Résumé
Background. Droplet digital PCR (ddPCR) has been shown to be more sensitive and precise in the quantification of SARS-CoV-2 when compared to traditional quantitative RT-PCR. Multiple studies have explored associations between SARS-CoV-2 viral load and patient outcomes;however, few have used ddPCR technology. Here we investigated the associations between viral load measured using ddPCR and clinical presentation and outcomes. Methods. We performed a retrospective observational study of individuals who tested positive for COVID-19 at the VA San Diego between August 2020 and December 2021. SARS-CoV-2 viral load from nasopharyngeal swabs was determined using ddPCR. Baseline demographics, past medical history, clinical course, and laboratory data were ed from the chart. Results. A total of 696 individuals were included, 86% (n=603) of whom were male. The average age was 50-years-old [range: 19-98]. Three-quarters of individuals (76%, n=528) were unvaccinated at diagnosis. Frequency of comorbidities are shown in Table 1. The majority of individuals developed symptoms with 75% (n=516) reporting respiratory symptoms, 47% (n=317) fever, 34% (n=230) GI symptoms, and 23% (n=161) loss of taste and/or smell. A total of 24% of veterans were evaluated only in the emergency department, 21% (n=149) were admitted to the hospital;9% (n=60) required ICU level of care, 33% of these (n=20) required intubation, and 16 individuals died during hospitalization. SARS-CoV-2 log10 viral load was not associated with age, and only a weak correlation was seen with time from onset of symptoms (r2=-0.1, p=0.04). No association was observed between viral load and peak CRP, ferritin, d-dimer, or nadir absolute lymphocyte count. Mean viral load was significantly higher in veterans reporting fever (5.0 vs 5.4, p=0.02) and respiratory symptoms (4.7 vs 5.3, p=0.01). Interestingly, vaccinated veterans also had higher viral loads(5.8 vs 5.0, p< 0.0001). Conclusion. Fever and respiratory symptoms were associated with higher viral loads as expected. The association of vaccination with higher viral load may reflect selection bias for infections in the delta wave. Future work will include multivariate analyses to adjust for medical history and timing of sampling.
Résumé
A 78-year- old man presented to the emergency department with acute confusion and urinary incontinence. His past medical history included type 2 diabetes with poor glycaemic control (HbA1c 126 mmol/mol Hb two months prior to admission). On examination he was febrile, tachycardic and clinically dehydrated. A chest x-ray confirmed right basal consolidation. Venous blood gas analysis showed an elevated glucose of 18.1 mmol/L and a raised anion gap metabolic acidosis. Capillary blood ketones were 6.1 mmol/L indicating diabetic ketoacidosis (DKA). Blood tests showed an acute kidney injury and markedly raised inflammatory markers (C-reactive protein 537 mg/L, WCC 11.6mg/l). A diagnosis of covid-19 pneumonia was made following detection of severe acute respiratory syndrome 2 (SARS CoV-2) on polymerase chain reaction (PCR) testing. The patient received treatment for DKA in accordance with the hospital's local clinical guidelines, which resolved rapidly within hours. His pneumonia was treated with intravenous ceftriaxone. The patient's clinical course in hospital was otherwise uncomplicated, but the case highlights the role of covid-19 as a possible precipitant of metabolic emergencies in patients with diabetes. There is increasing evidence describing the complex and multidirectional way in which covid-19 and diabetes interact. It is now well known that diabetes is one of the most important comorbidities associated with severe covid-19 disease. Recent research has suggested potential for the SARS CoV-2 virus itself to have a direct effect on beta cell function. This case illustrates the notion of diabetes being both a risk factor for and a condition that is worsened by covid-19.
Résumé
This paper focuses on the emergence, place and role of the digital humanities (DH), particularly in the Arab world, with reference to Oman, a country whose post-oil economy relies vastly on the development of national skills and expertise. It traces the development of DH globally and considers the challenges in Oman, focusing on the state of digitalisation of the economy and knowledge through both public and private development. By exploring the possible immediate and far-reaching goals of a DH program in a country that requires drastic changes to meet the economic and social needs of its citizens and residents in a twenty-first century, post-Covid-19 economy, this study looks at the extent to which institutions are primed to build upon existing scaffolding to achieve digital goals. While focusing on pedagogical outcomes and strategies, this study suggests that DH is imperative to the effective implementation of the Omani national vision 2040 in terms of facilitating knowledge creation and nation-building through heritage preservation and that the establishment of a Digital Humanities Research Centre would be essential toward promoting interdisciplinary work in a sustained and effective manner. © 2021, Addleton Academic Publishers. All rights reserved.
Résumé
Background: As countries around the world review interventions for containing the COVID-19 pandemic, movement of populations has been identified as a key factor of viral dispersal and limiting the population flow intensity has been applied to contain the current COVID-19 epidemic. Evolutionary analyses of well-annotated sequencing data can provide insights into viral transmission dynamics. Herein, we characterized the dynamics of COVID-19 transmission within California and across the Mexico-California (MX/CA) border, the busiest land border-crossing area in the world, to inform the containment policy in this binational context. Methods: All publicly available SARS-CoV-2 full genome sequences (human host) available on the GISAID database were collected (as of Nov. 16th, 2020). After sequence curation, a multistep phylogenetic approach was applied to identify putative clusters of transmission within CA (across counties), MX (across states) and across the MX/CA border. These clades were analyzed with a discrete phylogeographic model to evaluate transmission dynamics of COVID-19 in the MX/CA region. Results: From a total of 174,324 SARS-CoV-2 sequences including 5,471 sequences from Mexico (7 States, n=223)/California (29 counties, n=5,248), we identified 622 unique introduction events into the study region, including 381 clusters of size ≥3 from ≥2 locations (i.e. CA county and/or MX state). Of these, 339 (89%) clusters were from CA only across 23 counties, 5 (1.3%) were from MX only across 6 states and 38 (10%) included sequences from both CA and MX Discrete phylogeographic analysis revealed a complex viral migration network within CA/MX and across the border (Figure 1A, left panel). Analyses of the 38 clusters including sequences from CA and MEX showed bidirectional migration events across the border (Figure 1B). In particular we showed migration events in the border region from the border state of Baja California, MX to the border county of San Diego, CA and from the border county of Imperial County, CA to the border state of Sonora, MX (Figure 1A, right panel). Conclusion: This comprehensive analysis of all publicly available COVID-19 sequences showed local transmission across regions within CA and MX as well as across neighboring locations across the border. Similar to the 2009 H1N1 pandemic, the MX/CA border does not appear to be a major barrier to the spread of COVID-19, necessitating coordinated transnational intervention approaches.