Serum C-reactive protein greater than 75 mg/dL as an early available laboratory predictor of severe COVID-19: A systematic review.

INTRODUCTION: Severe COVID-19 management is still challenging. Having a laboratory factor to predict the severity of a patient's condition can be very useful in how to approach each patient. There have been studies concentrating on the correlation between serum C-reactive protein (CRP) level and COVID-19 severity but we aim to reach a threshold for CRP in disease severity determination. METHODS: We conducted a thorough search on PubMed, Web of Science and Google Scholar databases from early 2019 to October 2021, and 323 studies were assessed for eligibility in three phases. We used the Newcastle-Ottawa Scale to examine the validity of the studies. The t-test was applied for the CRP level cutoffs. RESULTS: Eventually, 11 articles and 1615 patients were included in this systematic review. Our analysis evaluated combined mean, median, and standard deviation of severe patients' CRP to be respectively 73.37, 53.80, and 47.936. Based on the combined mean, 75 mg/dL was suggested as an initial threshold for baseline CRP in hospitalized patients for developing severe conditions. CONCLUSION: This study recommends that COVID-19 patients with on-admission serum CRP levels of 75 mg/dL and more are likely associated with severe conditions. Thus, anti-inflammatory agents and further following may be helpful in these patients.

Cranial nerve involvement among COVID-19 survivors.

Introduction: COVID-19 was first reported in November 2019 in China and rapidly spread across the globe. COVID-19 causes neurologic symptoms and complications, which may persist even after recovery in patients. The objective of this research was to determine the involvement of cranial nerves in COVID-19 survivors. Method: This was a retrospective study. The study was conducted between March and July of 2022. The analysis included 98 patients with a certain positive polymerase chain reaction. SPSS software version 19 was utilized for data analysis. Results: The average age of the participants was 40.47 years (8.81). The olfactory nerve was found to be the most frequently involved cranial nerve (36.7%). Over 20% of participants had a taste disorder. The findings from the regression analysis indicated that lung involvement and age have a direct and significant relationship with cranial nerve involvement and can serve as its predictors (p = 0.001). Conclusion: It seems that cranial nerve involvement was sustained in COVID-19 patients who survived. In addition, elderly patients and patients with severe illnesses were more likely to show cranial symptoms. It is necessary to monitor COVID-19 survivors for neurological symptoms.

Severity of SARS-CoV-2 reinfection in vaccinated healthcare workers.

Background and Objectives: The most appropriate approach to control the SARS-CoV-2 epidemic is the widespread adoption of vaccination. Several vaccines against SARS-CoV-2 have been developed and authorized for use in various geographical regions. The aim of this study is to evaluate the efficacy of the vaccination agents presently utilized by healthcare workers (HCWs), and to investigate whether different COVID-19 vaccines would result in the alleviation of symptoms and the severity of clinical presentation. Materials and Methods: This multi-center survey was conducted on 329 vaccinated HCWs who were reinfected with COVID-19 between January 8, 2021 and April 8, 2021, in Tehran, Iran. Results: Overall, 92.1% and 70.8% of the participants had received 2 and 3 cumulative doses of COVID-19 vaccines, respectively. There were no differences between first/second and third-dose vaccines with the severity of SARS-CoV-2 infection. Expectedly, vaccination resulted in a less severe clinical presentation of SARS-CoV-2 infection, as reported by the participants. Conclusion: The results suggest that the efficacy of the vaccination agents presently utilized by HCWs was acceptable with no significant difference in vaccine type. Participants receiving at least two doses of vaccines in this survey exceeded 90%, which is comparably higher than studies conducted in other countries.

The Value of Spiral Chest Computed Tomography Scan in the Diagnosis of Asymptomatic Coronavirus Carriers among Paranasal Sinus and Pharynx Surgery Candidates

Abstract Introduction The nasopharynx and oropharynx are the main colonization sites of coronavirus. Therefore, patients with paranasal sinuses and pharyngeal problems (ear, nose, and throat [ENT] patients) predispose coronavirus infection. Ear, nose, and throat patients with concomitant asymptomatic coronavirus infection may develop severe pneumonia following surgical procedures. As a result, presurgical screening for coronavirus infection is a substantial concern. Objective We evaluated the usefulness of a spiral chest computed tomography (CT) scan in the diagnosis of asymptomatic coronavirus infection in the presurgical assessment of ENT patients Methods In this study, candidates of paranasal sinus or pharyngeal surgery were evaluated for coronavirus infection. Patients with neither history of coronavirus disease 2019 (COVID-19) nor compatible symptoms and signs were screened for asymptomatic coronavirus infection. These patients composed two groups: the first group underwent a reverse transcription polymerase chain reaction (RT-PCR) test of nasopharyngeal sample and spiral chest CTscan, but for the second one, only the latter was performed. Results In the first group, which consisted of 106 patients, 11 (10.4%) cases had positive RT-PCR test results, and 17 (16%) patients showed positive findings in favor of coronavirus infection in the spiral chest CT scan. In the second group, which consisted of 173 patients, 34 (19.7%) cases had positive chest CT scan results. Conclusion The chest CT scan has a valuable role in the early diagnosis of asymptomatic coronavirus carriers in patients highly predisposed to infection, especially in low resource areas, where the RT-PCR test is unavailable.

The Value of Spiral Chest Computed Tomography Scan in the Diagnosis of Asymptomatic Coronavirus Carriers among Paranasal Sinus and Pharynx Surgery Candidates.

Introduction The nasopharynx and oropharynx are the main colonization sites of coronavirus. Therefore, patients with paranasal sinuses and pharyngeal problems (ear, nose, and throat [ENT] patients) predispose coronavirus infection. Ear, nose, and throat patients with concomitant asymptomatic coronavirus infection may develop severe pneumonia following surgical procedures. As a result, presurgical screening for coronavirus infection is a substantial concern. Objective We evaluated the usefulness of a spiral chest computed tomography (CT) scan in the diagnosis of asymptomatic coronavirus infection in the presurgical assessment of ENT patients Methods In this study, candidates of paranasal sinus or pharyngeal surgery were evaluated for coronavirus infection. Patients with neither history of coronavirus disease 2019 (COVID-19) nor compatible symptoms and signs were screened for asymptomatic coronavirus infection. These patients composed two groups: the first group underwent a reverse transcription polymerase chain reaction (RT-PCR) test of nasopharyngeal sample and spiral chest CT scan, but for the second one, only the latter was performed. Results In the first group, which consisted of 106 patients, 11 (10.4%) cases had positive RT-PCR test results, and 17 (16%) patients showed positive findings in favor of coronavirus infection in the spiral chest CT scan. In the second group, which consisted of 173 patients, 34 (19.7%) cases had positive chest CT scan results. Conclusion The chest CT scan has a valuable role in the early diagnosis of asymptomatic coronavirus carriers in patients highly predisposed to infection, especially in low resource areas, where the RT-PCR test is unavailable.

Importance of pre-operative COVID-19 screening test in elective surgeries.

Background and Objectives: Since the COVID-19 pandemic initiation, more than 28 million elective surgeries were postponed with a cancellation rate of 72.3%. However, studies suggested that the patient treatment should be conducted within 12 weeks of diagnosis because delay in treatment might have had adverse impacts on patients' health status, prognosis, and pathologic stage. Hence, the current study aimed to assess the importance of a pre-operative COVID-19 screening test for the patients were candidates for elective surgery. Materials and Methods: This cross-sectional study was conducted on 141 patients who were candidates for any type of elective surgeries or cesarean section at a tertiary university-based hospital, between June 2020, and September 2020. Results: The mean age of participants was 41.38 ± 11.66 years. Of them, 91.5% were women and 8.5% were men. The COVID-19 polymerase chain reaction (PCR) screening tests were positive in 12 (8.5%) patients. From whose PCR tests were positive, only five people (less than half) had symptoms of COVID-19 such as fever (three patients), a distinctive smell (two patients), and cough (one patient). Suspected exposure to COVID-19 was reported in four of them. Conclusion: In this study, we found that more than half of PCR positive COVID-19 patients were asymptomatic. Therefore, to have a safe hospital environment, and improve patient health outcomes, the COVID-19 screening test should be applied before any interventions.

COVID-19, An early investigation from exposure to treatment outcomes in Tehran, Iran.

BACKGROUND: There is a growing need for information regarding the recent coronavirus disease of 2019 (COVID-19). We present a comprehensive report of COVID-19 patients in Iran. MATERIALS AND METHODS: One hundred hospitalized patients with COVID-19 were studied. Data on potential source of exposure, demographic, clinical, and paraclinical features, therapy outcome, and postdischarge follow-up were analyzed. RESULTS: The median age of the patients was 58 years, and the majority of the patients (72.7%) were above 50 years of age. Fever was present in 45.2% of the patients on admission. The most common clinical symptoms were shortness of breath (74%) and cough (68%). Most patients had elevated C-reactive protein (92.3%), elevated erythrocyte sedimentation rate (82.9%), and lymphocytopenia (74.2%) on admission. Lower lobes of the lung were most commonly involved, and ground-glass opacity (81.8%) was the most frequent finding in computed tomography scans. The administration of hydroxychloroquine improved the clinical outcome of the patients. Lopinavir/ritonavir was efficacious at younger ages. Of the 70 discharged patients, 40% had symptom aggravation, 8.6% were readmitted to the hospital, and three patients (4.3%) died. CONCLUSION: This report demonstrates a heterogeneous nature of clinical manifestations in patients affected with COVID19. The most common presenting symptoms are nonspecific, so attention should be made on broader testing, especially in age groups with the greatest risk and younger individuals who can serve as carriers of the disease. Hydroxychloroquine and lopinavir/ritonavir (in younger age group) can be potential treatment options. Finally, patients discharged from the hospital should be followed up because of potential symptom aggravation.

The application of direct viral cytopathic hypothesis to design drug trials in the battle against COVID-19.

COVID-19 has caused many deaths worldwide. Systemic complications alongside coagulopathy, and ARDS account for the majority of COVID-19 mortalities. The pathogenesis of the disease can be explained by two theories of direct viral cytopathy and systemic inflammatory cascade of events. ACE-2 is shown to be the cellular host receptor for SARS-CoV-2. It might be the key to explain the pathogenesis of systemic complications with a focus on the direct viral cytopathic hypothesis. Different medications tend to show up in many in vitro drug screens. However, more trials are needed to translate their application into in vivo efficacy.

The efficacy of remdesivir in coronavirus disease 2019 (COVID-19): a systematic review.

BACKGROUND AND OBJECTIVES: Researchers all around the world are working hard to find an effective treatment for the new coronavirus 2019. We performed a comprehensive systematic review to investigate the latest clinical evidence on the efficacy and safety of treatment with Remdesivir in hospitalized patients with COVID-19. MATERIALS AND METHODS: We performed a systematic search in Pubmed, Embase, Web of Science, Google scholar and MedRxiv for relevant observational and interventional studies. The outcomes measures were mortality rates, improvement rates, time to clinical improvement, all adverse event rates and severe adverse event rates. RESULTS: Three randomized controlled trials and 2 cohort studies were included in our study. In the 2 cohort studies, patients received Remdesivir for 10 days. 2 RCTs evaluated 10-day efficacy of treatment with Remdesivir versus placebo group and the other RCT compared its 5-day regimen versus 10-day regimen. Visual inspection of the forest plots revealed that the efficacy of Remdesivir was not much different in reducing 28-day mortality versus 14-day mortality rates. Besides, 10-day treatment regimen overpowered 5-day treatment and placebo in decreasing time to clinical improvement. All adverse event rates did not have a significant difference; however, severe adverse event rate was lower in the 5-day Remdesivir group compared to the 10-day and placebo groups. CONCLUSION: 5-day course of Remdesivir therapy in COVID-19 patients is probably efficacious and safe, and patients without invasive mechanical ventilation benefit the most. Treatment can be extended to 10 days if satisfactory improvement is not seen by day 5. Most benefits from Remdesivir therapy take place in the first 14 days of the start of the treatment.