Category: Nevin Manimala

J Infect Dev Ctries. 2024 Dec 31;18(12.1):S318-S325. doi: 10.3855/jidc.19332.

ABSTRACT

INTRODUCTION: Coronavirus disease 2019 (COVID-19) is associated with long-term symptoms, but the spectrum of these symptoms remains unclear. We aimed to identify the prevalence and factors associated with persistent symptoms in patients at the post-COVID-19 outpatient clinic.

METHODOLOGY: This cross-sectional, observational study included hospitalized severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected patients followed-up at a post-COVID-19 clinic between September 2021 and January 2022. Persistent symptoms, defined as lasting > 4 weeks after infection, were analyzed alongside symptom timing (28-90, 91-120, and > 120 days) and associated factors using multivariate analysis.

RESULTS: Among 277 patients, mean (SD) age was 56 (16.6) years, and 58.5% were male. Of these, 80.9% reported at least one persistent symptom. Common symptoms included dyspnea (48.2%), insomnia (42.4%), and myalgia (42.1%). In multivariate analysis, being female [odds ratio (OR) 3.41; 95% confidence interval (CI) 1.5-7.76], and oxygen therapy (OR 3.39; 95% CI 1.3-8.81) were independently associated factors with persistent symptoms. High-sensitivity C-reactive protein (HsCRP) (> 75 mg/dL) was an independent risk factor for dyspnea (adjusted OR 2.29; 95% CI 1.28-4.12), and fatigue (adjusted OR 2.24; 95% CI 1.25-4). Oxygen therapy was an independent risk factor for neurologic symptoms, i.e. insomnia (adjusted OR 2.05; 95% CI 1.15-3.65), and brain fog (adjusted OR 2.02; 95% CI 1.14-3.58).

CONCLUSIONS: There was a high prevalence of persistent COVID-19 symptoms. The most common symptom was dyspnea. Female gender and oxygen supplementation were independent associated factors. Continuous follow-up of these patients is still required.

PMID:39863949 | DOI:10.3855/jidc.19332

J Infect Dev Ctries. 2024 Dec 31;18(12.1):S310-S317. doi: 10.3855/jidc.19595.

ABSTRACT

INTRODUCTION: The global healthcare system faced unparalleled challenges during the coronavirus disease 2019 (COVID-19) pandemic, potentially reshaping antibiotic usage trends. This study aimed to evaluate the knowledge, perceptions, and observations of community pharmacists concerning antibiotic utilization during and after the pandemic; and offer crucial insights into its impact on antibiotic usage patterns and infection dynamics.

METHODOLOGY: This cross-sectional study involved 162 community pharmacists in Northern Cyprus. Data were gathered via a structured survey, including pharmacist demographics, antibiotic knowledge, perceptions of antibiotic resistance, and observations on antibiotic misuse during and after the COVID-19 pandemic. The data were analyzed by biostatistical methods.

RESULTS: Over 90% of pharmacists demonstrated high awareness of antibiotic overuse and resistance. The average antibiotic use knowledge score was 5.09/7. The majority expressed interest in further education (85.2%) and participation in campaigns (96.9%) to promote appropriate antibiotic use. Notably, 87.7% of participants observed an increase in respiratory infections post pandemic, and 45.7% reported administering more antibiotics, reflecting heightened demand. Furthermore, 63.6% noted increased demand for unprescribed antibiotics, while 45.7% expressed concerns about potential neglect of the antibiotic resistance issue as a consequence of the pandemic.

CONCLUSIONS: The study highlights critical changes in antibiotic dispensing patterns among community pharmacists during and after the COVID-19 pandemic. The results here underscore the pivotal role of pharmacists in antibiotic stewardship, advocating for ongoing education, and stricter prescription regulations to optimize antibiotic use and combat resistance.

PMID:39863948 | DOI:10.3855/jidc.19595

J Infect Dev Ctries. 2024 Dec 31;18(12.1):S305-S309. doi: 10.3855/jidc.19843.

ABSTRACT

INTRODUCTION: The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted public transportation systems worldwide. In this study, we evaluated the rate of COVID-19 positivity and its associated factors among users of public transportation in socioeconomically disadvantaged regions of Brazil during the pre-vaccination phase of the pandemic.

METHODOLOGY: This ecological study, conducted in Aracaju city in Northeast Brazil, is a component of the TestAju Program. This initiative was designed to expand COVID-19 testing to asymptomatic individuals in public spaces such as squares and bus terminals. Using logistic regression, we examined the relationship between COVID-19 positivity and factors such as demographics, socioeconomic status, and travel frequency. The Fruchterman-Reingold algorithm was used to explore transmission pathways across neighborhoods with varying living conditions.

RESULTS: Of the 1,420 public transport users tested via real time reverse transcriptase polymerase chain reaction (RT-PCR), 249 were positive, indicating a 17.5% positivity rate (95% CI: 15.7-19.6). Our findings revealed a higher positivity rate during periods of increased viral spread (OR = 4.3, 95% CI: 3.1-5.9) and in neighborhoods with poorer conditions (OR = 1.5, 95% CI: 1.1-2.1). Network analysis revealed affluent neighborhoods as significant transmission hubs of the disease.

CONCLUSIONS: Our study highlights the vital role of urban mobility patterns in the spread of COVID-19. Neighborhoods with better living conditions that serve as hubs of activity and movement, enable gatherings and interactions among people from diverse regions, including those from areas with higher infection rates.

PMID:39863947 | DOI:10.3855/jidc.19843

J Infect Dev Ctries. 2024 Dec 31;18(12.1):S298-S304. doi: 10.3855/jidc.19862.

ABSTRACT

INTRODUCTION: The objective of this study was to assess the effectiveness of ivermectin and colchicine as treatment options for coronavirus disease 2019 (COVID-19).

METHODOLOGY: A three-arm randomized controlled clinical trial was conducted in the Triage Clinic of the family medicine department at Ain Shams University Hospitals on participants who had been diagnosed with moderate COVID-19. Patients aged < 18 years or > 65 years, with any co-morbidities, pregnant or lactating females, and those with mild or severe COVID-19 confirmed cases were excluded. Sealed envelopes were used for randomization of intervention or control. Patients are followed until there was improvement of symptoms and no development of new symptoms for over one month.

RESULTS: A total of 120 patients (40.16 ± 10.74 years) with COVID-19 were enrolled; 40 patients in each arm. Out of them, 44 (36.6%) were male and 76 (63.4%) were female. Fever and cough were the predominant symptoms in each group. There was no statistically significant difference in the mean duration of fever between the ivermectin, colchicine, and control groups (7.3 ± 1.68, 6.6 ± 1.58, and 7.075 ± 1.58 days, respectively). The majority of patients (67.5%, 70%, and 72.5%) were completely cured within 10 days of infection, with no differences between the three groups (p > 0.05). A statistically significant improvement of inflammatory markers occurred in each of the three groups over time with no statistically significant difference between them.

CONCLUSIONS: Ivermectin and colchicine have no beneficial effect over standard care in the treatment of COVID-19.

PMID:39863946 | DOI:10.3855/jidc.19862

J Infect Dev Ctries. 2024 Dec 31;18(12.1):S289-S297. doi: 10.3855/jidc.19920.

ABSTRACT

INTRODUCTION: Coronavirus disease 2019 (COVID-19) is a life-threatening disease that was declared a pandemic in March 2020. Organ transplant recipients are vulnerable to infection and complications from COVID-19. The objective of this study was to investigate the rates of infection, mortality, and case-fatality ratios (CFR) in solid organ transplant recipients and patients on the waiting list for organ allocation in the period prior to the availability of specific vaccines.

METHODOLOGY: This was an observational study of official sources that are used to report information on COVID-19. Quantitative variables were described with arithmetic means and categorical variables with proportions. Percentages of positivity to infection, number of deaths, CFR, and all-cause mortality were calculated for each group and subgroup.

RESULTS: There were 2,551 eligible subjects; 602 (26.2%) were positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). There were 265 (10.4%) deaths from all causes during the follow-up period; 119 (44.9%) of them were associated with COVID-19, which indicated a COVID-19-related mortality rate of 4.7 %. CFRs were 21.4% and 17.1% in transplant recipients and waitlisted patients, respectively. CFR was significantly higher in transplant recipients (23.8%) than in patients waitlisted for kidney (16.5%; p = 0.044) Among SARS-CoV-2-positive patients, the probability of dying from COVID-19 was higher in the first group (87.3% and 73%, respectively; p = 0.034).

CONCLUSIONS: COVID-19 had a significant impact on the deaths of transplant patients and patients on the solid organ waiting list during the first year of the pandemic in Colombia, before the availability of vaccines.

PMID:39863945 | DOI:10.3855/jidc.19920

J Infect Dev Ctries. 2024 Dec 31;18(12.1):S282-S288. doi: 10.3855/jidc.20005.

ABSTRACT

INTRODUCTION: Despite efforts by health organizations to share evidence-based information, fake news hindered the promotion of social distancing and vaccination during the coronavirus disease 2019 (COVID-19) pandemic. This study analyzed COVID-19 knowledge and practices in a vulnerable area in northern Rio de Janeiro, acknowledging the influence of the complex social and economic landscape on public health perceptions.

METHODOLOGY: This cross-sectional study was conducted in Novo Eldorado – a low-income, conflict-affected neighborhood in Campos dos Goytacazes – using a structured questionnaire, following the peak of COVID-19 deaths in Brazil (July-December 2021). Statistical tests were used to delineate profiles and evaluate knowledge and preventive behaviors associated with COVID-19.

RESULTS: This study involved a cohort of 156 participants, predominantly women (74%), with an average age of 53 years. Almost half of the participants were identified as single (48%), and more than half had not completed elementary school. Notably, 68% believed they were well-informed about COVID-19. The answers to the questionnaire revealed that the majority correctly identified severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as a virus (65%); 72% recognized fever or cough as the main symptoms; and 71% recognized the importance of wearing masks. The overall mean score of the study was 7.628 (SD 1.583047). Social networks, especially ‘WhatsApp’ (65%), were the primary information sources. Those using social media or WhatsApp had higher knowledge scores (8.000 vs. 7.000, p = 0.0064).

CONCLUSIONS: Involving marginalized communities and using social media to disseminate accurate information and trust in science is necessary to tackle COVID-19 challenges.

PMID:39863944 | DOI:10.3855/jidc.20005

J Infect Dev Ctries. 2024 Dec 31;18(12.1):S275-S281. doi: 10.3855/jidc.18659.

ABSTRACT

INTRODUCTION: Inflammation plays a role in coronavirus disease 2019 (COVID-19) pathophysiology and anti-inflammatory drugs may help reduce the disease severity. Levamisole is an anthelmintic drug with immunomodulatory and possible antiviral effects. This study aimed to evaluate the role of levamisole in the treatment of patients with COVID-19.

METHODOLOGY: In this randomized controlled clinical trial, hospitalized patients with confirmed severe COVID-19 (arterial oxygen saturation < 90%) were randomly assigned to either experimental (n = 41) or control (n = 45) groups. Levamisole 50 mg orally daily was prescribed for the first group until discharge or death, for a maximum of 7 days, along with other standard treatments. Only standard treatments were prescribed to the control group. Clinical response (either improvement or failure) at the end of the fifth and seventh days, changes in laboratory indices, length of hospitalization, and mortality rate during the study were evaluated and recorded.

RESULTS: The rate of clinical improvement in the experimental group was significantly more than in the control group on the fifth (97.6% vs. 58.7%, p < 0.001) and seventh (95.8% vs. 66.7%, p = 0.007) days. Furthermore, the mean length of hospital stays in the experimental group (8.39 ± 3.54 days) was significantly shorter than in the control group (10.78 ± 5.40 days, p = 0.024). No patients died during the study.

CONCLUSIONS: Administering levamisole to hospitalized patients with severe COVID-19 reduced hospitalization time and improved several clinical outcomes.

PMID:39863943 | DOI:10.3855/jidc.18659

J Infect Dev Ctries. 2024 Dec 31;18(12.1):S267-S274. doi: 10.3855/jidc.20123.

ABSTRACT

INTRODUCTION: We aimed to present the changes that may occur in pulmonary functions in children who experienced more severe coronavirus disease 2019 (COVID-19) during long-term follow-up.

METHODOLOGY: A prospective longitudinal observational cohort study was conducted with 34 pediatric patients (7-18 years) who were hospitalized with COVID-19 infection (moderate n = 25, severe n = 9), and followed up at our Pediatric Infection Outpatient Clinic for approximately two years. Pulmonary function tests (PFTs) were performed using spirometry.

RESULTS: Data from the hospitalization period revealed no significant differences between the severity groups in terms of demographic, clinical, laboratory, radiological, treatment, and outcome (p > 0.05). The median time interval between COVID-19 infection and PFTs was 15 months (range 11-29 months), and there was no significant difference between severity groups (p = 0.878). Eight patients (24%) had abnormal pulmonary functions; among them, seven had an obstructive pattern (21%) and one had a restrictive pattern (3%). The severity groups had no statistical difference in pulmonary functions (p = 0.105). While forced expiratory volume in 1 second (FEV1) %, FEV1/forced vital capacity (FVC)%, and forced expiratory flow during the middle half of FVC (FEF25-75%) ratios were lower in the severe patient group, Z-scores were similar. Among the patients continuing polyclinic follow-up, 41% had persistent respiratory symptoms before PFTs. No differences were observed in PFTs when compared based on the presence of symptoms (p > 0.05).

CONCLUSIONS: We observed no significant long-term differences in pulmonary function between moderate and severe COVID-19 cases in children.

PMID:39863942 | DOI:10.3855/jidc.20123

J Infect Dev Ctries. 2024 Dec 31;18(12.1):S260-S266. doi: 10.3855/jidc.19091.

ABSTRACT

INTRODUCTION: Invasive candidiasis is an important cause of nosocomial infection and recent studies have shown an increase in the number of cases during the coronavirus disease 2019 (COVID-19) pandemic. The present study aimed to evaluate the epidemiology and incidence of invasive candidiasis before and during the COVID-19 pandemic at a reference tertiary hospital in Brazil.

METHODOLOGY: A retrospective observational study was performed with 148 patients infected with Candida spp.

RESULTS: The incidence of invasive candidiasis was 3.43 cases per 1000 admissions in the pre-pandemic period and 4.54 cases per 1000 admissions in the pandemic period, with a particularly high incidence in the intensive care unit. Compared to the pre-pandemic period, patients presented more frequently with immunosuppression (p = 0.01), sepsis (p = 0.03), and need for mechanical ventilation (p = 0.01) during the pandemic. The prevailing type of Candida spp. infection was candidemia, mostly by C. albicans. Invasive candidiasis was associated with high mortality; 52% of the infected patients died from this disease in the pre-pandemic period, while 62% died in the pandemic period. COVID-19, mechanical ventilation, and sepsis were significantly associated with mortality (p = 0.008, p < 0.001, and p < 0.001 respectively).

CONCLUSIONS: A high incidence of Candida infection was observed at a tertiary general hospital in Brazil between 2018 and 2022. An increase in incidence of Candida infection during the COVID-19 pandemic was associated with a greater number of critical patients. Sepsis, mechanical ventilation, and COVID-19 were related to higher mortality in patients with invasive candidiasis.

PMID:39863941 | DOI:10.3855/jidc.19091

J Infect Dev Ctries. 2024 Dec 31;18(12.1):S239-S248. doi: 10.3855/jidc.19218.

ABSTRACT

INTRODUCTION: We assessed the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and associated socio-occupational factors among delivery riders from a Brazilian city at two time points during the pandemic.

METHODOLOGY: Surveys for antibody and viral RNA testing were conducted from November 2020 to January 2021, and from March to May 2021 in a group of 117 delivery riders. A questionnaire on socio-occupational characteristics and coronavirus disease 2019 (COVID-19) preventive measures was completed. Factors associated with prevalence were analyzed using bivariate analyses and multiple logistic regression models.

RESULTS: The overall prevalence of COVID-19 was 15.4% (CI 9.0-23.0). Although not statistically significant, the prevalence was higher in the second phase of the survey (12% (CI 6.0-19.0)) than in the first (5.1% (CI 1.0-10.0)). The seroprevalence was significantly higher (p < 0.05) in the second phase of collection (10.3%) than in the first phase (3.4%). There were no statistically significant associations between the social characteristics assessed in the study and prevalence. Five behavioral variables were selected for the final multiple logistic regression model; and only the variable “cleans hands” had a significant association with the outcome, indicating that those who cleaned their hands had lower occurrence.

CONCLUSIONS: The prevalence among delivery riders was high and they were potentially exposed to risk of infection. Occupational activity and individual prevention behavior were better determinants of infection than social differences. It is necessary to take specific public measures for this group, especially during outbreaks of communicable diseases such as COVID-19.

PMID:39863939 | DOI:10.3855/jidc.19218