Clinical and Virological Characteristics of Hospitalized COVID-19 Patients in a German Tertiary Care Center during the First Wave of the SARS-CoV-2 Pandemic

Abstract BACKGROUND: Influenza is a major cause of morbidity and mortality worldwide. Following the 2009 pandemic, there was widened interest in studying influenza burden in all regions. However, since data from the World Health Organization (WHO) Middle East and North Africa (MENA) region remain limited, we aimed to contribute to the understanding of influenza burden in Lebanon. METHODS: A retrospective chart review extending over a period of 8 seasons from Jan 1st, 2008 till June 30 th , 2016 at a tertiary care center in Beirut was performed. All cases confirmed to have influenza based on rapid antigen detection or/and polymerase chain reaction on a respiratory sample were included for analysis. Data on epidemiology, clinical presentation, complications, antiviral use and mortality were collected for analysis. RESULTS: A total of 1829 cases of laboratory-confirmed influenza were identified. Average annual positivity rate was 14% (positive tests over total requested). Both influenza A and B co-circulated in each season with predominance of influenza A. Influenza virus started circulating in December and peaked in January and February. The age group of 19-50 years accounted for the largest proportion of cases (22.5%) followed by the age group of 5-19 years (18%). Pneumonia was the most common complication reported in 33% of cases. Mortality reached 3.8%. The two extremes of age (<2 years and ≥ 65years) were associated with a more severe course of disease, hospitalization, intensive care unit (ICU) admission, complications, and mortality rate. Of all the identified cases, 26% were hospitalized. Moderate-to-severe disease was more likely in influenza B cases but no difference in mortality was reported between the two types. Antivirals were prescribed in 68.8% and antibiotics in 41% of cases. There seemed to be an increasing trend in the number of diagnosed and hospitalized cases over the years of the study. CONCLUSION: Patients with laboratory-confirmed influenza at our center had a high rate of hospitalization and mortality. A population based prospective surveillance study is needed to better estimate the burden of Influenza in Lebanon that would help formulate a policy on influenza control.

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439. Clinical Characteristics and Mortality of an Initial Cohort of COVID-19 Patients in México City

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.632 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S287-S287

Author(s):

Paulo F Castañeda-Mendez ◽

José Luis Castillo-Álvarez ◽

Armando Barragán-Reyes ◽

Daniela Bay-Sansores ◽

Jessica Isabel Pulido-Enríquez ◽

...

Keyword(s):

Mechanical Ventilation ◽

Mexico City ◽

Clinical Characteristics ◽

Care Center ◽

Invasive Mechanical Ventilation ◽

Tertiary Care ◽

Case Series ◽

Special Focus ◽

Tertiary Care Center ◽

Initial Cohort

Abstract Background As of today, more than 8 million people have been infected and around 440,000 of them have lost their lives due to complications of SARS-CoV-2 infection. The first confirmed case of COVID-19 in Mexico was on February 28, 2020, and currently, there are more than 150,300 confirmed cases and more than 17,500 deaths have been reported, this work presents the characteristics of the first cases on a tertiary care center with special focus on common comorbidities in Mexicans. Methods We conducted a case series of patients with the diagnosis of pneumonia due to SARS-CoV-2 virus admitted to a tertiary care center in Mexico City, between March 14th and May 4th, 2020. Data collected included demographic information, comorbidities, clinical presentation, and outcomes. Regarding clinical outcomes, we measured the need of admission to Intensive Care Unit (ICU), mortality during hospitalization, discharge, and patients that remained hospitalized. Results 85 patients were included, median age 53.5 years; 69.4% were male. Most common clinical manifestations at admission were fever (61, 71.8%), cough (29, 34.1%), headache (25, 29.4%) and dyspnea (22, 25.9%). Most common comorbidities were overweight (44/82, 53.6%), obesity (25/82, 30.5%), hypertension (18, 21.2%), and diabetes (17, 20%). 31 of 85 (36.5%) patients were diagnosed with critical disease, whereas 54 of 85 (63.5%) were classified as non-critical. In the 31 critically ill patients, the length of invasive mechanical ventilation was 13 days [range {2–45}]; 5 patients (16.1%) required tracheostomy. The mean of mechanical ventilation prior to tracheostomy was 19.8 days [range {14–25}]. In all patients, the total length of hospitalization was 12.1 days [range {2–52}], 14.8 days [range {3–52}] in ICU patients, and 6.7 days [range {2–30}] in floor unit patients. No readmissions were documented. Global mortality was 4.7% (9.6% in ICU, 1.8% in floor unit). Of the 4 deceased patients, 3 presented comorbidities (75%), while 1 was previously healthy, documenting massive pulmonary embolism as the cause of sudden death. Conclusion This study shows that the clinical characteristics in this initial cohort are not different that described elsewhere. Mortality is low but it is mainly related to prevalent comorbidities in the Mexican population. Disclosures All Authors: No reported disclosures

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Clinical and virological characteristics of hospitalised COVID-19 patients in a German tertiary care centre during the first wave of the SARS-CoV-2 pandemic: a prospective observational study

Infection ◽

10.1007/s15010-021-01594-w ◽

2021 ◽

Author(s):

Charlotte Thibeault ◽

◽

Barbara Mühlemann ◽

Elisa T. Helbig ◽

Mirja Mittermaier ◽

...

Keyword(s):

Mechanical Ventilation ◽

Observational Study ◽

Median Duration ◽

Prospective Observational Study ◽

Invasive Mechanical Ventilation ◽

Tertiary Care ◽

Detailed Knowledge ◽

Care Centre ◽

Tertiary Care Centre ◽

Duration Of Symptoms

Abstract Purpose Adequate patient allocation is pivotal for optimal resource management in strained healthcare systems, and requires detailed knowledge of clinical and virological disease trajectories. The purpose of this work was to identify risk factors associated with need for invasive mechanical ventilation (IMV), to analyse viral kinetics in patients with and without IMV and to provide a comprehensive description of clinical course. Methods A cohort of 168 hospitalised adult COVID-19 patients enrolled in a prospective observational study at a large European tertiary care centre was analysed. Results Forty-four per cent (71/161) of patients required invasive mechanical ventilation (IMV). Shorter duration of symptoms before admission (aOR 1.22 per day less, 95% CI 1.10–1.37, p < 0.01) and history of hypertension (aOR 5.55, 95% CI 2.00–16.82, p < 0.01) were associated with need for IMV. Patients on IMV had higher maximal concentrations, slower decline rates, and longer shedding of SARS-CoV-2 than non-IMV patients (33 days, IQR 26–46.75, vs 18 days, IQR 16–46.75, respectively, p < 0.01). Median duration of hospitalisation was 9 days (IQR 6–15.5) for non-IMV and 49.5 days (IQR 36.8–82.5) for IMV patients. Conclusions Our results indicate a short duration of symptoms before admission as a risk factor for severe disease that merits further investigation and different viral load kinetics in severely affected patients. Median duration of hospitalisation of IMV patients was longer than described for acute respiratory distress syndrome unrelated to COVID-19.

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The Burden of Laboratory-confirmed Influenza Infection in Lebanon Between 2008 and 2016: A single tertiary care center experience

10.21203/rs.2.22568/v1 ◽

2020 ◽

Author(s):

Aia Assaf-Casals ◽

Zeina Saleh ◽

Sarah Khafaja ◽

Danielle Fayad ◽

Hady Ezzeddine ◽

...

Keyword(s):

Influenza A ◽

Influenza Infection ◽

Care Center ◽

Severe Disease ◽

Tertiary Care ◽

World Health ◽

Influenza B ◽

Age Group ◽

Tertiary Care Center ◽

Mena Region

Abstract BACKGROUND: Influenza is a major cause of morbidity and mortality worldwide. Following the 2009 pandemic, there was widened interest in studying influenza burden in all regions. However, data from the World Health Organization (WHO) Middle East and North Africa (MENA) region remain limited particularly from Lebanon. METHODS: A retrospective chart review extending over a period of 8 seasons from Jan 1st, 2008 till June 30 th , 2016 at a tertiary care center in Beirut was performed. All laboratory-confirmed cases of influenza were included for analysis. Data on epidemiology, clinical presentation, complications, antiviral use and mortality were collected for analysis. RESULTS: A total number of 1829 cases of laboratory-confirmed influenza were identified. Average annual positivity rate was 14%. Both influenza A and B co-circulated in each season with predominance of influenza A. Influenza virus started circulating in December and peaked in January and February. The age group of 19-50 years accounted for the largest proportion of cases (22.5%) followed by the age group of 5-19 years (18%). Pneumonia was the most common complication reported in 33% of cases. Mortality reached 3.8%. The two extremes of age (<2 years and ≥ 65years) were associated with a more severe course of disease, hospitalization, intensive care unit (ICU) admission, complications, and mortality rate. Of all the identified cases, 26% were hospitalized. Moderate-to-severe disease was more likely in influenza B cases but no difference in mortality was reported between the two types. Antivirals were prescribed in 68.8% and antibiotics in 41% of cases. There seemed to be an increasing trend in the number of diagnosed and hospitalized cases over the years of the study. CONCLUSION: Influenza causes a substantial hospitalization burden annually in Lebanon with significant morbidity across all age groups. A population based prospective surveillance study is needed to better estimate the burden of Influenza in Lebanon that would help formulate a policy on influenza control.

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Effect of zinc in severe pneumonia in children of 6 months to 5 years in Allied Hospital, Faisalabad.

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.09.781 ◽

2019 ◽

Vol 26 (09) ◽

pp. 1409-1412

Author(s):

Uzma Yasin ◽

Saif Ullah Sheikh ◽

Sahar Hamid

Keyword(s):

Teaching Hospital ◽

Conventional Treatment ◽

Care Center ◽

Tertiary Care ◽

Severe Pneumonia ◽

Controlled Clinical Trial ◽

Age Group ◽

Tertiary Care Center ◽

Double Blind ◽

Duration Of Symptoms

In Pakistan, pneumonia is very prevalent disease and major cause of death in pediatric age group. Objectives: Our objective is to see the effect of zinc supplementation in severe pneumonia. Study Design: Double blind controlled clinical trial. Setting: Tertiary Care Center of Teaching Hospital. Period: June 2015 to November 2015. Material & Methods: The study was conducted in tertiary care center of teaching hospital children with age group of “06 month to 05 years” diagnosed as case of severe pneumonia. They were randomly assigned to receive conventional treatment and supplementation with zinc (group A) and conventional treatment (group B) alone. They received 20mg of elemental zinc from first day of treatment along with conventional treatment. The characteristics like symptoms at admission and variable like age sex were not statistically different in both age groups. Result: The group who received zinc and conventional treatment showed significant decrease in duration of symptoms and duration of hospitalization. Conclusion: This study shows that administration of zinc along with antibiotics can fasten the healing and recovery of pneumonia. We suggest addition of zinc in treatment of pneumonia.

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The Burden of Laboratory-confirmed Influenza Infection in Lebanon Between 2008 and 2016: A single tertiary care center experience

10.21203/rs.2.22568/v2 ◽

2020 ◽

Author(s):

Aia Assaf-Casals ◽

Zeina Saleh ◽

Sarah Khafaja ◽

Danielle Fayad ◽

Hady Ezzeddine ◽

...

Keyword(s):

Influenza A ◽

Influenza Infection ◽

Care Center ◽

Severe Disease ◽

Tertiary Care ◽

High Rate ◽

World Health ◽

Influenza B ◽

Age Group ◽

Tertiary Care Center

Abstract BACKGROUND: Influenza is a major cause of morbidity and mortality worldwide. Following the 2009 pandemic, there was widened interest in studying influenza burden in all regions. However, since data from the World Health Organization (WHO) Middle East and North Africa (MENA) region remain limited, we aimed to contribute to the understanding of influenza burden in Lebanon. METHODS: A retrospective chart review extending over a period of 8 seasons from Jan 1st, 2008 till June 30 th , 2016 at a tertiary care center in Beirut was performed. All cases confirmed to have influenza based on rapid antigen detection or/and polymerase chain reaction on a respiratory sample were included for analysis. Data on epidemiology, clinical presentation, complications, antiviral use and mortality were collected for analysis. RESULTS: A total of 1829 cases of laboratory-confirmed influenza were identified. Average annual positivity rate was 14% (positive tests over total requested). Both influenza A and B co-circulated in each season with predominance of influenza A. Influenza virus started circulating in December and peaked in January and February. The age group of 19-50 years accounted for the largest proportion of cases (22.5%) followed by the age group of 5-19 years (18%). Pneumonia was the most common complication reported in 33% of cases. Mortality reached 3.8%. The two extremes of age (<2 years and ≥ 65years) were associated with a more severe course of disease, hospitalization, intensive care unit (ICU) admission, complications, and mortality rate. Of all the identified cases, 26% were hospitalized. Moderate-to-severe disease was more likely in influenza B cases but no difference in mortality was reported between the two types. Antivirals were prescribed in 68.8% and antibiotics in 41% of cases. There seemed to be an increasing trend in the number of diagnosed and hospitalized cases over the years of the study. CONCLUSION: Patients with laboratory-confirmed influenza at our center had a high rate of hospitalization and mortality. A population based prospective surveillance study is needed to better estimate the burden of Influenza in Lebanon that would help formulate a policy on influenza control.

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Characteristics of Pituitary Tumors Including Non-Functioning Tumors - a Tertiary Care Center Experience

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.1304 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A640-A640

Author(s):

Lohit Kumbar ◽

Mala Dharmalingam

Keyword(s):

Care Center ◽

Tertiary Care ◽

Pituitary Tumors ◽

Tertiary Care Center ◽

Duration Of Symptoms ◽

Significant Difference ◽

Males And Females ◽

The Mean ◽

Number Of Males ◽

Suprasellar Extension

Abstract Introduction: Pituitary tumors compromise 10-20% of intracranial tumors. Non-functioning pituitary adenomas (NFPAs) are benign neoplasms which constitutes about 1/3rd of the pituitary tumors. There is few data on the characteristics of non-functioning tumors comparing with functioning tumors. Wide spread availability of MRI has eased the diagnosis of non-functioning tumors and early diagnosis. Objectives: To study the characteristics of pituitary tumors and the incidence of non-functioning tumors and compare with functioning tumors presenting to a tertiary care center. MethodsA retrospective study including 146 individuals with pituitary tumor were included from 2014 to 2020. Results: The study included 62(42.5%) male and 84(57.5%) female. The mean age was 41.97 + 13.93 years in males and 39.88 + 16.12 years in females. The mean duration of symptoms prior to presentation was 7.52 + 7.12 months and 10.37 + 11.60 months in males and females respectively. Macroadenoma (size >1cm) incidence was more with 55(88.7%) in males and 58(69%) in females. More number of males (87.1%) underwent surgery when compared to females (64.3%)(p – 0.002). There was more number of suprasellar and invasion of pituitary tumors seen in males compared to females(P- <0.01). There was no significant difference between various parameters like TSH, T4, LH, FSH, prolactin, Electrolytes, cortisol, ACTH, GH and IGF1 between males and females(p- NS). Seventy percent (103) of them were non-functioning tumors. Functioning tumors included 7(4.8%) acromegaly, 8(5.5%) cushings disease, 2(1.4%) gonadotropinoma, 24(16.4%) prolactinoma and 2(1.4%) posterior fossa tumor. Mean age in non- functioning tumors was 43.74 + 15.5 years. Mean diameter of tumor in non-functioning tumors was 21.04 + 11.54 cm when compared to functioning tumors (17.03 + 10.33 cm)(p- 0.61). Most of the patients with non-functioning tumors who underwent surgery received post operatively hydrocortisone and levothyroxine when compared to patients with functioning tumors(p < 0.01). There was no significant difference in terms of gender, suprasellar extension, invasion and pituitary hormones(p-NS). ConclusionMost of the pituitary tumors in our study were macroadenomas with more number of males undergoing surgery as most of them had suprasellar extension and invasion. Non- functioning tumors should be followed up regularly as most of them required hydrocortisone and levothyroxine post-operatively.

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The Burden of Laboratory-confirmed Influenza Infection in Lebanon Between 2008 and 2016: A single tertiary care center experience

10.21203/rs.2.22568/v4 ◽

2020 ◽

Author(s):

Aia Assaf-Casals ◽

Zeina Saleh ◽

Sarah Khafaja ◽

Danielle Fayad ◽

Hady Ezzeddine ◽

...

Keyword(s):

Influenza A ◽

Influenza Infection ◽

Care Center ◽

Severe Disease ◽

Tertiary Care ◽

High Rate ◽

World Health ◽

Influenza B ◽

Age Group ◽

Tertiary Care Center

Abstract BACKGROUND: Influenza is a major cause of morbidity and mortality worldwide. Following the 2009 pandemic, there was widened interest in studying influenza burden in all regions. However, since data from the World Health Organization (WHO) Middle East and North Africa (MENA) region remain limited, we aimed to contribute to the understanding of influenza burden in Lebanon.METHODS: A retrospective chart review extending over a period of 8 seasons from Jan 1st, 2008 till June 30th, 2016 at a tertiary care center in Beirut was performed. All cases confirmed to have influenza based on rapid antigen detection or/and polymerase chain reaction on a respiratory sample were included for analysis. Data on epidemiology, clinical presentation, complications, antiviral use and mortality were collected for analysis.RESULTS: A total of 1829 cases of laboratory-confirmed influenza were identified. Average annual positivity rate was 14% (positive tests over total requested). Both influenza A and B co-circulated in each season with predominance of influenza A. Influenza virus started circulating in December and peaked in January and February. The age group of 19-50 years accounted for the largest proportion of cases (22.5%) followed by the age group of 5-19 years (18%). Pneumonia was the most common complication reported in 33% of cases. Mortality reached 3.8%. The two extremes of age (<2 years and ≥ 65years) were associated with a more severe course of disease, hospitalization, intensive care unit (ICU) admission, complications, and mortality rate. Of all the identified cases, 26% were hospitalized. Moderate-to-severe disease was more likely in influenza B cases but no difference in mortality was reported between the two types. Antivirals were prescribed in 68.8% and antibiotics in 41% of cases. There seemed to be an increasing trend in the number of diagnosed and hospitalized cases over the years of the study. CONCLUSION: Patients with laboratory-confirmed influenza at our center had a high rate of hospitalization and mortality. A population based prospective surveillance study is needed to better estimate the burden of Influenza in Lebanon that would help formulate a policy on influenza control.

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