Iron deficiency anemia and COVID-19

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a significant health and financial issue in the current century. Despite significant attempts to manage the illness, the transmission routes of the virus and its widespread genomic mutations have led to an increasing number of new infections and mortality rates. In the absence of specific treatment for this new virus, identifying and managing factors affecting the prognosis of the disease is one of the critical strategies to reduce disease mortality. Patients with iron deficiency anemia (IDA), who account for an estimated half a billion people globally, are more prone to infections due to immune system disorders. Since they visit hospitals more frequently for follow-up care and diagnosis, they are more susceptible to becoming infected with SARS-CoV-2. Once infected with SARS-CoV-2, low hemoglobin (Hb) levels and compromised immune systems disrupt the restriction of infection in these individuals, ultimately leading to severe complications of COVID-19.

Convalescent plasma transfusion in severe or critically ill COVID 19 patients: a rapid systematic review

Currently, there is no availability of any proven specific treatment or prevention strategy to fight against COVID-19. Convalescent plasma (CP) therapy is expected to increase survival rates in COVID-19 as in the case of emerging viral infection (SARS-CoV and MERS-CoV). To collect all the studies relevant to CP therapy in critically ill or severe COVID-19 patients and summarize the findings. The systematic review was conducted according to the PRISMA consensus statement. A systematic search was performed in PubMed, Scopus, Web of Science, and Cochrane databases on April 25, 2020. A total of six studies (28 patients) relevant to CP therapy in severe or critical COVID-19 are considered for inclusion. Two authors extracted the data about study characteristics, demographics, symptoms, co-morbidities, clinical classification of COVID-19, drug therapies, oxygen therapy, laboratory results, chest CT, neutralizing antibody titer, SARS-CoV-2 RNA load, aal outcome. The review findings revealed that CP therapy increases lymphocyte count, reduced s serum inflammatory markers (CRP, IL-6, Procalcitonin) and liver enzyme levels (AST or ALT). There was a rise in serum neutralizing antibody titers in 10 of 14 patients after CP transfusion. In 4 of 14 patients, the titer levels remain unchanged after CP transfusion. All 28 cases (100%) achieved negative to the SARS-CoV-2 RNA after CP transfusion. The convalescent plasma transfusion can improve neutralizing antibody titers and reduces the viral load in severe/critical COVID-19 patients. The review recommends a well-controlled trial design is required to give a definite statement on the safety and efficacy of convalescent plasma therapy in severe/critical COVID-19.

An outbreak of school influenza complicated with Mycoplasma pneumoniae infection

Objective: To describe the clinical features, causal agent and transmission mode of a fever outbreak in a school in Shanghai. Methods: Field epidemiological approaches including case definition development, searching for contacts, distribution of diseases description, environmental sampling and laboratory testing. Results: A total of 16 influenza-like cases were included, all concentrated in the one class of grade two, including 15 students and 1 teacher. Among student cases, the incidence rate was 36.59%(15/41), the average age was 7.4 years, the incidence rate was 36.84%(7/19) for boys, 36.36%(8/22) for girls. The clinical course was 5-15 days, with the median of 9 days, and 18.75%(3/16) of the cases stayed studying while sick. The nasopharyngeal swab specimens in 16 cases all tested positive for influenza B, of which 11 tested positive for mycoplasma pneumoniae and 1 case also tested positive for coronavirus OC43. Body temperature, number of mononuclear cells, and treatment time of patients infected with Influenza B and mycoplasma pneumoniae were higher than those of patients infected with influenza B alone(P < 0.05). The outbreak lasted for 12 days, all sick students were treated and discharged from hospital, with no severe cases or death, and the outbreak was effectively controlled. Conclusion: This campus cluster outbreak caused by influenza B and mycoplasma pneumoniae. Patients with influenza B with mycoplasma pneumoniae have severe symptoms and a long course of illness, suggesting the importance of early management of the epidemic.

Assessment of serum neopterin levels in patients hospitalized with severe COVID-19

Background: COVID-19 has caused a considerable number of hospital admissions in China since December 2019. Many COVID-19 patients experience signs of acute respiratory distress syndrome, and some are even in danger of dying. Background: to measure the serum levels of D-dimer, Neutrophil-Lymphocyte count ratio (NLR), and neopterin in patients hospitalized with severe COVID-19 in Baghdad, Iraq. And to determine the cut-off values (critical values) of these markers for the distinction between the severe patients diagnosed with COVID-19 and the controls. Materials and methods: In this case-control study, we collect blood from 89 subjects, 45 were severe patients hospitalized in many Baghdad medical centers who were diagnosed with COVID-19 infection, and 44 were apparently healthy subjects as a control. The time of collection is from September 15 th to December 31 th, 2021. The optimal cut-off points (critical values) and prognostic relevance of D-dimer, Neutrophil-Lymphocyte count ratio (NLR), and neopterin were investigated using (ROC) curves analysis. Results: In severe patients hospitalized with COVID-19 the levels of D-dimer, NLR, and neopterin were statistically significantly higher than in control participants (P < 0.005). The D-dimer, NLR, and neopterin tests have areas under the receiver operating characteristic (ROC) curves of 0.920, 0.90, and 0.74 respectively, and their critical values for the differentiation between the severe patients and control were 0.22 micro g/ml, 2.56, and 3.02 nmol/L. Conclusions: D-dimer, NLR, and neopterin levels in sever COVID-19 patients were higher than control, with values of greater than 0.22 micro g/ml, 2.56 and 3.02 nmol/L respectively was linked to a severe COVID-19 infection with good sensitivity and selectivity.

Death risk among COVID-19 patients with diabetes mellitus

Deaths from COVID-19 are increasing in patients with comorbidities. One of the most common comorbidities is diabetes mellitus. The researchers wanted to see how having diabetes affected the mortality rate of COVID-19 participants. This investigation is a case control observational analytical study. Different types of people, called "cases", and "controls", complete the research sample. Each group had 68 responders, for a grand total of 136. Medical records from COVID-19 patients treated at Airlangga University Hospital, Surabaya, between March 2020 and September 2021 serve as the study's secondary data source. The purpose of this study's data analysis is to calculate an odds ratio. Patients with COVID-19 with concomitant diabetes mellitus had an increased risk of death, and this risk increased with age, gender, and COVID-19 symptoms. In contrast, education, occupation, and laboratory results were not significantly related to mortality among COVID-19 individuals with concomitant diabetes mellitus (GDA status). The results of this study show that COVID-19 patients with concomitant diabetes mellitus are at a higher risk of death if they are over the age of 65, if they are male, and if they have severe symptoms.

Molecular investigation of Campylobacter spp. and Salmonella infection in children with community acquired diarrhea

Introduction : Acute gastroenteritis is a typical disorder that accounts for 8-12% of pediatric outpatient visits. Campylobacter and Salmonella infections account for about 8.4% and 11% of global diarrhea cases. Due to the importance of these bacteria in pediatric diseases, the aim of this study was to determine the infectious rate of Salmonella and Campylobacter species and also the frequency of the gene encoding Cytholethal distending toxin in children with community-acquired diarrhea. Materials and Methods: Stool samples of children under 5 years of age with diarrhea were collected. The samples were related to children referred to hospitals in Hamadan, Ardabil, Bandar Abbas and two hospitals in Tehran. DNA was extracted from the samples using a DNA extraction kit from stool. The presence of Campylobacter in the studied samples was detected by polymerase chain reaction using specific primers. A control stool sample was spiked with 10-fold dilution of C. jejuni suspension for LOD (detection limit determination) measurement. Results: In this study, PCR results showed a LOD of 100 CFU per gram in the spiked feces sample. Accordingly, out of 144 fecal samples of children with acute diarrhea, one case was positive for Campylobacter jejuni;this sample was also positive for the presence of cdtB gene. Presence of Salmonella was confirmed in two samples of the patients (1.4%). Conclusion: Low prevalence of Campylobacter and Salmonella was detected in symptomatic children under 5 years of age during the Covid-19 pandemic. Examination of these samples for viruses and other microbial agents can clarify the etiology of diarrhea in children referred to the hospitals.

High mortality among patients with severe COVID-19 and Do Not Intubate orders

INTRODUCTION. Moderate to severe respiratory distress among patients with COVID-19 is associated with a high mortality. This study evaluated ventilator support and mortality by Do Intubate (DI) or Do Not Intubate (DNI) orders. METHODS. This was a retrospective study of patients with COVID-19 and a supplemental oxygen requirement of 15 l/min. The patients were divided into two groups corresponding to the first and second wave of COVID-19 and were subsequently further divided according to DI and DNI orders and analysed regarding need of ventilator support and mortality. RESULTS. The study included 178 patients. The mortality was 24% for patients with DI orders (n = 115) and 81% for patients with DNI orders (n = 63) increasing to 98% (n = 46) for patients with DNI orders and very high flow oxygen requirements ( 30 l/min.). From the first to the second wave of COVID-19, the use of constant continuous positive airway pressure (cCPAP) increased from 71% to 91% (p < 0.001), whereas the use of mechanical ventilation decreased from 54% to 28% (odds ratio = 0.38 (95% confidence interval: 0.17-0.85)). CONCLUSION. The mortality was high for patients with DNI orders and respiratory distress with very high levels in supplemental oxygen in both the first and second wave of COVID-19 despite an increase in use of cCPAP and treatment with dexamethasone and remdesivir during the second wave. Hence, careful evaluation on transition to palliative care must be considered for these patients.

Comparative analysis of factors associated with the severe course of COVID-19 in the age groups under 60 and over 60 years of age

Introduction: Coronavirus infection is a disease that causes respiratory failure and complications in certain groups of people, leading to death. The factors associated with the severe course of COVID-19 have been fairly well studied by now;at the present stage, it is necessary to search for and study them in separate groups of people that differ in age, gender, ethnicity, the presence of background diseases, etc. to develop more personalized approaches to severe disease prevention. Background: To conduct a comparative analysis of the factors associated with the severe course of COVID-19 in people under and over 60 years of age and evaluate their prognostic significance in combination of factors. Materials and methods: A retrospective analysis of the clinical and laboratory parameters of 812 COVID-19 patients was carried out. Multiple logistic regression analysis was used to identify factors associated with the development of severe COVID-19. ROC analysis was performed to assess the prognostic significance of the set of identified statistically significant factors in the development of a severe course of COVID-19. Results: Multivariate logistic regression analysis showed that patients under 60 diabetes mellitus (OR=2,561, p=0,048), lymphopenia (OR=2,133, p=0,030), and pneumonia at admission (OR=2,556, p=0,011), rapid breathing (OR=3,497, p=0,001), low saturation (OR=4,076, p=0,006) were significantly associated with the development of severe COVID-19. At the same time, in patients older than 60 years, the presence of diabetes mellitus (OR=1,899, p=0,029), rapid breathing (OR=2,338, p=0,007) and low saturation (OR=4,248, p < 0,0001) were significantly associated with the development of a severe course of COVID-19. In groups under 60 and over 60 years of age, the prognostic value of the combination of all statistically significant factors corresponding to the groups was equal to the average level (AUC=0,760 and AUC=0,709, respectively) Conclusion: Factors associated with the development of a severe course of COVID-19 in elderly and middle-aged people have some differences related to the pathogenesis of the disease. For individuals under 60 years of age, factors associated with severe COVID-19 are diabetes mellitus, the presence of pneumonia on admission, dyspnea, low oxygen saturation, and lymphopenia. For individuals over 60 years of age, factors associated with severe COVID-19 are the presence of diabetes mellitus, shortness of breath, and low saturation. The combination of all the studied factors significantly increases the risk of developing a severe course of COVID-19 in both age groups.

Outcomes, risk factors, and incidence of acute kidney injury in hospitalized COVID-19 patients

Background: Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV2) is the virus causing Coronavirus Disease 2019 (COVID-19). Apart from respiratory disease, this virus can affect different organs. Objectives: Therefore, multiple mechanisms have been hypothesized for Acute Kidney Injury (AKI) in COVID-19. In this study, we evaluate the incidence and prognosis of AKI in COVID-19 patients. Methods: This retrospective cohort study assessed 397 COVID-19 patients hospitalized between April 1, 2020, and September 30, 2021. Patients with a sudden rise of serum creatinine level, more than 0.3 mg/dl in two days or more than 50% of the initial level in one week, were diagnosed with AKI. Demographic, laboratory, and clinical features were compared in AKI patients with patients without AKI. Results: A total of 397 patients with a mean age +or- standard deviation of 55.42 +or- 15.26 years were included in the study. According to diagnostic criteria, 48 (12.1%) patients developed AKI. Old age, a history of hypertension, and chronic renal failure were suggested as risk factors for AKI. High levels of C-Reactive Protein, Erythrocyte Sedimentation Rate, Lactate Dehydrogenase, D-dimer, and serum phosphorus upon arrival were also associated with an increased risk of AKI. In addition, the incidence of hypernatremia and hyperkalemia increased mortality in patients with AKI. Conclusion: The incidence of AKI in admitted COVID-19 patients affects the duration of hospitalization, the chance of ICU admission, and mortality. It is important to limit the use of nephrotoxic drugs and to maintain water-electrolyte balance to prevent the incidence of AKI and improve the outcome.

Correlation between laboratory findings and clinical severity among the COVID-19 patients in the tertiary care centre

Background: Coronavirus is a highly infectious novel virus we are in urge to know more about their clinical characteristics and laboratory findings for the characterization and selection of treatment protocol. Methods: Prospective, single centre study. Two months data was collected, clinical characteristics data from patient case sheet and the laboratoryvalues from the Hospital Information System (HIS) for the month of July and August 2020. Results: Of 462 patients, 55 (11.9%) are falls under asymptomatic category, 194 (42%) are in mild category, 167 (36.1%) are in moderate category and 46 (10%) in severe category. Fever 230 (49.8%) and cough 211 (45.7%) was most common clinical symptom with p value < 0.01. Non-severe vs severe, 340 (73.6%) and 201 (43.5%) showed decreased in eosinophil count and absolute eosinophil count, 125 (27.1%) and 80 (17.3%) patient showed decrease in lymphocyte count and absolute lymphocyte count, 200 (43.3%) showed increase in neutrophil count with a significance of p value >0.05.186 (40.3%) patients had one or more co-morbidities. Laboratory findings between Asymptomatic VS symptomatic, showed significance changes in neutrophil, lymphocyte, Aspartate aminotransferase, Alkaline phosphatase, globulin values (p value <0.05). Conclusion: Clinical severity categorization at the time of admission was very helpful for the treating doctors in proper understanding of disease progression and appropriate treatment of the patient. Presence of co-morbidity, abnormal laboratory values, old age group patients, higher Computed Tomography score, higher mortality rate are seen more in patients who were in clinical severity grade severe category than in non-severe category patients.

Comparative study of COVID- 19 pneumonia in first and second waves

Background: The main aim of the study was to evaluate the different parameters of the COVID-19 pneumonia in India during the first and second waves. Method: Five hundred RT-PCR positive and HRCT documented COVID-19 pneumonia patients each from first wave (June 2020-December 2020) and second wave (March 2021-May 2021) were selected. The results were evaluated in terms of age groups affected, gender wise distribution, and CT severity score on HRCT. The final conclusion was done by comparing these variables from first wave with the ones during the second wave and inferences drawn upon thereof. Results: During the first wave, majority of the population involved belonged to more than 45 years category whereas during the second wave majority belonged to the 18-45 years category. Further, the severity of the disease was more during the second wave than the first wave with more males being affected than females in both the waves. Conclusion: Second COVID-19 wave in India was more severe than the first wave in terms of the number of patients affected as well as the severity of the pneumonia in the involved patients, likely due to continuously mutating variants of the virus & lifting up of the restrictions.

The vaccination process against COVID-19 - present and future

In some people, SARS-CoV-2 infections cause mild symptoms, but in others they are severe, even fatal. The best way to control the pandemic and fight this "invisible enemy" is to vaccinate and create virus-specific immunity. The purpose of this article is to examine the level of vaccination and attitudes to conduct it in order to prevent infection, severe course and/or obtaining a digital certificate. Materials and methods: An anonymous and voluntary online survey was conducted in the period 21 October - 3 November 2021 among 106 respondents. Documentary, statistical method and method of graphic analysis of the obtained results were also used. Results and conclusions: The study confirms the negative trends observed in the vaccination process. Approximately 25% of the respondents have completed a vaccination course against COVID-19, and 34% have positive attitudes towards the vaccination process. Two thirds of the participants in the study have a negative attitude towards vaccination, with approximately half of them categorically stating that they would not be vaccinated under any circumstances.

COVID-19 inside out: in-hospital outcomes at a public sector tertiary care hospital in Karachi

Objective: To present in-hospital COVID-19 mortality and the associated factors at a public sector tertiary care hospital in Karachi Methodology: The current prospective, observational study was conducted at Jinnah Postgraduate Medical Center, Karachi, Pakistan from June 1 to August 30, 2021 with the approval of the hospital ethics committee. Data was collected prospectively from patients' medical record files. COVID-19 infection positive cases were diagnosed according to the guidelines of the WHO on laboratory investigation of real time polymerase chain reaction tests on a nasopharyngeal or oropharyngeal swab. Result: Total 143 patients were enrolled in the study with median (IQR) age of 58 (48-69). The majority of the patients were males (n=96, 67.13%) and had moderate to severe disease (n=128, 89.51%). During their hospital stay, patients developed the following complications;pneumonia (n=99, 69.23%), ARDS (n=19, 13.28%), sepsis (n=11, 7.69%), septic shock (n=5, 3.49%) and pedal edema (n=2, 1.39%). As many as 104 (72.72%), 69 (48.25%), and 42(29.37%) patients required pharmatherapy, non-invasive ventilation, and mechanical ventilation respectively. While 54 (37.76%) patients died during their hospital stay. On multivariable model, pneumonia, use of non-invasive ventilation, and mechanical ventilation, were identified as independent predictors of mortality. Conclusion: Most of the patients in our study had moderate to severe disease. Therefore, the study indicates that timely presentation to the hospital is of great importance to avoid adverse events which are significantly associated with mortality.

Outcome of patients with COVID pneumonia on high flow nasal oxygen therapy

Background & Aims: The coronavirus pandemic has caused a rapid surge in patients requiring intensive care unit (ICU) admission. The mainstay of treatment is supplemental oxygen therapy by an oxygen mask, nonrebreathing mask, high flow nasal oxygen therapy (HFNOT), non-invasive and invasive mechanical ventilation. HFNOT is a relatively newer, easy-to-use technique with better patient compliance. This study aimed to assess the outcome of HFNOT in Corona Virus disease (COVID) patients in ICU. Methods: This record based;retrospective study included 43 reverse transcriptase polymerase chain reaction (RTPCR) confirmed COVID patients whose respiratory support was initiated on HFNOT as per the inclusion criteria. The primary outcome of this study was to assess the number of patients requiring mechanical ventilation (HFNOT failure). The secondary outcome was to assess the association of HFNOT failure with age, co-morbidity index, and severity of illness. Results: Out of forty-three patients, twenty-five patients (58%) required conversion to mechanical ventilation. Eighteen patients (42%) were managed with HFNOT alone. HFNOT failure was more with increasing age and higher comorbidity score (p value<0.05). Conclusion: We concluded that HFNOT can be successfully used in COVID patients in ICU without the need for mechanical ventilation. However, it should be used cautiously in patients with higher 4C mortality scores.

Elevated platelet large cell-ratio levels as a demonstrative biomarker associated with severe COVID-19

Objective: To represent the effects of the severity of COVID-19 infection on platelet large cell ratio (PLC-R). Materials and Methods: A hundred eleven patients diagnosed with COVID-19 were included in this study. Positive results for SARS-CoV-2 based on a typical RT-PCR test performed on nasopharyngeal swabs were included in the study Groups. Patients with COVID-19 were divided into three Groups according to their chest CT features. Group 1 (45 patients) was defined as mild, Group 2 (34 patients) as moderate and Group 3 (32 patients) as severe. Complete blood count parameters including platelet volume indices (PVI) values, CRP, D-dimer and lipid profiles were analyzed in all study participants. The correlation between COVID-19 patient Groups and PLC-R values were demonstrated using SPSS and ANFC methods. Results: The significant impact of our study is that PLC-R was significantly higher in the severe COVID-19 patients than the moderate and mild patients. Spearman's rho correlation analysis showed that PLC-R and WBC levels increased, and Htc and Hb levels decreased with the severity of the disease. ROC analysis showed that PLC-R > 38.3% had 59.4% sensitivity and 68.4% specificity in predicting severe COVID-19 disease (AUC 0.672, %95 CI 0.560, 0.784;p=0.005, cut off=38.3). CRP, ferritin and D-dimer values of the patients in Group 3 were significantly higher than the patients in Group 1, and the iron values of the patients in Group 3 were significantly lower than the patients in Group 1. Conclusion: PLC-R values are useful for anticipating acute thrombotic events. Based on the results of our study, PLC-R values can be used as appropriate biomarkers to describe the severity of COVID-19 infection.

Modern aspects of COVID-19 in HIV-positive patients (literature review)

The article is devoted to the global problems of modern medicine - HIV infection and the COVID-19 pandemic. The review of the literature highlights current ideas about the pathogenesis and course of COVID-19 in patients with HIV infection, and also touches upon the problems of concomitant pathology and mental health of patients with HIV in the setting of the COVID-19 pandemic. It has been shown that HIV-positive patients are a risk group for the severe course of COVID-19, in particular, individuals with severe immunodeficiency (CD4+ T lymphocytes 200 cells/l) due to the development of synergetic lung damage by SARS-CoV-2 and secondary infectious agents such as cytomegalovirus and Pneumocystis carinii. It has been proven that one of the targets of the SARS-CoV-2 virus is CD4+ T cells, which in COVID-19 leads to a more rapid progression of immunodeficiency in patients with HIV infection and, thus, significantly increases the risk of secondary diseases and death. Particular attention should be paid to middle-aged and elderly people living with HIV, who, compared with HIV-negative patients, are more likely to have concomitant pathology - arterial hypertension, cardiomyopathy and diabetes mellitus, which are the risk factors for severe COVID-19. The results of studies on the effect of antiretroviral drugs on the course of COVID-19 showed that HIV-infected patients receiving tenofovir + emtricitabine have a lower risk of severe COVID-19 and associated hospitalization than patients receiving other HIV treatment regimens. Clinical and preclinical data support the potential use of tenofovir in the treatment of novel coronavirus infection.

The relationship between smoking status and smoking index against COVID-19 disease course in treated patients at Dr. M Djamil General Hospital, Padang

Background: Smoking is a risk factor for the development and worsening of respiratory diseases, including COVID-19 infection. Smoking can increase the risk of the severity of COVID-19 by two times because in smokers there is an increase in the expression of the ACE-2 gene by 25% compared to non-smokers. The purpose of this study was to determine the relationship between smoking status and smoking index on the course of COVID-19 disease treated at Dr. M Djamil General Hospital. Method: An observational analytic study with a retrospective cohort approach on COVID-19 patients who were treated at Dr. M. Djamil General Hospital. Data were taken from January to March 2021. The relationship between smoking status and smoking index on the course of COVID-19 was analyzed by Chi-Square. Results: This study found the most age was above 50 years with a vulnerable age of 50-59 years (28.4%) and female gender (56.7%). Non-smoker status (64.2%) and moderate smoking index (51.4%) were the most commonly found in this study. Clinically non-progressive COVID-19 (53.7%) was the most common. This study found that the maximum length of stay for COVID-19 patients was less than 21 days (53.7%) and the outcome of patients recovered (62.2%). This study found a significant relationship between the smoking index on the clinical progress of COVID-19 patients and there was a significant relationship between smoking status and the outcome of COVID-19 patients. This study found that smoking status and the smoking index had no significant relationship with the length of stay of COVID-19 patients. Conclusion: Smoking status is related to outcomes in COVID-19 patients and the smoking index is related to a progression in COVID-19 patients treated at Dr. M. Djamil General Hospital.

Characteristics of albumin levels and liver function in patients with COVID-19 at H. Adam Malik Hospital, Medan

Background: COVID-19 (Corona Virus Disease-2019) pandemic has a high mortality rate especially in Medan, Indonesia. Serum albumin and liver function tests are believed to be predictive biomarkers for prognosis in patients with infectious diseases, including COVID-19. This study aimed to investigate the association between the mortality events and severely ill COVID-19 patients' serum albumin and liver enzymes. Method: This is a cross-sectional study using secondary data from the medical records of H. Adam Malik Hospital patients with COVID-19 who were confirmed by RT-PCR from August to December 2020. All patients were analyzed for age, sex, hypoalbuminemia, increased liver enzymes and outcome using Chi-square tests (P <0.05). Results: The average age of severe COVID-19 patients at H. Adam Malik Hospital ranged from 41 to 60 years, with more women prevalence than men. Most of the patients had hypoalbuminemia (84.2%), an increase in AST (59.4)% and ALT (45.5%). There was no significant association between hypoalbuminemia and the disease outcome (P =0.12). There was a significant association between elevated liver enzymes and mortality in severely ill COVID-19 patients (P <0.001). Conclusion: We found that hypoalbuminemia is common in patients with severe COVID-19. However, we found that albumin levels had no association with the patients' mortality rate. Liver enzymes levels appear to be a predictive biomarker for outcomes in COVID-19 patients of H. Adam Malik Hospital. We found that higher ALT and AST levels were associated with significantly higher mortality.

C-reactive protein lymphocyte index in COVID-19: a little-explored tool

Background: COVID-19 develops severe inflammatory responses that can lead to death. It is essential in a pandemic to have accessible instruments to estimate the prognosis of the disease. The lymphocyte-to-C-reactive protein ratio (LCR) is a predictive biomarker studied in oncology, which could have some advantages in COVID-19 patients in the early stages of the disease. Our objective was to estimate the risk of LCR < 100 and mortality in hospitalized patients with COVID-19. Methods: hospitalized patients with COVID-19 seen between March to October 2020 were included. The patients were grouped according to LCR < 100 and LCR > 100. A Cox regression model was performed to estimate the association between LCR < 100 and mortality. Results: we included 730 patients with COVID-19. The mean age at diagnosis was 49.9 years (SD 16.8) and 401 (55%) were men. Cox regression model showed an association between LCR < 100 and mortality (HR 6.2;95% CI 1.6 to 23.5;p 0.008), adjusting by age. severe pneumonia, intensive care requirements, and comorbidities. Conclusion: LPCR < 100 in the initial assessment of hospitalized patients with COVID-19 suggests a higher risk of mortality.

Modeling the impact of some variables the COVID-19 severe with cart algorithm in Mashhad University of Medical Sciences

Introduction: Considering that the new corona virus (COVID -19) is still prevalent, one of the important concerns is the variables affecting the severity of the corona disease in the health of society. In this study, the CART algorithm was fitted to predict and determine the status of patients infected with COVID-19 in Mashhad University of Medical Sciences. Methods: This paper is a cross sectional-analytical study. Datasets were obtained from all of the people referred for the disease of COVID -19 collected at the Sinai system during the second peak and the fourth peak of the disease in Mashhad University of Medical Sciences. Data analysis was performed using JMP statistical software version 13. Then for modeling, data mining methods and CART algorithm are used. Results: The descriptive findings of our study showed that 6% of patients with positive PCR suffer from severe disease of COVID-19. The age variable was very important in the severity of the disease. The age of 60 years old is the cut-off point for the severity of the disease, which increases COVID-19 severe from about 3% under the age of 60 to about 18% over the age of 60. The diseases of heart, kidney, respiratory, blood fat, and diabetes were other important variables. Conclusion: The results of the CART model showed that for the age under 60 years the variables of heart disease, age, diabetes, respiratory disease, fat, gender, and kidney, and for the age over 60 years the variables of age, heart disease, kidney, respiratory and diabetes were respectively the most critical risk factors. According to the ROC curve, the fitted model has a good performance for COVID-19 severe disease, so it increases up to 6 times the prediction of the COVID-19 severe disease.