Mental health status among COVID-19 patients survivors of critical illness in Saudi Arabia:A 6-month follow-up questionnaire study

BACKGROUND Psychological assessment after intensive care unit(ICU)discharge is increasingly used to assess patients'cognitive and psychological well-being.However,few studies have examined those who recovered from coronavirus disease 2019(COVID-19).There is a paucity of data from the Middle East assessing the post-ICU discharge mental health status of patients who had COVID-19.AIM To evaluate anxiety and depression among patients who had severe COVID-19.METHODS This is a prospective single-center follow-up questionnaire-based study of adults who were admitted to the ICU or under ICU consultation for>24 h for COVID-19.Eligible patients were contacted via telephone.The patient’s anxiety and depression six months after ICU discharge were assessed using the Hospital Anxiety and Depression Scale(HADS).The primary outcome was the mean HADS score.The secondary outcomes were risk factors of anxiety and/or depression.RESULTS Patients who were admitted to the ICU because of COVID-19 were screened(n=518).Of these,48 completed the questionnaires.The mean age was 56.3±17.2 years.Thirty patients(62.5%)were male.The main comorbidities were endocrine(n=24,50%)and cardiovascular(n=21,43.8%)diseases.The mean overall HADS score for anxiety and depression at 6 months post-ICU discharge was 11.4(SD±8.5).A HADS score of>7 for anxiety and depression was detected in 15 patients(30%)and 18 patients(36%),respectively.Results from the multivariable ordered logistic regression demonstrated that vasopressor use was associated with the development of anxiety and depression[odds ratio(OR)39.06,95% confidence interval:1.309-1165.8;P<0.05].CONCLUSION Six months after ICU discharge,30% of patients who had COVID-19 demonstrated a HADS score that confirmed anxiety and depression.To compare the psychological status of patients following an ICU admission(with vs without COVID-19),further studies are warranted.

Effect of Prone Position in Severe Covid-19 Patients in a Referral Center: A Cohort Retrospective Study

Introduction: Covid-19 is defined as a pandemic disease by WHO, in November 2023, WHO recorded 772.1 million confirmed cases and 6.9 million deaths, including 68,382 confirmed cases and 1426 deaths in Madagascar. The management of severe cases of Covid-19 remains a challenge for the healthcare system in a resource-limited country, due to the consumption of human resources, the shortage of medical resources and the lack of capacity in resource-limited countries. Prone position (PP) improves survival in acute respiratory distress, and numerous studies have shown that during Covid-19, it reduces mortality rates at 28 and 90 days, and increases the number of days without mechanical ventilation. However, data on the beneficial effects of PP remain limited in low-income countries. In this context, our study aims to evaluate the benefits of the prone position for severe Covid-19 patients in a referral center in Madagascar. Method: This is a retrospective cohort study, during the 2nd and 3rd waves of COVID-19, over a period of 11 months in two wards managing COVID-19 cases. We included all patients aged 15 and over with severe forms of COVID-19 who required 6 l/min of oxygen therapy. Results: We enrolled 123 patients, including 40 in the prone position and 83 in the supine position, with a mean age of 60.5 ± 12 years. The prone position (DV) reduced the risk of probable complications of COVID-19 with a strong association in terms of use of respiratory assistance (OR = 0.15;95% CI = 0.05 - 0.47), respiratory deterioration (OR = 0.22;95% CI = 0.09 - 0.58), shock (OR = 0.30;95% CI = 0.11 - 0.79) and hemodynamic instability (OR = 0.33;95% CI = 0.12 - 0.95). Univariate analysis of the effect of prone position on SpO2 showed improvement with significant associations with SpO2 at Day 1- Day 3, D4 - D7, D8 - D14, and persisting even at D15 - D21, D3 and D2 before discharge, and at discharge. In the overall population, the mean length of hospital stay was 22.8 ± 22.1 days, with extremes of 1 and 67 days. Univariate analysis of the effect of the prone position showed a reduction in length of hospital stay with a strong association (p = 0.001) and a mean difference of 14 days. The prone position reduced mortality with a significant association (OR = 0.44;95% CI = 0.20 - 0.98). Conclusion: Awake prone position prevents complications of COVID, improves SPO2 even up to hospital discharge and reduces hospital stay. This practice is simple, less costly and suitable in low income countries.

Morbidity and Mortality of Acute Renal Failure in COVID-19 Patients in Intensive Care According to Waves/Variant: Case of the Grand Hôpital de l’Est Francilien Site de Meaux

Introduction: The incidence of acute renal failure (ARF) varies between 20% and 40% of cases for COVID-19 patients admitted to the intensive care unit, with very high mortality, but heterogeneous according to the different epidemic waves, probably due to the genetic variant phenomenon of the virus. The aim of this study is to determine the morbidity and mortality of COVID-19 patients admitted with ARF to the intensive care unit of the Grand H?pital Est Francilien (GHEF) according to the waves and variants. Methods: Cross-sectional observational study of COVID-19 patients with ARF admitted to the intensive care unit of the GHEF site in Meaux covering the period from March 1st 2020 to December, 31st 2021. Per-hospitalisation and outcome data were collected and analysed with SPSS version 25.0 software using the Chi-square or Fischer’s exact test or Student’s t-test and logistic regression for p Results: A total of 86 patients were included. The mean age was higher (70 ± 8.5) in patients in the fourth wave than in the other waves (p = 0.015), with male predominance in all waves without significant difference. Co-morbidities: hypertension, diabetes, heart disease, dyslipidaemia and arrhythmia complete with fibrillation were present in all waves. The majority of patients were classified as KDIGO 1 for the different waves (1st: 61.9%, 2nd: 86.5%, 3rd: 80%, and 4th: 75%), with the same trend according to variant (alpha: 80%, beta: 75%, delta: 81.3%, omicron: 75%). Mortality by the wave was: 1st: 28.5%, 2nd: 37.5%, 3rd: 23% and 4th: 11%) and by variant: alpha: 24.2%, beta: 44.8%, delta: 20.7%, omicron: 10.3%). Overall mortality was 33.7%. Case fatality was higher in the fourth wave. Hypertension, shock, failure to recover renal function, acute lung oedema, ventilator-associated lung disease and hyperkalaemia were factors associated with mortality (p Conclusion: Acute renal failure is common in COVID-19 patients admitted to the intensive care unit, and mortality is not negligible. The beta variants and the second wave presented more cases of renal impairment, although the mechanism is still unknown. Further studies are needed to understand this mechanism and perhaps to be able to identify the cause.

Gut microbiome therapeutic modulation to alleviate drug-induced hepatic damage in COVID-19 patients

Coronavirus disease 2019(COVID-19)infection caused by the severe acute respiratory syndrome coronavirus 2 virus,its symptoms,treatment,and post-COVID-19 effects have been a major focus of research since 2020.In addition to respiratory symptoms,different clinical variants of the virus have been associated with dynamic symptoms and multiorgan diseases,including liver abnormalities.The release of cytokines by the activation of innate immune cells during viral infection and the high doses of drugs used for COVID-19 treatment are considered major drivers of liver injury in COVID-19 patients.The degree of hepatic inflammation in patients suffering from chronic liver disease and having COVID-19 could be severe and can be estimated through different liver chemistry abnormality markers.Gut microbiota influences liver chemistry through its metabolites.Gut dysbiosis during COVID-19 treatment can promote liver inflammation.Here,we highlighted the bidirectional association of liver physiology and gut microbiota(gut-liver axis)and its potential to manipulate drug-induced chemical abnormalities in the livers of COVID-19 patients.

Insight into the liver dysfunction in COVID-19 patients: Molecular mechanisms and possible therapeutic strategies

As of June 2022,more than 530 million people worldwide have become ill with coronavirus disease 2019(COVID-19).Although COVID-19 is most commonly associated with respiratory distress(severe acute respiratory syndrome),metaanalysis have indicated that liver dysfunction also occurs in patients with severe symptoms.Current studies revealed distinctive patterning in the receptors on the hepatic cells that helps in viral invasion through the expression of angiotensinconverting enzyme receptors.It has also been reported that in some patients with COVID-19,therapeutic strategies,including repurposed drugs(mitifovir,lopinavir/ritonavir,tocilizumab,etc.)triggered liver injury and cholestatic toxicity.Several proven indicators support cytokine storm-induced hepatic damage.Because there are 1.5 billion patients with chronic liver disease worldwide,it becomes imperative to critically evaluate the molecular mechanisms concerning hepatotropism of COVID-19 and identify new potential therapeutics.This review also designated a comprehensive outlook of comorbidities and the impact of lifestyle and genetics in managing patients with COVID-19.

Mechanisms of gastrointestinal barrier dysfunction in COVID-19 patients

Coronavirus disease 2019(COVID-19)caused by the novel severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)has become a major global public health event,resulting in a significant social and economic burden.Although COVID-19 was initially characterized as an upper respiratory and pulmonary infection,recent evidence suggests that it is a complex disease including gastrointestinal symptoms,such as diarrhea,nausea,and vomiting.Moreover,it remains unclear whether the gastrointestinal symptoms are caused by direct infection of the gastrointestinal tract by SARS-CoV-2 or are the result of systemic immune activation and subsequent dysregulation of homeostatic mechanisms.This review provides a brief overview of the mechanisms by which SARS-CoV-2 disrupts the integrity of the gastrointestinal barrier including the mechanical barrier,chemical barrier,microbial barrier,and immune barrier.

Characterization of oral and gut microbiome and plasma metabolomics in COVID-19 patients after 1-year follow-up

Background:Due to the outbreak and rapid spread of coronavirus disease 2019(COVID-19),more than 160 million patients have become convalescents worldwide to date.Significant alterations have occurred in the gut and oral microbiome and metabonomics of patients with COVID-19.However,it is unknown whether their characteristics return to normal after the 1-year recovery.Methods:We recruited 35 confirmed patients to provide specimens at discharge and 1 year later,as well as 160healthy controls.A total of 497 samples were prospectively collected,including 219 tongue-coating,129 stool and 149 plasma samples.Tongue-coating and stool samples were subjected to 16S rRNA sequencing,and plasma samples were subjected to untargeted metabolomics testing.Results:The oral and gut microbiome and metabolomics characteristics of the 1-year convalescents were restored to a large extent but did not completely return to normal.In the recovery process,the microbial diversity gradually increased.Butyric acid-producing microbes and Bifidobacterium gradually increased,whereas lipopolysaccharideproducing microbes gradually decreased.In addition,sphingosine-1-phosphate,which is closely related to the inflammatory factor storm of COVID-19,increased significantly during the recovery process.Moreover,the predictive models established based on the microbiome and metabolites of patients at the time of discharge reached high efficacy in predicting their neutralizing antibody levels one year later.Conclusions:This study is the first to characterize the oral and gut microbiome and metabonomics in 1-year convalescents of COVID-19.The key microbiome and metabolites in the process of recovery were identified,and provided new treatment ideas for accelerating recovery.And the predictive models based on the microbiome and metabolomics afford new insights for predicting the recovery situation which benefited affected individuals and healthcare.

Treatment Outcomes in COVID-19 Patients with Brucellosis:Case Series in Heilongjiang and Systematic Review of Literature

Objective Clinical characteristics and outcome in COVID-19 with brucellosis patients has not been well demonstrated,we tried to analyze clinical outcome in local and literature COVID-19 cases with brucellosis before and after recovery.Methods We retrospectively collected hospitalization data of comorbid patients and prospectively followed up after discharge in Heilongjiang Infectious Disease Hospital from January 15,2020 to April29,2022.Demographics,epidemiological,clinical symptoms,radiological and laboratory data,treatment medicines and outcomes,and follow up were analyzed,and findings of a systematic review were demonstrated.Results A total of four COVID-19 with brucellosis patients were included.One patient had active brucellosis before covid and 3 patients had nonactive brucellosis before brucellosis.The median age was54.5 years,and all were males(100.0%).Two cases(50.0%)were moderate,and one was mild and asymptomatic,respectively.Three cases(75.0%)had at least one comorbidity(brucellosis excluded).All4 patients were found in COVID-19 nucleic acid screening.Case C and D had only headache and fever on admission,respectively.Four cases were treated with Traditional Chinese medicine,western medicines for three cases,no adverse reaction occurred during hospitalization.All patients were cured and discharged.Moreover,one case(25.0%)had still active brucellosis without re-positive COVID-19,and other three cases(75.0%)have no symptoms of discomfort except one case fell fatigue and anxious during the follow-up period after recovery.Conducting the literature review,two similar cases have been reported in two case reports,and were both recovered,whereas,no data of follow up after recovery.Conclusion These cases indicate that COVID-19 patients with brucellosis had favorable outcome before and after recovery.More clinical studies should be conducted to confirm our findings.

Automatic Diagnosis of COVID-19 Patients from Unstructured Data Based on a Novel Weighting Scheme

The extraction of features fromunstructured clinical data of Covid-19 patients is critical for guiding clinical decision-making and diagnosing this viral disease.Furthermore,an early and accurate diagnosis of COVID-19 can reduce the burden on healthcare systems.In this paper,an improved Term Weighting technique combined with Parts-Of-Speech(POS)Tagging is proposed to reduce dimensions for automatic and effective classification of clinical text related to Covid-19 disease.Term Frequency-Inverse Document Frequency(TF-IDF)is the most often used term weighting scheme(TWS).However,TF-IDF has several developments to improve its drawbacks,in particular,it is not efficient enough to classify text by assigning effective weights to the terms in unstructured data.In this research,we proposed a modification term weighting scheme:RTF-C-IEF and compare the proposed model with four extraction methods:TF,TF-IDF,TF-IHF,and TF-IEF.The experiment was conducted on two new datasets for COVID-19 patients.The first datasetwas collected from government hospitals in Iraq with 3053 clinical records,and the second dataset with 1446 clinical reports,was collected from several different websites.Based on the experimental results using several popular classifiers applied to the datasets of Covid-19,we observe that the proposed scheme RTF-C-IEF achieves is a consistent performer with the best scores in most of the experiments.Further,the modifiedRTF-C-IEF proposed in the study outperformed the original scheme and other employed term weighting methods in most experiments.Thus,the proper selection of term weighting scheme among the different methods improves the performance of the classifier and helps to find the informative term.

Pathological and immunohistochemical findings of lungs,heart,liver,and kidneys,and unexpected findings of fungi and parasites in lungs of deceased COVID-19 patients:A case series

Objective:To define histopathologic and immunohistochemical features of the lungs,heart,liver,and kidneys in patients who died from coronavirus disease 2019(COVID-19),and to determine the presence of SARS-CoV-2 in all tissues,as well as the presence of fungi and parasites in lung tissues.Methods:This retrospective case study was conducted in the intensive care units of Dokuz Eylül University Hospital,and patients(≥18 years)who died due to COVID-19 between October 2020 and April 2021 were included.The biopsy samples of the patient’s lung,heart,liver,and kidney tissues were studied.Results:In the study,we enrolled 12 patients(mean age:70 years;50%male).Alveolar epithelial cell damage and diffuse alveolar damage were predominant in lung tissues.Lobular lymphocyte infiltration,centrilobular sinusoidal dilatation,and microvesicular steatosis in the liver,together with pigmented cast,non-isometric vacuolar degeneration,and capillary plugging in the kidneys,were commonly found among the patients.SARS-CoV-2 nucleocapsid protein antibodies were detected in three lung and two kidney tissues,and so did angiotensin-converting enzyme 2 receptor positivity in one lung and more than half of the kidney tissues.The RT-PCR tests were positive in three lungs and one kidney tissue.After DNA isolation from lung tissues,Pneumocystis jirovecii was detected in nine patients,Aspergillus fumigatus in two,Microsporidia in three,and Cryptosporidium in two.Conclusions:SARS-CoV-2 is a multisystemic disease.Fungi and parasites should be investigated in critically ill COVID-19 patients prescribed corticosteroids.

Liver manifestations in COVID-19 patients:A review article

The coronavirus disease 2019(COVID-19)initially presented as a disease that affected the lungs.Then,studies revealed that it intricately affected disparate organs in the human body,with the liver being one of the most affected organs.This review aimed to assess the association between COVID-19 and liver function,shedding light on its clinical implication.However,its exact pathophysiology remains unclear,involving many factors,such as active viral replication in the liver cells,direct cytotoxic effects of the virus on the liver or adverse reactions to viral antigens.Liver symptoms are mild-to-moderate transaminase elevation.In some patients,with underlying liver disease,more serious outcomes are observed.Thus,liver function should be meticulously considered in patients with COVID-19.

The modified systemic inflammation score is a predictor of ICU admission of COVID-19 patients

Objective:To evaluate the effect of the modified systemic inflammation score(mSIS)on prognosis in patients diagnosed with COVID-19.Methods:In this retrospective cross-sectional study,181 patients were selected and divided into two groups:patients with and without admission to the intensive care unit(ICU).An albumin level of≥4.0 g/dL and lymphocyte-to-monocyte ratio(LMR)of≥3.4 was scored 0,an albumin level of<4.0 g/dL or LMR of<3.4 was scored 1,and an albumin level of<4.0 g/dL and LMR of<3.4 was scored 2.Results:A total of 242 COVID-19 positive patients were initially included in this study.Of these patients,61 were excluded and 181 patients remained.Among the 181 participants,94(51.9%)were female,and the median age was 61(51,75)years.The mSIS scale ranged from 0 to 2.After analysis,the median score was 0(0,0)in the non-ICU group and 2(0,2)in the ICU group(P<0.001).The median white blood cell,lymphocyte counts,and albumin levels were lower in the ICU group(P<0.001,P<0.001,and P<0.001,respectively).In logistic regression analysis lymphocytopenia(OR=5.158,95%CI=1.249-21.304,P=0.023),hypoalbuminemia(OR=49.921,95%CI=1.843-1352.114,P=0.020),AST elevation(OR=3.939,95%CI=1.017-15.261,P=0.047),and mSIS=2(OR=5.853,95%CI=1.338-25.604,P=0.019)were identified as independent predictors of ICU admission.Conclusion:The mSIS can be used as an independent parameter for establishing the intensive care needs of patients with COVID-19.

Acupuncture for olfactory dysfunction in infected COVID-19 patients:Study protocol for a randomized,sham-controlled clinical trial

Background:Olfactory dysfunction(OD)is a common symptom of Corona Virus Disease 2019(COVID-19).It is defined as the reduced or distorted ability to smell during sniffing(orthonasal olfaction)and represents one of the early symptoms in the clinical course of COVID-19 infection.A large online questionnaire-based survey has shown that some post-COVID-19 patients had no improvement 1 month after discharge from the hospital.Objective:To explore the efficacy of acupuncture for OD in COVID-19 infected patients and to determine whether acupuncture could have benefits over sham acupuncture for OD in post-COVID-19 patients.Methods:This is a single-blind,randomized controlled,cross-over trial.We plan to recruit 40 post-COVID-19 patients with smell loss or smell distortions lasting for more than 1 month.Qualified patients will be randomly allocated to the intervention group(real acupuncture)or the control group(sham acupuncture)at a 1:1 ratio.Each patient will receive 8 sessions of treatment over 4 weeks(Cycle 1)and a 2-week follow-up.After the follow-up,the control group will be subjected to real acupuncture for another 4 weeks(Cycle 2),and the real acupuncture group will undergo the 4-week sham acupuncture.The primary outcomes will be the score changes on the questionnaire of olfactory functioning and olfaction-related quality of life at week 6,8,12,and 14 from the baseline.The secondary outcomes will be the changes in the olfactory test score at week 6 and 12 from the baseline measured by using the Traditional Chinese version of the University of Pennsylvania Smell Identification Test(UPSIT-TC).Discussion:The results of this trial will help to determine the effectiveness of acupuncture for OD in post-COVID-19 patients.This may provide a new treatment option for patients.

Cardiovascular sequelae in post-COVID-19 patients with moderate to severe CT severity score: A follow-up study

Objective:To study cardiovascular sequelae of post-COVID-19 patients with moderate to severe computed tomography(CT)severity score.Methods:A prospective,non-randomized,observational study was conducted on 100 post-COVID-19 patients with moderate to severe CT severity scores from January 2021 to December 2021.Fifty-nine were male[mean age(54.1±12.2)years]and 41 were female[mean age(46.9±15.1)years].Patients with previous cardiovascular disease,previous chronic lung disease,and pre-existing primary or secondary pulmonary hypertension were excluded.Patients were examined,and serial electrocardiogram and 2D echocardiography were performed to detect any cardiovascular abnormality.Results:Post-COVID-19 patients had persistent symptoms,the most common being fatigue(59%).Most of these symptoms were relieved on follow-up.A rise in systolic,diastolic blood pressure,and pulse rate was observed.The electrocardiographic evaluation revealed ST-T segment changes,sinus tachycardia,ventricular hypertrophy,and arrhythmias among a considerable number of patients.On echocardiography,left ventricular diastolic dysfunction was most common(43%).Pulmonary hypertension,as evidenced by elevated pulmonary artery systolic pressure,was seen in 15%of patients.Conclusions:The present findings reveal an increased incidence of cardiovascular complications after recovery from COVID-19 infection in those without pre-existing cardiovascular or chronic lung disease.

Factors contributing to nurses'resilience in caring for COVID-19 patients:an integrative review

Objective:To summarize factors contributing to the resilience of nurses in caring for coronavirus disease 2019(COVID-19)patients.Methods:An integrative review was conducted according to the recommendations proposed by Whittemore and Knafl.Articles were searched through 8 electronic databases:Pub Med,Scopus,Clinical Key for Nursing,Pro Quest,Medline and Wiley Online Library,CINAHL,and Garuda,which are databases recommended by the Ministry of Education,Culture,Research,and Technology in Indonesia.Relevant ar ticles published in English and Indonesia between 2019 and 2022,being quantitative or qualitative theoreticalmethodological studies that analyzed or proposed factors to nurses’resilience in caring for COVID-19 patients,were included,whereas primary studies that used review as a methodology to review an object of research were excluded.Results:From the 17 ar ticles that were included in this study,3 factors were found that contributed to the resilience of nurses in caring for COVID-19 patients,namely personal factors,workplace/organizational factors,and social factors.Conclusions:Understanding factors related to nurses’resilience during the COVID-19 pandemic can contribute to meet nurses’resilience both physical y and psychologically.Good resilience of nurses during a pandemic is useful for improving nursing care services and patient safety,as well as for being able to avoid turnover intentions among nurses in pandemic time.

A Novel-based Swin Transfer Based Diagnosis of COVID-19 Patients

The numbers of cases and deaths due to the COVID-19 virus have increased daily all around the world.Chest X-ray is considered very useful and less time-consuming for monitoring COVID disease.No doubt,X-ray is considered as a quick screening method,but due to variations in features of images which are of X-rays category with Corona confirmed cases,the domain expert is needed.To address this issue,we proposed to utilize deep learning approaches.In this study,the dataset of COVID-19,lung opacity,viral pneumonia,and lastly healthy patients’images of category X-rays are utilized to evaluate the performance of the Swin transformer for predicting the COVID-19 patients efficiently.The performance of the Swin transformer is compared with the other seven deep learning models,including ResNet50,DenseNet121,InceptionV3,EfficientNetB2,VGG19,ViT,CaIT,Swim transformer provides 98%recall and 96%accuracy on corona affected images of the X-ray category.The proposed approach is also compared with state-of-the-art techniques for COVID-19 diagnosis,and proposed technique is found better in terms of accuracy.Our system could support clin-icians in screening patients for COVID-19,thus facilitating instantaneous treatment for better effects on the health of COVID-19 patients.Also,this paper can contribute to saving humanity from the adverse effects of trials that the Corona virus might bring by performing an accurate diagnosis over Corona-affected patients.

Vitamin D Levels in COVID-19 Patients Admitted to Intensive Care

Background: Vitamin D has garnered much attention for its role in immune function, more specifically, it’s conceivable link to the clinical severity of Covid-19 infections and therefore its potential application in prophylactic or therapeutic treatment. Vitamin D appears capable of inhibiting pulmonary inflammatory responses while enhancing innate defence mechanisms against respiratory pathogens with population-based studies showing an association between circulating vitamin D levels and lung function. We understand that infection with Sars-Cov-2 induces production of pro and anti-inflammatory cytokines, whilst Vitamin D downregulates production of pro-inflammatory Th1 cytokines including tumour necrosis factor and interferon Y, whilst increasing expression of anti-inflammatory cytokines by macrophages. Vitamin D is also involved in the renin-angiotensin system which is regulated by entry of the SARS-Cov-2 virus into cells via the ACE2 receptor, leading to cytokine storms, with subsequent fatal respiratory distress syndrome. The theoretical implications for Vitamin D status in the presentation of Covid-19 (the disease state of Sars-Cov-2) exist, yet data on its application is currently limited. Geographical variables depicting patterns between sun exposure, diet or Vit D status, and risk of death from Covid-19 have shown strong negative correlation. Aim: We aim to assess levels of Vitamin D deficiency in ICU patients who have tested positive for Sars-Cov-2 and who have exhibited respiratory symptoms. In this way, we hope to identify the possibility of Vitamin D as a significant contributing factor to disease progression in Covid patients. Sample: Male or Female patients of any age, who were admitted to the Intensive Care Unit exhibiting respiratory symptoms, with a positive Sars-Cov-2 PCR test, between 12/3/21 and 25/2/21. sample total: 79. Results: Testing was very inconsistent with only 67.1% having their Vitamin D levels checked. There was average delay in testing levels by 2 days. 64% of patients were found to be very deficient. Conclusion: This study highlights the strong correlation between Vitamin D status and severity of Covid-19 disease and thus demonstrates a potential huge shortfall in the testing and treatment of this immunodeficiency as it relates to Covid-19. Based on recommendations of Vitamin D levels required for protection of this viral syndrome, as much as 100% of patients sampled with severe disease could be deficient in Vitamin D.

Clinical Evaluation of the Safety and Efficacy of the Phytomedicine APIVIRINE Based on Aqueous Extracts of Dichrostachys glomerata (Forssk.). Chiov. (D. cinerea) in COVID-19 Patients without Signs of Severity

Background: Since the appearance of the COVID-19 pandemic, several drugs have also been proposed for the treatment of the COVID-19, but the therapeutic effectiveness of those drugs is not satisfactory. This situation has led to the search for therapeutic solutions based on recipes from traditional medicine. Aims: This study aimed to evaluate the clinical safety, efficacy and tolerability of the phytomedicine APIVIRINE in patients with non-severe COVID-19. Methods: Patients were included following defined criteria and followed on an outpatient basis until recovery in accordance with national guidelines for the management of single cases of COVID-19 in Burkina Faso. Vital signs, anthropometric parameters as well as electrocardiographic, hematological and biochemical examinations were measured on D4, D7, D14 and D21. Adverse events were recorded during maintenance. Results: The present study included 45 patients. The clinical signs present at inclusion were mostly cough (44.44%), asthenia (42.22%), headache (40%), and anosmia (35.55%). Dyspnoea and chest pain were less represented in 05 (11.11%) and 06 (13.33%) patients. Cough, dyspnoea, chest pain, fever, sore throat, headache, and nasal obstruction present at inclusion disappeared before Day 4 of treatment. Anosmia and asthenia disappeared before Day 7. At the inclusion visit (Day 1), CRP, WBC, and blood glucose were abnormal in 15 (33.33%), 13 (28.89%), and 11 (24.44%) patients respectively. In addition, 3 (6.66%) patients had elevated creatinine levels. Transaminases Alanine aminotransferase (ALAT) were elevated in 05 (11.11%) patients while Aspartate aminotransferase (ASAT) was elevated in 04 (8.89%) patients. After 4 days of treatment, the cure rate was 33.33% of patients and 48.89% after 7 days. The cumulative cure rate was 86.67% after 14 days of treatment. Conclusion: No serious side effects or allergic reactions were observed during treatment. No clinical complications were observed and all symptoms present resolved on the 7th day of treatment.

Role of baricitinib in COVID-19 patients:A systematic review and meta-analysis

BACKGROUND Recent studies have indicated the use of baricitinib in coronavirus disease 2019(COVID-19)patients.However,the use of baricitinib in COVID-19 patients is unclear so far.AIM To determine the precise role of baricitinib in the mortality of COVID-19 patients.METHODS The relevant studies were searched in PubMed,Google scholar,and Clinical trials registries till July 13,2021 and sorted out based on inclusion and exclusion criteria.The quality of studies was assessed using Newcastle-Ottawa Scale.A random-effect model was used,and the pooled estimate was calculated as the odds ratio with a 95%confidence interval using Rev Man 5.RESULTS A total of 11 studies(4 observational and 7 clinical trials)were found relevant for analysis.The overall estimate measure in terms of odds ratio for observational studies was 0.42[0.11,1.67],whereas for clinical trials it was 0.37[0.09,1.46],indicating a non-significant reduction in COVID-19 patient deaths in the baricitinib group versus the non-baricitinib group.CONCLUSION More studies are required to confirm the role of baricitinib in the deaths of COVID-19 patients.

The Effect of Dexamethasone versus Methylprednisolone in the Treatment of COVID-19 Patients in Jordan

Background: Previous studies focused on the treatment effect of steroids versus no steroids in treating severe COVID-19 patients, a few studies evaluated outcomes for treating those patients with either dexamethasone or methylprednisolone. Currently, we evaluate the difference in mortality associated with treating COVID-19 patients with dexamethasone versus methylprednisolone. Methods: With a retrospective multicenter study, records were reviewed for the admitted patients with severe COVID-19 during the peak of the severe COVID-19 pandemic. All admitted patients on dexamethasone or methylprednisolone were included. Patients were analyzed as all populations and propensity scores matched patients. Propensity scores were calculated for several confounders by the generalized linear model, and a “greedy” near-neighbor matching algorithm was used. Continuous variables with nonnormal distribution were analyzed by Wilcoxon signed rank test. Chi-squared and Fischer exact test analyzed categorical variables. P-values were adjusted by the Bonferroni method for both data cohorts. Body mass index was in categories. Radiological findings were divided into five categories. The outcomes: mortality, the need for home oxygen therapy, recovery, and residual symptoms on discharge were analyzed by an independent two-sample test for equality of proportions (with Yates correction), and logistic regression analysis. Results: Among the 1128 reviewed records, patients on dexamethasone or methylprednisolone were 1071, and the propensity score-matched patients were 784: dexamethasone 393 and methylprednisolone 391. There was no significant difference in the characteristics of patients between the two steroids (p-value and adjusted p-value > 0.05) for most variables. PSM adjusted a few discrepant variables before analysis. The outcome of the unmatched patients demonstrated dexamethasone benefit in the need for home oxygen therapy ( 0.05). However, matched patients demonstrated significantly lower mortality associated with dexamethasone treatment (difference -2.68%, 95%CI, -1.0, -0.004, p = 0.03, and OR 1.7, p = 0.017), and no difference for the other outcomes, including the need for home oxygen therapy (p-value > 0.05). Conclusion: Dexamethasone treatment caused significantly less mortality than methylprednisolone in treating our COVID-19 patients, but no significant difference in recovery, the need for home oxygen therapy, and residual symptoms on discharge.