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Mobeireek A, AlSaleh S, Ezzat L, Al-Saghier O, Al-Amro S, Al-Jebreen A, Torchyan A, AlHajji M, Ahmed L. Risk factors for intensive care admission in patients with COVID-19 pneumonia: A retrospective study. J Infect Public Health 2023; 16:1230-1235. [PMID: 37276717 DOI: 10.1016/j.jiph.2023.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 05/11/2023] [Accepted: 05/22/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19)-associated mortality is predominantly due to respiratory failure. However, risk factors and predictive models for disease progression in patients with COVID-19 are not consistent across the globe. In this study, we aimed to assess the risk factors associated with intensive care (ICU) admission and mortality in patients with COVID-19 pneumonia. METHODS Information was retrieved from the database of all patients admitted with COVID-19 pneumonia between March 2020 and July 2020 at a tertiary care center in Saudi Arabia. The patients' demographic, clinical, laboratory and radiological characteristics were analyzed. RESULTS Of 1054 patients admitted with PCR proven COVID-19, 254 patients (24%) with radiological evidence of pneumonia were enrolled. The median age was 55, with 25.6% above 65 years and 55.1% males. The comorbidities included hypertension (45%), diabetes (43%), dyslipidemia (24%), solid organ and bone marrow transplantation (14.5%), malignancy (13.4%), ischemic heart disease (10.6%) and chronic kidney disease (9.4%). The mortality rate was 4.7%, and 22.8% were admitted to the ICU. The risk factors for ICU admission were> 65 years of age (RR: 1.74, CI 95%, 1.10-2.74, p = 0.017), diabetes melitus (RR: 1.66, CI 95% 1.06-2.62, p = 0.028), heart failure (RR: 2.51, CI 95%, 1.28-4.93, p = 0.007), respiratory rate> 25 (RR: 2.75, CI 95%, 1.66-4.55, p < 0.001), upper lobe involvement (RR: 1.68, CI 95%, 1.02-2.77, p = 0.043), and C-reactive protein (CRP)> 140 (RR: 1.89, CI 95%, 1.14-3.13, p = 0.013). The risk factors for mortality were> 65 years of age (RR: 5.82, CI 95%, 1.81-18.68, p = 0.003), upper lobe involvement on chest radiography (RR:4.40, CI 95%, 1.22-15.86, p = 0.016), diffuse chest computed tomography changes (RR: 7.36, CI 95%, 2.31-23.46, p < 0.011), ischemic heart disease (RR: 4.20, CI 95%, 1.36-13.04, p = 0.028), chronic kidney disease (RR: 6.85, CI 95%, 2.35-19.90, p < 0.003), cerebrovascular disease (RR:13.61, CI 95%, 5.01-36.96 p < 0.001), respiratory rate> 25 (RR: 3.94, CI 95%, 1.32-11.78 p = 0.023), oxygen saturation< 90% on admission (RR: 12.19, CI 95%, 3.71-40.01, p < 0.001), thrombocytopenia (RR:4.16, CI 95%, 1.37-12.64, p = 0.013), and elevated troponin (RR: 6.20, CI 95%, 1.73-22.24, p = 0.003). CONCLUSIONS In this study, nearly a quarter of the patients with COVID-19 pneumonia required intensive care. We identified several risk factors associated with ICU admission and mortality that may be useful for predicting, triaging, and managing COVID-19 pneumonia patients. However, these findings need to be validated prospectively.
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Affiliation(s)
- Abdullah Mobeireek
- Department of Medicine, King Faisal Specialist Hospital and Resaerch Centre, Riyadh, Saudi Arabia; Alfaisal University, College of Medicine, Riyadh, Saudi Arabia,.
| | - Saud AlSaleh
- Department of Medicine, King Faisal Specialist Hospital and Resaerch Centre, Riyadh, Saudi Arabia
| | - Loui Ezzat
- Department of Medicine, King Faisal Specialist Hospital and Resaerch Centre, Riyadh, Saudi Arabia
| | - Osama Al-Saghier
- Department of Medicine, King Faisal Specialist Hospital and Resaerch Centre, Riyadh, Saudi Arabia
| | - Sultan Al-Amro
- Department of Radiology, King Faisal Specialist Hospital and Resaerch Centre, Riyadh, Saudi Arabia
| | - Abdulla Al-Jebreen
- Department of Radiology, King Faisal Specialist Hospital and Resaerch Centre, Riyadh, Saudi Arabia
| | - Armen Torchyan
- Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammed AlHajji
- Department of Medicine, King Faisal Specialist Hospital and Resaerch Centre, Riyadh, Saudi Arabia; Alfaisal University, College of Medicine, Riyadh, Saudi Arabia
| | - Liju Ahmed
- Department of Medicine, King Faisal Specialist Hospital and Resaerch Centre, Madinah Al-Munawwarah, Saudi Arabia
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Muaygil R, Aldekhyyel R, AlWatban L, Almana L, Almana RF, Barry M. Ethical uncertainty and COVID-19: exploring the lived experiences of senior physicians at a major medical centre. JOURNAL OF MEDICAL ETHICS 2023; 49:275-282. [PMID: 36600609 DOI: 10.1136/jme-2022-108369] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
Given the wide-reaching and detrimental impact of COVID-19, its strain on healthcare resources, and the urgent need for-sometimes forced-public health interventions, thorough examination of the ethical issues brought to light by the pandemic is especially warranted. This paper aims to identify some of the complex moral dilemmas faced by senior physicians at a major medical centre in Saudi Arabia, in an effort to gain a better understanding of how they navigated ethical uncertainty during a time of crisis. This qualitative study uses a semistructured interview approach and reports the findings of 16 interviews. The study finds that participants were motivated by a profession-based moral obligation to provide care during the toughest and most uncertain times of the pandemic. Although participants described significant moral dilemmas during their practice, very few identified challenges as ethical in nature, and in turn, none sought formal ethics support. Rather, participants took on the burden of resolving ethical challenges themselves-whenever possible-rationalising oft fraught decisions by likening their experiences to wartime action or by minimising attention to the moral. In capturing these accounts, this paper ultimately contemplates what moral lessons can, and must be, learnt from this experience.
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Affiliation(s)
- Ruaim Muaygil
- Department of Medical Education, The College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Raniah Aldekhyyel
- Department of Medical Education, The College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Lemmese AlWatban
- Department of Family and Community Medicine, The College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Lyan Almana
- The College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Rana F Almana
- Department of Pediatrics, King Abdullah Specialized Children's Hospital, Riyadh, Saudi Arabia
| | - Mazin Barry
- Infectious Diseases Unit, Department of Internal Medicine, The College of Medicine, King Saud University, Riyadh, Saudi Arabia
- Division of Infectious Diseases, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Intensive Care and Organ Support Related Mortality in Patients With COVID-19: A Systematic Review and Meta-Analysis. Crit Care Explor 2023; 5:e0876. [PMID: 36890875 PMCID: PMC9988289 DOI: 10.1097/cce.0000000000000876] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
To perform a systematic review and meta-analysis to generate estimates of mortality in patients with COVID-19 that required hospitalization, ICU admission, and organ support. DATA SOURCES A systematic search of PubMed, Embase, and the Cochrane databases was conducted up to December 31, 2021. STUDY SELECTION Previously peer-reviewed observational studies that reported ICU, mechanical ventilation (MV), renal replacement therapy (RRT) or extracorporeal membrane oxygenation (ECMO)-related mortality among greater than or equal to 100 individual patients. DATA EXTRACTION Random-effects meta-analysis was used to generate pooled estimates of case fatality rates (CFRs) for in-hospital, ICU, MV, RRT, and ECMO-related mortality. ICU-related mortality was additionally analyzed by the study country of origin. Sensitivity analyses of CFR were assessed based on completeness of follow-up data, by year, and when only studies judged to be of high quality were included. DATA SYNTHESIS One hundred fifty-seven studies evaluating 948,309 patients were included. The CFR for in-hospital mortality, ICU mortality, MV, RRT, and ECMO were 25.9% (95% CI: 24.0-27.8%), 37.3% (95% CI: 34.6-40.1%), 51.6% (95% CI: 46.1-57.0%), 66.1% (95% CI: 59.7-72.2%), and 58.0% (95% CI: 46.9-68.9%), respectively. MV (52.7%, 95% CI: 47.5-58.0% vs 31.3%, 95% CI: 16.1-48.9%; p = 0.023) and RRT-related mortality (66.7%, 95% CI: 60.1-73.0% vs 50.3%, 95% CI: 42.4-58.2%; p = 0.003) decreased from 2020 to 2021. CONCLUSIONS We present updated estimates of CFR for patients hospitalized and requiring intensive care for the management of COVID-19. Although mortality remain high and varies considerably worldwide, we found the CFR in patients supported with MV significantly improved since 2020.
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Adekanmbi O, Ilesanmi O, Idowu O, Esan A, Raji YR, Fowotade A, Ogunlade O, Akere A, Ololade O, Ojifinni K, Akinola O, Orunmuyi A, Eze U, Akinmoladun V, Adeoye A, Adebiyi A, Olapade-Olaopa EO, Otegbayo JA, Osungbade K. Characteristics and outcomes of patients hospitalized with COVID-19 at a tertiary hospital in Nigeria. Afr Health Sci 2023; 23:72-82. [PMID: 37545917 PMCID: PMC10398429 DOI: 10.4314/ahs.v23i1.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
Background Data regarding the features and outcomes of hospitalized COVID-19 patients in Africa are increasingly available. Objectives To describe socio-demographic, clinical and laboratory characteristics and outcomes of COVID-19 patients. Methods A cross-sectional study of 86 adult patients hospitalized with COVID-19 between March and November 2020. Characteristics were described in survivors and non-survivors. Results Mean age was 60.9±16.1 years, 53(61.6%) were male. Co-morbidities were found in 77(89.5%) patients. On severity, 6(7%) were mild, 23(26.7%) moderate, 51(59.3%) severe and 6(7%) critical. Oxygen saturation and respiratory rate were 71±22% and 38±11/minute in non-survivors and 90±7% and 31±7/minute in survivors respectively (p<0.001, p<0.001)). Overall mortality was 47.7% with no death among patients with mild disease and deaths in all patients with critical disease. Duration of hospitalization was 2.0(1.0-4.5) days in those who died and 12(7.0-15.0) days in those who survived (p<0.001). Of the 42 patients that received dexamethasone, 11(26.2%) died, while 31(73.8%) survived (p=<0.001). Conclusion Most of the patients had co-morbidities and there was high mortality in patients with severe and critical COVID-19. Mean oxygen saturation was low and respiratory rate high overall. Factors associated with mortality included: Significantly greater hypoxia and tachypnea, less dexamethasone use and shorter hospitalization.
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Affiliation(s)
- Olukemi Adekanmbi
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Olayinka Ilesanmi
- Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Community Medicine, University College Hospital, Ibadan, Nigeria
| | - Olusola Idowu
- Department of Anaesthesia, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Anaesthesia, University College Hospital, Ibadan, Nigeria
| | - Arinola Esan
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Yemi R Raji
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Adeola Fowotade
- Department of Medical Microbiology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Olubunmi Ogunlade
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Adegboyega Akere
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Oluwaseun Ololade
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Kehinde Ojifinni
- Department of Emergency Medicine, University College Hospital, Ibadan, Nigeria
| | - Olurotimi Akinola
- Department of Emergency Medicine, University College Hospital, Ibadan, Nigeria
| | - Akintunde Orunmuyi
- Department of Nuclear Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Uwom Eze
- Department of Pathology, University College Hospital, Ibadan, Nigeria
| | - Victor Akinmoladun
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Ibadan
- Department of Oral and Maxillofacial Surgery, University College Hospital, Ibadan
| | - Abiodun Adeoye
- Department of Medicine, University College Hospital, Ibadan, Nigeria
- Institute of Cardiovascular Disease, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Akindele Adebiyi
- Department of Community Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Community Medicine, University College Hospital, Ibadan, Nigeria
| | - E Oluwabunmi Olapade-Olaopa
- Department of Surgery, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Surgery, University College Hospital, Ibadan, Nigeria
| | - Jesse A Otegbayo
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Kayode Osungbade
- Department of Health Policy and Management, College of Medicine, University of Ibadan, Ibadan
- Disease Surveillance Unit, University College Hospital, Ibadan, Nigeria
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Shatizadeh Malekshahi S, Farahmand M, Choobin H. SARS-CoV-2 Related Viral Respiratory Co-Infections: A Narrative Review. TANAFFOS 2023; 22:19-26. [PMID: 37920316 PMCID: PMC10618585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 09/05/2022] [Indexed: 11/04/2023]
Abstract
Background Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is the new coronavirus originating from Wuhan, China, responsible for the illness known as coronavirus disease 2019 (COVID-19). Early experience and the recent literature have shown that co-infection of SARS-CoV-2 with another respiratory virus might occur. Similar symptoms of acute respiratory infections (ARIs) and COVID-19 represent a challenge for diagnostic and therapeutic efficacy and may modify COVID-19 outcomes. Materials and Methods We reviewed the literature on the epidemic pattern and major learning points on important aspects of SARS-CoV-2-related viral respiratory co-infections during the COVID-19 pandemic. Databases such as PubMed, Scopus, Science Direct, and Google Scholar were used to conduct a comprehensive search. Results The circulation of respiratory viruses changed as the COVID-19 epidemic continues. Phenomena like viral interference, resource competition, and differences in virus-host range might explain why simultaneous viral respiratory infections have seemed to vanish with the spread of SARS-CoV-2. Conclusion Key research to be conducted during this pandemic should include the simultaneous screening of other respiratory pathogens with many available commercial platforms for transmission containment and appropriate clinical management.
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Affiliation(s)
| | - Mohammad Farahmand
- Research Center for Emergency and Disaster Resilience, Red Crescent Society of the Islamic Republic of Iran, Tehran, Iran
| | - Hamzeh Choobin
- Department of Virology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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Uzun G, Althaus K, Hammer S, Bakchoul T. Assessment and Monitoring of Coagulation in Patients with COVID-19: A Review of Current Literature. Hamostaseologie 2022; 42:409-419. [PMID: 35477118 DOI: 10.1055/a-1755-8676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Coagulation abnormalities are common in patients with COVID-19 and associated with high morbidity and mortality. It became a daily challenge to navigate through these abnormal laboratory findings and deliver the best possible treatment to the patients. The unique character of COVID-19-induced coagulopathy necessitates not only a dynamic follow-up of the patients in terms of hemostatic findings but also the introduction of new diagnostic methods to determine the overall function of the coagulation system in real time. After the recognition of the high risk of thromboembolism in COVID-19, several professional societies published their recommendations regarding anticoagulation in patients with COVID-19. This review summarizes common hemostatic findings in COVID-19 patients and presents the societal recommendations regarding the use of coagulation laboratory findings in clinical decision-making. Although several studies have investigated coagulation parameters in patients with COVID-19, the methodological shortcomings of published studies as well as the differences in employed anticoagulation regimens that have changed over time, depending on national and international guidelines, limit the applicability of these findings in other clinical settings. Accordingly, evidence-based recommendations for diagnostics during acute COVID-19 infection are still lacking. Future studies should verify the role of coagulation parameters as well as viscoelastic methods in the management of patients with COVID-19.
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Affiliation(s)
- Günalp Uzun
- Center for Clinical Transfusion Medicine, University Hospital of Tuebingen, Tuebingen, Germany
| | - Karina Althaus
- Center for Clinical Transfusion Medicine, University Hospital of Tuebingen, Tuebingen, Germany.,Medical Faculty of Tuebingen, Institute for Clinical and Experimental Transfusion Medicine, Tuebingen, Germany
| | - Stefanie Hammer
- Center for Clinical Transfusion Medicine, University Hospital of Tuebingen, Tuebingen, Germany
| | - Tamam Bakchoul
- Center for Clinical Transfusion Medicine, University Hospital of Tuebingen, Tuebingen, Germany.,Medical Faculty of Tuebingen, Institute for Clinical and Experimental Transfusion Medicine, Tuebingen, Germany
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Bokhary DH, Bokhary NH, Seadawi LE, Moafa AM, Khairallah HH, Bakhsh A. Features and Outcomes of Confirmed COVID-19 Patients Presenting to the Emergency Department. Cureus 2022; 14:e25438. [PMID: 35774706 PMCID: PMC9237637 DOI: 10.7759/cureus.25438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2022] [Indexed: 12/15/2022] Open
Abstract
Objective This study is aimed to determine whether there is a correlation between demographic characteristics, symptoms, initial vital signs, laboratory findings, and clinical outcome(s) of patients with coronavirus disease 2019 (COVID-19). Methods This descriptive, single-center study retrospectively reviewed data from the medical records of patients confirmed with COVID-19 in a tertiary academic center in Jeddah, Saudi Arabia, between March and June 2020. Results The present study enrolled 1039 patients (mean age ± SD, 45.16 ± 19.33 years) suffering from COVID-19, of whom 60.9% were not known to have any medical illnesses. The most common comorbidity was cardiovascular disease (27.8%). Patients with advanced age (p < 0.001), cardiovascular disease (p < 0.001), diabetes mellitus (p = 0.003), asthma (p = 0.008), renal disease (p = 0.020), fever (p = 0.002), dyspnea (p < 0.001), tachypnea (p < 0.001), low albumin (p < 0.001), low alkaline phosphatase levels (p = 0.008), high C-reactive protein (p = 0.003), high fibrinogen (p = 0.047), and high lactate levels (p = 0.015) were more likely to be admitted. Conclusions Patients with increased age, multiple comorbidities, and unstable initial vital signs at emergency department presentation experienced a more severe course of COVID-19 and required admission.
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Alghamdi S. Clinical characteristics and treatment outcomes of severe (ICU) COVID-19 patients in Saudi Arabia: A single centre study. Saudi Pharm J 2021; 29:1096-1101. [PMID: 34366685 PMCID: PMC8332927 DOI: 10.1016/j.jsps.2021.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 08/01/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND There is limited information describing the presenting features and treatment outcomes of intensive care unit (ICU) patients with coronavirus disease 2019 (COVID-19) in Saudi Arabia. OBJECTIVE To investigates the clinical, epidemiological, laboratory, radiological, vital signs and treatment characteristics/outcomes of severe (ICU) COVID-19 patients in Albaha region, Saudi Arabia. METHODS A retrospective cohort study was conducted from 01 April 2020 to 31 August 2020 involving files review of 171 patients admitted to the ICU of a COVID-19 treatment centre as a result of severe symptoms. RESULTS Around a third of the ICU patients admitted were over 66 years of age, 59.6% males, 45% diabetics, 39% hypertensive, 25.7% smokers. Patients had symptoms such as 79% fever, 78% cough, 75% headache, 59% sore throat, 57% runny nose, and 75% cough. More than half of the patients had <90% oxygen saturation. Bilateral infiltration was present in about 43% of patients. 85.4% lymphopenia, and 70.8% D-dimer (>0.5 u/ml) were the most significant laboratory results. The median stay in the hospital ranged from 4 to 15.6 days, and the ICU time ranged from 4 to 12.7 days. Approximately 29% of patients received antiviral, antimalarial, and antibiotic treatment, while 27.5% of patients received antibiotics and antimalarial therapy alone. Incorporating hydroxychloroquine in treatment protocols did not improve patients' outcomes. CONCLUSIONS Older age and cardio-metabolic comorbidities increase the risks of sever COVID-19. Different treatment protocols fail to improve mortality rates and urgent efforts are required to prevent the disease and reduce its severity.
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Affiliation(s)
- Saleh Alghamdi
- Department of Clinical Pharmacy, Faculty of Clinical Pharmacy, Albaha University, Albaha, Saudi Arabia
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Graphical Trajectory Comparison to Identify Errors in Data of COVID-19: A Cross-Country Analysis. J Pers Med 2021; 11:jpm11100955. [PMID: 34683095 PMCID: PMC8537769 DOI: 10.3390/jpm11100955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/20/2021] [Accepted: 09/23/2021] [Indexed: 11/17/2022] Open
Abstract
Data from the early stage of a novel infectious disease outbreak provide vital information in risk assessment, prediction, and precise disease management. Since the first reported case of COVID-19, the pattern of the novel coronavirus transmission in Wuhan has become the interest of researchers in epidemiology and public health. To thoroughly map the mechanism of viral spreading, we used the patterns of data at the early onset of COVID-19 from seven countries to estimate the time lag between peak days of cases and deaths. This study compared these data with those of Wuhan and estimated the natural history of disease across the infected population and the time lag. The findings suggest that comparative analyses of data from different regions and countries reveal the differences between peaks of cases and deaths caused by COVID-19 and the incomplete and underestimated cases in Wuhan. Different countries may show different patterns of cases peak days, deaths peak days, and peak periods. Error in the early COVID-19 statistics in Brazil was identified. This study provides sound evidence for policymakers to understand the local circumstances in diagnosing the health of a population and propose precise and timely public health interventions to control and prevent infectious diseases.
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Bloodstream Infections in Hospitalized Patients with COVID-19: A Systematic Review and Meta-Analysis. Microorganisms 2021; 9:microorganisms9102016. [PMID: 34683337 PMCID: PMC8540195 DOI: 10.3390/microorganisms9102016] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 09/21/2021] [Accepted: 09/22/2021] [Indexed: 01/16/2023] Open
Abstract
Background: Little is known about the occurrence of bloodstream infections in hospitalized patients with COVID-19 and the related clinical consequences. The aim of this systematic review and meta-analysis was to estimate the pooled occurrence of BSIs among hospitalized patients with COVID-19 and mortality of this patient population. Methods: A systematic search was performed on PubMed, EMBASE, and Web of Science from inception to 19 April 2021. The primary outcome was the occurrence of BSIs among hospitalized patients with COVID-19. The secondary outcome was mortality at the longest available follow-up. Results: Forty-six studies met the inclusion criteria, with a total of 42,694 patients evaluated. The estimated occurrence of BSIs was 7.3% (95% CI 4.7–1.1%) among hospitalized patients with COVID-19, with a mortality rate of 41% (95% CI 30%–52.8%). The subgroup analysis conducted on patients admitted to ICU provided an estimated occurrence of 29.6% (95% CI 21.7%–38.8%). A higher occurrence of BSI was observed in patients with COVID-19, in comparison with patients without COVID-19 (OR 2.77; 95% CI 1.53–5.02; p < 0.001). Conclusions: Our analysis estimated the occurrence of BSIs among hospitalized patients with COVID-19 at around 7%. A four-times higher occurrence was estimated among patients admitted to ICU.
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Barry M, Robert AA, Temsah MH, Abdul Bari S, Akhtar MY, Al Nahdi F, Erlandez R, Al-Tawfiq JA, Al Khushail A, Al Hebaishi Y. COVID-19 Community Transmission among Healthcare Workers at a Tertiary Care Cardiac Center. Med Sci (Basel) 2021; 9:medsci9030049. [PMID: 34209161 PMCID: PMC8293443 DOI: 10.3390/medsci9030049] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 06/09/2021] [Accepted: 06/22/2021] [Indexed: 01/21/2023] Open
Abstract
Aim: To determine the frequency, mode of transmission, and outcome of Coronavirus Disease 2019 (COVID-19) among healthcare workers (HCWs) in a tertiary care cardiac center in the Kingdom of Saudi Arabia (KSA). Methods: This is a retrospective study of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infected HCWs and was conducted from 2 March to 31 December 2020. Data related to the presence of COVID-19 symptoms, mode of transmission, hospitalization, and mortality were collected from the patients’ medical records. Results: Of the 4462 patients tested for COVID-19 by real-time reverse transcriptase polymerase chain reaction (RT-PCR), 203 (4.5%) HCWs were positive; of these, 125 (61.6%) were males, and the most common age group was <40 years. The most commonly encountered health professionals were nurses (74, 36.4%), followed by therapists/technicians (48, 23.6%), housekeepers (25, 12.3%), and physicians (21, 10.4%). The majority (184, 90.6%) of the HCWs contracted COVID-19 in the community, and only 19 (9.4%) were healthcare-associated infections. Of the infected HCWs, 169 (83.3%) had mild symptoms and were managed in home isolation. The most common symptoms were fever (128, 63.1%), body ache (124, 61.8%), headache (113, 55.7%), dry cough (123, 60.6%), sore throat (97, 47.8%), body weakness (97, 47.8%), and fatigue (94, 46.3%). Comparing males and females, there was a significantly higher number of female nurses; in contrast, there was a higher number of male physicians, housekeepers, therapists/technicians, and other specialty HCWs. A significantly lower number of nurses, therapists/technicians were infected in the ≥40 years age group compared to <40 years. Furthermore, a significantly higher difference was observed among non-Saudi nurses compared to Saudi nurses. No mortality was documented among the included HCWs. Conclusions: In the largest tertiary cardiac center in KSA, most HCWs who contracted COVID-19 developed mild symptoms; nurses and those aged <40 years were most commonly infected, and most infections were acquired in the community. HCWs’ adherence to mitigation measures outside of the workplace is vital to curb the current pandemic and decrease nosocomial transmission risk.
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Affiliation(s)
- Mazin Barry
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia
- Correspondence:
| | - Asirvatham Alwin Robert
- Department of Endocrinology and Diabetes, Prince Sultan Military Medical City, Riyadh 12233, Saudi Arabia;
| | - Mohamad-Hani Temsah
- Pediatric Department, College of Medicine, King Saud University, Riyadh 11461, Saudi Arabia;
| | - Syed Abdul Bari
- Department of Infection Control, Prince Sultan Cardiac Center, Riyadh 12233, Saudi Arabia; (S.A.B.); (M.Y.A.); (F.A.N.); (R.E.)
| | - Muhammad Yasin Akhtar
- Department of Infection Control, Prince Sultan Cardiac Center, Riyadh 12233, Saudi Arabia; (S.A.B.); (M.Y.A.); (F.A.N.); (R.E.)
| | - Faizah Al Nahdi
- Department of Infection Control, Prince Sultan Cardiac Center, Riyadh 12233, Saudi Arabia; (S.A.B.); (M.Y.A.); (F.A.N.); (R.E.)
| | - Richilda Erlandez
- Department of Infection Control, Prince Sultan Cardiac Center, Riyadh 12233, Saudi Arabia; (S.A.B.); (M.Y.A.); (F.A.N.); (R.E.)
| | - Jaffar A. Al-Tawfiq
- Specialty Internal Medicine and Quality Department, Johns Hopkins Aramco Healthcare, Dhahran 31311, Saudi Arabia;
- Infectious Disease Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
- Infectious Disease Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Abdullah Al Khushail
- Department of Adult Cardiology, Prince Sultan Cardiac Center, Riyadh 12233, Saudi Arabia; (A.A.K.); (Y.A.H.)
| | - Yahya Al Hebaishi
- Department of Adult Cardiology, Prince Sultan Cardiac Center, Riyadh 12233, Saudi Arabia; (A.A.K.); (Y.A.H.)
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12
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Alqahtani SA, Barry M, Memish Z, Hashim A, Alfares MA, Alghamdi SA, Al-Hamoudi WK, Al-Judaibi B, Alhazzani W, Al-Tawfiq JA, Abaalkhail F. Use of COVID-19 vaccines in patients with liver disease and post-liver transplantation: Position statement of the Saudi association for the study of liver diseases and transplantation. Saudi J Gastroenterol 2021; 27:201-207. [PMID: 34100388 PMCID: PMC8448010 DOI: 10.4103/sjg.sjg_223_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Patients with chronic liver disease (CLD) and liver transplant recipients are at increased risk of morbidity and mortality from coronavirus disease 2019 (COVID-19). Although several studies demonstrated the safety and efficacy of COVID-19 vaccines in the general population, data in CLD patients and liver transplant recipients are lacking. Two COVID-19 vaccines were approved by the Saudi Food and Drug Authority and rolled out to several million recipients in Saudi Arabia. These vaccines are mRNA-based vaccine BNT162b2 from Pfizer/BioNTech and adenovirus-based AZD1222 from Oxford/AstraZeneca from three manufacturing sites (EU Nodes, Serum Institute of India, and South Korea Bio). The Saudi Association for the Study of Liver diseases and Transplantation (SASLT) has reviewed the available evidence and issued interim recommendations for COVID-19 vaccination in CLD and liver transplant recipients. Since there is no evidence contradicting the safety and immunogenicity of the currently approved COVID-19 vaccines in patients with CLD and hepatobiliary cancer and liver transplant recipients, the SASLT recommends vaccination in those patient populations. CLD and hepatobiliary cancer patients and liver transplant recipients should be prioritized depending on the risk factors for severe COVID-19. In transplant recipients, the optimal timing of vaccination remains unknown; however, immunization is recommended after the initial immunosuppression phase. Patients with CLD and liver transplant candidates or recipients should be closely monitored after COVID-19 vaccination. These patient populations should be included in future clinical trials to provide further evidence on the efficacy and safety of COVID-19 vaccines.
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Affiliation(s)
- Saleh A. Alqahtani
- Liver Transplant Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia,Division of Gastroenterology and Hepatology, Johns Hopkins University, Baltimore, MD, United States,Address for correspondence: Dr. Saleh A. Alqahtani, Liver Transplant Center, King Faisal Specialist Hospital and Research Center, Riyadh 12713, MD. E-mail:
| | - Mazin Barry
- Department of Internal Medicine, Division of Infectious Diseases, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Ziad Memish
- Research and Innovation Center, King Saud Medical City, Ministry of Health, Emory University, Riyadh, Saudi Arabia,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Almoutaz Hashim
- Department of Gastroenterology and Transplant Hepatology, College of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | - Mona A. Alfares
- Department of Infectious Disease, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Saad A. Alghamdi
- Liver Transplant Center, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Waleed K. Al-Hamoudi
- Department of Medicine, College of Medicine, Gastroenterology and Hepatology Unit, King Saud University, Riyadh, Saudi Arabia
| | - Bandar Al-Judaibi
- Department of Medicine, Division of Gastroenterology, and Multi-Organ Transplant Program, Western University and London Health Sciences Centre, London, Ontario,Division of Transplantation, University of Rochester, Rochester, NY
| | - Waleed Alhazzani
- Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Jaffar A. Al-Tawfiq
- Infectious Disease Unit, Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia,Infectious Disease Division, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA,Infectious Disease Division, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Faisal Abaalkhail
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia,Department of Medicine, Gastroenterology Section, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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13
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Aljamaan FS. Unusual Presentation of a Severe COVID-19 Case With Axillary Artery Thrombosis. Cureus 2021; 13:e15036. [PMID: 34150387 PMCID: PMC8200903 DOI: 10.7759/cureus.15036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2021] [Indexed: 11/30/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has been evolving since early 2020 with high critical care mortality and morbidity. High mortality rates have been linked largely to respiratory failure. Hypercoagulability status induced by the massive inflammatory storm has led to a high rate of thrombotic events, whether arterial or venous, contributing to COVID-19 mortality especially in critically ill patients. Thrombotic events might be the presenting feature of the disease or might happen during hospitalization. In this case report, we describe a case of a 67-year-old male with severe COVID-19 pneumonia who was found on presentation to have left axillary artery thrombosis requiring embolectomy; the case was managed successfully. We reviewed the pathophysiology of hypercoagulability associated with COVID-19, clinical implications, and most recent treatment recommendations.
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