key: cord-0953306-cerf7hxi authors: Ahmed, Randa I.; Khalil, Mahmoud A. F.; Mahmoud, Eman E.; Nakhla, Osama L.; Ali, Salah A.; Ahmed, Mona I. title: Comparison of the clinical and radiological manifestations of male patients with COVID‐19 from different ethnicities date: 2021-08-22 journal: Int J Clin Pract DOI: 10.1111/ijcp.14735 sha: a9d4738619da938b3aa9e273515c29641bac327d doc_id: 953306 cord_uid: cerf7hxi AIM: The coronavirus disease 2019 (COVID‐19) outbreak began in Wuhan, China, and quickly escalated into a significant pandemic threat. COVID‐19 is associated with variable morbidity and mortality rates, which differ greatly from one country to another. This study aimed to investigate the clinical findings of SARS‐CoV‐2 infection in different ethnic groups, as well as to identify the radiological manifestations and various biomarkers for the assessment of COVID‐19 patients. MATERIALS AND METHODS: The clinical data of 210 COVID‐19 patients with respiratory disorders, who attended the chest clinic at Mouwasat Hospital, Jubail, in the Eastern area of the Kingdom of Saudi Arabia from April to May 2020, were thoroughly reviewed. The patients were divided into seven groups based on their ethnicities (Saudi, Egyptian, Nepali, Filipino, Pakistani, Bangladeshi and Indian). The differences in the clinical findings, laboratory data and radiological manifestations between these groups were statistically analysed. RESULTS: The study included 210 COVID‐19 patients from seven ethnic groups (Saudi, Egyptian, Nepali, Filipino, Pakistani, Bangladeshi and Indian). Comorbidities were reported among 60.9% of patients, which were significantly higher among Filipinos at 73.3%. Dyspnoea was prevalent in the Saudi and Pakistani groups, while hypoxaemia was prevalent in the Indian group (40%). In terms of laboratory assessment, Bangladesh patients had the highest median of serum ferritin and lactate dehydrogenase (LDH) levels with a significant P value (<.001), while Saudi patients had the highest median of C‐reactive protein (CRP) levels with a significant P value (<.001). According to computed tomography (CT) findings, structural destruction was the most common finding in bilateral parenchymal affection among 88.6% of patients. Filipinos and Bangladeshis had the highest morbidity rates. CONCLUSION: There were great variations in clinical, radiological and even laboratory findings among different ethnic groups of COVID‐19 patients. contaminated surfaces. 1, 2 Clinical manifestations of viral pneumonia are commonly correlated with COVID-19 disease. Fever, fatigue, dry cough and shortness of breath are the most common findings. 2 The World Health Organization (WHO) classifies COVID-19 severity into mild disease, moderate disease (pneumonia), severe disease (severe pneumonia) and critical disease. 3 Variable rates of mortality have been documented from one country to another, ranging from 0.4% to 3.4%. 4 Nucleic acid detection-based techniques are a trustable tool for COVID-19 diagnosis. Chest computed tomography (CT) is a more sensitive but less specific method. However, it is considered one of the main methods used for diagnosis. 5 Regarding disease outcomes, 85% of patients have a good prognosis, while 15% have a poor prognosis as severe and critical cases with ARDS, coagulopathy, multiple organ dysfunction, etc. 6 Close monitoring of disease progression is crucial in the management of COVID-19. Laboratory biomarkers, including D-dimer (DD), lactate dehydrogenase (LDH), procalcitonin (PCT), C-reactive protein (CRP), total leucocytic count (TLC) and its differential count are essential parameters linked with COVID-19 progressions. 7 The current study aimed to characterise the different clinical and radiological findings of COVID-19 among different ethnic groups. Confirmed adult case of COVID-19 with chest symptoms of fever, cough, dyspnoea or atypical presentation. Cases of interstitial lung diseases (ILDs), lung cancer, sarcoidosis, patients on radiation, pneumoconiosis and younger than 14 years. All patients were involved in our study according to demographic information, clinical presentation, history of contact with a positive infected case of COVID-19, past medical history, comorbidities and laboratory investigation in the form of complete blood count (CBC), CRP, LDH, ferritin and PCT. Radiological evaluation is in the form of a chest X-ray and a CT scan of the chest. Detection of SARS-CoV-2 viral RNA was carried out on nasopharyngeal samples. 8 The samples for laboratory tests were collected on admission and during the hospital stay. Laboratory tests included total leukocyte and its differential cell count, in addition to CRP, ferritin, LDH, PCT and D-dimer levels. All tests were performed according to the manufacturer's instructions. Peripheral venous blood was collected for routine blood tests. A complete blood count (CBC) was measured using an automatic haematology analyser (Sysmex XS 500i, Japan). The biochemical parameters such as liver, renal function, ferritin and LDH were measured using the Cobas c 311 automated clinical chemistry analyser (Roche Diagnostics, Mannheim, • COVID-19 has been a global healthcare concern since December 2019 after its detection in Wuhan. • Clinical manifestations of viral pneumonia are commonly correlated with COVID-19 disease. • The mortality rate of COVID-19 differs greatly from one country to another. Chest X-ray in two views was performed for all patients. In addition, multidetector CT scanners (Somatom Sensation 64, Siemens Healthineers) were used for all CT scan chest examinations. The presetting parameters for a thorax routine were identical to those advised by the manufacturer. In all cases, images were reconstructed using the conventional filtered back-projection method with a soft tissue kernel of B20 and a lung kernel of B60 with a 1 mm slice thickness. Coronal and sagittal multiplanar reconstructions were also available in all cases. According to Pan et al, 11 a semi-quantitative CT severity grading was derived for each of the 5 lobes, taking into account the extent of anatomic involvement: (0) indicates no involvement; (1) up to 5% involvement; (2) 5%-25% involvement; (3) 26%-50% involvement; (4) 51%-75% engagement and (5) more than 75% involvement. Statistical analysis was done using the SPSS software package (version 16.0 for Windows; SPSS Inc, Chicago, IL, USA). Data were presented using numbers and per cent for qualitative variables, while the mean, standard deviation (SD) or median and interquartile range (IQR) were for quantitative variables. Comparison of qualitative variables between groups was done using the chi-squared test and the Fisher's exact test. For comparing quantitative variables, Student and ANOVA tests were used. The Kruskal-Wallis and Mann-Whitney tests were used for non-normally distributed variables. A P value of .05 or less was considered to be statistically significant. The specimens were collected from 210 COVID-19 patients. The study involved 7 different ethnic groups, with 30 patients in each group. The mean age of the studied groups was 41.99 ± 9.7 years. The average duration of the illness was 7 days. The majority of patients (64%) presented with a cough, while 6.7% of patients presented with fatigue (Table 1) . Cough and fever in relation to patient ethnicity were highly statistically significant (P = .001 and P < .001, respectively) ( In December 2019, there was a worldwide outbreak of COVID-19, which began in the Chinese city of Wuhan and quickly spread throughout the world. 12 among 25% of non-ICU patients. 13 In addition, many studies have highlighted the correlation of abnormal liver functions with severe COVID-19 disease. [14] [15] [16] [17] [18] In this report, COVID-19 was mainly studied in male patients. This could be attributed to the nature of the kingdom, in which the primary workers are male. This gender predominance is consistent with many previous reports. 7, 13, 19, 20 Also, the reduced level of COVID-19 infection among female patients could be as a result of sex hormones and X chromosomes that contribute to innate and adaptive immunity. 21 The mean age of the patients was about 42 years. This is in accordance with previous reports, which more or less documented comparable age mean. 7, 13, 19 Regarding the duration of illness, patients presented to our chest clinic within 7.38 ± 3.48 days of the illness. Understanding the association between ethnicity and COVID-19 is an essential priority in order to minimise morbidity and mortality. Our findings showed great variations in clinical, radiological and even laboratory findings among different ethnic groups. The current F I G U R E 1 Chest radiograph of Filipino patient. A, Chest X-ray of male Filipino patient showed bilateral middle and lower zones heterogeneous opacities with preserved lung marking as well as several reticulation more on the right side; B, CT scan chest showed bilateral peripherally located patchy areas of ground-glass opacity with thickening of interlobular setae and intralobular septal thickening given the crazy paving pattern, areas of vascular dilation and minimal traction bronchiectasis are also seen F I G U R E 2 Chest radiograph of Pakistanis patient. A, Chest X-ray of Pakistanis patient showed right basal fine reticular changes; while B, CT scan chest showed bilateral lower lobes few small nodules GGO, minimal bronchiolar dilatation noted on the left side report is of clinical and public health significance to provide an overview of disease behaviour among different ethnicities. However, there are some limitations to the current work, involving low numbers of study subjects and the absence of the female gender for proper sex comparison. In addition, the current study did not cover all of the world's ethnicities. The authors declared no conflict of interest. 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