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Background: The second wave of the COVID-19 pandemic caused significant demand for beds capable of delivering enhanced respiratory support. NHS England recommended the use of CPAP for patients with COVID-19 respiratory failure, a treatment which can be offered outside of a critical care facility, and on a Respiratory High Care/ Support Unit (RSU). The enhancement of Portsmouth's RSU provided CPAP and NIV for patients with COVID-19 respiratory failure. With our intensive care facilities at 300% their normal capacity, this greatly alleviated bed pressures on critical care. Varied levels of deprivation exist in Portsmouth's dense population. Deprivation has an impact on overall health, however the effect of postcode on outcomes for people going onto support for COVID-19 respiratory failure, is unknown. Method(s): Retrospective cohort analysis of consecutive patients admitted to Respiratory Support Unit during the second wave of the COVID-19 pandemic, from 02/11/2020 to 31/01/2021. 227 patients were included in the study with 8 removed due to incomplete data, all of the patients received respiratory support in the form of CPAP or NIV. We collected multivariate data including biochemical markers, demographics, oxygenation status, co-morbidities and outcomes. Outcomes measured were: 1) Death in RSU, 2) Discharge from RSU or 3) Intubation and Ventilation. To measure deprivation, we linked a persons postcode to an area called an LSOA (Lower-layer Super Output Area). These are small areas of similar population size, each of which has a deprivation score (ie. top 10%, to the lowest 10% areas of deprivation in the UK). This is measured using an 'index of multiple deprivation'. An individual's outcome from the RSU was then analysed in relation to the deprivation score allocated to their postcode. Result(s): We observed a significant number of patients discharged from RSU, without needing invasive mechanical ventilation. 80/219 were discharged directly. 45/219 died in RSU, and 94 were eventually admitted to ITU. The average stay on CPAP or NIV before needing admission to ITU was 3 days. Some biochemical markers which stood out in relation to the outcomes described were as follows: average LDH, D-dimer and Troponin levels were higher in those who were admitted to intensive care. In patients who died, the PCT was significantly higher on average when compared to the other two groups. In the group who were discharged, mean lymphocyte count was >1, in the other two groups this was <1. From our observations in Portsmouth, there is a negative correlation between deprivation and lower aged individuals admitted for COVID-19 related respiratory support. Overall, we also saw disproportionate representation of those from the most deprived 50% of the UK in our respiratory support unit. Conclusion(s): CPAP and NIV can effectively be used in an RSU during a spike of COVID-19, to safely minimise demand on critical care services. Deprivation may have an impact on outcomes in patients needing respiratory support related to COVID-19. Deprivation levels may help predict risk of needing enhanced respiratory support in certain age groups. Multiple biochemical markers may be of prognostic value in COVID-19.
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Introduction: Critically ill COVID-19-patients are at high risk of developing ICU-related malnutrition. This study aimed to examine the impact of proning on providing nutritional therapy for mechanically ventilated COVID-19-patients by comparing the achievement of nutritional goals and possible complications in patients who were proned vs. those who were not. Method(s): This is a single-center retrospective cohort study. We included all adult COVID-19 patients admitted to the ICU from 01/03/2020 until 31/05/2020 who required invasive mechanical ventilation (IMV), excluding those referred for ECMO. Data were extracted from electronic patient files. Weight-based nutrition targets were set in agreement with ESPEN guidelines [1]. Result(s): 32 patients were included (prone n = 16). Both groups were comparable in age, sex, comorbidities, biochemical markers and Nutrition Risk Screening on admission. Time on IMV was longer in the prone group (p = 0.032). The total time in prone position ranged from 19.5 h to 13.16 d. All patients received a NG tube, 1 proned patient received a jejunal tube. 6 received TPN (p = 0.654). Metoclopramide was used more often in the prone group (p = 0.028). The prevalence of vomiting (n = 4 vs. n = 5), large gastric residuals (n = 0 vs. n = 3) and VAP (n = 11 vs. n = 10) were comparable for the non-prone vs. prone group, resp. Table 1 shows the percentage of targets reached. These were lower in the prone group, though not statistically significant. However, when correcting for SAPS III-score, the impact of proning declined. Conclusion(s): These limited data suggest there is no significant difference in feeding COVID-19 patients on IMV that need proning vs. those who do not, except for metoclopramide use. Overall, reaching nutrition targets in these patients is challenging. This model suggests that disease impact is a greater influence on reaching nutritional goals than proning itself.
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Background: Immune-mediated lung injury and complex changes of the immune system, such as lymphopenia and cytokine storm, that have been associated with adverse outcomes underlining a fundamental role of host response in severe acute respiratory syndrome coronavirus 2 infection and the pathogenesis of the disease. Thymosin alpha 1 (Ta1) is one of the molecules used in the management of COVID-19, because it is known to restore the homeostasis of the immune system during infections and cancer. Aim(s): To study the impact of thymosin alpha on the biochemical markers and mortality in covid 19 patients. Methodology: A retrospective, single-centred study including 127 patients with laboratory detected moderate to severe SARS-CoV-2 infection admitted to designated COVID-19 centre in a tertiary care hospital from September 2021 to March 2022 was done. 52 patients received thymosin alpha 1 and their results were compared with 75 patients who received standard care without thymosin alpha. Clinical records, laboratory data, and radiological findings were analysed of patients treated with thymosin alpha 1 to evaluate the role of treatment outcome. Result(s): hospital mortality was 7.6% (n = 4) in the thymosin group as compared to 9.3% (n = 7) in the non-thymosin group. 40 patients in the thymosin group had increased CRP levels on day 1 as compared to 61 in the non-thymosin group. On day 5, 11 patients in thymosin group had increased levels as compared to 47 patients in the nonthymosin group with a significant p-value of<0.001. Statistically significant results were obtained on day 10, only 7 patients in the thymosin group had increased levels as compared to 30 in the nonthymosin group. On day 1, 46 patients in the thymosin group had increased level of IL-6 as compared to 53 in the non-thymosin group. Serial monitoring on day 5 showed that in thymosin group, 18 patients had increased levels as compared to 44 patients in the non-thymosin group (with a significant of<0.05). Again, on day 1difference was statistically significant when in thymosin group only 5 patients had elevated levels as compared to 23 in non-thymosin group. Conclusion(s): Significant difference was seen in terms of biochemical parameters but that could not be translated in clinical improvement in terms of mortality rates.
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Objective: Pneumonia is an infectious inflammation of the alveoli,distal airway,and interstitium caused by bacterial,viral,and other pathogens. Maxing Shigantang,originated from Treatise On Cold Damage Diseases,is a classic prescription for treating pneumonia,with significant clinical efficacy. However,its treatment mechanism is still elusive. Method(s): In that paper,the transcriptome-based multi-scale network pharmacology was used to reveal the overall pharmacological mechanism of Maxing Shigantang in treating pneumonia from six scales of tissue,cell,pathological process,biological process,signaling pathway, and target. Result(s):At the tissue level,Maxing Shigantang mainly acted on the focal tissue of pneumonia-lung and the main inflammatory immune tissues-blood and spleen. Analysis of cell,pathological process and biological process suggested that Maxing Shigantang could treat pneumonia by reversing inflammatory and immune functions and improving cardiopulmonary and vascular injury caused by pneumonia. Analysis of signaling pathway and target showed that Maxing Shigantang regulated inflammatory immune response pathways such as "coronavirus disease-COVID-19" and "Toll-like receptor signaling pathway",and related targets such as "MAPKAPK3" and "NRG1". Conclusion(s):This paper,from molecular to tissue levels,indicated Maxing Shigantang treated pneumonia mainly by regulating inflammatory immune response and improving cardiopulmonary and vascular injury.Copyright © 2023, China Academy of Chinese Medical Sciences Institute of Chinese Materia Medica. All rights reserved.
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OBJECTIVES: We aimed at analyzing the serum levels of citrullinated histone H3 (CitH3) in patients with dermatomyositis (DM) and their association with disease activity. METHODS: Serum CitH3 levels were measured using enzyme-linked immunosorbent assays in serum samples obtained from 93 DM patients and 56 healthy controls (HCs). Receiver operating characteristic (ROC) curve analysis was performed to evaluate the discriminant capacity of CitH3 and other disease variables. The association between CitH3 and disease variables was analyzed using Pearson's rank correlation. RESULTS: Serum CitH3 level was significantly lower in DM patients than in HCs (p < 0.001). The ROC curve analysis revealed that CitH3 strongly discriminated DM patients from HCs (area under the curve [AUC], 0.86), and a combination of CitH3 and the ratio of neutrophil to lymphocyte counts (NLR) showed a greater diagnostic value (AUC, 0.92). Serum CitH3 levels were markedly lower in DM patients with normal muscle enzyme levels than in HCs (all p < 0.001), and when compared to an elevated group, the CitH3 levels were comparable (all p > 0.05). The CitH3 levels showed no difference between DM in active and remission groups. However, in a paired test with 18 hospitalized DM patients, the CitH3 levels were higher in remission state than in active state. Moreover, the CitH3 levels showed no correlation with disease variables that were associated with the disease activity of DM. CONCLUSIONS: Serum CitH3 level may serve as a useful biochemical marker for screening patients with DM from HCs, while its role in monitoring DM disease activity requires further research.
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Dermatomyositis , Histones , Humans , Neutrophils , Biomarkers , ROC CurveABSTRACT
The pathogenesis of severe coronavirus infection COVID-19 is associated with activation of immune system, cytokine storm, impaired blood clotting, microvascular thrombosis, organ ischemia and multiple organ dysfunction syndrome. The role of various lymphocyte subpopulations in COVID-19 is still debated. The aim of our study was to analyze the subpopulational profile of peripheral blood lymphocytes in COVID-19 patients as compared with healthy donors. The study included 20 COVID-19 patients (11 males and 9 females,) and 26 healthy donors. Average age of the patients was 52 and 56 years, respectively. Clinical examinations were performed by standard laboratory methods. Peripheral blood lymphocytes were isolated in the Ficoll gradient. The cells were stained with antibodies to specific antigens of main lymphocyte populations, endothelial cells, and apoptotic cell markers. The analysis was performed by flow cytometry. The results showed that all patients had elevated C-reactive protein (14- to 35-fold), ferritin (1.2- to 13-fold), D-dimers (1.2- to 90-fold). 55% of men had a decrease in the absolute number of lymphocytes, in women this index was at the low normal limit. Cytometric analysis showed that, among peripheral blood lymphocytes, the proportion of functional cells expressing the CD45 marker ranged from 2 to 12% in 70% of patients, as compared with 80-99% among the donors. The proportion of CD45+ lymphocytes significantly correlated with the level of hemoglobin, but not with the levels of inflammatory biochemical markers. Among the functional lymphocytes of patients, there was a decrease in the proportion of CD3+, CD4+, CD8+T cells, increased proportion of natural killer CD56+ and the apoptotic (AnnexinV+) cell contents, but the proportion of CD19 and HLA-DR+B cells was not changed. Analysis of the lymphocyte (LC) subpopulations that did not express CD45 marker showed that this fraction contained different lymphocyte subsets with reduced expression of CD4, CD8, CD19, CD56 etc. in the blood of patients and donors. Higher percentage of endothelial cells expressing CD62P marker made the difference between patients and donors. Laboratory determination of lymphocyte subsets in blood samples of COVID-19 patients does not reflect the real severity pattern of the disease, thus requiring studies of the CD45-expressing functional cell populations.Copyright © Svirshchevskaya E.V. et al., 2023 The article can be used under the Creative Commons Attribution 4.0 License.
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Aim of the study. To evaluate the value of predictors of hemoadsorption clinical efficacy in patients with COVID-19. Materials and methods. This study analyzed the results of treatment of 62 patients with severe COVID-19 in the intensive care unit using selective hemoadsorption of cytokines. All patients with severe COVID-19 were admitted to the intensive care unit within 14 days from the disease onset were subdivided into two groups. Group 1 patients (n=32) received on a top of standard treatment the hemoperfusion (HP) procedure for 4 hours, for 2-3 days in a row, using a cytokine sorption column composed of mesoporous styrene-divinilbenzen copolymer matrix. Group 2 patients were not subjected to extracorporeal blood purification. All patients received IL-6 inhibitors at a baseline in accordance to the temporary guidelines. We evaluated factors of unfavorable outcomes by analyzing changes in biochemical markers of systemic inflammatory response and mortality rates in patients of both groups. Results. Initiation of HP later than 10 days from NCI onset (P < 0.001), length of stay in the ICU, extent of lung damage (P = 0.036) and the SOFA (Sequential Organ Failure Assessment) score (P = 0.009) were the most powerful predictors of unfavorable outcome. Levels of systemic inflammatory response markers (in-terleukin-6, CRP, D-dimer) in both groups did not significantly affect the survival rates and length of hospital stay (P > 0.05). HP group demonstrated better survival (P < 0.05). Mean hospital stay was 31 and 27 days, ICU stay - 11 and 8 days for Groups 1 and 2, respectively (P < 0.05). Conclusion. Treatment of severe COVID-19 patients with HP using novel domestic hemosorbent composed of styrene-divinilbenzen copolymer matrix resulted in decrease in CRP levels on the first day after application and, with early onset, contributed to a significant increase in survival and decreased hospital and ICU stay. Additional studies are warranted to clarify the optimal timing of the initiation of HP in severe COVID-19 patients.Copyright © 2023, V.A. Negovsky Research Institute of General Reanimatology. All rights reserved.
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Aim of the study. To evaluate the value of predictors of hemoadsorption clinical efficacy in patients with COVID-19. Materials and methods. This study analyzed the results of treatment of 62 patients with severe COVID-19 in the intensive care unit using selective hemoadsorption of cytokines. All patients with severe COVID-19 were admitted to the intensive care unit within 14 days from the disease onset were subdivided into two groups. Group 1 patients (n=32) received on a top of standard treatment the hemoperfusion (HP) procedure for 4 hours, for 2-3 days in a row, using a cytokine sorption column composed of mesoporous styrene-divinilbenzen copolymer matrix. Group 2 patients were not subjected to extracorporeal blood purification. All patients received IL-6 inhibitors at a baseline in accordance to the temporary guidelines. We evaluated factors of unfavorable outcomes by analyzing changes in biochemical markers of systemic inflammatory response and mortality rates in patients of both groups. Results. Initiation of HP later than 10 days from NCI onset (P < 0.001), length of stay in the ICU, extent of lung damage (P = 0.036) and the SOFA (Sequential Organ Failure Assessment) score (P = 0.009) were the most powerful predictors of unfavorable outcome. Levels of systemic inflammatory response markers (in-terleukin-6, CRP, D-dimer) in both groups did not significantly affect the survival rates and length of hospital stay (P > 0.05). HP group demonstrated better survival (P < 0.05). Mean hospital stay was 31 and 27 days, ICU stay - 11 and 8 days for Groups 1 and 2, respectively (P < 0.05). Conclusion. Treatment of severe COVID-19 patients with HP using novel domestic hemosorbent composed of styrene-divinilbenzen copolymer matrix resulted in decrease in CRP levels on the first day after application and, with early onset, contributed to a significant increase in survival and decreased hospital and ICU stay. Additional studies are warranted to clarify the optimal timing of the initiation of HP in severe COVID-19 patients.Copyright © 2023, V.A. Negovsky Research Institute of General Reanimatology. All rights reserved.
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BACKGROUND Tocilizumab (TCZ) is an interleukin-6 (IL-6) inhibitor approved for use in patients severely affected by COVID-19, which has been shown to reduce mortality but has as yet undetermined effects on procalcitonin (PCT) and C-reactive protein (CRP). In Malta, TCZ started being administered to COVID-19 patients who experience worsening symptoms or increased oxygen requirements over a period of hours in January 2021. This study aimed to assess the effect of TCZ on PCT primarily, and white cell count (WCC), lymphocyte and neutrophil counts, neutrophil to lymphocyte ratio (NLR), CRP and PaO2/FiO2 (P/F) ratio as secondary measures. METHODS Fifty patients who received tocilizumab were recruited to the treatment group along with a matched control group of 50 patients who did not receive the drug. Serum PCT and other biochemical markers were recorded daily for both groups and differences in the values for the two groups extracted. Outcome measures included differences between the biomarkers at 5, 10 and 15 days. RESULTS PCT and CRP were significantly lowered by administration of TCZ on Day 5. WCC, lymphocyte and neutrophil counts and P/F ratios were not affected. There was no difference in positive blood culture results between the two groups. CONCLUSI ON PCT and CRP may not be reliable indicators of bacterial superinfection in severe COVID-19 pneumonia patients who have been given TCZ.Copyright © 2023, University of Malta. All rights reserved.
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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.
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Background: Prone positioning is an emerging tool in the care provided to patients infected with COVID-19 with Acute Respiratory Distress Syndrome (ARDS) at Lung Center of the Philippines (LCP). Objective(s): This study aimed to characterize the clinical profile of COVID-19 confirmed cases undergoing protocol directed assisted prone positioning. Method(s): This retrospective single-arm cohort study involved 87 eligible patients seen from May 1, 2020 to April 30, 2021 by reviewing their medical records. Result(s): Patients were predominantly middle-aged (49.4%) males (69.0%) with normal BMI (56.3%). Hypertension (59.8%) was the most prevalent comorbidity. Patients were admitted because of acute hypoxemic respiratory failure that required respiratory support. Biochemical markers of inflammation and disease severity, such as LDH, D-dimers and ferritin were consistently high in our study population. On average, the duration of symptoms before intubation was 7.7 days (SD=3.7) while the number of days of illness prior to prone positioning was 10.1 (SD=4.9). In terms of clinical outcomes, 94.3% of the patients had no accidental extubation. However, the all-cause mortality accounted for 29.9%. The mean number of days intubated was 14.1 days (SD=9.3) while the average length of hospital stay was 18.1 days (SD=11.4). Conclusion(s): This study revealed a broad picture and proportion of COVID-19 with ARDS undergoing protocol directed assisted prone positioning. Prone position is safe and impacts the clinical outcome of patients.
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Introduction: Blood tests play an important role in the early detection of disease given that they provide doctors with information about inflammatory processes. A complete blood count (CBC) is easy and inexpensive to perform. These parameters can be used alone as markers of inflammation. Their mutual ratio is also an indicator of early inflammation.4 In light of previous studies, the use of circulating biomarkers instead of inflammation and immune system has been considered a prognostic indicator for COVID-19 positive patients. Aims/ objective: To examines the role of biomarkers from peripheral blood samples in the diagnosis of hospitalized COVID-19 patients with a history of fever. Materials and Method: Haematological biomarkers and coagulation profile was compared between RT-PCR positive and negative patients. Systemic inflammatory index (SII) was calculated by multiplying thrombocyte count with neutrophil count and dividing the value by lymphocyte count. Neutrophil lymphocyte ratio (NLR) was calculated by dividing absolute neutrophil count by absolute lymphocyte count. Platelet lymphocyte ratio (PLR) was calculated by dividing absolute platelet by absolute lymphocyte count. Fisher exact test and unpaired t-test were used to compare categorical and continuous data respectively. Results: Analysis was done on 57 retrospective cases of RT-PCR positive patients and 61 RT-PCR negative patients with history of fever. COVID-19 positive patients showed leukopenia, neutropenia, thrombocytopenia, and lymphocytosis. SII and NLR decreased and PLR increased. PT and APTT were generally within normal limits in most of the patients. There was significant difference between two groups with respect to lymphocyte counts and PLR. Conclusion: The most standardized non-invasive and inexpensive tests such as CBC, coagulation and biochemical tests are available to assess disease severity for wise allocation of medical resources in developing countries such as India where resources and care are limited.
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Coronavirus disease 2019 (COVID-19) is a kind of viral pneumonia which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The emergence of SARS-CoV-2 has been marked as the third introduction of a highly pathogenic coronavirus into the human population after the severe acute respiratory syndrome coronavirus (SARS-CoV) and the Middle East respiratory syndrome coronavirus (MERS-CoV) in the twenty-first century, Forcing scientists to continue Research to discover a vaccine for this disease in in request to control and boundary the range Of the disease. This study was designed to hit upon out whether here are side effects on vaccinated people who received covid-19 vaccine or not by measuring the body's vitality by some of biochemical tests.Subjects:75 individuals between women and men aged (17-68 years)were enrolled in this study .Several biochemical tests were performed on them before taking the vaccine,a week to10 days after the first dose, and a week to 10 days after the second dose of covid-19 vaccine. RESULT(S): All subjects in this Study received the Pfizer-Bio N Tech vaccine and no systemic side effects were Observed in subjects vaccinated during the study period. Conclusion(s): From the Results of the current study, there were no abnormal biochemical markers, increased, or changes in basic body functions after receiving the Pfizer vaccine. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
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Background: COVID-19 pandemic originated in the city of Wuhan in Hubie province of China and within three months of its origin the disease extended to nearly 221 countries in the world. Objective(s): The objective is Study of hematological and various biochemical Markers in COVID-19 patients admitted in a tertiary care centre . Methodology: In this single-center study, records of 170 patients hospitalized with COVID-19 were studied for hematological profile and biochemical markers. Records of patients with laboratory-confirmed COVID-19 disease hospitalized between April 2020, to August 2020, were included in the analysis. Result(s): A total of 170 patients were enrolled of Age Group 20-80 year of which 80% (136/170) were asymptomatic and 20% (34/170) symptomatic. 17% patients had co-existing illnesses. Clinical spectrum among COVID-19 patients varied from being asymptomatic to having symptoms like fever, dry cough, breathlessness with few progressing to respiratory failure and multi-organ failure. In our study, 96.0% (163/170) recovered while 4.0% (7/170) died. Mean age, total leucocyte count (TLC), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and lactate dehydrogenase (LDH),Procalcitonin, CRP, D dimer of severely ill patients were significantly higher than those of patients with non-severe illness. Conclusion(s): The clinicians may consider the hematological and biochemical parameters in the patients with COVID-19 in future decision-making. Elevated NLR, TLC, LDH, C-Reactive Protein, Procalcitonin, D dimer and lymphopenia were seen in the symptomatic patients especially manifesting severe disease. Early intervention and periodic monitoring of these parameters in patients, especially with severe disease may help in improving disease outcome. Copyright © 2022 Ubiquity Press. All rights reserved.
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Aims The Omicron variant of SARS-CoV-2 variant has rapidly spread in the UK since December 2021.There was a significant increase in the number of children testing positive for SARS-CoV-2 in December 2021 in the population served by this DGHS. A clustering of cases of PIMS- TS was noted in the last week of December 2021 and the first week of January 2022. The focus of this descriptive study of PIMS-TS patients from a single centre is to report the clustering of cases in the Omicron dominant period and to describe the dilemma of managing children who present with fever and pain abdomen. Methods Children confirmed to have PIMS-TS and one child who presented mimicking PIMS -TS were identified, their investigations, treatment and outcomes were reviewed Results A cluster of 6 children diagnosed as PIMS -TS presented from the 29th of December 2021 to the 8th of January 2022.The mean age of patients was 9.3 years. There was ethnic variation with 3 Asian, 2 Afro Caribbean and one White child. Mean CRP was 226( range 85-400). All children presented with fever of more than 3 days.3 children presented with partial Kawasaki features, 2 children were treated for shock and 2 children presented with pain abdomen and fever. A 15 year old presented with fever, pain abdomen and tenderness in the right iliac fossa. He was managed initially as appendicitis. Blood markers for PIMS-TS were significantly raised along with raised CRP of 204. CT abdomen showed ileitis. His NPA RT- PCR was positive for SARS-CoV-2. He continued to have high fever, a diagnosis of PIMS-TS was made. There was significant improvement in both clinical condition and biochemical markers following IV Methylprednisolone. On the same day a 11 year old presented with fever, pain abdomen and increased irritability. He had global developmental delay and was PEG fed. He was initially managed as PIMS-TS then diagnosed to have appendicitis. CT abdomen showed a perforated appendix. He had a good outcome after surgery Conclusion The clustering of cases of PIMS- TS may be specific to this geographical area and multi-ethnic population following a period of high SARS-CoV-2 prevalence in the community with the Omicron variant. PIMS-TS can closely mimic appendicitis and distinguishing between both can be difficult. In the first child, CRP was unusually high (202) which helped in making a diagnosis avoiding unnecessary surgery. In the second child clinical acumen and involvement of multiple specialist teams helped in making the diagnosis of appendicitis. The global developmental delay and the child being nonverbal proved to be confounding factors. Cases of PIMS-TS can have bowel inflammation, it is also possible that COVID-19 can occur with other pathologies. Radiology findings need to be interpreted with the clinical picture. Clinical acumen, considering a range of differentials working closely with other specialities enables us to make a correct diagnosis for the unwell child who presents in the COVID-19 pandemic.
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Numerous systemic infections may have hypercoagulation as one of the complications, which may range from asymptomatic presentation of elevation of biochemical markers of coagulation such as that of fibrin and thrombin generation, to a much severe, symptomatic, life-threatening, disseminated intravascular coagulation (DIC), which results in the formation of thrombi in the microvasculature of various organs. This phenomenon contributes to increase in morbidity and mortality in various infectious diseases. The current review discusses various mechanisms of hypercoagulation during infections such as tissue factor activation, endothelial cell activation, inhibition of physiological anticoagulant pathways, and fibrinolysis inhibition. The review also discusses pathophysiological changes in the coagulation system and its management in the recent pandemic of COVID-19. The article also discusses role of various parenteral and oral anticoagulants in the management of infectious diseases. The review provides clinical data on various anticoagulants used during hospitalization and extended prophylaxis for the management of venous thromboembolism in various infections. Methodology Because this is a review of published literature and no humans or animals were involved, ethical committee approval was not required and patient consent was not required.
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Background: Appropriate management of inflammatory bowel disease (IBD) often requires multiple specialist appointments per year. Living in rural locations may pose a barrier to regular specialist care. Saskatchewan (SK) has a large rural population. Prior to COVID-19, telehealth (TH) in SK was not routinely used for either patient assessment or follow up. Furthermore, TH was exclusively between hospitals and specific TH sites without direct contact using patient's personal phones. Aims: The objective of this study was to assess the differences in demographics, disease characteristics, outcomes, and health care utilization between patients from rural SK with IBD who used TH and those who did not. Methods: A retrospective chart review was completed on all rural patients (postal code S0∗) with IBD in SK who were followed at the Multidisciplinary IBD Clinic in Saskatoon between January 2018 and February 2020. Patients were classified as using TH if they had ever used it. Information on demographics, disease characteristics, and access to IBD-related health care in the year prior to their last IBD clinic visit or endoscopy was collected. Data was not collected for clinic visits after March 1, 2020 as all outpatient care became remote secondary to the COVID-19 pandemic. Mean, standard deviations, median and interquartile ranges (IQR) were reported. Mann-Witney U and Chi-Square tests were used to determine differences between the groups. Results: In total, 288 rural SK IBD patients were included, 30 (10.4%) used TH and 258 (89.6%) did not. Patient demographics were not significantly different between the two groups;although, there was a statistically significant difference in the proportion of ulcerative colitis patients (17% TH vs. 38% non-TH, p=0.02). The percentage of patients with clinical remission was 87% for TH patients and 74% for non-TH patients (p=0.13). There were no significant differences in health care utilization patterns and biochemical markers of disease, including c-reactive protein (CRP) and fecal calprotectin (FCP) (p>0.05). Conclusions: Prior to the pandemic, a small percentage of patients with IBD in rural SK ever used TH. A small proportion of UC patients used TH. No significant differences in disease characteristics, outcomes, or health care utilization were identified. Further study is warranted to identify barriers to use of this technology to tailor care to this patient group and improve access to care, especially now as the COVID-19 pandemic has drastically changed the use of virtual care.
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COVID-19 requires a complex assessment of disease progression. We aimed to assess the prognostic value of biochemical and complete blood count (CBC) parameters and their indexes in the progression of COVID-19 in patients with Diabetes mellitus (DM). Data from 784 patients hospitalized at the University Clinical Center Nis were assessed. Patients were divided into the control and DM groups. Disease progression was defined as a lethal outcome or intensive care treatment requirement. Patients' laboratory data upon admission was observed. There were 163 subjects (20.8%) with DM and 621 (79.2%) controls. In 52.8% of DM patients and 45.6% of controls, progression was observed. The ANOVA test showed significance between progression and IL-6 (P < 0.05), neutrophil-lymphocyte ratio (NLR) (P < 0.05), and CRP-IL-6 ratio (P = 0.02) in both groups. In controls, CRP (P = 0.012) and LDH (P = 0.000) were also highlighted. ROC analysis showed the best results for IL-6 (AUC = 0.77 and 0.64). There was a significant positive correlation of CRP, NLR, and CRP-IL-6 ratio (P = 0.05) with progression, while IL-6 correlated more significantly (P = 0.01) in DM patients. In controls, all correlations were of high significance (P = 0.01). Commonly assessed CBC and biochemistry parameters showed a more significant link to progression in controls than in DM patients, whereas the most highlighted marker was IL-6.
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Background: Severe acute respiratory syndrome coronavirus 2 is the causative agent of coronavirus disease 2019 (COVID-19). The release of alarmins results in a “cytokine storm,” which can be attenuated by the immunomodulatory and anti-inflammatory effects of dexamethasone. Aim: To evaluate and assess the effect of dexamethasone in two different doses, on D-dimer, serum ferritin, C-reactive protein (CRP) levels, and granulocyte/lymphocyte (%) in patients with COVID-19. Patients and methods: A total of 100 patients were randomly divided into two groups;group A patients received a higher dose of dexamethasone than those in group B. Measurements of certain hematological and biochemical markers, including D-dimer, serum ferritin, CRP, and granulocyte/lymphocyte ratio were done for all the patients in both groups. These indices were compared at different times of treatment between the two groups. Results: The D-dimer and granulocyte/lymphocyte ratio measurements were statistically non-significant in both the groups in all three readings. The serum ferritin measurement was significant only on the 6th day of treatment. The results demonstrated that group A patients had significantly lower CRP levels on both the 3rd and 6th days of treatment. Conclusion: Administration of a slightly higher dose of dexamethasone (8 mg per day for three days, then 6 mg per day for another 3 days) in patients hospitalized with COVID-19 effectively reduces the inflammatory and hematological biomarkers in patients who required supplemental oxygen therapy.
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Objectives: This present study was to evaluate the role of biomarkers for diagnosis and management of COVID-19 patients. Methods: Throat-swab upper respiratory specimens were obtained from 100 patients and real-time PCR (polymerase chain reaction) was used to confirm SARS-CoV-2 infection. Clinical characteristics and blood biochemical tests of COVID-19 patients were examined and recorded. Venous blood (4.5 mL) was obtained. Blood samples were dispensed into a gel tube. All tubes were allowed to stand for 30 minutes at room temperature, followed by centrifugation for 10 minutes at 3500 rpm to get the serum. Liver and kidney function test were performed to all patients. Results: In this present study, out of 100 COVID-19 patients, they had 20(20%) diabetic, 29(29%) smokers, 04(04%) cancerous and 15(15%) hypertensives. Mean age of COVID-19 patients was 42.4±13.18 years. Conclusions: Abnormalities in biochemical markers play a pivotal role in the SARS-CoV-2 pandemic, it is not only from a diagnostic point of view but also in terms of the management and prognosis of COVID-19 patients. It helps for clinical decision making in order to adjust the therapy to the biological changes experienced by the subjects. Changes in the biochemical markers indicate abnormalities in various tissues and organs, indicating the development of COVID-19. Urea, CK, and LDH show the most predictive parameters of severe COVID-19 patients. LDH as an important biomarker is associated with poor outcomes in COVID-19 patients.