Biochemical markers and NLR levels in COVID-19 infection: In cases with severe pulmonary involvement according to CT score

Objectives: Many studies have been conducted on ferritin, fibrinogen, D-dimer, and neutrophil-lymphocyte ratio (NLR), which are biochemical tests, to determine the severity and prognosis of the disease in the early period of coro-navirus disease 2019 (COVID-19) infection. We aimed to determine the compatibility of these easily accessible and affordable tests with computed tomography (CT) in determining the severity of the disease at an early stage. Methods: This study was carried out retrospectively on 79 patients. In all patients, nasal and pharyngeal swabs were collected and tested for SARS-CoV-2 RNA with reverse transcription-polymerase chain reaction assay. The severity of the disease was determined by computed tomography imaging. According to lung involvement, patients who were found to have a severe infection and divided into the severe group (n=26), and those with milder symptoms were divided into the non-severe group (n=53). The demographic information and laboratory parameters of the patients were obtained from the medical records of the hospital. Analyses were performed using the Statistical Package for the Social Sciencesversion 23.0 for Windows. Results: NLR (8.36±2.45;3.3±2.04 p<0.001), ferritin (ng/mL) (736.1±240.2;374.7±248.4 p<0.001), fibrinogen (mg/mL) (725.7±84.9;416.5±186.1 p<0.001), D-dimer (ug/mL) (3.68±1.42;1.55±1.16 p<0.001), and C-reactive protein (CRP) (mg/ dL) (81.1±11.9;27.9±13.8 p<0.001) levels were found to be significantly higher in the severe group than the non-severe group. In addition, CRP (mg/mL) levelswere positively correlated with NLR (r=0.607 p<0.01). Receiver operator curve analyses were carried out to assess the efficacy of NLR, ferritin, fibrinogen, and D-dimer parameters. Conclusion: These results suggest that NLR, ferritin, fibrinogen, and D-dimer may be useful biomarkers for the early detection of critical cases of COVID-19 infection, paralleling CT findings. These available tests can benefit clinicians in low-resource settings where access to complicated diagnostic methods may be limited. © 2023, Kare Publishing. All rights reserved.

Incidence of COVID-19 Vaccination-Related Uveitis and Effects of Booster Dose in a Tertiary Uveitis Referral Center.

Background: We report vaccine and booster-related uveitis in Singapore, a country with high vaccination and booster rates to highlight the differences and potential role of prophylactic treatment for sight-threatening infectious uveitis. Methods: Clinical data extracted from the de-identified uveitis database in Singapore National Eye Center. Six patients (eight eyes) developed uveitis within 14 days after undergoing COVID-19 vaccination (primary and/or booster). Results: All patients received two doses of COVID-19 vaccination, and 1.39% (6/431) developed COVID-19 vaccine-related uveitis. Fifty-percent% (3/6) with non-infectious anterior uveitis (NIAU) presented with a non-granulomatous anterior uveitis (AU). The remaining (3/6) presenting with a granulomatous AU were diagnosed with reactivation of cytomegalovirus, varicella-zoster virus and toxoplasma chorioretinitis, respectively. All the patients responded to definitive treatment specific to their diagnosis. The mean visual acuity at presentation was 0.36 ± 0.20 logMAR and improved to 0.75 ± 0.09 (p = 0.009). Mean time from vaccination to uveitis was 9.7 (range: 3-14) days. All patients developed uveitis after second vaccination dose. 16.67% (1/6) patients had a recurrence after the third booster dose. None of the three patients with infectious uveitis developed recurrence but had received maintenance therapy up to or during the booster. Conclusion: Uveitis after COVID-19 vaccination is uncommon. In our series, a higher rate of reactivations of latent infections was seen. With definitive treatment, all cases were self-limited without systemic sequelae. Prophylactic treatment during booster vaccine may prevent reactivation of sight-threatening infections and reduce morbidity although risk-benefits should be considered for individual patients given the low rate of occurrence.

Differential impact of the angiotensin-converting enzyme-2 (ACE2 rs4343 G>A) and miR-196a2 rs11614913 C>T gene alterations in COVID-19 disease severity and mortality.

The recent coronavirus outbreak from Wuhan China in late 2019 caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) resulted in a global pandemic of coronavirus-19 disease (COVID-19). Understating the underlying mechanism of the pathogenesis of coronavirus infection is important not only because it will help in accurate diagnosis and treatment of the infection but also in the production of effective vaccines. The infection begins when SARS-CoV-2 enters the cells through binding of its envelope glycoprotein to angiotensin-converting enzyme2 (ACE2). Gene variations of ACE2 and microRNA (miR)-196 are associated with viral infection and other diseases. The present study investigated the association of the ACE2 rs4343 G>A and miR-196a2 rs11614913 C>T gene polymorphisms with severity and mortality of COVID-19 using amplification refractory mutation system PCR in 117 COVID-19 patients and 103 healthy controls from three regions of Saudi Arabia. The results showed that ACE2 rs4343 GA genotype was associated with severity of COVID-19 (OR=2.10, P-value 0.0028) and ACE2 rs4343 GA was associated with increased mortality with OR=3.44, P-value 0.0028. A strong correlation between the ACE2 rs4343 G>A genotype distribution among COVID-19 patients was reported with respect to their comorbid conditions including sex (P<0.023), coronary artery disease (P<0.0001), oxygen saturation <60 mm Hg (P<0.0009) and antiviral therapy (0.003). The results also showed that the CT genotype and T allele of the miR-196a2 rs11614913 C>T were associated with decreased risk to COVID-19 with OR=0.76, P=0.006 and OR=0.54, P=0.005, respectively. These results need to be validated with future molecular genetic studies in a larger sample size and different populations.

Kynurenine pathway in Coronavirus disease (COVID-19): Potential role in prognosis.

BACKGROUND: It is known that inflammatory responses play an important role in the pathophysiology of COVID-19. AIMS: In this study, we aimed to examine the role of kynurenine (KYN) metabolism on the severity of COVID-19 disease AQ5. MATERIALS & METHODS: Seventy COVID-19 patients of varying severity and 30 controls were included in the study. In addition to the classical laboratory parameters, KYN, tryptophan (TRP), kynurenic acid (KYNA), 3 hydroxykynurenine (3OHKYN), quinolinic acid (QA), and picolinic acid (PA) were measured with mass spectrometry. RESULTS: TRP, KYN, KYN:TRP ratio, KYNA, 3OHKYN, PA, and QA results were found to be significantly different in COVID-19 patients (p < 0.001 for all). The KYN:TRP ratio and PA of severe COVID-19 patients was statistically higher than that of mild-moderate COVID-19 patients (p < 0.001 for all). When results were examined, statistically significant correlations with KYN:TRP ratio, IL-6, ferritin, and procalcitonin were only found in COVID-19 patients. ROC analysis indicated that highest AUC values were obtained by KYN:TRP ratio and PA (0.751 vs 0.742). In determining the severity of COVID-19 disease, the odd ratios (and confidence intervals) of KYN:TRP ratio and PA levels that were adjusted according to age, gender, and comorbidity were determined to be 1.44 (1.1-1.87, p = 0.008) and 1.06 (1.02-1.11, p = 0.006), respectively. DISCUSSION & CONCLUSION: According to the results of this study, KYN metabolites play a role in the pathophysiology of COVID-19, especially KYN:TRP ratio and PA could be markers for identification of severe COVID-19 cases.

Complex mathematical SIR model for spreading of COVID-19 virus with Mittag-Leffler kernel.

This paper investigates a new model on coronavirus-19 disease (COVID-19), that is complex fractional SIR epidemic model with a nonstandard nonlinear incidence rate and a recovery, where derivative operator with Mittag-Leffler kernel in the Caputo sense (ABC). The model has two equilibrium points when the basic reproduction number R 0 > 1 ; a disease-free equilibrium E 0 and a disease endemic equilibrium E 1 . The disease-free equilibrium stage is locally and globally asymptotically stable when the basic reproduction number R 0 < 1 , we show that the endemic equilibrium state is locally asymptotically stable if R 0 > 1 . We also prove the existence and uniqueness of the solution for the Atangana-Baleanu SIR model by using a fixed-point method. Since the Atangana-Baleanu fractional derivative gives better precise results to the derivative with exponential kernel because of having fractional order, hence, it is a generalized form of the derivative with exponential kernel. The numerical simulations are explored for various values of the fractional order. Finally, the effect of the ABC fractional-order derivative on suspected and infected individuals carefully is examined and compared with the real data.

Association of blood groups on the risk of COVID-19 infection, morbidity, and mortality.

OBJECTIVE: We aimed to compare the effects of blood groups and Rh factor on the development of coronavirus-19 disease (COVID-19) with all aspects such as clinical course, inflammatory parameters, and organ-specific biochemical parameters with a significant number of patients. METHODS: This multicenter study was carried out retrospectively on 3551 patients hospitalized with the diagnosis of COVID-19 and whose blood groups were recorded during the time of hospitalization. As control groups, 22133 individuals' medical data who were admitted to the blood bank affiliated with our hospitals during the last year was used. The differences between the blood groups and clinical characteristics were analyzed. RESULTS: Of the 3551 patients, A Rh (+) blood group was found to be in a higher ratio in the case group than controls, with increased risk to be infected (case: 41.3% vs. control: 38.8%), (OR 1.113; 95% CI: 1.036-1.197; p=0.003). Meanwhile O Rh (+) blood group ratios were significantly lower in the case group than in the control group (case: 26% vs. control: 28.3%) (OR 0.862; 95% CI: 0.823-0.966; p=0.005). There was no significant difference between blood groups in terms of admission to the intensive care units and mortality, it was observed that patients with AB Rh (+) blood group have a greater risk for intubation than others (OR: 1.467; 95% CI: 1.040-2.071; p=0.028). CONCLUSION: We demonstrated that people with blood group A Rh (+) more susceptible to COVID-19, whereas blood group 0 Rh (+) have a protective effect against the infection. Once a person has been infected with severe acute respiratory syndrome coronavirus 2, we should be mindful that patients with blood group AB Rh (+) would be prone to intubation more than other blood groups.

A survey of cardiopulmonary resuscitation in COVID-19 patients.

BACKGROUND AND AIMS: The novel coronavirus 2 (SARS-CoV-2) pandemic has placed severe resource constraints on hospitals. High mortality rates of the COVID-19 have overwhelmed the resuscitation services. The constant fear of virus infection during cardiopulmonary resuscitation (CPR) has placed severe restrictions on the resuscitation services. Reports of poor outcomes after CPR further dampened the spirits of CPR providers. Hence we surveyed CPR practices for COVID -19 patients across hospitals in India by health care providers. MATERIAL AND METHODS: An online survey using Google Forms was initiated to collect data on performance of CPR in diagnosed cases of COVID-19 after in-hospital cardiac arrest. The survey's web-link was publicized using social media, and participation sought of all personnel involved in CPR delivery in COVID-19 patients. The responses received were analyzed. The main outcome measured were determination of the percentage of COVID-19 patients discharged home who were administered CPR. RESULTS: There were 248 responses from different parts of India. At the time of cardiac arrest, 194 victims had diffuse lung infiltrates, 22 had mild lung disease, while 32 had no documented lung lesion. Twenty-five victims had evidence of pulmonary embolism, 39 had cardiac involvement, and 3 had brain involvement. Return of spontaneous circulation (ROSC) was achieved in 59.27% of cases but ROSC sustained in only 22.59%. 7.25% of patients, who received CPR, could be discharged home. CONCLUSION: The survey has shown reasonable survival rates after CPR administration in COVID-19 patients suffering from IHCA. We should not ignore the need to maximize live outcomes after CPR, even in COVID-19 patients.

Efficacy of broccoli and glucoraphanin in COVID-19: From hypothesis to proof-of-concept with three experimental clinical cases.

COVID-19 is described in a clinical case involving a patient who proposed the hypothesis that Nuclear factor (erythroid-derived 2)-like 2 (Nrf2)-interacting nutrients may help to prevent severe COVID-19 symptoms. Capsules of broccoli seeds containing glucoraphanin were being taken before the onset of SARS-CoV-2 infection and were continued daily for over a month after the first COVID-19 symptoms. They were found to reduce many of the symptoms rapidly and for a duration of 6-12 h by repeated dosing. When the patient was stable but still suffering from cough and nasal obstruction when not taking the broccoli capsules, a double-blind induced cough challenge confirmed the speed of onset of the capsules (less than 10 min). A second clinical case with lower broccoli doses carried out during the cytokine storm confirmed the clinical benefits already observed. A third clinical case showed similar effects at the onset of symptoms. In the first clinical trial, we used a dose of under 600 µmol per day of glucoraphanin. However, such a high dose may induce pharmacologic effects that require careful examination before the performance of any study. It is likely that the fast onset of action is mediated through the TRPA1 channel. These experimental clinical cases represent a proof-of-concept confirming the hypothesis that Nrf2-interacting nutrients are effective in COVID-19. However, this cannot be used in practice before the availability of further safety data, and confirmation is necessary through proper trials on efficacy and safety.

Haematological manifestations, mechanisms of thrombosis and anti-coagulation in COVID-19 disease: A review.

Coronavirus-19 disease (COVID-19), a zoonosis, was first reported in the city of Wuhan, province of Hubei, China in December 2019. The disease is caused by the Severe Acute Respiratory Syndrome-CoronaVirus-2 (SARS-CoV-2). As of 12th of May 2020, 4,256,022 confirmed cases affecting 212 countries with 287,332 deaths have been reported. The common symptoms reported in patients with COVID-19 are fever, dry cough, dyspnoea and gastrointestinal symptoms such as vomiting and diarrhoea. Non-survivors often succumb due to widespread pulmonary intravascular coagulopathy, arterial and venous thromboembolism, disseminated intravascular coagulopathy (DIC), secondary hemophagocytic lymphohistiocytosis (sHLH), and multiorgan dysfunctional syndrome (MODS). All hospitalised patients should be monitored closely for thrombotic events. Patients who develop bleeding episodes should be managed according to standard DIC guidelines. The main objectives of this review are 1) to provide a succinct background of this novel disease 2) discuss the haematological presentations and mechanisms of thrombosis 3) emphasize the role of anti-coagulation prophylaxis 4) explore the management of coagulopathy 5) provide insight on management of patients with COVID-19 disease and pre-existing bleeding disorders.

Ensuring Sustainability of Continuous Kidney Replacement Therapy in the Face of Extraordinary Demand: Lessons From the COVID-19 Pandemic.

With the exponential surge in patients with coronavirus disease 2019 (COVID-19) worldwide, the resources needed to provide continuous kidney replacement therapy (CKRT) for patients with acute kidney injury or kidney failure may be threatened. This article summarizes subsisting strategies that can be implemented immediately. Pre-emptive weekly multicenter projections of CKRT demand based on evolving COVID-19 epidemiology and routine workload should be made. Corresponding consumables should be quantified and acquired, with diversification of sources from multiple vendors. Supply procurement should be stepped up accordingly so that a several-week stock is amassed, with administrative oversight to prevent disproportionate hoarding by institutions. Consumption of CKRT resources can be made more efficient by optimizing circuit anticoagulation to preserve filters, extending use of each vascular access, lowering blood flows to reduce citrate consumption, moderating the CKRT intensity to conserve fluids, or running accelerated KRT at higher clearance to treat more patients per machine. If logistically feasible, earlier transition to intermittent hemodialysis with online-generated dialysate, or urgent peritoneal dialysis in selected patients, may help reduce CKRT dependency. These measures, coupled to multicenter collaboration and a corresponding increase in trained medical and nursing staffing levels, may avoid downstream rationing of care and save lives during the peak of the pandemic.