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Background: Understanding the COVID-19 disease course in terms of viral shedding is important to assist in providing a tailored isolation and treatment practice. Therefore, the current study aimed to estimate time to viral clearance and identify determinants among SARS-CoV-2 infected individuals admitted to Millennium COVID-19 Care Center in Ethiopia. Methods: A Prospective observational study was conducted among 360 randomly selected SARS-CoV-2 infected individuals who were on follow up from 2nd June to 5th July 2020. Kaplan Meier plots, median survival times, and Log-rank test were used to describe the data and compare survival distribution between groups. Association between time to viral clearance and determinants was assessed using the Cox proportional hazard survival model, where hazard ratio, P-value, and 95% CI for hazard ratio were used for testing significance Results: The Median time to viral clearance was 16 days. The log-rank test shows that having moderate and severe disease, one or more symptoms at presentation, and presenting with respiratory and constitutional symptoms seems to extend the time needed to achieve viral clearance. The Final Cox regression result shows that the rate of achieving viral clearance among symptomatic patients was 44% lower than patients who were asymptomatic (AHR=0.560, 95% CI=0.322-0.975, p-value=0.040). Conclusions: Presence of symptoms was found to be associated with delayed viral clearance implying that symptomatic patients are more likely to be infectious and therefore, attention should be paid to the practices regarding isolation and treatment of COVID-19 patients.
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Humanos , Masculino , Femenino , Administración de la Seguridad , Infecciones por Coronavirus , SARS-CoV-2 , COVID-19 , Carga ViralRESUMEN
BACKGROUND: To describe persistent symptoms in long COVID-19 non-severe outpatients and report the 6-month clinical recovery (CR) rate. METHODS: Observational study enrolling outpatients (≥ 18 years) with confirmed non-severe COVID-19 (positive nasopharyngeal RT-PCR or presence of SARS-CoV-2 antibodies) who consulted for persistent symptoms after the first pandemic wave (March-May 2020). CR was assessed at the 6-month visit and defined as complete (no symptom), partial (persistent symptoms of lower intensity) or lack of recovery (no improvement). RESULTS: Sixty-three patients (79% women, mean age: 48 years) enrolled; main symptoms (mean 81 days after acute infection): asthenia/myalgia (77%), dyspnea (51%), headaches (35%), cough (33%). At 6 months (n=56), 30% had complete, 57% partial, and 13% lack of recovery. The proportion of patients with>2 persistent symptoms was 26% at 6 months (main symptoms: dyspnea [54%] and asthenia/myalgia [46%]). CONCLUSION: We observed a slow but high recovery rate at 6 months among these outpatients.
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COVID-19 , Astenia , COVID-19/complicaciones , Disnea , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Mialgia , Pacientes Ambulatorios , SARS-CoV-2 , Síndrome Post Agudo de COVID-19RESUMEN
BACKGROUND: The COVID-19 pandemic started a little later in Ethiopia than the rest of the world and most of the initial cases were reported to have a milder disease course and a favorable outcome. This changed as the disease spread into the population and the more vulnerable began to develop severe disease. Understanding the risk factors for severe disease in Ethiopia was needed to provide optimal health care services in a resource limited setting. OBJECTIVE: The study assessed COVID-19 patients admitted to Millennium COVID-19 Care Center in Ethiopia for characteristics associated with COVID-19 disease severity. METHODS: A cross-sectional study was conducted from June to August 2020 among 686 randomly selected patients. Chi-square test was used to detect the presence of a statistically significant difference in the characteristics of the patients based on disease severity (Mild vs Moderate vs Severe). A multinomial logistic regression model was used to identify factors associated with COVID-19 disease severity where Adjusted Odds ratio (AOR), 95% CIs for AOR and P-values were used for significance testing. RESULTS: Having moderate as compared with mild disease was significantly associated with having hypertension (AOR = 2.30, 95%CI = 1.27,4.18), diabetes mellitus (AOR = 2.61, 95%CI = 1.31,5.19for diabetes mellitus), fever (AOR = 6.12, 95%CI = 2.94,12.72) and headache (AOR = 2.69, 95%CI = 1.39,5.22). Similarly, having severe disease as compared with mild disease was associated with age group (AOR = 4.43, 95%CI = 2.49,7.85 for 40-59 years and AOR = 18.07, 95%CI = 9.29,35.14for ≥ 60 years), sex (AOR = 1.84, 95%CI = 1.12,3.03), hypertension (AOR = 1.97, 95%CI = 1.08,3.59), diabetes mellitus (AOR = 3.93, 95%CI = 1.96,7.85), fever (AOR = 13.22, 95%CI = 6.11, 28.60) and headache (AOR = 4.82, 95%CI = 2.32, 9.98). In addition, risk factors of severe disease as compared with moderate disease were found to be significantly associated with age group (AOR = 4.87, 95%CI = 2.85, 8.32 for 40-59 years and AOR = 18.91, 95%CI = 9.84,36.331 for ≥ 60 years), fever (AOR = 2.16, 95%CI = 1.29,3.63) and headache (AOR = 1.79, 95%CI = 1.03, 3.11). CONCLUSIONS: Significant factors associated with severe COVID-19 in Ethiopia are being older than 60 years old, male, a diagnosis of hypertension, diabetes mellitus, and the presence of fever and headache. This is consistent with severity indicators identified by WHO and suggests the initial finding of milder disease in Ethiopia may have been because the first people to get COVID-19 in the country were the relatively younger with fewer health problems.
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COVID-19/complicaciones , COVID-19/epidemiología , Índice de Severidad de la Enfermedad , Adulto , Anciano , Anciano de 80 o más Años , Comorbilidad/tendencias , Estudios Transversales , Etiopía/epidemiología , Femenino , Hospitalización , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Pandemias , Gravedad del Paciente , Estudios Retrospectivos , Factores de Riesgo , SARS-CoV-2/patogenicidadRESUMEN
INTRODUCTION: Persistent symptoms have recently emerged as a clinical issue in COVID-19. We aimed to assess the prevalence and risk factors in symptomatic non-hospitalized individuals with mild COVID-19. METHODS: We performed a prospective cohort study of symptomatic COVID-19 outpatients, from March to May 2020, with weekly phone calls from clinical onset until day 30 and up to day 60 in case of persistent symptoms. The main outcomes were the proportion of patients with complete recovery at day 30 and day 60 and factors associated with persistent symptoms. RESULTS: We enrolled 429 individuals mostly women (72.5%) and healthcare workers (72.5%), with a median age of 41.6 years [IQR 30-51.5]. Symptoms included: cough (69.7%), asthenia (68.8%), anosmia (64.8%), headaches (64.6%), myalgia (62.7%), gastrointestinal symptoms (61.8%), fever (61.5%), and ageusia (60.8%). Mean duration of disease was 27 days (95%CI: 25-29). The rate of persistent symptoms was 46.8% at day 30 and 6.5% at day 60 consisting in asthenia (32.6%), anosmia (32.6%), and ageusia (30.4%). The probability of complete recovery was 56.3% (95%CI: 51.7-61.1) at day 30 and 85.6% (95%CI: 81.2-89.4) at day 60. Factors associated with persistent symptoms were age>40 (HR 0.61), female sex (HR 0.70), low cycle threshold (HR 0.78), and ageusia (HR 0.59). CONCLUSIONS: COVID-19 - even in its mild presentation - led to persistent symptoms (up to one month) in nearly half of individuals. Identification of risk factors such as age, gender, ageusia and viral load is crucial for clinical management and argues for the development of antiviral agents.
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COVID-19 , Adulto , COVID-19/epidemiología , Femenino , Humanos , Persona de Mediana Edad , Pacientes Ambulatorios , Prevalencia , Estudios Prospectivos , SARS-CoV-2RESUMEN
BACKGROUND: The COVID-19 pandemic seems to have a different picture in Africa; the first case was identified in the continent after it had already caused a significant loss to the rest of the world and the reported number of cases and mortality rate has been low. Understanding the characteristics and outcome of the pandemic in the African setup is therefore crucial. AIM: To assess the characteristics and outcome of Patients with COVID-19 and to identify determinants of the disease outcome among patients admitted to Millennium COVID-19 Care Center in Ethiopia. METHODS: A prospective cohort study was conducted among 1345 consecutively admitted RT-PCR confirmed Patients with COVID-19 from July to September, 2020. Frequency tables, KM plots, median survival times and Log-rank test were used to describe the data and compare survival distribution between groups. Cox proportional hazard survival model was used to identify determinants of time to clinical recovery and the independent variables, where adjusted hazard ratio, P-value and 95% CI for adjusted hazard ratio were used for testing significance and interpretation of results. Binary logistic regression model was used to assess the presence of a statistically significant association between disease outcome and the independent variables, where adjusted odds ratio, P-value and 95% CI for adjusted odds ratio were used for testing significance and interpretation of results. RESULTS: Among the study population, 71 (5.3%) died, 72 (5.4%) were transferred and the rest 1202 (89.4%) were clinically improved. The median time to clinical recovery was 14 days. On the multivariable Cox proportional hazard model; temperature (AHR = 1.135, 95% CI = 1.011, 1.274, p-value = 0.032), COVID-19 severity (AHR = 0.660, 95% CI = 0.501, 0.869, p-value = 0.003), and cough (AHR = 0.705, 95% CI = 0.519, 0.959, p-value = 0.026) were found to be significant determinants of time to clinical recovery. On the binary logistic regression, the following factors were found to be significantly associated with disease outcome; SPO2 (AOR = 0.302, 95% CI = 0.193, 0.474, p-value = 0.0001), shortness of breath (AOR = 0.354, 95% CI = 0.213, 0.590, p-value = 0.0001) and diabetes mellitus (AOR = 0.549, 95% CI = 0.337, 0.894, p-value = 0.016). CONCLUSIONS: The average duration of time to clinical recovery was 14 days and 89.4% of the patients achieved clinical recovery. The mortality rate of the studied population is lower than reports from other countries including those in Africa. Having severe COVID-19 disease severity and presenting with cough were found to be associated with delayed clinical recovery of the disease. On the other hand, being hyperthermic is associated with shorter disease duration (faster time to clinical recovery). In addition, lower oxygen saturation, subjective complaint of shortness of breath and being diabetic were associated with unfavorable disease outcome. Therefore, patients with these factors should be followed cautiously for a better outcome.
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COVID-19/epidemiología , Hospitalización/estadística & datos numéricos , Adulto , Etiopía/epidemiología , Femenino , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Pandemias/estadística & datos numéricos , Embarazo , Modelos de Riesgos Proporcionales , Estudios Prospectivos , SARS-CoV-2/patogenicidad , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del TratamientoRESUMEN
OBJECTIVES: To describe the characteristics, evolution and risk factors for long-term persistence of olfactory and gustatory dysfunctions (OGD) in COVID-19 outpatients. PATIENTS AND METHODS: We conducted a prospective study in SARS-CoV-2 infected outpatients with OGD. Weekly phone interviews were set up starting from COVID-19 onset symptoms and over the course of 60 days, using standardized questionnaires that included a detailed description of general symptoms and OGD. The primary outcome was the proportion of patients with complete recovery of OGD at D30. Rate and time to recovery of OGD, as well as risk factors for late recovery (>30 days), were evaluated using Cox regression models. RESULTS: Ninety-eight outpatients were included. The median time to onset of OGD after first COVID-19 symptoms was 2 days (IQR 0-4). The 30-day recovery rate from OGD was 67.5% (95% CI 57.1-75.4) and the estimated median time of OGD recovery was 20 days (95% CI 13-26). Risk factors for late recovery of OGD were a complete loss of smell or taste at diagnosis (HR=0.26, 95% CI 0.12-0.56, P=0.0005) and age over 40 years (HR=0.56, 95% CI 0.36-0.89, P=0.01). CONCLUSIONS: COVID-19 patients with complete loss of smell or taste and over age 40 are more likely to develop persistent OGD and should rapidly receive sensorial rehabilitation.
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COVID-19/complicaciones , Trastornos del Olfato/etiología , Trastornos del Gusto/etiología , Adulto , Atención Ambulatoria , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Trastornos del Olfato/epidemiología , Estudios Prospectivos , Factores de Riesgo , Trastornos del Gusto/epidemiologíaRESUMEN
BackgroundThe COVID-19 pandemic seems to have a different picture in Africa; the first case was identified in the continent after it has already caused a significant loss to the rest of the world and the reported number of cases and mortality rate has been low. Understanding the characteristics and outcome of the pandemicin the African setup is therefore crucial. AimTo assess the characteristics and outcome of COVID-19 patients and to identify determinants of the disease outcome among patients admitted to Millennium COVID-19 Care Center in Ethiopia. MethodsA prospective cohort study was conducted among 1345 consecutively admitted RT-PCR confirmed COVID-19 patients from July to September, 2020. Frequency tables, KM plots, median survival times and Log-rank test were used to describe the data and compare survival distribution between groups. Cox proportional hazard survival model was used to identify determinants of time to clinical improvement and the independent variables, where adjusted hazard ratio, P-value and 95% CI for adjusted hazard ratio were used for testing significance and interpretation of results. Binary logistic regression model was used to assess the presence of a statistically significant association between disease outcome and the independent variables, where adjusted odds ratio, P-value and 95% CI for adjusted odds ratio were used for testing significance and interpretation of results ResultsAmong the study population, 71 (5.3%) died, 72 (5.4%) were transferred and the rest 1202 (89.4%) were clinically improved. The median time to clinical improvement was 14 days. On the multivariable Cox proportional hazard model; temperature (AHR= 1.135, 95% CI= 1.011, 1.274, p-value=0.032), COVID-19 severity (AHR= 0.660, 95% CI= 0.501, 0.869, p-value=0.003), and cough (AHR= 0.705, 95% CI= 0.519, 0.959, p-value=0.026) were found to be significant determinants of time to clinical improvement. On the binary logistic regression, the following factors were found to be significantly associated with disease outcome; SPO2 (AOR= 0.302, 95% CI= 0.193, 0.474, p-value=0.0001), shortness of breath (AOR= 0.354, 95% CI= 0.213, 0.590, p-value=0.0001) and diabetes mellitus (AOR= 0.549, 95% CI= 0.337, 0.894, p-value=0.016). ConclusionsThe average duration of time to clinical improvement was 14 days and 89.4 % of the patients achieved clinical improvement. The mortality rate of the studied population is lower than reports from other countries including those in Africa. Having severe COVID-19 disease severity and presenting with cough were found to be associated with delayed clinical improvement of the disease. On the other hand, being hyperthermic is associated with shorter disease duration (faster time to clinical improvement). In addition, lower oxygen saturation and subjective complaint of shortness of breath and being diabetic were associated with unfavorable disease outcome. Therefore, patients with these factors should be followed cautiously for a better outcome.
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OBJECTIVES: To assess genotypic sensitivity scores (GSSs), plasma antiretroviral concentrations (PACs) and immunovirological outcomes at Week 96 (W96) in patients with persistent low-level viraemia (LLV). METHODS: On 1 January 2017, we analysed data from patients on three-drug regimens with persistent LLV defined as at least two consecutive plasma viral loads (pVLs) between 21 and 200 copies/mL (including one pVL of ≥50 copies/mL), at the Pitié-Salpêtrière Hospital. Outcomes were: GSS, PACs and HIV-DNA load at study entry; and virological status and proportion of patients with resistance-associated mutations (RAMs) at W96. RESULTS: Fifty-seven patients were included, with median age of 52.6 years (IQR 45.2-57.9), last CD4 count of 658 cells/mm3 (IQR 462-909) and total ART duration of 10.2 years (IQR 5.7-15.2). LLV duration was 14.0 months (IQR 5.5-22.3). GSS was 3 in 46/57 (81%) patients and PACs were adequate in 53/57 (93%) patients. Median total HIV-DNA was 2.65 log10 copies/106 cells (IQR 2.44-2.86). During follow-up, 26/57 (46%) had experienced ART modifications. At W96, 38/57 (67%) patients remained with LLV, 15/60 (26%) had achieved confirmed pVL of <20 copies/mL and 4/57 (7%) had virological failure. The four virological failures were due to three ART interruptions and one incomplete adherence (selection of Y181C RAM). No factors (patient characteristics at study entry, GSS, PACs, total HIV-DNA load and ART modification) were associated with W96 viral outcome, except for time from HIV diagnosis and the LLV duration at study entry. CONCLUSIONS: A substantial number of patients harbouring LLV had no resistance to ART and adequate PACs. Two-thirds of these patients remained with this LLV status.
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Fármacos Anti-VIH , Infecciones por VIH , VIH-1 , Preparaciones Farmacéuticas , Fármacos Anti-VIH/uso terapéutico , Antirretrovirales/uso terapéutico , Terapia Antirretroviral Altamente Activa , Recuento de Linfocito CD4 , Farmacorresistencia Viral , Infecciones por VIH/tratamiento farmacológico , VIH-1/genética , Humanos , Persona de Mediana Edad , Carga Viral , Viremia/tratamiento farmacológicoRESUMEN
UNLABELLED: Thrombocytopenia is a current situation for making a blood smear in routine practice in a medical analysis laboratory. Recent automated hematology analyzers enumerate platelets and generate histograms and specific flags. Operators must be aware of the characteristics of their analyzer in order to avoid spurious results in the case where microscopy review is not possible. OBJECTIVE: We evaluated the diagnostic performance of various graphical anomalies in the detection of large platelets and platelet clumps. PATIENTS AND METHODS: Three hundred cases of thrombocytopenia were included in the study on the basis of a platelet count less than 150 × 10(9)/L. This evaluation is expressed by the results of the sensitivity, specificity, positive predictive value and negative predictive value compared to the microscopic review of blood smear. RESULTS: Graphical performances are variable according to microscopic review of blood smears. Indeed, a not fitted curve is the most sensitive change on platelet histogram to the presence of large platelet. A high specificity to the presence of platelet clumps is announced when the platelet curve fails to return to the baseline. Moreover, characteristic findings on the DIFF scattergram are very specific to the presence of platelet clumps. CONCLUSION: A normal platelet histogram can validate with great confidence thrombocytopenia in cases where a blood smear cannot be read immediately.
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Plaquetas/citología , Tamaño de la Célula , Reconocimiento de Normas Patrones Automatizadas , Agregación Plaquetaria , Trombocitopenia/diagnóstico , Plaquetas/patología , Citodiagnóstico/métodos , Citodiagnóstico/normas , Humanos , Reconocimiento de Normas Patrones Automatizadas/normas , Recuento de Plaquetas/instrumentación , Recuento de Plaquetas/métodos , Valor Predictivo de las Pruebas , Sensibilidad y Especificidad , Trombocitopenia/sangreRESUMEN
Aim. The aim of this study was to investigate the frequency of exfoliation syndrome in the Central Anatolia region of Turkey and to evaluate its relationship with cardiovascular and ocular diseases. Methods. Patients over the age of 45 years who presented to the clinic were included in the study. All cases underwent a comprehensive ophthalmology examination. Exfoliation syndrome was diagnosed with the presence of exfoliative material on the lens anterior capsule or iris on slit lamp examination. The patients were divided into two groups as the exfoliation syndrome group and nonexfoliation syndrome group according to the presence of exfoliative material. Results. Exfoliative material was found in one or both eyes of 212 of the 2103 patients (10.1%) evaluated within the scope of the study. A significant relationship was found between exfoliation syndrome and increasing age and male gender. A significant relationship was found between exfoliation syndrome and glaucoma, cataracts, age-related macular degeneration, and phacodonesis. While no relationship was found between exfoliation syndrome and hypertension or diabetes mellitus, a significant relationship was found with coronary artery disease. Conclusion. The unilateral or bilateral exfoliation syndrome frequency was 10.1% in this hospital-based study. A statistically significant relationship was found between exfoliation syndrome and advancing age, gender, and coronary artery disease.
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This paper discusses spinal cord tumors including imaging characteristics with emphasis on magnetic resonance imaging and advances in treatment. This is a retrospective study of 20 cases patients with neoplasms arising from the spinal cord. All of our cases were explored by magnetic resonance imaging (1.5T) using T1-weighted imaging (Spin Echo), T2-weighted imaging (Spin Echo) and T1-weighted imaging with Gadolinium administration. Pain is the earliest symptom, characteristically occurring at night when the patient is supine. Ependymoma were observed in 11 cases. Astrocytoma was noted in five cases. Other uncommon tumors were identified in four cases: oligodendroglioma (n=1), epidermoid cyst (n=1), hemangioblastoma and metastasis (n=1). In MRI most tumors are isointense or slightly hypointense compared to the normal cord signal with homogenous or irregular enhancement. We describe the characteristic magnetic resonance findings and differential diagnosis of spinal cord tumors. Spinal cord lesions comprise approximately 2-4% of all central nervous system neoplasms. Magnetic resonance imaging plays a central role in the imaging of spinal cord neoplasms.
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Brown tumors are classic bony lesions of hyperparathyroidism. They usually occur in severe forms with osteolytic subperiosteal lesions. Facial bones are a rare localization: 2% of all cases. The aim of this study was to report a case of multiple craniofacial location of brown tumors and to discuss, within a review of the literature, the role of imagery in the diagnosis of this disease.
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Adenoma/diagnóstico , Hiperparatiroidismo Primario/diagnóstico , Lipoma/diagnóstico por imagen , Neoplasias Maxilares/diagnóstico por imagen , Neoplasias Primarias Múltiples , Neoplasias de las Paratiroides/diagnóstico , Complicaciones Neoplásicas del Embarazo , Adenoma/diagnóstico por imagen , Adenoma/cirugía , Adulto , Biopsia , Femenino , Humanos , Hiperparatiroidismo Primario/sangre , Lipoma/etiología , Lipoma/patología , Maxilar/patología , Neoplasias Maxilares/etiología , Neoplasias Maxilares/patología , Hormona Paratiroidea/sangre , Neoplasias de las Paratiroides/diagnóstico por imagen , Neoplasias de las Paratiroides/cirugía , Embarazo , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
The authors report a case of tubular duplication of the oesophagus discovered in a 1 month old infant and describe the main characteristics of this rare anomaly.
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Esófago/anomalías , Esófago/diagnóstico por imagen , Humanos , Recién Nacido , Masculino , RadiografíaRESUMEN
The influence of 2 transport stressors (loading and noise) on several serum and plasma biochemical variables was studied in 4 calves. When calves were loaded and kept for 30 minutes on a motionless transport simulator or were exposed to the noise of the working simulator, increases in plasma epinephrine and serum cortisol and nonesterified fatty acids concentrations were similar to changes observed in calves subjected to simulated transport for 30 minutes. Results indicate that loading and noise have an important role in transport stress.