Predictors Associated with In-hospital Mortality among COVID-19 Patients during the Second Wave in a Tertiary Care Hospital, Gujarat, India: A Retrospective Observational Study

Background: Fatalities due to coronavirus disease 2019 (COVID-19) have already crossed to more than 5 million globally so far. Hence, it is crucial for us to identify the risk factors associated with hospital deaths starting from first contact which can help to give timely treatment to the targeted population. Objectives: This retrospective cohort study was conducted to identify various factors related to in-hospital mortality related to COVID-19 in our region. Materials and methods: The present study was a single-center, retrospective cohort study of 675 adult patients, admitted with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection between 1st April and 25th May 2021 in our tertiary care hospital. Baseline demographic profile, comorbidities, clinical characteristics, and investigatory findings were analyzed for increased odds of mortality. Results: A total of 181 (26.8%) patients died and 494 (73.2%) survived. There were 65.4% of males and no difference was found between genders in terms of mortality. Comorbidities associated with in-hospital death in our cohort were age group ?50 years (p<0.001), diabetes (p<0.0007), and renal injury (p<0.0001). More than half of the patients died during the first week of admission. Breathlessness (83%) was the most common symptom in non-survivors. Neutrophil-to-lymphocyte ratio (NLR), S. creatinine, D-dimer, ferritin, and C-reactive protein (CRP) were increased significantly among the patients who died. Multivariate logistic regression revealed age ?50 years [adjusted odds ratio (AOR) 2.30, 95% confidence interval (CI) 1.45–3.64] and oxygen (O2) saturation <94% at the time of admission (AOR 2.62, 95% CI 1.75–3.93) were associated with mortality. Conclusion: Overall in-hospital mortality was 26.8%. Higher age and low O2 saturation were the major risk factors associated with in-hospital mortality.

Characterization of a novel antifungal protein from Acacia senegal seeds

Aim: The aim of the present study was to isolate antifungal protein from seeds of Acacia senegal in order to develop a new, effective and environmental friendly biofungicide.Methodology: Antifungal protein from A. senegal seeds was extracted and purified through ammonium sulphate precipitation, dialysis, ion exchange and gel filtration chromatography. The novel antifungal was characterized employing SDS-PAGE, chitinase activity and antifungal efficacy. The purified protein was also characterized through MALDI-TOF MS/MS. Results: The yield of purified antifungal protein was estimated to be 0.96 mg 25 g-1 seeds and its molecular mass determined by SDS PAGE was 52.9 kDa. The purified protein exhibited antifungal activity against phytopathogenic fungi viz., Macrophomina phaseolina and Fusarium oxysporum also possessed chitinase activity. The purified protein was characterized through MALDI-TOF MS/MS and its spectra revealed 14 peptides with their specific amino acid sequences. Interpretation: The antifungal protein isolated from A. senegal seeds has broad-spectrum antifungal activity with chitinase activity against pathogenic fungi that can be exploited for management of fungal disease as biopesticide to promote sustainable agriculture

Preconditioning the human myocardium with intracoronary adenosine.

This study was designed to study the role of adenosine in ischaemic preconditioning. The clinical, electrocardiographic and metabolic parameters of ischaemia were compared before and after intracoronary adenosine during percutaneous transluminal coronary angioplasty in 15 patients with significant stenosis of the left anterior descending artery. Baseline ischaemia was demonstrated by inflating the balloon of appropriate size at its nominal pressure for 30 seconds. Intracoronary adenosine was then administered in dose of 1000 to 6000 mgm/ml. The balloon was repositioned and inflated at nominal pressure for 180 seconds. As compared to 1st balloon inflation, the 2nd balloon inflation produced less severe chest pain, less ST segment deviation on the intracoronary ECG (7.40 +/- 3.94 vs 4.30 +/- 2.15 mm; p < 0.05) and lower coronary sinus lactate levels as compared to the first (0.28 +/- 0.06 vs 0.22 +/- 0.04 mmol/lit; p < 0.05). In conclusion, this study proves that by injecting intracoronary adenosine it is possible to precondition the human myocardium.

Adenosine-induced chest pain: is it due to myocardial ischaemia? Clinical, electrocardiographic, haemodynamic and metabolic study.

Adenosine has recently been demonstrated to be a mediator of angina in human beings. The present study was undertaken to document the presence or absence of myocardial ischaemia on clinical, haemodynamic, electrocardiographic and metabolic evidences after intracoronary administration of adenosine. Fifteen patients with chronic stable angina (12 males and 3 females), positive exercise stress test and documented significant stenosis of the left anterior descending coronary artery (LAD) were included in the study. The surface and intracoronary electrocardiograms (ECGs), pulmonary artery diastolic pressure and coronary sinus lactate levels were monitored at baseline and after intracoronary administration of adenosine in all patients. Adenosine was administered intracoronary in doses of 1000-8000 microgram depending on the provocation of chest pain. Typical angina was observed in all patients. There were no signs of ischaemia on surface or intracoronary ECG. There was no statistically significant difference between the pulmonary artery diastolic pressure and coronary sins lactate levels at baseline and post-adenosine administration (p > 0.05). It is concluded that intracoronary administration of adenosine produces chest pain in patients with chronic stable angina by mechanism other than myocardial ischaemia.

Coronary artery stenting in acute myocardial infarction.

Little information is available on the use of coronary stents to treat suboptimal results during direct angioplasty in acute myocardial infarction (AMI). In this study, we report 16 cases of AMI who underwent stent implantation in infarct-related artery for suboptimal results and their 6 months angiographic follow-up. Immediate angiographic success was achieved in all patients. The minimal luminal diameter increased from 0.06 +/- 0.12 mm to 2.89 +/- 0.12 mm (p < 0.001). One patient died in the hospital on day 8 due to subacute stent thrombosis. No patient required emergency bypass surgery. Two patients required blood transfusion for groin haematoma and one required intracoronary thrombolysis. All patients underwent exercise stress test at 1 month and at 3 months and coronary angiography at 4 months or earlier it indicated. At the end of 6 months follow-up, 4 patients had a positive exercise test and coronary angiography revealed angiographic restenosis in 3 and progression of disease in other vessels in 1 patient. We conclude that stent deployment is a viable option to treat suboptimal results after direct angioplasty in AMI.