Journal of Ideas in Health (JIDHealth)
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Association between CHA2DS2-VASc score and in-hospital death in ICU patients with COVID-19
Get PDFBackground: CHA2DS2-VASc score is a scientifically proven risk assessment score for patients with atrial fibrillation. It may be a good predictor of in-hospital death in COVID-19 patients. The present study aimed to evaluate the association between CHA2DS2-VASc score and in-hospital mortality in the prognosis of intensive care unit (ICU) patients with COVID-19.
Methods: Eighty-four COVID-19 patients who were hospitalized in the ICU were retrospectively analyzed in a tertiary health care center, and the CHA2DS2-VASc score was determined. All analyses were performed using SPSS statistical software (SPSS Inc., Chicago, IL, USA, 20.0). A p-value <0.05 was considered statistically significant.
Results: The median age of patients was 60.0 years, and most were males (75.0%). Findings of the study showed that the CHA2DS2-VASc score was considerably higher among the hospitalized patients than discharged patients (3.08 ± 1.72 vs. 1.38 ± 1.16; p<0.001), and patients who required mechanical ventilation compared to those who did not require mechanical ventilation (3.03 ± 1.68 vs. 1.15 ± 0.97; P <0.001), respectively. Patients with CHA2DS2-VASc score of ≥3 had substantially higher age [67(45-87) vs. 58(19-75); P ˂0.001], computed tomography involvement score [67.5(20-90) vs. 35(15-90); P ˂0.001] and need for mechanical ventilation [29(90.6%) vs. 22(42.3%); P ˂0.001]. A significant difference was found in oxygen saturation on admission (P =0.001) between the two groups. In-hospital death was significantly higher among patients with a CHA2DS2-VASc score of ≥3 (P <0.001). The CHA2DS2-VASc score was positively correlated with white blood cells count (r=0.257, P =0.018) and negatively correlated with the number of days spent in the hospital (r=-0.184, P=0.130) due to higher in-hospital death in ICU patients with COVID-19.
Conclusion: CHA2DS2-VASc score may be an effective tool to estimate in-hospital death in COVID-19 patients who were hospitalized in the ICU
Sex differences on the contextual factors and physical activity levels among the Nigerian people during the COVID-19
Get PDFBackground: In the context of flattening the curve of the spread of coronavirus in Nigeria, some factors were considered. This study aimed to investigate the relationship between some of the considered factors and physical activity and investigate sex differences on physical activity during the coronavirus pandemic in Nigeria.
Methods: The study was cross-sectional using an online survey and recruited participants from Nigeria\u27s southwest geopolitical zone through the snowball sampling technique. Descriptive statistics (such as percentages), correlation analyses, and t-test of independent measures were used to analyze the data collected. The data collection was conducted from April to June 2020.
Results: The participants\u27 age ranges from 18 to 73years, with a mean age of 42.9 years, a median of 43years, and a standard deviation of 5.41. The result showed a significant difference between males and females (x ̅= 1001.21; SD=1371.83) on moderate physical activity during the pandemic in Nigeria. However, there was no significant relationship between contextual factors; perception of the spread [r (467) =0.028; P>0.05], fear of contracting COVID-19 [r (467) =0.041; P>0.05], stay at home measures [r (467) =-0.030; P>0.05], sensitizing others about COVID-19 [r (467) =-0.044; P>0.05], compliance with safety rules and regulations [r (467) =0.052; P>0.05] and overall physical activity.
Conclusion: The study concluded that the relationship between contextual variables and physical activity among Nigerian people during the COVID-19 pandemic is not significant. Secondly, males and females are not different on vigorous and walking physical activity levels
Understanding SARS-CoV-2 features of infectivity, aggressiveness, and transmissibility: an insect-vector theory for SARS-CoV-2 dissemination
Get PDFThe severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a ribonucleic acid–based (RNA-based) lineage B β-coronavirus characterized by 10-20 times higher infectivity and transmissibility even across species than previous coronaviruses. The significant infectivity rate of SARS-CoV-2 is due to its different host cell entry mechanisms that are mainly via angiotensin-converting enzyme 2 (ACE2) receptors contrasting earlier coronaviruses that used mainly the endosomal route. Due to the widespread distribution of ACE2 receptors throughout our body, various routes of infectivity are possible, highlighting the necessity of employing multiple forms of protection besides face masks to limit inter-human transmissibility. SARS-CoV-2 exhibits other remarkable features such as the ability to escape the immune system repeated genomic mutations that make it difficult to design a vaccine to address all viral strains and form huge host cell syncytia leading to massive tissue destruction. If we accept SARS-CoV-2 primary reservoir from bats, we should investigate the routes of viral inter-species propagation. In this article, a new theory is proposed- that the dissemination of the virus from the bats to other species and humans could have been possible via an insect vector, as insects possess significant amounts of both ACE2 receptors and a disintegrin and metalloprotease 17 (ADAM-17) enzymes that are essential for virus infectivity.
Covid-19 in Iraq: an estimated cost to treat patients at a private clinic
Get PDFThe impact of the COVID-19 pandemic extended to health, social and economic aspects of human life. The international failure to combat this crisis has left many countries suffering under the influence of successive waves of the pandemic. In this report, we present a private medical clinic\u27s experience dealing with the COVID-19 epidemic in Iraq. The adopted protocol to treat COVID-19 patients has briefly been discussed with an estimated cost of treatment in the private sector. We found that most COVID-19 patients recovered from the disease, except for cases that were associated with co-morbidities. The cost of treatment in the private sector is expensive, and most infected people could not afford it without public sector support
A cross-sectional study of socio-demographic and clinical profile of HIV patients at ART plus centre, Sawai Man Singh Hospital, Jaipur, India
Get PDFBackground: This study aimed to understand the regional variation in the socio-demographic and clinical profile of human immunodeficiency virus (HIV) infected patients at antiretroviral therapy plus centre of Sawai Man Singh (SMS) hospital, Jaipur, India.
Methods: A descriptive cross-sectional study was conducted on HIV patients from January to December 2019. The HIV-positive patients of all age groups and all categories were included in the study. The socio-economic status was assessed by BG Prasad classification-based consumer price index. However, the clinical staging was done according to the World Health Organization (WHO) classification of HIV/AIDS. Data were expressed as mean ± standard deviation.
Results: Among 525 HIV patients 59.16% were males, 40.26% females and 0.57% intersex. About half (51.0%) in the reproductive age group with mean age 36 ±13 years. The commonest mode of HIV transmission was heterosexual (89.77%). Maximum belonged to social class I (57.84%) and class II (26.05 %) of BG Prasad\u27s socioeconomic status. Each of the non-agricultural laborers and semi-skilled workers constitutes 18.0%, and the housewives were 23.6%. At the time of presentation, baseline CD4+Tcell count was <350 /mm3 in 55.0% of HIV patients. Pulmonary tuberculosis and skin involvement were the most predominant secondary opportunistic infections accounting for 24.8% and 7.8%, respectively. More than half (52.09%) of patients were in WHO clinical stage I of HIV disease.
Conclusion: Socio-demographic and clinical profile of study participants reflect an impact of early case detection and timely institution of highly active antiretroviral therapy
A systematic review and meta-analysis of the efficacy and safety of remdesivir in COVID-19 patients
Get PDFBackground: This systematic review compares the efficacy and safety of remdesivir between its recipient and non-recipient COVID-19 patients from the recently published randomized controlled trials (RCT).
Methods: For eligible trials comparing the above outcomes, a literature search took place in the PubMed database. The reviewed trials data were abstracted and critically appraised using the Cochrane tool. Then, a random-effect meta-analysis followed to compare the risk between the compared interventions in risk ratio (RR). By plying the I2 and Chi2 statistics, the heterogeneity estimation happened. A sensitivity analysis iterated the preliminary meta-analysis using a fixed-effect model.
Results: Two eligible RCTs included in this review sourced data from about 833 COVID-19 patients from 115 hospitals in Asia, Europe, and the US. The risk of bias was primarily low. Random-effect meta-analysis suggested a clinical improvement (RR: 1.09; 95% CI: 1.02, 1.16; P=0.02; I2: 0%) and decrease in the risk of any serious side effects (RR: 0.64; 95% CI: 0.43, 0.94; P<0.001; I2: 0%) in the remdesivir treated COVID-19 patients. The rest of the outcomes did not vary between the juxtaposed interventions.
Conclusion: Evidence-based on early RCTs suggest that remdesivir is a clinically useful and safe drug to treat COVID-19 patients
Evaluation of chest computed tomography features in COVID-19: a single-center retrospective study
Get PDFBackground: Even though Real-Time Polymerase Chain Reaction (RT-PCR) is a gold standard for confirming COVID-19, it continues to be plagued by a lack of RT-PCR kits and the potential of false-negative results. Hence, during the second wave of COVID-19 in India, Computed Tomography (CT) scan is an emerging diagnostic tool in evaluating the severity of illness in COVID-19 pneumonia. The present study endeavored to assess chest CT features of COVID-19 pneumonia in Indian population.
Methods: This was a single-center, retrospective, observational study conducted in 300 consecutive adults RT-PCR confirmed COVID-19 patients from 1, Jan 2021 to 31, March 2021 at a private radio diagnostic center. Data regarding baseline demographics, clinical and laboratory characteristics, extent, pattern, and type of abnormal CT findings were noted.
Results: The study population (204 males and 108 females) had mean age of 43.18 ± 8.27 years. Our study\u27s most common clinical presentation was cough (48.1%) and fever (47.1%), respectively. Lung parenchymal abnormalities were found in 294 (94.2%) patients. Abnormal CT findings revealed the involvement of bilateral (45.6%) and multilobar (42.9%) with a predominant peripheral (92.3%) and posterior (80.8%) distribution. According to the type of opacity, Ground Glass Opacity (GGO) was the dominant abnormality found in 270 (91.8%) patients, in which pure GGO (36.7%), GGO with crazy paving pattern (39.8%), and GGO mixed with consolidation (52.0 %) were noted. Peri-lesional or intralesional segmental or subsegmental pulmonary vessel enlargement was found in 192 (65.3 %) patients.
Conclusion: During the second wave of COVID-19, a chest CT scan is a modality of choice in diagnosing COVID-19 pneumonia and related lung parenchymal changes
Pancytopenia in pregnant patients with COVID-19 infection and vitamin B12 deficiency: a case report study
Get PDFBackground: Folate and vitamin B 12 deficiency can lead to pancytopenia in pregnancy. Some cases of pancytopenia due to COVID-19 infection have also been reported. The two cases that we present are related to the coincidence of pregnancy and deficiency of folic acid and vitamin B12 with COVID-19 infection.
Case presentation: A 26-year- woman G3P1L1A1 and 21-year-woman G2P1L1 presented with pancytopenia and mild COVID-19 infection. The antenatal period was uneventful, and both cases also had folate and vitamin B12 deficiency. They received blood products, folic acid, and vitamin B12 supplementation. COVID- 19 infection was managed well with analgesic and vital monitoring. Postpartum hemorrhage occurred in the second case, which was well managed with uterotonics. All laboratory parameters came out to be normal after three months of supplementation of folic acid and vitamin B12.
Conclusion: Pancytopenia in pregnancy due to folate and vitamin B12 deficiency and COVID- 19 infection can be easily managed with timely intensive targeted therapy, but we should be extra vigilant while handling such complicated cases, keeping in mind all possible differential diagnoses for pancytopenia
Underreporting of treatment outcomes in hospitalized COVID-19 infected diabetes patients: a systematic review, meta-analysis, and meta-regression
Get PDFBackground: Prolonged inpatient care requirements and time constraints of research and researchers lead to the non-reporting of the treatment outcome of certain COVID-19 infected diabetes patients in published manuscripts. This study aims to quantify its global burden.
Methods: A search for citations addressing the above outcome ensued chiefly in the PubMed, Embase, and Scopus databases, irrespective of the publication date and geographical region. Recruited studies were critically appraised with the National Heart, Lung, and Blood Institute\u27s tool. Using the random-effects meta-analysis with an exact binomial method and Freeman-Tukey double arcsine transformation, the overall and subgroup-wise weighted pooled prevalence of the missing treatment outcome data was determined. The heterogeneity and publication bias assessment utilized I2 and Chi2 statistics, and funnel plot, and Egger\u27s test, respectively.
Results: Ten publications (primarily case series; 70.0%) included in this review sourced data from 6687 COVID-19 infected inpatient diabetes patients from Asia, Australia, Europe, and North America. The global pooled prevalence of missing treatment outcome data among these patients was 33.0% (95% CI: 15.0-53.0%; I2: 99.53%; P of Chi2: <0.001). It was highest in Europe (63%; 95% CI: 61.0-66.0%). Publication bias assessment was not suggestive of any small study effect.
Conclusion: A considerable proportion of crucial prognosis information of hospitalized COVID-19 patients with diabetes goes underreported. It increases the risk of biasing the contemporary COVID-19-diabetes literature. The reporting of these data in the post-publication era or postponing the primary publication until the availability of all patients\u27 treatment outcome data, when feasible, is recommended to address this enigma
Knowledge, attitude, and practice towards COVID-19 among Libyan people- a web-based cross-sectional study
Get PDFBackground: Successful plans in disaster and epidemics management depend on the feedback response and the assessment of knowledge, attitudes, and practices among the target population. This study aims to assess the knowledge, attitude, and practice towards COVID-19 among Libyan people.
Methods: A cross-sectional web-based survey designed to assess the knowledge, attitude, and practice towards COVID-19 among the Libyan people from 13-20 October 2020. A self-administered questionnaire was recruited to collect the data of 287 participants. SPSS version 16.0 was used to analyze the data using univariate and multivariable regression data analyses.
Results: More than half of respondents were males (53.7%), married (61.3%), aged less than 45 years old, highly educated (46.3%), employed (44.6%), urban resident(79.8%), experience good or very good health (71.1%) and earned more than USD 200 monthly (84.3.%). The participants showed a high rate of good knowledge (81.0%), attitude (71.1%), and practice (83.7%) towards COVID-19, respectively. Regression analysis showed that married (P=0.056), female (P=0.037), living in the urban regions (P<0.001) with good income of more than USD 2020 (P=0.001) were significantly associated with upper knowledge score. Females (P=0.040) were more significantly associated with positive attitude scores than males. Regarding practice score, married (P=0.001), females (P=0.059) had better practice, but poor-rated health status (P=0.018) was significantly associated with the weak practice.
Conclusion: The distinction of urban regions with good knowledge, optimistic attitudes, and acceptable practices towards COVID-19 determines the government\u27s action compass towards more interest in supporting males, unhealthy, and those living in the rural areas with accurate and timely knowledge