Point-of-Care Testing in Primary Care

Point-of-care testing (POCT) in pediatric primary care is essential for clinicians to make a timely and accurate diagnosis. The COVID-19 pandemic has highlighted the importance of timely and accurate testing strategies to correctly identify the etiology of upper and lower respiratory infections. Additionally, pediatric POCT continues to be important in rural and underserved communities where access to hospital laboratories may be less available. This chapter will focus on seven rapid tests: Group A streptococcus (GAS), influenza A & B, SARS-CoV-2 (COVID-19), human immunodeficiency virus (HIV), C-reactive protein (CRP), human chorionic gonadotropin (hCG), and hemoglobin A1c (HbA1c). © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Predictors of Mortality in Sepsis Patients Resulting from Severe and Critical COVID-19

Patients with severe and critical COVID-19 may exhibit sepsis and mortality resulting from multi-organ failure. Neutrophil-lymphocyte-ratio (NLR) values, C-reactive protein (CRP) levels, sequential organ failure assessment (SOFA), and acute physiology and chronic health evaluation II (APACHE-II) scores were used to assess the risk of mortality in sepsis patients resulting from severe COVID-19 infection. The adequacy of NLR, CRP, SOFA, and APACHE-II scores were evaluated as predictors of mortality in septic COVID-19 patients at Dr. Kariadi Hospital Semarang, Indonesia, between August 2021 and July 2022. The subjects included severe and critical COVID-19 patients who fulfilled the WHO interim guidelines and Sepsis-3 criteria. A total of 211 patients were included, which were divided into survivor (n = 116) and non-survivor (n = 95) groups. NLR values, CRP levels, SOFA, and APACHE-II scores were measured within 24 hours of patient admission. Univariate and multivariate logistic regression analyses were used to identify the risk factors for COVID-19 mortality. Receiver operating characteristic curve analysis was used to predict the mortality of severe COVID-19 patients. The results indicated that the APACHE-II score was an independent predictor of mortality in sepsis patients resulting from severe and critical COVID-19. © 2023 by SPC (Sami Publishing Company).

C-Reactive Protein (CRP): A poor prognostic biomarker in COVID-19.

Introduction: The COVID-19 pandemic continues to be rampant with considerable morbidity and mortality worldwide since its emergence in December 2019. Several studies have focused on identifying different predictive factors of poor prognosis, including biological markers, such as C Reactive Protein among others. The objective of our work was to determine whether the CRP levels on admission to the intensive care unit are predictive of an unfavorable evolution of patients with COVID-19 through the experience of the Anesthesia and Intensive Care Unit of the University Hospital of Oujda and to compare our results with those reported in the literature. Methods: We conducted a retrospective, monocentric, descriptive and analytical study in the Department of Anesthesia and Intensive Care of the Mohammed VI University Hospital of Oujda, Morocco, between March 2020 and October 2021, including all critically ill patients admitted to the department during this period and meeting the inclusion criteria. The baseline admission CRP value was arbitrarily set at 100mg/d, thus conditioning the division of our patients into two groups (group 1: CRP < 100mg/L, group 2: CRP ≥ 100mg/L). Results: Among our 1035 included patients, 291 patients with had a CRP<100mlg/L (group 1) and 744 presented a CRP level equal or superior to 100mg/L (group 2). Lung parenchymal involvement was more severe or even critical (CT involvement > 75%) in group 2 (60.8%) compared to group 1 (39.2%). In group 2, 79.8% of patients were mechanically ventilated, compared to 20.2% of patients in group 1. Finally, the mortality rate in patients with a CRP ≥ 100mg/l was 77.4%, compared with 22.6% for patients with a CRP < 100mg/l. These findings are all statistically highly significant (p<0.001). Conclusion: Given the high contagiousness of the virus and the emergence of several variants, the management of the COVID-19 pandemic has focused more on prevention through vaccination against the virus, but also on an early identification of patients likely to evolve unfavorably for a personalized management.

Study immunity and genetic in Covid 19

The aim of this study was to determine the immue function of human leukocyte antigens and some vital indicators in Covid 19 patients. This study was conducted at Ibn Al-Khatib hospital, Baghdad. Sixty four blood sample of Covid 19 patients (32male and 32female patients), while healthy volunteers group 15 male and 15 female with age between 10 to 60. Level of IL-1b, CD4, WBC, ESR, Urea, sugar test, were measured,results showed a significant increase (P<0.01) in each measured of IL-1b, CD4, WBC, ESR, Urea, Sugar. The more infection of Covid 19 with some factors such as, smoking, chronic diseases. The measurement of the level of IL-1b, CD4 by means of the enzyme - linked immunosorbent assay (ELISA), and WBC, PLT, measurement method using ABX micros 60 hematology analyzer, Urea, Sugar semi-automated chemistry analyzer using Mindray BC-5000. The data was analyzed with Graph pad prism software. © 2023 Author(s).

Effect some parameter of immunity CD4 and IL1 in Covid 19

The aim of this study was to determine the immune function of human leukocyte antigens and some vital indicators in Covid 19 patients. This study was conducted at Ibn Al-Khatib hospital, Baghdad. Sixty four blood sample of Covid 19 patients (32 male and 32 female patients), while healthy volunteers group 15 male and 15 female with age between 10 to 60. Level of IL-1b, CD4, WBC, ESR, Urea, sugar test, were measured results showed a significant increase (P<0.01) in each measured of IL-1b, CD4, WBC, ESR, Urea, Sugar. The more infection of Covid 19 with some factors such as, smoking, chronic diseases. The measurement of the level of IL-1b, CD4 by means of the enzyme - linked immunosorbent assay (ELISA), and WBC, PLT, measurement method using ABX micros 60 hematology analyzer, Urea, Sugar semi-automated chemistry analyzer using Mindray BC-5000. The data was analyzed with Graph pad prism software. © 2023 Author(s).

COVID-19 Biomarkers at the Crossroad between Patient Stratification and Targeted Therapy: The Role of Validated and Proposed Parameters.

Clinical knowledge about SARS-CoV-2 infection mechanisms and COVID-19 pathophysiology have enormously increased during the pandemic. Nevertheless, because of the great heterogeneity of disease manifestations, a precise patient stratification at admission is still difficult, thus rendering a rational allocation of limited medical resources as well as a tailored therapeutic approach challenging. To date, many hematologic biomarkers have been validated to support the early triage of SARS-CoV-2-positive patients and to monitor their disease progression. Among them, some indices have proven to be not only predictive parameters, but also direct or indirect pharmacological targets, thus allowing for a more tailored approach to single-patient symptoms, especially in those with severe progressive disease. While many blood test-derived parameters quickly entered routine clinical practice, other circulating biomarkers have been proposed by several researchers who have investigated their reliability in specific patient cohorts. Despite their usefulness in specific contexts as well as their potential interest as therapeutic targets, such experimental markers have not been implemented in routine clinical practice, mainly due to their higher costs and low availability in general hospital settings. This narrative review will present an overview of the most commonly adopted biomarkers in clinical practice and of the most promising ones emerging from specific population studies. Considering that each of the validated markers reflects a specific aspect of COVID-19 evolution, embedding new highly informative markers into routine clinical testing could help not only in early patient stratification, but also in guiding a timely and tailored method of therapeutic intervention.

Statistical Processing of Relationship Between Biomarkers and Disease Severity Caused by COVID-19 Infection-Delta Variant

Severe infectious disease caused by acute respiratory syndrome, COVID-19 (SARS-CoV-2), spread rapidly worldwide, infecting several million people. According to scientific data, the disease develops through several different stages. After 2–4 days of infection and disease development, the lower respiratory tract is attacked and in a relatively short time interstitial pneumonia develops in a certain number of patients (with genetic predisposition between 5 and 10% of cases). Patients infected with COVID-19 have symptoms such as very high temperatures, fever, persistent cough, joint and bone pain, in some cases diarrhea, and loss of appetite and taste. Disease monitoring should primarily include erythrocyte sedimentation rate, leukocyte count, leukocyte count formula, C-reactive protein (CRP), determination of troponin I (hsTnI) and T (cTnT) levels, N-terminal pro-B natriuretic peptide (NT-proBNP), fibrinogen, and D-dimer level. Previous studies have shown that in pneumonia developed from chronic and acute obstructive pulmonary infections, high levels of D-dimer are observed in patients, and it is suggested that this parameter can be used as a specific prognostic biomarker, and the values higher than > 1000 ng/ml represent increased risk factors for mortality in patients with COVID-19. Because vascular thrombosis affects the promotion of an unfavorable clinical progression for the patient, the identification of early and accurate predictors of the worst outcome seems to be essential for timely and appropriate anticoagulant treatment in patients with SARS-CoV-2 infection. Overall, these data suggest that acute myocardial damage, or heart failure, may be an important indicator of disease severity and adverse prognosis in patients with COVID-19. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Cluster Analysis of Biochemical Markers as Predictor of COVID-19 Severity

Numerous blood biomarkers are altered in COVID-19 patients;however, no early biochemical markers are currently being used in clinical practice to predict COVID-19 severity. COVID-19, the most recent pandemic, is caused by the SRS-CoV-2 coronavirus. The study was aimed to identify patient groups with a high and low risk of developing COVID-19 using a cluster analysis of several biomarkers. 137 women with confirmed SARS CoV-2 RNA testing were collected and analyzed for biochemical profiles. Two-dimensional automated hierarchy clustering of all biomarkers was applied, and patients were sorted into classes. Biochemistry marker variations (Ferritin, lactate dehydrogenase LDH, D-dimer, and C- reactive protein CRP) have split COVID-19 patients into two groups(severe cases and non-severe cases groups). Ferritin, lactate dehydrogenase LDH, D-dimer and CRP were markedly increased in COVID-19 patients in the first group (severe cases). Our findings imply that early measured levels of (Ferritin, lactate dehydrogenase LDH, D-dimer, and C- reactive protein CRP) are linked to a decreased probability of COVID-19 severity. Elevated levels of this biomarker may predict COVID severity development. © 2022 University of Baghdad. All rights reserved.

A Retrospective Analysis of the Importance of Biochemical and Hematological Parameters for Mortality Prediction in COVID-19 Cases.

Introduction The recent coronavirus disease 2019 (COVID-19) pandemic has devastated the world's health and economy and has devastatingly affected social and emotional spheres. Although it was the older population who faced the worst, a good number of the younger population also lost their lives. It was very important to predict who will progress to the worst clinical outcome. Consequently, quick and accurate ways of forecasting mortality in COVID-19 cases are essential to save lives. In this study, 11 predictive parameters, namely, D-dimer, creatinine, C-reactive protein (CRP), lactate dehydrogenase (LDH), ferritin, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), systemic inflammatory index (SII), platelet count, absolute neutrophil count (ANC), and absolute lymphocyte count (ALC), were studied for determining their significance as predictive parameters of mortality in COVID-19-affected patients. Methods We conducted a retrospective study of essential parameters, namely, D-dimer, creatinine, CRP, LDH, ferritin, NLR, PLR, SII, platelet count, ANC, and ALC, in confirmed COVID-19 cases for one year between 2020 and 2021. The medical information was obtained from the digital storage sources of the hospital. All cases were segregated into surviving and non-surviving cases. All parameters were collected, results were tabulated, and each individual parameter was then analyzed to see if it showed any significant deviations in non-surviving cases and could help predict mortalities. Statistical analysis was conducted using the latest version of the Statistical Package for the Social Sciences (SPSS) software (IBM SPSS Statistics, Armonk, NY, USA). Results Each of the parameters was individually studied. D-dimer, creatinine, LDH, ferritin, CRP, NLR, PLR, SII, and ANC showed a statistically significant increase in non-surviving cases. Compared to surviving cases, ALC and platelets showed a statistically significant decrease in non-surviving instances. Conclusion All the studied parameters showed significant deviations in non-surviving cases and could help predict mortalities. This study also stresses the utility of readily available hematological ratios such as NLR and SII for prognosis in COVID-19 subjects.

Demographic Characteristics of the Patients with Cutaneous Vasculitis Due to COVID-19 Infection.

Background: Cutaneous manifestations of coronavirus disease 2019 (COVID-19) range from mild skin rashes to severe vasculitis. In the current study, we evaluated the demographic characteristics of the patients with cutaneous vasculitis following COVID-19 infection. Materials and Methods: In the current study, we evaluated 799 hospitalised patients with COVID-19 infection for development of cutaneous vasculitis. Demographic and clinical characteristics of the patients were obtained using questionnaires and patients' records. Cutaneous vasculitis of the suspected patients were confirmed using skin biopsy and direct immunofluorescence. Results: We detected 24 hospitalised cases with cutaneous vasculitis presenting with petechia, purpura, livedoretcularis and acrocyanosis. Our data showed a significant relationship between male sex, advanced age, C-reactive protein (CRP) level and presence of comorbidities with development of cutaneous vasculitis. In addition, we found a positive association between the severity of COVID-19 infection and occurrence of cutaneous vasculitis. Conclusion: Our findings are suggestive that clinicians must be aware of cutaneous vasculitis risk as prognostic value in the patients with severe COVID-19 infection.

termination of xanthine, hypoxanthine and c- reactive protein in the serum of patients of coronavirus and patients vaccinated with fizer

Background: The coronavirus associated with severe acute respiratory syndrome type 2 causes Coronavirus disease 2019 (COVID-19) (SARS-CoV-2). Xanthine is a purine nucleotide that is found in the majority of human tissues and fluids, as well as other biota. Hypoxanthine is a purine derivative that occurs naturally. C-reactive protein (CRP) is an annular (ring-shaped) pentameric protein that is detected in blood plasma and whose circulating levels increase in response to inflammation. The aim of the current study is evaluation of serum (Xanthine, Hypoxanthine, and C-RP) patients of COVID-19 (vaccinated and unvaccinated) with P-fizer vaccine.Methods: The study was done in Babylon University/College of Science. Study continued five months from 3-1 to 3-5 - 2022.. 150 samples of blood were obtained from three groups.50 blood samples were obtained from healthy people (group I), 50 blood samples were drawn from COVID-19 patients unvaccinated (group II), and 50 samples were obtained from COVID-19 patients vaccinated with P-fizer (group III). The target parameters were (Xanthine, Hypoxanthine, and C-RP). (Xanthine and Hypoxanthine) were measured by HPLC instruments. C-RP was measured by the ichroma instrument.Results: The result showed age was shown to be not significant between groups. Xanthine showed a significant increase in the non-vaccinated group of patients compared to the rest of the groups, where it was 2.16 ± 0.02, While in the vaccinated group, it was 0.68 ± 0.01. Hypoxanthine also showed a significant increase in unvaccinated patients. CRP showed a significant increase in unvaccinated patients.Conclusion: The current study concluded that the Pfizer vaccine had an effect on (Xanthine, Hypoxanthine,C-reactive protein (CRP)) concentrations for the better in the vaccinated group of patients. © 2022, ResearchTrentz Academy Publishing Education Services. All rights reserved.

COVID-19 Vaccination-Induced Cholangiopathy and Autoimmune Hepatitis: A Series of Two Cases.

The coronavirus disease 2019 (COVID-19) pandemic has been associated with significant morbidity and mortality. Following the introduction of vaccines, various side effects have been reported. Whilst those reported may be attributed to the vaccine itself, at times, it may simply incite an immunological phenomenon. We present a case series of two patients who presented with symptoms of yellowing of the eyes and the skin along with fatigue, and tiredness, following vaccination for COVID-19. The diagnosis of post COVID-19-vaccination related hepatitis is one of the fewer, less understood, yet reported side effects associated with significant morbidity. The diagnosis of COVID-19 vaccination-related cholangitis is an outcome reported here for the first time to the best of our knowledge. It was alarming that both patients did not have any significant past history of medical ailments. A prompt assessment followed by investigations including liver biopsy assisted in a timely understanding of the phenomenon with complete resolution of the symptoms.

Prevalence and Clinical Significance of Antiphospholipid Antibodies in Hospitalized Patients With COVID-19 Infection.

BACKGROUND: Coronavirus disease 2019 (COVID-19) infection is associated with an increased risk of arterial thromboembolic events (ATE) and venous thromboembolic events (VTE). Hypercoagulability associated with COVID-19 infection is multifactorial, and underlying pathogenic mechanisms potentially responsible for thrombosis include inflammation resulting in endothelial damage, platelet activation and the presence of antiphospholipid antibodies (APAs). Antiphospholipid antibody syndrome is one of the very few causes which is associated with venous and arterial thromboembolic events. COVID-19 patients have a high prevalence of APAs as well as both ATE and VTE, but their clinical significance in COVID-19 patients is not fully understood yet. OBJECTIVES: In this study, we intend to find the prevalence of APAs in hospitalized COVID-19 patients at the time of diagnosis and determine whether their presence has any clinical significance. METHODS: This is a retrospective single-institution study involving patients hospitalized for the management of COVID-19 infection at The University of Toledo Medical Center. After obtaining approval from the biomedical institutional review board at The University of Toledo, antiphospholipid antibody (APA) testing was done on pre-stored blood samples of these patients and hospital charts were reviewed till six months from the positive COVID-19 test result. Two groups were created based on the patients' APA testing results (APA positive and APA negative) and used for statistical comparison. Any patients with positive lupus anticoagulant (LA) or abnormal titers APA antibodies were labeled as positive. Demographic data, prognostic outcomes and laboratory values were compared either using Mann-Whitney U-test for continuous variables or Fisher's exact test for categorical variables. RESULTS: The prevalence of APAs in hospitalized COVID-19 patients at the time of diagnosis was 39.3% in this study. There was no difference in demographic variables between the APA-positive and APA-negative groups. The prevalence of APAs was higher in smokers, where 91% of the APA-positive patients were smokers. There was no statistically significant difference in prognostic outcomes including six-month mortality between APA-positive and APA-negative patients. The comorbidity profile was the same in the two groups. APA-positive patients were found to have lower nadir of absolute lymphocyte count and higher nadir levels of C-reactive protein during hospitalization. CONCLUSIONS: The prevalence of APA positivity in hospitalized COVID-19 patients is higher in our study than in historical studies involving non-COVID-19 hospitalized patients, particularly in smokers. However, there is no correlation between APA positivity and prognostic outcomes including six-month mortality. At this point, it is unclear whether APAs are just bystanders or have a pathogenic role. Routine testing of APA in COVID-19 patients is not indicated. Further prospective studies to elucidate the persistence and clinical implications of APAs are needed.

C-reactive protein (CRP) and Lactate Dehydrogenase (LDH) as diagnostic and early prognostic marker of adverse disease outcomes in critical COVID-19 patients

Background: We used standard laboratory test to determine tissue injury and inflammatory state on the physiological condition of fever, cough, headache in 672 patients tested for CRP and 407 patients tested for LDH out of a total of 994 COVID-19 admissions during the period of April 2021-September 2021 at Parul Sevashram Hospital, Vadodara. The data was stratified based on the survivor/non-survivor status and severity of disease condition based on Ward or ICU admissions. The results were correlated with the vales of serum CRP and LDH levels for determining their prognostic significance. Patients and Methods: This is a retrospective, singlecentre, observational study using the data collected from MRD division through electronic records and standardized data collection template. It included patients who were tested for CRP and LDH at times of admission. Mean, Standard deviation, Median and Interquartile range (IQR) were used to present continuous variables. Student’s t-test was used for testing differences between the two groups applicable. For study of single variables, Z-score was performed. The SPSS version 16 software was used for performing linear regression in this study and statistical analysis was done. Result: Among 994 total enrolled patients with COVID-19, 672/994 (67.7%) patients were tested for CRP and 407/994 (40%) for LDH at the time of hospitalization. Our COVID-19 patients showed elevated concentration of LDH (median 699 U/L (IQR 485-1040);normal range 80-285), elevated CRP (median 48.35 mg/L (IQR 20.7-74.4);normal range <6.0), LDH values (median)(U/L) have been found to be significantly higher in non-survivors [791(588-1495)] as compared to the survivors [699 (492-1010)], (P value <0.0001). Moreover, the values of serum CRP (mg/L) were also higher in the non-survivor group as compared to the survivor group. [64.7(39.5-97.5) versus 39.8(16.9-67.15)]. This difference was highly significant (P value 2.92461E-11). Conclusion: LDH and CRP levels can assist to identify COVID-19 patients with the acute respiratory failure and at high risk of fatality. A high LDH may be related to tissue damage and high CRP related to inflammatory markers. Both the markers significantly correlate with increased incidences of death in COVID-19 patients. © 2022 by the Author(s).

Comparison of clinical outcomes and risk factors for COVID-19 infection in cancer patients without anticancer treatment and noncancer patients.

Background: Previous studies have shown that cancer patients have higher rates of coronavirus disease 2019 (COVID-19) infection and mortality than noncancer patients. However, the differences between cancer patients undergoing regular follow-up without anticancer treatment and noncancer patients with COVID-19 have remained insufficiently investigated. Methods: A retrospective case-control study of 52 patients with COVID-19 infection was performed with a 1:3 matched proportion of cancer patients undergoing regular follow-up without anticancer treatment and noncancer patients. The demographic characteristics, clinical data, laboratory tests, treatment, and complications of patients were collected from medical records. Chi-square tests and univariate and multivariate regressions were performed to assess the differences between these two cohorts of COVID-19 patients with and without cancer and risk factors for severe events in COVID-19 patients. Results: Increased C-reactive protein (CRP) (>4 mg/L) (p = 0.015) and lactate dehydrogenase (LDH) (>243 IU/L) (p = 0.038) were identified as risk factors for severe events in all enrolled COVID-19 patients based on multivariate analysis, but cancer as a chronic disease (p = 1.000) was not identified as an independent risk factor for severe events in COVID-19 patients. Compared with noncancer patients, cancer patients had a significantly longer median hospitalization time (29 days vs. 19 days, p = 0.048) and a higher incidence of hypoalbuminemia complications (84.6 vs. 46.2%, p = 0.016). Conclusions: Increased CRP and LDH were risk factors for severe events in all enrolled COVID-19 patients, and an increased incidence of hypoalbuminemia complications and longer hospitalization were noted in COVID-19 cancer patients undergoing regular follow-up without anticancer treatment compared with noncancer patients.

Analysis of blood samples from 42 patients with varying degrees of infection during the epidemic of COVID-19: a retrospective study.

BACKGROUND: Blood samples from 42 patients with coronavirus disease 2019 (COVID-19) with varying degrees of infection were examined to further explore the relationship between clinical features, immune factors and COVID-19, as well as the diagnostic and predictive values of clinical features and immune factors in severe disease progression. METHODS: This study included 42 nucleic acid-positive COVID-19 patients admitted to the First Hospital of Jiaxing from January 26, 2020 to February 21, 2020, who were divided into mild-moderate group and severe group based on respiratory rate, resting oxygen saturation and alveolar oxygen partial pressure/O2 inhalation. On February 21, 2020, clinical data including sex, age, body mass index (BMI), past medical history, clinical symptoms, hematology indexes [white blood cell (WBC); neutrophil (NEUT); lymphocyte (LYM); C-reactive protein (CRP)] were collected. The chi-square test was used to compare the clinical data differences between the two groups, so as to perform comparative analysis in the context of serious disease development. RESULTS: There were 8 cases of severe disease, and 34 cases of mild and moderate symptoms. Comparative analysis showed that patients with advanced age (≥60 years, OR =5.800, P=0.0286), history of hypertension (OR =5.800, P=0.0286) and pulmonary lobe lesions (≥4, OR =6.273, P=0.0270) were more likely to develop serious diseases. In addition, according to clinical symptoms, chest pain was more prominent in patients with severe disease. Laboratory tests showed that levels of WBC (severe 4.96±1.76 vs. mild-moderate 5.45±2.01, P=0.5300), NEUT (severe 3.56±1.44 vs. mild-moderate 3.94±1.87, P=0.5945) and LYM (severe 0.91±0.25 vs. mild-moderate 1.11±0.51, P=0.2903) were normal or decreased, but CRP level (severe 31.03±9.38 vs. mild-moderate 12.53±15.73, P=0.0029) was obviously increased, especially in patients with severe disease, with statistically significant difference between groups. CONCLUSIONS: Patients with hypertension and advanced age are more likely to develop deteriorate with COVID-19, and the number of lung lobes with lesions and chest pain may indicate disease progression. Notably, CRP level is significantly elevated in severe disease and it may be closely related to COVID-19 progression.

Serum albumin levels monitoring in ICU in early days and mortality risk association in patients with moderate to severe COVID-19 pneumonia.

Objective: To establish correlation between serum albumin during early days of ICU admission and risk of death in COVID-19 pneumonia. Methods: In this retrospective study, we included 76 patients hospitalized in ICU, who stayed for at least four days with COVID-19 pneumonia, from May 1, 2020 to June 30, 2020 in Lahore Health Care Hospital and Al-Shafi Hospital. Patients were labelled as COVID-19 pneumonia on radiological basis as bilateral 'ground-glass opacity' in lower zones and RT-PCR positive result in nasopharyngeal swab. All patients were oxygen dependent, either on high flow oxygen via non rebreathing mask or invasive positive pressure ventilation support. Serum albumin levels were measured daily from first day to fourth day of ICU admission. The data was analyzed using SPSS version 26 and Microsoft excel 2016. Results: Out of 76 patients of COVID-19 pneumonia admitted in ICU who stayed for more than four days, 38 patients expired. The mean age of all the patients was 58.9±12.56 years, 38(50%) of the patients were ≥60 years and 49 (62%) of them were male. On day four of ICU admission, mean serum albumin of discharged patients was 3.83±0.22 g/dl while mean serum albumin level of expired patients was 2.96±0.46 g/dl. Strong negative correlation (r = -767) was found between decrease in serum albumin level and increase number of deaths from COVID-19 pneumonia. Weak correlation was observed between increase in serum CRP and increase number of deaths in the same patients. Conclusion: Daily monitoring of serum albumin level of COVID-19 pneumonia patients can be used as a biological marker for monitoring of cytokine storm and risk of death in COVID-19 pneumonia.

Oxidative stress status and vitamin D levels of asymptomatic to mild symptomatic COVID-19 infections during the third trimester of pregnancy: A retrospective study in Metz, France.

It is believed that the subtle equilibrium between tolerance and immunity during the unique biological state of pregnancy, which is characterized by further physiological and hormonal changes, rends pregnant women more vulnerable to coronavirus disease 2019 (COVID-19). In this retrospective study, confirmed COVID-19-positive pregnant women (n = 15) during their third trimester, comprising asymptomatic (n = 7) and mild symptomatic (n = 8), and healthy pregnant controls (n = 20), were enrolled between June 1, 2020 and  June 1, 2021 from the Hospital CHR Metz-Thionville in Metz, France. Vitamin D concentrations, C-reactive protein (CRP), and oxidative stress markers including superoxide dismutase (SOD), catalase (CAT), reduced (GSH) and oxidized (GSSG) glutathione levels, hydrogen peroxide (H2 O2 ), and the total antioxidant capacity, measured the ferric reducing ability of plasma (FRAP), were evaluated in the serum of patients and controls. Results showed that all pregnant women (patients and controls) enrolled in this study were vitamin D deficient (<20 ng/ml). However, mild COVID-19 pregnant women were severely vitamin D deficient (<12 ng/ml), which may suggest a link between vitamin D deficiency and the symptomatology of COVID-19 illness in singleton pregnancy. No differences between the levels of CRP and the majority of the studied oxidative stress markers in COVID-19-positive pregnant women (asymptomatic and/or mildly symptomatic patients) versus COVID-19-negative pregnant women were found, suggesting the absence or a low magnitude of oxidative stress in pregnant women with COVID-19. This may also explain the absence of severe courses of COVID-19 infection. More studies are warranted to investigate the role of vitamin D supplementation and antioxidant-rich diets in the prevention against severe forms of COVID-19 in pregnant women.

A comparative analysis of clinical characteristics in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between Wuhan and Zhoushan, China.

BACKGROUND: We aimed to identify any differences in the clinical characteristics of patients treated in Zhoushan Hospital and Wuhan Fourth Hospital, Gutian campus to provide insights into measures to better control the coronavirus disease 2019 (COVID-19) pandemic and treat COVID-19 patients. METHODS: All cases included in this retrospective study from January 10, 2020 to March 15, 2020 were confirmed by laboratory detection of SARS-CoV-2. Data of epidemiological characteristics, clinical characteristics, laboratory results, radiological findings, treatments, and outcomes were obtained from electronic medical records and compared between the patient groups. RESULTS: A correlation analysis was performed to detect correlations between the serum C-reactive protein (CRP) level and other laboratory findings. COVID-19 patients treated in Wuhan more commonly had fever and shortness of breath, and less commonly had headache compared to those treated in Zhoushan (P=0.002, 0.039, and 0.015, respectively). The period from illness onset to hospitalization in Wuhan was 11.7±7.2 days, which was longer than that in Zhoushan (4.2±3.7 days; P=0.002), whereas the period from illness onset to shortness of breath in Wuhan was 5.4±5.0 days, which was shorter than that in Zhoushan (14.0±5.6 days; P=0.020). Computed tomography scans showed linear opacities, reticulation, and patchy shadows more commonly in cases treated in Wuhan (P=0.016, 0.013, and 0.008, respectively). The mean CRP level in Zhoushan patients was lower than that in Wuhan patients (P<0.001), and the CRP level was correlated with several laboratory findings related to the immune response. CONCLUSIONS: COVID-19 patients treated at Wuhan Fourth Hospital, Gutian campus had more severe symptoms than those treated at Zhoushan Hospital. Earlier in-hospital treatment, as conducted in Zhoushan, may be beneficial in reducing the severity of illness in COVID-19 patients. Additionally, the correlations between the CRP level and indicators of immune function in COVID-19 patients warrant further investigation.

Interleukin-6 in SARS-CoV-2 induced disease: Interactions and therapeutic applications.

Interleukin-6 (IL-6) is a multi-tasking cytokine that represents high activity in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and cancer. High concentration of this pleiotropic cytokine accounts for hyperinflammation and cytokine storm, and is related to multi-organ failure in patients with SARS-CoV-2 induced disease. IL-6 promotes lymphopenia and increases C-reactive protein (CRP) in such cases. However, blockade of IL-6 is not a full-proof of complete response. Hypoxia, hypoxemia, aberrant angiogenesis and chronic inflammation are inter-related events occurring as a response to the SARS-CoV-2 stimulatory effect on high IL-6 activity. Taking both pro- and anti-inflammatory activities will make complex targeting IL-6 in patient with SARS-CoV-2 induced disease. The aim of this review was to discuss about interactions occurring within the body of patients with SARS-CoV-2 induced disease who are representing high IL-6 levels, and to determine whether IL-6 inhibition therapy is effective for such patients or not. We also address the interactions and targeted therapies in cancer patients who also have SARS-CoV-2 induced disease.