Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis

THE EFFECT OF URIC ACID LEVEL ON THE SEVERITY OF COVID-19

Epidemiological and clinical features of COVID-19 have been reported, but risk factors need to be determined to predict the course of the disease. In our study, we aimed to determine the effect of uric acid level on the severity of the disease. COVID-19 patients who received inpatient treatment between March 11, 2020 and May 30, 2020, and whose uric acid level was measured were included in the study. Demographic characteristics, comorbidities, symptoms, clinical course, laboratory parameters, and treatments were recorded. The study included 83 patients, of these 43 (52%) were males. The mean age was 59±17.1 years. The mean uric acid and albumin levels of the patients who needed oxygen were lower than in those who did not need oxygen (p=0.471 and p=0.057, respectively). There was a significant relationship between the presence of hypouricemia and mortality (p=0.019). In addition, the mean uric acid levels of patients who needed intensive care or died were lower than the mean uric acid levels of patients who did not need intensive care or who lived (p=0.665 and p=0.241, respectively). Oxygen need, intensive care need, and low uric acid level were found to be associated with increased length of hospital stay (p=0.00, p=0.001, p=0.012, and r=-0.276, respectively). Our study results suggest that uric acid levels may be associated with disease severity in the course of COVID-19.

Are we Ready for Real-Time Continuous Glucose Monitoring in the Hospital Setting? Benefits, Challenges, and Practical Approaches for Implementation : Case Vignette: Remote Real-Time Continuous Glucose Monitoring for Hospitalized Care in Quincy Koala

PURPOSE OF REVIEW

While preliminary evidence for use of real-time continuous glucose monitoring (rtCGM) in the hospital setting is encouraging, challenges with currently available devices and technology will need to be overcome as part of real-world integration. This paper reviews the current evidence and guidelines regarding use of rtCGM in the hospital and suggests a practical approach to implementation.

RECENT FINDINGS

There is now a considerable body of real-world evidence on the benefits of reducing dysglycemia in the hospital using both traditional point-of-care (POC) glucose testing and rtCGM. Benefits of rtCGM include decreased frequency of hypo- and hyperglycemia with reduced need of frequent POC checks and it is both feasible and well-accepted by nursing staff and providers. If expansion to additional sites is to be considered, practical solutions will need to be offered. Recommendations for an operational workflow and tools are described to guide implementation in the non-ICU setting. Further testing in randomized controlled trials and real-world dissemination and implementation designs is needed, together with industry and technology collaborations, to further streamline the integration into health systems.

The association between excess weight and COVID-19 outcomes: An umbrella review

This umbrella review assessed the association between excess weight and COVID-19 outcomes. MEDLINE, PsycINFO, and CINAHL were systematically searched for reviews that assessed the association between excess weight and COVID-19 outcomes. A second-order meta-analysis was conducted on the available data for intensive care unit admission, invasive mechanical ventilation administration, disease severity, hospitalization, and mortality. The quality of included reviews was assessed using the AMSTAR-2 appraisal tool. In total, 52 systematic reviews were included, 49 of which included meta-analyses. The risk of severe outcomes (OR = 1.86; 95% CI: 1.70 to 2.05), intensive care unit admission (OR = 1.58; 95% CI: 1.45 to 1.72), invasive mechanical ventilation administration (OR = 1.70; 95% CI: 1.57 to 1.83), hospitalization (OR = 1.82; 95% CI: 1.61 to 2.05), and mortality (OR = 1.35; 95% CI: 1.24 to 1.48) following COVID-19 infection was significantly higher in individuals living with excess weight compared with those with a healthy weight. There was limited evidence available in the included reviews regarding the influence of moderating factors such as ethnicity, and the majority of included reviews were of poor quality. Obesity appears to represent an important modifiable pre-infection risk factor for severe COVID-19 outcomes, including death.

Effects of physical inactivity behavior during COVID-19 pandemic on physical fitness, body composition, inflammatory cytokine, and immunocytes in older adults: A retrospective and prospective study

The prolonged period of COVID-19 has ingrained physical inactivity as a habit, leading to a reluctance to move. This has resulted in a decline in physical fitness and the loss of a healthy body composition. While this trend is particularly noticeable among the older adults, its impact on the immune cell defense system, which is crucial for minimizing viral infections, remains unclear. This study aimed to investigate the physical fitness, body composition, cytokines and immunocytes of older adults who engaged in physical activity (PA) before the COVID-19 pandemic but had to stop it due to the lockdown. A total of 172 older adults aged 61 to 85 years participated in this study: 90 in non-PA group (NPAG, 34 men and 56 women), and 82 in PA group (PAG, 29 men and 53 women). Physical inactivity was 45.13 ± 5.67 weeks in the NPAG and 1.70 ± 0.43 weeks in the PAG. Although there was no significant difference in calorie intake, PA volume showed a significant decrease in NPGA (P < 0.001). VO₂max, strength, and sit-ups decreased in NPAG, whereas they maintained or increased in PAG (Ps < 0.001). NPAG experienced an increase in fat mass (∼33.0 %), along with a decrease in muscle mass (∼10.4 %), but PAG showed slight increases (∼1.1 % vs. ∼1.5 %, Ps < 0.001). Interleukin-6 (∼38.9 %), tumor necrosis factor-α (∼38.3 %), and C-reactive protein (∼33.6 %) increased, whereas immunocytes decreased in NPAG (Ps < 0.001). In contrast, those in PAG showed the opposite phenomenon. This study indicates that even during the COVID-19 situation, maintaining active PA in the older adults helps retain beneficial physical fitness and body composition, reduces inflammatory factors, and contributes to preserving or enhancing the function of immunocytes.

Clinical and Nutritional Aspects and Outcomes of Covid-19 in Cancer and Non-Cancer Pediatric Patients

The SARS-CoV-2 virus has been the subject of study by several researchers worldwide since 2020; however, there are points to be clarified. This study aimed to analyze the clinical and nutritional aspects of hospitalized cancer and non-cancer pediatric patients and the association with COVID-19 outcomes. This is a cohort study of hospitalized children and adolescents with a laboratory diagnosis of COVID-19. Patients were assessed according to the presence or absence of previous oncological diseases. Sociodemographic, clinical and nutritional data were investigated during the course of the infection. Outcomes included Intensive Care Unit (ICU) admission, longer length of stay (14 days), criticality, and death. Oncological disease was found in 16 (19.3%) patients, most of whom had B-type acute lymphoid leukemia. In Poisson regression, adjusted for age and comorbidity, an association was found between oncological disease and length of stay ≥14 days (RR 4.30; 95% CI 1.46 - 15.6; p = 0.013), COVID-19 criticality (RR 3.82; 95% CI 1.66 - 30.9; p = 0.010) and death (RR 3.42; 95% CI 0.94 - 9.96; p = 0.035). The research revealed that cancer patients had longer hospital stays, were more likely to have the severe form of COVID-19, and had a 3.42 times greater risk of dying.

COVID-19 Mortality among Hospitalized Patients: Survival, Associated Factors, and Spatial Distribution in a City in São Paulo, Brazil, 2020

The aims of this study were to analyze patient survival, identify the prognostic factors for patients with COVID-19 deaths considering the length of hospital stay, and evaluate the spatial distribution of these deaths in the city of Jundiaí, São Paulo, Brazil. We examined prognostic variables and survival rates of COVID-19 patients hospitalized at a reference hospital in Jundiaí, Brazil. A retrospective cohort of hospitalized cases from April to July of 2020 was included. Descriptive analysis, Kaplan-Meier curves, univariate and multivariate Cox regression, and binary logistic regression models were used. Among the 902 reported and confirmed cases, there were 311 deaths (34.5%). The median survival was 27 days, and the mean for those discharged was 46 days. Regardless of the length of hospital stay, desaturation, immunosuppression, age over 60, kidney disease, hypertension, lung disease, and hypertension were found to be independent predictors of death in both Cox and logistic regression models.

Questionnaire and polysomnographic evaluation of obstructive sleep apnea in a cohort of post-COVID-19 patients

To evaluate the efficiency of 5 screening questionnaires for obstructive sleep apnea (OSA), OSA frequency, and the association between OSA and COVID-19 severity in recent COVID-19 cases, and to compare the use of the oxygen desaturation index (ODI) as an alternative measure for the respiratory disturbance index (RDI). This open cohort study recruited patients with recent COVID-19 (within 30-180 days) diagnosed using reverse transcription polymerase chain reaction. Participants were screened for OSA using the following 5 sleep disorder questionnaires prior to undergoing type I polysomnography: the Sleep Apnea Clinical Score (SACS), Epworth Sleepiness Scale (ESS), STOP-Bang score, No-Apnea score, and Berlin questionnaire. Polysomnography revealed that 77.5% of the participants had OSA and that these patients exhibited higher COVID-19-related hospitalization (58%) than those exhibited by non-apneic patients. The Kappa coefficient showed reasonable agreement between RDI > 5/h and No-Apnea score, RDI > 15/h and Berlin questionnaire score, and Epworth Sleepiness Scale and STOP-Bang score, but only moderate agreement between RDI > 15/h and No-Apnea score. An OSA-positive No-Apnea score increased the specificity of the SACS to 100% when RDI > 5/h. The intraclass correlation coefficient showed 95.2% agreement between RDI > 5/h and ODI > 10/h. The sequential application of the No-Apnea score and SACS was the most efficient screening method for OSA, which had a moderately high incidence among the post-COVID-19 group. We demonstrated an association between OSA and COVID-19 related hospitalization and that ODI could be a simple method with good performance for diagnosing OSA in this population.

Immunotherapy for Parkinson's Disease and Alzheimer's Disease: A Promising Disease-Modifying Therapy

Alzheimer's disease (AD) and Parkinson's disease (PD) are two neurodegenerative diseases posing a significant disease burden due to their increasing prevalence and socio-economic cost. Traditional therapeutic approaches for these diseases exist but provide limited symptomatic relief without addressing the underlying pathologies. This review examines the potential of immunotherapy, specifically monoclonal antibodies (mAbs), as disease-modifying treatments for AD and PD. We analyze the pathological mechanisms of AD and PD, focusing on the roles of amyloid-beta (Aβ), tau (τ), and alpha-synuclein (α-syn) proteins. We discuss the latest advancements in mAb therapies targeting these proteins, evaluating their efficacy in clinical trials and preclinical studies. We also explore the challenges faced in translating these therapies from bench to bedside, including issues related to safety, specificity, and clinical trial design. Additionally, we highlight future directions for research, emphasizing the need for combination therapies, improved biomarkers, and personalized treatment strategies. This review aims to provide insights into the current state and future potential of antibody-based immunotherapy in modifying the course of AD and PD, ultimately improving patient outcomes and quality of life.

Chronic disease patients have fewer social contacts: A pilot survey with implications for transmission dynamics

Non-communicable diseases (NCD) are the most important cause of death in the world. The socio-economic costs associated with NCDs makes it imperative to prevent and control them in the 21st century. The severe toll that the COVID-19 pandemic has taken worldwide is an unfortunate illustration of our limited insight into the infectious risk for the global population. Co-incidence between NCD and infection offers an underexplored opportunity to design preventive policies. In a pilot survey, we observed that the NCD population displays a substantial reduction in their social contacting behavior as compared to the general population. This indicates that existing mathematical models based on contact surveys in the general population are not applicable to the NCD population and that the risk of acquiring an infection following a contact is probably underestimated. Our demonstration of reduced social mixing in several chronic conditions, raises the question to what extent the social mixing is influenced by the burden of disease. We advocate the design of disease-specific contact surveys to address how the burden of disease associates with social contact behavior and the risk of infection. The SARS-CoV-2 pandemic offers an unprecedented opportunity to gain insight into the importance of infection in the NCD population and to find ways to improve healthcare procedures.

Strain imaging as a prognostic indicator for complications in COVID-19 patients

The goal of this study was to determine the potential for right ventricular (RV) and left ventricular (LV) strain to predict cardiopulmonary complications of COVID-19. We identified 276 patients with COVID-19 who underwent transthoracic echocardiography within 30 days of COVID-19 diagnosis at our institution. Patients were excluded if they had a history of any primary outcomes before COVID-19 diagnosis or insufficient imaging. LV global longitudinal strain (GLS) and RV GLS were obtained using 2-dimensional speckle-tracking echocardiography. Primary outcomes were death, pulmonary embolism, congestive heart failure (CHF), cardiomyopathy, pulmonary fibrosis, pulmonary hypertension, acute respiratory distress syndrome (ARDS), and myocardial infarction (MI) occurring after COVID-19 diagnosis. In the final analysis of 163 patients, mean RV GLS and LV GLS were reduced, and 43.6% developed at least one primary outcome. There were significant differences in LV GLS distribution in terms of CHF, cardiomyopathy, and MI in bivariate analysis. However, LV GLS was not significantly associated with CHF after adjusting for LV ejection fraction and RV fractional area change, nor with MI after adjusting for troponin T. RV GLS was significantly associated with ARDS after adjusting for other variables. In the risk stratification of patients with COVID-19, strain imaging can provide incremental prognostic information, as worsened RV GLS is associated with the development of ARDS.

Clinical-laboratory characteristics predictive of COVID-19 severity: a prospective hospital cohort, in Pernambuco, Northeast Brazil

OBJECTIVE

To describe the clinical-laboratory profile and analyze the factors associated with the severity of COVID-19.

METHODS

A prospective cohort study involving patients with COVID-19 admitted to a tertiary hospital in Recife, Brazil. All cases were confirmed by RT-PCR and classified according to severity criteria. A descriptive statistical analysis of the population's characteristics was conducted. Risk factors associated with the outcome of the case according to severity were analyzed by calculating the odds ratio (OR) using the general equation estimation (GEE) model.

RESULTS

Among the 75 cases included, 64% were female, and 62.7% were aged 65 years or older. The median length of stay was 9 days (6 - 14). Hypertension (65.3%) and Diabetes Mellitus (36%) were the most frequent comorbidities. Severe forms of COVID-19 constituted 41.3% of the sample. The factors associated with severity were a history of asthma (OR=4.58, 95%CI:1.13 - 18.7), report of anorexia (OR=1, 12, 95%CI:1.01-1.24), and laboratory changes that included elevated platelets (OR=1.00, 95% CI:1.00-1.01), elevated D'Dimer (OR=1, 26, 95% CI:1.04-1.52), elevated aspartate aminotransferase (OR=1.00, 95% CI:1.00-1.01), and gamma-glutamyl transferase (OR=1.22, IC95 %:0.98-1.51), hypernatremia (OR=1.31, 95%CI:1.12-1.52), and hyperkalemia (OR=1.21, 95% CI:1.04-1.41).

CONCLUSION

Multisystemic involvement with a tendency for thrombophilia, electrolyte disturbances, and hepatic aggression, reflected by laboratory changes, were factors associated with the severity of COVID-19.

Risk Factor Analysis of Death due to COVID-19 with Comorbid Condition in the Community of the Wetland Environment in Banjar District

Background

The prevalence of confirmed cases of COVID-19 is high and tends to continue to increase in Indonesia. Based on data, the Province of South Kalimantan, Indonesia in early mid-2021 experienced a high spike in cases, resulting in a large number of deaths, especially in Banjar Regency. Active COVID-19 cases in South Kalimantan in July 2021 were recorded at 5,279 (12.41%) out of 42,527 positive cases. Data compiled from the COVID-19 Task Force (Satgas) showed that Banjar Regency was the third highest area of the cumulative number of deaths, with as many as 47 people dying in one day. The results of many research on risk factors for COVID-19 cases vary widely. People with comorbidities are a very vulnerable group.

Objective

This study aims to identify the relationship between comorbid conditions and death based on data from COVID-19 admission in the Wetland Environment community in Banjar Regency, South Kalimantan, Indonesia in the years 2020-2021.

Methods

This is a retrospective analytical observational study which used purposive sampling. The data were collected from the case form report (CFR). The dependent variable in this study was inpatients at Ratu Zaleha Hospital who died and were diagnosed as positive for COVID-19, while the independent variables were age (productive/non-productive), tuberculosis, hypertension, diabetes mellitus, asthma, pneumonia, heart disease, COPD (lung disease), HIV/AIDS, chronic kidney disease (CKD), and stroke (CVA). Data were analyzed by univariate, bivariate, and multivariate analyses with logistic regression method to obtain adjusted OR.

Results

Out of 700 patients with confirmed COVID-19 infection, 273 (39%) had no comorbidity while 427 (61%) had at least one comorbid condition. There were 330 (47.1%) male patients and 370 (52.9%) female patients. There were 565 (80.7%) patients who belong in the productive age and 135 (19.35%) in the non-productive age. Results showed that age (p=0.002), asthma (p=0.026), chronic kidney disease (p=0.000), and heart disease (p=0.002) are significant risk factors of COVID-19 death in Banjar Regency.

Conclusion

Based on our analysis of COVID-19-related deaths in Banjar Regency in Ratu Zaleha Hospital on the year 2020-2021, diabetes, pneumonia, kidney failure, and COPD were associated with increased mortality.

Modelling the long-term health impact of COVID-19 using Graphical Chain Models brief heading: long COVID prediction by graphical chain models

BACKGROUND

Long-term sequelae of SARS-CoV-2 infection, namely long COVID syndrome, affect about 10% of severe COVID-19 survivors. This condition includes several physical symptoms and objective measures of organ dysfunction resulting from a complex interaction between individual predisposing factors and the acute manifestation of disease. We aimed at describing the complexity of the relationship between long COVID symptoms and their predictors in a population of survivors of hospitalization for severe COVID-19-related pneumonia using a Graphical Chain Model (GCM).

METHODS

96 patients with severe COVID-19 hospitalized in a non-intensive ward at the "Santa Maria" University Hospital, Terni, Italy, were followed up at 3-6 months. Data regarding present and previous clinical status, drug treatment, findings recorded during the in-hospital phase, presence of symptoms and signs of organ damage at follow-up were collected. Static and dynamic cardiac and respiratory parameters were evaluated by resting pulmonary function test, echocardiography, high-resolution chest tomography (HRCT) and cardiopulmonary exercise testing (CPET).

RESULTS

Twelve clinically most relevant factors were identified and partitioned into four ordered blocks in the GCM: block 1 - gender, smoking, age and body mass index (BMI); block 2 - admission to the intensive care unit (ICU) and length of follow-up in days; block 3 - peak oxygen consumption (VO2), forced expiratory volume at first second (FEV1), D-dimer levels, depression score and presence of fatigue; block 4 - HRCT pathological findings. Higher BMI and smoking had a significant impact on the probability of a patient's admission to ICU. VO2 showed dependency on length of follow-up. FEV1 was related to the self-assessed indicator of fatigue, and, in turn, fatigue was significantly associated with the depression score. Notably, neither fatigue nor depression depended on variables in block 2, including length of follow-up.

CONCLUSIONS

The biological plausibility of the relationships between variables demonstrated by the GCM validates the efficacy of this approach as a valuable statistical tool for elucidating structural features, such as conditional dependencies and associations. This promising method holds potential for exploring the long-term health repercussions of COVID-19 by identifying predictive factors and establishing suitable therapeutic strategies.

Impact of Spa Therapy on Symptoms and Quality of Life in Post-COVID-19 Patients with Chronic Conditions

Background: With limited pharmacological interventions, post-COVID-19 condition is a clinical challenge, and supplementary therapies are essential for symptom relief and enhancing quality of life (QoL). In our prospective observational study, we aimed to evaluate the impact of Salus per aquam (Spa) therapy on post-COVID-19 symptoms and QoL in individuals who suffer from chronic joint, musculoskeletal, skin, and/or respiratory conditions. Methods: A total of 159 individuals undergoing Spa therapy were enrolled, and 78 of them had post-COVID-19 symptoms, assessed using Visual Analogue Scale (VAS) and modified British Medical Research Council Questionnaire (mMRC-DS scales), as well as the Short Form 36 Health Status Survey (SF-36) questionnaire for QoL. Results: Spa therapy significantly reduced most post-COVID-19 symptoms, especially chronic fatigue, pain, brain fog, and persistent cough (all p < 0.05), as well as physical (+72%) and emotional (+66%) limitations. When stratified by sex, males showed a greater improvement from baseline, while females consistently displayed a higher amelioration in all QoL dimensions. Moreover, full vaccination with 3-4 doses significantly protected against SARS-CoV-2 re-infections and post-COVID-19 development (p < 0.05). Conclusions: Spa therapy demonstrated effectiveness in mitigating post-COVID-19 symptoms and enhancing QoL in patients suffering from chronic diseases.

Evaluation of Clinical Effects of COVID-19 Infection and Vaccines on Myasthenia Gravis

Introduction

In this study, we aimed to investigate the clinical effects of COVID-19 infection and vaccines on Myasthenia gravis (MG) during the pandemic.

Methods

A total of 141 MG patients between April 2020 and December 2021 were retrospectively analyzed. Data including demographic and clinical characteristics of patients, COVID-19 test results, and vaccine types (mRNA-BNT162b2 and/or inactivated-CoronaVac) were recorded. All patients were followed by face-to-face interviews and/or phone calls. Worsening MG symptoms after COVID-19 infection or vaccines were noted.

Results

A total of 60 patients were diagnosed with COVID-19, and reverse transcriptase-polymerase chain reaction test results were COVID-19 positive in 54 (90%) patients. Twenty-eight (46.7%) patients had lung involvement, while 20(33.3%) patients were followed in the ward. Twelve (20%) patients were followed in the intensive care unit, and two of them (3.3%) died. Both deceased patients were unvaccinated. The most common symptoms were fatigue (78.3%), and 13(21.7%) patients were asymptomatic. Of the patients, 96(68%) received at least one dose BNT162b2 or CoronaVac, while 30.4% of the patients received ≥3 doses of vaccines. The local skin irritation and fatigue rate was significantly higher with BNT162b2 vaccine than CoronaVac (p<0.001 and p=0.004, respectively). No serious side effect was observed with either vaccine. Five patients had worsening MG symptoms after vaccination during a six-week follow-up. None of the patients experienced myasthenic crises.

Conclusion

Our study results suggest that COVID-19 infection affects MG similar to the general population and does not lead to worsening MG symptoms. Both mRNA and inactivated vaccines with proven efficacy can be used safely in MG patients.

Comprehensive Analysis of SARS-CoV-2 Dynamics in Bangladesh: Infection Trends and Variants (2020-2023)

The first case of COVID-19 was detected in Bangladesh on 8 March 2020. Since then, the Government of Bangladesh (GoB) has implemented various measures to limit the transmission of COVID-19, including widespread testing facilities across the nation through a laboratory network for COVID-19 molecular testing. This study aimed to analyze the dynamics of SARS-CoV-2 in Bangladesh by conducting COVID-19 testing and genomic surveillance of the virus variants throughout the pandemic. Nasopharyngeal swabs were collected from authorized GoB collection centers between April 2020 and June 2023. The viral RNA was extracted and subjected to real-time PCR analysis in icddr,b's Virology laboratory. A subset of positive samples underwent whole-genome sequencing to track the evolutionary footprint of SARS-CoV-2 variants. We tested 149,270 suspected COVID-19 cases from Dhaka (n = 81,782) and other districts (n = 67,488). Of these, 63% were male. The highest positivity rate, 27%, was found in the >60 years age group, followed by 26%, 51-60 years, 25% in 41-50 years, and the lowest, 9% in under five children. Notably, the sequencing of 2742 SARS-CoV-2 genomes displayed a pattern of globally circulating variants, Alpha, Beta, Delta, and Omicron, successively replacing each other over time and causing peaks of COVID-19 infection. Regarding the risk of SARS-CoV-2 infection, it was observed that the positivity rate increased with age compared to the under-5 age group in 2020 and 2021. However, these trends did not remain consistent in 2022, where older age groups, particularly those over 60, had a lower positivity rate compared to other age groups due to vaccination. The study findings generated data on the real-time circulation of different SARS-CoV-2 variants and the upsurge of COVID-19 cases in Bangladesh, which impacted identifying hotspots and restricting the virus from further transmission. Even though there is currently a low circulation of SARS-CoV-2 in Bangladesh, similar approaches of genomic surveillance remain essential for monitoring the emergence of new SARS-CoV-2 variants or other potential pathogens that could lead to future pandemics.

Exploring the underlying molecular mechanisms of acute myocardial infarction after SARS-CoV-2 infection

An increase in acute myocardial infarction (AMI)-related deaths has been reported during the COVID-19 pandemic. Despite evidence suggesting the association between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and AMI, the underlying mechanisms remain unclear. Here, we integrated mRNA and microRNA expression profiles related to SARS-CoV-2 infection and AMI from public databases. We then performed transcriptomic analysis using bioinformatics and systems biology approaches to explore the potential molecular mechanisms of SARS-CoV-2 infection affects AMI. First, twenty-one common differentially expressed genes (DEGs) were identified from SARS-CoV-2 infection and AMI patients in endothelial cells datasets and then we performed functional analysis to predict the roles of these DEGs. The functional analysis emphasized that the endothelial cell response to cytokine stimulus due to excessive inflammation was essential in these two diseases. Importantly, the tumor necrosis factor and interleukin-17 signaling pathways appeared to be integral factors in this mechanism. Interestingly, most of these common genes were also upregulated in transcriptomic datasets of SARS-CoV-2-infected cardiomyocytes, suggesting that these genes may be shared in cardiac- and vascular-related injuries. We subsequently built a protein-protein interaction network and extracted hub genes and essential modules from this network. At the transcriptional and post-transcriptional levels, regulatory networks with common DEGs were also constructed, and some key regulator signatures were further identified and validated. In summary, our research revealed that a highly activated inflammatory response in patients with COVID-19 might be a crucial factor for susceptibility to AMI and we identified some candidate genes and regulators that could be used as biomarkers or potential therapeutic targets.

The Effect of Pulmonary Hypertension on Mortality and Intensive Care Unit Admission in Patients With SARS-CoV-2 Infection: A Systematic Review and Meta-Analysis

AIM

Severe COVID-19 can cause acute respiratory distress syndrome, hypoxia, systemic complications, and increased mortality. Pulmonary hypertension (PH) is a major global health issue associated with worsening symptoms and increased mortality. This systematic review aimed to assess the influence of PH onset among COVID-19 patients on all-cause mortality and intensive care unit (ICU) admission.

METHOD

An unrestricted search of five databases up to June 2022 was undertaken. Pulmonary hypertension was assessed using transthoracic echocardiogram, computed tomography, or right heart catheterisation. After duplicate screening, data extraction, and risk of bias assessment, random effects meta-analyses of odds ratios (OR) and their 95% confidence intervals (CI) were performed for all-cause mortality and ICU admission.

RESULTS

From the 26 studies that were included (3,373 patients, 76% males, median age 62.6 years), PH in COVID-19 patients was significantly associated with higher odds for all-cause mortality (26 studies; OR 3.89; 95% CI 2.85-5.31; p<0.001) and higher odds for ICU admission (six studies; OR 2.50; 95% CI 1.69-3.70; p<0.001). Meta-regression/subgroup analyses by patient demographics, comorbidities, or therapeutic regimens, and sensitivity analyses did not find any differences.

CONCLUSION

Evidence from observational studies indicates that PH in COVID-19 patients is associated with increased odds of mortality and ICU admission.

The impact of long term COVID-19 infection on the patients' erectile function and on anxiety and on depression as well as the impact of daily tadalafil 5 mg supplementation in patients with erectile dysfunction

OBJECTIVES

The study examined the impact of long term COVID-19 infection on the patients' erectile function and anxiety and depression in the same patients as well as the impact of daily tadalafil 5 mg supplementation on their erectile function.

METHODS

Recovered 114 men were evaluated by the validated Arabic version of the international index of erectile function (ArIIEF-5) and the Arabic versions of the patient health questionnaire-9 (PHQ-9) and the generalized anxiety disorder-7 (GAD-7) at time of presentation, at 3 months and at 6 months, respectively. Forty recovered patients who still complained of ED received tadalafil 5 mg daily for 2 months then were evaluated again at 3 and 6 months by penile duplex, the Arabic versions of the patient health questionnaire-9 (PHQ-9) and the generalized anxiety disorder-7 (GAD-7) at the same periods, respectively.

RESULTS

At the time of presentation, there was a positive correlation between the severity of COVID-19 infection, ArIIEF-5 and PHQ-9 (r = 0.249, p = 0.008; r = 0.241, p = 0.010, respectively). Most of the patients showed normal penile duplex parameters. There were 40 ED patients at presentation, 5 ED patients at 3 months and 3 ED patients at 6 months, respectively.

CONCLUSIONS

ED in COVID-19 patients who were not suffering from chronic illnesses before the affection, is primarily psychological and completely responsive to tadalafil.

Clinical characteristics and outcomes of COVID-19 cases admitted to adult intensive care units during the pandemic: A single center experience

BACKGROUND

COVID-19 is the largest recorded pandemic in history. It causes several complications such as shock, pneumonia, acute respiratory distress syndrome, and organ failure. The objective was to determine COVID-19 outcomes and risk factors in the intensive care (ICU) setting.

METHODS

A retrospective review of prospectively collected data was conducted. Adult patients with a positive RT-PCR test for COVID-19 admitted to ICUs of a tertiary care hospital between 2020 and 2022 were included. Patients who had severe complex trauma were excluded. The outcomes examined included ventilation use and duration, length of stay (LOS), and mortality.

RESULTS

A total of 964 patients were included. The mean ( ± standard deviation, SD) age was 63.7 ± 16.9 years. The majority of the patients were males (59.0 %) and Saudi (75.7 %). Ventilation use was documented in 443 (57.1 %) patients, with a mean ( ± SD) ventilation duration of 9.7 ± 8.4 days. Death occurred in 361 (37.4 %) patients after a mean ( ± SD) of 33.3 ± 44.5 days from infection. The mean ( ± SD) LOS was 30.6 ± 54.1 days in hospital and 5.2 ± 5.4 days in ICU. Ventilation use was associated with older age, males, longer ICU LOS, mortality, and admission to medical-surgical ICU. Crude mortality use was associated with older age, longer ICU LOS, use of ventilator, shorter ventilation duration, and admission to medical-surgical or respiratory ICUs.

CONCLUSIONS

COVID-19 patients admitted to adult ICUs are at high risk of death and mechanical ventilation. The crude risks of both outcomes are higher in older age and longer ICU LOS and are very variable by ICU type.

COVID-19 Frequency in Hospitalized Psychiatric Patients: A Systematic Review

OBJECTIVE

The COVID-19 pandemic affected individuals in different contexts (e.g. long-term care facilities, schools, communities), including psychiatric hospitals. Thus, the objective of this systematic review, duly registered and approved on PROSPERO (CRD42023427835), is to assess the frequency of positive COVID-19 cases among patients hospitalized in psychiatric hospitals.

METHODS

A total of 4,922 articles were identified in the database searches, and 17 studies conducted in psychiatric hospitals from different regions of the world were selected.

RESULTS

The frequency of positive COVID-19 cases among patients hospitalized in psychiatric hospitals ranged from 1.8% to 98.8%. Out of a total of 19,573 patients hospitalized in psychiatric hospitals, the pooled mean frequency of positive COVID-19 cases was 11.9%. The majority of patients presented COVID-19 symptoms (e.g. cough, fever and others). The COVID-19 diagnosis was primarily conducted through RT-PCR testing in 88.9% of the studies.

CONCLUSION

In conclusion, there is discrepancy in the methodology of the studies assessing the frequency of positive COVID-19 cases in psychiatric hospitals. However, this review allowed us to understand how the COVID-19 pandemic has impacted the population hospitalized in psychiatric hospitals.

Individual risk factors associated with SARS-CoV-2 infection during Alpha variant in high-income countries: a systematic review and meta-analysis

Objectives

This study aimed to systematically appraise risk factors associated with SARS-CoV-2 infection in high-income countries during the period of predominance of the Alpha variant (January 2020 to April 2021).

Methods

Four electronic databases were used to search observational studies. Literature search, study screening, data extraction and quality assessment were conducted by two authors independently. Meta-analyses were conducted for each risk factor, when appropriate.

Results

From 12,094 studies, 27 were included. The larger sample size was 17,288,532 participants, more women were included, and the age range was 18-117 years old. Meta-analyses identified men [Odds Ratio (OR): 1.23, 95% Confidence Interval (CI): 1.97-1.42], non-white ethnicity (OR: 1.63, 95% CI: 1.39-1.91), household number (OR: 1.08, 95% CI: 1.06-1.10), diabetes (OR: 1.22, 95% CI: 1.08-1.37), cancer (OR: 0.82, 95% CI: 0.68-0.98), cardiovascular diseases (OR: 0.92, 95% CI: 0.84-1.00), asthma (OR: 0.83, 95% CI: 0.75-0.92) and ischemic heart disease (OR: 0.82, 95% CI: 0.74-0.91) as associated with SARS-CoV-2 infection.

Conclusion

This study indicated several risk factors for SARS-CoV-2 infection. Due to the heterogeneity of the studies included, more studies are needed to understand the factors that increase the risk for SARS-CoV-2 infection.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021244148, PROSPERO registration number, CRD42021244148.

Immune Response and Risk of Decompensation following SARS-CoV-2 Infection in Outpatients with Advanced Chronic Liver Disease

Advanced chronic liver disease (ACLD) is associated with a wide spectrum of immune dysfunction. The clinical impact of SARS-CoV-2 on the development of decompensation and immune response in unvaccinated outpatients has not as yet been clearly defined. This study aimed to evaluate the clinical and immunological impact of SARS-CoV-2 on outpatients with ACLD. This is an observational case-control study, in which ACLD outpatients were included prospectively and consecutively and classified into two groups: SARS-CoV-2 infected and non-infected. Patients' baseline characteristics and infection data were collected and analyzed. Immunoglobulin G (IgG) levels against Spike 1 were evaluated. The primary endpoint was risk of liver decompensation during follow-up, assessed after propensity score matching and adjusted by Cox regression. Between October 2020 and July 2021, ACLD outpatients (n = 580) were identified, and 174 patients with clinical follow-up were included. SARS-CoV-2 infection incidence was 7.6% (n = 44). Risk of liver decompensation was significantly higher after infection (HR = 2.43 [1.01-5.86], p = 0.048) vs. non-infection. The time of IgG evaluation was similar in all patients (n = 74); IgG concentrations were significantly higher in compensated vs. decompensated patients (1.02 ± 0.35 pg/mL vs. 0.34 ± 0.16 pg/mL, p < 0.0001) and correlated with hemoglobin levels. The dysregulation of the innate immune response in patients with decompensated liver disease increased the risk of further decompensation following SARS-CoV-2, mainly due to a worsening of ascites.

Neurological Complications of COVID-19: Unraveling the Pathophysiological Underpinnings and Therapeutic Implications

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease (COVID-19), induced a global pandemic with a diverse array of clinical manifestations. While the acute phase of the pandemic may be waning, the intricacies of COVID-19's impact on neurological health remain a crucial area of investigation. Early recognition of the spectrum of COVID-19 symptoms, ranging from mild fever and cough to life-threatening respiratory distress and multi-organ failure, underscored the significance of neurological complications, including anosmia, seizures, stroke, disorientation, encephalopathy, and paralysis. Notably, patients requiring intensive care unit (ICU) admission due to neurological challenges or due to them exhibiting neurological abnormalities in the ICU have shown increased mortality rates. COVID-19 can lead to a range of neurological complications such as anosmia, stroke, paralysis, cranial nerve deficits, encephalopathy, delirium, meningitis, seizures, etc., in affected patients. This review elucidates the burgeoning landscape of neurological sequelae associated with SARS-CoV-2 infection and explores the underlying neurobiological mechanisms driving these diverse manifestations. A meticulous examination of potential neuroinvasion routes by SARS-CoV-2 underscores the intricate interplay between the virus and the nervous system. Moreover, we dissect the diverse neurological manifestations emphasizing the necessity of a multifaceted approach to understanding the disease's neurological footprint. In addition to elucidating the pathophysiological underpinnings, this review surveys current therapeutic modalities and delineates prospective avenues for neuro-COVID research. By integrating epidemiological, clinical, and diagnostic parameters, we endeavor to foster a comprehensive analysis of the nexus between COVID-19 and neurological health, thereby laying the groundwork for targeted therapeutic interventions and long-term management strategies.

Prevalence and perception of pre-morbid lifestyle-related risk factors among covid-19 survivors in Lagos state and Abuja capital city of Nigeria

INTRODUCTION

This study investigated the prevalence and perception of premorbid lifestyle-related risk factors among Covid-19 Survivors in Abuja and Lagos, Nigeria.

METHODOLOGY

A cross-sectional descriptive survey design was used to collect data from 522 consenting adult Covid-19 survivors in Abuja (274) and Lagos (248), Nigeria, using a self-developed, close-ended and validated questionnaire called the Lifestyle-related Factors in Covid-19 Questionnaire (LFC-19 Questionnaire) through a multistage sampling technique. Descriptive and inferential statistical analysis was done using the Statistical Package for Social Science (SPSS) with P value set at ≤ 0.05. Ethical approval was obtained for the study.

RESULTS

A significant number of Covid-19 Survivors were overweight/obese (67.8%) and had a history of physical inactivity (73.8%). A small proportion had premorbid chronic diseases (23.8%) as well as pre-existing lifestyle-related risk factors such as inadequate consumption of fruits (67.2%) and vegetables (60.0%) and physical inactivity (73.8%).

CONCLUSION

This study revealed that most Covid-19 survivors residing in Lagos State and in Abuja capital city of Nigeria were either overweight or obese. This was due to physical inactivity, an unhealthy diet consisting of low fruit and vegetable consumption and poor sleep. Additionally, the study showed that patients' perceptions of their risk factors were often inaccurate as it differed from what was measured. The findings from this study will assist public health professionals and clinicians in designing and implementing more effective Covid-19 management strategies that incorporate healthy lifestyle practices and lifestyle modifications and assist public health promotion and communication specialists in designing appropriate and evidence-based preventive messages.

Impact of the COVID-19 pandemic from the perspective of patients with cardiovascular disease in Australia: mixed-methods study

OBJECTIVES

The study explored the perceived impacts of COVID-19 and its associated policies and social restrictions on health, self-management and access to healthcare.

DESIGN

Cross-sectional observational (online survey) and qualitative study (semi-structured interviews and thematic analysis).

SETTING

Australia.

PARTICIPANTS

People with self-reported cardiovascular disease (CVD) and/or risk factors.

RESULTS

Survey responses were collected from 690 participants (43.8% women, 40.1% over 65 years). Participants reported that their heart health had been affected by the pandemic (26.3%), were less likely to exercise (47.1%), have a healthy diet (25.9%) and take medications (9.4%). A large proportion were admitted to hospital (46.2%) and presented to the emergency department (40.6%). Difficulties in accessing healthcare providers (53.2%) and use of telemedicine (63.6%) were reported. We conducted 16 semi-structured interviews and identified five key themes: adding burden in seeking medical care, impediments in accessing a readjusted health system, exacerbating vulnerability and distress, coping with self-management and adapting to telehealth.

CONCLUSIONS

Patients with CVD expressed an additional burden in seeking medical care and difficulties navigating a readjusted health system during the COVID-19 pandemic. Associated policies and access issues heightened vulnerabilities and distress, making self-management of health difficult for patients with CVD.

Association between COVID-19 severity and relatively high serum adiponectin levels at the time of admission

At the beginning of 2020, coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) led to epidemics worldwide. Obesity and visceral fat accumulation have been reported to be independent risk factors for severe COVID-19. Several reports have focused on the levels of adipocytokines/adipokines, including adiponectin (APN), which is exclusively secreted from adipocytes, although the importance of these factors in acute disease conditions remains unclear. Therefore, we investigated the relationship between serum adiponectin levels and COVID-19 severity. Patients with COVID-19 who were admitted to Sumitomo Hospital (Osaka, Japan) from May through October 2021 were included. A total of 107 patients were enrolled in this study. We obtained the anthropometric and clinical laboratory data of the patients at the time of admission and examined the associations between various parameters and COVID-19 severity. The mean period from onset to admission was 6.5 ± 2.8 days. We divided the patients into "non-severe" (mild, moderate-I and moderate-II) (n = 80) and "severe" (n = 27) groups. The "severe" patients were significantly older than "non-severe" patients. Additionally, no significant differences were observed in BMI, sex, or the period from onset to admission. The serum adiponectin levels of "severe" patients at the time of admission were significantly greater than those of "non-severe" patients even after adjusting for age, sex, and BMI. These results suggest that the serum APN levels at the time of admission can predict COVID-19 severity. However, further investigations on the changes in APN levels in acute diseases are needed.

From Herd Health to Public Health: Digital Tools for Combating Antibiotic Resistance in Dairy Farms

The emergence of antimicrobial resistance (AMR) is a significant threat to global food security, human health, and the future of livestock production. Higher rates of antimicrobial use in dairy farming and the sheer lack of new antimicrobials available for use focused attention on the question of how the dairy production sector contributed to the development of AMR and paved the path toward taking action to curtail it on the targeted type of farms. This paper aims to provide an introduction to a phenomenon that has gained considerable attention in the recent past due to its ever-increasing impact, the use of antimicrobial drugs, the emergence of antimicrobial resistance (AMR) on dairy farms, and seeks to discuss the possibilities of approaches such as digital health monitoring and precision livestock farming. Using sensors, data, knowledge, automation, etc., digital health monitoring, as well as Precision Livestock Farming (PLF), is expected to enhance health control and minimize disease and antimicrobial usage. The work presents a literature review on the current status and trends of AMR in dairy farms, an understanding of the concept of digital health monitoring and PLF, and the presentation and usefulness of digital health monitoring and PLF in preventing AMR. The study also analyses the strengths and weaknesses of adopting and incorporating digital technologies and artificial intelligence for dairy farming and presents areas for further study and level of use.

A moderately higher time-in-range threshold improves the prognosis of type 2 diabetes patients complicated with COVID-19

Objective

After fully lifting coronavirus disease 2019 (COVID-19) pandemic control measures in mainland China in 12/2022, the incidence of COVID-19 has increased markedly, making it difficult to meet the general time-in-range (TIR) requirement. We investigated a more clinically practical TIR threshold and examined its association with the prognosis of COVID-19 patients with type 2 diabetes(T2D).

Research design and methods

63 T2D patients complicated with COVID-19 were evaluated. Patients were divided into favorable outcome group and adverse outcome group according to whether achieving composite endpoint (a >20-day length of stay, intensive care unit admission, mechanical ventilation use, or death). TIR, the time-below-range (TBR) and the time-above-range (TAR) were calculated from intermittently scanned continuous glucose monitoring. Logistic regression analysis and other statistical methods were used to analyze the correlation between glucose variability and prognosis to establish the appropriate reference range of TIR.

Results

TIR with thresholds of 80 to 190 mg/dL was significantly associated with favorable outcomes. An increase of 1% in TIR is connected with a reduction of 3.70% in the risk of adverse outcomes. The Youden index was highest when the TIR was 54.73%, and the sensitivity and specificity were 58.30% and 77.80%, respectively. After accounting for confounding variables, our analysis revealed that threshold target ranges (TARs) ranging from 200 mg/dL to 230 mg/dL significantly augmented the likelihood of adverse outcomes.

Conclusion

The TIR threshold of 80 to 190 mg/dL has a comparatively high predictive value of the prognosis of COVID-19. TIR >54.73% was associated with a decreased risk of adverse outcomes. These findings provide clinically critical insights into possible avenues to improve outcomes for COVID-19 patients with T2D.

Mental health status among chronic disease patients in Bangladesh during the COVID-19 Pandemic: Findings from a cross-sectional study

Context

The COVID-19 epidemic has had a substantial influence on the mental health of chronic disease patients. However, there is a scarcity of research on them in Bangladesh.

Aims

This study aims to explore the prevalence of and identify the risk factors for depression, anxiety, and stress symptoms during the COVID-19 pandemic among people with chronic diseases in Bangladesh.

Materials and Methods

This cross-sectional study involving face-to-face and telephone interviews was carried out among Bangladeshi people diagnosed with chronic diseases between September and November 2020. The total sample size was 878, and a convenient sampling technique was used. Logistic regression analysis was performed to investigate potential influencing factors for depression, anxiety, and stress.

Results

The mean age of respondents was 50.10 years. Among them, 35.0%, 36.0%, and 29.0% suffered from depression, anxiety, and stress symptoms, respectively. In multivariable logistic regression, depression had a significant positive association with higher age (≥60 years), lower income, rural residency, and loss of close family members due to COVID-19. Anxiety had a significant positive association with higher age (≥40 years), lower education, lower income, rural residency, and loss of close family members due to COVID-19. Stress had a significant positive association with higher age (≥40 years), no income, rural residency, and loss of close family members due to COVID-19.

Conclusion

It is urgent to consider the risk of developing mental health distress among chronic disease patients, especially aged people, by health service providers and generate effective programs for emergency situations.

A Complex Interplay: Navigating the Crossroads of Tobacco Use, Cardiovascular Disease, and the COVID-19 Pandemic: A WHF Policy Brief

The Coronavirus Disease 2019, commonly referred to as COVID-19, is responsible for one of the deadliest pandemics in human history. The direct, indirect and lasting repercussions of the COVID-19 pandemic on individuals and public health, as well as health systems can still be observed, even today. In the midst of the initial chaos, the role of tobacco as a prognostic factor for unfavourable COVID-19 outcomes was largely neglected. As of 2023, numerous studies have confirmed that use of tobacco, a leading risk factor for cardiovascular and other diseases, is strongly associated with increased risks of severe COVID-19 complications (e.g., hospitalisation, ICU admission, need for mechanical ventilation, long COVID, etc.) and deaths from COVID-19. In addition, evidence suggests that COVID-19 directly affects multiple organs beyond the respiratory system, disproportionately impacting individuals with comorbidities. Notably, people living with cardiovascular disease are more prone to experiencing worse outcomes, as COVID-19 often inherently manifests as thrombotic cardiovascular complications. As such, the triad of tobacco, COVID-19 and cardiovascular disease constitutes a dangerous cocktail. The lockdowns and social distancing measures imposed by governments have also had adverse effects on our lifestyles (e.g., shifts in diets, physical activity, tobacco consumption patterns, etc.) and mental well-being, all of which affect cardiovascular health. In particular, vulnerable populations are especially susceptible to tobacco use, cardiovascular disease and the psychological fallout from the pandemic. Therefore, national pandemic responses need to consider health equity as well as the social determinants of health. The pandemic has also had catastrophic impacts on many health systems, bringing some to the brink of collapse. As a result, many health services, such as services for cardiovascular disease or tobacco cessation, were severely disrupted due to fears of transmission and redirection of resources for COVID-19 care. Unfortunately, the return to pre-pandemic levels of cardiovascular disease care activity has stagnated. Nevertheless, digital solutions, such as telemedicine and apps, have flourished, and may help reduce the gaps. Advancing tobacco control was especially challenging due to interference from the tobacco industry. The industry exploited lingering uncertainties to propagate misleading information on tobacco and COVID-19 in order to promote its products. Regrettably, the links between tobacco use and risk of SARS-CoV-2 infection remain inconclusive. However, a robust body of evidence has, since then, demonstrated that tobacco use is associated with more severe COVID-19 illness and complications. Additionally, the tobacco industry also repeatedly attempted to forge partnerships with governments under the guise of corporate social responsibility. The implementation of the WHO Framework Convention on Tobacco Control could address many of the aforementioned challenges and alleviate the burden of tobacco, COVID-19, and cardiovascular disease. In particular, the implementation of Article 5.3 could protect public health policies from the vested interests of the industry. The world can learn from the COVID-19 pandemic to better prepare for future health emergencies of international concern. In light of the impact of tobacco on the COVID-19 pandemic, it is imperative that tobacco control remains a central component in pandemic preparedness and response plans.

The impact of COVID-19 on tuberculosis in most populated state of India: A geospatial meta-analysis

Background

Tuberculosis is one of the major burdens to developing nations. India is among the countries categorized by the World Health Organization (WHO) as experiencing a significant burden of TB, HIV-associated TB, and MDR/RR-TB within the context of low- and middle-income nations. Globally South East Asian and African region alone accounted for 82% of death (HIV negative), where India accounts for 36% of TB fatalities.

Materials and Methods

The data was extracted from NIKSHAY web portal on TB notification cases in UP, India. The random effects meta-analysis was performed to estimate pooled proportion of TB cases in public and private notified during both the periods. Spatial analysis was used to display the spread of TB cases across the state, during both the periods.

Results

A total 75 districts data on TB notified cases were available for current investigation. The pooled proportion of TB cases were 0.24 (0.21, 0.27) and 0.76 (0.73, 0.79) during COVID-19 period for private and public hospitals, respectively. Similarly, the pooled proportion of TB cases were 0.26 (0.23, 0.29) and 0.74 (0.71, 0.77) post-COVID-19 for private and public hospitals, respectively.

Conclusion

The proportion of TB cases were more in public hospital as compared to private hospitals during COVID-19 period. Similarly, result was obtained in post-COVID-19 period.

Role of serum lactate to predict early clinical deterioration in hospitalized adult patients with severe acute respiratory syndrome coronavirus-2 infection: A retrospective study

Background

Hospitalized patients with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection are at risk of further clinical deterioration and poor outcome. In this study, clinical risk factors of the requirement of mechanical ventilation within the first 24 h of hospital admission in coronavirus disease 2019 pneumonia patients have been evaluated.

Methods

In this retrospective study, admission characteristics of SARS-CoV-2-infected patients and risk factors for requiring mechanical ventilation and death within 24 h of admission have been evaluated. Predictive ability was evaluated by area under the receiver operating characteristic (AUROC) curve and independent association was checked by a logistic regression model.

Results

One hundred and forty-three subjects were recruited in this study and the median (interquartile range) age of the included subjects was 51 (40-60) years, and 68.5% (98 of 143) patients were male. Subjects who required mechanical ventilation in the first 24 h of admission had higher baseline respiratory rate (P < 0.0001), lower oxyhemoglobin saturation (P < 0.0001), higher serum lactate (P < 0.0001), and higher percentage of subjects complained of shortness of breath at the time of presentation (P = 0.005) and higher sequential organ function assessment (SOFA) score (P < 0.001). Serum lactate, baseline respiratory rate, and oxyhemoglobin saturation were predictors of the requirement of mechanical ventilation with an AUROC (95% confidence interval) of 0.80 (0.72-0.88), 0.75 (0.66-0.84), and 0.77 (0.68-0.86), respectively. Logistic regression revealed that a model reported that baseline serum lactate (P < 0.001) and SOFA score (P < 0.001) were independent predictors of mechanical ventilation within 24 h of intensive care unit admission.

Conclusion

Baseline serum lactate level predicts early requirement of mechanical ventilation in adult subjects with SARS-CoV-2 infection even after adjustment of disease severity parameters, SOFA score.

Association of Abnormal Cardiac Biomarkers and Cardiovascular Complications, with Mortality in Patients with SARS-CoV-2 Infection in Latin America

BACKGROUND

The COVID-19 pandemic has highlighted a correlation between cardiac complications and elevated cardiac biomarkers, which are linked to poorer clinical outcomes.

OBJECTIVE

This study aims to determine the clinical impact of cardiac biomarkers in COVID-19 patients in Latin America.

SUBJECTS AND METHODS

The CARDIO COVID 19-20 Registry is a multicenter observational study across 44 hospitals in Latin America and the Caribbean. It included hospitalized COVID-19 patients (n = 476) who underwent troponin, natriuretic peptide, and D-dimer tests. Patients were grouped based on the number of positive biomarkers.

RESULTS

Among the 476 patients tested, 139 had one positive biomarker (Group C), 190 had two (Group B), 118 had three (Group A), and 29 had none (Group D). A directly proportional relationship was observed between the number of positive biomarkers and the incidence of decompensated heart failure. Similarly, there was a proportional relationship between the number of positive biomarkers and increased mortality. In Group B, patients with elevated troponin and natriuretic peptide and those with elevated troponin and D-dimer had 1.4 and 1.5 times higher mortality, respectively, than those with elevated natriuretic peptide and D-dimer.

CONCLUSIONS

In Latin American COVID-19 patients, a higher number of positive cardiac biomarkers is associated with increased cardiovascular complications and mortality. These findings suggest that cardiac biomarkers should be utilized to guide acute-phase treatment strategies.

Acceptance and Hesitancy Towards Covid-19 Vaccination Among Dialysis Patients in a Dialysis Center in Khartoum in 2022

Background

COVID-19, a highly infectious virus, poses significant risks, particularly for immuno-compromised individuals. Vaccination remains a key preventive measure, yet acceptance rates vary among populations globally.

Objective

This study aims to assess COVID-19 vaccine acceptance and hesitancy among dialysis patients atDr. Salma Center for Dialysis in 2022, highlighting the primary reasons for hesitancy within this vulnerable group.

Methods

A descriptive cross-sectional study was conducted at Dr. Salma Center in Khartoum, Sudan, in 2022. A systematic random sampling method was employed to select participants, who were interviewed using a structured questionnaire.

Results

Of a sample of 137 patients, 125 completed the questionnaire with 91.2% response rate. Approximately half of the respondents reported vaccine hesitancy 50%, with 77% acknowledging the severity of COVID-19 but only 53% advised vaccination among their peers. Primary concerns included vaccine side effects 24.8% and mistrust of production companies 10.4%. No significant associations were found between vaccine hesitancy and demographic factors.

Conclusion

The study reveals a notable prevalence of COVID-19 vaccine hesitancy among dialysis patients at Dr. Salma Center in Khartoum, 2022. Addressing this hesitancy requires concerted efforts to bridge the trust gap between patients and healthcare systems, coupled with targeted awareness campaigns to correct misinformation and reinforce confidence in vaccines.

Medication Use Among Pregnant Women With SARS-CoV-2 Infection and Risk of Hospitalization-A Study in Two Brazilian Hospitals

There is limited evidence about the use of medications among pregnant women with COVID-19, as well as risk factors for hospitalization due to COVID-19 in pregnancy. We aimed to describe the use of medications among SARS-CoV-2-positive pregnant women at the time around infection and identify predictors for hospitalization due to COVID-19 in two hospitals in Brazil. This is a hospital record-based study among pregnant women with positive SARS-CoV-2 tests between March 2020 and August 2022 from two Brazilian hospitals. Characteristics of sociodemographic, obstetrical, and COVID-19 symptoms were extracted retrospectively. The prevalence use of medications was based on self-reported use, and this was administered at the hospital. Logistic regression was used to estimate predictors of hospitalization due to COVID-19. There were 278 pregnant women included in the study, of which 41 (14.7%) required hospitalization due to COVID-19. The remaining 237 (85.3%) had mild symptoms or were asymptomatic. Most of the women had the infection in the third trimester (n = 149; 53.6%). The most prevalent medications used across all trimesters were analgesics (2.4% to 20.0%), antibacterials (15.0% to 23.1%), and corticosteroids (7.2% to 10.4%). Pre- or gestational hypertensive disorder (odds ratio (OR) 4.94, 95% confidence interval (CI) 1.65, 14.87) and having at least one dose of vaccine against SARS-CoV-2 (OR 0.13, 95% CI 0.04, 0.39) were associated with hospitalization due to COVID-19. Analgesics, antibacterials, and corticosteroids were the most frequently used medications among pregnant women with COVID-19. Women with hypertensive disorders have almost a five-fold increased risk of hospitalization due to COVID-19. Vaccination was the strongest protective factor for severe COVID-19. The COVID-19 vaccination among pregnant women should be promoted, and pregnant women diagnosed with COVID-19 who have hypertensive disorders should be closely monitored.

Diabetes and Infectious Diseases with a Focus on Melioidosis

Diabetes mellitus (DM) leads to impaired innate and adaptive immune responses. This renders individuals with DM highly susceptible to microbial infections such as COVID-19, tuberculosis and melioidosis. Melioidosis is a tropical disease caused by the bacterial pathogen Burkholderia pseudomallei, where diabetes is consistently reported as the most significant risk factor associated with the disease. Type-2 diabetes is observed in 39% of melioidosis patients where the risk of infection is 13-fold higher than non-diabetic individuals. B. pseudomallei is found in the environment and is an opportunistic pathogen in humans, often exhibiting severe clinical manifestations in immunocompromised patients. The pathophysiology of diabetes significantly affects the host immune responses that play a critical role in fighting the infection, such as leukocyte and neutrophil impairment, macrophage and monocyte inhibition and natural killer cell dysfunction. These defects result in delayed recruitment as well as activation of immune cells to target the invading B. pseudomallei. This provides an advantage for the pathogen to survive and adapt within the immunocompromised diabetic patients. Nevertheless, knowledge gaps on diabetes-infectious disease comorbidity, in particular, melioidosis-diabetes comorbidity, need to be filled to fully understand the dysfunctional host immune responses and adaptation of the pathogen under diabetic conditions to guide therapeutic options.

Clinical characteristics and outcomes of COVID-19 in children and adolescents with diabetes in Daegu, South Korea

PURPOSE

Children with comorbidities have a higher risk of severe, coronavirus disease 2019 (COVID-19). This study investigated the clinical features and outcomes of COVID-19 in children and adolescents with diabetes between January and March 2022.

METHODS

We retrospectively reviewed the medical records of 123 children and adolescents (73 with type 1 diabetes and 50 with type 2 diabetes, 59 males and 64 females) aged <18 years who had been diagnosed with diabetes. Data were collected from 7 academic medical centers in Daegu, South Korea.

RESULTS

Thirty-five children with diabetes were diagnosed with COVID-19 (18 with type 1 and 17 with type 2 diabetes). Eighteen of the 35 children with diabetes and COVID-19 and 50 of the 88 children with diabetes alone received a COVID-19 vaccination. No significant differences were observed between patients with diabetes and COVID-19 and patients with diabetes alone in the type of diabetes diagnosed, sex, age, body mass index, hemoglobin A1c, or vaccination status. All children with diabetes and COVID-19 had mild clinical features and were safely managed in their homes. Fourteen children had a fever of 38℃ or higher that lasted for more than 2 days, 11 of whom were not vaccinated (p=0.004). None experienced post-COVID-19 conditions.

CONCLUSION

All children and adolescents with pre-existing diabetes had mild symptoms of COVID-19 due to low disease severity, high vaccination rates, uninterrupted access to medical care, and continuous glucose monitoring. Unvaccinated children with diabetes who experienced COVID-19 presented with higher and more frequent fevers compared to vaccinated children.

The involvement of circulating miR-146a and miR-27a in patients with atherosclerotic cardiovascular disease after SARS-CoV-2 infection

BACKGROUND

Atherosclerotic cardiovascular disease (ASCVD) is a group of clinical diseases based on pathology of atherosclerosis that is the leading cause of mortality worldwide. There is a bidirectional interaction between ASCVD and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Alterations in circulating miRNAs levels are involved in the development of ASCVD in patients infected with SARS-CoV-2, however, the correlation between ASCVD co-infection with SARS-CoV-2 and alterations of cardiac-specific miRNAs is not well understood.

HYPOTHESIS

The circulating miR-146a and miR-27a are involved in bidirectional interactions between ASCVD and SARS-CoV-2 infections.

METHODS

Circulating miR-146a and miR-27a levels were measured in serum and PBMCs deriving from ASCVD patients and controls after SARS-CoV-2 infection by qRT-PCR analysis. The levels of neutralizing antibodies-resistant SARS-CoV-2 in human serum was determined by competitive magnetic particle chemiluminescence method. Interleukin (IL)-6 levels were detected by automatic biochemical analyzer using electrochemiluminescence.

RESULTS

Significant downregulation of circulating miR-146a and upregulation of miR-27a in ASCVD patients after infection with SARS-CoV-2 compared with controls were observed, among which the alterations were more evident in ASCVD patients comorbid with hyperlipidemia and diabetes mellitus. Consistently, correlation analysis revealed that serum miR-146a and miR-27a levels were associated with the levels of lipids and glucose, inflammatory response, and immune function in ASCVD patients. Remarkably, SARS-CoV-2 S protein RBD stimulation of PBMCs derived from both ASCVD and controls significantly downregulated miR-146a, upregulated miR-27a expression levels, and promoted IL-6 release in vitro.

CONCLUSIONS

The circulating miR-146a and miR-27a are involved in metabolism, inflammation, and immune levels in patients with ASCVD after SARS-CoV-2 infection, laying the foundation for the development of strategies to prevent the risk of SARS-CoV-2 infection in ASCVD patients.

Long-term Effects of COVID-19 on Vascular Parameters-A Prospective Longitudinal Ultrasound Clinical Study

Objective

To investigate the longitudinal effects of COVID-19 on major vascular structures and parameters and clinical outcomes.

Design

Observational prospective trial.

Setting

Post-COVID-19 research clinic established by University of Louisville Division of Infectious Diseases.

Participants

The study population consisted of 72 post-COVID-19 individuals and 11 non-COVID-19 infected participants in the control group. The participants were recruited from adult hospitals and from the community. The enrollment started in October 2020 and follow-up periods were at 3, 6, and 12 months from their initial COVID-19 diagnosis.

Interventions

The participants were interviewed for medical and COVID-19 infection history. Samples of white blood cell (WBC), C-reactive protein (CRP), and D-dimer were taken at each visit. Certified sonographers performed vascular ultrasound on the study participants.

Measurements and Main Results

Median intima-media thickness (IMT) was increased in mild/asymptomatic (0.80 mm) and severe/critical (0.90 mm) groups when compared with controls (0.60 mm; P < .001 for both groups). In the asymptomatic/mild group, 6-month median IMT (0.88 mm) was increased, compared with the 3-month group (0.75 mm), with P = .026. Increased age was associated with decreased mean arterial blood velocities (cm/s): common carotid (r = -0.236, P = .032), internal carotid (r = -0.208, P = .048), and subclavian artery mean velocity (r = -0.357, P = .003). We did not find any instance of deep vein thrombosis. Median D-dimer, CRP, and WBC in the control group differed from asymptomatic/mild COVID-19 group (P = .026, .011, and .003, respectively). Moreover, WBC in the asymptomatic/mild group and moderate COVID-19 group differed from severe/critical group (P = .025 and P = .027, respectively); CRP also differed between asymptomatic/mild group and severe/critical group (P = .014).

Conclusions

There were differences in intima-media lumen thickness (IMT), arterial velocities, and inflammatory markers in post-COVID-19 patients. There was no instance of deep vein thrombosis in this post-COVID-19 study cohort. The increased IMT might infer atherosclerosis, which has shown to increase cardiovascular risks. It is not yet known whether the increase in IMT due to COVID should be treated in the same way as non-COVID-19 atherosclerosis-through statins, for example-or whether regular cardiovascular risk reduction would be useful. Clinical trial and mechanistic studies should be performed to further our understanding of COVID-19-related vascular pathologies.

Association between olfactory dysfunction and COVID-19 severity: A prospective study in a highly complex hospital in Peru

INTRODUCTION

Olfactory dysfunction has been included among the early symptoms of coronavirus disease (COVID-19). Evidence suggests that a relationship exists between the duration of olfaction disorders and the probability of developing severe COVID-19. Given the scope of the COVID-19 pandemic, this study aimed to determine the frequency of smell alteration and its association with the severity of COVID-19 in a referral hospital in Peru, which is one of the most affected countries in the Latin American region.

MATERIALS AND METHODS

This study was an observational, prospective cohort study that included patients with COVID-19 who were treated at the Hospital Nacional Edgardo Rebagliati Martins from August to November 2020. To assess the association, the chi-square test of independence or Fisher's exact test was performed. The outcome variable was COVID-19 severity, and the exposure variable was olfactory dysfunction. The first data collection was in the emergency department and the follow-up was via telephone.

RESULTS

A total of 179 patients were included. The mean age was 61.6 ± 15.5 years, and 129 patients (72.1%) were male. Olfactory dysfunction was observed in 43 patients (24%). An inverse association was found between age and olfactory dysfunction (P = .002). No significant association was found between COVID-19 severity level and olfactory alteration (P = .056). However, a direct association was found between COVID-19 severity and age (P = .003), cough (P < .001), and respiratory distress (P = .003).

CONCLUSION

This study did not find any association between the severity of COVID-19 and olfactory dysfunction. It showed a low incidence rate of smell alteration compared with studies from other regions. Moreover, smell alteration was associated with younger age.

Prevalence of Obesity and its Effects in Patients With COVID-19: A Systematic Review and Meta-analysis

Background: Coronavirus disease 2019 (COVID-19) is an emerging infectious disease worldwide. Obesity has been proven to increase the susceptibility of an individual to infections, but the relationship between obesity and COVID-19 is still unclear. This study aimed to conduct a systematic review and meta-analysis of the prevalence of obesity and its effects in patients with COVID-19. Methods: Web of Science, PubMed and Embase were searched for English language studies up to May 22, 2020. We used a random or fixed-effects model to calculate pooled prevalence rates and odds ratio (OR) with 95% confidence intervals (CI). Results: Twelve studies with a total of 14 364 patients met the inclusion criteria. The pooled prevalence of obesity in patients with COVID-19 was 32.0% (95% CI, 26%-38%, P < .001). The prevalence of obesity in ICU COVID-19 patients were 37.0% (95% CI, 29%-46%, P < .001). Comparing between obese and non-obese patients, the meta-analysis showed that obesity was an important risk factor associated with COVID-19 patients needed for ICU care (OR: 1.36, 95% CI 1.22-1.52, P < .001). Conclusion: Obesity was highly prevalent (32.0%) in patients with COVID-19, especially in ICU patients (37.0%), and was an important risk factor for COVID-19 patients needed for ICU care.

Perturbations of the T-cell receptor repertoire in response to SARS-CoV-2 in immunocompetent and immunocompromised individuals

BACKGROUND

Functional T-cell responses are essential for virus clearance and long-term protection after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, whereas certain clinical factors, such as older age and immunocompromise, are associated with worse outcome.

OBJECTIVE

We sought to study the breadth and magnitude of T-cell responses in patients with coronavirus disease 2019 (COVID-19) and in individuals with inborn errors of immunity (IEIs) who had received COVID-19 mRNA vaccine.

METHODS

Using high-throughput sequencing and bioinformatics tools to characterize the T-cell receptor β repertoire signatures in 540 individuals after SARS-CoV-2 infection, 31 IEI recipients of COVID-19 mRNA vaccine, and healthy controls, we quantified HLA class I- and class II-restricted SARS-CoV-2-specific responses and also identified several HLA allele-clonotype motif associations in patients with COVID-19, including a subcohort of anti-type 1 interferon (IFN-1)-positive patients.

RESULTS

Our analysis revealed that elderly patients with COVID-19 with critical disease manifested lower SARS-CoV-2 T-cell clonotype diversity as well as T-cell responses with reduced magnitude, whereas the SARS-CoV-2-specific clonotypes targeted a broad range of HLA class I- and class II-restricted epitopes across the viral proteome. The presence of anti-IFN-I antibodies was associated with certain HLA alleles. Finally, COVID-19 mRNA immunization induced an increase in the breadth of SARS-CoV-2-specific clonotypes in patients with IEIs, including those who had failed to seroconvert.

CONCLUSIONS

Elderly individuals have impaired capacity to develop broad and sustained T-cell responses after SARS-CoV-2 infection. Genetic factors may play a role in the production of anti-IFN-1 antibodies. COVID-19 mRNA vaccines are effective in inducing T-cell responses in patients with IEIs.

Clinical outcomes in patients with diabetes and stress hyperglycemia that developed SARS-CoV-2 infection

INTRODUCTION

Diabetes and stress hyperglycemia have been related with poorer clinical outcomes in patients infected by SARS-CoV-2 and at risk for severe disease.

OBJECTIVE

To evaluate clinical outcomes in three groups of patients (with diabetes, without diabetes and with stress hyperglycemia) with SARS-CoV-2 infection.

MATERIALS AND METHODS

A retrospective cohort study was conducted in Cali (Colombia). We included patients 18 years old or older with a diagnosis of SARS-CoV-2 infection, managed in the emergency room, hospitalization, or intensive care unit between March 2020 and December 2021. Immunocompromised patients and pregnant women were excluded. Patients were classified into three groups: without diabetes, with diabetes, and with stress hyperglycemia. A comparison between the groups was performed.

RESULTS

A total of 945 patients were included (59.6% without diabetes, 27% with diabetes, and 13.4% with stress hyperglycemia). Fifty-five-point three percent required intensive care unit management, with a higher need in patients with stress hyperglycemia (89.8%) and diabetes (67.1%), with no difference between these groups (p = 0.249). We identified a higher probability of death in the group with stress hyperglycemia versus the one without diabetes (adjusted OR = 8.12; 95% CI: 5.12-12.88; p < 0.01). Frequency of acute respiratory distress syndrome, need for invasive mechanical ventilation, use of vasopressors and inotropes, need for de novo renal replacement therapy, and mortality was higher in patients with metabolic alterations (diabetes and stress hyperglycemia).

CONCLUSIONS

Diabetes and stress hyperglycemia were associated with worse clinical outcomes and mortality in patients with COVID-19. These patients should be identified early and considered them high risk at the COVID-19 diagnosis to mitigate adverse outcomes.

Using a general practice research database to assess the spatio-temporal COVID-19 risk

BACKGROUND

In Flanders, general practitioners (GPs) were among the first ones to collect data regarding COVID-19 cases. Intego is a GPs' morbidity registry in primary care with data collected from the electronic medical records from a sample of general practices. The Intego database contain elaborate information regarding patient characteristics, such as comorbidities. At the national level, the Belgian Public Health Institute (Sciensano) recorded all test-confirmed COVID-19 cases, but without other patient characteristics.

METHODS

Spatio and spatio-temporal analyses were used to analyse the spread of COVID-19 incidence at two levels of spatial aggregation: the municipality and the health sector levels. Our study goal was to compare spatio-temporal modelling results based on the Intego and Sciensano data, in order to see whether the Intego database is capable of detecting epidemiological trends similar to those in the Sciensano data. Comparable results would allow researchers to use these Intego data, and their wealth of patient information, to model COVID-19-related processes.

RESULTS

The two data sources provided comparable results. Being a male decreased the odds of having COVID-19 disease. The odds for the age categories (17,35], (35,65] and (65,110] of being a confirmed COVID-19 case were significantly higher than the odds for the age category [0,17]. In the Intego data, having one of the following comorbidities, i.e., chronic kidney disease, heart and vascular disease, and diabetes, was significantly associated with being a COVID-19 case, increasing the odds of being diagnosed with COVID-19.

CONCLUSION

We were able to show how an alternative data source, the Intego data, can be used in a pandemic situation. We consider our findings useful for public health officials who plan intervention strategies aimed at monitor and control disease outbreaks such as that of COVID-19.

Clinical Course and Factors Associated With Hospital Admission and Mortality among Sars-Cov 2 Patients within Nairobi Metropolitan Area

This study aims to investigate the clinical course and factors associated with hospital admission and mortality among SARS-CoV-2 patients within the Nairobi Metropolitan Area. The study utilizes a multicenter retrospective cohort design, collecting clinical characteristics and laboratory parameters of hospitalized patients from March 2020 to May 2022. Data analysis includes percentages, frequencies, chi-square tests, Kaplan-Meier analysis, pairwise comparisons, and multivariate regression models. Ethical considerations are observed throughout the research process. The study findings highlight significant associations between comorbidities, such as hypertension, and increased mortality risk due to COVID-19. Symptoms including fever, cough, dyspnea, chest pain, sore throat, and loss of smell/taste are also identified as predictors of mortality. Abnormal laboratory parameters, such as oxygen saturation, procalcitonin, glucose levels, serum creatinine, and gamma-glutamyl transpeptidase, are associated with mortality. However, demographic factors and certain vital signs do not exhibit significant associations. Recommendations based on this study suggest increased monitoring and management of comorbidities, early identification and management of symptoms, regular monitoring of laboratory parameters, continued research and collaboration, and implementation of preventive measures. Overall, a multidisciplinary approach involving healthcare professionals, researchers, policymakers, and the public is crucial to improve COVID-19 outcomes and reduce mortality rates. Adaptation of strategies based on emerging evidence and resource allocation is essential for effective management of the pandemic.

Air pollution and its effects on lung health in never-smoker youth of Delhi NCR versus Pauri Garhwal: a comparative cross-sectional study

Background

Ambient air pollution is a major factor that can affect lung growth and reduce lung capacity. This study aims at drawing parallel between respiratory discomfort and lung function between youth of Delhi-National Capital Region (NCR) where air pollution level is poor and hazardous as compared to that of Pauri Garhwal (Uttarakhand) where air pollution level is low via a comparative cross-sectional study.

Methods

A community-based cross-sectional study conducted among 354 never-smoker subjects (177 from NCR and 177 from Pauri) between the ages of 15 and 29 years. Pulmonary Function Test coupled with COPD Assessment Test (CAT)-based questionnaire for respiratory problems helped elicit information regarding lung health of subjects.

Results

Mean forced vital capacity (FVC), forced expiratory volume in 1st second (FEV1), forced expiratory flow 25-75%, FEV1/FVC ratio, and peak expiratory flow rate were lower by 12.9%, 17%, 5%, 7.8%, and 7.3%, respectively, in NCR participants as compared to that of Pauri. Upon spirometry, restrictive pattern was present in 40 (22.6%), and obstructive pattern was present in 9 (5.1%) of NCR participants. Out of these, nine (5.1%) having obstructive pattern, five (55.6%) had 50% ≤ FEV1<80%, and four (44.4%) had 30% ≤ FEV1<50% of predicted value. Neither restrictive nor obstructive pattern was found evident in subjects from Pauri. The mean CAT score in subjects from NCR was 5.2 ± 4.9 and .46 ± 1.1 in subjects from Pauri.

Conclusion

Subjects belonging to NCR performed poorly in spirometry and reported higher respiratory complaints in comparison to participants from Pauri Garhwal.

Characteristics, Outcomes, and Associations of Venous Thromboembolism in Diabetic Patients Infected With COVID-19 in Riyadh, Saudi Arabia

Background The associations and risk factors for venous thromboembolism (VTE) among hospitalized COVID-19 patients remain ambiguous in the literature, with some conflicting findings, especially in Saudi Arabia. In this study, we aim to elaborate on these data by examining regional patient populations and exploring the incidence, lab findings, and outcomes of VTE among hospitalized COVID-19 patients known to have diabetes mellitus (DM). Methodology This cross-sectional study was conducted at King Abdulaziz Medical City in Riyadh. The BestCare system was used to collect patients' data between September 2020 and February 2022. JMP15 was used for data analysis. Frequencies and percentages were used for categorical data, and median and interquartile ranges were used for quantitative data. The chi-square and Kruskal-Wallis rank-sum tests were used to assess the difference between categorical and quantitative variables, respectively. Nominal logistical regression was used to assess diabetes as a risk factor for developing VTE among COVID-19 patients. Results Data from 153 admitted patients were collected after they satisfied the inclusion criteria. Of these patients, 39 (25.49%) developed VTE. The demographic data included age group, gender, and DM status presented as frequencies and percentages. Through bivariate analysis, patients with longer hospital stays had at least one episode of VTE (p = 0.0072). Using nominal logistic regression analysis, diabetes as a risk factor (odds ratio = 4.11, confidence interval = 0.955-5.05, p = 0.0287) was significantly associated with the development of VTE in COVID-19 patients. Conclusions Based on our study, diabetes proved significant when evaluating the possible factors regarding VTE development in COVID-19 patients. In addition, the length of stay also played a critical role in the severity of VTE in COVID-19 patients. Similar studies should be conducted on a national scale in Saudi Arabia to accomplish two goals: first, to gain further understanding of the impact of the variables investigated in our population, and second, to publish data that are more generalizable to the larger population of Saudi Arabia.

Prevalence of Hypertension and Diabetes in Severe COVID-19: A Cross-Sectional Study from Single Center, Kabul

Introduction

Previous studies have reported an association between certain medical conditions, such as hypertension and diabetes, and severe COVID-19.

Objective

To determine the prevalence of hypertension and diabetes among severe COVID-19 patients who were admitted to the only specialized center for COVID-19 in Kabul, Afghan-Japan Hospital Kabul, Afghanistan.

Methods

A cross-sectional design was utilized, including 202 patients, admitted to Afghan-Japan Hospital during the first six months of 2022. Medical records of patients tested positive for COVID-19 via Polymerase chain reaction (PCR) with oxygen saturation levels below 90% at the time of admission were included in the study. Age, sex, and the presence of hypertension and diabetes were the studied variables. Descriptive statistics were used for analysis.

Results

The median age of the patients were 63 (IQR=54.75-75) years. Males and females each accounting for 50% of the total, and the majority of the patients (50.5%) were in the age group 60-79. Of 202 patients, 143 (70.8%) had hypertension, 42 (20.8%) had diabetes, 147 patients (72.77%) had at least one of these comorbidities. Fifty-five patients (27.22%) were without diabetes and without hypertension. The prevalence of hypertension and diabetes was higher among female, ie, 57.1% and 54.5% respectively. Patients in the 40-59 year old group had the highest rate of hypertension (75.6%). The highest prevalence of diabetes was seen in the 60-79 year old group.

Conclusion

The study found a higher prevalence of hypertension in severe COVID-19 cases compared to global reports and the general adult population in Afghanistan. The relationship between hypertension and COVID-19 risk needs further investigation. The prevalence of diabetes was also higher, consistent with findings from other countries.