EFFICACY OF BARICITINIB IN PATIENTS TREATED WITH CORTICOSTEROIDS FOR SEVERE COVID-19 PNEUMONIA: A RETROSPECTIVE OBSERVATIONAL COHORT STUDY

Intro Current evidence is still lacking in use of baricitinib among COVID-19 patients that require low flow oxygen and have systemic inflammation. Therefore, we are keen to evaluate the efficacy of baricitinib therapy among this group of patients, in preventing progression into high flow oxygen devices, mechanical ventilation and reducing mortality. Methods All hospitalised COVID-19 patients that required low flow oxygen with evidence of elevated inflammatory markers (either CRP > 50mg/L or ferritin > 500 mcg/L) were enrolled. It compared those that received standard of care (SOC) between April 2021 and May 2021, with another cohort of patients that received baricitinib and SOC between August 2021 and September 2021. Statistics were propensity score matched for age, gender, comorbidities, oxygen level, CRP and SPO2/FiO2 ratio. Findings Five-hundred fifty patients were included in the standard of care arm (SOC, n=275) and baricitinib-treated arm (BCT-SOC, n=275). Subjects in baricitinib-treated arm received a median 7 days of baricitinib. There was a significant reduction in the need for mechanical ventilation with baricitinib- treated arm compared with SOC arm (11.3% [31/275] BCT-SOC, 18.9% [52/275] SOC;HR 0.55, 95%CI 0.35-0.86;p=0.009). We found more patients in baricitinib- treated arm progressed into non-invasive ventilation or other high flow oxygen devices (26.9% [74/275] BCT-SOC, 19.6% [54/275] SOC;HR 1.45, 95%CI 1.02- 1.46;p=0.037). There was no significant difference in 28-day mortality among 2 groups (8% [22/275] BCT-SOC, 6.9% [19/275] SOC, HR 1.16, 95%CI 0.63-2.1;p=0.646). Discussion In our cohort of COVID-19 patients that require low flow oxygen and have systemic inflammation, a short course of baricitinib used in conjunction with SOC reduced needs of mechanical ventilation. This could help relieve our intensive care burden during COVID-19 crisis. Conclusion Despite showing reduced needs of invasive ventilation, it did not translate into mortality benefits. Thus, prospective randomized study is required to determine the optimal timing for initiation of baricitinib.

Clinical severity of COVID-19 with omicron variant predominance in relation to vaccination status, age, comorbidities- a single center in Selangor, Malaysia.

INTRODUCTION: Recently, the rapid surge of reported COVID-19 cases attributed to the Omicron variant of severe acute respiratory syndrome coronavirus (SARS-CoV-2) created an immediate concern across nations. Local information pertaining to the new variant of concern (VOC) is lacking. We aimed to determine the clinical characteristics of COVID-19 during a period of Omicron prevalence among patients hospitalised from February 1 to 21, 2022 at Sungai Buloh Hospital and to estimate the risks of disease progression presumably caused by this variant in association with gender, age, comorbidity, and vaccination status. MATERIALS AND METHODS: In this retrospective, singlecentered, retrospective cohort study, all hospitalised adults with laboratory-confirmed COVID-19, aged 18 and above, were recruited from February 1 to 21, 2022. Clinical characteristics, investigations, and outcomes were assessed. RESULTS: A total of 2279 patients aged 18 years and above with laboratory-proven COVID-19 were recruited and analysed, excluding 32 patients owing to incomplete data. Majority of the study population had a mean age of 41.8 ± 17.7, was female-predominant (1329/2279, 58.6%), had completed a primary series of vaccination with a booster (1103/2279, 48.4%), and had no underlying medical conditions (1529/2279, 67.4%). The risk of COVID-19-related disease progression was significantly lower in hospitalised patients under the age of 50 who were female, had no comorbidity, and had completed two doses of the primary series with or without a booster. [respectively, OR 7.94 (95% CI 6.16, 10.23); 1.68 (1.34, 2,12); 2.44 (1.85, 3.22); 2.56 (1.65, 3.97), p< 0.001]. CONCLUSION: During the period of Omicron prevalence, a favourable outcome of COVID-19 was strongly associated with female gender, age below 50, a comorbidity-free condition, and having completed immunization. With this new observation, it could help improve public health planning and clinical management in response to the emergence of the latest VOC.

Identification of warning signs in Malaysian patients having COVID-19 infection who progress to severe form of the illness

INTRODUCTION: Coronavirus disease 2019 (COVID-19) is an infectious disease caused by a novel coronavirus, now widely known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has caused 3 major pandemic waves in Malaysia. We aimed to identify the warning signs as indicators that predict the progression of disease. MATERIALS AND METHODS: This is a retrospective cohort study of adult patients more than 12 years of age presenting with laboratory-confirmed COVID-19 admitted in three separate hospitals around the country. RESULTS: Of the 228 patients initially admitted with mild illness, 47 had progressed requiring oxygen. The median time from admission to deterioration was 3 days (IQR 2 - 5). Age more than ≥50years old (median age = 42.5, IQR = 28.8 - 57.0), higher temperature (mean = 37.3, IQR 36.8 - 38.0), MEWS score >3 (9, 19.1%), Neutrophil-to-lymphocyte ratio (NLR) >3.13 , (18, 38.3%) C-reactive protein (CRP) >5. (12, 27.3%), multiple zonal involvement on the chest radiography on admission (2, IQR 1-3) were more common in the deteriorated group on admission. On multivariate analysis, multiple comorbidities (HR = 7.40, 95 percent CI 2.58-21.2, p0.001), presence of persistent fever (HR = 2.88, 95 percent CI 1.15 - 7.2, p = 0.024), MEWS scoring >3 (HR of 6.72 ;95 percent CI 2.81-16.0, p0.001) were associated with progression to severe illness. CONCLUSION: In our cohort, we found that several factors were associated with the severity of COVID19. Early detection of these factors could correctly identify patients who need more intensive monitoring, and early referral for ICU care.

Case series of COVID-19 with spontaneous pneumomediastinum

Spontaneous pneumomediastinum is a rare condition in viral pneumonia. However, it can arise spontaneously in COVID-19 patients with no other risk factors. Here we present four cases of spontaneous pneumomediastinum in patients with COVID-19 pneumonia with no other precipitating factors.

Environmental surface sampling of SARS-CoV-2 in selected hospitals in Malaysia.

COVID-19 has spread rapidly worldwide. The role of fomites in facilitating onward transmission is plausible. This study aimed to determine the presence of viable virus and its persistence on the surfaces of fomites in wards treating COVID-19 patients in Malaysia. This study was conducted in two stages. First, environmental sampling was performed on random days in the intensive care unit (ICU) and general wards. Then, in the second stage, samples were collected serially on alternate days for 7 days in two selected general wards. In Stage 1, a total of 104 samples were collected from the surfaces of highly touched and used areas by patients and healthcare workers. Only three samples were tested positive for SARS-COV-2. In Stage 2, three surface samples were detected positive, but no persistence of the virus was observed. However, none of the SARS-CoV-2 RNA was viable through tissue culture. Overall, the environmental contamination of SARS-CoV-2 was low in this hospital setting. Hospitals' strict infection control and the compliance of patients with wearing masks may have played a role in these findings, suggesting adherence to those measures to reduce occupational exposure of COVID-19 in hospital settings.