Blood Transfusion in Covid-19 Patients: One Year Survey

Introduction: Due to the COVID-19 outbreak, many chronic patients and elective surgical procedures have been postponed to create spaces for the hospitalization of COVID-19 patients, raising issues related to this change. The objective of this study is to assess the effect of the COVID-19 pandemic on the demand for blood products transfusion. Materials ant methods: The study presents the results of a retrospective study of blood transfusions in COVID-19 patients admitted to the Constanta County Emergency Clinical Hospital. The period of study was January-December 2021. We compared the transfusion requirement for each type of blood component in COVID 19 patients versus patients with non-COVID pathology. Results and discussions: During 2021, we transfused 282 COVID-19 patients;150 patients had only Covid pneumonia (of which 19 patients with severe forms needed intensive care in ICU-Covid), and 132 patients had various co-morbidities. The maximum blood requests was registered in the period February - April 2021, with a peak of 63 patients in April 2021. The main co-morbidities in patients with Covid 19 were: severe anemia in patients with malignant hemopathies. Anemia at admission in patients with Covid pneumonia is reported in more than 40% of patients. Moderate anemia (Hb <11 g/dL) is considered as an independent risk factor for the severe course of COVID-19 infection and mortality in these patients. The transfusion requirement in these patients was greater than 1.43 RBC (units/patient), 0.81 Plasma units/patient, 0.40 Platelets concentrate units + single donor platelet concentrate units/patient, in accordance with the associated pathology. Conclusion(s): The most requested product was packed red blood cells, the correction of anaemia being an important factor in preventing the severe course of the disease. The platelet requirement was 0.15 units/patient, thrombocytopenia being present in patients with severe evolution of the infection (hospitalized in ICU-COVID). The most requested blood groups were O+ and A+. COVID-19 transfusion data will help plan and prepare for the use of blood resources during the pandemic.Copyright © 2022 Sevigean Ali et al., published by Sciendo.

Predictors of Mortality among COVID-19 Patients - A Case Control Study at Tertiary Care Center, Nanded (Maharashtra).

Background: The novel Coronavirus is belonging to the family of SARS & MERS-CoV, the impact of the earlier is more dreadful as demonstrated by the steady increase in morbid cases. The average incubation period of COVID-19 is 1-14 days with a mean of 6 days. Aim - To evaluate predictors of mortality among COVID-19 patients. Objectives - 1. To assess risk predictors associated with mortality among COVID-19 patients 2. To a suggest prediction model for preventing mortality in future outbreaks. Materials and Methods: Study design - A case-control study. Study place -Tertiary care center, Nanded, Maharashtra. The present study included 400 cases that died off due to Covid-19 and 400 controls survived COVID-19 disease in a 1:1 proportion. Results: On admission, a significant difference was observed among cases and controls with reference to the percentage of SpO2 (p < 0.05). The proportion of associated co-morbidities among cases was very high i.e., 75.75% as compared to controls with a proportion of 29.25% co-morbidities. The median days of hospital stay were significantly lower in cases compared to controls (3 days vs 12 days, P < 0.001). Conclusion: Length of hospital stay (in days) was showing a significant difference among cases and control (3 days Vs 12 days); hospital stay was less (median 3 days) for cases, as they reported late and thus died earlier; hence concluded that early hospital admission will decrease chances of death due to COVID-19.

Correlation of Lactate Dehydrogenase Level with Severity of Disease and In-hospital Outcome in Individuals Diagnosed with COVID-19: A Retrospective Study

Introduction: The presence of tissue damage in the lungs, kidneys, heart, or other organs can be detected by monitoring the level of Lactate Dehydrogenase (LDH) in the blood and considered a reliable biomarker in early prediction of patients' prognosis. Aim: To determine extent of correlation between LDH level with the spectrum and in-hospital outcome of Coronavirus Disease -2019 (COVID-19) infected patients. Materials and Methods: This retrospective research was undertaken during March 2020 to May 2020, based on the data of 205 COVID-19 infected patients, reported at Dammam Medical Complex, Dammam, Eastern Province, Saudi Arabia. Patients' records were retrieved and the following data were recorded-age, gender, nationality, co-morbidities, lactate dehydrogenase level, number of days since the patient tested positive (Up to 7,14 and > 14 days), COVID-19 symptoms [mild, moderate, or severe as per British Thoracic Society guidelines (CURB (Confusion, Blood Urea Nitrogen, Respiratory Rate, Blood Pressure)-65)]. The data was collected and tabulated as mean +/- SD, frequency and percentages. Analysis was carried out using specialized software of Statistical Package for Social Sciences (SPSS) version 20.0. Results: On analysis of the collected data of all 205 included patients, the LDH level was found significantly high among males, 46-60 years old, and among non-Saudi patients. The severity of COVID-19 symptoms and LDH levels were found to have a strong relationship (p-value < 0.001). Patients between the ages of 46 and 60 were more likely (4.3 times) to have poor outcomes, and diabetes mellitus was predicted to be 2.32 times more likely to be associated with poor COVID-19 outcomes. Raised LDH levels were > 5 times more likely to lead to in-hospital poor outcomes compared to those with borderline LDH levels. Conclusion: LDH level is a reliable predictor for the cause of COVID-19. The results of the present study suggest that patients aged 46-60 years, diabetic patients, or those suffering from severe symptoms of COVID-19 have raised levels of LDH.

Predictors of COVID-19 severity and outcomes in Indian patients with rheumatic diseases: a prospective cohort study.

Objective: There is dearth of data regarding the outcomes of coronavirus disease 2019 (COVID-19) among rheumatic and musculoskeletal disease (RMD) patients from Southeast Asia. We report the clinicodemographic profile and identify predictors of COVID-19 outcomes in a large cohort of Indian RMD patients. Methods: This prospective cohort study, carried out at the Postgraduate Institute of Medical Education and Research, Chandigarh (a tertiary care centre in India), included RMD patients affected with COVID-19 between April 2020 and October 2021. Demographic and clinical and laboratory details of COVID-19 and underlying RMD were noted. Predictors of mortality, hospitalization and severe COVID-19 were identified using stepwise multivariable logistic regression. Results: A total of 64 severe acute respiratory syndrome coronavirus-2-infected RMD patients [age 41.5 (19-85) years; 46 (72%) females] were included. Eighteen (28%) patients had severe COVID-19. Twenty-three (36%) required respiratory support [11 (17%) required mechanical ventilation]. Thirty-six (56%) patients required hospitalization [median duration of stay 10 (1-42) days]; 17 (27%) required intensive care unit admission. Presence of co-morbidities [odds ratio (OR) = 4.5 (95% CI: 1.4, 14.7)] was found to be an independent predictor of COVID-19 severity. Co-morbidities [OR = 10.7 (95% CI: 2.5, 45.4)] and underlying lupus [OR = 7.0 (95% CI: 1.2, 40.8)] were independently associated with COVID-19 hospitalization. Ongoing rheumatic disease activity [OR = 6.8 (95% CI: 1.3, 35.4)] and underlying diagnosis of lupus [OR = 7.1 (95% CI: 1.2, 42.4)] and SSc [OR = 9.5 (95% CI: 1.5, 61.8)] were found to be strong independent predictors of mortality. Age, sex, underlying RMD-associated interstitial lung disease and choice of immunosuppressive therapy were not associated with COVID-19 severity or adverse outcomes. Conclusion: The presence of co-morbidities was independently associated with COVID-19 severity and hospitalization. Ongoing rheumatic disease activity and the presence of lupus or SSc independently predicted mortality. Age, sex, type of immunosuppressive therapy and presence of RMD-associated interstitial lung disease did not affect COVID-19 severity or outcomes in Indian RMD patients.

Association of Pre-Pregnancy Obesity and COVID-19 with Poor Pregnancy Outcome.

BACKGROUND AND OBJECTIVES: During the COVID-19 pandemic, a possible overlap of obesity and COVID-19 infection has raised concerns among patients and healthcare professionals about protecting pregnant women from developing a severe infection and unwanted pregnancy outcomes. The aim of this study was to evaluate the associations of body mass index with clinical, laboratory, and radiology diagnostic parameters as well as pregnancy complications and maternal outcomes in pregnant patients with COVID-19. MATERIALS AND METHODS: Clinical status, laboratory, and radiology diagnostic parameters and pregnancy outcomes were analyzed for pregnant women hospitalized between March 2020 and November 2021 in one tertiary-level university clinic in Belgrade, Serbia, due to infection with SARS-CoV-2. Pregnant women were divided into the three sub-groups according to their pre-pregnancy body mass index. For testing the differences between groups, a two-sided p-value <0.05 (the Kruskal-Wallis and ANOVA tests) was considered statistically significant. RESULTS: Out of 192 hospitalized pregnant women, obese pregnant women had extended hospitalizations, including ICU duration, and they were more likely to develop multi-organ failure, pulmonary embolism, and drug-resistant nosocomial infection. Higher maternal mortality rates, as well as poor pregnancy outcomes, were also more likely to occur in the obese group of pregnant women. Overweight and obese pregnant women were more likely to develop gestational hypertension, and they had a higher grade of placental maturity. CONCLUSIONS: Obese pregnant women hospitalized due to COVID-19 infection were more likely to develop severe complications.

Otorhinolaryngological presentations of mucormycosis amid COVID-19 pandemic in a tertiary care hospital.

Objective: To describe presentations, comorbidities, investigations, and surgical treatment of patients with mucormycosis amid the COVID-19 pandemic in a tertiary care hospital in Khyber Pakhtunkhwa, Pakistan. Methods: This descriptive study was conducted at the department of ENT, and Head and Neck Surgery, Medical Teaching Institute, Lady Reading Hospital, Peshawar, Pakistan from June 2020 to June 2021. All the patients fulfilling the inclusion criteria were included. Patients with COVID-19 were diagnosed based on real-time polymerase chain reaction (RT-PCR). After diagnosing mucormycosis computed tomography (CT) scan and/or magnetic resonance imaging (MRI) were performed for subsequent surgical clearance. After taking informed consent demographic data were collected on a proforma and analyzed using SPPS version 25. Results: Out of 23 patients males were 14(60.9%), females were 9 (39.1%) with a male: female ratio of 1.5:1. Mean ± SD age was 51.26 ± 1.41 years. Nasal obstruction and headache were the most common (8, 34.8%) presentations. The commonest co-morbidities were hypertension with diabetes mellitus (8, 34.8%). Out of 23 patients, 16(69.6%) had COVID-19 PCR positive. The majority of patients (17, 73.9%) were not vaccinated against COVID-19. Most of the patients (9, 39.1%) had HbA1c levels of 7% to 8.9%. The commonest surgery was endoscopic debridement of paranasal sinuses (9, 39.1%), while the commonest CT scan finding was a heterogeneous lesion involving the nose, maxillary and ethmoid sinuses (12, 52.2%). Conclusion: Mucormycosis of paranasal sinuses with/or without intracranial extension is frequently seen in unvaccinated patients having uncontrolled diabetes and COVID-19 infection.

Characteristics and outcomes of an international cohort of 600 000 hospitalized patients with COVID-19.

BACKGROUND: We describe demographic features, treatments and clinical outcomes in the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) COVID-19 cohort, one of the world's largest international, standardized data sets concerning hospitalized patients. METHODS: The data set analysed includes COVID-19 patients hospitalized between January 2020 and January 2022 in 52 countries. We investigated how symptoms on admission, co-morbidities, risk factors and treatments varied by age, sex and other characteristics. We used Cox regression models to investigate associations between demographics, symptoms, co-morbidities and other factors with risk of death, admission to an intensive care unit (ICU) and invasive mechanical ventilation (IMV). RESULTS: Data were available for 689 572 patients with laboratory-confirmed (91.1%) or clinically diagnosed (8.9%) SARS-CoV-2 infection from 52 countries. Age [adjusted hazard ratio per 10 years 1.49 (95% CI 1.48, 1.49)] and male sex [1.23 (1.21, 1.24)] were associated with a higher risk of death. Rates of admission to an ICU and use of IMV increased with age up to age 60 years then dropped. Symptoms, co-morbidities and treatments varied by age and had varied associations with clinical outcomes. The case-fatality ratio varied by country partly due to differences in the clinical characteristics of recruited patients and was on average 21.5%. CONCLUSIONS: Age was the strongest determinant of risk of death, with a ∼30-fold difference between the oldest and youngest groups; each of the co-morbidities included was associated with up to an almost 2-fold increase in risk. Smoking and obesity were also associated with a higher risk of death. The size of our international database and the standardized data collection method make this study a comprehensive international description of COVID-19 clinical features. Our findings may inform strategies that involve prioritization of patients hospitalized with COVID-19 who have a higher risk of death.

Exploration of Sex and Age-Based Associations in Clinical Characteristics, Predictors of Severity, and Duration of Stay among COVID-19 Patients at the University Hospital of Saudi Arabia.

COVID-19 infection has a spectrum of variable clinical severity between populations because of their characteristic demographic features, co-morbidities, and immune system reactions. This pandemic tested the healthcare system's preparedness, which depends on predictors of severity and factors related to the duration of hospital stays. Therefore, we carried out a single-center, retrospective cohort study in a tertiary academic hospital to investigate these clinical features and predictors of severe disease and study the different factors that affect hospital stay. We utilized medical records from March 2020 to July 2021, which included 443 confirmed (positive RT-PCR) cases. The data were explained using descriptive statistics and analyzed via multivariate models. Among the patients, 65.4% were female and 34.5% were male, with a mean age of 45.7 years (SD ± 17.2). We presented seven age groups with ranges of 10 years and noticed that patients aged 30-39 years old comprised 23.02% of the records, while patients aged 70 and above comprised 10%. Nearly 47% were diagnosed as having mild, 25% as moderate, 18% as asymptomatic, and 11% as having a severe case of COVID-19 disease. Diabetes was the most common co-morbidity factor in 27.6% of patients, followed by hypertension (26.4%). Our population's predictors of severity included pneumonia, identified on a chest X-ray, and co-morbid conditions such as cardiovascular disease, stroke, ICU stay, and mechanical ventilation. The median length of hospital stay was six days. It was significantly longer in patients with a severe disease and who were administered systemic intravenous steroids. An empirical assessment of various clinical parameters could assist in effectively measuring the disease progression and follow-up with patients.

Induced Depressive Disorder Following the First Dose of COVID-19 Vaccine.

INTRODUCTION: Several COVID-19 vaccines have been implemented. However, some side effects of the vaccine have been reported, which are sometimes very harmful. Reported cases and data are still very limited regarding the psychiatric side effects of the COVID-19 vaccine. To our knowledge, only one case has been reported. In this paper, we report the case of a patient who presented an acute depressive episode 24 hours after receiving his first dose of the BNT162b2mRNA vaccine. CASE REPORT: The case was a 26-year-old man with a history of Down syndrome with moderately good autonomy for daily routine tasks. The patient, who presented hypothyroidism at 10 years old and schizophrenia at 15 years old, was doing well before the vaccination and received his first dose of the BNT162b2mRNA vaccine. Twenty-four hours later, he presented depressive symptoms that resolved spontaneously after one week. Then, fifteen days later, the symptoms reappeared, and the episode lasted for 5 weeks. The patient received 10 mg/day of escitalopram besides his usual treatment. The depressive symptoms improved considerably by the second day of treatment. DISCUSSION: The presented case illustrated significant diagnostic challenges, especially when taking into account the sequential relationship between the COVID-19 vaccine and the occurrence of depressive symptoms. A single case of depression has been reported after the administration of the COVID-19 vaccine. Scientific evidence suggests the important role of the immune system in the pathophysiology of various psychiatric disorders, including depression. CONCLUSION: Health professionals must take into consideration the potential psychiatric side effects even being rare so far, especially in vulnerable subjects. Further studies are required to establish the causal effects of depressive symptoms occurring during the weeks following the COVID-19 vaccine bolus injection.

Demographic Factors and Co Morbidities Associated with Post Covid-19 Recovery among Admitted Patients in Tertiary Care Hospitals of Khyber Pakhtunkhwa

Objective: To study the relationship of demographic factors and co-morbidities with post-COVID-19 recovery in tertiary care hospitals of Peshawar. Methodology: This research was conducted in tertiary care hospitals of Khyber Pakhtunkhwa extending over a period of 6 months starting from 1st July 2020 to 31st December 2020. It was an analytical descriptive study (cross-sectional). Patients were selected through a non-probability consecutive sampling technique. Descriptive statistics were performed with SPSS software 22.0 in the form of the mean (sd) and percentages while univariate and multivariate logistic regression scrutiny was performed with STATA version 13.0. Result(s): A mean age (48.94+/-17.57) was observed up to the post-infection recovery or death. The mean age of post-infection recovered patients in the age series of 18-35 years and >55 years was significantly significant (P<0.05) Out of those who recovered, 110 (79.5%) were males and 49(20.5%) were females while those who died of the infection 15(36.6%) were females and 26(83.8%) were males. Univariate analysis showed that age, residence, hypertension, and ischemic heart disease were the covariates significantly associated (p.value <0.05) with post COVID recovery. In multivariate analysis with adjusted OR, "residence" was the only covariate associated with post-infection recovery. Adjusting for the effect of age, gender, hypertension, diabetes, ischemic heart disease, those who were living in urban areas were most likely to recover from COVID-19 infection as compared to the peri-urban residents (OR=0.067, CI: 0.013-0.333). In the full deduced model, adjusting for age, gender, diabetes, hypertension and ischemic heart disease, being an urban resident was 0.08 times more likely to survive or alive after getting COVID-19 infection as compared to dwellers living in city outskirts (OR=0.08, CI: 0.016-0.360). Conclusion Patients suffering from chronic hypertension and ischemic heart diseases were the most affected having higher post-infection mortalities compared to diabetic patients while, from a demographic point of view, being a resident of an urban area was a protective factor for post-infection recovery. Copyright © 2022 Lahore Medical And Dental College. All rights reserved.

Correlation of Lactate Dehydrogenase Level with Severity of Disease and In-hospital Outcome in Individuals Diagnosed with COVID-19: A Retrospective Study

Introduction: The presence of tissue damage in the lungs, kidneys, heart, or other organs can be detected by monitoring the level of Lactate Dehydrogenase (LDH) in the blood and considered a reliable biomarker in early prediction of patients' prognosis. Aim(s): To determine extent of correlation between LDH level with the spectrum and in-hospital outcome of Coronavirus Disease-2019 (COVID-19) infected patients. Material(s) and Method(s): This retrospective research was undertaken during March 2020 to May 2020, based on the data of 205 COVID-19 infected patients, reported at Dammam Medical Complex, Dammam, Eastern Province, Saudi Arabia. Patients' records were retrieved and the following data were recorded-age, gender, nationality, co-morbidities, lactate dehydrogenase level, number of days since the patient tested positive (Up to 7,14 and >14 days), COVID-19 symptoms [mild, moderate, or severe as per British Thoracic Society guidelines (CURB (Confusion, Blood Urea Nitrogen, Respiratory Rate, Blood Pressure)-65)]. The data was collected and tabulated as mean+/-SD, frequency and percentages. Analysis was carried out using specialized software of Statistical Package for Social Sciences (SPSS) version 20.0. Result(s): On analysis of the collected data of all 205 included patients, the LDH level was found significantly high among males, 46-60 years old, and among non-Saudi patients. The severity of COVID-19 symptoms and LDH levels were found to have a strong relationship (p-value<0.001). Patients between the ages of 46 and 60 were more likely (4.3 times) to have poor outcomes, and diabetes mellitus was predicted to be 2.32 times more likely to be associated with poor COVID-19 outcomes. Raised LDH levels were >5 times more likely to lead to in-hospital poor outcomes compared to those with borderline LDH levels. Conclusion(s): LDH level is a reliable predictor for the cause of COVID-19. The results of the present study suggest that patients aged 46-60 years, diabetic patients, or those suffering from severe symptoms of COVID-19 have raised levels of LDH. Copyright © 2023 Journal of Clinical and Diagnostic Research. All rights reserved.

Comparative Study of Outcomes of COVID-19 Infection in Vaccinated and Unvaccinated Patients- A Retrospective Analysis

Introduction: Vaccine development was the highest priority during the Coronavirus disease 2019 (COVID-19) pandemic. An ideal vaccine should decrease the risk of infection and reduce the incidence and severity of the disease. Risk of disease or infection following COVID-19 vaccination needs to be evaluated for its efficacy and effectiveness. Aim(s): To compare the severity of the disease, oxygen requirement, and mortality between vaccinated and unvaccinated COVID-19 patients. Material(s) and Method(s): This retrospective study was done on the data of the patients who were admitted to Nizams Institute of Medical Sciences. All the admitted patients with COVID-19 disease, diagnosed by either Reverse Transcriptase Polymerase Chain Reaction (RTPCR) or rapid antigen detection method from April 2021 to October 2021, were included. Parameters recorded were: age, gender, co-morbidities, clinical staging as per institute protocol, vaccination status, oxygen requirement, the requirement of non invasive or invasive ventilation, inflammatory markers like C-Reactive Protein (CRP), ferritin, D dimer, Computed Tomography (CT) severity index, and outcomes. Result(s): The mean age of patients was 49.7+/-14.8 yrs in the unvaccinated group, and 52.75+/-16.2 yrs in the vaccinated group. Out of 175 patients, 102 (58.28 %) were unvaccinated. There were 25 (14.28%) deaths, of which 20 (80%) were unvaccinated and 5 (20%) were vaccinated. Oxygen requirement was more among the unvaccinated 73/96 (76.04%). High flow oxygen / mechanical ventilation requirement was higher in unvaccinated compared to vaccinated, 38 (76%) vs 12 (24%) respectively (p-value <0.005). The mortality rate was higher in unvaccinated patients with co-morbidity, with an odds ratio of 3.32 (1.2-9.3), p-value=0.02. Serum ferritin levels were significantly higher in the unvaccinated group, 858.15+/-935.5 vs 473.4+/-663.2 ng/mL, p-value 0.007. CT severity index in the unvaccinated group was 13.82+/-5.4, and for the vaccinated group, it was 11.58+/-5.49. Conclusion(s): Severe disease, oxygen requirement, and mortality were low in vaccinated patients. Vaccination has also resulted in a statistically significant decrease in mortality in patients with co-morbidities. Serum ferritin levels were also found to be lower in vaccinated patients. Copyright © 2023 Journal of Clinical and Diagnostic Research. All rights reserved.

Analysis of daily COVID-19 death bulletin data during the first two waves of the COVID-19 pandemic in Thiruvananthapuram district, Kerala, India.

Context: Coronavirus disease 2019 (COVID-19) mortality trends can help discern the pattern of outbreak evolution and systemic responses. Aim: This study aimed to explore patterns of COVID-19 deaths in Thiruvananthapuram district from 31 March 2020 to 31 December 2021. Setting and Design: Secondary data analysis of COVID-19 deaths in Thiruvananthapuram district was performed. Materials and Methods: Mortality data were obtained from the district COVID-19 control room, and deaths in the first and second waves of COVID-19 were compared. Statistical Analysis: We summarised data as proportions and medians with the inter-quartile range (IQR) and performed Chi-square tests to make comparisons wherever applicable. Results: As on 31 December 2021, 4587 COVID-19 deaths were reported in Thiruvananthapuram district, with a case fatality rate of 0.91%. We observed high mortality among older persons (66.7%) and men (56.6%). The leading cause of death was bronchopneumonia (60.6%). The majority (88.5%) had co-morbidities, commonly diabetes mellitus (54.9%). The median interval from diagnosis to hospitalisation was 4 days (IQR 2-7), and that from hospitalisation to death was 2 days (IQR 0-6). The deaths reported during the second wave were four times higher than those of the first wave with a higher proportion of deaths in the absence of co-morbidities (p < 0.001). The majority of the deceased were unvaccinated. Ecological analysis with vaccine coverage data indicated 5.4 times higher mortality among unvaccinated than those who received two vaccine doses. Conclusions: The presence of co-morbidities, an unvaccinated status, and delay in hospitalisation were important reasons for COVID-19 deaths. Primary level health providers can potentially help sustaining vaccination, expeditious referral, and monitoring of COVID-19 patients.

Efficacy and safety of early soluble urokinase plasminogen receptor plasma-guided anakinra treatment of COVID-19 pneumonia: A subgroup analysis of the SAVE-MORE randomised trial.

Background: The SAVE-MORE trial demonstrated that anakinra treatment in COVID-19 pneumonia with plasma soluble urokinase plasminogen activator (suPAR) levels of 6 ng/mL or more was associated with 0.36 odds for a worse outcome compared to placebo when expressed by the WHO-Clinical Progression Scale (CPS) at day 28. Herein, we report the results of subgroup analyses and long-term outcomes. Methods: This prospective, double-blind, randomised clinical trial, recruited patients with a confirmed SARS-CoV-2 infection, in need of hospitalisation, lower respiratory tract infection and plasma suPAR ≥6 ng/mL from 37 academic and community hospitals in Greece and Italy. Patients were 1:2 randomised to subcutaneous treatment with placebo or anakinra (100 mg) once daily for 10 days. Pre-defined subgroups of Charlson's comorbidity index (CCI), sex, age, level of suPAR, and time from symptom onset were analysed for the primary endpoint (overall comparison of distribution of frequencies of the scores from the WHO-CPS between treatments on day 28), by multivariable ordinal regression analysis in the intention to treat (ITT) population. This trial is registered with the EU Clinical Trials Register (2020-005828-11) and ClinicalTrials.gov (NCT04680949). Findings: Patients were enrolled between 23 December 2020 and 31 March 2021; 189 patients in the placebo arm and 405 patients in the anakinra arm were the ITT population. Multivariable analysis showed that anakinra treatment was accompanied by significantly lower odds for worse outcome compared to placebo at day 28 for all studied subgroups (CCI ≥ 2, OR: 0.34, 95% confidence intervals [CI] 0.22-0.50; CCI < 2, OR: 0.38, 95% CI 0.21-0.68; suPAR > 9 ng/mL, OR: 0.35, 95% CI 0.19-0.66; suPAR 6-9 ng/mL, OR: 0.35, 95% CI 0.24-0.52; patients ≥65 years, OR: 0.41, 95% CI 0.25-0.66; and patients <65 years, OR: 0.29, 95% CI 0.19-0.45). The benefit was uniform, irrespective of the time from start of symptoms until the start of the study drug. At days 60 and 90, anakinra treatment had odds of 0.40 (95% CI 0.28-0.57) and 0.46 (95% CI 0.32-0.67) respectively, for a worse outcome compared to placebo. The costs of general ward stay, ICU stay, and drugs were lower with anakinra treatment. Interpretation: Anakinra represents an important therapeutic tool in the management of COVID-19 that may be administered in all subgroups of patients; benefits are maintained until day 90. Funding: Hellenic Institute for the Study of Sepsis; Swedish Orphan Biovitrum AB.

Black Fungus: Pandemic Devastating India?

Black fungus is the latest threat to the patients who just recovered from the covid-19. Black fungus is a type of mucormycosis infection, predominantly seen in patients with co-morbidities, mainly diabetes, cancer, immunocompromised infections, and organ transplant. Rising black fungus cases are not only a major aesthetic problem disrupting the medical and socioeconomic system, but it also senses another upcoming pandemic in India. Black fungus has a clinical appearance that is indistinguishable from other common illnesses at first, and it is invariably deadly unless diagnosed early or untreated vigorously. Rapid and precise diagnostic procedures, as well as the availability of less toxic, more effective antifungal drugs like posaconazole and isavuconazole, should be pursued as targets for improved black fungus care. The liposomal Amphotericin B had brought new rays of hope for treating black fungus by providing better efficacy amongst people. Since there is a dearth of literature regarding the management of black fungus patients, the article focused on the incidences, prevalence, diagnosis, and treatment protocol, to gain insight into the extent of this epidemic in India in 2021. Copyright © 2020 the American Physiological Society.

Association of hematological and biochemical parameters with clinical profile of COVID-19 patients in Visakhapatnam, India

Background: The cytokine cascade in COVID-19 is responsible for its clinical manifestations. Timely management of patients with dismal prognosis may improve their clinical outcome. The study aimed to analyze the hematological and biochemical parameters among COVID-19 patients and the factors associated with laboratory changes and COVID-19 infection. Materials and Methods: A retrospective, cross-sectional study was conducted in a designated district COVID hospital. COVID-19 patient’s medical records were converted into an electronic database which included demographic data, recent exposure history, existing co-morbidities, symptoms, and laboratory findings. Results: Out of the 1340 patients, 69.25% were males. Symptomatics accounted for 57.61%. The common co-morbidities among infected patients were diabetes mellitus (13.88%), hypertension (15%), and chronic obstructive pulmonary disease/asthma (2.16%), which had a significant positive correlation with COVID-19. The common symptoms were fever (50.39%), dry cough (46.24%), dyspnea (30.7%), and myalgia (28.5%). Leucocytosis, neutrophilia, lymphopenia, and thrombocytopenia were reported in 5.22%, 11.34%, 27.16%, and 3.41% of patients, respectively. Elevated aspartate aminotransferase, alanine aminotransferase, hypoalbuminemia, and hyperglobulinemia were observed in 13.88%, 19.4%, 24.77%, and 10% of patients, respectively. Symptomatics had significantly higher values for neutrophil percentage, neutrophil–lymphocyte ratio (NLR), derived NLR, lymphocyte-to-monocyte ratio, platelet-to-lymphocyte ratio, lymphocyte–leucocyte ratio, systemic immune-inflammatory index, blood urea, and indirect bilirubin levels and significantly lower values for lymphocyte percentage, absolute lymphocyte count, and serum albumin. The logistic regression analysis revealed a significant association of deranged laboratory parameters among symptomatic COVID-19 patients and those with pre-existing co-morbidities. Conclusion: Neutrophilia, lymphopenia, and deranged liver function tests were significantly present in COVID-19 patients. The inflammation in COVID-19 is exhibited as remarkable hematological and laboratory changes whose careful interpretation can offer a clinical window for risk stratification and appropriate therapeutic interventions.

Angiotensin II and human obesity. A narrative review of the pathogenesis

Angiotensin II (Ang II) is a hormone and the main effector of the renin-angiotensin system (RAS). This peptide has crucial pathophysiologi-cal effects on hypertension, cardiac hypertrophy, endothelial proliferation, inflammation and tissue remodelling through G protein-coupled receptors. The pro-inflammatory role of Ang II has been reported in various inflammatory pro-cesses. Obesity is linked to a chronic inflammatory process which in turn is the cause of some of its morbidities. Ang II is related to the comorbidities related to the comorbidities of obesity, which include alterations in the heart, kid-ney, hypertension and coagulation. In this regard, activation of AT1 receptors by Ang II can induce an inflammatory process mediated by the transcription factor NF-kB, triggering inflammation in various systems that are related to the comorbidities observed in obesity. The aim of this review was to highlight the pro-inflammatory effects of Ang II and the alterations induced by this hormone in various organs and systems in obesity. The search was done since 1990 through Medline, EMBASE and PubMed, using the keywords: angiotensin II;an-giotensin II, obesity;angiotensin II, kidney, obesity;angiotensin II, coagulation, obesity;angiotensin II, inflammation, obesity;angiotensin II, adipose tissue, obesity;angiotensin II, hypertension, obesity;angiotensin II, insulin resistance, obesity;angiotensin II, adiponectin, leptin, obesity;angiotensin II, COVID-19, obesity. Angiotensin II through its interaction with its AT1 receptor, can induce alterations in diverse systems that are related to the comorbidities observed in obesity. Therapeutic strategies to decrease the production and action of Ang II could improve the clinical conditions in individuals with obesity. Copyright © 2022, Instituto de Investigaciones Clinicas. All rights reserved.

A Study on Correlation between Mortality and Co-Morbidities in Patients with Covid 19 Infection

Background: Coronavirus disease 2019 (COVID-19) is a new respiratory infection caused by a coronavirus known as SARS coronavirus 2. (SARS- CoV-2). The virus is a member of the coronavirus family, which are zoonotic pathogens that cause and transmit infections between humans and various animals. The World Health Organization (WHO) has designated coronavirus disease 2019 (COVID-19) a pandemic, with 20% of infected individuals requiring hospitalisation and 6% requiring critical care and invasive ventilatory support. Comorbidities are thought to be a greater risk for reducing the survival probability of SARSCoV- 2 patients. Different types of pre- existing diseases have been identified as comorbidities in SARS-CoV-2 infection, which increases susceptibility and poses risks of more severe outcomes and deaths in COVID-19 patients.Thisstudy is to identify different comorbidities of the patients who died due to COVID-19 admitted in GMERS medical college and general hospital in city Gandhinagar in Gujarat state. Method(s):This is a retrospective study of patients admitted to covid hospital, GMERS medical college and hospital, Gandhinagar who had been reported positive either with RTPCR Test or rapid antigen test and died in hospital during the period of April 2020 to April 2021. Result(s): In present study, majority (62.9%) of the study participants were in the age group of 51 to 70 years. The mean age of the study participants was61.91 years.58.4% of the COVID- 19 patients were males while 41.6% were females. 93.2% of the COVID-19 patients were having any comorbidity while among 6.8% of the patients were without any comorbidities withhypertension was most common(57.5%) followed by diabetes(53.4%). 44.8% of the study patientswere having only single comorbidity while 55.2% were having more than or equals to two comorbidities. The mean interval between hospital admission and death of the patients was 4.5 days. Conclusion(s): It has been concluded that old age, male gender has more severe outcome in case of COVID-19. Hypertension and diabetes mellitus were also reported among more than 50% of the patients who died from COVID-19. Copyright © 2022 Ubiquity Press. All rights reserved.

Clinical Correlation and Radiological Profile of SARS-COVID-19 Patients: A Record Based Cross Sectional Study in a Tertiary Care Hospital in Eastern Odisha

The present Covid-19 pandemic caused by corona virus (SARS-CoV-2) is an unpredictable public health burden in India and abroad. Worldwide emergency steps are taken to counter the current situation. Odisha state (Eastern India) is now passing through a crucial period with a huge number of corona positive cases with high degree of mortality and morbidity. The aim of the present study is to correlate the demographic, clinical and radiological profiles of Covid-19 patients. The present study was carried out in the Covid-19 Hospital of S C B medical college Cuttack. This was a record based cross sectional study of 196 patients from 01/05/2021 to 01/06/2021. Plain X Rays were taken in all the patients to evaluate the incidence of disease. Total number of 196 Covid-19 cases was included in this study with male female ratio being 2.16:1. Maximum male patients were seen amounting (68%) and females (32%) respectively. Severity was mild to moderate in 80 % of cases. The diagnostic features of novel SARS-CoV-2 infection were observed in 32 % cases in x ray images of thorax. The co-morbid conditions for mortality were diabetes mellitus and hypertension. The chest X rays of corona virus 2 (SARS-CoV-2) infected patients are showing typical ground glass opacity (GGO), mixed GGO with consolidation bilaterally in the peripheral part of middle and lower lobe of lungs. The clinical co-morbid condition observed to be associated with high mortality in SARS-CoV-2 cases were diabetes and hypertension. Copyright © 2022, Global Research Online. All rights reserved.

Abnormalities in cardiac and inflammatory biomarkers in ambulatory subjects after COVID-19 infection.

Background: Coronavirus-2019 (COVID-19) is known to affect the heart and is associated with a pro-inflammatory state. Most studies to date have focused on clinically sick subjects. Here, we report cardiac and proinflammatory biomarkers levels in ambulatory young adults with asymptomatic or mild COVID-19 infection compared to those without infection 4-8 weeks after severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) testing. Methods: 131 asymptomatic or mildly symptomatic subjects were enrolled following testing for SARS-COV-2. Fifty subjects tested negative, and 81 subjects tested positive. Serum samples were collected for measurement of C-reactive protein, ferritin, interleukin-6, NT-pro-B-type natriuretic peptide, and cardiac troponin 28-55 days after SARS-COV-2 RT-PCR testing. Results: Biomarker levels trended higher in SARS-COV-2-positive vs negative subjects, but differences in biomarker levels or proportion of subjects with elevated biomarkers were not statistically significant with respect to SARS-COV-2 status. Among individuals with ≥ 1 comorbidity, odds of elevated CRP were greater compared to individuals without any comorbidities (odds ratio [OR] = 2.90); this effect size was increased 1.4-fold among SARS-COV-2-positive subjects (OR = 4.03). Similarly, NT-pro-BNP was associated with CVD, with the strongest association in COVID-positive individuals (OR = 16.9). Conclusions: In a relatively young, healthy adult population, mild COVID-19 infection was associated with mild elevations in cardiac and proinflammatory biomarkers within 4-8 weeks of mild or asymptomatic COVID-19 infection in individuals with preexisting comorbidities, but not among individuals without comorbidities. For the general population of young adults, we did not find evidence of elevation of cardiac or proinflammatory biomarkers 4-8 weeks after COVID-19 infection.Clinical Perspective: This is a characterization of cardiac and proinflammatory biomarkers in ambulatory subjects following asymptomatic or mild COVID-19 infection. Young, ambulatory individuals did not have cardiac and proinflammatory biomarker elevation 4-8 weeks after mild COVID-19 infection. However, COVID-19 infection was associated with biomarker elevations in select individuals with comorbidities.Clinical study number: H-47423.