ABSTRACT
Background/Aims: Neutrophil-to-lymphocyte ratio (NLR) is a proven marker in coronavirus disease 2019 (COVID-19) severity and mortality. However, the utility of a sequential NLR 2 (on day 5) in comparison to baseline NLR in predicting clinical outcomes and severity remains largely unexplored. Methods: This was a hospital-based retrospective observational study. Results: Higher mortality (19.9% vs. 48%) and a more severe disease (14.8% vs. 21%) were observed with elevated NLR 1 and NLR 2, respectively. NLR 2 at a cutoff of 9.88 was a better predictor of mortality, when compared to NLR 1 at 5.67, and NLR 2 has a strong correlation with mortality rates in COVID-19. Conclusion: Our study demonstrated that NLR 1 and NLR 2 were more reliable predictors of mortality than disease severity;in comparison, NLR 2 is a more accurate predictor of mortality than NLR 1. The study unravels the potential role of a sequential NLR 2, to have a better correlation in predicting the clinical severity and outcomes. The potential role of NLR 2 in assessing the interim progression of the disease and thereby initiating specific interventions at critical junctures to influence the outcome is unveiled and merits exploration in detail by larger studies. © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
ABSTRACT
African Americans (AAs) with high-risk APOL1 alleles are at an increased risk of developing early onset focal segmental glomerulosclerosis (FSGS) and rapid progression of chronic kidney disease. In some cases, severe COVID-19 pneumonia is associated with kidney injury known as COVID-19-Associated Nephropathy, the exact mechanisms of which are unclear. A 25-year-old AA female presented with mild respiratory symptoms and positive for SARS-CoV-2 and was admitted to Emergency in March 2020. Her serum creatinine (sCr) was 1.4 mg/dL, albumin 2.92 g/dL;she recovered clinically and was discharged. She returned to hospital 25 days later with severe kidney failure, sCr of 28 mg/dL, potassium of 5.6 mmol/L and urine protein/creatinine (uPCR) of 10355 mg/g. She was initiated on hemodialysis. Kidney biopsy showed CG with acute tubular necrosis with direct invasion of the glomerular cells by particles resembling coronavirus. Hemodialysis was discontinued and she was discharged home on oral prednisone at 1mg/kg/day. After 5 months, she was tapered off of prednisone and her sCr improved to 2.6 mg/dL with uPCR of 3133 mg/g. Genetic testing with Renasight, a 382 renal gene panel was performed, yielding homozygosity for the APOL1 risk allele (c.[1024A>G;1152T>G] (p. [Ser342Gly;Ile384Met]) (G1 allele). High-risk APOL1 risk variants occur in 13% of AAs.These individuals have an estimated 4% lifetime risk for incurring FSGS. However, a ‘2nd hit' is necessary for kidney disease to develop. COVID-19 may lead to kidney injury due to tissue ischemia, cytokine storm, hypercoagulability or direct viral-mediated mechanisms. In COVID-19 related kidney biopsies, CG is often described. Although glucocorticoid sensitivity in such patients is not well-defined, our patient showed response to oral prednisone. This case adds to growing evidence that SARS-CoV-2 infection contributes to CG. The dual effect of high-risk APOL1 variants and SARS-CoV-2 in effecting CG remains to be elucidated. Testing with a broad renal genetic panel could help define genetic variants that promote complications from SARS-CoV-2 infection.
ABSTRACT
Aims and Objectives: The advent of the novel coronavirus disease-2019 (COVID-19) pandemic has sparked a global crisis. Cumulatively, the modifications in patient care and financial restraints are leading to heightened levels of anxiety amongst dentists, making it imperative to comprehend the psychological health implications of the dental professionals. This study aimed to evaluate the psychological impact of the COVID-19 pandemic among Indian Dentists through an online web-based survey.Materials and Methods: The present randomized survey was designed to evaluate the anxiety levels. A total sample size of 405 was calculated. The questionnaire included demographic information and all the variables linked to probable cause of stress during clinical practices and the future prospects of the profession. The questions had to be responded on a scale of 1-10. The responses were statistically analyzed by subjecting the responses to descriptive analysis, Student's t test, and Pearson's chi-square tests.Results: A total of 405 responses were received. The levels of anxiety reported were high. Majority of the dentists were troubled by the thought of being in a high-risk profession and of transmitting the disease to others. Almost all questions were responded with a score of >5 on a scale of 1-10 depicting heightened anxiety levels. The fear levels were noted to be elevated in patients aged more than 35 years.Conclusion: Long-term unrecognized anxiety can predispose to significant psychiatric morbidity and fatigue. Identifying and acknowledging adverse factors in a crisis situation will facilitate early intervention to reduce and mitigate the impact of stress. © 2020 Journal of International Oral Health. Published by Wolters Kluwer . Medknow.