scholarly journals Predictors of illness severity in COVID-19 cases

2020 ◽  
Author(s):  
Reem A. AlDossary ◽  
Amani Alnimr ◽  
Reem Aljindan ◽  
Khaled Alkharsah ◽  
Ahmed Al-Qurayn ◽  
...  
Keyword(s):  
Case Fatality ◽  
Severity Of Illness ◽  
P Value ◽  
Rt Pcr ◽  
Asian Ethnicity ◽  
Cycle Threshold ◽  
Viral Shedding ◽  
Epidemiological Features ◽  
First Case ◽  
Clinical Presentations

Abstract Background Multiple studies worldwide reported the clinical and epidemiological features of coronavirus disease 2019 (COVID-19) with limited reports form the Middle East area. Methods This is an observational study to describe the clinical and epidemiological features of 341 COVID-19 cases in the Eastern Province of Saudi Arabia over the first three months from reporting the first case in the country and identify factors associated with severity of the illness. Results The median age was 45 years and males were twice as affected as females (p value < 0.0001). The duration of viral shedding ranged from 9 to 36 days. The most common clinical presentations include fever, shortness of breath, cough, myalgia, sore throat, vomiting, and headache. Severe and critical cases were significantly higher in males compared to females (23% vs 8.7%), senior adults (> 65 years), Bengali ethnicity, and in patient with com-morbidities including diabetes, hypertension, and dyslipidemia (p-value = 0.001). Furthermore, case fatality rate was found to be 10% and was significantly higher in male gender compared to female (13.8%vs 2.6%), and in Asian ethnicity (17.9%) compared to Arabs (6%) and African counterparts (0) (p-value = 0.002). No association was found between viral load represented by the RT-PCR cycle threshold (Ct) values and severity of illness. Conclusion Age, gender and ethnicity are important predictors of COVID-19 severity while Cycle threshold (Ct) of SARS-CoV-2 RT-PCR test cannot be used as a predictor of criticality of illness.

scholarly journals Assessment of health system preparedness to deal with the second wave of COVID-19 in a remote tribal district Surguja, Chhattisgarh, India-April 2021

2021 ◽  
Vol 8 (9) ◽  
pp. 4456
Author(s):  
Amitabha Dan ◽  
Pushpendra Ram ◽  
Khyati Aroskar ◽  
Pragati B. Gaikwad ◽  
Achhelal R. Pasi
Keyword(s):  
Case Fatality ◽  
P Value ◽  
High Risk Population ◽  
Rt Pcr ◽  
Cross Sectional ◽  
Primary Health Centres ◽  
Care Workers ◽  
Urban Rural ◽  
Test Of Significance ◽  
Second Wave

Background: Present study was conducted to assess the preparedness of the Surguja district to curtail COVID-19.Methods: We conducted a cross-sectional observational study from May 2020 to March 2021 through records of 2 primary health centres areas selected by convenient sampling (farthest and nearest to district headquarters). Data on existing facilities and logistics was from district headquarters. Preparedness was assessed through checklist. Observations were presented as rates, ratios and proportions. Standard error of difference between two proportions was used as test of significance and p value≤0.05 was considered significant.Results: For Surguja district population of 925938 (65% rural), overall attack rate was 1.15%, case fatality rate was 0.96% (102/10636); there was 1 DCH, 9 DCHC, 6 CHCs, 25 PHCs, 3 upgraded PHCs, 197 subcentres, 12 CCC, 01 RT-PCR laboratory and 228 COVID vaccination centres. There were 1151 isolation beds; 300 with oxygen support (26%); ICU beds 134 (11.60%) with 34 ventilators. Cumulative 258229 tests; antigen 67.90%, test positivity rate 4.10% (urban 8.2%, rural 1.7%).  This urban-rural difference in test positivity rate was statistically significant (p<0.001). Health care workers, 94.81% (12722/13418) had received one dose of vaccine with 53.36% (6789/13418) both doses. Above 45 years eligible population; 66.68% (154254/231331) received one dose of vaccine.Conclusions: Surveillance and management of COVID-19 were as per GOI guidelines issued. However, to enhance response we recommended strict implementation of appropriate behaviour in community, establishment of containment zones/facilities for high risk population in urban area blocks and increasing laboratories with RT-PCR testing in appropriate proportions.

scholarly journals Long-term clinical, virological and immunological outcomes in patients hospitalized for COVID-19: antibody response predicts long COVID

2021 ◽  
Author(s):  
Javier García-Abellán ◽  
Sergio Padilla ◽  
Marta Fernández-González ◽  
José A. García ◽  
Vanesa Agulló ◽  
...  
Keyword(s):  
Significant Proportion ◽  
Severity Of Illness ◽  
Antibody Responses ◽  
Rt Pcr ◽  
Prospective Longitudinal Study ◽  
Viral Shedding ◽  
Persistent Symptoms ◽  
Clinical Events ◽  
Prospective Longitudinal

ABSTRACTObjectiveLong-term data following SARS-CoV-2 infection are limited. We aimed to characterize the medium and long-term clinical, virological, and immunological outcomes after hospitalization for COVID-19, and to identify predictors of long-COVID.MethodsProspective, longitudinal study conducted in COVID-19 patients confirmed by RT-PCR. Serial blood and nasopharyngeal samples (NPS) were obtained for measuring SARS-CoV-2 RNA and S-IgG/N-IgG antibodies during hospital stay, and at 1, 2 and 6 months post-discharge. Genome sequencing was performed where appropriate. Patients filled out a COVID19-symptom-questionnaire (CSQ) at 2-month and 6-month visits, and those with highest scores were characterized.ResultsOf 146 patients (60% male, median age 64 years) followed-up, 20.6% required hospital readmission and 5.5% died. At 2-months and 6-months, 9.6% and 7.8% patients, respectively, reported moderate/severe persistent symptoms. SARS-CoV-2 RT-PCR was positive in NPS in 11.8% (median Ct=38) and 3% (median Ct=36) patients at 2-months and 6-months, respectively, but no reinfections were demonstrated.Antibody titers gradually waned, with seroreversion occurring at 6 months in 27 (27.6%) patients for N-IgG and in 6 (6%) for S-IgG. Adjusted 2-month predictors of the highest CSQ scores (OR [95%CI]) were lower peak S-IgG (0.80 [0.66-0.94]) and higher WHO-severity-score (2.57 [1.20-5.86]); 6-month predictors were lower peak S-IgG (0.89 [0.79-0.99]) and female sex (2.41 [1.20-4.82]); no association was found with prolonged viral shedding.ConclusionsLate clinical events and persistent symptoms in the medium and long term occurred in a significant proportion of patients hospitalized for COVID-19. Gender, severity of illness and weaker antibody responses, but not viral shedding, were associated with long-COVID.SummaryThis study characterizes the long-term clinical, virological, and immunological outcomes following COVID-19 hospitalization. We found a significant proportion of late clinical events and persistent symptoms. Gender, severity of illness and weaker antibody responses, but not viral shedding, predicted long-COVID.

scholarly journals Persistence of live virus in critically ill patients infected with SARS-COV-2: a prospective observational study

Critical Care ◽  
2022 ◽  
Vol 26 (1) ◽  
Author(s):  
Duane J. Funk ◽  
Jared Bullard ◽  
Sylvan Lother ◽  
Gloria Vazquez Grande ◽  
Lauren Garnett ◽  
...  
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Severity Of Illness ◽  
Vero Cells ◽  
Rt Pcr ◽  
Icu Patients ◽  
Live Virus ◽  
Cycle Threshold ◽  
Viral Culture ◽  
Culture Negative

Abstract Background Research on the duration of infectivity of ICU patients with COVID-19 has been sparse. Tests based on Reverse Transcriptase polymerase chain reaction (RT-PCR) detect both live virus and non-infectious viral RNA. We aimed to determine the duration of infectiousness based on viral culture of nasopharyngeal samples of patients with COVID-19. Methods Prospective observational study in adult intensive care units with a diagnosis of COVID-19 Pneumonia. Patients had repeated nasopharyngeal sampling performed after day 10 of ICU admission. Culture positive rate (based on viral culture on Vero cells in a level 4 lab) and Cycle threshold from RT-PCR were measured. Results Nine patients of the 108 samples (8.3%, 95% CI 3.9–15.2%) grew live virus at a median of 13 days (interquartile range 11–19) after their initial positive test. 74.1% of patients were RT-PCR positive but culture negative, and the remaining (17.6%) were RT-PCR and culture negative. Cycle threshold showed excellent ability to predict the presence of live virus, with a Ct < 25 with an AUC of 0.90 (95% CI 0.83–0.97, p < 0.001). The specificity of a Ct > 25 to predict negative viral culture was 100% (95% CI 70–100%). Conclusion 8.3% of our ICU patients with COVID-19 grew live virus at a median of 13 days post-initial positive RT-PCR test. Severity of illness, use of mechanical ventilation, and time between tests did not predict the presence of live virus. Cycle threshold of > 25 had the best ability to determine the lack of live virus in these patents.

scholarly journals Clinical effect and antiviral mechanism of T-705 in treating severe fever with thrombocytopenia syndrome

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Hao Li ◽  
Xia-Ming Jiang ◽  
Ning Cui ◽  
Chun Yuan ◽  
Shao-Fei Zhang ◽  
...  
Keyword(s):  
Viral Load ◽  
Supportive Care ◽  
Fatal Outcome ◽  
Animal Experiments ◽  
Case Fatality ◽  
Rt Pcr ◽  
Cycle Threshold ◽  
Viral Loads ◽  
Severe Fever

AbstractSevere fever with thrombocytopenia syndrome (SFTS) virus (SFTSV) is an emerging tick-borne virus with high fatality and an expanding endemic. Currently, effective anti-SFTSV intervention remains unavailable. Favipiravir (T-705) was recently reported to show in vitro and in animal model antiviral efficacy against SFTSV. Here, we conducted a single-blind, randomized controlled trial to assess the efficacy and safety of T-705 in treating SFTS (Chinese Clinical Trial Registry website, number ChiCTR1900023350). From May to August 2018, laboratory-confirmed SFTS patients were recruited from a designated hospital and randomly assigned to receive oral T-705 in combination with supportive care or supportive care only. Fatal outcome occurred in 9.5% (7/74) of T-705 treated patients and 18.3% (13/71) of controls (odds ratio, 0.466, 95% CI, 0.174–1.247). Cox regression showed a significant reduction in case fatality rate (CFR) with an adjusted hazard ratio of 0.366 (95% CI, 0.142–0.944). Among the low-viral load subgroup (RT-PCR cycle threshold ≥26), T-705 treatment significantly reduced CFR from 11.5 to 1.6% (P = 0.029), while no between-arm difference was observed in the high-viral load subgroup (RT-PCR cycle threshold <26). The T-705-treated group showed shorter viral clearance, lower incidence of hemorrhagic signs, and faster recovery of laboratory abnormities compared with the controls. The in vitro and animal experiments demonstrated that the antiviral efficacies of T-705 were proportionally induced by SFTSV mutation rates, particularly from two transition mutation types. The mutation analyses on T-705-treated serum samples disclosed a partially consistent mutagenesis pattern as those of the in vitro or animal experiments in reducing the SFTSV viral loads, further supporting the anti-SFTSV effect of T-705, especially for the low-viral loads.

Impairment Tutorial: Functionally Limiting Upper Extremity Pain: Controversies in Impairment Rating

2003 ◽  
Vol 8 (5) ◽  
pp. 4-12
Author(s):  
Lorne Direnfeld ◽  
James Talmage ◽  
Christopher Brigham
Keyword(s):  
Upper Extremity ◽  
Radicular Pain ◽  
Illness Behavior ◽  
Orthopedic Surgeon ◽  
First Case ◽  
Clinical Presentations ◽  
Whole Person ◽  
Physical Examinations ◽  
Upper Extremity Impairment ◽  
The Individual

Abstract This article was prompted by the submission of two challenging cases that exemplify the decision processes involved in using the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides). In both cases, the physical examinations were normal with no evidence of illness behavior, but, based on their histories and clinical presentations, the patients reported credible symptoms attributable to specific significant injuries. The dilemma for evaluators was whether to adhere to the AMA Guides, as written, or to attempt to rate impairment in these rare cases. In the first case, the evaluating neurologist used alternative approaches to define impairment based on the presence of thoracic outlet syndrome and upper extremity pain, as if there were a nerve injury. An orthopedic surgeon who evaluated the case did not base impairment on pain and used the upper extremity chapters in the AMA Guides. The impairment ratings determined using either the nervous system or upper extremity chapters of the AMA Guides resulted in almost the same rating (9% vs 8% upper extremity impairment), and either value converted to 5% whole person permanent impairment. In the second case, the neurologist evaluated the individual for neuropathic pain (9% WPI), and the orthopedic surgeon rated the patient as Diagnosis-related estimates Cervical Category II for nonverifiable radicular pain (5% to 8% WPI).

The Protective Effect of Metformin against Oxandrolone-Induced Infertility in Male Rats

2020 ◽  
Vol 26 ◽  
Author(s):  
Abdulqader Fadhil Abed ◽  
Yazun Bashir Jarrar ◽  
Hamzeh J Al-Ameer ◽  
Wajdy Al-Awaida ◽  
Su-Jun Lee
Keyword(s):  
Gene Expression ◽  
Male Infertility ◽  
Protective Effect ◽  
Histological Examination ◽  
Sperm Count ◽  
Serum Testosterone ◽  
Male Rats ◽  
P Value ◽  
Protective Effects ◽  
Rt Pcr

Background: Oxandrolone is a synthetic testosterone analogue that is widely used among bodybuilders and athletes. However, oxandrolone causes male infertility. Recently, it was found that metformin reduces the risk of infertility associated with diabetes mellitus. Aim: This study aimed to investigate the protective effects of metformin against oxandrolone-induced infertility in male rats. Methods: Rats continuously received one of four treatments (n=7) over 14 days: control DMSO administration, oxandrolone administration, metformin administration, or co-administration of oxandrolone and metformin. Doses were equivalent to those used for human treatment. Subsequently, testicular and blood samples were collected for morphological, biochemical, and histological examination. In addition, gene expression of the testosterone synthesizing enzyme CYP11A1 was analyzed in the testes using RT-PCR. Results: Oxandrolone administration induced male infertility by significantly reducing relative weights of testes by 48%, sperm count by 82%, and serum testosterone levels by 96% (ANOVA, P value < 0.05). In addition, histological examination determined that oxandrolone caused spermatogenic arrest which was associated with 2-fold downregulation of testicular CYP11A1 gene expression. However, co-administration of metformin with oxandrolone significantly ameliorated toxicological alterations induced by oxandrolone exposure (ANOVA, P value < 0.05). Conclusion: Metformin administration protected against oxandrolone-induced infertility in male rats. Further clinical studies are needed to confirm the protective effect of metformin against oxandrolone-induced infertility among athletes.

An Updated Review on COVID-19

2020 ◽  
Vol 20 ◽  
Author(s):  
Mahmoud Ahmed Ebada ◽  
Ahmed Wadaa Allah ◽  
Eshak Bahbah ◽  
Ahmed Negida
Keyword(s):  
Screening Tool ◽  
Distress Syndrome ◽  
Reproduction Number ◽  
Case Fatality ◽  
Current Data ◽  
Future Research ◽  
Rt Pcr ◽  
Viral Structure ◽  
Discharge Criteria ◽  
Serology Testing

: Coronavirus Disease (COVID-19) pandemic has affected more than seven million individuals in 213 countries worldwide with a basic reproduction number ranging from 1.5 to 3.5 and an estimated case fatality rate ranging from 2% to 7%. A substantial proportion of COVID-19 patients are asymptomatic; however, symptomatic cases might present with fever, cough, and dyspnoea or severe symptoms up to acute respiratory distress syndrome. Currently, RNA RT-PCR is the screening tool, while bilateral chest CT is the confirmatory clinical diagnostic test. Several drugs have been repurposed to treat COVID-19, including chloroquine or hydroxychloroquine with or without azithromycin, lopinavir/ritonavir combination, remdesivir, favipiravir, tocilizumab, and EIDD-1931. Recently, Remdesivir gained FDA emergency approval based on promising early findings from the interim analysis of 1063 patients. The recently developed serology testing for SARSCoV-2 antibodies opened the door to evaluate the actual burden of the disease and to determine the rate of the population who have been previously infected (or developed immunity). This review article summarizes current data on the COVID-19 pandemic starting from the early outbreak, viral structure and origin, pathogenesis, diagnosis, treatment, discharge criteria, and future research.

COVID-19 Related Web Search Behaviors: An Analytical Study of Google Trends-based Query Volumes in Indonesia (Preprint)

2020 ◽  
Author(s):  
Vita Widyasari ◽  
Karisma Trinanda Putra ◽  
Jiun-Yi Wang
Keyword(s):  
Web Search ◽  
Public Awareness ◽  
Relevant Information ◽  
Community Response ◽  
Google Trends ◽  
P Value ◽  
Basic Information ◽  
First Case ◽  
The Government ◽  
Economic Anxiety

BACKGROUND The volume of search keywords on Google can be used as a reference to an ongoing online trend during COVID-19 pandemic. OBJECTIVE This study was aimed to estimate the responsiveness and public awareness in early days of the COVID-19 outbreak in Indonesia using Google Trends relative search volumes (RSV). METHODS Sixty terms or keywords forming six topics included in the analysis were basic information, prevention, government policy, socio-economic, anxiety, and other issues related to COVID-19. All these keywords were checked for surveillance purposes between January 1 and May 4, 2020. The Python programming language was used for data mining from Google Trends databases. Correlation analysis was conducted to examine the correlations between the incidence of COVID-19 and the search terms. RESULTS Community response and awareness in the six topics were associated with the number of COVID-19 cases (r range between 0.570-0.825, P-value<.005). Before the first case announced in Indonesian, the prominent topics were basic information and other issues. One month after the first case, all topics experienced an increase in RSV. In the phase of outbreak, socio-economic and anxiety got much more attentions. CONCLUSIONS The government should consider to optimize the internet as a media for timely delivering most relevant information and dynamically respond massive queries, and improve health communications to increase public awareness and intention to prevent the disease.

Impact of hydroxychloroquin/azithromycin protocol on COVID-19 case-fatality rate reduction in Algeria. (Preprint)

2020 ◽  
Author(s):  
Ahmed Youssef Kada
Keyword(s):  
Case Fatality Rate ◽  
Doubling Time ◽  
Case Fatality ◽  
World Health ◽  
Fatality Rate ◽  
Therapeutic Protocol ◽  
First Case ◽  
The World ◽  
The Impact ◽  
At Home

BACKGROUND Covid-19 is an emerging infectious disease like viral zoonosis caused by new coronavirus SARS CoV 2. On December 31, 2019, Wuhan Municipal Health Commission in Hubei province (China) reported cases of pneumonia, the origin of which is a new coronavirus. Rapidly extendable around the world, the World Health Organization (WHO) declares it pandemic on March 11, 2020. This pandemic reaches Algeria on February 25, 2020, date on which the Algerian minister of health, announced the first case of Covid-19, a foreign citizen. From March 1, a cluster is formed in Blida and becomes the epicentre of the coronavirus epidemic in Algeria, its total quarantine is established on March 24, 2020, it will be smoothly alleviated on April 24. A therapeutic protocol based on hydroxychloroquine and azithromycin was put in place on March 23, for complicated cases, it was extended to all the cases confirmed on April 06. OBJECTIVE This study aimed to demonstrate the effectiveness of hydroxychloroquin/azithromycin protocol in Algeria, in particular after its extension to all patients diagnosed COVID-19 positive on RT-PCR test. We were able to illustrate this fact graphically, but not to prove it statistically because the design of our study, indeed in the 7 days which followed generalization of therapeutic protocol, case fatality rate decrease and doubling time increase, thus confirming the impact of wide and early prescription of hydroxychloroquin/azithromycin protocol. METHODS We have analyzed the data collected from press releases and follow-ups published daily by the Ministry of Health, we have studied the possible correlations of these data with certain events or decisions having a possible impact on their development, such as confinement at home and its reduction, the prescription of hydroxychloroquine/azithromycin combination for serious patients and its extension to all positive COVID subjects. Results are presented in graphics, the data collection was closed on 31/05/2020. RESULTS Covid-19 pandemic spreads from February 25, 2020, when a foreign citizen is tested positive, on March 1 a cluster is formed in the city of Blida where sixteen members of the same family are infected during a wedding party. Wilaya of Blida becomes the epicentre of coronavirus epidemic in Algeria and lockdown measures taken, while the number of national cases diagnosed begins to increases In any event, the association of early containment measures combined with a generalized initial treatment for all positive cases, whatever their degree of severity, will have contributed to a reduction in the fatality rate of COVID 19 and a slowing down of its doubling time. CONCLUSIONS In Algeria, the rapid combination of rigorous containment measure at home and early generalized treatment with hydroxychloroquin have demonstrated their effectiveness in terms of morbidity and mortality, the classic measures of social distancing and hygiene will make it possible to perpetuate these results by reducing viral transmission, the only unknown, the reopening procedure which can only be started after being surrounded by precautions aimed at ensuring the understanding of the population. CLINICALTRIAL Algeria, Covid-19, pandemic, hydroxychloroquin, azithromycin, case fatality rate

Covid-19 Cases in India: A Visual Exploratory Data Analysis Model (Preprint)

2020 ◽  
Author(s):  
Jayesh S
Keyword(s):  
Data Analysis ◽  
Exploratory Data Analysis ◽  
Case Fatality ◽  
Public Health Emergency ◽  
Virus Spread ◽  
Analysis Model ◽  
Case Fatality Ratio ◽  
First Case ◽  
Exploratory Data ◽  
The Government

UNSTRUCTURED Covid-19 outbreak was first reported in Wuhan, China. The deadly virus spread not just the disease, but fear around the globe. On January 2020, WHO declared COVID-19 as a Public Health Emergency of International Concern (PHEIC). First case of Covid-19 in India was reported on January 30, 2020. By the time, India was prepared in fighting against the virus. India has taken various measures to tackle the situation. In this paper, an exploratory data analysis of Covid-19 cases in India is carried out. Data namely number of cases, testing done, Case Fatality ratio, Number of deaths, change in visits stringency index and measures taken by the government is used for modelling and visual exploratory data analysis.

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