Clinical profile and short-term outcomes of RT-PCR- positive patients with COVID-19: a cross-sectional study in a tertiary care hospital in Dhaka, Bangladesh

OBJECTIVE

The COVID-19 pandemic is still raging worldwide. While there is significant published evidence on the attributes of patients with COVID-19 from lower-income and middle-income countries, there is a dearth of original research published from Bangladesh, a low-income country in Southeast Asia. Based on a case series from a tertiary healthcare centre, this observational study has explored the epidemiology, clinical profile of patients with COVID-19 and short-term outcomes in Dhaka, Bangladesh.

DESIGN AND SETTING

A total of 422 COVID-19-confirmed patients (via reverse transcription-PCR test) were enrolled in this study (male=271, female=150, 1 unreported). We have compiled medical records of the patients and descriptively reported their demographic, socioeconomic and clinical features, treatment history, health outcomes, and postdischarge complications.

RESULT

Patients were predominantly male (64%), between 35 and 49 years (28%), with at least one comorbidity (52%), and had COVID-19 symptoms for 1 week before hospitalisation (66%). A significantly higher proportion (p<0.05) of male patients had diabetes, hypertension and ischaemic heart disease, while female patients had asthma (p<0.05). The most common symptoms were fever (80%), cough (60%), dyspnoea (41%) and sore throat (21%). The majority of the patients received antibiotics (77%) and anticoagulant therapy (56%) and stayed in the hospital for an average of 12 days. Over 90% of patients were successfully weaned, while 3% died from COVID-19, and 41% reported complications after discharge.

CONCLUSION

The diversity of clinical and epidemiological characteristics and health outcomes of patients with COVID-19 across age groups and gender is noteworthy. Our result will inform the clinicians and epidemiologists of Bangladesh of their COVID-19 mitigation effort.

Environmental hazards and distribution of radioactive black sand along the Rosetta coastal zone in Egypt using airborne spectrometric and remote sensing data

High-resolution airborne gamma ray spectrometry, conducted in 2003, was used to estimate radioactive elements spatial abundance along the Rosetta coastal zone area. It was noticed that both Uranium and Thorium are concentrated in the black sand deposits along the beach. In contrary, Potassium was observed in high level abundance at the cultivated Nile Delta lands due to the accumulated usage of fertilizers. Exposure Rate (ER), Absorbed Dose Rate (ADR) and Annual Effective Dose Rate (AEDR) were calculated to evaluate the radiation background influence in human. Results indicated that the human body in the study sites is subjected to radiation hazards exceeds the accepted limit for long duration exposure. In addition, the areas covered by the highest concentration of Uranium and Thorium show the highest level of radiogenic heat production. Detection the environmental hazards of the radioactive black sands in the study site encouraged this research to monitor the spatial and temporal distribution of these sediments. The Landsat Thematic Mapper images acquired in 1990, 2003 and 2013 were analyzed using remote sensing image processing techniques. Image enhancements, classification and changes detection indicated a positive significant relationship between the patterns of coastline changes and distribution of the radioactive black sand in the study sites. The radioactive black sands are usually concentrated in the eroded areas. Therefore, in 1990 high concentration of the radioactive black sands were observed along the eastern and western flanks of the Rosetta promontory. Distribution of these sediments decreased due to the construction of the protective sea walls. Most of the radioactive black sands are transported toward the east in Abu Khashaba bay under the effect of the longshore currents and toward the west in Alexandria and Abu Quir bay under the action of the seasonal reverse currents.

Use of remote sensing techniques and aeromagnetic data to study episodic oil seep discharges along the Gulf of Suez in Egypt

Four successive oil discharges were observed during the last 2 years following the recording of the earthquake events. Oil slicks were clearly observed in the thermal band of the Enhanced Thematic Mapper images acquired during the discharge events. Lineaments were extracted from the ETM+ image data and SRTM (DEM). The seismic activity is conformable in time and spatially related to active major faults and structural lineaments. The concerned site was subjected to a numerous earthquakes with magnitudes ranging from 3 to 5.4 Mb. Aeromagnetic field data analyses indicated the existence of deep major faults crossing the Gebel El-Zeit and the Mellaha basins (oil reservoirs). The magnetic field survey showed major distinctive fault striking NE-SW at 7000 m depth. Occurrence of these faults at great depth enables the crude oil to migrate upward and appear at the surfaces as oil seeps onshore and as offshore slicks in the Gemsa-Hurghada coastal zone.

Changes in Abdominal Wounds Following Treatment With Sirolimus and Steroids in a Rat Model

Wound healing complications have been observed in patients receiving sirolimus (SLR). This study examined the degree and duration of delayed healing in various protocols using SLR. Sprague-Dawley rats underwent a standard midline abdominal incision and wound closure. Groups of 6 rats each were randomized to receive different doses of SLR (2 and 5 mg/kg) with or without loading dose (10 mg/kg x3 days), and with or without steroids (20 mg/kg x3 days followed by 5 mg/kg for 2 weeks). Rats were humanely killed on postoperative days 5, 10, or 15. Wound breaking force was measured using the EHMI BIAX-II instrument and tensile strength was calculated. Wounds in control animals had gradual increase in tensile strength during the 15-day observation. In contrast, high and loading doses of SLR caused reduction in wound strength until day 10, but the wounds' tensile strength became equivalent to control by day 15. The addition of steroids prolonged wound recovery with low doses of SLR until day 15 and had very profound effects on healing in high-dose SLR-treated animals (>50% reduction) that continued beyond the 2 weeks of observation. Low doses of SLR in non-steroid-treated animals had a short-term (5-day) impact on wound healing; high dose and loading doses delayed healing for 10 to 15 days. The addition of steroids had a synergistic effect on delayed wound healing, particularly in animals receiving high-dose SLR, which demonstrated prolonged wound weakness. These results may provide practical guidelines for postoperative introduction of SLR in the context of various clinical protocols.

Medication noncompliance--a thriving problem

A study was conducted among out-patients attending the Melaka Tengah Health Clinic to determine their compliance status towards antihypertensive, antidiabetic and antiasthmatic drugs. A total of 585 patients were enrolled in this study. Assessment of compliance was carried out using pill-counting and house-to-house interviews 14 days from the date of medication dispensed at the counter. The noncompliance rate among the 464 successfully interviewed patients was 56%. The mean noncompliance percentage was 78.0 +/- 43.1% (range: -10.0-314.3%). Among the four variables of compliance studied, race was not seen as a determinant of compliance. The older age group and those taking two or more drugs were statistically significant to be a noncomplier. Females were highly likely not to comply with drug therapy. Patients who conform to their refill dates were not really drug compliers. Forgetting to take their drugs and inability to read instructions on drug labels were the main reasons given. Underdosing was more common than overdosing, with an estimated cost of RM20,261.00 of unused medications per year.

A polyphasic reassessment of the genus Paenibacillus, reclassification of Bacillus lautus (Nakamura 1984) as Paenibacillus lautus comb. nov. and of Bacillus peoriae (Montefusco et al. 1993) as Paenibacillus peoriae comb. nov., and emended descriptions of P. lautus and of P. peoriae

Seventy-seven strains representing 10 species in the Paenibacillus polymyxa 16S rRNA group and 3 other species that exhibit phenetic relatedness to members of this group, Bacillus lautus, "Bacillus longisporus," and Bacillus peoriae, were characterized genotypically and phenotypically by performing an amplified ribosomal DNA restriction analysis, a randomly amplified polymorphic DNA analysis, a fatty acid methyl ester analysis, sodium dodecyl sulfate-polyacrylamide gel electrophoresis of whole-cell proteins, pyrolysis mass spectrometry, and API and other routine phenotypic tests. These analyses revealed distinct clusters representing Paenibacillus alvei, Paenibacillus amylolyticus, Paenibacillus azotofixans, Paenibacillus durum, Paenibacillus larvae subsp. larvae, Paenibacillus larvae subsp. pulvifaciens, B. lautus, Paenibacillus macerans, Paenibacillus macquariensis, B. peoriae, P. polymyxa, and Paenibacillus validus, which confirmed the distinctness of these species, but appreciable within-species heterogeneity was observed in P. alvei, B. lautus, P. macerans, P. polymyxa, and P. validus. The type strain of Paenibacillus pabuli did not cluster with other strains of this species, and in several analyses a relationship between strains of P. pabuli and "B. longisporus" was observed. As the analyses showed that B. lautus and B. peoriae are closely related to the genus Paenibacillus, these species are reclassified as members of this genus.

Paenibacillus (formerly Bacillus) gordonae (Pichinoty et al. 1986) Ash et al. 1994 is a later subjective synonym of Paenibacillus (formerly Bacillus) validus (Nakamura 1984) Ash et al. 1994: emended description of P. validus

A polyphasic study in which we performed an amplified ribosomal DNA restriction analysis, sodium dodecyl sulfate-polyacrylamide gel electrophoresis of whole-cell proteins, a gas chromatographic analysis of methylated fatty acids, pyrolysis mass spectrometry, a random amplified polymorphic DNA analysis, a phenotypic analysis, and an analysis of the levels of DNA binding of Paenibacillus gordonae and Paenibacillus validus strains (including both type strains) showed that these organisms form a homogeneous group and that the names P. gordonae and P. validus are therefore synonyms. P. validus has nomenclatural priority, and an emended description of this species is given; the type strain is strain LMG 11161 (= ATCC 43897).

Intravitreal ceftriaxone in a rabbit model. Dose- and time-dependent toxic effects and pharmacokinetic analysis

Ceftriaxone's toxic effects were assessed in albino rabbits after intravitreal injection. Doses up to 5 mg did not alter the B-wave amplitude. Following 7.5-and 20-mg doses, B-wave amplitude ratios were depressed at 24 hours and normal at seven and 14 days. A 50-mg dose caused a temporarily flat B-wave 24 hours after injection. At two weeks this ratio exhibited a moderate increase but remained 2 SDs below the mean preinjection ratio. Eyes receiving up to 20 mg were normal histologically at 14 days. A 50-mg dose induced generalized retinal edema and disruption of the retinal layers 24 hours after injection; at two weeks there were no histologic changes in the retina. Immediately after a 2-mg intravitreal injection, vitreous ceftriaxone levels were 1,345 +/- 4.9 mg/L; by 72 hours they had decreased to 17.6 +/- 1.4 mg/L. The mean peak aqueous level was 80.2 +/- 12.2 mg/L at 72 hours.

Ocular pharmacokinetics of ceftriaxone following subconjunctival injection in rabbits

Aqueous and vitreous kinetics were studied after anterior subconjunctival injection of 100 mg of ceftriaxone sodium in phakic and aphakic rabbit eyes. Mean peak ceftriaxone concentrations (microgram per milliliter +/- SE, n = 3 to 5 rabbits per determination) were as follows: phakic eyes, 159.5 +/- 42 at one hour in aqueous humor and 25.3 +/- 6.6 at two hours in vitreous fluid; aphakic eyes, 105.1 +/- 20.5 at one hour in aqueous humor and 43.1 +/- 15.4 at one hour in vitreous humor. The ability of ceftriaxone to eliminate an incipient bacterial infection was also evaluated. Ten aphakic rabbits were challenged intravitreally with 700 colony-forming units of Staphylococcus aureus. Six of the ten immediately received subconjunctival injections of ceftriaxone sodium (100 mg). At 48 hours following the challenge, all four control eyes yielded greater than 5.6 X 10(5) colonies per milliliter. In the six eyes receiving ceftriaxone, five were sterile and one yielded 1.4 X 10(2) colonies per milliliter.