RESUMO
BACKGROUND: Bronchial asthma affects about 20% of Qatar's population. The impact of asthma on COVID-19 outcomes is controversial. The aim of this study was to explore the impact of asthma on COVID-19 outcomes and the predictors of COVID-19-related morbidity and mortality in a cohort of asthma patients infected by COVID-19. METHODS: This is a retrospective cohort study of adult patients with asthma infected with COVID-19, who were recruited from Hamad Medical Corporation (HMC), the main healthcare system in Qatar. Patients were matched to a control group of non-asthmatic COVID-19 patients (1:2) based on sex, age, and other comorbidities. RESULTS: Between March and August 2020, 616 patients with asthma met the inclusion criteria. The need for hospitalization among patients with asthma was independently associated with older age (adjusted odds ratio [aOR] for 10 years, 1.32; 95% confidence interval [CI], 1.13-1.54; p = 0.001) and hypertension (aOR, 2.4; 95% CI, 1.43-3.93; p = 0.001) but not with the use of inhaled corticosteroids (ICS), long-acting beta2 agonists, montelukast, or tiotropium. Patients with asthma required less hospitalization for COVID-19 than non-asthmatic patients (28.2% vs. 37.3%, respectively; aOR, 0.59; 95% CI, 0.77-0.90; p < 0.001). However, admission to the intensive care unit (ICU) was comparable between both groups (3.3% vs. 2.2%; aOR, 1.64; 95% CI, 0.78-3.43; p = 0.193). No difference in mortality rate was observed between the two groups. CONCLUSIONS: In Qatar, adult patients with asthma do not appear to be at higher risk of COVID-19-related hospitalization or ICU admission compared to the general adult COVID-19-infected population. Older age and hypertension were the only significant predictors of COVID-19-related hospitalization among patients with asthma. Further larger studies are required to confirm such an association.
RESUMO
COVID-19 vaccines are generally proven safe in all population and are highly recommended. However, rare adverse events have been reported. We hereby present a case of an 18-year-old man who presented to emergency department with fever, meningitis like symptoms, shortness of breath, chest pain, skin rash, and extreme fatigue. He had cardiac manifestations including hypotension, elevated troponin, and reduced ejection fraction. High inflammatory markers were also noted. He was initially worked up for and treated as a possible infectious etiology, but the microbiological studies were negative and there was no response to treatment. Since he had recently received booster dose of Pfizer-BioNTech COVID-19 vaccination three weeks prior to onset of symptoms, a possibility of Multisystem inflammatory syndrome in children (MIS-C) was made. His presentation fulfilled all the diagnostic criteria. The possibility for MIS-C being related to vaccination was proposed after relevant serological tests showed that the antibodies, he had were due to COVID-19 vaccine, not to a prior infection. After he received appropriate immunomodulatory treatment (IVIG and methylprednisolone) as per the guideline, he showed marked clinical improvement. Our case report highlights the need to consider MIS-C as a potential differential in young patients who present with unexplained multisystem illness with increased inflammatory markers and negative microbiologic work-up. MIS-C can be secondary to COVID-19 vaccination as well as to prior COVID-19 infection.
RESUMO
BACKGROUND: In Qatar, home diagnostic tests are available over the counter in community pharmacies. While possibly beneficial, these tests have the potential for harm if they are used in the absence of pharmacist counseling. OBJECTIVES: To determine the public views, level of awareness and use of home diagnostic tests and to evaluate the extent of community pharmacists' involvement in educating the public about these tests in Qatar. SETTING: Qatar's Supreme Council of Health lists 245 community pharmacies in Qatar. Ten community pharmacies were randomly selected from the list as study sites. METHOD: The investigators visited selected pharmacies on different weekdays and at different times of the day. Members of the public who appeared to be over 16 years of age and able to communicate in English or Arabic were randomly approached, provided with the study objectives, and requested to participate. Those who offered oral consent were anonymously interviewed using a multipart survey. MAIN OUTCOME MEASURES: Measures include the public awareness and use of home diagnostic tests and the extent of community pharmacist involvement in educating the public about these tests. RESULTS: During the 5-month study period, 297 patients answered the survey (60 % response rate). Most respondents were aware of at least one home diagnostic test (98 %). The top four home diagnostic tests that the respondents had ever heard of included: thermometers (91 %), blood pressure monitors (91 %), blood sugar tests (86 %) and regular pregnancy tests (72 %). Seventy-one percent of respondents had performed at least one home diagnostic test. When asked about the factors that influenced their choice of the home diagnostic tests, the pharmacist was only cited by 7 % of respondents. The majority of respondents (>80 %) agreed that using a home diagnostic test is convenient, comfortable and helps them in early diagnosis and treatment of healthcare conditions. Only 31 % agreed that the pharmacist offered sufficient information on what to do in case the test result turns to be positive. The study results suggest that generally, the public has good attitudes and awareness of home diagnostic tests. However, the results indicate that Qatar community pharmacists are not sufficiently involved in public education about home diagnostic tests. Pharmacists should take a more active role in counseling the public on the proper use of these tests.