure to low-dose ionizing radiation affect bone marrow thrombopoiesis?

BACKGROUND: The biological effects of high levels of radiation exposure are fairly well known, but the effects of low levels of radiation are more difficult to determine because the deterministic effects do not occur at these levels. METHODS: In order to assess the risk of this exposure on BM thrombopoiesis, we measured reticulated platelets (RP) by flow cytometry in 14 hospital workers (12 technicians and 2 nurses) exposed to low level ionizing radiation in Radiotherapy Department in South Egypt Cancer Institute. RESULTS: There are significant difference in the percentage of RP in the peripheral circulation of the workers (p = .008) and no significant difference in the proportion of other blood elements in the peripheral circulation. CONCLUSIONS: We think that measuring RP by flow cytometry is a rapid, non-invasive method to asses an early affection of thrombopoiesis. This type of monitoring may be used as an indicator to detect early BM affection and to demand more controls in radiation protection.

Platelet function, activation and apoptosis during and after apheresis.

Platelets are known to undergo shape change, activation, release reaction and apoptosis/necrosis during processing and storage. Apheresis may have a deleterious impact on platelet achievability and functional integrity. Platelet concentrates from 50 male volunteers obtained by COBE spectra were screened for platelet activation (CD62 and CD154) and apoptosis (phosphatidylserine detected by Annexin V). Donor samples before separation, during apheresis and at the third day of storage were used as baseline donor samples. Platelet aggregation to adenosine diphosphate (ADP) and collagen was performed. There was a statistically significant increase in the expression of activation markers in two different samples (during separation samples and third day samples). Although the increase in Annexin V expression was not so observable, it showed a significant increase also. There was marked decline in the platelet aggregation. The correlations between the values of CD62, CD154 and Annexin V were detected in baseline samples and increased during separation and at the third day of platelets storage. Correlation between values of platelet aggregation to collagen and Annexin V was relevant only in the baseline samples. No other correlations were encountered between platelet aggregation and markers of activation and apoptosis during apheresis and storage. Initial platelet activation induced by apheresis may have an impact on phosphatidylserine expression with no impact on aggregation function of platelets during storage.