الفهرس 
REVIEW OF LITERATUREOnly 14 pages are availabe for public view
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Abstract
SUMMARY
Corona virus (COVID-19) a viral outbreak was reported in Wuhan, Hubei Province, China since December 2019 (Holshue et al., 2020), when clusters of pneumonia cases of unknown etiology were reported there (Hawryluck et al., 2004). Within few weeks, the number of cases has continued to increase dramatically not just within Wuhan but spread also to other regions of China (Chen Wang et al., 2020), and on the 11th of March; due to the rapid spread of the infection across the world, the WHO declared the COVID-19 to be a pandemic where the number of affected countries reached 114 country (Roy et al., 2020).
The COVID-19 infection is so far considered the largest outbreak of atypical pneumonia since the severe acute respiratory syndrome (SARS) outbreak in 2003. It is highly contagious affecting a large number of populations where the total number of cases and deaths since its beginning surpassed those of SARS or any of its ancestors (Cuiyan Wang et al., 2020).
Evidence provided from published studies showed that human-to-human transmission occurs from symptomatic people to others who are in close contact through virus-laden respiratory droplets, direct contact with infected persons, or by contact with contaminated objects and surfaces (Ong et al., 2020).
Based on data from the first cases in Wuhan and investigations conducted by the China CDC and local CDCs, the incubation time could be generally within 3 to 7 days (median 5.1 days, similar to SARS) and up to 2 weeks as the longest time from infection to symptoms was 12.5 days (95% CI, 9.2 to 18) (Lauer et al., 2020).
Previous studies have shown that patients with COVID-19 present with fever, dry cough, dyspnea, fatigue and lymphopenia. covid-19 is more likely to infect elderly adult men; and those with chronic comorbidities are at higher risk of severe acute respiratory syndrome and even death in severe patients (Zhang et al., 2020; Huang et al., 2020).
Global spread included Egypt, and the first case was recorded in Egypt on February 14, 2020. The total number of confirmed cases on May 1, 2020, was 5895, with case fatality rate of 6.9%. Children were affected like other age groups, but total incidence was less than 10%. Confirmed cases among health care workers were 11% of the total confirmed cases (Mostafa et al., 2020).
This rapid tendency towards increase can cause anxiety and fear to the general population. Thus the main aim of this work is to study morbidity and estimate various parameters of management and outcomes in an inclusive sample of COVID19 cases admitted to isolation department in El-Dakhla hospital. And to evaluate the independent risk factors associated with mortality of patients with COVID-19.
This observational cross-sectional study enrolled 106 Patients who entered the isolation Department or intensive care unit with Clinical, radiological and laboratory manifestations of Corona Virus Disease.
The study period was one year after obtaining the approval from the medical ethical committee of faculty of medicine Ain Shams University.
Patients were being excluded if they were less than 18 years old. An official permission was obtained from El-Dakhla General Hospital.
An oral informed consent was obtained from all the study participant after explaining the aims of the study and they were subjected to:
I. Completed full history taking
II. Clinical examination
III. Investigations:
• Laboratory investigations (Complete blood picture (CBC), Oxygen saturation, D-dimer, CRP)
• Radiological investigations (CT chest and CXR)
IV. Management protocol for COVID 19 According to Ministry Of Health Of Egypt:
• We collected the Outcome data of cases which improved and controlled by the management protocol and who deteriorated and moved to the intensive care unit.
Data collected, coded, entered, and analyzed using Microsoft Excel software. Data were then imported into statistical package for the social sciences (Statistical Package for the Social Sciences) software for analysis version 28.
In this observational descriptive study,the mean age of died patients were 63.85 ± 12.3 years old but the mean age of improved patients was 49.3±14.12 years old where mortality was associated with getting older.
Mortality was associated with not being vaccinated (vaccination was a protective factor against mortality), with no patient in the died group having been vaccinated compared to 54.8% in the improved group.
There were no severe chest CT findings among vaccinated patients and only one vaccinated patient entered the ICU. However, 50 (98%) of vaccinated patients were treated in the chest department. Also the mean hospital stay duration among vaccinated patients (mean 10.76 ± 3.61 days) was lower than that of unvaccinated patients (mean 16.55 ± 8.08 days). So, significantly, vaccination was associated with decreased the severity of chest affection, admission in ICU, and duration of admission.
Our findings also revealed that mortality was related to the severity of chest affection by CT, as severe patchy consolidation represented 84.6% and 3.2% among the died and improved groups and increased the risk of mortality by 126.5 folds, but mild patchy consolidation represented 0% and 22.6% among died and improved groups and was linked to a lower mortality risk (COR=0).
All died patients (100%) were admitted to the ICU but only five patients improved in the ICU with a percentage (5.4%) of all improved cases. And admission duration was significantly higher in patients who died (mean 23.54 days versus 12.4 days among the died and improved groups, respectively).
The current study also found that bad values of pulse, temperature, respiratory rate, and oxygen saturation on room air and on O2 therapy were associated with mortality.
According to laboratory data of the studied cases, it was found that bad values of CRP, white blood cells, absolute lymphocytes, and D dimer were associated with mortality.
By using binary backward regression analysis of factors significantly related to mortality, lower duration of admission, and not being admitted to ICU decreased the risk of mortality among the studied patients yet statistically non-significant (p>0.05) while higher CRP on admission increased risk by 1.186 folds.
CONCLUSION
The study established the clinical and laboratory characteristics of 106 community-infected COVID-19 patients, from the results we can conclude that age, vaccination state, severity of chest CT affection, ICU admission and duration, vital data (Pulse, Temperature, Respiratory rate, O2 saturation on room air, O2 saturation on O2 therapy), laboratory data (CRP, WBCs, Absolute lymphocytes and D dimer) are important factors to assess the prognosis and severity of COVID-19 infection.
RECOMMENDATIONS
1. Strategies such as minimizing the source of infection, the route of transmission and taking care of infected patients remain as the main challenges for health authorities in all countries in controlling the COVID-19 pandemic.
2. More future studies are needed to find out more correlations between COVID-19 severity and mortality with diagnostic and management characteristics.
3. General population should be urgently vaccinated to reduce the disease severity and mortality.