Sequential Dengue Infection: Prevention Priorities.

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Association between Chronic Liver Disease Caused by Viral Hepatitis, Hospitalisation for COVID-19 and Mortality.

OBJECTIVE:  To evaluate the association between chronic liver disease (CLD) caused by viral hepatitis and COVID-19 hospitalisation, as well as the risk of disease progression and mortality among COVID-19 hospitalised patients in relation to their prior CLD status. STUDY DESIGN: A cohort study. Place and Duration of the study: Bahawal Victoria Hospital and Sir Sadiq Abbasi hospital, affiliated with Qauid-e-Azam Medical College, Bahawalpur, Pakistan, from July to December 2021. METHODOLOGY: In the main group analysis, the risk of hospitalisation for COVID-19 among CLD patients was determined, with the presence of CLD due to chronic viral hepatitis B and C as the exposure variable and hospitalisation for COVID-19 as the outcome measure. Patients hospitalised for a medical condition other than COVID-19 (non-COVID medical admissions) served as an external control group. In the sub-group analysis, the risk of disease severity and mortality were determined among COVID-19 admitted patients having a prior status of CLD, with disease progression to death serving as the primary outcome measure while the exposure variable remained the same as in the main analysis. RESULTS: A total of 3,976 participants [mean age 51 ±14.8 years; 54.1% men; 1616 hospitalised with COVID-19, including 27 (1.7%) exposed to CLD; and 2,360 non-COVID medical admissions, including 208 (8.8%) exposed to CLD] were evaluated. There was less likelihood of hospitalisation for COVID-19 among patients with CLD (1.7% vs. 8.8%; RR=0.270; 95% CI=0.189, 0.386; p<0.001). There was less risk of death among CLD patients admitted for COVID-19 when compared with those admitted for non-COVID CLD-related complications (14.8% vs. 35.1%; RR= 0.422; 95% CI=0.168-1.06; p=0.035). Among COVID-19 admissions, CLD was associated with a decreased risk of death compared with other comorbid conditions (14.8% vs. 36.9%; RR=0.401; 95% CI=0.162-0.994; p=0.04). CONCLUSION: CLD caused by viral hepatitis was significantly less likely to be present among COVID-19 hospitalised patients. There was a lower risk of severe COVID-19 and mortality owing to it among CLD patients compared to those with other comorbid conditions. KEY WORDS: COVID-19, Hospitalisations, Chronic liver disease, Viral hepatitis, COVID-19 severity, Death outcome.

Predictors of fatal neurological complications among admitted COVID-19 patients with their implication in outcome: A Case Control study.

BACKGROUND: COVID-19 is known to be associated to potentially fatal neurological complications; therefore, it is essential to understand the risk factors for its development and the impact they have on the outcome of COVID-19 patients. AIMS: To determine the risk factors for developing fatal neurological complications and their outcome in hospitalized COVID-19 patients. MATERIAL AND METHODS: Case control study based on hospitalized patients was conducted from July 15th 2021 to December 15th 2021. Cases and controls were COVID-19 confirmed patients with and without severe neurological manifestations. Age, comorbid conditions, vaccination status, Blood Sugar Random (BSR), D-dimers levels, anticoagulation type and dosage were taken as predictors (exposure variables) for developing neurological complications. In the case-only (subgroup) analysis, 28-day mortality were analyzed using the same predictors including admission hypoxemia. Chi square test and regression model were built to calculate OR with 95%CI. RESULTS: Among 383 patients (median age, 56 years [IQR, 24-110]; 49.9% men); 95 had neurological complications (cases) and 288 did not (controls). Development of neurological complications among COVID-19 related hospitalizations was significantly associated with old age >71 yrs. (cases, 23.2%; controls, 13.5%; OR, 3.31; 95% CI, 1.28-8.55), presence of diabetes mellitus (37.9% vs. 24%; OR, 1.9; 95% CI, 1.2-3.1), admission hyperglycemia (BSR 351-600 mg/dl), (29.5% vs. 7.6%; OR, 3.11; 95%CI, 1.54-6.33), raised D-dimer levels 5000-10,000 ng/ml (41% vs. 11.8%; OR, 5.2; 95% CI, 3.02-8.9), prophylactic dose anticoagulation (43.2% vs. 28.1%; OR, 1.9; 95%CI, 1.2-3.1), and unvaccinated status of COVID-19 patients (90.5% vs. 75.6%; OR, 3.01; 95% CI, 1.44-6.25). Neurological complications with COVID-19 were associated with increased likelihood of death or invasive mechanical ventilation by day 28 (86.3% vs. 45.1%; OR, 7.66; 95% CI, 4.08-14.4). In case-only analysis (median age, 56 years [IQR, 27,110]; 50.5% women), 67 (70.5%) had CVE, 21 (22.1%) had Encephalitis, and 7 (7.4%) had GBS as neurological manifestations. 28-day mortality among these patients was strongly associated with a lower likelihood of vaccination. (6.1% cases vs. 30.8% controls; OR, .146; 95%CI, .033- .64), being younger 17-45 yrs. (12.2% vs. 46.2%; OR, .162; 95%CI, .045-.58), having no comorbid condition (19.5% vs. 61.5%; OR, .151; 95%CI, .044- .525), having cerebrovascular events and GBS as type of neurological manifestation (76.8% vs.30.8%; OR, 7.46; 95%CI, 2.06-26.96), (2.4% vs. 38.4%; OR, .04; 95%CI, .007- 0.24) respectively, and presence of hypoxemia at admission (91.5% vs. 15.4%; OR, 58.92; 95%CI, 10.83-320.67). CONCLUSION: Old age, presence of Diabetes Mellitus, unvaccinated status of patients, high BSR at admission, high D-dimers, and prophylactic dose anticoagulation were identifies as increased risk factors for developing serious neurological complications among COVID-19 patients. Neurological problems in COVID-19 patients raised death risk 7.6-fold. The most common neurological complication was cerebrovascular events, followed by encephalitis and GBS. Unvaccinated status, cerebrovascular events, and admission hypoxemia are associated with an increased likelihood of 28-day mortality among these patients.

Association of disease severity and death outcome with vaccination status of admitted COVID-19 patients in delta period of SARS-COV-2 in mixed variety of vaccine background.

To understand the effectual role of COVID-19 vaccination, we must analyze its effectiveness in dampening the disease severity and death outcome in patients who acquire infection and require hospitalization. The goal of this study was to see if there was an association between disease progression in admitted COVID-19 patients and their prior vaccination exposure. A prospective cohort study based on 1640 admitted COVID-19 patients were carried between June 2021 and October 2021. Depending on vaccination exposure they were divided into vaccinated (exposed) and unvaccinated (unexposed) groups, excluding partially vaccinated patients. Disease severity was assessed at admission on severity index scale. Disease progression to mortality or need of mechanical ventilation and survival were taken as outcome. Absolute difference with 95%CI and Risk Ratio were calculated using cross tabulation, Chi square test and multivariable logistic regression analysis. Among 1514 total analyzed cohort (median age, 53 years [IQR, 17,106]; 43.7% from 46 to 65 years of age group, 56.2% males,33.4% with no comorbid factor for disease progression) 369(24.4%) were vaccinated breakthrough cases and 1145(75.6%) were unvaccinated controls. 556(36.7%) progressed to death or mechanical ventilation, 958(63.3%) patients survived and were discharged home. Disease progression to death or mechanical ventilation was significantly associated with decreased likelihood of vaccination (24.9% among vaccinated breakthrough vs 40.5% unvaccinated controls, [Absolute difference -15.6% 95%CI (-10.2% to -20.6%); RR 0.615 95%CI (0.509, 0.744); p <.001]). This association was stronger for old age population and for increase time span between second dose of vaccine and onset of symptoms. There was no statistically significant difference among different types of vaccination and occurrence of outcome when compared to unvaccinated controls (RR 0.607(0.482, 0.763); 0.673(0.339, 1.33) and 0.623(0.441, 0.881) for Inactivated virus vaccine, mRNA and Adenovirus vector-based vaccine respectively. The patients who were fully vaccinated against SARS-COV-2 die or shift to mechanical ventilation less frequently than unvaccinated COVID-19 admitted patients.

Maternal Mortality with SARS-COV-2 during its 4th Wave in Pakistan: The Vaccine Paradox and Pregnancy.

The goal of this study was to investigate the maternal death rate among admitted pregnant patients with SARS-COV-2 during its 4th wave in Pakistan. It was a cross-sectional analytical study, carried on pregnant patients admitted due to COVID-19, in Sadiq Abbasi Hospital from 15th August to 15th September, 2021. Thirty-three PCR confirmed and HRCT suggestive patients were included with mean age of 28 ± 4.5 years and mean gestational age of 28.5 ± 6 weeks. Twenty-seven (81%) were non-vaccinated, 22 (66%) were admitted with severe disease, 13 (39.4%) and 11 (33.3%) were on non-invasive and invasive ventilator support, respectively. Only nine (27%) patients could continue their pregnancy. Fifteen (45%) patients had severe oligohydramnios. Twenty-two (66.7%) patients were died, all were unvaccinated. Regression analysis for maternal mortality predicted by severity and vaccination status was significant with R2=.68, F (1, 31) =66.6, p <.001 CI (-.69, -.42) and R2=.44, F (1, 31) = 24.8, p <.001 CI (-1.14, -.48), respectively. There was substantial mortality in the admitted and non-vaccinated pregnant patients with COVID-19. Key Words: Pregnancy, Vaccination, Severe COVID, Maternal outcome.