The impact of a prolonged lockdown and utilization of diabetes telemedicine on cardiometabolic health in people with diabetes during the COVID-19 outbreak in Saudi Arabia.

OBJECTIVE: To mitigate the spread of COVID-19, Saudi Arabia implemented a nationwide lockdown that lasted for approximately five months. Due to the limited availability of telemedicine in Saudi Arabia, many people with diabetes (PWD) lost access to diabetes care services during the lockdown period. Here, we examined the impact of lockdown on cardiometabolic health in PWD and how this may have differed between those who utilized diabetes telemedicine during lockdown versus those who did not. METHODS: Hemoglobin A1C (A1C), body weight, lipid, and other cardiometabolic parameters were retrospectively reviewed in 384 PWD who attended routine clinic visits in the pre-lockdown (September 2019 to March 2020) and post-lockdown (Aug to Dec 2020) periods. Changes in cardiometabolic parameters from pre- to post-lockdown were compared across 3 groups according to the type of visit that they had during lockdown (April to July 2020): "no visit" (n = 215), "in-person" visit (n = 44), or "virtual" visit (n = 125). The virtual visits in our institution followed a simplified protocol that utilized technological tools readily available to most PWD and clinicians. RESULTS: PWD who attended "virtual" visits during lockdown were the youngest and most likely to have type 1 diabetes; followed by those who attended "in-person" visits and those who had "no visit". A significant reduction in A1C from pre- to post-lockdown periods was noted in PWD who attended a "virtual visit" (9.02 to 8.27%, respectively, p < 0.01) and those who attended an "in-person" visit (9.18 to 8.43%, respectively, p < 0.05) but not in those who had "no visit" (8.75 to 8.57%, p > 0.05). No significant changes were noted in serum glucose, blood pressure, or lipid parameters during the lockdown in any of the groups. CONCLUSION: Simplified telemedicine visits, including real-time audio calls, were as effective as in-person visits in improving glycemic control in PWD during the lockdown period in a country where telemedicine infrastructure was not well-established. Older adults and those with type 2 diabetes were less likely to utilize telemedicine; suggesting a potential risk of digital divide that warrants greater attention in the future.

SARS-2 COVID-19-induced immunity response, a new prognostic marker for the pregnant population correlates inversely with neonatal Apgar score.

BACKGROUND: The COVID-19 infection has impacted pregnancy outcomes; however, few studies have assessed the association between haematological parameters and virus-related pregnancy and neonatal outcomes. We hypothesised differences in routine haematology indices in pregnant and non-pregnant COVID-19 patients as well as COVID-19-negative pregnant subjects and observed neonatal outcomes in all pregnant populations. Further, we tested if pattern identification in the COVID-19 pregnant population would facilitate prediction of neonates with a poor Apgar score. METHODS: We tested our hypothesis in 327 patients (111 COVID-19-positive pregnant females, 169 COVID-19-negative pregnant females and 47 COVID-19-positive non-pregnant females) in whom standard routine laboratory indices were collected on admission. RESULTS: Pregnant COVID-19-positive patients exhibited higher WBC, neutrophil, monocyte counts as well as neutrophil/lymphocyte and neutrophil/eosinophil ratio compared to non-pregnant COVID-19-positive patients (p = 0.00001, p = 0.0023, p = 0.00002, p = 0.0402, p = 0.0161, p = 0.0352, respectively). Preterm delivery was more prevalent in COVID-19-positive pregnant patients accompanied with a significantly lower birth weight (2894.37 (± 67.50) g compared with 3194.16 (± 50.61) g, p = 0.02) in COVID-19-negative pregnant patients. The COVID-19-Induced Immunity Response (CIIR) was defined as (WBC × neutrophil) / eosinophil; Apgar scores were significantly and inversely correlated with the CIIR index (r =-0.162). INTERPRETATION: Pregnancy appears to give rise to an increased immune response to COVID-19 which appears to protect the mother, however may give rise to complications during labour as well as neonatal concerns. CIIR is a simple metric that predicts neonatal distress to aid clinicians in determining the prognosis of COVID-19 and help provide early intensive intervention to reduce complications.

Study of Morphological Spectrum of Peripheral Blood Smear Changes in Coronavirus Disease 2019 (COVID-19) Positive Patients and its Correlation with Clinical Severity

Introduction: Peripheral blood changes in Coronavirus disease 19(COVID-19) are diverse and have been reported in literature in theform of brief communications and case series with relatively smallersample size and with a handful of studies showing associationbetween peripheral blood smear (PBS) and clinical severity of thedisease.Aims &Objectives: To highlight the numerical and morphologicalchanges in COVID-19 patients and to compare the same in IntensiveCare Unit (ICU) and non-ICU settings as well as between COVID-19survivors and deceased patients.Materials &Methods: This cross-sectional study included 80COVID-19 positive (41 ICU and 39 non-ICU) patients and 32COVID-19 negative ICU patients, done in Department of Pathology,ABVIMS &Dr RML Hospital, New Delhi from December 2020 toFebruary 2021. Complete blood counts (CBC) and PBS findings werestudied and scored by two pathologists blindfoldedly.Result: Among CBC parameters, absolute lymphocyte count (ALC)and absolute eosinophil count (AEC) were significantly lower inCOVID-19 positive cases as compared to COVID-19 negative group(p = 0.001 &p = 0.001). On PBS, COVID-19 positive group showedsignificant left myeloid shift (p = 0.021), Dohle bodies (p = 0.025)with significant prominence of acquired pseudo pelger-huet anomaly,ring shaped neutrophils, monolobulate neutrophils and plasmacytoidlymphocytes as compared to control group (p = 0.000, p = 0.009,p = 0.046 &p = 0.011 resp). The overall mean White blood cell(WBC) counts were higher in COVID-19 positive ICU patients ascompared to non-ICU COVID positive patients with significant shiftto left (p = 0.017). Ring shaped neutrophils, monocyte vacuolationand large granular lymphocyte (LGL) were significantly higher inCOVID-19 positive ICU patients as compared to non-ICU patients(p = 0.007, p = 0.008 &p = 0.004 resp). Deceased group (14/39 ICUCOVID positive cases) showed significantly high WBC count(p = 0.018) with marked neutrophilia (p = 0.024) and toxic granulation (p = 0.01) and prominence of monocyte vacuolization, ringshaped neutrophils, large granular lymphocytes and reactive lymphocytes as compared to survivor.Conclusions: Morphological parameters like myeloid left shift, ringshaped neutrophils, monocyte vacuolation, LGLs and reactive lymphocytes emerged as highly sensitive markers of COVID-19 diseaseseverity. Therefore, serial CBC with comprehensive PBS analysisshould be done in every newly diagnosed hospitalized COVID-19patients to potentially predicts the course of disease and its clinicaloutcome.