Influencing factors of negative conversion time of nucleic acid detection in 228 patients infected with Omicron variant of SARS-CoV-2 in Shanghai

Objective: To analyze and compare the effects of different clinical characteristics on the negative conversion time of nucleic acid detection after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant infection, and to provide a scientific basis for the isolation and treatment of coronavirus disease 2019 (COVID-19). Methods: The epidemiological and clinical data of 228 mild SARS-CoV-2 Omicron variant infected patients diagnosed in Shanghai were retrospectively collected from April 27, 2022 to June 8, 2022 in Wujiaochang designated Hospital, Yangpu District, Shanghai. The negative conversion time of nucleic acid detection was used as the outcome variable, and the patients were divided into A (18 days) and B (>18 days). Univariate and multivariate logistic regression analysis were used to analyze the influencing factors of the negative conversion time of nucleic acid detection. Results: The mean nucleic acid conversion time of 228 patients was (18.7+or-12.1) d, with the median time of 18 (2-46) d. Among them, 120 patients in group A had an average nucleic acid conversion time of (13.2+or-2.0) d, and 108 cases in group B had an average nucleic acid conversion time of (20.8+or-1.3) d. Univariate analysis showed that there were no statistically significant differences in the effects of hypertension, coronary heart disease, diabetes, hypokalemia, malignant tumors, neuropsychiatric diseases, chronic digestive diseases on the negative nucleic acid conversion time (P > 0.05);however, there were significant differences in the effects of combined cerebrovascular disease, leukopenia, chronic respiratory system diseases and vaccination on the negative nucleic acid conversion time (P < 0.05). Further multivariate logistic regression analysis revealed that the combination of chronic respiratory diseases and non-vaccination were significant risk factors for prolongation of negative nucleic acid conversion time (P < 0.05). Conclusions: The results of this study show that gender, age and whether hypertension, coronary heart disease, diabetes mellitus, hypokalemia, malignant tumor, neuropsychiatric disease and chronic digestive disease have no significant effect on the nucleic acid conversion time, whereas chronic respiratory disease and no vaccination are significantly correlated with the prolongation of nucleic acid conversion time in SARS-CoV-2 Omicron-infected patients.

A hospital based observational study of clinical spectrum and outcome of mucormycosis during the COVID pandemic

Background : Mucormycosis is a life threatening fungal disease caused by the filamentous fungi mucormycetes. Though a known entity for decades, it began to manifest in an unprecedented manner in the COVID scenario specially with the second wave in India. The objectives were to describe the demographic characteristics, clinical presentations, risk factors, therapy and in-hospital mortality of patients with Mucormycosis. Material and Methods : We conducted a retrospective observational study for a period of six months from March 2021 to August 2021. The data was collected for cases of mucormycosis from multiple centres all over West Bengal and analysed. All consecutive individuals with confirmed mucormycosis were enrolled in this study. The data documenting demographic particulars, presentation, predisposing factors and comorbiditieswere recorded in a pre validated case report form Details of investigation recording site and extent of disease, therapeutic intervention and outcome was mentioned . Statistical analysis was done using SPSS 21.0 for MS-Windows. Results : The total number of cases from March to August 2021 was 263 . There were 171 males and 92 females and the mean age of occurrence was 50.8+or-0.4 years .In West Bengal clusters of cases were being reported most commonly from the districts of North 24 Parganas, Kolkata, Jalpaiguri, Darjeeling and Hooghly. Some cases admitted here hailed from outside states like Bihar, Jharkhand, Odisha and Assam. The majority of the cases 74.22% (196)were COVID Associated Mucormycosis (CAM) while only 25.78% were non COVID associated. Diabetes mellitus was associated in 78.7% and history of prolonged steroid therapy in 57.4% of cases. We encountered rhino orbital mucormycosis in 99.24% of cases and cerebral involvement in 47.3%. They were treated with Amphotericin B deoxycholate along with endoscopic debridement. The most common side effects of Amphotericin B Deoxycholate were hypokalemia (93%), hypomagnesemia (32%) and AKI (74%) of the cases . The number of patients discharged was 16.7% and 10 left against medical advice (LAMA) . In hospital deaths were recorded to be 26.7%. Cause of death was commonly -AKI, septic shock and multiorgan failure . Conclusion : Prevention is better than cure of this devastating disease which is difficult todiagnose and treat . Awareness about mucormycosis and careful clinical evaluation of post-COVID patients is mandatory in this era in order to rapidly diagnose and treat mucormycosis.

Deoxycholate amphotericin for management of mucormycosis: a retrospective cohort study from South India.

Introduction: Liposomal amphotericin use is limited in developing countries due to its extremely high cost and availability. Therefore, the study aimed to evaluate deoxycholate amphotericin B's utility and adverse effect profile in patients with mucormycosis. Methodology: This retrospective cohort study from 2019 to 2021 included patients with proven mucormycosis who received deoxycholate amphotericin B for more than or equal to five days and had at least three creatinine values on treatment. Baseline demographic details, risk factors and treatment details of all the patients were recorded. In addition, the details of treatment-related adverse effects and outcomes were ascertained. Results: Of the 57 included patients, a history of diabetes, COVID-19 and steroid use was present in 49 (86%), 43 (75.4%) and 33 (57.9%) patients, respectively. Isolated rhino-orbital mucormycosis was the most common presentation (n=49, 86%). The median time of follow-up was 48 (30.5-90) days. A total of 8 (14%) patients died during the hospital stay. The median duration of amphotericin treatment was 21 (14-40) days. Thirty-nine patients (68.4%) developed hypokalaemia on treatment, while 27 (47.4%) patients developed hypomagnesaemia. A total of 34 (59.6%) patients developed AKI on treatment. The median day of development of AKI was 6 (4-10) days. The median baseline, highest and final creatinine values were 0.78 (0.59-0.94) mg/dl, 1.27 (0.89-2.16) mg/dl and 0.93 (0.74-1.59) mg/ dl respectively. The median percentage change from baseline to highest value and last follow-up value was 45% (0.43%-161%) and 25% (-4.8%-90.1%) respectively. The final creatinine was less than 150% of the baseline in 36 (63.2%) patients. Conclusion: Deoxycholate amphotericin is an acceptable alternative for treating mucormycosis in resource-constrained settings.

Features of therapy for panic disorder, associated with the SARS-CoV-2 pandemic

Introduction. Due to the significant similarity between the symptoms of SARS-CoV-2 acute respiratory syndrome and panic disorder (PD), diagnosis presents significant difficulties. PD tend to develop chronically, with lifelong relapses. Purpose of the work: to identify the features of the clinical manifestation of PD in the presence of COVID-19 and to substantiate the optimal therapy regimen. Methods. We analyzed the data of 86 patients who were diagnosed with PD when they applied for a consultative neurological appointment CF UMC from May 2020 to May 2021. Panic disorder was screened according to the Sheehan Anxiety Rating Scale (ShARS). Results. Among the patients there were 54 (62.8%) women and 32 (37.2%) men. On the ShARS scale, severe anxiety disorder (80 points and higher) was identified in 39 (45.3%), in the rest anxiety (from 30 to 80 points) was clinically expressed. The diagnosis of PD in 21 (24.4%) was diagnosed earlier than contracting a covid infection. The rest were exposed for the first time to 26 (30.2%) patients who had not previously visited a neurologist and 39 (45.3%) patients who visited a neurologist with diagnoses of somatoform autonomic dysfunction, vascular cephalgia, migraine, obsessive-compulsive disorder. A history of bronchial asthma was observed in 13 (15.1%) cases. The types of panic attacks were regarded as large (extensive) PR (4 symptoms or more) - in 55 (64%), in other cases as symptomatically poor. The peculiarity of the course of PR against the background of SARS-CoV-2 is determined by the occurrence of hypochondriac phobias against the background. At the same time, agoraphobia and avoidant behavior characteristic of PD were not observed. Conclusion. The use of benzodiazepines for anxiolytic purposes, anti-asthma drugs may be counterproductive in the treatment of anxiety disorders. The iatrogenic risk is superimposed on possible hypokalemia, prolongation of the QTc interval, arterial hypertension caused by COVID-19. Evaluation of the results of the neuropharmacological analysis and the appointment of drugs with anxiolytic action Bifren, in more severe cases of Pregabin in PR showed a clinical positive effect.

Comparison of Sodium and Potassium Levels among COVID-19 Patients on Arterial Blood Gas Analysers and Clinical Chemistry Autoanalysers

Introduction: The electrolytes and Arterial Blood Gas (ABG) analysis are the crucial part of the evaluation in Coronavirus Disease 2019 (COVID-19) patients. Hyponatremia and hypokalemia are the electrolyte imbalance, commonly seen in COVID-19 and hence, patients require serial monitoring of electrolytes. Variations of sodium and potassium levels between arterial and venous blood are known, however as per existing literature, there are no previous studies on the comparison of electrolytes in COVID-19 patients, when analysed in arterial and venous blood, by different methods and its significance in clinical practice. Aim: To determine whether the sodium and potassium levels of COVID-19 patients are comparable when simultaneously analysed in arterial whole blood and venous serum sample, by ABG analyser and chemistry Autoanalyser (AA) respectively. Materials and Methods: This prospective observational study was conducted among COVID-19 positive patients admitted in Medical Intensive Care Unit at a Tertiary Care Super-specialty Hospital, Pune, Maharashtra, India, from February 2021 to June 2021. A total of 100 arterial and 100 venous blood samples of COVID-19 patients were analysed for sodium and potassium levels on Gem Premier 3000 Blood Gas Analyser and Auto-Quant 400i chemistry AA. The statistical analysis was done by the Bland Altman method to assess the agreement between the method of measurement for sodium and potassium levels in arterial and venous samples. Shapiro-Wilk's test was applied to check normal distribution and statistical variables in sodium and potassium values measured by two methods. Results: The mean values for sodium in arterial blood were 135.91 +/- 8.36 mmol/L and in serum was 140.26 +/- 8.49 mmol/L. The mean value of potassium in arterial blood was 4.12 +/- 0.76 mmol/L and in serum 4.41 +/- 0.67 mmol/L. Coefficients of variation for arterial and venous sample sodium level was 4.21 mmol/L and for potassium was 0.28, with bias (95% limits of agreement) of 4.96-3.46 mmol/L and 0.35-0.21 mmol/L, respectively. Conclusion: The present study found a significant difference in electrolyte levels when compared between arterial whole blood in ABG analyser and venous serum sample in chemistry autoanalyser in COVID-19 patients. So, the clinicians must be aware of these variations and the same has to be kept in mind, while interpreting the results in COVID-19.

Serum electrolytes imbalances in COVID-19 patients (a single center study)

Introduction. Abnormality of main electrolytes is a common complication in hospitalized patients. Concerning, hazards of electrolyte imbalance and its effect on management of patient, measurement of electrolytes are important. Tubular effect of virus and drugs side effect is another challenging item. Methods. All covid-19 patients admitted to general hospital of khorramabad city (capital of lorestan province) included in cross sectional study. Totally, 232 samples were collected during first three months of 2020. Two main electrolytes (sodium and potassium) were measured in all cases. Given the effect of kidney function for each patient, GFR was measured. Statistical analysis performed using software SPSS 26. Results. In patients complicated with AKI, 27.8%% had sodium abnormality and 27.7% had potassium disturbances. hyponatremia was more frequent than hypernatremia. But, hyperkalemia was more frequent than hypokalemia. Conversely, in patient non- complicated with AKI, frequency of sodium and potassium abnormality was, 6.3% and 14.8% respectively which hypokalemia was the most frequent abnormality. There were no significant statistical differences between above results. Conclusion. There are some discrepancies between types of sodium or potassium abnormalities in similar studies. Differences of severity of covid19 disease and comorbidities may be influence on results. Concerning outcomes of hypo-hyperkalemia or hypo-hypernatremia, physicians should be pay attention to serial measurement of main electrolytes in hospitalized covid19 patients. Proper fluid therapy in AKI or non-AKI patients is necessary.

[Acute myocardial infarction and severe hypokalaemia due to liquorice consumption during COVID-19 confinement]. / Infarto agudo de miocardio e hipopotasemia severa por consumo de regaliz durante el confinamiento por COVID-19.

Liquorice is one of the oldest known herbs with medicinal properties and comprises up to 300 active compounds. It has been used for millennia for its digestive, anti-inflammatory and anti-infective properties. However, its possible toxic effects were described only a few years ago and there is growing interest in the side effects associated with chronic consumption. The main active component of liquorice is the prodrug glycyrrhizin and its active metabolite glycyrrhetic acid. It is a rare cause of hypokalaemia due to suppression of the renin-angiotensin-aldosterone axis, causing pseudohyperaldostenonism (PHA). We describe a rare case of secondary acute myocardial infarction in a patient with chronic consumption of liquorice.

Low serum potassium among patients with COVID-19 in Bangkok, Thailand: Coincidence or clinically relevant?

Our cross-sectional study estimated the prevalence and clinical relevance of hypokalaemia among confirmed COVID-19 cases admitted in three hospitals in Bangkok during the early outbreak in Thailand. Of 36 patients, nine were in the hypokalaemia group (25%) and 27 in the normokalaemia group (75%). All cases were asymptomatic, and 94.4% had mild hypokalaemia. Hypokalaemia was found significantly earlier in the course of COVID-19 without evidence of significant extrarenal potassium loss. Body temperature and mean serum sodium in the hypokalaemia group tended to be higher than the normokalaemia group. Hypokalaemia and potentially higher serum sodium among COVID-19 patients were the remarkable findings. This issue warrants for further investigation.

Case Report: Renal potassium wasting in SARS-CoV-2 infection.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with many potentially fatal complications. Renal involvement in various forms is common in addition to serum electrolyte disturbances. Early reports suggest that hypokalaemia may frequent those with SARS-CoV-2 infection and various aetiological factors may cause this electrolyte disturbance. A Chinese retrospective study has demonstrated renal potassium wasting in patients infected with SARS-CoV-2, however, it is not known if these patients were receiving diuretic therapy which may be a contributing factor. This case report illustrates an example of renal potassium wasting in SARS-CoV-2 infection in the absence of diuretics and extra-renal mechanisms with important lessons learned.

Acute Metabolic Emergencies in Diabetes: DKA, HHS and EDKA.

Emergency admissions due to acute metabolic crisis in patients with diabetes remain some of the most common and challenging conditions. DKA (Diabetic Ketoacidosis), HHS (Hyperglycaemic Hyperosmolar State) and recently focused EDKA (Euglycaemic Diabetic Ketoacidosis) are life-threatening different entities. DKA and HHS have distinctly different pathophysiology but basic management protocols are the same. EDKA is just like DKA but without hyperglycaemia. T1D, particularly children are vulnerable to DKA and T2D, particularly elderly with comorbidities are vulnerable to HHS. But these are not always the rule, these acute conditions are often occur in different age groups with diabetes. It is essential to have a coordinated care from the multidisciplinary team to ensure the timely delivery of right treatment. DKA and HHS, in many instances can present as a mixed entity as well. Mortality rate is higher for HHS than DKA but incidences of DKA are much higher than HHS. The prevalence of HHS in children and young adults are increasing due to exponential growth of obesity and increasing T2D cases in this age group. Following introduction of SGLT2i (Sodium-GLucose co-Transporter-2 inhibitor) for T2D and off-label use in T1D, some incidences of EDKA has been reported. Healthcare professionals should be more vigilant during acute illness in diabetes patients on SGLT2i without hyperglycaemia to rule out EDKA. Middle aged, mildly obese and antibody negative patients who apparently resemble as T2D without any precipitating causes sometime end up with DKA which is classified as KPD (Ketosis-prone diabetes). Many cases can be prevented by following 'Sick day rules'. Better access to medical care, structured diabetes education to patients and caregivers are key measures to prevent acute metabolic crisis.

Electrolyte Disturbances in SARS-CoV-2 Infection.

The global pandemic secondary to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is leading to unprecedented global morbidity and mortality. With a bewildering array of complications, renal involvement in various forms is common, including serum electrolyte derangements. Hypokalaemia secondary to SARS-CoV-2 was common in a reported Chinese cohort. Here we review the emerging evidence on hypokalaemia and SARS-CoV-2 infection, the potential pathophysiological mechanisms based on early clinical and histopathological data and important clinical implications. Mechanisms of hypokalaemia are multifactorial and so the electrolyte disturbance can be difficult to avoid. We provide further support to the theory of renin-angiotensin-aldosterone (RAS) activation, discuss the strengths and weaknesses of implicating RAS involvement and highlight the importance of calculating the transtubular potassium gradient to identify those at risk of hypokalaemia and its complications.