Clinical Complications in Patients with SARS-CoV-2 in a Secondary Care Hospital in Tijuana, Mexico

Research Article

J Fam Med. 2022; 9(2): 1288.

Clinical Complications in Patients with SARS-CoV-2 in a Secondary Care Hospital in Tijuana, Mexico

Sanchez-Sanchez SS¹*, Ortiz-Leon R², Alvarez-Franco CA¹, Salazar-Perfecto MA¹, Orduño-Cabrera LA¹ and Acosta-Ovalle P¹

1Department of Family Medicine, Family Medicine Unit #27, IMSS, Baja California, Mexico

2Department of Internal Medicine, General Regional Hospital #1, IMSS, Baja California, Mexico

*Corresponding author: Sanchez-Sanchez Sandra Soledad, Department of Family Medicine, Family Medicine Unit #27, IMSS, Baja California, Mexico

Received: January 05, 2022; Accepted: February 04, 2022; Published: February 11, 2022

Abstract

Background: The SARS-CoV-2 has caused a social, economic and health crisis around the world. Its clinical manifestations present a variety that ranges from the absence of symptoms to the most serious forms of the disease, which require intensive care with high mortality.

Objective: To analyze the clinical complications in patients with SARSCoV- 2 in the regional general hospital #1 of Tijuana, Mexico.

Methods: A review of clinical records of patients with SARS-CoV-2 was carried out at regional general hospital #1 in Tijuana, Mexico, from April 2020 to April 2021. Clinical complications were identified such as Severe Acute Respiratory Syndrome (SARS), acute kidney injury, acute liver failure, heart attack, shock, myocarditis, arrhythmia, pulmonary thromboembolism, cerebrovascular event, delirium, acute meningoencephalitis, seizures, anosmia, dysgeusia, Guillain-Barré syndrome, gastrointestinal bleeding, systemic inflammatory response syndrome, depression, anxiety and confirmed death. Descriptive statistics were used, the qualitative variables were expressed in frequencies and percentages, and the quantitative variables in measures of central tendency and dispersion, the information obtained was analyzed in the statistical program SPSS version 25.

Results: 722 patients were analyzed, of which 59% (n=426) were men and 41% (n=296) were women, with a median of 55 years. The most frequent occupation was employees (51%, n= 369). Of the clinical characteristics, SARS appeared in 72% (n=520), SIRS 71% (n=515), acute kidney injury in 14% (n=100) and death in 50% (n=361) of the cases.

Conclusions: It is important to know all the SARS-CoV-2 complications. Patients who recover from this pathology develop sequelae of different degrees of severity.

Keywords: COVID-19; SARS-CoV-2; Pandemic; Complications

Introduction

On December 31, 2019, the WHO China Office was informed of cases of pneumonia of unknown etiology detected in Wuhan city, Hubei province of China [1]. The number of patients increased rapidly, the Chinese government decided to close the city on January 23, 2020, although the virus had already spread throughout China and around the world. The World Health Organization officially declared the pandemic on March 11, 2020. The virus that causes pneumonia was isolated in December 2019 and was found to be a strain of β-coronavirus [2]. On January 9, 2021, a total of 87,589,206 confirmed cases of patients infected by SARS-CoV-2 were reported worldwide, with a global fatality rate of 2.2%; a total of 38,417,522 confirmed cases were registered in the American continent [3]. In Mexico the number of cases was 1,524,036 [4].

The transmission of SARS-CoV-2 can occur through direct, indirect or close contact with infected people through their respiratory secretions which are expelled when they cough, sneeze, speak or sing [5]. Droplets of respiratory secretions remain suspended in the air and can be moved more than one meter away. Particles and droplets that are <5 μm in diameter have the ability to easily enter the alveolar region [6]. Body secretions and excretions that contain viruses can be aerosolized into infectious droplets or particles in many ways. Respiratory secretions are aerosolized through daily activities and medical procedures [7].

The incubation period is 14 days after exposure, with a median of 4 days. The most common symptoms that appear in this pathology are fever, fatigue, dry cough, anorexia, myalgia, dyspnea and sputum production; the less frequent symptoms are gastrointestinal such as nausea, vomiting and diarrhea [8]. Anosmia/hyposmia has also been present, which could be due to an inflammatory obstruction of the olfactory clefts or postviral anosmia, due to alteration of the olfactory neuroepithelium [9]. The majority of patients infected with SARSCoV- 2 have mild or moderate disease, but approximately 15% have severe disease and 5% have critical illness with complications such as SARS, respiratory failure, septicemia, septic shock, thromboembolism, multiorgan failure, cardiac and renal lesions [10].

The diagnosis of SARS-CoV-2 must be made with an epidemiological study, clinical manifestations and the reverse transcriptase polymerase chain reaction (RT-PCR). RT-PCR is the gold standard; it becomes negative in nasopharyngeal samples from day eight from the onset of symptoms [11]. Another laboratory technique is the detection of IgM/IgG antibodies against the SARSCoV- 2 virus, after 7 days by ELISA or immunochromatographic technique; the sensitivity and specificity of both techniques are different [12]. In the diagnostic imaging, computed tomography (CT) is the most evaluated. The findings in the CT scan of patients with SARS-CoV-2 have divided into typical, atypical or very atypical; the typical findings are multiple peripheral and basal distribution ground glass opacities, vascular thickening, and a cobblestone pattern; the atypical findings are ground glass opacities, parahilar, apical and lymphadenopathies, and the very atypical findings are calcifications, nodular pattern, masses, cavities, pleural thickening and budding tree [13].

In risk factors, higher mortality has been seen in patients older than 60 years, men and patients than with comorbidities [13]. Specifically, cardiovascular disease, high blood pressure, diabetes mellitus, and cancer can predict severe disease [14]. Of the laboratory severity markers, a gradual elevation of neutrophil levels, indicators of inflammation and damage to the myocardial muscle, has been observed as the disease progresses. There is activation of the coagulation, in which thrombin converts fibrinogen to fibrin and is subsequently degraded, generating D-Dimer. Excessive activation of coagulation is related to thrombotic events, tissue damage and worse prognosis [15].

The complications by SARS-CoV-2 can generate sequelae and high mortality rates. It is essential to recognice complications in order to improve therapeutic strategies and limit the damage as much as possible; currently, there are few publications in our region about complications related to SARS-CoV-2, the present study aims to analyze clinical complications in patients with SARS-CoV-2 in the Regional General Hospital #1 of Tijuana, Mexico.

Materials and Methods

Study design and population

A descriptive cross-sectional study was carried out in Tijuana, Mexico between April 2020 to April 2021. The research was developed at the regional general hospital #1 of the Instituto Mexicano del Seguro Social (IMSS), a secondary level hospital. The records of patients hospitalized by SARS-CoV-2 were included. Patients without confirmatory test by PCR and with incomplete records were excluded and patients who had voluntarily discharged were eliminated from the study.

Variables

The Hospital Administration System was accessed to locate only patients who met the inclusion criteria, to collect their age, gender, occupation and any of the following complications: SARS, acute kidney injury, acute liver failure, heart failure, medical condition shock, myocarditis, arrhythmia, pulmonary embolism, cerebrovascular event, delirium, acute meningoencephalitis, seizures, anosmia, dysgeusia, Guillain-Barré syndrome, gastrointestinal bleeding, systemic inflammatory response syndrome, depression, anxiety and confirmed death. The information obtained was attached to the standardized data collection form.

Statistical analysis

Once the information was collected, the analysis was carried out using the SPSS version 25. Descriptive statistics were used; the qualitative variables were expressed as frequencies and percentages, and the quantitative variables as measures of central tendency and dispersion.

Ethics

The study was approved by the Local Committee for Ethics and Health Research number 204, with registration number R-2021- 204-014. The research was conducted under the General Health Law on Health Research, the Declaration of Helsinki and bioethical principles.

Results

A census of patients with SARS-CoV-2 was carried out, obtaining a total of 722 patients, according to our selection criteria. The sample had the following sociodemographic characteristics: Of the 722 patients, 59% (n=426) were men and 41% (n=296) were women, the median age was 55 years. In occupation, 51.1% (n=369) were employees, 23.9% (n=173) were dedicated to the home, 19.3% (n=140) were retired, 3.1% (n=23) were merchants, 0.5% (n=4) students, 1.2% (n=9) unemployed and the remaining 0.5% (n=4) were infants or newborns (Table 1).

Citation:Sanchez-Sanchez SS, Ortiz-Leon R, Alvarez-Franco CA, Salazar-Perfecto MA, Orduño-Cabrera LA and Acosta-Ovalle P. Clinical Complications in Patients with SARS-CoV-2 in a Secondary Care Hospital in Tijuana, Mexico. J Fam Med. 2022; 9(2): 1288.