Predictors of mortality and morbidity in critically ill COVID-19 patients: An experience from a low mortality country.

Background and Aims: Clinical characteristics and factors associated with mortality in patients admitted to the intensive care unit (ICU) in countries with low case fatality rates (CFR) are unknown. We sought to determine these in a large cohort of critically ill COVID-19 patients in Qatar and explore the early mortality predictors. Methods: We retrospectively studied the clinical characteristics and outcomes in patients admitted to the ICU at the national referral hospital for COVID-19 patients in Qatar. Logistic regression analysis was used to determine factors associated with mortality. Results: Between March 7 and July 16, 2020, a total of 1079 patients with COVID-19 were admitted to the ICU. The median (IQR) age of patients was 50 (41-59) years. Diabetes (47.3%) and hypertension (42.6%) were the most common comorbidities. In-hospital mortality was 12.6% overall and 25.9% among those requiring mechanical ventilation. Factors independently associated with mortality included older age ([OR]; 2.3 [95% CI; 1.92-2.75] for each 10-year increase in age, p < 0.001), chronic kidney disease (OR; 1.9 [95% CI; 1.02-3.54], p = 0.04), active malignancy (OR; 6.15 [95% CI; 1.79-21.12], p = 0.004), lower platelet count at ICU admission (OR; 1.41 [95% CI; 1.13-1.75] for each 100 × 103/µl decrease, p = 0.002), higher neutrophil-to-lymphocyte ratio at admission (OR; 1.01 [95% CI; 1-1.02] for each 1- point increase, p = 0.016), higher serum ferritin level at admission (OR; 1.05 [(95% CI; 1.02-1.08] for each 500 µg/L increase, p = 0.002), and higher serum bilirubin level at admission (OR; 1.19 [95% CI; 1.04-1.36] for each 10 µmol/L increase, p = 0.01). Conclusions: The mortality rate among critically ill COVID-19 patients is low in Qatar compared to other countries. Older age, chronic kidney disease, active malignancy, higher neutrophil-to-lymphocyte ratios, lower platelet counts, higher serum ferritin levels, and higher serum bilirubin levels are independent predictors of in-hospital mortality.

Fatal Coronavirus Disease 2019-associated Pulmonary Aspergillosis; A Report of Two Cases and Review of the Literature.

Coronavirus Disease 2019 (COVID-19)-associated pulmonary aspergillosis is an emerging entity. We report two fatal cases of putative COVID-19-associated pulmonary aspergillosis. Both cases were diagnosed on the basis of respiratory tract cultures yielding Aspergillus species and otherwise unexplained clinical and radiological deterioration. Existing published literature on COVID-19-associated pulmonary aspergillosis indicate poor outcomes and high mortality. CAPA should be considered in patients with critical COVID-19 who have unexplained progressive respiratory failure despite optimized supportive care. Diagnostic work-up should be initiated as early as possible and should ideally include fungal cultures, galactomannan detection and Aspergillus PCR on tracheal aspirates or broncho-alveolar lavage fluid. Empiric systemic antifungal therapy may be justified in selected cases, pending diagnostic work up results. Large, multi-center studies are required to further understand the pathogenesis of invasive aspergillosis in COVID-19, and the optimal diagnostic and treatment strategies.

The pattern of indoor and outdoor respiratory allergens in asthmatic adult patients in a humid and desert newly developed country.

BACKGROUND: Studies have shown that allergens are very important sensitizing agents in patients with asthma. Respiratory disorders such as asthma and allergic rhinitis are common in the State of Qatar. OBJECTIVE: To characterize the most frequent indoor and outdoor respiratory allergens involved in bronchial asthma and allergic rhinitis in the State of Qatar. DESIGN: A hospital-based prospective study conducted. SETTING: Allergy Laboratory at the Hamad General Hospital and Hamad Medical Corporation, Doha, State of Qatar. PATIENTS: Adult patients over 12 years of age diagnosed with bronchial asthma and/or allergic rhinitis who were referred for allergy skin pick test. 1106 adult patients recruited with respiratory diseases of suspected allergic origin who attended Allergy Clinic at the Hamad General Hospital, during three years from January 2001 to April 2003. Total of 1106 whom 607 were females (54.9%) and 499 were males (45.1%) and their mean was age 30 years (12-48). METHODS: Skin Prick Test [SPT] was performed on 1106 patients for common allergens whom The blood sample was taken for measuring specific IgE concentration. RESULTS: There were 1106 patients studied and 569 patients (51.4%) had positive skin prick test. All patients expressed clinical allergy, 464 patients (52%) had asthma and rhinitis, 286 patients (32%) had rhinitis alone and 137 patients (15%) had asthma alone. The population sample had a higher prevalence of diagnosed asthma among females (32.7%) than in males (29.8%) and also skin conditions such as eczema, pruritus, and urticaria higher in females (9.1%%) than males (7.0%). Similarly, males had higher prevalence of allergic rhinitis (86.0%) than in females. There were 318 (55.9%) patients whose asthma developed before they were 10 years old. The percentage of asthmatic patients with a positive family history of asthma was 44%. The most common allergens detected in order of frequency were Dermatophagoides Pteronyssimus (Der p l) in 248 patients (41.6%), Dermatophagoides Farinae (Der f l) in 220 patients (36.9%), Cockroach allergen (Bla g l) in 192 patients (32.2%). The study showed that females are more exposed to pollen, grasses and tress, but males are mostly exposed to mites and insects. Furthermore, Molds and Yeast were common among males. CONCLUSION: In conclusion, the frequency of indoor and outdoor allergens in state of Qatar, based on skin prick test study showed the dominance of house dust mites, pollen, grasses which are more or less same to other countries with similar and even with different climate. Reduced exposure to these agents will help control raising severity of these disease.

Acute pancreatitis complicated by spontaneous unilateral adrenal hemorrhage.

A 52-year-old lady with a history of hypertension, dilated cardiomyopathy and diabetes mellitus type 2, presented with severe upper abdominal pain and vomiting of 4 hours duration. Acute pancreatitis was diagnosed based on high serum amylase and an abdominal computerized tomography scan. On the 3rd day she developed fever, increasing abdominal pain and shortness of breath. A repeated computerized tomography scan showed severe pancreatic necrosis and right adrenal hemorrhage.

Adult lead poisoning from a herbal medicine.

A 56-year-old Indian lady presented with one week history of abdominal pain, jaundice and chronic polyarthralgia. She had evidence of hemolytic anemia and hepatitis. Her blood lead level was high and a peripheral blood film showed dense basophilic stippling. It is believed that the lead toxicity was due to the use of Indian herbal medicine.

Indications, diagnostic yields and complications of transbronchial biopsy over 5 years in the State of Qatar.

OBJECTIVES: To review the indications, diagnostic yields and complications of transbronchial biopsy (TBB) in a tertiary hospital in the State of Qatar. METHODS: A retrospective review of our records revealed 1006 adult flexible fibre optic bronchoscopies (FFB) at Hamad General Hospital, State of Qatar between January 1999 and December 2003. A total of 85 (8.4%) TBB were performed, but complete data were available for 71/85 (83.5%), which were reviewed for indications, diagnostic yields and complications. RESULTS: Adequate samples were obtained in 58/71 TBBs (81.7%), while 13/71 TBBs (18.3%) yielded bronchial mucosa. The main indications in 16/71 (22.5%) TBBs for radiographic localized pulmonary disease were to rule out tuberculosis (TB) in 13 cases, and malignancy in 3 cases. Tuberculosis was verified in 3 (23%) of the 13 cases with localized disease. Fifty-five out of 71 (77.5%) TBBs were performed for radiographic diffuse pulmonary disease: 16/55 (29%) for miliary shadows, while 39/55 (70.9%) were carried out for reticular/reticulonodular infiltrates. Histopathology showed granulomatous lesions consistent with TB in 10/16 (62.5%) cases of miliary shadow. In the other pattern of diffuse disease, the histopathological diagnosis were obtained in 25/39 (64%) cases. It showed non-specific pulmonary fibrosis in 13 cases, sarcoidosis in 4 cases, connective tissue disease associated interstitial fibrosis in 4 cases, bronchiolitis obliterans organizing pneumonia (BOOP) in one case, eosinophilic pneumonia in one case, amiodarone toxicity in one case and lymphangitis carcinomatosis in one case. The main complications were minor bleeding <50 cc in 17 cases (23.9%), pneumothorax in 7 cases (9.8%)) and one case had sepsis. CONCLUSION: Our experience substantiates previous reports of the value and safety of transbronchial biopsy in the rapid diagnosis of smear-negative miliary TB. In diffuse lung diseases of a non-infectious nature, other than sarcoidosis, lymphangitis carcinomatosis and few other conditions, a pathological diagnosis are much less likely to be reliably made on small pieces of tissue such as those provided by TBB.