Association of gynecomastia and fatty liver and epicardial fat in COVID-19 patients (preprint)

Objectives: We aimed to determine the association between gynecomastia, hepatic steatosis through liver density and epicardial fat thickness in CT-scans of COVID-19 patients. Methods and Materials: In this descriptive-analytical cross-sectional study, Gynecomastia, fatty liver and epicardial fat were measured using CT-scan. The collected data were analyzed using Graphpad Prism 9 software. A significance level of less than 0.05 was considered. Results: Among 341 men hospitalized with COVID-19 infection, 35 (10%) were admitted to intensive care unit (ICU) and 62 (18%) died. The prevalence of gynecomastia and fatty liver was 35% and 20% respectively. Patients' age had a direct positive correlation with mortality (r=0.21, P<0.001) and epicardial fat (r=0.28, P<0.001). Bilateral gynecomastia was not associated with mortality or ICU admission, the prevalence of fatty liver, and the amount of epicardial and retro-areolar fat. However, right-sided gynecomastia was associated with the prevalence of fatty liver (r=0.11 and P=0.05) and left-sided gynecomastia was associated with epicardial fat (r=0.14 and P=0.01). In this study, the prevalence of fatty liver was positively correlated to the amount of epicardial fat (r = 0.12, P = 0.02) and retro-areolar fat (r = 0.34, P < 0.001). Conclusion: Bilateral gynecomastia was not associated with mortality or ICU admission, prevalence of fatty liver, and epicardial and retro-areolar fat volume. But right-sided gynecomastia was associated with the prevalence of fatty liver and left sided gynecomastia was associated with epicardial fat. The amount of retro-areolar fat was recognized as a risk factor for the death of patients.

Diabetic ketoacidosis and Covid-19 management in a term pregnant patient; A case report (preprint)

Background: Covid-19 can have remarkable effects on pregnancy, and pregnant women with this infection are at higher risk for developing ketoacidosis. In this case report, we report a 35-year-old pregnant woman infected with Covid-19 with early manifestations of ketoacidosis during term pregnancy.

COVID-19 in a case of Toxic Epidermal Necrolysis (preprint)

The COVID-19 pandemic is a major health issue and patients with underlying conditions are more susceptible to catastrophic outcomes. Toxic epidermal necrolysis (TEN) is a severe systemic disease caused by immune system hypersensitive reaction. We present a case of TEN that later complicated with COVID-19,Deep Vein Thrombosis(DVT),Pulmonary Emboli(PE),and death.

Frequency of COVID-19 in patients with myocardial infarction treated with primary percutaneous coronary intervention (preprint)

Introduction: COVID-19 is a disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) There are some evidences that myocardial injury may play a role in increasing mortality in patients with COVID-19. In this study, we investigated the prevalence of COVID-19 in patients with myocardial infarction treated with primary percutaneous coronary intervention (PCI) and demographic and clinical indicators of patients with this complication for a six months period.Methods: This cross-sectional study was retrospective and descriptive and all patients with acute myocardial infarction under primary PCI including 85 patients were included in the study. Measured parameters included COVID-19, age, sex, ethnicity, diabetes, and hypertension. Data were analyzed by SPSS.v25 software.Results: 14 patients with MI under primary PCI (16.5%) had COVID-19. COVID-19 was diagnosed by RT-PCR for 2 patients and by lung CT scan of the remaining 12. Background Diabetes and Hypertension were present in 21.4% (n = 3) and 7.1% (n = 1) of COVID-19 patients, respectively. Recurrence of MI occurred in 14.3% (2 cases) of patients with COVID-19. The death occurred in only one case of COVID-19 patients, a 70-year-old Persian woman with diabetes and hypertension. There was no significant difference between age and sex, ethnicity, underlying diabetes, and underlying hypertension between COVID-19 and non-COVID-19 groups.Conclusion: The prevalence of COVID-19 is significant in MI patients undergoing primary PCI. Further studies are recommended to investigate the role and mechanism of demographic and contextual variables on the severity and consequences of primary PCI in MI patients with COVID-19.

Altered Transcript Levels of Cytokines in COVID-19 Patients (preprint)

The pandemic caused by severe acute respiratory syndrome coronavirus 2 and the related disorder i.e. “coronavirus disease 2019” (COVID-19) have encouraged researchers to unravel the molecular mechanism of disease severity. Several lines of evidence support the impact of "cytokine storm" in the pathogenesis of severe forms of the disorder. We aimed to assess the expression levels of nine cytokine coding in COVID-19 patients admitted in a hospital. Expression levels of IFN-G, IL-2, IL-4, IL-6, IL-17, TGF-B, IL-8 and IL-1B were significantly higher in COVID-19 patients compared with healthy controls and in both female and male patients compared with sex-matched controls. However, expression of none of these cytokines was different between ICU-admitted patients and other patients except for IL-6 whose expression was lower in the former group compared with the latter (ratio of means = 0.33, P value = 4.82E-02). Expression of TNF-A was not different between COVID-19 patients and healthy controls. Then, we assessed diagnostic power of cytokine coding genes in differentiating between COVID-19 patients and controls. The area under curve (AUC) values range from 0.94 for IFN-G to 1.0 for IL-2 and IL-1B. After combining the transcript levels of all cytokines, AUC, sensitivity and specificity values reached 1.0, 1.0 and 0.99, respectively. For differentiation between ICU-admitted patients and other patients, IL-4 with AUC value of 0.68, had the best diagnostic power among cytokine coding genes. Expression of none of cytokine coding genes was correlated with the assessed clinical/demographic data including age, gender, ICU admission, or CRP/ESR levels. Our study provides further evidence for contribution of “cytokine storm” in the pathobiology of moderate/severe forms of COVID-19.

Transverse myelitis in COVID-19 patients: Report of two cases (preprint)

Background: COVID-19 has been associated with several neurological complications. One of these complications is transverse myelitis. Several cases of acute transverse myelitis are reported in association with this disease among the world. As there is lack of knowledge about the association of COVID-19 and myelitis and the clinical features of this complication are still ambiguous, we report two patients with transverse myelitis following COVID-19 infection.  Patients: This study was performed in a referral center of COVID-19 in Iran(Shohada Tajrish hospital) and two patients with paraparesis and diagnosis of transverse myelitis were enrolled. Both patients had longitudinally extensive transverse myelitis that resulted in paraparesis. One of the patients had favorable outcome after treatment with plasma exchange but the other had no improvement following treatment.Conclusion: Transverse myelitis could be a complication of COVID-19 and infarction and inflammation could be suggested as probable mechanisms for this condition.