Factors for prolonged hospital length of stay in discharged patients with COVID-19

Hospitals were overburdened during peak periods of Coronavirus disease 2019 (COVID-19) pandemic, and bed occupancy was full. The ability to predict and plan patients' hospital length of stay allows predictability in terms of the free capacity of hospital facilities. The purpose of this article is to evaluate the factors that influence the hospital length of stay among discharged (recovered) from COVID-19 patients. This will allow the prediction of the likely number of bed days in the conditions of intensive workload of medical facilities for hospital care. A total of 441 discharged after hospital treatment for COVID-19 patients are followed up. Factors for prolonged hospital length of stay are searched among the indicators recorded at admission. Median hospital length of stay of the patients discharged from COVID-19 ward is 9 days (IQR 6-12) and in the COVID-19 intensive care unit 12 days (IQR 9.75-18.75). The median length of stay assessed by a survival analysis is 35 days in the COVID-19 unit and only 8 days in intensive care, due to the high mortality in the intensive care unit. The longer hospital length of stay of patients discharged from the COVID-19 wards is associated with the presence of hypertension (median 10 vs. 8 days for patients without the disease, p=0.006), ischemic heart disease (10 vs. 8 days, p<0.001), cerebrovascular disease (10 vs. 8 days, p=0.061 - did not reach significance), peripheral arterial disease (12 vs. 8 days, p=0.024), chronic renal failure or chroniodialysis (14 vs. 8 days, p<0.001), oncological illness (11 vs. 8 days, p=0.024), presence of at least one comorbidity (9 vs. 8 days, p=0.006), arrival at the hospital by ambulance vs. the patient's own transport (11 vs. 8 days, p=0.003), severe lung involvement shown on X-ray (10 vs. 8 days, p=0.030) or CT (18 vs. 10 days, p=0.045). Prolonged hospital length of stay is associated with older age (Spearman's rho=0.185, p<0.001), greater number of comorbidities (Spearman's rho=0.200, p<0.001), lower oxygen saturation on admission (Spearman's rho=- 0.294, p<0.001) and lower lymphocytes count (Spearman's rho=-0.209, p<0.001), as well as higher CRP (Spearman's rho=0.168, p<0.001), LDH (Spearman's rho=0.140, p=0.004), ferritin (Spearman's rho=0.143, p=0.004) and d-dimer (Spearman's rho=0.207, p<0.001). The multiple linear regression model found that the increase in the number of bed days of discharged from COVID-19 unit patients depends on the way the patient arrived at the Emergency Department (by ambulance instead of on their own transportation) and the presence of an accompanying oncological disease (R2=0.628, p<0.001). The hospital length of stay of patients discharged from COVID-19 intensive care unit is associated with the presence of hypertension (median 14 vs. 9 days for patients without the disease, p=0.067 - significance not reached) and at least one comorbidity (14 vs. 9 days, p=0.067 - significance not reached). The number of bed days is higher when recorded more comorbidities (Spearman's rho=0.818, p=0.004), lower oxygen saturation (Spearman's rho=-0.605, p=0.067 - significance not reached) and higher leukocytes count (Spearman's rho=0.546, p=0.102 - significance not reached). A multiple linear regression model demonstrated the hospital length of stay of patients in the COVID-19 intensive care unit as an outcome of the number of comorbidities only (R2=0.826, p=0.003). The ability to estimate and forecast quickly the number of bed-days based on a small number of variables would help reduce the burden on the healthcare system during a pandemic.

Utility of the Brixia CXR score, C-Reactive Protein and Absolute Neutrophil Count in Predicting the Need for Invasive Mechanical Ventilation, Length of Hospital Stay, and Mortality in Moderate to Severe COVID-19 Patients

Background: The Brixia Chest X-ray (CXR) score, C-reactive protein (CRP), and the absolute neutrophil count (ANC) have been useful to predict outcomes in Coronavirus disease 2019 (COVID-19 patients). We studied the utility of the Brixia CXR score, CRP, and ANC in predicting the outcomes in terms of the need for invasive mechanical ventilation, length of stay, and mortality in moderate-severe COVID-19 patients. Material(s) and Method(s): This was a single-centre, retrospective, study on 122 COVID-19 patients. Brixia CXR score, CRP, and ANC on admission to the hospital and the fifth day of hospital stay were noted along with the need for invasive mechanical ventilation (IMV), prolonged length of stay (LOS) >= 14 days, and mortality. Result(s): 122 patients were included for analysis. The median and interquartile range (IQR) for baseline CRP was 81.50 (39-151) mg/L and 11.0 (4-30) mg/L (p < 0.001) on the fifth day. The median and IQR for baseline Brixia score was 10.0 (7-13), and on the fifth day was 7 (4-11) (p <0.001). The receiver operating characteristic curve (ROC) showed that the baseline CRP >= 52.5mg/L predicted both the need for IMV, with an area under the curve (AUC) of 0.628, and prolonged LOS with an AUC of 0.608. The ROC curve depicted that the baseline ANC >8500/muL predicted IMV requirement with an AUC of 0.657. The fifth day CRP >= 32 mg/L, ANC >= 11,000/ muL and Brixia CXR score >= 7 predicted a higher mortality in hospitalized patients. Conclusion(s): Baseline CRP (> 52.5mg/L) predicts the need for IMV and a prolonged LOS, but not mortality. Baseline ANC (> 8500/muL) predicted the need for IMV. CRP, Brixia CXR score, and ANC on the fifth day were not useful to predict LOS or mortality, though there was a significant reduction in CRP and Brixia CXR score on the fifth day compared to baseline after treatment. The fifth day CRP >= 32 mg/L, ANC >= 11,000/ muL and Brixia CXR score >= 7 predicted a higher mortality.Copyright © 2023, College of Anaesthesiologists of Sri Lanka. All rights reserved.

Analysis of epidemiological features of COVID-19 in Pavlodar region

Introduction: Coronavirus infection (COVID-19), first reported at the end of 2019, which has spilled over into a worldwide pandemic and has affected all aspects of our modern lives. The aim is to study and analyze the epidemiological features of COVID-19 in the Pavlodar region. Materials and methods: Study design is a descriptive retrospective study analysis. The data were obtained from official sources of the Republican Center for e-Health of the Ministry of Health of the Republic of Kazakhstan. The study includes patients from June 30, 2020 to October 31, 2021 who received outpatient and inpatient treatment for coronavirus infection in medical institutions of the Pavlodar region. Study materials - uploading reports from the Republican Center for e-Health of the Ministry of Health of the Republic of Kazakhstan. Results: This article presents epidemiological data on the incidence of coronavirus infection in the population of Pavlodar region. The number of detected cases of COVID-19 from June 30, 2020 to October 31, 2021 was 29,443. Distribution of patients by sex predominated women - 17,831 (60.56%), than men - 11,612 (39.44%). The majority of cases were in the age group from 61 to 70 years old, with a male to female ratio of 1:1.54. Statistical significance was found between duration of stay and type of inpatient care (p < 0.001, VS-MPR*=2.135 x 10+22). Conclusion: The study showed that the number of women who fell ill prevailed over the number of men who fell ill, although the number of deaths among men prevailed over the number of deaths among women. In the study, there was no significant difference in the duration of stay for men and women in home care, compared to patients under 24-hour observation.

COVID-19 inside out: in-hospital outcomes at a public sector tertiary care hospital in Karachi

Objective: To present in-hospital COVID-19 mortality and the associated factors at a public sector tertiary care hospital in Karachi Methodology: The current prospective, observational study was conducted at Jinnah Postgraduate Medical Center, Karachi, Pakistan from June 1 to August 30, 2021 with the approval of the hospital ethics committee. Data was collected prospectively from patients' medical record files. COVID-19 infection positive cases were diagnosed according to the guidelines of the WHO on laboratory investigation of real time polymerase chain reaction tests on a nasopharyngeal or oropharyngeal swab. Result: Total 143 patients were enrolled in the study with median (IQR) age of 58 (48-69). The majority of the patients were males (n=96, 67.13%) and had moderate to severe disease (n=128, 89.51%). During their hospital stay, patients developed the following complications;pneumonia (n=99, 69.23%), ARDS (n=19, 13.28%), sepsis (n=11, 7.69%), septic shock (n=5, 3.49%) and pedal edema (n=2, 1.39%). As many as 104 (72.72%), 69 (48.25%), and 42(29.37%) patients required pharmatherapy, non-invasive ventilation, and mechanical ventilation respectively. While 54 (37.76%) patients died during their hospital stay. On multivariable model, pneumonia, use of non-invasive ventilation, and mechanical ventilation, were identified as independent predictors of mortality. Conclusion: Most of the patients in our study had moderate to severe disease. Therefore, the study indicates that timely presentation to the hospital is of great importance to avoid adverse events which are significantly associated with mortality.

Association between comorbidities and outcome of COVID-19 patients at Dr. M. Djamil general hospital padang

Background: COVID-19 has spread rapidly throughout the world with high morbidity and mortality estimated up to 20%. This number will increase with the presence of comorbidities. Comorbidities were associated with complex clinical management and impacted on COVID-19 disease outcomes. This study aims to determine the association between comorbidities and the outcome of COVID-19 patients at Dr. M. Djamil Hospital. Method: We conducted an observational study with a retrospective cohort design on COVID-19 patients treated at Dr. M. Djamil Hospital. Data were taken from medical records from January to March 2021. Association between comorbidities and the outcome of COVID-19 patients was analyzed by Chi-Square or Fisher Exact Test. Results: The majority patientss were female (56.4%) and ages above 50 years old (64.3%) were the majority of patients. The most common was hypertension (36.56%). The longest length of stay of COVID-19 patients was more than 21 days (52.9%). The outcomes of COVID-19 patients were recovered (59.5%), recovered with sequelae (5.7%), and died (34.8%). Diabetes mellitus affected the end of treatment outcome. There was no relationship of type of comorbidity with length of stay. The more co-morbidities a patient suffers, the condition when infected with COVID-19 will get worse. Conclusion: The number of comorbidities affects the outcome of COVID-19 patients. Diabetes mellitus is most common that affects the end of treatment outcome for COVID-19 patients at Dr. M. Djamil Hospital.

Hematological findings in COVID-19 and their correlation with severity of Disease

Objective: To evaluate the efficacy of hematological parameters to predict severity of COVID-19 patients. Method: This was a cross-sectional comparative study conducted at Central Park Teaching Hospital, Lahore in COVID ward and COVID ICU between April 23, 2021 to June 23, 2021. Patients of all ages and both genders with positive PCR admitted in the COVID ward and ICU during this time span of two months were included in the study. Data was collected retrospectively. Results: This study included 50 patients with male to female ratio of 1.38:1. Though males are more affected by COVID-19 but the difference is not statistically significant. The mean age of the study population was 56.21 and the patients in the severe disease group have higher age. It was observed that in severe/critical group the mean values of total leukocyte count 21.76×103 µI (p-value= 0.002), absolute neutrophil count 71.37% (p-value=0.045), neutrophil lymphocyte ratio (NLR) 12.80 (p-value=0.00) and PT 11.9 seconds (p-value=0.034) and the difference was statistically significant. While in severe/critical group, the mean values of hemoglobin 12.03g/dl (p-value=0.075), lymphocyte count 28.41% (p-value=0.8), platelet count 226×103 µI (p-value=0.67) and APTT 30.7 (p-value=0.081) and the difference was not significantly different between groups. Conclusion: It can be concluded from the study that total leucocyte count, absolute neutrophil count and neutrophil lymphocyte ratio can predict in-hospital mortality and morbidity in COVID-19 patients.

The relationship between smoking status and smoking index against COVID-19 disease course in treated patients at Dr. M Djamil General Hospital, Padang

Background: Smoking is a risk factor for the development and worsening of respiratory diseases, including COVID-19 infection. Smoking can increase the risk of the severity of COVID-19 by two times because in smokers there is an increase in the expression of the ACE-2 gene by 25% compared to non-smokers. The purpose of this study was to determine the relationship between smoking status and smoking index on the course of COVID-19 disease treated at Dr. M Djamil General Hospital. Method: An observational analytic study with a retrospective cohort approach on COVID-19 patients who were treated at Dr. M. Djamil General Hospital. Data were taken from January to March 2021. The relationship between smoking status and smoking index on the course of COVID-19 was analyzed by Chi-Square. Results: This study found the most age was above 50 years with a vulnerable age of 50-59 years (28.4%) and female gender (56.7%). Non-smoker status (64.2%) and moderate smoking index (51.4%) were the most commonly found in this study. Clinically non-progressive COVID-19 (53.7%) was the most common. This study found that the maximum length of stay for COVID-19 patients was less than 21 days (53.7%) and the outcome of patients recovered (62.2%). This study found a significant relationship between the smoking index on the clinical progress of COVID-19 patients and there was a significant relationship between smoking status and the outcome of COVID-19 patients. This study found that smoking status and the smoking index had no significant relationship with the length of stay of COVID-19 patients. Conclusion: Smoking status is related to outcomes in COVID-19 patients and the smoking index is related to a progression in COVID-19 patients treated at Dr. M. Djamil General Hospital.

Analysis of the Effects of COVID-19 on Hip Fractures in Korea Without Lockdown: Interrupted Time Series Analysis Using a Nationwide Cohort.

BACKGROUND: The purpose of this study was to investigate the change in the incidence rate, length of hospital stay (LOS), in-hospital mortality rate, and surgical method of hip fractures during the coronavirus disease 2019 (COVID-19) pandemic in South Korea where lockdown restrictions were not implemented. METHODS: We calculated the expected values of the incidence of hip fractures, in-hospital mortality and LOS of hip fracture patients in 2020 (COVID period) based hip fracture database of the Korean National Health Insurance Review and Assessment (HIRA) during a 9-year period from 2011 to 2019 (pre-COVID period). A generalized estimating equation model with Poisson distribution and logarithmic link function was used to estimate adjusted annual percent change (PC) of incidence rate and 95% confidence intervals (CIs). Then, we compared the annual incidence, in-hospital mortality rate and LOS in 2020 with the expected values. RESULTS: The overall incidence rate of hip fracture in 2020 was not significantly different from the expected value (PC, -5%; 95% CI, -13 to 4; P = 0.280). In women, the incidence rate of hip fracture in age groups over 70 years was smaller than the predicted value (P < 0.001). The in-hospital mortality rate was not significantly different from the expected value (PC, 5%; 95% CI, -8 to 19; P = 0.461). The mean LOS was larger than the expected value by 2% (PC, 2%; 95% CI, 1 to 3; P < 0.001). In intertrochanteric fracture, the proportion of internal fixation was smaller than the predicted value by 2% (PC, -2%; 95% CI, -3 to -1; P < 0.001), and that of hemiarthroplasty was larger than the predicted value by 8% (PC, 8%; 95% CI, 4 to 14; P < 0.001). CONCLUSIONS: In 2020, the incidence rate of hip fracture did not significantly decrease, and in-hospital mortality rate did not significantly increase compared to the expected rates, which were projected based on the HIRA hip fracture data from 2011 to 2019. Only LOS increased slightly.

Predictors of Mortality among COVID-19 Patients - A Case Control Study at Tertiary Care Center, Nanded (Maharashtra).

Background: The novel Coronavirus is belonging to the family of SARS & MERS-CoV, the impact of the earlier is more dreadful as demonstrated by the steady increase in morbid cases. The average incubation period of COVID-19 is 1-14 days with a mean of 6 days. Aim - To evaluate predictors of mortality among COVID-19 patients. Objectives - 1. To assess risk predictors associated with mortality among COVID-19 patients 2. To a suggest prediction model for preventing mortality in future outbreaks. Materials and Methods: Study design - A case-control study. Study place -Tertiary care center, Nanded, Maharashtra. The present study included 400 cases that died off due to Covid-19 and 400 controls survived COVID-19 disease in a 1:1 proportion. Results: On admission, a significant difference was observed among cases and controls with reference to the percentage of SpO2 (p < 0.05). The proportion of associated co-morbidities among cases was very high i.e., 75.75% as compared to controls with a proportion of 29.25% co-morbidities. The median days of hospital stay were significantly lower in cases compared to controls (3 days vs 12 days, P < 0.001). Conclusion: Length of hospital stay (in days) was showing a significant difference among cases and control (3 days Vs 12 days); hospital stay was less (median 3 days) for cases, as they reported late and thus died earlier; hence concluded that early hospital admission will decrease chances of death due to COVID-19.

Enhanced Recovery After Cleft Lip Repair: Protocol Development and Implementation in Outreach Settings.

INTRODUCTION: Clefts of the lip are of the most common congenital craniofacial anomalies. The development and implementation of an enhanced recovery after surgery (ERAS) protocol among patients undergoing cleft lip repair may decrease postoperative complications, accelerate recovery, and result in earlier postoperative discharge. METHODS: A modified ERAS program was developed and applied through Global Smile Foundation outreach craniofacial programs. The main components of this protocol include: (1) preoperative patient education, (2) nutrition screening, (3) smoking cessation when applicable, (4) use of topical anesthetic adjuncts, (5) facial nerve blocks, (6) postoperative analgesia, (7) preferential use of short-acting narcotics, (8) antibiotic administration, (9) use of elbow restraints, (10) early postoperative oral feeding and hydration, and (11) discharge planning. RESULTS: Between April 2019 and March 2020, GSF operated on 126 patients with cleft lip from different age groups and 58.8% of them were less than 1 year of age. Three patients (2.4%) had delayed wound healing and one (0.8%) had postoperative bleeding. There were no cases of mortality, length of hospital stay did not exceed 1 postoperative day, and patients were able to tolerate fluids intake at discharge. CONCLUSION: The implementation of an ERAS protocol among patients undergoing cleft lip repair has shown to be highly effective in minimizing postoperative discomfort while reducing opioids use, decreasing the length of stay in hospital, and leading to early oral feeding resumption. The ERAS principles described carry increased relevance in the context of the ongoing COVID-19 pandemic and opioid crisis and can be safely applied in resource-constrained settings.

Admission glycemia associated with mortality and hospital stay in a multidisciplinary service of a Peruvian national hospital

Objective: Evaluate the association between glycemia on admission and adverse outcomes in hospitalized patients with COVID19 in a Peruvian national hospital. Methods: Retrospective, observational cohort study. We collected data from electronic medical records of COVID19 patients in a medical specialties service. Patients were classified according to blood glucose levels on admission: <= and >140mg/dL. Primary outcome was mortality, and the secondary a composite that included mortality, septic shock, mechanical ventilation, or transfer to ICU. We also evaluated hospital stay and a multivariate logistic regression sub analysis was performed in diabetic patients. Results: 169 patients were evaluated. The mean age was 61 years, 64.5% were male. 71% had at least one comorbidity, the most frequent: arterial hypertension (34%), obesity (30%) and diabetes (26%). 70% presented tomographic gravity. Median blood glucose at admission was 126.5mg/dL (IQR: 109- 157mg/dL), one of every 3 had blood glucose levels >140mg/dL. Mortality rate was 9700 deaths per 100000 person-weeks, with a frequency of 21.3%. No significant difference was found between hyperglycemia and normoglycemia, mortality and in composite outcome. Patients with hyperglycemia on admission had longer hospital stay than normoglycemic patients (19 vs 13 days, p<0.01). In sub-analysis with multivariate logistic regression for composite outcome among diabetic patients, admission blood glucose >180mg/dL presented OR of 6.42 (95% CI: 1.07-38.6) for composite outcome, adjusted for age and clinical severity at admission. Conclusions: Hyperglycemia at admission was associated with a longer hospital stay and diabetic patients with hyperglycemia >180mg/dL had a 6-fold increased risk of presenting an adverse outcome.

Comparison of the Efficacy of High-Dose Methylprednisolone and 6 mg Dexamethasone in Treatment in Patients with Severe COVID-19 Pneumonia

Introduction: The course of SARS-CoV-2 disease has a clinical spectrum ranging from mild upper respiratory tract infection to fulminant pneumonia. The use of corticosteroids is recommended in the treatment of severe COVID-19 pneumonia. The present study aimed to compare the efficacy of high-dose methylprednisolone and dexamethasone treatment in patients hospitalized with severe COVID-19 pneumonia. Material(s) and Method(s): The participants were divided into Group M, receiving >=250 mg intravenous methylprednisolone therapy, and Group D receiving 6 mg intravenous dexamethasone therapy. The efficacy of treatments, length of hospital stays, ventilator requirements, anti-cytokine treatment requirements, and mortality rates were evaluated in both groups. Result(s): Two hundred eighty-eight (69.1%) patients received dexamethasone and 129 (30.9%) received methylprednisolone. While overall mortality in the study was 11%, this rate was 10.4% in Group D and 12.4% in Group M (p> 0.05). The rate of patients requiring intensive care was 15.8% in total, with a rate of 14.6% in Group D and 18.6% in Group M (p> 0.05). However, the total length of hospital stay was nine (7-39) days in Group M and 13 (7-29) days in Group D (p= 0.009). Anticytokines were required in 14.4% of the patients during treatment [40 in Group D, 20 in Group M (p> 0.05)]. Conclusion(s): In this study, it was determined that early methylprednisolone treatment shortened the hospital stay. In addition, there was no statistically significant difference between Group M and Group D in terms of mechanical ventilation requirement, which showed an additional positive effect. However, mortality rates in patients receiving dexamethasone were found to be lower than in those receiving methylprednisolone, yet this difference did not reach statistical significance.Copyright © 2023 Bilimsel Tip Yayinevi. All rights reserved.

Therapeutic Effectiveness of Interferon-α2b against COVID-19 with Community-Acquired Pneumonia: The Ukrainian Experience.

Despite several targeted antiviral drugs against SARS-CoV-2 currently being available, the application of type I interferons (IFNs) still deserves attention as an alternative antiviral strategy. This study aimed to assess the therapeutic effectiveness of IFN-α in hospitalized patients with COVID-19-associated pneumonia. The prospective cohort study included 130 adult patients with coronavirus disease (COVID-19). A dose of 80,000 IU of IFN-α2b was administered daily intranasally for 10 days. Adding IFN-α2b to standard therapy reduces the length of the hospital stay by 3 days (p < 0.001). The level of CT-diagnosed lung injuries was reduced from 35% to 15% (p = 0.011) and CT injuries decreased from 50% to 15% (p = 0.017) by discharge. In the group of patients receiving IFN-α2b, the SpO2 index before and after treatment increased from 94 (92-96, Q1-Q3) to 96 (96-98, Q1-Q3) (p < 0.001), while the percentage of patients with normal saturation increased (from 33.9% to 74.6%, p < 0.05), but the level of SpO2 decreased in the low (from 52.5% to 16.9%) and very low (from 13.6% to 8.5%) categories. The addition of IFN-α2b to standard therapy has a positive effect on the course of severe COVID-19.

Urban Traumatic Moving Injuries Before and During SARS-CoV-2: A Multilinear Regression Analysis.

Background The onset of the coronavirus pandemic (COVID-19/SARS-CoV-2) saw an overall decline in traffic. Fundamental shifts in the pattern of traffic-related traumas were observed across the United States and beyond.  Objectives This study aims to predict changes in the length of stay (LOS) for patients sustaining traumatic moving injuries before and during the coronavirus pandemic.  Methods All moving injuries (bicycle accidents, pedestrians struck, motor vehicle/motorcycle accidents) before and during the first SARS-CoV-2 wave in the US were extracted from our hospital's trauma registry. The study period was from March 1st to October 31st of 2019 and 2020, respectively. Ordinary least squares (OLS) multilinear regression models were estimated with a significance level of 0.05.  Results In both periods, the Glasgow coma scores (GCS), ICU LOS, injury severity scores (ISS), and admitting service had significant impacts on hospital duration. Higher GCS scores increased the hospital LOS by 0.811 days in 2019 and 0.587 days in 2020. A higher ISS resulted in an increase in LOS by 0.207 days in 2019 and 0.124 days in 2020. The ICU admissions increased LOS by 0.82 days in 2019 and 1.25 days in 2020. Admissions to trauma services increased in duration by 2.111 days in 2019 and 1.379 days in 2020. Average LOS dropped from 3.09 to 2.50 days between both periods.  Conclusion Our trauma center saw significant changes in the admission patterns of moving injuries during COVID-19. We must therefore be better prepared to handle increased volume during public health emergencies and potential reductions in trauma utilization. Local injury prevention efforts may help reduce the burden on trauma centers during such emergencies as they did during COVID-19, allowing for greater focus on non-trauma patients.

Monotherapy versus polytherapy of enoxaparin and hydroxychloroquine for the treatment of COVID-19: A randomized controlled clinical trial.

Objectives: The current study aims to assess the efficacy and safety of Enoxaparin and hydroxychloroquine (HCQ) used as monothrapy or polytherapy versus standard care alone in Coronavirus 2019 (COVID-19) infected patients. Methods: The current study included two hundred patients with laboratory confirmed COVID-19 infection. Patients admitted to hospital were randomly allocated into four groups: group I: received standard COVID-19 therapy, group II: received Enoxaparin 40mg/day subcutaneously (SC) plus standard therapy, group III: received 400 mg/day HCQ plus standard therapy & group IV: received a combination of 400 mg/day HCQ and Enoxaparin plus standard COVID-19 therapy. The disease progression was evaluated by duration to a negative polymerase chain reaction (PCR), length of hospital or Intensive Care Unit (ICU) stay, and mortality rate. The safety of treatments was evaluated by measuring adverse effects. Results: The length of hospital stay, ICU admission and mortality were significantly decreased in Enoxaparin plus standard COVID-19 therapy group versus other groups. Conclusion: These findings suggest that Enoxaparin was safe, effective, and well tolerated and has a role in decreasing the progression of the disease and its complications while HCQ did not discover any evidence of extra therapeutic benefits.

Predictive value of multiple variable models including nutritional risk score (NRS 2002) on mortality and length of stay of patients with covid-19 infections. The INCOVO study.

BACKGROUND AND AIMS: This study aimed at evaluating associations between nutritional status and outcomes in patients with Covid-19 and to identify statistical models including nutritional parameters associated with in-hospital mortality and length of stay. METHODS: Data of 5707 adult patients hospitalized in the University Hospital of Lausanne between March 2020 and March 2021 were screened retrospectively 920 patients (35% female) with confirmed Covid-19 and complete data including nutritional risk score (NRS 2002), were included. This cohort was divided into three subgroups: NRS <3: no risk of malnutrition; NRS ≥3 to <5: moderate risk malnutrition; and NRS ≥5: severe risk of malnutrition. The primary outcome was the percentage of in-hospital deaths in the different NRS subgroups. The secondary outcomes were the length of hospital stay (LOS), the percentage of admissions to intensive care units (ICU), and the length of stay in the ICU (ILOS). Logistic regression was performed to identify risk factors associated with in-hospital mortality and hospital stay. Multivariate clinical-biological models were developed to study predictions of mortality and very long length of stay. RESULTS: The mean age of the cohort was 69.7 years. The death rate was 4 times higher in the subgroup with a NRS ≥ 5 (44%), and 3 times higher with a NRS ≥ 3 to <5 (33%) compared to the patients with a NRS<3 (10%) (p < 0.001). LOS was significantly higher in the NRS ≥ 5 and NRS ≥ 3 to <5 subgroups (26.0 days; CI [21; 30.9]; and 24.9; CI [22.5; 27.1] respectively) versus 13.4; CI [12; 14.8] for NRS<3 (p < 0.001). The mean ILOS was significantly higher in the NRS ≥ 5 (5.9 days; versus 2.8 for NRS ≥ 3 to <5, and 1.58 for NRS<3 (p < 0.001)). In logistic regression, NRS ≥ 3 was significantly associated with the risk of mortality (OR: 4.8; CI [3.3; 7.1]; p < 0.001) and very long in-hospital stay (>12 days) (OR: 2.5; CI [1.9; 3.3]; p < 0.001). Statistical models that included a NRS ≥ 3 and albumin revealed to be strong predictors for mortality and LOS (area under the curve 0.800 and 0.715). CONCLUSION: NRS was found to be an independent risk factor for in-hospital death and LOS in hospitalized Covid-19 patients. Patients with a NRS ≥ 5 had a significant increase in ILOS and mortality. Statistical models including NRS are strong predictors for an increased risk of death and LOS.

Successful intrapericardial fibrinolysis on acute recurrent purulent pericarditis with impending cardiac tamponade during pandemic situation: a rare case report

Introduction: Acute recurrent purulent pericarditis is an uncommon pericardium infection that can be life-threatening due to pus production, leading to cardiac tamponade. Case presentation: We report a 36-year-old man referring to our hospital with impending cardiac tamponade who needed urgent pericardiocentesis. The patient's complaints were worsening dyspnea and palpitations in the last two days. The patient had been hospitalized for the same complaint and had pericardiocentesis due to cardiac tamponade approximately three weeks earlier. Physical exam, ECG, and CXR suggest impending cardiac tamponade. Echocardiography indicated massive right and left pericardial effusion and right atrial collapse. The Covid-19 screening test was positive;however, RT-PCR revealed a negative result. The patient was diagnosed with recurrent acute purulent pericarditis with impending cardiac tamponade requiring urgent pericardiocentesis. After the procedure, 1.5 million units of intrapericardial fibrinolytic were administered to patients. His improved hemodynamic and clinical symptoms indicate a successful procedure. Conclusion: This case highlights the challenges of managing an acute recurrent purulent pericarditis patient due to Staphylococcus A. infection in the current pandemic era, including distinguishing it from other contagious diseases due to nonspecific dyspnea, limited therapeutic options, and the effectiveness of intrapericardial fibrinolytic in improving the overall patient conditions, and reducing the mortality rate.

Incidence and predisposing factors for de novo post-COVID-19 irritable bowel syndrome

Objective: Postinfectious irritable bowel syndrome (IBS) is a known entity. We evaluated the incidence of post-COVID-19 IBS in patients discharged from the hospital and analyzed its correlation with the clinical and laboratory parameters, and treatment during the hospital stay. Methods: Three hundred three COVID-19 hospitalized patients without prior history of IBS were prospectively followed after their discharge and were evaluated as per Rome-IV criteria for IBS. Results: One hundred seventy-eight patients were males (58.7%). The age range was 17-95 years (mean +or- SD, 55.9 +or- 15.8). A total of 194 (64%) had mild COVID-19, 74 (24.4%) had moderate COVID-19, whereas 35 (11.6%) had severe COVID-19 infection. Sixteen (5.3%) patients had concomitant GI symptoms during COVID-19 infection. IBS symptoms were found to be present in 32 (10.6%) patients, out of which 17 (53.13%) had diarrhea-predominant, 10 (31.25%) had constipation-predominant, and five (15.62%) had mixed-type IBS. Post-COVID-19 IBS was more common in the female sex (P < 0.001), concomitant GI symptoms with COVID-19 (P < 0.001), oxygen requirement (P = 0.015), deranged liver function tests at the time of admission (P = 0.002), high procalcitonin (P = 0.013), high C-reactive protein levels (P = 0.035);whereas negative correlation was found with remdesivir treatment (P = 0.047). After performing regression analysis, female sex (P < 0.001), oxygen requirement during hospital stay (P = 0.016), GI symptoms during COVID-19 infection (P < 0.001), and high procalcitonin levels (P = 0.017) were independently associated with post-COVID-19 IBS. Conclusion: GI symptoms during active COVID-19 infection increase the chances of developing post-COVID-19 IBS. The risk of developing post-COVID-19 IBS increases in female patients, those requiring oxygen and having high procalcitonin levels during COVID-19 infection.

Mortality in post-discharge COVID-19 patients from a tertiary care center - a follow-up study

Background: Among many responsibilities, the doctors from the COVID war room of our institute were assigned to take telephonic follow-up of discharged COVID patients to provide any medical assistance if needed. During this process, few relatives of the patient's informed back that the patients had died after discharge from the COVID wards. Aim and Objective: Such data of death in the COVID patients after discharged are limited in India;hence, we conducted this study so that more information is generated. Materials and Methods: Relatives of these COVID patients were asked about date and place of death. Other data including gender, age, date of admission, date of discharge, and requirement of oxygen were available with the COVID war room and were used for evaluation. Results: Out of the 892 COVID discharged patients (between August and October 2020) who could be contacted, 19 (2.13%) patients (6 females and 13 males) had died after discharge from the COVID ward. Characteristics of these 19 patients included higher age (n = 11 were 61-80 years old and n = 3 were >80 years old), hospital stay of 11-20 days (n = 12), and required oxygen support (n = 12). Most deaths occurred within 20 days (n = 16) after discharge from the COVID ward. Conclusions: The current study reports deaths occurring COVID patients after discharge. Most of these deaths occurred within 4 weeks of cure and in elderly patients. More research with long-term follow-up is needed in "cured" COVID-19 patients so that appropriate preventive measures can be undertaken in the future.

Dynamic characteristics of specific antibodies IgM, IgG and viral RNA in patients with COVID-19

Objective: To study the changed trend of IgM and IgG specific antibody with chemiluminescent immunoassay (CLIA) and RT-PCR in SARS-CoV-2 infection patients during hospitalization. Methods: A total of 100 hospitalized patients with SARS-CoV-2 infection who admitted to the First People's Hospital of Zhaoqing were divided into vaccinated group and unvaccinated group according to whether they were vaccinated COVID-19 vaccine or not. The unvaccinated group was further divided into severe, normal, mild and asymptomatic groups. The nucleic acid test results, the positive rate of IgM and IgG antibodies measured by CLIA, and the dynamic trend of S/CO values of all SARS-CoV-2 infected patients since admission 0-<8 days, 8-<15 days, 15-<22 days, 22-<29 days, 29-<36 days and36 days were monitored, and the statistical differences between different groups were compared. Results: The positive rate of IgM antibody in the unvaccinated group 55.6% (15/27) and 0 (0/27) were all significantly higher than that in the vaccinated group 68.5% (50/73) and 49.0% (36/73) at 8-<15 days and 36 days of hospitalization (X2=11.048, 20.805, P < 0.05). The positive rate of IgG antibody in the vaccinated group 96.3% (26/27) and 100% (27/27) were all significantly higher than that in the unvaccinated group 45.2% (31/73) and 78.1% (57/73) at 0-< 8 days and 8-<15 days of hospitalization (X2=21.268, 7.576, P < 0.05). The positive rate of RNA in the unvaccinated were all significantly higher than that in the vaccinated group at 8-<15 days 76.7% (56/73) and 29.6% (8/27), 15-<22 days 65.8% (48/73) and 14.8% (4/27), 22-<29 days 42.5%(31/73) and 7.4% (2/27), 29~<36 days 26.0% (19/73) and 7.4% (2/27) of hospitalization (X2=18.694,20.490, 10.957, 4.119, all P < 0.05). The S/CO value of IgG antibody in the vaccinated group were all significantly higher than that in the unvaccinated group at differentperiods of hospitalization (t=2.841, 7.135, all P < 0.05), but there was no significant difference in the S/CO value of IgM antibodyat different periods of hospitalization in pairwise comparison (P > 0.05). The IgM and IgG antibody levels of severe patients in the unvaccinated group were significantly higher than those in the normal, mild, and asymptomatic groups at 22-<29 days and 29-<36 days of hospitalization (F=17.694,15.116, 4.037, 4.115, all P < 0.05). Conclusion: IgM and IgG antibody levels in severe patients are more activated by immune defense during recovery. In the case of vaccination, IgM antibody can well reflect the whole course of SARS-CoV-2 infection.