Initial viral cycle threshold values in patients with COVID-19 and their clinical significance.

BACKGROUND: The connection between initial viral cycle threshold (Ct) values of the SARS-CoV-2 with symptoms and hospital course is not clearly studied. METHODS: This is a retrospective study of hospitalized COVID-19 patients from Jun 1st 2020 to March 30th, 2021 examining the relationship between initial viral cycle threshold (Ct) values of SARS-CoV-2 as obtained from nasopharyngeal samples. The clinical presentations and outcomes were analyzed in relation to the initial Ct values. RESULTS: The study included 202 hospitalized COVID-19 patients with a mean age (± SD) of 54.75 (± 15.93) and 123 (60.9%) males and 79 (39.1%) females. Of all the patients, the most frequent comorbidity was diabetes mellitus (95; 47%) and the most frequent symptoms were fever (148; 73.3%) and cough (141; 69.8%). There was no significant difference in relation to underlying conditions, clinical presentation, radiographic and laboratory data among those with low, medium and high Ct values. The mean Ct values showed no statistical change over the 10-month study period. CONCLUSIONS: Initial SARS-CoV-2 Ct values did not show any association with clinical symptoms and did not predict the need for mechanical intubation or death.

Coronavirus disease 2019 (COVID-19) in special groups: A single-center experience in sickle cell disease patients in Saudi Arabia.

BACKGROUND: Sickle cell disease (SCD) is a group of hereditary diseases, inherited as autosomal recessive disorder, which causes mutation in the ß-globin gene. As a result, there is a change in the sixth amino acid from glutamic acid to valine. The affected red blood cell is then prone to polymerization and sickling crisis under conditions of low oxygen tension. One of the major causes of mortality in SCD is acute chest syndrome (ACS). On the other hand, coronavirus disease 2019 (COVID-19) is a pandemic disease that carries significant mortality and morbidity worldwide with unknown outcomes in the affected SCD population. This study was created for that reason. MATERIALS AND METHODS: We report a case series of ten SCD patients who were affected by COVID-19 and required admission between May 1, 2020, and October 30, 2020, at a tertiary care hospital in Dhahran, eastern region of Saudi Arabia. Historical data were obtained retrospectively from electronic records. MS Excel was used for data entry, and SPSS version 23 was used for data analysis. RESULTS: The mean age of the patients involved in the study was 32 years, and the mean duration of symptoms was 5.7 days. None required critical care admission, and there was no mortality. All patients were discharged from hospital in good condition with no requirement of home oxygen. CONCLUSION: Although we expected a fatal outcome of SCD patients affected by COVID-19 infection, our limited case series showed favorable disease behavior and outcome, with a suspicion of underlying unclear protective mechanism from serious complications. However, further studies are required to better understand COVID-19 behavior in SCD patients.

Clinical Features and Outcome of Low and High Corticosteroids in Admitted COVID-19 Patients.

INTRODUCTION: There is no specific anti-viral therapies for 2019 Coronavirus Diseases (COVID-19) infection. Here, we compared patients receiving steroids at different dosages versus no steroids in severe and critical COVID-19 patients. METHODS: We retrospectively studied COVID-19 patients who received low-dose or high-dose corticosteroid therapy compared to no steroid. RESULTS: The study period, June-August 2020, included 169 patients with COVID-19 were included and there were 39.1% female and 60.9% male with an average age of 53.1 years. The distribution of cases was as follows: high-dose 39 (23.1%), low-dose 54 (32.0%), and no steroid 76 (45.5%). Of all the patients, Intensive Care Unit (ICU) admission was for 31 (18.3%), nine (5.3%) required intubation, and 52 (30.8%) had no comorbidities. There is no difference in the mean age between the different groups. However, those being treated with steroid were more likely to have a high sequential organ failure assessment (SOFA) score (0.37 ± 0.68, 0.36 ± 0.67 and 0.04 ± 0.34, for low-dose, high-dose steroid and no steroid groups, respectively (p = 0.001). Cox regression was not possible as the mortality rate was very low (3/169; 1.78%) and none of the multivariate methods would be possible. However, there was a significant difference in the hospital Length of stay (LOS) and the ICU LOS. CONCLUSION: Cox regression was not possible as the mortality rate was very low (1.78%) and none of the multivariate methods would be possible as the model will not converge. However, in t-test only, intubation was associated risk of mortality.

The sensitivity, specificity, predictive values, and likelihood ratios of fecal occult blood test for the detection of colorectal cancer in hospital settings.

OBJECTIVES: To study the performance of a single test using two fecal occult blood tests with colonoscopy for the detection of colorectal cancer (CRC) for the first time in Saudi Arabia to determine possible implications for the anticipated colorectal screening program. MATERIALS AND METHODS: We compared the performance of guaiac and immunochemical fecal occult blood tests for the detection of CRC among patients of 50-74 years old attending two hospitals in the Eastern Region of Saudi Arabia. Samples of feces were collected from 257 asymptomatic patients and 20 cases of confirmed CRC, and they were tested simultaneously by the guaiac-based occult blood test and monoclonal antibody-based immunoassay kit. Colonoscopy was performed on all participants and the results were statistically analyzed with both positive and negative occult blood tests of both methods. RESULTS: Of the 277 subjects, 79 tested positive for occult blood with at least one method. Overall, the number of those with an occult blood-positive result by both tests was 39 (14.1%), while for 198 (71.5%), both tests were negative (P<0.0001); 40 (14.4%) samples showed a discrepant result. Colonoscopy data were obtained for all 277 patients. A total of three invasive cancers were detected among the screening group. Of the three, the guaiac test detected two cases, while the immunochemical test detected three of them. Of the 20 control cases, the guaiac test detected 13 CRC cases (P=0.03), while the immunochemical test detected 16 of them (P<0.0001). The sensitivity of guaiac and immunochemical tests for the detection of CRC in the screening group was 50.00% (95% confidence interval [CI] =6.76-93.24) and 75.00% (95% CI =19.41-99.37), respectively. For comparison, the sensitivity of the guaiac fecal occult blood test for detecting CRC among the control group was 65.00% (95% CI =40.78-84.61) while that of FIT was 80.00% (95% CI =56.34-94.27). The specificity of the guaiac and immunoassay tests was 77.87% (95% CI =72.24-82.83) and 90.12% (95% CI =85.76-93.50), respectively. The positive likelihood ratio of guaiac and immunochemical tests for the detection of CRC was 2.26 (95% CI =0.83-6.18) and 7.59 (95% CI =3.86-14.94), whereas the negative likelihood ratio was 0.64 (95% CI =0.24-1.71) and 0.28 (95% CI =0.05-1.52), respectively. The positive predictive values of guaiac and immunochemical tests were 3.45% (95% CI =0.426-11.91) and 10.71% (95% CI =2.27-28.23), respectively. There was no marked difference in the negative predictive values for both methods. The sensitivity of the fecal occult blood test by FIT was significantly higher for stages III and IV colorectal cancer than for stages I and II (P=0.01) and it was insignificant for the guaiac fecal occult blood test (P=0.07). CONCLUSION: In areas where other advance screening methods of CRC are not feasible, the use of FIT can be considered.