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Background and aims: The coronavirus disease 19 (COVID-19) pandemic has spread rapidly around the globe with considerable morbidity and mortality. Coexistence of comorbidities with COVID-19 have consistently been reported as risk factors for unfavorable prognosis. We aim at this study to evaluate the impact of comorbidities in COVID-19 patients on the outcome and determine predictors of prolonged hospital stay, requisite for ICU admission or decease. Methods: Four hundreds and thirty nine adult patients who are admitted through (June and July 2020) in Assiut and Aswan University Hospitals were included in the study. All participants were diagnosed with COVID-19 according to Egyptian Ministry of Health guidance as definite case or Probable case. Detection of SARS-CoV-2 RNA was done by (TaqMan 2019-nCoV Control Kit v1 (Cat. No. A47532) supplied by QIAGEN, Germany on the Applied Biosystem 7500 Fast RT PCR System, USA. Results: Patients with comorbidities represented 61.7% of all cases. Constitutional symptoms especially myalgia and LRT symptoms such as dyspnea were significantly higher in patients with comorbidities (P < 0.05). Patients with comorbidities had significantly worse laboratory parameters. ICU admission was higher in patients with comorbidities (35.8%). Among different comorbidities 45.4% of CVD cases were admitted in ICU followed by DM cases (40.8%). Also, patients with comorbidities needed invasive mechanical ventilation more than those without comorbidity (31 vs. 10.7%, P<0.001). Significant lower frequency of recovery was found in COVID-19 patients with comorbidities (59% vs. 81%, P<0.001) and death rate was significantly higher in cases with comorbidities (P< 0.001). The survival rates in cases with pre-existing CVD and neurological diseases were lower than those without disease (P<0.002 and 0.001 respectively). Conclusion: Association of cardiovascular comorbid conditions including hypertension or neurological diseases together with COVID-19 infections carries higher risks of mortality. However, other comorbidities such as diabetes mellitus, chronic pulmonary or kidney diseases may also contribute to increased COVID-19 severity.

ObjectiveTo determine the incidence, risk factors, and impact on outcome of prolonged empirical antifungal treatment in ICU patients.MethodsRetrospective observational study performed during a one-year period. Patients who stayed in the ICU >48 h, and received empirical antifungal treatment were included. Patients with confirmed invasive fungal disease were excluded. Prolonged antifungal treatment was defined as percentage of days in the ICU with antifungals > median percentage in the whole cohort of patients.ResultsAmong the 560 patients hospitalized for >48 h, 153 (27%) patients received empirical antifungal treatment and were included in this study. Fluconazole was the most frequently used antifungal (46% of study patients). Median length of ICU stay was 19 days (IQR 8, 34), median duration of antifungal treatment was 8 days (IQR 3, 16), and median percentage of days in the ICU with antifungals was 48% (IQR 25, 80). Seventy-seven patients (50%) received prolonged empirical antifungal treatment. Chemotherapy (OR [95% CI] 2.6 [1.07-6.69], p = 0.034), and suspected infection at ICU admission (3.1 [1.05-9.48], p = 0.041) were independently associated with prolonged empirical antifungal treatment.Duration of mechanical ventilation and ICU stay were significantly shorter in patients with prolonged empirical antifungal treatment compared with those with no prolonged empirical antifungal treatment. However, ICU mortality was similar in the two groups (46 versus 52%, p = 0.62).ConclusionEmpirical antifungal treatment was prescribed in a large proportion of study patients. Chemotherapy, and suspicion of infection at ICU admission are independently associated with prolonged empirical antifungal treatment.

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The susceptibility of patients to certain pathologies, such as tuberculosis (TB), is associated to the phenotype of their haptoglobin (Hp). The objective of this study was to investigate the prognostic value of the haptoglobin phenotype in tuberculosis by determining the association of Hp phenotypes with certain epidemiological and clinical characteristics of tuberculosis in Côte d'Ivoire. In a case-control study, 131 tuberculosis and 109 non-tuberculosis as controls, voluntary blood donors were recruited in Abidjan. From venous blood samples, phenotyping of Hp was performed by polyacrylamide gel electrophoresis according to Raymond's method. Comparisons were made using chi2 test at risk α = 5%. We found three phenotypes: Hp1-1, Hp2-1, Hp2-2 in the respective proportions of 27.5%, 50.5% and 22 % in the control population (n = 109) and 36.6%, 54.2% and 9.2% in the tuberculosis population (n = 131). Among the population carrying the Hp1 allele, 58.3% were tuberculosis patients compared to 41.7% in controls subject (p = 0.006). Among TB patients, 33.3% carried Hp2-2 subtype compared to 66.7% in controls (p = 0.011). The Hardy-Weinberg’s equilibrium showed that tuberculosis patients carring Hp2-2 phenotype died early. Hp phenotype was not associated to TB-HIV co-infection, neither to TB treatment nor to response to anti-tuberculosis treatment. We concluded that there is an association between Hp phenotype and TB infection prognosis. Hp2-2, less antioxidant seemed to be associated to the disease with poor prognosis.

The creatinine clearance and urinary pH changes were studied in 12 male dogs in whom the ureters were unilaterally obstructed for periods ranging from 2 days to 27 weeks. The obstruction was then released and the recovery was studied. Using the contralateral kidney as control, significant drop in the creatinine clearance was observed to be consistently associated with failure to produce acidic urine. The obstructed kidneys with urinary pH above 7.00 had significant reduction in creatinine clearance when compared with obstructed kidneys with urinary pH 7.00 or less (p less than 0.005). The marked drop in the creatinine clearance and rise in urinary pH was observed to occur in kidneys obstructed for more than 3 weeks. With obstruction for shorter periods, the ability to produce acidic urine is preserved and the recovery potential is good.

Objectives To investigate the digital literacy of staff in London, UK, community pharmacies and to explore their perceptions about the use of eHealth tools. Methods The study population was community pharmacy staff (N = 21,346) in Greater London. A survey tool was divided into six sections: Use of the internet; Use of social media; Use of mobile health applications (MHAs); Perception of and practical use of digital health tools; Scenario-based questions and demographics. Responses were analysed in SPSS. Following data collection, Health Education England’s (HEE’s) Digital Capabilities Framework (DCF) was published. The authors mapped the survey tool retrospectively to the framework. Key findings Almost all respondents (98.0%, n = 551/562) used eHealth tools at work, mainly to access medicine information (89.8%, n = 495/551). Almost one-third (31.7%, N = 178/562) used social media regularly, while many (79.4%, N = 446/562) were aware of MHAs. Self-perceived digital literacy indicated that 63.3% (n = 356/562) deemed themselves to be above average. Under 35s rated their digital literacy more highly than over 35s (P &lt; 0.001). HEE’s DCF indicated that actual digital literacy was lower than that of self-perceived. Despite the high use of eHealth tools, respondents were reluctant to recommend these to the public for health advice. Conclusions Community pharmacy staff self-report their digital literacy to be high yet do not use these skills for public health purposes. Furthermore, these self-reported skills appear to be over-estimated. Despite high levels of use of digital tools at work, staff do not use them for public health, therefore, further training to build confidence to better utilise them is recommended.