Knowledge,attitude, and practice regarding COVID-19 among COVID-19 patients and their correlation with the outcomes: A cross-sectional study

Objective: To assess the knowledge, attitude, and practice (KAP) regarding COVID-19 among COVID-19 patients and their relation with the outcomes.Methods: This cross-sectional study was carried out among COVID-19 patients (18-year-old or older) consecutively admitted to a dedicated COVID-19 hospital located in northwest Rajasthan, India. Data regarding socio-demographic parameters, KAP, and primary composite outcome (admission to intensive care unit, mechanical ventilation, or in-hospital death) were collected. KAP scores were compared between different demographic variables and primary composite outcomes. Association between different demographic variables, primary composite outcomes, and KAP scores were determined through multivariate linear regression. Besides, the correlation among KAP scores was analyzed. Results: Out of the total 222 patients, most of them (65.76％) had average KAP scores towards COVID-19. The mean scores for knowledge were 7.88, with an overall correct rate of 71.63％; the mean attitude scores were 2.42, with an overall correct rate of 60.50％; the mean practice scores were 5.12, with an overall correct rate of 64.00％. Patients who met the primary composite outcomes had higher knowledge scores, but lower attitude and practice scores. The result showed a significant positive correlation between the level of education, socioeconomic class, and knowledge, attitude, and practice towards COVID-19. Knowledge towards COVID-19 was significantly associated with a positive attitude and good practice. Conclusions: Our findings show that adult COVID-19 patients have average KAP towards COVID-19 among COVID-19 patients. Poor attitude and practice towards COVID-19 are associated with adverse outcomes, so it is suggested to strengthen attitude and practice towards COVID-19 to improve the outcomes.     

Comparison of laboratory parameters,clinical symptoms and clinical outcomes of COVID-19 and influenza in pediatric patients: A systematic review and meta-analysis

BACKGROUNDNew and more severe clinical manifestations associated with the coronavirus disease 2019 (COVID-19) are emerging constantly in the pediatric age group. Patients in this age group are also primary carriers of the influenza virus and are at a higher risk of developing severe infection. However, studies comparing influenza and COVID-19 to show which condition causes a more severe form of disease amongst the pediatric age group are scarce. AIMTo compare the laboratory results, clinical symptoms and clinical outcomes in pediatric patients with COVID-19 and influenza.METHODSA systematic and comprehensive search was carried out in databases and search engines, including EMBASE, Cochrane, MEDLINE, ScienceDirect and Google Scholar from 1964 until January 2022. A meta-analysis was carried out using a random-effects model and pooled odds ratio (OR) or standardized mean difference (SMD) and 95%CI.RESULTSA total of 16 studies satisfied the inclusion criteria. Pediatric COVID-19 patients had a significantly reduced risk of cough (pooled OR = 0.16; 95%CI: 0.09 to 0.27), fever (pooled OR = 0.23; 95%CI: 0.12 to 0.43), and dyspnea (pooled OR = 0.54; 95%CI: 0.33 to 0.88) compared to influenza patients. Furthermore, total hemoglobin levels (pooled SMD = 1.22; 95%CI: 0.29 to 2.14) in COVID-19 patients were significantly higher as compared to pediatric influenza patients. There was no significant difference in symptoms such as sore throat, white blood cell count, platelets, neutrophil and lymphocytes levels, and outcomes like mortality, intensive care unit admission, mechanical ventilation or length of hospital stay.CONCLUSIONCOVID-19 is associated with a significantly lower rate of clinical symptoms and abnormal laboratory indexes compared to influenza in the pediatric age group. However, further longitudinal studies of the outcomes between influenza and COVID-19 pediatric patients are needed.     

Iatrogenic anaemia and transfusion thresholds in ICU patients with COVID-19 disease at a tertiary care hospital

BackgroundPatients with severe COVID-19 disease frequently develop anaemia as the result of multiple mechanisms and often receive transfusions. The aims of this study were to assess the impact of repeated blood samplings on patients’ anaemic state using standard-volume tubes, in comparison with the hypothetical use of low-volume tubes and to evaluate the transfusion policy adopted.Study design and methodsTransfusion data of mechanically ventilated non-bleeding patients with COVID-19 disease hospitalized in ICU for a minimum of 20 days were recorded. The total volume of blood drawn for samplings with standard-volume tubes and the corresponding red blood cell mass (RBCM) removed during hospitalization for each patient were calculated and compared with the hypothetical use of low-volume tubes.ResultsTwenty-four patients fulfilled the inclusion criteria. Ten patients were anaemic at ICU admission (41.7 %). Overall, 6658 sampling tubes were employed, for a total of 16,786 mL of blood. The median RBCM subtracted by blood samplings per patient accounted for about one third of the total patients’ RBCM decrease until discharge.The use of low-volume tubes would have led to a median saving of about one third of the drawn RBCM.Eleven patients were transfused (45.8 %) at a mean Hb value of 7.7 (± 0.5) g/dL.ConclusionThe amount of blood drawn for sampling has a significant role in the development of anaemia and the use of low-volume tubes could minimize the problem.Large high-powered studies are warranted to assess the more appropriate transfusion thresholds in non-bleeding critically ill patients with COVID-19 disease.     

Benefits of ozone on mortality in patients with COVID-19: A systematic review and meta-analysis

BackgroundThe Coronavirus disease-2019 (COVID-19) pandemic continues, and the death toll continues to surge. Ozone therapy has long been used in the treatment of a variety of infectious diseases, probably through its antioxidant properties and the supply of oxygen to hypoxic tissues. This systematic review and meta-analysis aimed to determine the efficacy of ozone on mortality in patients with COVID-19.MethodsA systematic search was made of PubMed, Embase, Cochrane Library, and clinicaltrials.gov, without language restrictions. Prospective controlled trials on treatment of COVID-19 with ozone, compared with placebo or blank, were reviewed. Studies were pooled to risk ratios (RRs) and weighted mean differences (WMDs), with 95% confidence intervals (CIs).ResultsEight trials (enrolling 371 participants) met the inclusion criteria. Ozone therapy showed significant effects on mortality (RR 0.38, 95% CI 0.17–0.85; P = 0.02), length of hospital stay (WMD −1.63 days, 95% CI −3.05 to −0.22 days; P = 0.02), and polymerase chain reaction (PCR) positivity (RR 0.07, 95% CI 0.01–0.34; P = 0.001).ConclusionsOzone therapy significantly reduced mortality, PCR positivity, and length of stay in hospitalized patients with COVID-19. Ozone therapy should be considered for COVID-19 patients.     

The effect of higher-intensity dosing of anticoagulation on the clinical outcomes in hospitalized patients with COVID-19: A meta-analysis of randomized controlled trials

ObjectiveWe aimed to perform a meta-analysis to summarize the overall evidence from randomized controlled trials related to higher-intensity anticoagulation in hospitalized patients with COVID-19.MethodsA systematic literature search was performed in electronic databases to identify randomized controlled trials comparing the clinical outcomes between intermediate/ therapeutic anticoagulation and prophylactic anticoagulation. Meta-analyses with random-effects models were used to estimate the pooled odds ratio (OR) for outcomes of interest at a 95% confidence interval (CI).ResultsEight randomized controlled trials were included, with a total of 5405 hospitalized patients with COVID-19. The meta-analysis revealed no statistically significant difference in the odds of mortality (pooled OR = 0.92; 95% CI 0.71–1.19) but a statistically significant reduction in the odds of development of thrombotic events (pooled OR = 0.55; 95% CI 0.42–0.72), and significantly increased odds of development of major bleeding (pooled OR = 1.81; 95% CI 1.20–2.72) with the use of intermediate/therapeutic anticoagulation, relative to prophylactic anticoagulation. Subgroup analysis in patients with a severe course of COVID-19 observed a statistically significant reduction in the odds of development of thrombotic events (pooled OR = 0.66; 95% CI 0.45–0.98) but no significant difference in the odds of development of major bleeding events (pooled OR = 1.37; 95% CI 0.74–2.56), with the use of intermediate/therapeutic anticoagulation, relative to prophylactic anticoagulation.ConclusionThere could be net clinical benefits with higher-intensity dosing of anticoagulation relative to prophylactic-dosing of anticoagulation among hospitalized patients with severe COVID-19.     

疑似或确诊新型冠状病毒肺炎患者手术管理方法

新型冠状病毒肺炎疫情暴发,当手术室接诊疑似或确诊患者手术时,除医护人员严格执行隔离措施外,科室应结合本次疫情特点制定周密的处置流程及管理制度。本文结合国家规范及本次疫情的诊疗救治方案,从术前筛查、人员及环境准备、术中关注、术后处理、人员培训、科室管理等方面进行详细总结,以方便临床实施。     

Clinical,laboratory and radiological features and outcomes of moderate to severe COVID-19 patients: A descriptive retrospective study

Objective: To describe the clinical, laboratory and radiological characteristics and outcomes of moderate-to-severe coronvirus disease 2019 (COVID-19) patients.Methods: We retrospectively analyzed 43 RT-PCR confirmed moderate-to-severe COVID-19 patients who were admitted to a tertiary care center. The primary composite outcomes were admission to intensive care unit, requirement of mechanical ventilation, and death. Results: The median age of the patients was 50 years, and 62.8％ of the patients were male. Out of 43 patients, 15 (34.88％) were categorized as severe. A total of 26 (60.47％) patients had 1 or more comorbidities [diabetes (34.88％) and hypertension (30.23％)]. The median duration from the onset of symptoms to admission was 3 days, and the most common symptoms were dyspnoea (90.7％), cough (79.07％), fever (69.77％), and body ache (46.51％). Leucopenia was presented in 14 (32.56％) patients, lymphopenia in 26 (60.47％) patients, and monocytosis in 7 (16.28％) patients. Besides, 40 (93.02％) patients had bilateral patchy nodular or interstitial infiltration on chest X-ray. The primary outcomes occurred in 20 patients (46.5％), among whom 8 required mechanical ventilation. The patients who had met the primary outcomes were older. They were prone to have at least 1 comorbidity (P=0.004), diabetes (P=0.01), hypertension, higher sequential organ failure assessment score, more tachycardia, lower SpO2, lower PaO2/FiO2, more thrombocytopenia, and more pancytopenia. Conclusions: This retrospective study identified several risk factors for poor outcomes in adults with COVID-19. In particular, older age, tachycardia, high SOFA score, low SpO2, low PaO2/FiO2, presence of comorbidities in form of diabetes and hypertension, thrombocytopenia, and pancytopenia at admission were associated with higher odds of ICU admission, a requirement of mechanical ventilation and in-hospital death.     

In-hospital use of ACE inhibitors/angiotensin receptor blockers associates with COVID-19 outcomes in African American patients

BACKGROUNDThe angiotensin-converting enzyme (ACE) D allele is more prevalent among African Americans compared with other races and ethnicities and has previously been associated with severe coronavirus disease 2019 (COVID-19) pathogenesis through excessive ACE1 activity. ACE inhibitors/angiotensin receptor blockers (ACE-I/ARB) may counteract this mechanism, but their association with COVID-19 outcomes has not been specifically tested in the African American population.METHODSWe identified 6218 patients who were admitted into Mount Sinai hospitals with COVID-19 between February 24 and May 31, 2020, in New York City. We evaluated whether the outpatient and in-hospital use of ACE-I/ARB is associated with COVID-19 in-hospital mortality in an African American compared with non–African American population.RESULTSOf the 6218 patients with COVID-19, 1138 (18.3%) were ACE-I/ARB users. In a multivariate logistic regression model, ACE-I/ARB use was independently associated with a reduced risk of in-hospital mortality in the entire population (OR, 0.655; 95% CI, 0.505–0.850; P = 0.001), African American population (OR, 0.44; 95% CI, 0.249–0.779; P = 0.005), and non–African American population (OR, 0.748, 95% CI, 0.553–1.012, P = 0.06). In the African American population, in-hospital use of ACE-I/ARB was associated with improved mortality (OR, 0.378; 95% CI, 0.188–0.766; P = 0.006), whereas outpatient use was not (OR, 0.889; 95% CI, 0.375–2.158; P = 0.812). When analyzing each medication class separately, ARB in-hospital use was significantly associated with reduced in-hospital mortality in the African American population (OR, 0.196; 95% CI, 0.074–0.516; P = 0.001), whereas ACE-I use was not associated with impact on mortality in any population.CONCLUSIONIn-hospital use of ARB was associated with a significant reduction in in-hospital mortality among COVID-19–positive African American patients.FUNDINGNone.     

Vaccination status of COVID-19 patients followed up in the ICU in a country with heterologous vaccination policy: A multicenter national study in Turkey

ObjectiveVaccination against severe acute respiratory syndrome coronavirus-2 (SARS-2) prevents the development of serious diseases has been shown in many studies. However, the effect of vaccination on outcomes in COVID-19 patients requiring intensive care is not clear.MethodsThis is a retrospective multicenter study conducted in 17 intensive care unit (ICU) in Turkey between January 1, 2021, and December 31, 2021. Patients aged 18 years and older who were diagnosed with COVID-19 and followed in ICU were included in the study. Patients who have never been vaccinated and patients who have been vaccinated with a single dose were considered unvaccinated. Logistic regression models were fit for the two outcomes (28-day mortality and in-hospital mortality).ResultsA total of 2968 patients were included final analysis. The most of patients followed in the ICU during the study period were unvaccinated (58.5%). Vaccinated patients were older, had higher Charlson comorbidity index (CCI), and had higher APACHE-2 scores than unvaccinated patients. Risk for 28-day mortality and in-hospital mortality was similar in across the year both vaccinated and unvaccinated patients. However, risk for in-hospital mortality and 28-day mortality was higher in the unvaccinated patients in quarter 4 adjusted for gender and CCI (OR: 1.45, 95% CI: 1.06–1.99 and OR: 1.42, 95% CI: 1.03–1.96, respectively) compared to the vaccinated group.ConclusionDespite effective vaccination, fully vaccinated patients may be admitted to ICU because of disease severity. Unvaccinated patients were younger and had fewer comorbid conditions. Unvaccinated patients have an increased risk of 28-day mortality when adjusted for gender and CCI.     

新冠肺炎疫情下流感病原学检测结果分析及防控策略探讨

目的从甲型、乙型流感病原学检测结果探讨新冠肺炎的防控策略。方法用甲型流感病毒抗原检测试剂盒和乙型流感病毒抗原检测试剂盒对某综合医院发热门诊2017年至2019年3个冬季(当年12月1日至次年3月31日)就诊发热合并呼吸道症状患者的咽拭子液进行甲型、乙型流感病毒抗原检测,然后通过试剂提供阴阳性比对卡进行结果判读。结果2017年至2019年3个冬季(当年12月1日至次年3月31日)共检测33968份甲型流感标本,28533份乙型流感标本,甲型流感阳性率为13.81%,乙型流感阳性率为1.21%。2018年冬季甲型流感阳性率高于2017年和2019年冬季,2019年冬季乙型流感阳性率高于2018年冬季;甲型流感阳性率1月份比其他月份高;乙型流感阳性率总数1月份虽比其他月份高,但2017年冬季以2月份最高,2018年冬季3月份最高;2017年、2018年冬季老年人甲型流感阳性率高于儿童,2019年冬季儿童甲型流感阳性率高于老年人;2017年冬季老年人乙型流感阳性率高于儿童,2018、2019年冬季儿童乙型流感阳性率高于老年人,以上各项差异均有统计学意义(均P<0.01)。甲型、乙型流感阳性率女性略高于男性,但差异无统计学意义(P>0.05)。结论自从2020年1月新冠肺炎疫情防控开始,2、3月份流感病毒送检人数及阳性率显著降低,预防措施有效控制了流感病毒的感染率。其防控策略为:广泛开展健康教育,采取果断措施常抓防控管理;冬、春季是防控重点,老弱群体更是重要保护人群;加强发热门诊筛查,固守新冠肺炎的前哨阵地;抓紧研究疫苗药物,提高新冠肺炎的诊治水平;切实做好个人防护,保证医护和患者的生命安全。     

Disparities in co-payments for influenza vaccine among the elderly,during the COVID-19 pandemic in Japan

IntroductionSeasonal influenza vaccination for the elderly is highly recommended during the COVID-19 pandemic. In Japan, the amount of subsidy for influenza differs among municipalities. Thus, we investigated the amount of and variation in subsidy for influenza vaccination for the elderly in 2020.MethodsThis was an ecological study of 1,922 municipalities in Japan. The amount of subsidy for influenza vaccines for the elderly in each municipality was surveyed through websites or via telephone. Geographic and financial data for municipalities and prefectures were obtained from the open data. The amount of co-payment for the influenza vaccine and the geographical and financial status of each municipality were compared, according to the aging rate. Univariate logistic regression analysis was performed to explore factors related to the free influenza vaccine.ResultsMunicipalities with higher aging rates tended to have higher median co-payments for vaccines in 2020. (0 yen vs 1000 yen, p < 0.001) In addition, they tended to have worse financial conditions and lower per capita incomes. A similar trend was observed in the analysis by prefecture, i.e., a higher influenza mortality rate in prefectures with a higher aging rate. Despite having lower incomes, municipalities and prefectures with higher aging populations had higher mortality rates from influenza and higher co-payments for influenza vaccination.ConclusionsIn Japan, there is a disparity among elderly people; areas with an aging population have higher co-payments for influenza vaccines despite lower incomes, suggesting that the government needs to implement corrective measures to reduce this disparity.     

Clinical outcomes of initially asymptomatic patients with COVID-19: a Korean nationwide cohort study

BackgroundThis study was performed to compare severe clinical outcome between initially asymptomatic and symptomatic infections and to identify risk factors associated with high patient mortality among initially asymptomatic patients.MethodsIn this retrospective, nationwide cohort study, we included 5621 patients who had been discharged from isolation or died from COVID-19 by 30 April 2020. The mortality rate and admission rate to intensive care unit (ICU) were compared between initially asymptomatic and symptomatic patients. We established a prediction model for patient mortality through risk factor analysis among initially asymptomatic patients.ResultsThe prevalence of initially asymptomatic patients upon admission was 25.8%. The mortality rates were not different between groups (3.3% vs. 4.5%, p = .17). However, initially symptomatic patients were more likely to receive ICU care compared to initially asymptomatic patients (4.1% vs. 1.0%, p < .0001). The age-adjusted Charlson comorbidity index score (CCIS) was the most potent predictor for patient mortality in initially asymptomatic patients.Conclusions The mortality risk was not determined by the initial presence of symptom among hospitalized COVID-19 patients. The CCIS was the most potent predictors for mortality. The clinicians should predict the risk of death by evaluating age and comorbidities but not the initial presence of symptom.

Key messages

• The mortality rate was not different between initially asymptomatic and symptomatic patients.
• Symptomatic patients were more likely to admitted to the intensive care unit.
• Age and comorbidities were the potent risk factors for mortality.

     

Candida dubliniensis fungemia in a patient with severe COVID-19: A case report

Candida dubliniensis phenotypically mimics Candida albicans in its microbiological features; thus, its clinical characteristics have yet to be fully elucidated. Here we report the case of a 68-year-old Japanese man who developed C. dubliniensis fungemia during treatment for severe coronavirus disease 2019 (COVID-19). The patient was intubated and received a combination of immunosuppressants, including high-dose methylprednisolone and two doses of tocilizumab, as well as remdesivir, intravenous heparin, and ceftriaxone. A blood culture on admission day 11 revealed Candida species, which was confirmed as C. dubliniensis by mass spectrometry. An additional sequencing analysis of the 26S rDNA and ITS regions confirmed that the organism was 100% identical to the reference strain of C. dubliniensis (ATCC MYA-646). Considering the simultaneous isolation of C. dubliniensis from a sputum sample, the lower respiratory tract could be an entry point for candidemia. Although treatment with micafungin successfully eradicated the C. dubliniensis fungemia, the patient died of COVID-19 progression. In this case, aggressive immunosuppressive therapy could have caused the C. dubliniensis fungemia. Due to insufficient clinical reports on C. dubliniensis infection based on definitive diagnosis, the whole picture of the cryptic organism is still unknown. Further accumulation of clinical and microbiological data of the pathogen is needed to elucidate their clinical significance.     

Mortality in patients with COVID-19 requiring extracorporeal membrane oxygenation: A meta-analysis

BACKGROUNDCoronavirus disease 2019 (COVID-19) has become a worldwide pandemic and significant public health issue. The effectiveness of extracorporeal membrane oxygenation (ECMO) in treating COVID-19 patients has been called into question.AIMTo conduct a meta-analysis on the mortality of COVID-19 patients who require ECMO.METHODSThis analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes 2020 (PRISMA) and has been registered at the International Prospective Register of Systematic Reviews (number CRD42020227414). A quality assessment for all the included articles was performed by the Newcastle-Ottawa Scale (NOS). Studies with tenor more COVID-19 patients undergoing ECMO were included. The random-effects model was used to obtain the pooled incidence of mortality in COVID-19 patients receiving ECMO. The source of heterogeneity was investigated using subgroup and sensitivity analyses.RESULTSWe identified 18 articles with 1494 COVID-19 patients who were receiving ECMO. The score of the quality assessment ranged from 5 to 8 on the NOS. The majority of patients received veno-venous ECMO (93.7%). Overall mortality was estimated to be 0.31 [95% confidence interval (CI): 0.24-0.39; I² = 84.8%] based on random-effect pooled estimates. There were significant differences in mortality between location groups (33.0% vs 55.0% vs 37.0% vs 18.0%, P < 0.001), setting groups (28.0% vs 34.0%, P < 0.001), sample size (37.0% vs 31.0%, P < 0.001), and NOS groups (39.0% vs 19.0%, P < 0.001). However, both subgroup analyses based on location, setting, and sample size, and sensitivity analysis failed to identify the source of heterogeneity. The funnel plot indicated no evident asymmetry, and the Egger''s (P = 0.95) and Begg''s (P = 0.14) tests also revealed no significant publication bias.CONCLUSIONWith more resource assessment and risk-benefit analysis, our data reveal that ECMO might be a feasible and effective treatment for COVID-19 patients.     

Risk factors in pediatric hospitalization for influenza A and B during the seven seasons immediately before the COVID-19 era in Japan

IntroductionThe risk factors in pediatric influenza immediately before the COVID-19 era are not well understood. This study aims to evaluate the risk factors for hospitalization in pediatric influenza A and B for the recent seasons.MethodsChildren with a fever of ≥38 °C and laboratory-confirmed influenza at 20 hospitals in outpatient settings in Japan in the 2013/14 to 2019/20 seasons were retrospectively reviewed. Possible risk factors, including gender, age, comorbidities, nursery school or kindergarten attendance, earlier diagnosis, no immunization, lower regional temperature, earlier season, and period of onset, were evaluated using binary logistic regression methods.ResultsA total of 13,040 (type A, 8861; B, 4179) children were evaluated. Significant risk factors (p < 0.05) in multivariate analyses were young age, lower regional temperature, earlier season, respiratory illness (adjusted odds ratio [aOR]:2.76, 95% confidence interval [CI]:1.84–4.13), abnormal behavior and/or unusual speech (aOR:2.78, 95% CI:1.61–4.80), and seizures at onset (aOR:16.8, 95% CI:12.1–23.3) for influenza A; and young age, lower regional temperature, respiratory illness (aOR:1.99, 95% CI:1.00–3.95), history of febrile seizures (aOR:1.73, 95% CI:1.01–2.99), and seizures at onset (aOR:9.74, 95% CI:5.44–17.4) for influenza B.ConclusionsIn addition to previously known factors, including young age, seizures, and respiratory illness, abnormal behavior and/or unusual speech and lower regional temperature are new factors. Negative immunization status was not a risk factor for hospitalization. A better understanding of risk factors may help improve the determination of indications for hospitalization during the future co-circulation of influenza and COVID-19.