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Introduction: Achalasia is a motility disorder of the esophagus characterized by impaired relaxation of the lower esophageal sphincter and loss of peristalsis in the distal esophagus. It is a rare condition with an annual incidence of 0.5-1.2 per 100,000 individuals. The etiology of primary achalasia is unknown, however secondary achalasia can be attributed to malignancy, infections or systemic diseases such as amyloidosis. An infrequent complication of achalasia is esophageal squamous cell carcinoma which has a prevalence of 26 in every 1,000 cases. We present a case of interval locoregionally advanced esophageal squamous cell carcinoma only 2 years after a normal upper endoscopy. Case Description/Methods: A 67-year-old female with known achalasia and previous pneumatic dilation in her 30s presented to our outpatient clinic in 2019 with complaints of worsening chronic dysphagia. EGD was performed which revealed a significantly dilated esophagus with candida esophagitis. Despite completing antifungal therapy, she continued to experience dysphagia to solids and liquids. Barium swallow demonstrated absent peristalsis with pooling of contrast within the esophagus. High-Resolution Manometry testing demonstrated absent peristalsis. She opted for surgical myotomy, however due to COVID restrictions, the procedure was delayed. Repeat EGD was performed in 2022 for pre-surgical evaluation and showed a large obstructing friable esophageal mass in the lower third of the esophagus. Pathology was consistent with invasive poorly differentiated squamous cell carcinoma. PET scan showed locoregional disease with FDG-avid esophageal and gastrohepatic node lesions. She was started on chemoradiation with Paclitaxel and Carboplatin (Figure). Discussion(s): The risk of esophageal squamous cell carcinoma in achalasia has significantly increased with incidence of approximately 1 in 300 patients. The presumed mechanism of malignancy in achalasia is poor emptying resulting in food stasis, bacterial overgrowth and inflammation leading to dysplasia and development of carcinoma. Given the relatively low incidence, there are currently no guidelines on routine endoscopic screening to assess for malignancy in patients with achalasia. Survival rates are poor as patients are often diagnosed at advanced stages. This case aims to illustrate the importance and need for interval screening in individuals with long standing achalasia to improve outcomes.
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Background: Tixagevimab(Txg)/cilgavimab (Cgv) was given emergency use authorization (EUA) to provide passive immunity against COVID-19(CoV) for immunocompromised (IC) pts who may not mount an adequate response to CoV vaccination [1]. Recipients of allogeneic hematopoietic cell transplant (Allo-HCT) are amongst the most IC. Due to high risk of mortality and complications of CoV in this population, Txg/ Cgv was used as pre-exposure prophylaxis (PrEP) under EUA without prior study. Our study aims to assess efficacy and adverse events (AE) of Txg/Cgv administration in this cohort of patients to help guide future practice. Method(s): We retrospectively investigated Allo-HCT recipients who received Txg/Cgv as PrEP. Data were gathered including changes in blood counts, incidence of graft-vs-host-disease (GVHD), history of prior CoV infection and vaccination status. Pts who developed CoV infection after PrEP were assessed for supplemental oxygen(O2) need and hospitalization. Data cutoff date was 9/30/2022. Result(s): A total of 18 Allo-HCT recipients received Txg/Cgv. Table 1 summarizes patient and transplant characteristics. Thirteen (72.2%) pts received 2 doses of 150mg of Txg / Cgv, while 4 pts received 1 dose of 300mg, and one patient received one dose of 150mg. Median time to first dose was 213 days [range 22-3660] post-transplant. Two pts had lab confirmed CoV, one at 24 days post dosing and the 2nd patient at 22 days post dose. Neither required supplemental O2;one was hospitalized for fever. Prior to dosing, 44.4% (8/18) of pts had GVHD. (Table Presented) (Figure Presented) (Figure Presented) Of these, 62.5% (5/8) had no changes in the severity of their GVHD. Two of 8 (25%) pts with pre-existing chronic GVHD had a flare of symptoms. Two (25%) had improvement of GVHD. Two pts developed new onset acute GVHD following Txg/Cgv administration, one requiring 1mg/kg prednisone and the other topical steroids (2/18, 11%). Figure 1 summarizes GVHD patterns observed. Hematologic parameters did not change significantly, see Figure 2. None of the pts reported any subjective AE following dosing. Summary: Txg/Cgv was found to be safe and effective for Allo-HCT pts, without significant toxicity. Two patients had new onset GVHD and 2 patients had progressive GVHD. Whether there is a true association between Txg/Cgv and development of GVHD should be investigated in a larger cohort and then investigated for possible underlying mechanisms.Copyright © 2023 American Society for Transplantation and Cellular Therapy
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Background: The role of genetic conditions in the development of cardiomyopathy is well established;however, recognition and referral for genetic testing remains underutilized. Systematic review of complex cases can increase general awareness in this area of practice. Here we describe the case of a patient with resolved severe stress induced cardiomyopathy (SIC), who was ultimately found to have heterozygous transthyretin-mediated amyloidosis (TTRA). Case: A 27-year-old man (family history positive for a brother status post heart transplant) presented with ataxia and cough due to legionella pneumonia. TTE showed left ventricular (LV) diastolic diameter of 6.2cm, LV ejection fraction 20-25%. He suffered rapid decompensation with mixed cardiogenic/septic shock requiring peripheral VA ECMO and Impella-CP placement. Course notable for brief cardiac arrest on hospital day (HD) 2, incidental diagnosis of COVID 19 on HD 14, conversion to VV ECMO on HD 15, and ECMO decannulation on HD 23. Repeat TTE prior to discharge showed normalization of biventricular function. Discussion(s): Despite resolution of refractory shock and normalization of biventricular function prior to discharge, the TTE finding of mild LV dilation and strong family history prompted outpatient pursuit of genetic testing which revealed a heterozygous TTRA mutation (val142ile). Work-up to assess cardiac involvement included: a 99m-technetium pyrophosphate scintigraphy found to be indeterminate, an aborted endomyocardial biopsy due to inability to smoothly advance a bioptome (presumably related to ECMO cannulation), and a cardiac MRI (pending at the time of this submission). If a cardiac phenotype is discovered, the patient will be started on targeted treatment of cardiac amyloid. Screening of first-degree family members has been initiated. Conclusion(s): Given the current state of under-diagnosis of genetic cardiomyopathies and its association with significant morbidity and mortality, it is prudent to consider genetic testing in young patients based on clinical history. Examples of clinical scenarios to prompt further testing include: anatomical findings (i.e. cardiac chamber enlargement, left ventricular hypertrophy), family history of cardiomyopathy, or clinical markers suggestive of alternative diagnoses (i.e. neuropathy, renal insufficiency, mediastinal lymphadenopathy). This thoughtful and algorithmic use of genetic testing may help improve long-term patient outcomes given improvements in both detection, family screening, and treatment for disease-specific cardiomyopathies.Copyright © 2022
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Introduction: Cardiac sarcoidosis (CS) classically manifests as a restrictive cardiomyopathy or conduction abnormalities, though the full scope of phenotypes may be underrecognized. We present an atypical case of mitral regurgitation (MR) and aortic regurgitation (AR) attributed to CS. Case Presentation: A 33-year-old woman with a history of hypertension, tobacco use, and COVID-19 infection two months prior presented with worsening dyspnea on exertion, orthopnea and lower extremity edema. Initial work up revealed elevated pro-BNP and troponin, and a CXR with pulmonary edema. A prior CTA showed mediastinal and hilar lymphadenopathy. Echocardiogram was notable for mildly dilated LV, severe hypokinesis of the basal inferior myocardium, LVEF 50-55%, moderate MR and moderate AR. cMR revealed multiple foci of predominantly mid-wall late gadolinium enhancement (LGE) in the LV, including a focus adjacent to the posteromedial papillary muscle (Fig. 1). Cardiac PET showed extensive patchy, focal hypermetabolic activity in the LV inferobasal, anterobasal and anterolateral walls. With high suspicion for CS, the patient opted for treatment with steroids and follow-up PET over extracardiac lymph node biopsy due to procedural risk. Discussion(s): Isolated CS is underdiagnosed and can present with a wide range of symptoms. Detection is limited by current diagnostic criteria, namely difficulty ascertaining affected tissue, which may limit recognition of the full range of presentations. Diagnosis and treatment vary widely among institutions but there is consensus on starting immunosuppression and pursuing follow-up cardiac PET for suppression of inflammatory activity in cases of high clinical suspicion. Our patient plans to undergo repeat PET and have ongoing discussion about lymph node biopsy. COVID-19 myocarditis remains on our differential, however given the patchy nature of LGE on cMR which correlated with the FDG uptake on PET, CS is considered the most probable diagnosis. Conclusion(s): CS should be considered in the differential diagnosis for young patients with structural valve abnormalities, even in the absence of arrhythmias or cardiomyopathy. High clinical suspicion may justify early immunosuppressive treatment to prevent irreversible myocardial injury and/or fatal arrhythmias. Whether this treatment will result in resolution of the structural defects remains to be seen and further investigated.Copyright © 2022
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Background: In the current pandemic of COVID-19, hydroxychloroquine (HCQ) is recom-mended as an experimental drug for prophylaxis and treatment of the illness. Although it is a safe drug, it can rarely produce a severe drug reaction 'drug rash with eosinophilia and systemic symptoms syndrome (DRESS)', and to differentiate it from systemic viral infections is challenging. Case Presentation: A 45-year old male nurse working in a COVID-19 ward consumed HCQ weekly for two weeks for prevention of SARS-COV-2 illness. He presented with fever, pruritic maculopapular palmar rash, cervical lymphadenopathy for 12 hours and was quarantined as a suspected COVID-19 case. His laboratory tests revealed lymphopenia, eosinophilia, atypical lymphocytes, raised liver en-zymes along with IgM negative, IgG positive rapid antibody test of SARS-COV-2. However, his throat swabs for SARS-COV-2 by real-time PCR were negative on day 1 and 7. He was finally diagnosed as definite DRESS based on the RegiSCAR score of six. He responded to levocetirizine 5 mg OD and oral prednisolone 60 mg daily tapered over 7 days. Conclusion(s): DRESS due to HCQ is 'probable', 'of moderate severity', and 'not preventable' adverse effect mimicking SARS-COV-2 illness.Copyright © 2021 Bentham Science Publishers.
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Background: The Zebrafish animal model has the potential use to study COVID19 infection in-depth due to its genetic similarity with humans. It has antiviral property. As we know, SARS-CoV-2 is an RNA virus, which has a high genetic mutation rate, therefore difficult to understand its structure. It is a great way to understand the genetic dynamics of Zebrafish, which is related to orthologous human genes. Objective(s): The study aims to validate the possible role of the Zebrafish animal model in the COVID19 diagnosis. Method(s): We have reviewed a lot of literature towards the Zebrafish model and tried to explore the possible connection in the diagnosis of COVID19. Result(s): We observed a very close bridge between the Zebrafish model and COVID19 towards possible drug discovery diagnosis. Conclusion(s): This research will be helpful to unlock the mechanism clues, finding new therapeutic tar-gets, and understanding adaptability to host.Copyright © 2021 Bentham Science Publishers.
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Background. Tocilizumab (TCZ) was approved by the Food and Drug Administration under emergency use authorization for treatment of COVID-19 in patients requiring supplemental oxygen, non-invasive or invasive mechanical ventilation, or extracorporeal membrane oxygenation. Despite multiple clinical trials, there remain unanswered questions surrounding TCZ use. Methods. This multi-hospital retrospective cohort study included patients who received TCZ for COVID-19 between January 29th, 2021 and June 30th, 2021 at five University of Pennsylvania Health System (UPHS) hospitals. Patients were eligible for TCZ per UPHS criteria if they scored >= 5 on the World Health Organization (WHO) ordinal scale for <= 24 hours and experienced < 14 days of acute COVID-19 symptoms. Descriptive statistics were performed to characterize usage within the health system. Results. This study evaluated 134 patients who received TCZ for the treatment of COVID-19. TCZ was ordered a median of 22 hours (interquartile range [IQR], 13.2 - 41.5) after hospital admission. A majority of patients (76.1%) were admitted to the intensive care unit and a small portion (12.7%) had a WHO ordinal scale that was >5 at time of TCZ order entry. All patients received concomitant dexamethasone therapy at a total prednisone equivalent of 400 mg (IQR, 335.6 - 480). Overall 33.6% of patients experienced an adverse event (ADE) within 30 days of TCZ administration (Table 1). Most common ADEs included bacterial infection (29.9%), hepatitis (6.7%), and fungal infection (3%);other etiologies of ADEs were not accounted for. All-cause mortality (Table 2) at day 30 occurred in 20.9% of patients and median time from TCZ administration to mortality was 12.5 days (IQR 5 - 18.3). Ninety-six patients in the cohort (71.6%) were discharged by day 30. Of the subgroup discharged by day 30, the majority (70.8%) were discharged to home. Conclusion. Patients who received TCZ for severe COVID-19 experienced 20.9% mortality;mortality was higher among those with higher ordinal scale at the time of TCZ dosing. A large portion of patients (70.8%) were discharged to home within 30 days. One third of patients experienced an adverse event, primarily bacterial or fungal infection. Our experience may be useful in counseling patients about anticipated effects of TCZ.
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Background. The ongoing state of the COVID-19 pandemic necessitates the characterization of the biological basis of disease severity. We aimed to correlate the clinical severity of illness upon hospitalization with inflammatory sero-biomarker levels. Methods. A single-center prospective cohort study was conducted at a 776-bed tertiary care urban academic medical center in Detroit, Michigan. Adults with con-firmed reverse-transcriptase-polymerase-chain-reaction assay for COVID-19 were recruited in equal numbers into four disease severity categories, as defined by the WHO, upon hospital admission from January 8th, 2021 to September 1st, 2021. Electronic medical charts were reviewed. In addition to clinical markers, cytokines and chemokines were assessed to gain detailed understanding of COVID-19 pathology. Results. We included 200 patients with 50 patients each in the mild, moderate, severe and critical illness. The mean age of the cohort was 58.6. +/-15.9 yrs, 104 (52%) were males, and 135(67.5%) were blacks. The common comorbidities were hypertension (67.5%), diabetes (37%) and chronic lung diseases (26.5%). At the time of admission, oxygen therapy was needed in 49.5% but intubation in only 0.5%. Conclusion. We noted COVID-19 severity dependent changes in the clinical representation as well as the biomarker profiles. Clinical markers such as CRP, LDH, D-dimer and Ferritin were relatable to COVID-19 severity. Inflammatory cytokines and chemokines such as CCL-2, CXCL-10, IL-1ra, IL-6 and TNF-alpha also varied with the severity of disease. Our results provide a system level insight into the inflammatory state of COVID-19 at the time of hospital representation.
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Background. The SARS-CoV-2 viral load and its association with COVID-19 severity remain a widely discussed topic with a little or no consensus. With these considerations we aimed to investigate SARS-CoV-2 viral load in the saliva/sputum in COVID-19 patients with varying severity levels. Methods. A single-center prospective cohort study at Ascension St John Hospital, Detroit, MIchigan was conducted during early January 2021 and September 2021. We recruited 200 subjects with a PCR-confirmed COVID-19 and 18 year of age and older. Further these subjects were divided into mild, moderate, severe and critical cohorts based on WHO defined criteria. Further we collected sputum/saliva samples and measured them for SARS-CoV-2 viral load. . Results. We recruited 50 patients in each cohort totaling to 200 patients.Our study cohort was made up of 104 (52%) males and 96 (48%) females. We note severity level differences matching with the COVID-19 severity at the hospital presentation. Conclusion. These results were interesting to provide an insight into COVID-19 severity and clinical representation.
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Langerhans cell histiocytosis (LCH) is a rare disease that commonly affects the skin and bones and is found mostly in children. Gastrointestinal (GI) involvement in adults is rare and is diagnosed during a routine colonoscopy from the biopsy of polypoid lesions. The pathophysiology of LCH is unclear. We describe an adult patient with LCH in remission who presented with extensive GI involvement after severe acute respiratory syndrome coronavirus 2 infection. This case report identifies severe acute respiratory syndrome coronavirus 2 as a trigger for the worsening of LCH and adds more data to the literature, given this is the first case with fulminant GI involvement.
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Introduction: The COVID-19 pandemic and lockdown restrictions have significantly affected delivery of healthcare amongst UK hospitals. Some centres had reduced screening rates of pre mature babies, while others documented higher rates. The purpose of this study is to explore the effect of first UK lockdown restrictions on ROP prevalence and treatment. Method(s): Participants were pre-mature babies born during UK first Lockdown between 23 March 2020 to 20th October 2020 at Royal London Hospital. They were identified using the national neonatal database (BadgerNet). Severity of ROP, birthweight, gestational age, treatment and total number were compared to same data in corresponding dates in 2019. Independent T test was used to compare the demographics and a chi-squared test was used to compare the prevalence of various stages of ROP between the two groups. Result(s): 107 babies were included,(2020 n = 51, 2019 n = 56). Although the mean birth wight in 2020 (991 g) was less than that in 2019 (1021grams), this was not significant (P = 0.6). More babies were born below 1000 g in 2020 (60%) compared to 2019 (53%) (P = 0.1). The mean gestational age (27 weeks) was equal in the two years (P = 0.7). 62.7% of babies in 2020 had grade 2 or more of ROP compared to 50% in 2019. Treatment rate was 14% in 2020 compared to 5 % in 2019 (P = 0.1). Conclusion/Relevance: Our pilot study showed no statistical significance in the prevalence of babies with ROP between 2019 and 2020, However we have subjectively noted younger and smaller babies during the lockdown, hence the higher treatment rate. Copyright © 2022
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Background: Tabebuia impetiginosa is an important medicinal plant rich in lapachol, alpha-lapachone, and beta-lapachone known to possess several biological activities. Objective(s): In this study, we investigated the drug potential of lapachol, alpha-lapachone, and beta-lapachone using molecular docking, molecular dynamic (MD), and drug-likeness properties. Material(s) and Method(s): The computational study was performed using SwissADME software for the determination of the pharmacokinetic properties of the tested compounds. AutoDock Vina and Genetic Optimization for Ligand Docking (GOLD) were used for the docking analysis, and MD simulations were run using Schrodinger's Desmond Simulation. Result(s): The three compounds lapachol, alpha-lapachone, and beta-lapachone binds to cysteine (Cys)-histidine (His) catalytic dyad (Cys145 and His41) along with the other residues with, respectively, the following docking score 48.69, 47.06, and 47.79. Against viral entry receptor, human angiotensin-converting enzyme 2 (hACE-2), alpha-lapachone exhibited the highest GOLD Fitness score complex (54.82) followed by lapachol (42.53) and beta-lapachone and hACE-2 (38.74) generating several active sites in the target proteins. A 100 ns MDs simulation study revealed the stable conformation of bioactive compounds within the cavity of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) of hACE-2 protein and main protease (Mpro). From the dynamic study, it was observed that lapachol was tightly bound with catalytic dyad residue Cys145 of Mpro with more than 40% time of simulation, also post-simulation MM-GBSA binding free energy (DELTAG Bind) revealed the highest energy score (-51.18 +/- 5.14 kcal/mol) among the evaluated complex. Moreover, the absorption, distribution, metabolism, and excretion (ADME) properties demonstrated that the investigated compounds passed the pharmacokinetic and drug-likeness criteria without undesirable effects. Conclusion(s): The computational study highlighted that these compounds could be highly recommended and developed as part of an effective drug against the SARS-CoV-2 virus. Copyright © 2022 Pharmacognosy Magazine.
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Introduction: The COVID-19 pandemic has led to an increased burden being placed on our health care system. In this study, we aim to expand upon the impact of COVID-19 on a head and neck cancer population by examining the number of patients presenting to a university emergency department with an initial presentation of head and neck cancer during the pandemic and immediately before it. Method(s): A retrospective analysis of medical records of patients presenting to the emergency department (ED) at Baylor University Medical Center (BUMC) who received a diagnosis of head and neck cancer (HNC) either in the ED or in the admission immediately after was performed for a 6-month pre- COVID-19 time period (September 2019-February 2020) and a 6-month post-COVID-19 time period (April 2020-September 2020). Data analysis of patient presentation and final diagnosis was performed. Analysis of total ED encounters at BUMC per month over both time periods was also performed. Result(s): A chart review of 892 patients found 217 HNCrelated admissions in the pre-COVID-19 period and 228 in the post. In the pre-COVID-19 period, 9 patients presented with a primary diagnosis of HNC either in the ED or upon subsequent admission, accounting for 4.1% of HNC-related admissions. In the post-COVID-19 period, 14 patients presented with a primary diagnosis of HNC either in the ED or upon subsequent admission, accounting for 6.1% of HNCrelated admissions. In the pre-COVID-19 period, 1.9 per 10,000 ED visits resulted in a diagnosis of HNC. Comparatively, in the post-COVID-19 period, 3.8 per 10,000 ED visits resulted in a diagnosis of HNC. There was a sharp increase in ED-related HNC diagnoses in May of 2020, with 6.9 per 10,000 ED visits resulting in a diagnosis of HNC. Of ED-related HNC diagnoses, 75% made in May of 2020 were stage IV at the time of diagnosis. Conclusion(s): There has been a significant increase in the amount of primary HNC diagnoses made in the ED or upon subsequent admission since the start of the COVID-19 pandemic. HNC diagnosed at ED presentation or upon subsequent admission are more likely to be late stage, highlighting delays in care secondary to the COVID-19 pandemic.
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BACKGROUND: In-person clinic visits can be challenging for underserved populations due to social determinants of health such as transportation, time off work, and childcare responsibilities. These challenges were further compounded during the COVID-19 pandemic, which propelled primary care physicians to rapidly incorporate telehealth into their practice. The aim for this project was to assess our internal medicine residents' views on, preparation for, and comfort with telehealth. METHODS: With technical support from our local Area Health Education Center (AHEC) chapter, we created a telehealth training module specific to our residency continuity clinics. Upper-level Internal Medicine residents were surveyed regarding their experience and comfort level with the use of telehealth in their continuity clinics. First-year residents were excluded, as they were assigned to in-person clinic visits during the peak of the pandemic. Survey results were analyzed using descriptive statistics. Themes, areas of improvement, and next steps were identified. RESULTS: Approximately 57 percent of Wake Forest Internal Medicine residents (n=38) completed the newly developed telehealth online training module and associated survey assessing resident experience and comfort level with telehealth. Many respondents (71.9%) stated that they had not received prior training in telehealth. However, 65.7% of residents surveyed stated they felt comfortable managing patients through telehealth. Many of those surveyed believed telehealth benefits the health of patients (84.4%,) is an important learning opportunity during residency (93.8%,) and expect to use telehealth in their future career (97.1%.) A majority of residents felt telehealth could be a suitable alternative for routine follow-up and chronic disease management, but mentioned the lack of patient connectivity to video and need for access to objective data like vital signs and physical exam. CONCLUSIONS: Internal Medicine residents were eager to incorporate telehealth into their current training and future careers, despite most not having received prior telehealth training. Residents recognized the limitations of telehealth and frequently suggested home measurements of vital signs to improve management decisions. Thus, “Know Your Numbers” pilot project was created, which targets patients with poorly controlled diabetes and hypertension, was designed to provide residents with greater exposure to telehealth, as well as equip patients with the remote monitoring tools necessary to better inform treatment recommendations. Patients are scheduled for interval telehealth visits between their regularly scheduled in-person visits with their resident primary care physician. Residents will be surveyed again in July 2022 to assess changes in comfort level and experience with telehealth.
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Introduction: Diabetes Mellitus is a chief reason for morbidity and mortality globally. It is also a major comorbidity contributory factor in COVID-19. Patients with diabetes have an increased susceptibility to viral and bacterial infections, including those affecting the respiratory tract. Numerous scoring systems have been developed to evaluate and stratify the risk of Communityacquired Pneumonia (CAP). CURB 65 scorings are one of the time tested and relatively easy methods. However, comparative CURB 65 SCORE data analysing its correlation between diabetes mellitus (DM) & non - diabetic mellitus (NDM) in hospitalized covid 19 patients is lacking. Therefore, this study aimed to evaluate and perform a comparative analysis of CURB 65 scores between diabetic & non- diabetic hospitalized COVID 19 confirmed patients. Methods: This cross-sectional single-centre research evaluated hundred and forty COVID 19 positive patients with and without diabetes from April to June 2021. Following the evaluation of the glycemic status of the patient, CURB 65 scores were calculated. Cohorts were grouped as mild, moderate and severe illnesses, based on the CURB 65 score. Duration of hospitalisation, the requirement of the ventilator, ICU admission and mortality were recorded. Patients were monitored until they were discharged or deceasement. Results: Of the sixty-nine patients who were diabetic, 65.2 % had a mild illness, 30.4% had moderate and 4.3 % had severe illness. Of the rest 71 patients who were non-diabetic 97.2 % had mild, 2.8% had moderate and none had severe illness. There is a significant association between patients with and without diabetes when compared with their CURB 65 score with a p-value <0.0001 and a chi-square value of 24. Seventeen DM patients were hospitalised in ICU and 13 required ventilation, whilst only 4 NDM patients were in ICU and 3 required ventilator support. The mean value of the duration of hospital stay for the DM group was 9.25 days with an SD of ± 5.0. In comparison mean value for NDM cohorts was 7.01 days with an SD of ± 4.30. The difference was statistically significant with a p-value of 0.005. No mortality was noted in NDM patients. In contrast, 17 DM patients succumbed. The difference in mortality was statistically significant with a p-value of <0.0001. Conclusion: CURB 65 was found to be of increased value for diabetic patients. The severity of illness is more in the diabetes population than in the non-diabetic population. © 2022 The authors.