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Background: Laboratory parameters play a key role in triaging, predicting disease course, severity and may determine prognosis COVID-19 patients. Material and methods: Aim and Objectives: To study the relation of clinical and laboratory parameters (total WBC count, neutrophil: lymphocyte ratio, serum ferritin, serum D-dimer, serum LDH, CRP, ESR) with severity and outcome of Corona Virus Disease (COVID-19) confirmed by real-time RT-PCR. Sample size: It was a time-bound study conducted over 3 months (1st April to 30th June, 2020). A total of 206 patients will be included in this study satisfying the inclusion criteria. Study design: This was a prospective, observational and non-interventional study conducted on patients with laboratory-confirmed COVID-19 admitted in a tertiary care teaching hospital. Statistical Analysis: Data will be analyzed for mean, percentage, standard deviation, and chi-square test for quantitative data by using appropriate statistical tests using INSTAT software version 8.0 (trial version) and p-value < 0.05 will be considered statistically significant. Results: Total of 206 patients of both genders were included in the present study. Total 141 (68.44%) patients were males and 65 (31.55%) patients were females (Chi Sq. 56.07;DF:1;p < 0.001). Among all the groups according to the severity of illness, 'D' group was the most common group (n = 99;45.06%). Age > 60 years (17.48%), obesity (13.11%), hypertension (10.19%), COPD (5.83%), and diabetes mellitus (5.83%) were the most frequent risk factors or comorbidities associated with COVID-19 disease. Many patients had multiple risk factors in the present study. The majority (3/4th) of the patients were in C and D group (moderate) with co-morbidities and about 1/4th were in the severe group. Total 5 (2.43%) patients with COVID-19 patients succumbed to death with an overall case fatality rate of 2.43%. The case fatality rate was significantly higher among the patients with risk factors or comorbidities (p = 0.0124). Late presentation, associated comorbidity, advancing age, High level of ferritin, D-dimer, CRP, PaO2/FiO(2) ratio less than 100 at the time of admission were associated with mortality. The terminal event in patients who have succumbed was bradycardia followed by cardiorespiratory arrest. The cause of death was ARDS with bilateral extensive pneumonia. Conclusions: Late presentation, associated comorbidity like diabetes mellitus, advancing age, High level of ferritin, D-dimer, CRP, PaO2/FiO(2) ratio less than 100 at the time of admission were associated with mortality. The terminal event in patients who have succumbed was bradycardia followed by cardiorespiratory arrest. The cause of death was ARDS with bilateral extensive pneumonia.
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Background: Data on the persistence of COVID-19 antibodies against SARSCoV-2 in maintenance hemodialysis (MHD) patients from the U.S. is still scarce and an association with race and ethnicity is unknown. We explore antibody dynamics in MHD patients from three U.S. states with a diverse racial and ethnic background. Methods: We obtained consent from MHD patients with COVID-19, confirmed by RT-PCR, from 12 clinics. Phase 1 antibody testing was done between June and August 2020. Re-testing was done 6-8 months later. Antibodies were tested with an emergency use authorized assay (Diazyme DZ-LITE SARS-CoV-2 IgG CLIA kit). Linear mixedeffects models were employed to estimate the IgG half-life in patients with repeated IgG measurements. Patients were stratified by sex, race, ethnicity, obesity, and medians of age, dialysis vintage and body mass index. Results: 104 patients (age 63.8±13 years, 67 (64.4%) males;48 (46.2%) Africa-American, and 34 (32.7%) Hispanics) were studied. IgG was obtained 82 days (range 13 to 151) and 253 days (range 170 to 309) post-COVID-19. At initial testing, 101 (97.1%) patients were positive for IgG. 89 of them were available for repeated testing, where 74 (83.1%) showed persistent IgG. The luminescence signal was declined by 35.5 AU/ mL (95% CI 28.7 to 42.4) from 47.8 ± 44.9 to 12.3 ± 21.1 AU/mL (P<0.0001;paired t-test;Figure.1). The estimated half-life of IgG was 62.8 days (95% CI 56.8 to 68.8). We observed no significant differences in the stratified analysis (Table 1;all p > 0.05). Conclusions: The half-life of IgG against SARS-CoV-2 was approximately 63 days, corroborating reports from both the general and other MHD populations. Importantly, we found no association between IgG half-life, race and ethnicity.
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The pandemic of coronavirus started in December 2019 is a great challenge for mankind. Even though the mortality rate is less but still the virus has successively managed to cause this catastrophe. Many theories of the virus emergence have come forward but still the exact origin of the virus is unknown. This disease possesses serious concern as the appearance of the symptoms is different;mild to severe ARDS (Acute respiratory distress syndrome), also the strain circulating in different areas are showing different severity. It is very important to understand the host-pathogen interaction for the complete understanding of the disease. Along with the environmental factors, host genetic factors also play to accomplish disease severity. The main aim of this review is to understand various factors such as host immune response, host genes, age and factors which can change the pathogenesis of the virus from individual to individual. It might be able to address several ways to tackle the virus in different individuals.
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Amid rise in Covid-19 cases throughout the world including India. So study was initiated to find out the impact on different domains of health. A self-administered questionnaire was prepared, which consist of questions per-taining to the change in physical and mental health along with the quality of life during the lockdown period and was distributed through Google forms. During the survey, a total of 663 responses were collected, of which 604 responses were analyzed. Out of responses that were calculated, the physical health of 370 participants (61.30%) was improved, physical health of 111 (-18.40%) participants has deteriorated and the remaining 123 (20.30%) participants barely changed. The mental health of 274 (-45.30%) participants was declined, 201 (33.20 %) respondents tried to maintain a healthy mental state while 129 (29.30%) members maintained a peaceful state of mind. The quality of life of 290(48%) was adversely affected, 218 (36%) participants were able to maintain a healthier lifestyle, and their quality of life increased, while 96 (15.8%) remained unchanged. Quality of life is most negatively ham-pered whereas there is improved physical health status in the adult popula-tion. All the 3 components are Physical and Mental health along with Quality of life was affected due to Covid-19 related lockdown but out of these, physical health was 61.3% positively affected while mental health and QOL were deteriorated by 45% and 48% respectively.
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Objective: The COVID-19 pandemic has brought many challenges to pediatrics including diabetes care. In our district general pediatric unit during COVID-19 we have experienced ten new type 1 diabetes with 50% presenting in severe diabetic ketoacidosis (DKA). 40% of all DKAs were complicated with hypokalemia and 70% with acute kidney injury. Due to the severity of the presentations and frequency of complications, a dynamic education program was introduced to improve DKA management and patient outcomes. Methods: A DKA education week was introduced which was organized and implemented by the clinical registrar team. The week consisted of didactic consultant teaching on the DKA guideline, registrar led multi-disciplinary team (MDT) simulation sessions of a severe DKA in ED and cerebral edema developing in the ward setting, including nursing staff and general pediatric consultants. This was complimented with a practical skills session for prescribing in DKA, a focused session on the important aspects for reviewing a child with DKA and a journal club session on the evidence behind the DKA guideline. Reiterating the MDT approach, there was a specific teaching session for nurses. Remote teaching was incorporated for all sessions, via ZOOM, to ensure maximal impact. Results: 94% of the junior team participated in at least one aspect of the teaching program, feedback rated it as 5/5 for useful content. 100% of DKA management adhered to the DKA guideline following the education week with a significant improvement in junior trainee efficiency and competences. Individual peer feedback demonstrated improved confidence with prescribing and reviewing patients in particular for the junior members of the medical team. Conclusion: It is crucial that education in diabetes is reactive and dynamic to adapt to the challenges from COVID-19. Themed MDT education weeks in response to emerging trends is important for patient care and it can be junior led by an engaged registrar team.
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Background: In addition to an aggressive pneumonia, patients hospitalized with COVID-19 have marked inflammatory and hypercoagulable states, with downstream cardiovascular and thrombotic events. Hemodialysis patients have baseline increases in inflammation and hypercoagulability. However, to our knowledge, little is known about the level of inflammation and hypercoagulability among non-hospitalized in-center hemodialysis patients with COVID-19. We collected inflammatory and coagulation markers among hemodialysis patients with COVID-19 who were managed as outpatients. Methods: Patients in our dialysis program with one positive nasopharyngeal swab PCR for SARS-CoV-2 were consecutively admitted to an outpatient COVID-19 hemodialysis shift. While receiving their usual dialysis prescription, the patients also had weekly measurements of D-Dimer, Fibrinogen, C-reactive protein (CRP), and Serum Ferritin, until they tested negative x 2 for SARS-CoV-2. Results: 16 consecutive patients were admitted to the COVID-19 isolation shift over 30 days. Their average age was 60 yr, 56% were Black, 25% Hispanic, and 44% female. Causes of ESKD included diabetes (75%), glomerular diseases (19%), and hypertension (6%). No patients received intravenous iron supplementation while on the isolation shift. Table 1 displays the inflammatory marker levels in this group. Note, the 4-fold (D-Dimer), 6-fold (Ferritin) and 21-fold (CRP) increase in these biomarkers from normal levels. Conclusions: Our initial, unique data show an increase in inflammatory markers in a cohort of non-hospitalized COVID-19 hemodialysis patients. Such an increase may be from the pro-inflammatory impact of COVID-19 in a group with pre-existing high levels of inflammation from uremia and oxidative stress. Additional investigation as to whether these elevated markers associate with cardiovascular and thrombotic events (dialysis circuit and vascular access clotting, sudden cardiac death) is needed.