Successful Treatment of Diabetic Ketoacidosis in a Patient with Insulin Allergy and Coronavirus Disease 2019: A Case Report

Diabetic ketoacidosis is a frequent hyperglycemic emergency. During the coronavirus disease 2019 pandemic, researchers showed a higher prevalence of diabetic ketoacidosis and mortality compared with the preceding years. It is expected that lung involvement in coronavirus disease 2019 decreases compensation capacity for ketoacidosis. Thus, management of the diabetic keto-acidosis is critical in patients with coronavirus disease 2019. Insulin allergy makes the treatment procedure more complicated in these patients. Desensitization procedures or immunomodulatory therapies are not a routine part of treating diabetic ketoacidosis due to the urgency of the disease. Insulin administration to patients with insulin allergy and coronavirus disease 2019 may cause a risk of decreased maintaining oxygenation and compensating for ketoacidosis and endanger airway safety due to possible anaphylaxis. Clinicians should check all preparations for a possible need for anaphylaxis treatment and difficult airway management, including invasive procedures before insulin therapy. Here, we wanted to share a case of successful treatment of diabetic ketoacidosis in a patient with insulin allergy and coronavirus disease 2019. Copyright © Author(s).

Effect of Routine Thromboprophylaxis with Low Molecular Weight Heparin in Hospitalized COVID-19 Patients: A Retrospective Study

Objective: Current guidelines recommend thromboprophylaxis with low molecular weight heparin (LMWH) in patients with coronavirus disease-2019 (COVID-19). However, there is no current consensus on the routine application of thromboprophylaxis. This study aimed to evaluate the effect of routine application of LMWH on clinical outcomes including mortality and the need for intensive care unit (ICU) admission in hospitalized COVID-19 patients. Material and Methods: All confirmed patients with COVID-19 hospitalized in COVID-19 dedicated wards, from March 15 to May 15, 2020, were included in this retrospective cohort study. Two groups of patients were established, according to the non-routine and routine application of LMWH with therapeutic, weight-based, anticoagulation dosing. Clinical, laboratory and treatment data were collected, analyzed, and compared between the two groups. The initial and extreme values of the laboratory tests were used for analysis. A logistic regression model was developed to assess the factors related to in-hospital adverse outcomes. Results: A total of 1,511 patients (797 men, median age 59.0 years) were retrospectively analyzed [group non-routine LMWH (n=828);group routine LMWH (n=683)]. Multivariate logistic regression analysis showed routine use of LMWH, favipiravir administration, extreme values of white blood cell count, neutrophil lymphocyte ratio, and troponin I as factors independently associated with in-hospital adverse outcomes (odds ratio=0.25, 95% confidence interval: 0.83-0.91;p<0.001 for routine use of LMWH). Conclusion: In hospitalized COVID-19 patients routine treatment with therapeutic LMWH dosage was associated with a 75% decrease in mortality and need for ICU admission compared with the non-routine administration when adjusted for other variables in this study. © 2022, Turkiye Klinikleri. All rights reserved.

No association of anti-osteoporosis drugs with COVID-19-related outcomes in women: a nationwide cohort study.

This study was performed to evaluate whether the use of drugs in the treatment of osteoporosis in women is associated with COVID-19 outcomes. The results showed that the risk of hospitalization, intensive care unit admission, and mortality was not altered in individuals taking anti-osteoporosis drugs, suggesting no safety issues during a COVID-19 infection. INTRODUCTION: Whether patients with COVID-19 receiving anti-osteoporosis drugs have lower risk of worse outcomes has not been reported yet. The aim of this study was to evaluate the association of anti-osteoporosis drug use with COVID-19 outcomes in women. METHODS: Data obtained from a nationwide, multicenter, retrospective cohort of patients diagnosed with COVID-19 from March 11th to May 30th, 2020 was retrieved from the Turkish Ministry of Health Database. Women 50 years or older with confirmed COVID-19 who were receiving anti-osteoporosis drugs were compared with a 1:1 propensity score-matched COVID-19 positive women who were not receiving these drugs. The primary outcomes were hospitalization, ICU (intensive care unit) admission, and mortality. RESULTS: A total of 1997 women on anti-osteoporosis drugs and 1997 control patients were analyzed. In the treatment group, 1787 (89.5%) women were receiving bisphosphonates, 197 (9.9%) denosumab, and 17 (0.9%) teriparatide for the last 12 months. Hospitalization and mortality rates were similar between the treatment and control groups. ICU admission rate was lower in the treatment group (23.0% vs 27.0%, p = 0.013). However, multivariate analysis showed that anti-osteoporosis drug use was not an independent associate of any outcome. Hospitalization, ICU admission, and mortality rates were similar among bisphosphonate, denosumab, or teriparatide users. CONCLUSION: Results of this nationwide study showed that preexisting use of anti-osteoporosis drugs in women did not alter the COVID-19-related risk of hospitalization, ICU admission, and mortality. These results do not suggest discontinuation of these drugs during a COVID-19 infection.

False Positive Computed Tomography Imaging for Coronavirus-2019

A 79-year-old female patient presented to the emergency unit with cough and severe shortness of breath. Due to a bilateral multilobular ground glass density result from thoracic tomography, the patient was admitted to intensive care with the preliminary diagnosis of corona virus-2019 (COVID-19), and a continuous positive airway pressure was applied. A polymerase chain reaction (PCR) test was performed, and treatment with hydroxychloroquine and azithromycin was initiated. At the same time, the patient with an arterial blood pressure of 190/100 mm/hg was administered with diuretic treatment to reduce lung congestion. The follow-up computed tomography of the patient showed rapid recovery, and ground glass appearances had completely resolved. The PCR was negative and the patient was diagnosed with acute lung edema. The treatment was prescribed, and the patient was discharged from the hospital. Thoracic tomography findings are useful in early period for COVID-19 diagnosis;however, it may show similar results as other diseases that cause respiratory failure and lead to misleading interpretations.