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Mnguni AT, Schietekat D, Ebrahim N, Sonday N, Boliter N, Schrueder N, Gabriels S, Cois A, Tamuzi JL, Tembo Y, Davies MA, English R, Nyasulu PS. The interface between SARS-CoV-2 and non-communicable diseases (NCDs) in a high HIV/TB burden district level hospital setting, Cape Town, South Africa. PLoS One 2023; 18:e0277995. [PMID: 37796879 PMCID: PMC10553288 DOI: 10.1371/journal.pone.0277995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 12/22/2022] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND COVID-19 experiences on noncommunicable diseases (NCDs) from district-level hospital settings during waves I and II are scarcely documented. The aim of this study is to investigate the NCDs associated with COVID-19 severity and mortality in a district-level hospital with a high HIV/TB burden. METHODS This was a retrospective observational study that compared COVID-19 waves I and II at Khayelitsha District Hospital in Cape Town, South Africa. COVID-19 adult patients with a confirmed SARS-CoV-2 polymerase chain reaction (PCR) or positive antigen test were included. In order to compare the inter wave period, clinical and laboratory parameters on hospital admission of noncommunicable diseases, the Student t-test or Mann-Whitney U for continuous data and the X2 test or Fishers' Exact test for categorical data were used. The role of the NCD subpopulation on COVID-19 mortality was determined using latent class analysis (LCA). FINDINGS Among 560 patients admitted with COVID-19, patients admitted during wave II were significantly older than those admitted during wave I. The most prevalent comorbidity patterns were hypertension (87%), diabetes mellitus (65%), HIV/AIDS (30%), obesity (19%), Chronic Kidney Disease (CKD) (13%), Congestive Cardiac Failure (CCF) (8.8%), Chronic Obstructive Pulmonary Disease (COPD) (3%), cerebrovascular accidents (CVA)/stroke (3%), with similar prevalence in both waves except HIV status [(23% vs 34% waves II and I, respectively), p = 0.022], obesity [(52% vs 2.5%, waves II and I, respectively), p <0.001], previous stroke [(1% vs 4.1%, waves II and I, respectively), p = 0.046]. In terms of clinical and laboratory findings, our study found that wave I patients had higher haemoglobin and HIV viral loads. Wave II, on the other hand, had statistically significant higher chest radiography abnormalities, fraction of inspired oxygen (FiO2), and uraemia. The adjusted odds ratio for death vs discharge between waves I and II was similar (0.94, 95%CI: 0.84-1.05). Wave I had a longer average survival time (8.0 vs 6.1 days) and a shorter average length of stay among patients discharged alive (9.2 vs 10.7 days). LCA revealed that the cardiovascular phenotype had the highest mortality, followed by diabetes and CKD phenotypes. Only Diabetes and hypertension phenotypes had the lowest mortality. CONCLUSION Even though clinical and laboratory characteristics differed significantly between the two waves, mortality remained constant. According to LCA, the cardiovascular, diabetes, and CKD phenotypes had the highest death probability.
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Affiliation(s)
- Ayanda Trevor Mnguni
- Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Khayelitsha District Hospital, Cape Town, South Africa
| | | | | | | | | | - Neshaad Schrueder
- Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Shiraaz Gabriels
- Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Annibale Cois
- Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Jacques L. Tamuzi
- Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Yamanya Tembo
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Mary-Ann Davies
- School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Health Impact Assessment Directorate, Western Cape Government, Cape Town, South Africa
| | - Rene English
- Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Peter S. Nyasulu
- Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Medicine and Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Matthies A, Trauer M, Chopra K, Jarman RD. Diagnostic accuracy of point-of-care lung ultrasound for COVID-19: a systematic review and meta-analysis. Emerg Med J 2023; 40:407-417. [PMID: 36868811 DOI: 10.1136/emermed-2021-212092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 01/31/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND Point-of-care (POC) lung ultrasound (LUS) is widely used in the emergency setting and there is an established evidence base across a range of respiratory diseases, including previous viral epidemics. The necessity for rapid testing combined with the limitations of other diagnostic tests has led to the proposal of various potential roles for LUS during the COVID-19 pandemic. This systematic review and meta-analysis focused specifically on the diagnostic accuracy of LUS in adult patients presenting with suspected COVID-19 infection. METHODS Traditional and grey-literature searches were performed on 1 June 2021. Two authors independently carried out the searches, selected studies and completed the Quality Assessment Tool for Diagnostic Test Accuracy Studies (QUADAS-2). Meta-analysis was carried out using established open-source packages in R. We report overall sensitivity, specificity, positive and negative predictive values, and the hierarchical summary receiver operating characteristic curve for LUS. Heterogeneity was determined using the I2 statistic. RESULTS Twenty studies were included, published between October 2020 and April 2021, providing data from a total of 4314 patients. The prevalence and admission rates were generally high across all studies. Overall, LUS was found to be 87.2% sensitive (95% CI 83.6 to 90.2) and 69.5% specific (95% CI 62.2 to 72.5) and demonstrated overall positive and negative likelihood ratios of 3.0 (95% CI 2.3 to 4.1) and 0.16 (95% CI 0.12 to 0.22), respectively. Separate analyses for each reference standard revealed similar sensitivities and specificities for LUS. Heterogeneity was found to be high across the studies. Overall, the quality of studies was low with a high risk of selection bias due to convenience sampling. There were also applicability concerns because all studies were undertaken during a period of high prevalence. CONCLUSION During a period of high prevalence, LUS had a sensitivity of 87% for the diagnosis of COVID-19 infection. However, more research is required to confirm these results in more generalisable populations, including those less likely to be admitted to hospital. PROSPERO REGISTRATION NUMBER CRD42021250464.
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Affiliation(s)
- Ashley Matthies
- Emergency Department, Homerton University Hospital NHS Foundation Trust, London, UK .,School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Michael Trauer
- School of Health and Life Sciences, Teesside University, Middlesbrough, UK.,Emergency Department, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
| | - Karl Chopra
- Emergency Department, Homerton University Hospital NHS Foundation Trust, London, UK.,School of Health and Life Sciences, Teesside University, Middlesbrough, UK
| | - Robert David Jarman
- Accident and Emergency Department, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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Fatouh MM, Kandil NM, EL Garhy NM. Correlation between chest CT scores and clinical impact in patients re-infected with COVID-19 during the two attacks: an observational study. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2022. [PMCID: PMC8900098 DOI: 10.1186/s43055-022-00739-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Worldwide, millions of people got COVID-19 infection since the start of the pandemic with a large number of deaths. Re-infection with SARS-CoV-2 is possible, because it can mutate into new strains as it is an RNA virus. The main objective of our study is to correlate between CT severity score of the patients re-infected with COVID-19 during the first and second attack and its clinical impact.
Results We performed a retrospective cohort study. It was carried out on fifty symptomatic patients (11 females and 39 males). Their ages ranged from 38 to 71 years. We included only patients who were re-infected after more than 6 months of the first infection and showed clinical symptoms with SARS-CoV-2 PCR-positive test. We found that CT severity score was decreased in the second infection in 47 (94%) of our patients associated with decreased respiratory distress as well as oxygen requirements, while the CT severity score was increased in two patients and only one patient showed no change in CT score severity between two infections. Conclusion The reduction in CT severity score in the majority of re-infected patients suggested the role of the immunity developed from first infection in protection against severe lung affection in case of repeated infection even after 6 months despite poor immunity against re-infection.
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Pettenuzzo T, Giraudo C, Fichera G, Della Paolera M, Tocco M, Weber M, Gorgi D, Carlucci S, Lionello F, Lococo S, Boscolo A, De Cassai A, Pasin L, Rossato M, Vianello A, Vettor R, Sella N, Navalesi P. Chest X-ray Does Not Predict the Risk of Endotracheal Intubation and Escalation of Treatment in COVID-19 Patients Requiring Noninvasive Respiratory Support. J Clin Med 2022; 11:jcm11061636. [PMID: 35329962 PMCID: PMC8950017 DOI: 10.3390/jcm11061636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/12/2022] [Accepted: 03/14/2022] [Indexed: 02/05/2023] Open
Abstract
Forms of noninvasive respiratory support (NIRS) have been widely used to avoid endotracheal intubation in patients with coronavirus disease-19 (COVID-19). However, inappropriate prolongation of NIRS may delay endotracheal intubation and worsen patient outcomes. The aim of this retrospective study was to assess whether the CARE score, a chest X-ray score previously validated in COVID-19 patients, may predict the need for endotracheal intubation and escalation of respiratory support in COVID-19 patients requiring NIRS. From December 2020 to May 2021, we included 142 patients receiving NIRS who had a first chest X-ray available at NIRS initiation and a second one after 48–72 h. In 94 (66%) patients, the level of respiratory support was increased, while endotracheal intubation was required in 83 (58%) patients. The CARE score at NIRS initiation was not predictive of the need for endotracheal intubation (odds ratio (OR) 1.01, 95% confidence interval (CI) 0.96–1.06) or escalation of treatment (OR 1.01, 95% CI 0.96–1.07). In conclusion, chest X-ray severity, as assessed by the CARE score, did not allow predicting endotracheal intubation or escalation of respiratory support in COVID-19 patients undergoing NIRS.
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Affiliation(s)
- Tommaso Pettenuzzo
- Institute of Anesthesiology and Intensive Care, Padua University Hospital, 13 Via Gallucci, 35121 Padua, Italy; (T.P.); (A.B.); (A.D.C.); (L.P.); (P.N.)
| | - Chiara Giraudo
- Institute of Radiology, Padua University Hospital, 2 Via Nicolò Giustiniani, 35128 Padua, Italy;
- Institute of Anesthesiology and Intensive Care, Department of Medicine, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (M.D.P.); (M.T.); (M.R.); (R.V.)
| | - Giulia Fichera
- Pediatric Radiology, Padua University Hospital, 2 Via Nicolò Giustiniani, 35128 Padua, Italy;
| | - Michele Della Paolera
- Institute of Anesthesiology and Intensive Care, Department of Medicine, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (M.D.P.); (M.T.); (M.R.); (R.V.)
| | - Martina Tocco
- Institute of Anesthesiology and Intensive Care, Department of Medicine, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (M.D.P.); (M.T.); (M.R.); (R.V.)
| | - Michael Weber
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, 23 Spitalgasse, 1090 Vienna, Austria;
| | - Davide Gorgi
- Internal Medicine, Department of Medicine, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (D.G.); (S.C.)
| | - Silvia Carlucci
- Internal Medicine, Department of Medicine, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (D.G.); (S.C.)
| | - Federico Lionello
- Respiratory Pathophysiology Division, Department of Cardio-Thoracic, Vascular Sciences and Public Health, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (F.L.); (S.L.); (A.V.)
| | - Sara Lococo
- Respiratory Pathophysiology Division, Department of Cardio-Thoracic, Vascular Sciences and Public Health, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (F.L.); (S.L.); (A.V.)
| | - Annalisa Boscolo
- Institute of Anesthesiology and Intensive Care, Padua University Hospital, 13 Via Gallucci, 35121 Padua, Italy; (T.P.); (A.B.); (A.D.C.); (L.P.); (P.N.)
| | - Alessandro De Cassai
- Institute of Anesthesiology and Intensive Care, Padua University Hospital, 13 Via Gallucci, 35121 Padua, Italy; (T.P.); (A.B.); (A.D.C.); (L.P.); (P.N.)
| | - Laura Pasin
- Institute of Anesthesiology and Intensive Care, Padua University Hospital, 13 Via Gallucci, 35121 Padua, Italy; (T.P.); (A.B.); (A.D.C.); (L.P.); (P.N.)
| | - Marco Rossato
- Institute of Anesthesiology and Intensive Care, Department of Medicine, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (M.D.P.); (M.T.); (M.R.); (R.V.)
- Internal Medicine, Department of Medicine, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (D.G.); (S.C.)
| | - Andrea Vianello
- Respiratory Pathophysiology Division, Department of Cardio-Thoracic, Vascular Sciences and Public Health, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (F.L.); (S.L.); (A.V.)
| | - Roberto Vettor
- Institute of Anesthesiology and Intensive Care, Department of Medicine, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (M.D.P.); (M.T.); (M.R.); (R.V.)
- Internal Medicine, Department of Medicine, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (D.G.); (S.C.)
| | - Nicolò Sella
- Institute of Anesthesiology and Intensive Care, Padua University Hospital, 13 Via Gallucci, 35121 Padua, Italy; (T.P.); (A.B.); (A.D.C.); (L.P.); (P.N.)
- Institute of Anesthesiology and Intensive Care, Department of Medicine, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (M.D.P.); (M.T.); (M.R.); (R.V.)
- Correspondence:
| | - Paolo Navalesi
- Institute of Anesthesiology and Intensive Care, Padua University Hospital, 13 Via Gallucci, 35121 Padua, Italy; (T.P.); (A.B.); (A.D.C.); (L.P.); (P.N.)
- Institute of Anesthesiology and Intensive Care, Department of Medicine, University of Padua, 2 Via Nicolò Giustiniani, 35128 Padua, Italy; (M.D.P.); (M.T.); (M.R.); (R.V.)
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The Role of Ionizing Radiation for Diagnosis and Treatment against COVID-19: Evidence and Considerations. Cells 2022; 11:cells11030467. [PMID: 35159277 PMCID: PMC8834503 DOI: 10.3390/cells11030467] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/22/2022] [Accepted: 01/25/2022] [Indexed: 02/06/2023] Open
Abstract
The Coronavirus disease 2019 (COVID-19) pandemic continues to spread worldwide with over 260 million people infected and more than 5 million deaths, numbers that are escalating on a daily basis. Frontline health workers and scientists diligently fight to alleviate life-threatening symptoms and control the spread of the disease. There is an urgent need for better triage of patients, especially in third world countries, in order to decrease the pressure induced on healthcare facilities. In the struggle to treat life-threatening COVID-19 pneumonia, scientists have debated the clinical use of ionizing radiation (IR). The historical literature dating back to the 1940s contains many reports of successful treatment of pneumonia with IR. In this work, we critically review the literature for the use of IR for both diagnostic and treatment purposes. We identify details including the computed tomography (CT) scanning considerations, the radiobiological basis of IR anti-inflammatory effects, the supportive evidence for low dose radiation therapy (LDRT), and the risks of radiation-induced cancer and cardiac disease associated with LDRT. In this paper, we address concerns regarding the effective management of COVID-19 patients and potential avenues that could provide empirical evidence for the fight against the disease.
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