BACKGROUND: The COVID-19 is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study aims to describe the clinical characteristics of COVID-19 patients admitted to Hospital Tengku Ampuan Afzan (HTAA), Pahang, Malaysia and to identify the clinical and laboratory markers for severe disease, complications and virologic clearance according to clinical staging.
METHODS: This was a single-centre, retrospective, descriptive study. All COVID-19 patients admitted to HTAA from March 9 to April 15, 2020, were included in the study. Patients were categorised according to clinical staging. Data obtained from the medical report includes baseline characteristics of patients, comorbidities, presenting symptoms, laboratory findings, treatments, complications, and outcomes.
RESULTS: Of the total of 247 patients hospitalised, the majority consisted at clinical-stage 1 (43%) and stage 2 (39%) disease. Older patients, diabetes mellitus, hypertension, cardiovascular diseases, and chronic kidney disease were found more common among patients with severe disease. Fever was uncommon and the majority had normal haemoglobin levels, white cell counts, and platelet counts. C-reactive protein (CRP) was found statistically significant to predict pneumonia or hypoxia at a cut-off value of 14mg/L (sensitivity 73.8%, specificity 91.3%) and 50mg/L (sensitivity 100%, specificity 96.4%) respectively. Pneumonia was mostly diagnosed radiologically using chest radiography, especially among clinical stage 3. Acute kidney injury (AKI) was a significant complication, with 31% of clinical stage 3 and above developed AKI and 44% of them requiring haemodialysis. Median virologic clearance time was 15 days from onset of illness, and asymptomatic patients had longer clearance time.
CONCLUSION: COVID-19 presented with a wide spectrum of clinical patterns. CRP was a valuable predictor of severe disease. In this study risk and severity of acute kidney injury were found to be higher. A longer duration of virologic clearance was observed among the asymptomatic patients.
On March 17, 2003 the Kelantan Health Department was notihed about a possible typhoid outbreak following a wedding party. An investigation was carried out to identiy the source and recommend control measures. Active case detection, yield investigation and case»control study were conducted. Cases were symptomatic attendees with a stool or blood culture positive for Salmonella
typhii. Each control had a negative culture and denied symptoms. Of the more than 1 OOO guests, 477 experienced fever; 152 met the case definition. The party hostess was found to be an Salmonelb typhii carrier. Syrup prepared with untreated well water was identified as the most likely source for this outbreak, with an odds ratio 14.0 (95% C1: 2.9, 104.1). This was a common source
outbreak of typhoid. We recommend that all food handlers at large parties be screened for typhoid and other foodborne diseases and samples of higherisk foods should be kept for few days after each event in case they are needed for testing.