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Tan KT, Benedict SLH, Chang CY, Chidambaram SK, Abd Jamil I, Bahrudin MS, Kandasamy SS, Khor CS. Clinical severity of COVID-19 with omicron variant predominance in relation to vaccination status, age, comorbidities- a single center in Selangor, Malaysia. Med J Malaysia 2022; 77:558-563. [PMID: 36169066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Recently, the rapid surge of reported COVID-19 cases attributed to the Omicron variant of severe acute respiratory syndrome coronavirus (SARS-CoV-2) created an immediate concern across nations. Local information pertaining to the new variant of concern (VOC) is lacking. We aimed to determine the clinical characteristics of COVID-19 during a period of Omicron prevalence among patients hospitalised from February 1 to 21, 2022 at Sungai Buloh Hospital and to estimate the risks of disease progression presumably caused by this variant in association with gender, age, comorbidity, and vaccination status. MATERIALS AND METHODS In this retrospective, singlecentered, retrospective cohort study, all hospitalised adults with laboratory-confirmed COVID-19, aged 18 and above, were recruited from February 1 to 21, 2022. Clinical characteristics, investigations, and outcomes were assessed. RESULTS A total of 2279 patients aged 18 years and above with laboratory-proven COVID-19 were recruited and analysed, excluding 32 patients owing to incomplete data. Majority of the study population had a mean age of 41.8 ± 17.7, was female-predominant (1329/2279, 58.6%), had completed a primary series of vaccination with a booster (1103/2279, 48.4%), and had no underlying medical conditions (1529/2279, 67.4%). The risk of COVID-19-related disease progression was significantly lower in hospitalised patients under the age of 50 who were female, had no comorbidity, and had completed two doses of the primary series with or without a booster. [respectively, OR 7.94 (95% CI 6.16, 10.23); 1.68 (1.34, 2,12); 2.44 (1.85, 3.22); 2.56 (1.65, 3.97), p< 0.001]. CONCLUSION During the period of Omicron prevalence, a favourable outcome of COVID-19 was strongly associated with female gender, age below 50, a comorbidity-free condition, and having completed immunization. With this new observation, it could help improve public health planning and clinical management in response to the emergence of the latest VOC.
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Affiliation(s)
- K T Tan
- Sungai Buloh Hospital, Department of Internal Medicine, Selangor, Malaysia.
| | - S L H Benedict
- Sungai Buloh Hospital, Department of Internal Medicine, Selangor, Malaysia
| | - C Y Chang
- Sungai Buloh Hospital, Department of Internal Medicine, Selangor, Malaysia
| | - S K Chidambaram
- Sungai Buloh Hospital, Department of Internal Medicine, Selangor, Malaysia
| | - I Abd Jamil
- Sungai Buloh Hospital, Department of Crisis Preparedness and Response Centre, Selangor, Malaysia
| | - M S Bahrudin
- Sungai Buloh Hospital, Department of Crisis Preparedness and Response Centre, Selangor, Malaysia
| | - S S Kandasamy
- Sungai Buloh Hospital, Department of Internal Medicine, Selangor, Malaysia
| | - C S Khor
- Sungai Buloh Hospital, Department of Internal Medicine, Selangor, Malaysia
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Gani YM, Chidambaram SK, Sim BLH, Sothivadivel S, Aziz AA, Mustapa NI, Wong XC, Chai LSL, Song KWR, Rajahram GS, Zaidan NZ, Ibrahim FZ, Kamaruddin N, Vijayasingham S. Identification of warning signs in Malaysian patients having COVID-19 infection who progress to severe form of the illness. Med J Malaysia 2022; 77:189-195. [PMID: 35338626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Coronavirus disease 2019 (COVID-19) is an infectious disease caused by a novel coronavirus, now widely known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has caused 3 major pandemic waves in Malaysia. We aimed to identify the warning signs as indicators that predict the progression of disease. MATERIALS AND METHODS This is a retrospective cohort study of adult patients more than 12 years of age presenting with laboratory-confirmed COVID-19 admitted in three separate hospitals around the country. RESULTS Of the 228 patients initially admitted with mild illness, 47 had progressed requiring oxygen. The median time from admission to deterioration was 3 days (IQR 2 - 5). Age more than ≥50years old (median age = 42.5, IQR = 28.8 - 57.0), higher temperature (mean = 37.3, IQR 36.8 - 38.0), MEWS score >3 (9, 19.1%), Neutrophil-to-lymphocyte ratio (NLR) >3.13 , (18, 38.3%) C-reactive protein (CRP) >5. (12, 27.3%), multiple zonal involvement on the chest radiography on admission (2, IQR 1-3) were more common in the deteriorated group on admission. On multivariate analysis, multiple comorbidities (HR = 7.40, 95 percent CI 2.58-21.2, p0.001), presence of persistent fever (HR = 2.88, 95 percent CI 1.15 - 7.2, p = 0.024), MEWS scoring >3 (HR of 6.72 ;95 percent CI 2.81-16.0, p0.001) were associated with progression to severe illness. CONCLUSION In our cohort, we found that several factors were associated with the severity of COVID19. Early detection of these factors could correctly identify patients who need more intensive monitoring, and early referral for ICU care.
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Affiliation(s)
- Y M Gani
- Hospital Sungai Buloh, Department of Medicine, Selangor, Malaysia.
| | - S K Chidambaram
- Hospital Sungai Buloh, Department of Medicine, Selangor, Malaysia
| | - B L H Sim
- Hospital Sungai Buloh, Department of Medicine, Selangor, Malaysia
| | - S Sothivadivel
- Hospital Sungai Buloh, Department of Medicine, Selangor, Malaysia
| | - A A Aziz
- Hospital Sungai Buloh, Department of Diagnostic Imaging, Selangor, Malaysia
| | - N I Mustapa
- Hospital Sungai Buloh, Department of Pathology, Selangor, Malaysia
| | - X C Wong
- Institute for Clinical Research, Digital Health Research and Innovation Unit, Malaysia
| | - L S L Chai
- University Malaya Medical Centre, Faculty of Medicine, Malaysia
| | - K W R Song
- Hospital Lahad Datu, Ministry of Health, Sabah, Malaysia
| | | | - N Z Zaidan
- Hospital Melaka, Department of Medicine, Melaka, Malaysia
| | - F Z Ibrahim
- Hospital Melaka, Department of Medicine, Melaka, Malaysia
| | - N Kamaruddin
- Hospital Melaka, Department of Medicine, Melaka, Malaysia
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Nur Munirah I, Chidambaram SK. Case series of COVID-19 with spontaneous pneumomediastinum. Med J Malaysia 2022; 77:92-94. [PMID: 35087002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Spontaneous pneumomediastinum is a rare condition in viral pneumonia. However, it can arise spontaneously in COVID-19 patients with no other risk factors. Here we present four cases of spontaneous pneumomediastinum in patients with COVID-19 pneumonia with no other precipitating factors.
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Affiliation(s)
- I Nur Munirah
- Hospital Sungai Buloh, Department of Medicine, Infectious diseases Unit, Malaysia.
| | - S K Chidambaram
- Hospital Sungai Buloh, Department of Medicine, Infectious diseases Unit, Malaysia
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Rajendiran S, Thahir SSA, Veloo Y, Suppiah J, Pahrol MA, Shakor ASA, Mohamad N, Ramly N, Shariff HM, Karim RA, Chidambaram SK, Senian R, Ahmad N, Thayan R, Shaharudin R. Environmental surface sampling of SARS-CoV-2 in selected hospitals in Malaysia. Trop Biomed 2021; 38:462-468. [PMID: 34608120 DOI: 10.47665/tb.38.3.089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
COVID-19 has spread rapidly worldwide. The role of fomites in facilitating onward transmission is plausible. This study aimed to determine the presence of viable virus and its persistence on the surfaces of fomites in wards treating COVID-19 patients in Malaysia. This study was conducted in two stages. First, environmental sampling was performed on random days in the intensive care unit (ICU) and general wards. Then, in the second stage, samples were collected serially on alternate days for 7 days in two selected general wards. In Stage 1, a total of 104 samples were collected from the surfaces of highly touched and used areas by patients and healthcare workers. Only three samples were tested positive for SARS-COV-2. In Stage 2, three surface samples were detected positive, but no persistence of the virus was observed. However, none of the SARS-CoV-2 RNA was viable through tissue culture. Overall, the environmental contamination of SARS-CoV-2 was low in this hospital setting. Hospitals' strict infection control and the compliance of patients with wearing masks may have played a role in these findings, suggesting adherence to those measures to reduce occupational exposure of COVID-19 in hospital settings.
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Affiliation(s)
- S Rajendiran
- Environmental Health Research Centre (EHRC), Institute for Medical Research (IMR), Ministry of Health, 40170 Shah Alam, Selangor Darul Ehsan, Malaysia
| | - S S A Thahir
- Environmental Health Research Centre (EHRC), Institute for Medical Research (IMR), Ministry of Health, 40170 Shah Alam, Selangor Darul Ehsan, Malaysia
| | - Y Veloo
- Environmental Health Research Centre (EHRC), Institute for Medical Research (IMR), Ministry of Health, 40170 Shah Alam, Selangor Darul Ehsan, Malaysia
| | - J Suppiah
- Infectious Disease Research Centre (IDRC), Insitute for Medical Research (IMR), Ministry of Health, 40170 Shah Alam, Selagor Darul Ehsan, Malaysia
| | - M A Pahrol
- Environmental Health Research Centre (EHRC), Institute for Medical Research (IMR), Ministry of Health, 40170 Shah Alam, Selangor Darul Ehsan, Malaysia
| | - A S A Shakor
- Environmental Health Research Centre (EHRC), Institute for Medical Research (IMR), Ministry of Health, 40170 Shah Alam, Selangor Darul Ehsan, Malaysia
| | - N Mohamad
- Environmental Health Research Centre (EHRC), Institute for Medical Research (IMR), Ministry of Health, 40170 Shah Alam, Selangor Darul Ehsan, Malaysia
| | - N Ramly
- Environmental Health Research Centre (EHRC), Institute for Medical Research (IMR), Ministry of Health, 40170 Shah Alam, Selangor Darul Ehsan, Malaysia
| | - H M Shariff
- Infectious Disease Research Centre (IDRC), Insitute for Medical Research (IMR), Ministry of Health, 40170 Shah Alam, Selagor Darul Ehsan, Malaysia
| | - R A Karim
- Infectious Disease Research Centre (IDRC), Insitute for Medical Research (IMR), Ministry of Health, 40170 Shah Alam, Selagor Darul Ehsan, Malaysia
| | - S K Chidambaram
- Hospital Sungai Buloh, Ministry of Health, 47000 Sungai Buloh, Selangor Darul Ehsan, Malaysia
| | - R Senian
- Hospital Kuala Lumpur (HKL), Ministry of Health, 50586 Kuala Lumpur, Wilayah Persekutuan, Malaysia
| | - N Ahmad
- Infectious Disease Research Centre (IDRC), Insitute for Medical Research (IMR), Ministry of Health, 40170 Shah Alam, Selagor Darul Ehsan, Malaysia
| | - R Thayan
- Infectious Disease Research Centre (IDRC), Insitute for Medical Research (IMR), Ministry of Health, 40170 Shah Alam, Selagor Darul Ehsan, Malaysia
| | - R Shaharudin
- Environmental Health Research Centre (EHRC), Institute for Medical Research (IMR), Ministry of Health, 40170 Shah Alam, Selangor Darul Ehsan, Malaysia
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Abstract
A 44-year-old woman was admitted to our hospital with dengue fever. She developed a haematoma in the right arm at the site of a previous arterial line insertion. Due to coexisting thrombocytopenia, the bleeding was severe enough to cause compartment syndrome. An emergency fasciotomy was performed and her limb salvaged. The case illustrates one important potential complication of this common infectious disease.
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Affiliation(s)
- C Khoo
- CS Khoo, Department of Internal Medicine, Ampang Hospital, Jalan Mewah Utara, 68000 Ampang, Selangor, Malaysia. E-mail
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