Electrolyte abnormalities in hospitalized COVID-19 patients at tertiary referral centers in Tehran: Hypermagnesemia as a marker of fatality: A retrospective cross-sectional study.

Background and Aims: To evaluate biochemical abnormalities and their association with the outcome of hospitalized coronavirus disease 2019 (COVID-19) patients at a tertiary referral center in Iran. Methods: This retrospective study was conducted on COVID-19 patients who were admitted at tertiary referral centers in Tehran, Iran, from March 2021 to 2022. Demographic and biochemical laboratory data of the patients including blood sodium, potassium, calcium, and magnesium were collected from patient treatment sheets of severe COVID-19 patients admitted to a different ward of the hospital. A logistic regression model was fitted to identify the associated parameters with mortality. Results: Four hundred and ninety-nine patients with COVID-19, including 287 males (57.5%), who had a mean age of 58.95 ± 16.60 years, were enrolled. Thirty-eight patients (7.62%) died during hospitalization. The factors we found to be independently associated with an increased risk of in-hospital death were having comorbidity (mortality of 94.7%, vs. 61% among those without comorbidity; odds ratio, 17.71; 95% confidence interval [CI], 3.81-82.37), hypermagnesemia (34.2%, vs. 26.2% among those with normal magnesium; odds ratio, 9.71; 95% CI, 2.958-31.91), and having a male gender (34.2%, vs. 26.2% among those were female; odds ratio, 9.71; 95% CI, 2.958-31.91). Conclusions: Hypermagnesemia, having a male gender, and the existence of comorbidity in patients with COVID-19 is associated with an increase in mortality. Further studies on the pathogenic mechanisms and therapeutic implications need to be done.

The effectiveness of gabapentin and gabapentin/montelukast combination compared with dextromethorphan in the improvement of COVID-19- related cough: A randomized, controlled clinical trial.

INTRODUCTION: Cough is one of the most common presenting symptoms of COVID-19, which can persist for weeks or months. OBJECTIVE: The goal of this study was to evaluate the effectiveness of gabapentin (GBT) alone and in combination with montelukast (MTL) for improving cough. METHODS: In this open-label randomized controlled clinical trial, eligible cases were patients hospitalized with moderate to severe COVID-19 who had cough with a Breathlessness, Cough, and Sputum Scale (BCSS) score of at least 2 based on its cough subscale. The participants were randomly assigned to three groups including two experimental groups and one control group. The first and second experimental groups received GBT and GBT/MTL, respectively, whereas the control group received dextromethorphan (DXM). Treatment duration was 5 days in all groups. Before and after the interventions, the severity of cough was evaluated using BCSS scale and Visual Analog Scale (VAS). RESULTS: A total of 180 patients were included; GPT, GPT/MTL, and DXM consisted of 76, 51, and 53 patients, respectively. There was no significant difference between the three groups in terms of age, gender, and comorbidities (P > 0.05). Regarding BCSS and VAS scores, there was significant reduction from the baseline values in all groups (P < 0.0001), with the change rate being significantly higher in DXM group. The amount of reduction of BCSS in the GPT/MTL group was significantly more than the GPT group, whereas there was no significant difference between the two groups regarding VAS score. Although the duration of hospitalization differed between the groups with the GPT/MTL group having the shortest duration, the difference was statistically significant only between the GPT and GPT/MTL groups (P < 0.0001). CONCLUSION: GPT, both alone and in combination with MTL, improves cough frequency and severity in hospitalized patients with COVID-19, with the combination being more efficacious. This regimen may be useful in patients who cannot tolerate opioids.

Co-infection of Klebsiella pneumonia, Cytomegalovirus, Aspergillus and Zygomycete in a patient with SARS-CoV-2.

Co-infection between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other pathogens has become a serious threat. There are the reports of fungal, bacterial, and viral co-infections with SARS-CoV-2. We report the unusual case of concomitant aspergillosis, mucormycosis, cytomegalovirus pneumonia, and also klebsiella pneumoniae empyema as the complication of SARS-CoV-2.

Hematologic malignancies and COVID‐19 infection: A monocenter retrospective study

IntroductionHematologic malignancies are risk factors for severe COVID‐19 infection. Identification of risk factors correlated with mortality in these groups of patients is important in the assessment strategy. We studied the characteristics of patients with hematologic malignancies and COVID‐19 and then analyzed the predictors of mortality.MethodsEligible for the analysis were hospitalized patients with hematologic malignancies and confirmed COVID‐19 infection observed between January 2020 and March 2021. Patients were categorized based on the type of malignancy and phase of the treatment.ResultsA total of 194 COVID‐19 infected patients with hematologic malignancies were included. The median age was 44 (15–81) years;135 of them were males and 59 were females. Acute myeloid leukemia was the most frequent cancer type (43.8%). A total of 119 patients had severe COVID‐19 and 61 patients were admitted to the intensive care unit. A total of 92 deaths occurred in all cases for an overall case‐fatality rate of 47%. Male gender, preinduction and induction phase of the treatment, intensive care admission, low levels of oxygen saturation, Rhesus (RH) factor positivity, and higher fibrinogen level correlated with mortality.ConclusionThis study focuses on the epidemiology, risk factors, outcomes, and predictors of mortality of COVID‐19 among patients with hematologic malignancies. Patients with hematologic malignancies are at high risk of mortality.

Hematologic malignancies and COVID-19 infection: A monocenter retrospective study.

Introduction: Hematologic malignancies are risk factors for severe COVID-19 infection. Identification of risk factors correlated with mortality in these groups of patients is important in the assessment strategy. We studied the characteristics of patients with hematologic malignancies and COVID-19 and then analyzed the predictors of mortality. Methods: Eligible for the analysis were hospitalized patients with hematologic malignancies and confirmed COVID-19 infection observed between January 2020 and March 2021. Patients were categorized based on the type of malignancy and phase of the treatment. Results: A total of 194 COVID-19 infected patients with hematologic malignancies were included. The median age was 44 (15-81) years; 135 of them were males and 59 were females. Acute myeloid leukemia was the most frequent cancer type (43.8%). A total of 119 patients had severe COVID-19 and 61 patients were admitted to the intensive care unit. A total of 92 deaths occurred in all cases for an overall case-fatality rate of 47%. Male gender, preinduction and induction phase of the treatment, intensive care admission, low levels of oxygen saturation, Rhesus (RH) factor positivity, and higher fibrinogen level correlated with mortality. Conclusion: This study focuses on the epidemiology, risk factors, outcomes, and predictors of mortality of COVID-19 among patients with hematologic malignancies. Patients with hematologic malignancies are at high risk of mortality.

COVID-19 and Acute Pancreatitis: A Case Report

Coronavirus disease-2019 (COVID-19) became a serious public health problem and caused a rapid pandemic. Fever, dry cough, and dyspnea are the most common symptoms of COVID-19. In addition to the respiratory symptoms, gastrointestinal manifestations of COVID-19 are also increasingly recognized. Herein, the authors present a patient with COVID-19 complicated with acute pancreatitis.

Coinfection by Aspergillus and Mucoraceae Species in Two Cases of Acute Rhinosinusitis as a Complication of COVID-19.

Acute invasive fungal rhinosinusitis (AIFR) is a life-threatening infection often found in immunocompromised patients. In the COVID-19 era, reports of AIFR have emerged, with high mortality and morbidity rate. This paper presents two cases of COVID-19 associated AIFR with the combined proven fungal etiology of Aspergillus flavus and Rhizopus arrhizus in case 1 and Aspergillus fumigatus and Rhizopus arrhizus in case 2. Both patients received liposomal amphotericin B then posaconazole combined with aggressive surgical debridement of necrotic tissues with a favorable clinical outcome. Mixed etiology AIFR can influence the outcome; hence, further studies are required upon this new threat.

Crimean-Congo hemorrhagic fever in the COVID-19 pandemic: A case study.

In the COVID-19 pandemic, the overlap of clinical features between other viral infections makes a reliable diagnosis difficult in the initial stage of illness. We describe a confirmed case of CCHF in Tehran Province during this year, who was first misdiagnosed as COVID-19 infection.

An extremely rare mucocutaneous adverse reaction following COVID-19 vaccination: Toxic epidermal necrolysis.

Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN), is a type of delayed hypersensitivity reaction that requires urgent medical intervention. In the COVID-19 era, COVID-19 vaccines are currently being widely administered and mucocutaneous adverse reactions following vaccination have been reported; however, severe cutaneous adverse reactions associated with COVID-19 vaccines including SJS/TEN, are extremely rare. Herein, we describe a case of COVID-19 vaccination induced TEN which developed 1 day after receiving the first dose of Sinopharm COVID-19 vaccine with favorable clinical outcome.

Mixed etiology COVID-19 associated acute rhinosinusitis caused by two Aspergillus species.

INTRODUCTION: Acute invasive fungal rhino-sinusitis (AIFR) is a life-threatening infection that is mostly found in immunocompromised patients with serious morbidity and mortality. Recently, reports of AIFR have also emerged among SARS-CoV-2 infected patients. CASE PRESENTATION: A 50-year-old diabetic woman, previously diagnosed with COVID-19 pneumonia, was presented to the hospital with left facial pain on day 12 after discharge. Paranasal sinuses computed tomography was performed and according to the mucosal thickening in both maxillary sinuses and ethmoidal air cells, the patient underwent functional endoscopic sinus surgery (FESS) and necrosis were observed. The histopathologic examination revealed mycelium with septation suspected to Aspergillus and the culture was consistent with Aspergillus flavus and also Aspergillus niger . We reported a case of COVID-19 associated AIFR with two combined Aspergillus species from Iran. The patient received liposomal amphotericin B, which then switched to voriconazole combined with aggressive surgical debridement of necrotic tissues with a clinically favorable outcome. CONCLUSION: Mixed etiology AIFR can influence the outcome. However, further investigation is required upon this new threat.

COVID-19 reinfection or reactivation in a renal transplant patient.

Recurrences of COVID-19 infection may occur in immunocompromised patients. Reinfection or reactivation of COVID-19 virus is a challenging issue in these patients.

COVID-19 and immunocompromised conditions: Ongoing challenging issue

One of the most serious complications of COVID-19 is the development of uncontrolled production of cytokines that poses a major factor contributing to COVID-19 morbidity and mortality. The exact effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on clinical and biochemical course of in patients with underlying immune compromised conditions is not well known with recent available data. The present letter aimed to draw attention to COVID-19 in immune deficiency. [ABSTRACT FROM AUTHOR] Copyright of European Journal of Inflammation (Sage Publications, Ltd.) is the property of Sage Publications, Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Relationship between CT Severity Score and Capillary Blood Oxygen Saturation in Patients with COVID-19 Infection.

Background: COVID-19 pneumonia is responsible for the latest pandemic. Usage of pulmonary computed tomography (CT) scan is known to be an important method in the diagnosis of COVID-19. Here, we aimed to evaluate the relationship between CT severity score and capillary blood oxygen saturation in patients with COVID-19 infection. Methods and material: This is a cross-sectional study performed in 2020 on patients with COVID-19 infection. All patients underwent pulmonary CT scan and CT severity score was calculated. The initial capillary oxygen saturation by the time of admission was also collected. Data were collected and analyzed. Results: A total number of 270 patients diagnosed with COVID-19 infection entered the study. The initial mean capillary oxygen saturation was 89.65 ± 8.09%. The mean score in patients was 15.16 ± 8.08. We also indicated that 27 patients had hypoxia by the time of admission and these patients had significantly higher CT severity scores (p = 0.001). Diabetes mellitus (p = 0.001), hypertension (p = 0.001), and chronic obstructive pulmonary disease (COPD) (p = 0.03) and totally having an underlying disease (p < 0.001) were significantly associated with decreased capillary oxygen saturation. Patients with hypertension (p = 0.001) and patients with the previous medical disease (p = 0.01) had significantly higher CT severity scores than others. There was a significant reverse relationship between CT severity score and capillary oxygen saturation (r = -0.44, p < 0.001). Conclusions: We showed that there was a significant reverse relationship between CT severity score and capillary oxygen saturation which has great clinical importance. Furthermore, we indicated that previous medical history could also play an important role in CT severity score. How to cite this article: Aalinezhad M, Alikhani F, Akbari P, Haji Rezaei M, Soleimani S, Hakamifard A. Relationship between CT Severity Score and Capillary Blood Oxygen Saturation in Patients with COVID-19 Infection. Indian J Crit Care Med 2021;25(3):279-283.

Fatal invasive pulmonary aspergillosis in an immunocompetent patient with COVID-19 due to Aspergillus terreus: A case study.

Case reports of CAPA emerged. In most of the reports, the predominant species is Aspergillus fumigatus. Uncommon species are less reported. Due to poor clinical outcome with Aspergillus terreus, the increasing reports with this agent require attention.

Fatal disseminated aspergillosis in an immunocompetent patient with COVID-19 due to Aspergillus ochraceus.

Aspergillus infection is a well-known complication of severe influenza and severe acute respiratory syndrome coronavirus (SARS-CoV), and these infections have been related with significant morbidity and mortality even when appropriately diagnosed and treated. Recent studies have indicated that SARS-CoV-2 might increase the risk of invasive pulmonary aspergillosis (IPA). Here, we report the first case of Aspergillus ochraceus in a SARS-CoV-2 positive immunocompetent patient, which is complicated by pulmonary and brain infections. Proven IPA is supported by the positive Galactomannan test, culture-positive, and histopathological evidence. The patient did not respond to voriconazole, and liposomal amphotericin B was added to his anti-fungal regimen. Further studies are needed to evaluate the prevalence of IPA in immunocompetent patients infected with SARS-CoV-2. Consequently, testing for the incidence of Aspergillus species in lower respiratory secretions and Galactomannan test of COVID-19 patients with appropriate therapy and targeted anti-fungal therapy based on the primary clinical suspicion of IPA are highly recommended.

Acute Mesenteric Ischemia in a Patient with COVID-19: A Case Report.

The severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) presents clinical manifestations similar to the influenza, severe acute respiratory syndrome (SARS-CoV), and Middle East respiratory syndrome (MERS-CoV). However, in the course of the coronavirus disease 2019 (COVID-19), various pathological complications of high clinical significance have remained unknown. Impaired blood supply to the visceral vascular system can cause serious life-threatening acute damage. We report a case of extensive acute mesenteric ischemia associated with SARS-CoV-2 infection confirmed in a patient hospitalized in Amin Hospital - a COVID-19 referral center in Isfahan University of Medical Sciences, Isfahan, Iran. This case highlights the importance of paying attention to serious and less common or less known clinical manifestations other than fever, dry cough, dyspnea, and myalgia.