Liver enzymes in high-risk patients diagnosed with COVID-19

Introduction: It is important to know the alterations in liver enzymes in patients with COVID-19, as markers of liver damage. Objective: To identify alterations in liver enzymes in high-risk patients with COVID-19. Methods: A prospective descriptive study was carried out on alterations in liver enzymes in 56 patients admitted with COVID-19. The variables studied were age, sex, evolution towards gravity, and liver enzymes. Serum samples were taken on the first day of admission and on the fifth day to determine liver enzymes. The Ritis index was also found. Results: The average age was 66.64 ± 13.12 years, 51.8% were older men and 37.5% progressed towards severity. In all enzymes there was an increase in the mean on the fifth day of the study. Lactate dehydrogenase (LDH) and γ-glutamyl transpeptidase (GGT) were found to be high in most of the patients from the first day. On the fifth day, aspartate aminotransferase (AST) was high in 71.4% of non-severe patients and alanine aminotransferase (ALT) in severe cases. At the beginning, a Ritis index < 1 was more frequent, but on the fifth day the Ritis index > 1 increased by 42.9% in seriously ill. 56.6% of seriously ill patients modified this index on the fifth day. Conclusions: The elevation of the mean liver enzymes on the fifth day was demonstrated. LDH and GGT remained high from the beginning of the disease. The majority of severe patients reversed the Ritis index on the fifth day. © 2022, Editorial Ciencias Medicas. All rights reserved.

LEUKOCYTOCLASTIC VASCULITIS IN MITRAL VALVE ENDOCARDITIS

Background: Vasculitis is a known, although not commonly observed, manifestation of bacterial endocarditis. It is imperative that diagnosis is made promptly and appropriately treated, as vasculitis can often be painful and uncomfortable for patients. Case: 75-year-old male is admitted to the hospital for Coronavirus Disease 2019 (COVID-19). Several weeks after recovering from his respiratory infection, patient developed a diffuse, purpuric rash that began on his forearms and gradually spread throughout his bilateral upper extremities to his hands and fingers, as well as to his shoulders and lateral chest. Skin biopsy was performed and revealed findings suggestive of leukocytoclastic vasculitis. Blood work revealed Methicillin Resistant Staph Aureus (MRSA) bacteremia, sensitive to Vancomycin. Transthoracic echocardiogram revealed native mitral valve endocarditis. Transesophageal echocardiogram was not performed due to patient's underlying comorbidities and high risk. Decision-making: Patient was diagnosed with leukocytoclastic vasculitis secondary to bacterial endocarditis. Rheumatologic workup, including antineutrophil cytoplasmic antibodies, antinuclear antibodies, serum complement levels, anti-smith antibodies and double stranded deoxyribonucleic acid, was negative. Patient was ultimately discharged on a prolonged course of Vancomycin and his diffuse rash resolved one month later. Conclusion: There are only a few case reports describing the direct association between leukocytoclastic vasculitis and infective endocarditis. It is important to consider the association of vasculitis and endocarditis in order to effectively treat because immunosuppression, particularly with steroids, is the gold standard treatment for vasculitis. Our patient experienced near complete resolution of the rash after completion of antibiotics and no other therapy was deemed necessary.

Clinical-epidemiological characterization of pediatric patients infected with sars-cov-2 in santiago de cuba province

Introduction: The world is currently immersed in looking for a solution to the scourge that is ravaging humanity: the new coronavirus which is taking thousands of lifes, in spite of the efforts carried out and the strategies implemented by the different governments. Objective: To characterize from the clinical-epidemiological point of view pediatric patients infected by SARS-CoV-2. Cases presentation: In the series of cases predominated patients coming from Santiago de Cuba province (60%), the age group of 6 to 10 years and the masculine sex (40 and 80%, respectively). The persistence of the symptoms took place in the first week in hospital and the most frequent symptoms were dry cough and fever. It was implemented the protocol for treatment and 50.0% of the patients presented slight adverse reactions;likewise, in 90.0% of the cases the polimerase´s chain reaction in real time was negative after 14 days. The 80.8% of the cases were contacts of patients positive to SARS-CoV-2 and 2 of them presented bacterial pneumonia as a complication. Conclusions: COVID-19 does not represent a health problem in the pediatric population of the Eastern zone in terms of mobility and morbidity, but it is a source of infection for adults. It has been proved that after 14 days of hospital stay the PCR in real time is negative and it is confirmed that one of the transmission ways of the disease is person to person. © 2020, Editorial Ciencias Medicas. All rights reserved.