Electrocardiographic Manifestations in COVID-19 Patients — An Observational Study from a Tertiary Care Centre in North Eastern India

Introduction : The Coronavirus disease 2019 (COVID-19) primarily involves respiratory system but may also affect the Cardiovascular System leading to abnormal ECGs. Its early recognition is crucial as it may be associated with increased mortality. Hence we aimed to find out various Electrocardiographic (ECG) manifestations of COVID19 patients admitted in a Tertiary Care Hospital and its relation to disease severity. Methods : We performed a hospital-based retrospective observational study between April, 2021 to November 2021 and analyzed the ECG changes at admission by three Cardiologists according to standard definitions and diagnostic criteria. Results : Out of 579 patients, ECG of 473 was available for analysis. ECG was normal in 227 (48%) and abnormal in 246 (52%) patients. Most common abnormal ECG finding in COVID19 patients was Sinus Tachycardia(19.5%) and less common findings were Sinus Bradycardia (5.3%), Incomplete Right Bundle Branch Block (RBBB) (3.2%), atrial fibrillation (2.5%), complete RBBB (2.3%), atrial premature complexes (2.3%), S1Q1T3 pattern (2.1%), first degree AV block (1.5%), ST-T wave changes (1.3%), Atrial flutter (1.1%). In mechanically ventilated patients, incidence of acute Right Ventricular Pressure Overload (RVPO) related ECG findings were more frequent. Conclusion : There is a wide spectrum of ECG manifestations in COVID-19 patients which varies depending upon the severity of COVID as well as prior Cardiovascular status, associated comorbidities and need for ventilatory support. Knowledge of ECG changes might help in risk stratification and triaging of COVID-19 patients.

Association between Clinical Malaria and Blood Lipids in North Eastern India.

Background: Changes in lipid profile are seen in many patients infected with malaria parasite. The malaria parasite causes hepatocellular damage and disturbs lipid handling by the liver. Inside hepatocytes and erythrocytes the parasite replicates rapidly scavenging cholesterol and lipids required for its growth and metabolism from the host. It also requires host lipids for detoxification of free heme to form the malarial pigment, haemozoin. The important question is whether these changes are characteristic for malaria infection or are they simply part of an acute phase reaction? This study analyzes the correlation between malaria infection and derangements in lipid profiles. Materials and Methods: This study comprised of 29 confirmed malaria cases, and 29 subjects in apparent good health, without the infection were included as control cases. Malaria cases were confirmed using rapid antibody-based diagnostic card tests that detect histidine-rich protein 2 (HRP2) or lactate dehydrogenase antigens in finger-prick blood samples followed by microscopic confirmation of malaria parasite. A 12 -hour fasting lipid profile was estimated by enzymatic method on day 2. Data obtained were statistically analyzed using Student’s t Test, assuming p<0.05 as significant. All issues related to ethics were taken care of during the whole course of study. Results: As compared with control subjects, patients with malaria showed low HDL (16.48±6.490 mg/dL versus 41.38±15.110 mg/dL), low LDL (70.45±22.720 mg/dL versus 104.46±27.353 mg/dL), low cholesterol (103.52±35.331 mg/dL versus 169.45±34.040 mg/dL) and elevated triglycerides (214.24±109.365 mg/dL versus 131.15±30.813 mg/dL). The observations show a statistically significant difference in HDL, LDL, cholesterol and triglycerides between malaria patients and control subjects (p<0.05). Conclusion: These results show a characteristic pattern of derangements of lipid profile in malaria. Further studies are required to understand the diagnostic, prognostic and therapeutic implications of these derangements.