Assessment of Liver Enzymes in Hospitalized Patients with COVID-19 and Its Relationship with Length of Stay, Recovery and Death

Background and Objective: In the epidemic of COVID-19, intensive care units usually bear a heavy burden due to overcrowding of patients who need hospitalization, which can be due to liver involvement in these patients. This study was conducted to assess the relationship between liver enzymes in COVID-19 patients and the need for hospitalization in the intensive care unit, as well as to investigate its relationship with the length of stay in the intensive care unit. Methods: In this analytical cross-sectional study, 622 hospitalized patients with COVID-19 who referred to Firoozgar Hospital were investigated in terms of length of stay, recovery or death and its relationship with abnormal liver enzymes. Findings: The mean level of AST and ALT in people hospitalized in ICU was 49 (95% CI: 43.4-54.6) and 29.2 (95% CI: 24.1-34.2), respectively, and it was 42.5 (95% CI: 36.7-48.3) and 31.2 (95% CI: 25.8-36.6), respectively, in the general ward. The mean level of AST and ALT in patients hospitalized for less than 7 days was 49.4 (95% CI: 43.9-54.8) and 27 (95% CI: 21.6-32.3), respectively, and in patients hospitalized for more than 7 days was 41.6 (95% CI: 35.6-47.5) and 32.2 (95% CI: 37.3-27.1), respectively. None of the abnormal data was significant based on hospital department and length of stay. Conclusion: The results of this study did not show any significant relationship between the need for admission to ICU and the abnormal levels of liver enzymes. Furthermore, no relationship was found between the length of stay and the severity of liver involvement based on the assessment of abnormal liver enzymes.

A case of category five COVID-19 patient transfused with convalescent plasma

Background: COVID-19 is an emerging infectious disease, caused by a novel coronavirus, named SARS-CoV-2. It emerged in Wuhan city, Hubei province, China in December 2019. Convalescent plasma (CP) has been used in a number of emerging infections for which there are no proven antivirals, including SARS, MERS, and Ebola virus disease (EVD). It may also be a potentially effective treatment strategy for COVID-19 disease before COVID-19 vaccinations was introduced. In this case report, we described a case of a 59 years old lady with no known medical illness or no known drug allergies and she was diagnosed with Covid-19 with Class 4A (requiring nasal prong) on 8/10/2020, her oxygen saturation was 96% under nasal prong. During her initial admission, she was given favipravir and interferon as alternative treatment for Covid-19. Unfortunately, at 3rd day of illness, her oxygen level deteriorated to 94% under nasal prong (72% from arterial blood gas) thus, she was transferred to intensive care unit for non-invasive ventilation support. The next day, she was intubated as her condition worsen. On 5th day of illness, she was transfused with convalescent plasma and subsequently extubated as she improved clinically. Aims: To evaluate the effectiveness of convalescent plasma in treating a case of category 5 Covid-19 patient at Hospital Tuanku Ja'afar. Methods: The data regarding the patient's clinical information was retrospectively collected from the patient case notes and the laboratory information system. Results: Other than clinically improved, we noted the CT value from tracheal aspirate PCR prior to the transfusion was 24.60 while the CT value 48 h post transfusion showed 31.62. This showed that the patient had clinical improvement post convalescent plasma transfusion. Summary/Conclusions: Convalescent plasma should be considered in treatment of Covid-19.

A computational study at blocking probability of the SARS-CoV-2 spike protein through the binding of cellular receptors

In this paper, the SARS-CoV-2 spike encoding gene sequences were analyzed to find the structural homology of S proteins. The S protein of SARS-CoV-2 was obtained from homology modeling and the protein-protein docking was performed to elucidate sites active in S protein for ACE2, dipeptidyl peptidase 4 (DPP4), chemokine receptor 5 (CCR5), and AXL. The two crucial binding sites of S protein, known as RBD and CTD, were investigated. Three-dimensional structures of 8 possible RBD/CTD-receptor complexes were evaluated using molecular dynamic (MD) simulations. The best simulation models of the SARS-CoV-2 S protein active sites with the receptors were obtained for the ACE2 receptor (PDB:6VW1), providing 99.5% and 98.5% coverage for CTD and RBD, respectively. The SARS-CoV- 2 S protein may connect with the ACE2 receptor via the RBD sites of the S protein and the ACE2 peptidase domain (PD), which can be blocked by encoding gene sequence in the active sites of S protein, offering an attractive protection approach against this novel SARS-CoV-2 virus.

A Case Series of COVID-19 Respiratory Infection in Hospitalized Children: Clinical and Computed Tomography Challenges

Our objective was to evaluate clinical and computed tomographic features in hospitalized children with COVID-19 infection who were admitted to the pediatric center of excellence, children's medical center. In this case-series, we report twelve patients with clinical symptoms of acute respiratory infections at the beginning or after admission who have PCR-proved (throat swab samples) COVID-19 infection and underwent computed tomography imaging. Six patients had an underlying disease and atypical findings with no clinical suspicion at the beginning. Tachypnea (75%) represented the most common physical finding. Computed tomography was abnormal in 83.3% of patients. Subpleural consolidation, peribronchial thickening, round consolidation, and Halo sign was depicted. The empirical regimen in our hospital included hydroxychloroquine and oseltamivir. Some of the patients managed easily, but others had prolonged hospital stay, especially patients with significant underlying conditions.

Atypical and novel presentations of Coronavirus Disease 2019: a case series of three children.

Typical presentations of Coronavirus Disease 2019 (Covid-19) including respiratory symptoms (cough, respiratory distress and hypoxia), fever and dyspnoea are considered main symptoms in adults, but atypical presentation in children could be a diagnostic challenge. We report three children whose initial presentation was gastrointestinal, and in whom Covid-19 infection was found, concluding that cases of acute appendicitis, mesenteric adenitis and flank tenderness may mask an infection with this virus, and should therefore be investigated.

Liver enzymes and inpatient deaths in COVID-19 hospitalized patients

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [COVID-19] quickly turned into a pandemic. Gastrointestinal involvement, especially liver diseases, is one of the main complications of COVID-19 patients. Objectives: The current study aimed to evaluate the high incidence of liver involvement in COVID-19 hospitalized patients and its association with mortality. Methods: A total of 560 hospitalized patients with a confirmed diagnosis of COVID-19 were included. Death was considered as the outcome. In addition to liver enzymes, demographic, clinical, and other laboratory data were also collected. Alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels_ 40 were considered as abnormal. To investigate the association between abnormal levels of liver enzymes and death, multiple regression logistic was used. Results: According to the findings, 29.1% (95% CI = 25.3% - 32.9%) of patients had high levels (_ 40 IU) of ALT, and 45.1% (95% CI = 40.9% - 49.3%) had high levels of AST (_ 40 IU). The frequency (based on %) of high levels of AST (_ 40 U/liter) was significantly higher in patients who died [67.3% (95% CI = 54.5% - 80.1%] of COVID-19 than those who survived [44.9% (95% CI = 39.7% - 50.0%)] (Pvalue < 0.001). No significant difference was detected in ALT between expired [29.1% (95% CI = 16.7% - 41.5%)] and survived patients [30.7% (95% CI = 25.9% - 35.5%] (P-value = 0.791). AST was found to have an independent association with death in multiple logistic regression (Wald = 4.429, OR (95% CI) = 1.014 (1.008 - 1.020), P-value = 0.035). Conclusions: Liver involvement is a common finding in COVID-19 hospitalized patients. Higher levels of AST were significantly associated with an increased mortality rate in COVID-19 patients.