Potential Association of Hypernatremia With Mortality in Patients With Acute Kidney Injury and COVID-19.

Background The outcome of acute kidney injury (AKI) in patients with COVID-19 and the factors associated with its outcome, including mortality, are understudied among the Indian population. Objective The objective of this study is to determine the outcome of AKI in a cohort of patients with COVID-19 admitted to medical wards and associated intensive care unit (ICU) and the factors associated with its outcome, including mortality. Method This is a retrospective study of patients with COVID-19 and AKI admitted to a tertiary care hospital. A total of 1765 patients were admitted to a hospital with COVID-19 between March 23, 2021, and June 30, 2021, during the second wave of the pandemic chiefly attributed to SARS-Co-V-2 lineage B.1.617. Patients with AKI for whom a nephrology call was sought for management (N=60) were included. Measurements carried out were the stage of AKI, co-morbidities, ICU admission, mechanical ventilation, lab parameters, and mortality. We classified AKI by comparing the highest to lowest recorded serum creatinine in hospital and staged AKI based on the Kidney Disease: Improving Global Outcomes (KDIGO) system. We further developed stepwise logistic regression models to find independent factors associated with mortality.  Results Out of the 1765 patients hospitalized with COVID-19, a total of 60 (3.4%) patients with AKI were referred to nephrology for management. The observed mortality in this cohort was 41/60 (68.3%). AKI stage 3 was observed to be the most common (78.3%). Based on a univariate analysis of association, age, chronic kidney disease, admission to ICU, the requirement for vasopressor and ventilation, lactate dehydrogenase (LDH) DH, liver function tests (LFT), hypernatremia, and leucocytosis were associated with the mortality of patients (p<0.05) with AKI and COVID-19 infection. Multivariate analysis using logistic regression led to the identification of hypernatremia (OR 5.24 {0.95-42.31}) and multiple co-morbidities (OR 2.59 {1.03-8.75}, p<0.07) as potential factors independently associated with mortality. Conclusion The study indicates the potential association of hypernatremia with mortality in AKI, along with the simultaneous presence of multiple co-morbidities with COVID-19. As the statistical power of the association is weak, we are claiming the association as potential only. It needs to be confirmed in other larger studies.

Mucormycosis following COVID-19 infection-An epidemic developing in a pandemic, a case series from a tertiary care hospital of India.

When the world is still struggling to fight the Coronavirus disease-19 pandemic, an epidemic of mucormycosis following the COVID-19 infection is increasing in India. Mucormycosis is a rare life-threatening fungal infection with a high mortality rate. Is this increase due to the rampant usage of corticosteroids, some immune dysfunction in COVID-19, uncontrolled blood sugar, increased ferritin, use of industrial oxygen, use of unsterile mask, or use of unsterile water as a humidifier in oxygen delivery systems? This remains a question. In this case series, we present five cases of rhino-orbito-cerebral mucormycosis which followed after the COVID-19 infection in these patients. We have included patients' clinical, laboratory, and radiological data in this case series and reviewed the literature.

Comparison of standard dose with high dose of methylprednisolone in the management of COVID-19 patients admitted in ICU.

CONTEXT: The pathological progression in severe Coronavirus Disease 2019 (COVID-19) includes an excessive and unregulated pro-inflammatory cytokine storm. Though the efficacy of corticosteroids like methylprednisolone (MPS) in severe COVID-19 is proven now, its dose and duration are not precise. AIMS: Our study aimed to compare the effect of a standard dose (SD) of MPS (60-120 mg/day) to a high dose (HD) of MPS (>120 mg/day) on the outcome of hospitalized COVID-19 patients. SETTINGS AND DESIGN: This study was a cross-sectional study. Patients admitted to AIIMS, Bhopal's intensive care unit (ICU) from July 2020 to March 2021 were enrolled in the study. METHODS AND MATERIAL: The patient's medical records were extracted from the medical record section of the hospital. The primary endpoint was the all-cause mortality during the hospital stay. The secondary endpoints were the need for mechanical ventilation, the use of vasopressors, the occurrence of acute kidney injury (AKI), and secondary infections. STATISTICAL ANALYSIS USED: Data were entered in the MS Excel spreadsheet and coded appropriately. RESULTS: Our data showed that survival, the need for mechanical ventilation, the occurrence of AKI, and secondary bacterial infection are comparable among the two groups with no significant difference. The logistic regression analysis showed that there is a slightly higher risk of death for patients with an acute respiratory distress syndrome (ARDS) receiving HD of corticosteroids compared to SD, though these results were found to be statistically non-significant. CONCLUSIONS: In hospitalized patients suffering from severe COVID-19 pneumonia, an SD of MPS is as effective as an HD of MPS in terms of reduction in mortality and need for mechanical ventilation.

Evaluation of liver function in symptomatic COVID-19 patients.

CONTEXT: The coronavirus disease 2019 (COVID-19) is a viral respiratory illness which was first detected in Wuhan, Hubei Province, China. A few case studies demonstrated that 14-53% of the cases of COVID-19 reported abnormal levels of liver enzymes during disease progression. Patients with severe COVID-19 seem to have higher rates of hepatic dysfunction. AIMS: Our aim was to investigate the changes in the liver function test in COVID-19 patients admitted to hospital and its association with the severity of the disease, length of hospital stay, and outcome of patients. SETTINGS AND DESIGN: This was a cross-sectional study involving 678 COVID-19 patients, who were admitted at AIIMS, Bhopal. METHODS AND MATERIAL: The case records of 678 patients were evaluated by the research team from the Department of Medicine, AIIMS, Bhopal, and data were analyzed. All laboratory data were obtained. The liver function tests (LFT) including alanine aminotransferase, aspartate aminotransferase, and total bilirubin values were recorded, and liver dysfunction defined as any parameter having more than the upper limit of normal value. RESULTS: From April 2020 to September 2020, a total of 678 COVID-19 patients were screened, and 600 were assessed for eligibility; 78 were excluded due to either significant alcohol history or due to prior liver disease. Among the 600 patients, 265 patients (44.16%) had liver dysfunction while 335 patients (55.83%) had a normal liver function. The patients having a severe disease were more affected by liver dysfunction than the mild disease patients. The average hospital stay was more in those patients having liver dysfunction than in those patients with normal liver function. Among the patients with normal LFT on admission, 97.9% got cured while 2.1% died. Among the patients with liver dysfunction, 80.4% got cured and 19.6% died. CONCLUSIONS: Hepatic injury is common in severe COVID-19 patients, which may be caused by direct injury to the bile duct cells by a virus or indirectly by a cytokine storm. The liver function should be evaluated in all symptomatic COVID-19 patients. In patients with pre-existing liver diseases, special attention should be paid to monitoring and treatment.

Evolution of pathology teaching for MBBS students during COVID-19 pandemic lockdown: Moving from a real to a virtual classroom.

BACKGROUND: The COVID-19 pandemic lockdown has forced university hospitals to forego traditional classes and embrace online teaching platforms as the sole modality of medical education. Herein, we describe our experience of shifting from the arena of a real to a virtual classroom during the lockdown phase. Materials and. METHODS: The institutional subscription of G-suite was used for creating a virtual Google classroom. Google Calendar, Google Meet, and Google Forms were used for notification of schedules, conducting theory and practical classes, and conducting assessments, respectively. The learner-centric SNAPPS model was adapted for an interactive case-based learning (CBL) program using multimedia tools. Students' perspective on online education was assessed based on their responses to a validated questionnaire. RESULTS: The conduction of online classes, particularly the live practical classes and the CBL program got the maximum affirmative (up to 85%) responses. Students of the same batch also performed better in a test following the online CBL (77.03% vs 73.3%, P = 0.03, paired t-test statistically significant) compared to a test before it. However, access to laptops and poor Internet connectivity were significant causes of concern for nearly 40% of students. CONCLUSION: The use of virtual classroom has proved to be an efficient method for continuing teaching of Pathology to MBBS students in times of lockdown when face-to-face conventional teaching was not possible. The experience indicated that in the future a judicious mixture of traditional and online classes may be a more effective educational design for teaching Pathology to MBBS students.

Corticosteroids in Covid-19 pandemic have the potential to unearth hidden burden of strongyloidiasis.

COVID-19 pandemic has posed formidable public health and clinical challenges to the entire humanity. A significant proportion of the COVID-19 patients have been provided immunosuppressive agents, particularly corticosteroids, as a part of management of moderate to severe COVID-19 disease. This has the drawback of development of strongyloides hyperinfection to disseminated infection in latent strongyloides infection patients. We are reporting the case of strongyloidiasis hyperinfection in a COVID-19 patient from a developing country, who initially received corticosteroid therapy for management of COVID-19, but later presented to hospital with non-specific, strongyloides related symptoms.

Guillain-Barre Syndrome following SARS-COVID-19 Infection: A Case Report from India.

Severe acute respiratory syndrome coronavirus 2 (SARS-COVID-19) is a novel coronavirus that started in Wuhan City in China in December 2019. It can cause acute respiratory infection. Guillain-Barre syndrome (GBS) is an autoimmune disease characterized by rapidly progressing ascending paralysis that is triggered by an infection or immune stimulation which produces an abnormal immune response that targets peripheral nerves. In most cases, it is preceded by a bacterial or viral infection. This is a case of a 36-year-old male patient from India who developed progressive acute flaccid paralysis after SARS-COVID-19 infection. Clinical examination and lab studies lead to the diagnosis of GBS. The patient was treated with intravenous immunoglobulins and supportive treatment. Following treatment, there was a substantial improvement in weakness as reported by the patient and was confirmed by clinical evaluation. This is an uncommon manifestation of SARS-COVID-19 infection and suggests the presence of an immune-mediated process leading to damage of the nervous system.