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Introduction: Some patients with COVID-19 infection develop proteinuria or Acute Kidney Injury, and cases of COVID-19 related Collapsing Glomerulopathy have also been reported. Three published human kidney biopsy studies did not find viral particles in the glomeruli or tubules. This raises the possibility of glomerular and kidney injury induced by the extensive cytokine storm documented early on in the pandemic in hospitalized COVID-19 patients. Mutated forms of Human Angiopoietin-like 4 (protein 8520) were previously shown to reduce proteinuria in rat models of FSGS and diabetic nephropathy (Clement LC, Mace C et al. Nature Medicine 2014). Using different components or innate and adaptive immunity triggered during infection, we developed cytokine cocktails that mimic the COVID-19 cytokine storm, and tested the ability of protein 8520 to reduce glomerular injury in this model. Methods: After baseline urine and blood collections, two groups of BALB/c mice (mean n = 5 mice per group) were injected intravenously with dose 1.8 X of COVID Cocktail D. One hour later, they received 10 μg of His-Tag purified protein 8520 or control human albumin. Overall activity status was documented at 6 and 24 hours. At 24 hours after model induction, blood and urine samples were collected, and the mice euthanized, followed by harvesting of multiple organs including kidneys. Urine albumin was measured by ELISA (Bethyl Labs), and urine and serum creatinine by Mass Spectrometry. Results: Baseline urine albumin to creatinine ratio was similar between the two groups. At 24 hours, urine albumin to creatinine ratio was significantly lower in the 8520 treated compared to control treated group (P < 0.05). Serum creatinine on Day 1 was similar between both groups, and not significantly elevated compared to baseline. Kidney sections were processed for light and electron microscopy, and analysis of these studies is in progress. Conclusions: Treatment with recombinant mutated human Angiopoietin-like 4 reduces albuminuria in a mouse model of the COVID-19 cytokine storm. Further studies will be conducted to establish a potential therapeutic role in viral cytokine storms. No conflict of interest
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Tourism, a booming industry pre-COVID has been devastated by the gradual and world wide spread of corona virus. International tourist arrivals could decline between 58-78% (UNWTO, 2020). Tourism and hospitality sector have emerged as the biggest sufferer from the lockdown, quarantine and border closures due to corona virus. The closed borders and restrictions imposed on air travel by the governments have put the travel and tourism activities on hold. Tourism scenario may appear to be grim at present but the industry is bound to bounce back once the situation begins to normalize. Whenever lockdown would be lifted, safety would be the prime concern of tourists along with the need and desire to seek refuge in the lap of nature for soothing and calming the agitated nerves after enduring months of stress induced by COVID-19 threat. Governments and tourism planners have already started to formulate strategies to resume travel and economic growth. In the wake of COVID-19, this paper is an attempt to draw attention of tourism planners and also to devise strategies to deal with the changing travel preferences post-COVID. © 2021 Publishing India Group. All rights reserved.
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Background: AKI has historically plagued those with ARDS and during the pandemic especially so with large resultant mortality rates. During the past year those centers so equipped offered ECMO to treat severe COVID pneumonia. We compared the non COVID ARDS requiring ECMO with patients with COVID pneumonia requiring ECMO. The aim of the study was to understand the difference in the renal outcomes and its effects of mortality and thereby help in prognostication. Methods: This is a single center retrospective study where patients with COVID pneumonia needing ECMO in between March 2020 to April 2021 were compared with non COVID ARDS patients needing ECMO between April 2013 to April 2021. The 2 groups were compared and risk ratio calculated for the incidence of AKI, the need for Renal replacement therapy (RRT) and the mortality associated with it. Results: After excluding the patients who did not meet the criteria, 26 COVID patients treated with ECMO were compared with 22 patients with non COVID ARDS treated with ECMO. The median age of COVID group was higher (48 years vs 36 years) and the median number of days needing ECMO for the COVID group was higher (13 days vs 31 days). Incidence of AKI and the AKI needing RRT were similar in the 2 groups. The overall mortality in patients with COVID pneumonia was higher. Patients with COVID who developed AKI had 1.32 times the risk of mortality, which increased to 1.62 when RRT was needed. Conclusions: This is a first study comparing the renal outcomes of COVID ARDS requiring ECMO and non COVID ARDS requiring ECMO. Even though the median age and the median number of the days on ECMO were higher for the COVID group, surprisingly the incidence of AKI and those needing RRT were similar. But there was a significantly higher mortality when patients on ECMO developed AKI and even higher for those on RRT. This could be attributed to the cytokine storm seen with causing a multiorgan dysfunction which can manifest in the form of AKI. Presence of AKI needs to be identified early and can be used for the prognostication in COVID pneumonia.
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Importance & Objective: First case of Covid-19 pneumonia was reported in Wuhan and soon it became pandemic.1 Pulmonary tuberculosis (TB) is mainly a disease of tropical and poor countries like India.9 Initially, it wasn’t clear how these two diseases will interact with each other. We tried to determine if TB has any impact on course and prognosis of Covid-19 pneumonia. Design & Setting: In this retrospective analytical study, data of 7774 patients were collected from various state government owned hospitals of India. Chest CT scans were reviewed for present or past stigmata of pulmonary TB, CORADS and CT severity score. Statistical analysis was done for class wise frequency distribution and association of attributes were calculated. Results: 95.01% Patients with Covid- 19 pneumonia didn’t have CT signs of history of active or old healed pulmonary TB, while 4.99% had it. In first group 44.85 % mild, 36.17 % moderate and 13.98 % had severe disease, while in second group figure is 3.39 % 1.21 % and 0.40 % respectively. Probability of TB providing immunity against developing moderate or severe form of Covid-19 pneumonia is 0.6778. Conclusions: Patients with active or past history of TB are less prone to develop moderate or severe form of Covid-19 pneumonia. It may be the reason for less mortality in health resource poor India as compared to Europe or America. © 2021 Journal of Association of Physicians of India. All rights reserved.
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In a country like India, where the major decease are been caused because of the Air pollution, which has affected around 4 million lives because of this pollution only, the cause of the rise in Air pollution is not only from the factories but also the vehicles which use to run on the streets as corona-virus can stay in the air for around 30 minutes, which can cause problems to millions of lives moving on the street, mostly the poor. In India air pollution has rated to almost least in the past 20 years which has contributed to the break from spreading.In India, Delhi and other most populated states stated a drastic downfall in Air pollution with about 60 percent decline in air pollution of PM - 2.5 particularly known as "fine particulate matters" in Delhi when compared with 2019 while the pollution control in other countries couldn't see much change and which has also seen a rise in corona-virus cases.In this paper we have analyzed the impact of rising in the number of the corona-virus cases concerning the most polluted cities to state the actual scenario that is air pollution leads to a rise in a pandemic situation. This paper is primarily based on secondary sources of data collection including the state-wise downfall in the level of air pollution, impact on the environment from the deadly disease i.e. Corona-virus, prospects, impact on the health of the individual. © 2021 Karadeniz Technical University. All rights reserved.
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Today celebrities are not just the entertainers who just entertain the public with the acting and style. But they are the part of the public now, who enjoy public recognition by using social media platforms for interacting with large numbers of followers. For an audience a celebrity can be film actors, sports person or others famous personality of a particular. Social media platforms also show news feeds about celebrities contributing towards the good cause. And celebrities also share their videos or messages on social media platforms, so fans should also follow them and contribute towards the noble cause. Celebrities massages, activities can have the power to impact a large number of people. Followers of a particular celebrity consider them as an opinion leader. This research paper explores the impact of celebrity endorsement in public awareness campaigns (focusing on Covid 19 coronavirus). © 2020. All Rights Reserved.
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With the advancement of new technology changing every day, TV has become an essential part of human life. TV market of India is the third largest market in the world (In terms of revenue), TV industry of India with approx. 800 satellite channels is one of the largest broadcasting industry. Television has immense reach with wider influence on the minds of people across communities, society and everyday life in general. The Indian Government has supported the growth of TV by taking some initiatives like digitalization of cable networks and also by increasing the limit of Foreign Direct Investment (FDI) i.e 74% to 100% in cable and Direct-to-home (DTH) satellite platforms. Public health community and policy makers don't appreciate the importance and power of the media in shaping the health of the general public. As this research paper discusses, however, the media plays a number of roles in educating the public about health issues, media also aware the general public about the health problems and media also has a responsibility to report accurate health and science information to the public. This research paper specifically discusses how the TV news media can place health issues on the national public agenda and can catalyze action at the national and local levels with special focus on COVID - 19. © 2020 All Rights Reserved
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Introduction: Thrombocytopenia is a rare complication of renal replacement therapy with most of the cases reported in intermittent hemodialysis patients. There is limited data regarding the incidence of thrombocytopenia caused by continuous renal replacement therapy (CRRT). We report a case of thrombocytopenia in patient treated with CRRT for severe AKI from COVID-19 sepsis unrelated to heparin. Case Description: A 73-year female with history of type 2 diabetes mellitus was admitted for Coronavirus Disease 2019 (COVID-19) pneumonia. Patient developed acute hypoxic respiratory failure requiring mechanical ventilation despite treatment with hydroxychloroquine, azithromycin and convalescent plasma. Hospital course was complicated by septic shock and acute kidney injury with serum creatinine rising from a baseline of 0.8 mg/dl. Continuous veno-venous hemodialysis (CVVHD) without any anticoagulation was initiated due to severe fluid overload. Significant thrombocytopenia below 50,000/mm3 was noted 2 days after CVVHD treatment. Patient received multiple antibiotics and heparin drip before CVVHD and platelet counts were above 150,000/ mm3. Heparin induced thrombocytopenia (HIT) was ruled out with negative serotonin release assay and platelet counts remain low despite the discontinuation of all potential agents. Disseminated intravascular coagulopathy was excluded based on coagulation tests. Platelet counts finally went up to 160,000/mm3 on subsequent CVVHD holidays and again dropped to 70,000/mm3 after CVVHD was resumed. Discussion: The rate of rise in platelet count more than 150,000/mm3 in 2 days after cessation of CVVHD supports the diagnosis of thrombocytopenia caused by CVVHD. Although the exact mechanisms remain unclear, previous studies suggested that the mechanical destruction of platelets by the hemofilter or allergic reaction to dialyzer membrane as some of the reasons. Some studies have found that severe decline (more than 50%) in platelet count was associated with increased mortality and decreased rate of renal recovery. Thrombocytopenia on CVVHD unrelated to HIT is an under-acknowledged complication. Understanding the multiple etiologies of thrombocytopenia will help prevent the excessive use of blood products, fluid overload state and the potential clotting issue of CVVHD due to transfusion.
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Background: Angiotensin converting enzyme (ACE 2) receptor has been implicated as an entry point for severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) causing pandemic coronavirus disease 2019 (COVID-19). Experts have postulated the potential benefits of using ACEI/ARB to reduce the severity of acute lung injury and as the treatment of hypertension in COVID-19. However, there is limited data in showing the renal outcomes after the use of angiotensin converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) in COVID-19 patients. Methods: This is a retrospective, single center study of 300 patients diagnosed with COVID-19 confirmed by real-time reverse transcription polymerase chain reaction. Four groups were divided based on ACEI/ARB exposure. Group 1 (n=51 patients;17%) were initiated on ACEIs/ARBs during hospitalization, group 2 (n=58 patients;19%) were on ACEIs/ARBS at home and discontinued, group 3 (n=76 patients;25%) were on ACES/ ARBS at home and continued during hospitalization and group 4 (n=116 patients;38%) were never treated with ACEIs/ARBS. The primary end points including the incidence of AKI using KDIGO definition, hyperkalemia, the necessity of dialysis and the secondary end points being the length of total hospital stays, the recovery rate, mortality rate were compared between group 1,2,3 with 4 using adjusted odd ratios (ORs). Results: In group 1, the use of ACEI/ARB has 4 times higher risk of developing AKI than the control group 4 (P= 0.001, 95% CI of 1.70-9.59). and is 4.6 times for stage 2 or above AKI (P= 0.001;95% CI of 1.8-11.5). OR for hyperkalemia is 5.7 (P= 0.001, 95% CI of 2.09-15.5) and for hemodialysis is 3.7 (P= 0.02, 95% CI of 1.2-11.2). Their mortality rate is increased 2.9 times (P=0.026, 95% CI of 1.23-7.44). In group 2, the incidence of AKI is 7.5 times higher (P= <0.001, 95% CI of 3.3-17) and 3.5 times (P=0.001, 95% CI of 1.6-7.7) for stage 2 above AKI. OR for the initiation of hemodialysis and the mortality rate are not statistically significant after adjusted with variables. In group 3, no statistically significant data were found. Conclusions: Our findings suggest that the initiation of ACEI/ARB in COVID 19 patients have increased risk of AKI, hyperkalemia, necessity of dialysis and mortality rate.
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Background: Coronavirus disease 2019 (COVID-19) emerged from China in late 2019 as a respiratory disease of unknown cause. A novel coronavirus 2019-CoV was implicated as the cause. A high proportion of patients goes into septic shock from COVID- 19infection and develop acute kidney injury (AKI) which often requiring continuous renal replacement therapy (CRRT). Clinical experience has suggested that these patients are hypercoagulable with studies showing increased rates of thrombosis. This complicates the administration of CRRT as this leads to more frequent clotting of the dialysis catheter and sequelae of blood loss, time off dialysis, and increased use of resources Methods: We retrospectively audited all patients admitted at our center from February to April 2020 who developed severe AKI requiring CRRT and compared the number of CRRT clotted in the first 7 days in COVID-19 negative (N = 49) and positive (N = 55) patients. Pediatric patients were excluded from this analysis. We also collected data on other variables which may influence rate frequency such as location of catheter, INR, and presence of systemic anticoagulation Results: We found that patients who tested positive for COVID-19 had a higher number of clotting events in the first 7 days of CRRT (3.51 vs 1.63, p < 0.00008). This population had higher incidence of AKI vs ESRD, number of pressor, and PEEP. Also, COVID 19 patients on anticoagulation has decreased clotting frequency compare to COVID 19 positive patients not on anticoagulation (2.7 vs 4.3, P <0.05) Conclusions: This data confirms our clinical experience that coagulopathy in COVID-19 positive patients lead to a greater incidence of CRRT clotting and the use of systemic anticoagulation was effective in reducing the number of clotting events.