Risk factors for Hyponatremia in COVID-19 hospitalised patients.

Objectives: To determine the risk factors for Hyponatremia in Coronavirus disease 2019 (COVID-19) patients. Methods: Medical records of all patients admitted in COVID-19 Isolation Intensive Care Unit of Farooq Hospital Westwood Branch, Lahore from 1st July to 30th September, 2020 were retrospectively reviewed. Patients with confirmed diagnosis of COVID-19 by Real Time Polymerase Chain Reaction (RT-PCR) and having Hyponatremia (serum Sodium (s/Na+ <135mEq/L) were included, patients with Eunatremia (s/Na+ within 135 - 145mEq/L) were taken as control while subjects with Hypernatremia (s/Na+ >145mEq/L) at admission, incomplete medical records and pregnant females were excluded from the study. Demographic, clinical and laboratory data at time of admission in hospital was extracted. Results: Of 182 included patients, 79.1% (n=144) were male 40.7% (n=74) had Diabetes Mellitus (DM) and 44.5% (n=81) were hypertensive. Forty seven percent (n=86) patients had Hyponatremia while 52.7% (n=96) were eunatremic. Forty nine percent (n=90) patients had Acute Kidney Injury (AKI) and 4.9% (n=9) patients died. Risk factors for Hyponatremia were age >60 years (OR=2.52, p=0.006); DM (OR=2.79, p=0.001); Hypoxemia (OR=3.74, p<0.001); Lymphopenia (OR=7.62, p<0.009); Hypoalbuminemia (OR=9.15, p<0.001); high serum Ferritin (OR=4.46, p<0.001), high Neutrophil to Lymphocyte Ratio (NLR) (OR=3.58, p<0.001) and AKI (OR=3.40, p<0.001). Conclusions: Hyponatremia was common in COVID-19 hospitalized patients. Increasing age, DM, Hypoxemia, Hypoalbuminemia, high serum Ferritin and AKI were the most significant risk factors for Hyponatremia. Hyponatremic patients had comparatively higher mortality than Eunatremic patients.

Association of Chest Xray (CXR) findings with outcomes in COVID-19 Patients.

Objective: To investigate chest radiography findings in suspected coronavirus disease-2019 patients in a tertiary care setting. METHODS: The retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised data of coronavirus disease-2019 cases admitted to the tertiary care centre from March 1 to March 30, 2020. A predesigned proforma was used to gather data, including demographics, like age and gender, co-morbidities, presenting symptoms and chest radiography findings during the admission. Length of stay and mortality were the outcome measures. Data was analysed using SPSS 22. RESULTS: Of the 154 suspected cases, 46(29.8%) tested positive for coronavirus disease-2019; 29(63%) males and 17(37%) females with a mean age of 50.7±19.1 years. Abnormal chest radiography was noted in 25(54.3%) cases, with bilateral pulmonary infiltrates being the most common finding 19(41.3%). Mortality was the outcome in 7(28%) of these cases, and the mean length of hospital stay was 9.3±7.3 days. Abnormal chest radiography findings were associated with an increased risk of mortality (p=0.009) and a longer hospital stay (p=0.017). Conclusion: Abnormal chest radiography findings were frequently seen in coronavirus disease-2019 patients and were also associated with increased risk of mortality and prolonged hospital stay.

Frequency and Risk Factors for Acute Kidney Injury in patients with COVID-19

Objective: To determine the frequency of Acute Kidney Injury (AKI) and its underlying risk factors in patients with Coronavirus Disease (COVID-19). Methods: This retrospective study was conducted by reviewing the medical records of patients admitted in Covid-19 Intensive Care Unit (ICU) of Farooq Hospital, West Wood Branch, Lahore during the period from 1st April, 2020 to 30th June, 2020. COVID-19 was diagnosed on basis of Real Time Polymerase Chain Reaction (RT-PCR) through nasal swab. Demographic, clinical and laboratory data were collected at the time of admission in the hospital. AKI was diagnosed on basis of ≥ 0.3 mg/dl increase in serum Creatinine (sCr) from baseline during the hospital stay. The outcome of study was AKI. Results: One hundred and seventy-six patients who fulfilled the inclusion criteria were recruited of which most were males (78.4%). The mean age was 51.26 ± 15.20 years and the frequency of AKI was 51.1%. The risk factors for AKI were increasing age (OR=2.10, p=0.017);presence of COVID-19 symptoms (OR=6.62, p=0.004);prolonged hospital stay (OR=2.26, p=0.011);Diabetes Mellitus (OR=1.81, p=0.057);hypoxemia (OR=5.98, p=0.000);leukocytosis (OR=2.91, p=0.002);lymphopenia (OR=5.77, p=0.000);hypoalbuminemia (OR=4.94, p=0.000);elevated C-reactive protein (CRP) (OR=6.20, p=0.000) and raised D-diamers (OR=3.16, p=0.000). Conclusions: AKI was present in half of the COVID-19 patients. The most significant risk factors for AKI were increasing age, prolonged hospital stay, hypoxemia, hypoalbuminemia, DM and raised inflammatory markers.

Novel coronavirus disease 2019 and its impact on pregnancy and neonates. (COVID-19 Supplement.)

The global spread of coronavirus disease 19 (COVID-19), resulting from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a serious public health emergency, especially for susceptible individuals and communities, including health care workers, patients with chronic infections, and pregnant females. Generally, pregnant females are more vulnerable to respiratory infections. Primary literature on the relationship between COVID-19 and pregnancy was collected from the PubMed, NCBI, and Google Scholar databases and a Google web search. The relevant articles, including a few articles related to severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1) and Middle East Respiratory Syndrome (MERS), were carefully reviewed and included in this comprehensive report. The comparison of SARS, MERS, and COVID-19 showed that maternal mortality and neonatal complications were more frequent in SARS and MERS than in COVID-19. The delivery outcomes of COVID-19-infected mothers were found to be better than those of mothers infected with SARS or MERS. No study has reported the presence of SARS-CoV-2 in amniotic fluid, placenta tissue, umbilical cord blood, gastric juice, or the mother's milk. Only one case report exists of a neonate being born with COVID-19 from an infected mother. The current clinical research data indicate that COVID-19 has low adverse effects on pregnancy and fetal health. No study supports vertical transmission of the virus from mother to fetus. Delivery via caesarean section has been found to be significantly safer than vaginal delivery. It is necessary to investigate congenital diseases in neonates at a large scale, and it is important to collect data from pregnant females and fetuses to ensure the health and safety of mothers and neonates.