Clinical features of patients with severe acute respiratory syndrome coronavirus 2 Delta variant infection and abnormal liver function in Guangdong Province, China. TT -? ? ? ? ? ?.

Objective To investigate the clinical features of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Delta variant infection and abnormal liver function in Guangdong Province, China. Methods The patients with SARS-CoV-2 Delta variant infection who belonged to the same chain of transmission in Guangdong Province (Guangzhou and Foshan) and were admitted to Guangzhou Eighth People's Hospital, Guangzhou Medical University from May 21 to June 18, 2021 were enrolled in this study, and the judgment criteria for liver function were alanine aminotransferase (male/female) > 50/40 U/L, aspartate aminotransferase > 40 U/L, total bilirubin > 26 mumol/L, gamma-glutamyl transpeptidase > 60 U/L, and alkaline phosphatase (ALK) > 125 U/L. Abnormality in any one item of the above criteria was defined as abnormal liver function, and such patients were included in analysis (the patients, aged < 18 years, who had a mild or moderate increase in ALP alone were not included in analysis). Clinical data were compared between the patients with normal liver function and those with abnormal liver function, and the etiology and prognosis of abnormal liver function were analyzed. The Mann-Whitney U test was used for comparison of continuous data between two groups;the chi-square test was used for comparison of categorical data between two groups. Results Among the 166 patients with SARS-CoV-2 Delta variant infection, 32 (19.3%) had abnormal liver function with mild-to-moderate increases in liver function parameters, and compared with the normal liver function group, the abnormal liver function group had a significantly higher proportion of critical patients (chi2=38.689, P < 0.001) and significantly higher age and inflammatory cytokines [C-reactive protein type, serum amyloid A, and interleukin-6 (IL-6)](all P < 0.05). Among the 32 patients with abnormal liver function, 13 patients had abnormal liver function on admission (defined as primary group), while 19 patients had normal liver function on admission but were found to have abnormal liver function by reexamination after treatment (defined as secondary group). For the primary group, the evidence of abnormal liver function was not found for 3 patients (3/13, 23.1%), and the possibility of toxic liver injury directly associated with SARS-CoV-2 infection was considered. Among the 19 patients in the secondary group, 9 (47.4%) had mild/common type and 10 (52.6%) had critical type, and all critical patients had the evidence of liver injury indirectly caused by the significant increases in C-reactive protein type, serum amyloid A, and IL-6 and hypoxemia;the evidence of abnormal liver function was not found for only 1 patient (1/19, 5.3%), and the possibility of toxic liver injury directly associated with SARS-CoV-2 infection was considered. All 32 patients with abnormal liver function had [JP2]significant reductions in liver function parameters after treatment including liver protection. Conclusion As for the patients with SARS-CoV-2 Delta variant infection who belong to the same chain of transmission in Guangdong Province, the critical patients show a significantly higher proportion of patients with abnormal liver function than the patients with other clinical types, and other factors except SARS-CoV-2 infection and indirect injury caused by SARS-CoV-2 infection are the main cause of liver injury.Copyright © 2022 Editorial Board of Jilin University. All rights reserved.

The Association of Physical Activity and Physical Fitness Levels with Liver Enzymes in COVID-19 Patients.

Introduction: Exercise is one of the lifestyle interventions recommended to reduce liver damage and improve health. The present study aimed to investigate the relationship between physical activity and physical fitness with the liver enzymes of COVID-19 patients. Material(s) and Method(s): Four hundred patients infected with COVID-19 (57.6+/-14.6, body mass 28.1+/-4.7 kg/m2) admitted to the Masih Daneshvari Hospital in Tehran participated in the present study. After Introducing with the work procedure, Beck and Stanford's questionnaires were used to check their physical activity. Each participant filled out the physical fitness self-assessment questionnaire to self-report his/her physical fitness. Fasting blood samples were taken to measure aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and lactate dehydrogenase. Result(s): The statistical analysis of the collected data revealed a significant correlation between physical activity with aspartate aminotransferase (p=0.035) and alanine aminotransferase (P=0.001), and there was a difference between different levels of physical activity. The results also showed is no significant relationship between alanine (p=0.068) and aspartate aminotransferase (p=0.375) with physical fitness. However, there was no significant relationship between physical activity and physical fitness with alkaline phosphatase (p =0.271) and lactate dehydrogenase (p =0.311). Conclusion(s): According to the findings, it can be concluded that regular physical activity prior to COVID-19 infection is associated with high levels of liver alanine aminotransferase and aspartate aminotransferase.Copyright © 2022, Research Institute for Endocrine Sciences. All rights reserved.

Study of Biochemical Markers of Covid-19 in Western Punjab

Background: To determine the association between various demographic indicators and biochemical markers in COVID-19 patients in Western-Punjab. Material(s) and Method(s): An observational cross-sectional study was done on one hundred and fifty cases of all ages admitted in Isolation ward, reporting to Adesh Institute of Medical Sciences and Research, Bathinda, India with COVID-19(RT-PCR/ or RAT) from January 2022 to March 2022 were included. Clinical features like fever, cough and shortness of breath were recorded. Blood sample was collected in plain tube for biochemical markers like serum albumin, creatinine, ferritin, LDH, CRP and urea, SGOT, SGPT, procalcitonin, D-dimer, ESR, IL-6, ALP, bilirubin were analysed. Association of the clinical features and these biochemical markers were determined. Result(s): Patients were divided into 3 groups according to different ages (<40 years, 40-60 years, >60 years). Out of 150 patients 26 (17.3%) belonged to age group < 40, 60 (40.0%) belonged to age group 40-60 years and 64 (42.7%) belonged to age group >60 years. Mean age was 55.93 + / - 14.91. Out of 150, 39 (26.0%) were females and 111(74.0%) were males. 44 (29.3%) cases had hypertension and 59(39.3%) cases had diabetes mellitus. Urea levels in 118 (78.7%) patients were above normal reference values e and was statistically significant (p<0.015). 73 (48.7%) had SGOT levels above normal range [statistically significant (p<0.025)] while as 63 (42%) had SGOT above normal range [statistically significant (p<0.001)]. 98 (65.3 %) had IL-6 above normal range [statistically significant (p<0.003)]. While as albumin levels in 38 (25.3%) patients were within normal range and 112 (74.7%) patients had albumin below normal range [statistically significant (p<0.014)]. ESR (100%), D-dimer (100%), procalcitonin (100%), LDH (94%) were uniformly raised in almost all patients. Rest of the markers like ferritin (74%), bilirubin (6%), CRP (90%), creatinine (15.3%), ALP (14.7%) was also raised but was not statistically significant. Conclusion(s): Indian patients with COVID-19 disease showed variable pattern of clinical features.Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

Association of Ferritin with Liver Function Parameters in COVID-19 Patients

Introduction: Corona Virus 19(COVID-19) is a complex multisystemic disease which remains to be a great challenge to the international health care system. Liver damage can occur in COVID-19 patients due to immune mediated inflammation such as cytokine storm induced by ferritin. The effect of ferritin on liver biochemistries in COVID-19 patients are still obscure. Aim(s): To study the association of ferritin with liver function parameters in COVID -19 patients. To find the association of ferritin with liver enzymes such as Aspartate transaminase, Alanine transaminase, AST: ALT ratio, Alkaline phosphatase, albumin,total protein and serum bilirubin. Material(s) and Method(s): The study was a retrospective cross-sectional study conducted at Sri Ramachandra laboratory services and medical records department of SRIHER. Ethical approval was obtained from Institutional ethical committee (IEC), SRIHER to collect the data of COVID -19 patients who were RT-PCR positive. The patients were enrolled on the basis of their inclusion and exclusion criteria. All the liver function parameters were analyzed in Beckmann Coulter 5800. Result(s): A significant elevation in AST and ALT were observed. There was no significant alteration in serum alkaline phosphatase indicating that biliary obstruction was not a significant component in COVID -19 infection. The levels of total protein and albumin were considerably decreased. Increased levels of bilirubin was noticed in mild and severe COVID-19 patients. Conclusion(s): COVID -19 patients showed significant correlation of ferritin with liver function parameters thus all the COVID -19 patients should have their liver test indicators assessed and monitored periodically to prevent mortality due to liver damage.

CLINICAL FEATURES AND CHARACTERISTIC OF CHOLANGIOPATHY AFTER SEVERE COVID-19

Introduction Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 virus (SARS-CoV-2), can commonly lead to abnormal liver tests, mostly transaminase elevation. Recently, a novel entity of cholangiopathy was discovered in patients who recovered from critical COVID-19 infection. However, understanding of this disease is limited due to its rarity. Methods We reviewed Pubmed, Embase, and Web of Science Core Collection databases from inception to Nov 30th, 2021, to identify studies reporting cholangiopathy after severe COVID-19 infection. “SARS-CoV-2” or “COVID-19” with “cholangiopathy” were used as keywords to search. Our study is to summarize the clinical features and characteristics of cholangiopathy after severe COVID-19 illness. Results Literature review identified 15 articles including 33 patients for reviews. Most studies were performed in the United States. The mean age of participants from all studies is 52.17 ± 13.98 years old. Among the 33 included patients, the majority are male (29, 88%) and the common medical histories include hypertension (n=11), obesity (n=8), and diabetes mellitus (n=8). The length of stay (LOS) during hospitalization was prolonged with a mean of 80.23 ± 33.14 days. All patients were intubated and put on mechanical ventilation during medical intensive care stay with 12 patients having a history of endotracheal cardiac output monitoring. The mean peak of serum alkaline phosphatase, aspartate aminotransferase, alanine transaminase and total bilirubin were 2106.96 (U/l) ± 784.04, 1456.09 (U/l) ± 2325.10, 983.57 (U/l) ± 1244.44 and 14.04 (mg/dl) ± 8.41, respectively. Cholangiopathy after severe COVID illness mimics secondary sclerosing cholangitis on magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography studies with ductal beading but the presence of unique severe cholangiocyte injury and intrahepatic microangiopathy is suggestive of direct hepatic injury due to COVID-19. In terms of outcome, 7 patients were documented as deceased. Eight patients underwent liver transplantation (Table 1). Discussion Cholangiopathy is a late complication of severe COVID-19 after prolonged ICU stay with potential for long-term liver morbidity and liver failure needing liver transplantation. Further studies are warranted to understand pathogenesis, natural history, therapeutic interventions, and prognostic indicators. (Table Presented)

HETEROTOPIC OSSIFICATION AFTER COVID-19 INFECTION - CASE REPORT

Background/Aims Heterotopic ossification (HO) is the abnormal formation and deposition of mature lamellar bone within soft tissue, associated with trauma, surgery, neurologic injury and prolonged immobilisation. Several recent case reports have demonstrated this condition in COVID-19 patients requiring mechanical ventilation. Methods We present a case of heterotopic ossification in the shoulder after a long stay in intensive care unit (ICU) due to COVID-19 infection. Results A 55-year-old man with stable psoriatic arthritis on sulfasalazine was admitted to ICU for mechanical ventilation after contracting COVID-19 infection. After discharge from ICU, he began noticing increasing right shoulder pain with restricted movements of abduction, internal and external rotation. His serum alkaline phosphatase was moderately elevated. Despite physiotherapy and NSAIDs, there was slow improvement. Shoulder x-ray showed significant bony overgrowth around proximal humerus which was initially thought to be part of his psoriatic arthritis. It was confirmed at Rheumatology/Radiology MDT to be heterotopic ossification. A computed tomography of the right shoulder was requested to evaluate the extent of the condition and orthopaedic advice was sought. Conclusion There are many factors contributing to the development of heterotopic ossification including trauma, spinal cord injury, brain injury, hypoxia, prolonged immobilisation with limitation of joint movement and prolonged bed rest which cause alterations in calcium homeostasis, male sex and over 60 years of age. New onset joint pain and stiffness in patients who have recovered from COVID-19 especially those who had long ICU stay should be further investigated for this condition. Treatment includes analgesia and physiotherapy with potential surgical intervention.

Common Symptom, Rare Etiology: A Case Metastatic Cancers of Unknown Primary Origin Presenting with Epistaxis and Gingival Bleeding

Introduction: Epistaxis and gingival bleeding are among the most common presentation to the emergency department for patients with thrombocytopenia. Here, we present a case who was admitted to the emergency department with thrombocytopenia and was diagnosed with metastatic cancer of unknown primary origin. Case Report: A 26-year-old male patient was admitted to the emergency department with gingival bleeding and epistaxis. The body temperature was 38.3 °C. Petechial rash, ecchymosis or organomegaly was not detected on physical examination. Laboratory results revealed thrombocytopenia as 31 × 103 (159-388 × 103/μL). Although hemoglobin and leukocyte counts were normal, no band or precursor cell was observed in the patient's peripheral blood smear. There was no history of weight loss, night sweats, arthritis, malar rash, photosensitivity, contact with ticks, animals, or a COVID-19 patient. Serological tests performed for infections such as HIV, EBV, HCV, Crimean-Congo hemorrhagic fever were negative. Bone marrow biopsy was performed due to the unexplained cytopenia, reported as "signet ring cell metastatic adenocarcinoma". Gastrointestinal system endoscopy was performed to detect primary cancer. A biopsy was taken from the antrum and corpus revealed gastritis. An FDG PET-CT was revealed heterogeneously pathologically increased FDG attitude in all axial and appendicular bones. Despite all the modalities of diagnosis, the origin was not found and the patient was transferred to the oncology department for treatment with a diagnosis of cancer of unknown origin with bone marrow infiltration. Conclusion: Bone marrow metastases should be kept in mind in patients presenting with thrombocytopenia.

Prevalence of Liver Dysfunction in COVID-19 Infections and Its Correlation with Severity and Mortality

Aim: To evaluate the prevalence of liver dysfunction and its correlation with severity and mortality in patients with Covid-19 infection. Materials and methods: Total 120 patients fulfilled the inclusion criteria were enrolled for the study after giving informed consent and were divided into two groups (moderate and severe Covid-19 infection). Patients were treated as per national guideline for Covid-19 infection as mentioned in flow chart above. Hemogram and Liver function test and inflammatory markers (C-reactive protein, Lactate dehydrogenase, D-dimer and ferritin) were performed on every alternate day of hospitalization. Patients were followed during whole hospitalization course and weekly for 1 month after discharge with these tests. Approval for the study was sought from Institutional Ethical committee. Results: The median levels of ALT, AST, ALP, GGT, LDH, TBIL, DBIL, and albumin were 20 U/L (IQR, 14–31), 20 U/L (IQR, 17–26), 75 U/L (IQR, 55–193), 21 U/L (IQR, 14–36), 198 U/L (IQR, 172–232), 8.4 umol/L (IQR, 6.5–11.3), 3.4 umol/L (IQR, 2.3–4.6), and 45 g/L (IQR, 41–47), respectively. Severe patients had significantly higher levels of ALT (26 vs 20 U/L, p=0.017), AST (31 vs 20 U/L, p < 0.001), GGT (30 vs 21 U/L, p < 0.001), LDH (334 vs 197 U/L, p < 0.001), TBIL (10.2 vs 8.3 umol/L, p=0.029), DBIL (4.9 vs 3.3 umol/L, p < 0.001), but significantly lower albumin (37 vs 45 g/L, p < 0.001) than non-severe patients. Abnormal AST (40% vs 7%, p < 0.001), LDH (90% vs 35%, p < 0.001), DBIL (20% vs 7%, p < 0.001), and albumin (50% vs 8%, p < 0.001) were commonly observed in severe patients, compared with non-severe patients. On multivariate analysis, age >60 years, male gender, BMI > 30 kg/m2, comorbidity, abnormal LDH and albumin on hospital admission, and abnormal peak hospitalization LDH and albumin were associated with progression to severe COVID-19 (OR > 1;p < 0.05). Conclusion: This large sample retrospective cohort study, we described the longitudinal changes of liver function parameters in patients with COVID-19. In addition, we con-firmed patients with abnormal liver function parameters were at increased risk of severe COVID-19 and death.