The effectiveness of Tocilizumab in severe covid 19 pneumonia among critically ill patients

Background: Tocilizumab, an interleukin-6 (IL-6) antagonist, is being evaluated for the management of covid-19 pneumonia. The objective of this study was to assess the effectiveness of Tocilizumab in severe covid-19 pneumonia. Method(s): This was a retrospective, observational, single centre study performed in 121 patients diagnosed with severe covid-19 pneumonia. 83 patients received standard of care treatment whereas 38 patients received tocilizumab along with standard of care. Tocilizumab was administered intravenously at 8mg/kg (upto a maximum of 800mg). The second dose of Tocilizumab was given 12 to 24 hours apart. The primary outcome measure was ICU related and hospital related mortality. The secondary outcome measures were change in clinical status of patients measured by WHO (World Health Organisation) 7 category ordinary scale, changes in interleukin-6 (IL-6) levels, secondary infections and duration of ICU stay. Result(s): Tocilizumab was administered between 3-27 days after the patient reported symptoms ( a median of 10.9 days ) and between the 1st to 3rd day of ICU admission (median of 2.1 days) . In Tocilizumab group, 16(42.1%) of 38 patients died in ICU whereas in standard of care group, 27(32.53%) of 83 patients died. The difference in clinical status assessed using WHO (World Health Organisation) 7 category ordinary scale at 28 days between Tocilizumab group and standard of care group was not statistically significant (odds ratio 1.35, 95% confidence interval 0.61 to 2.97, p = 0.44). Conclusion(s): Tocilizumab plus standard care was not superior to standard care alone in reducing mortality and improving clinical outcomes at day 28.Copyright © RJPT All right reserved.

The Diagnostic Value of Inflammatory Markers (CRP, IL6, CRP/IL6, CRP/L, LCR) for Assessing the Severity of COVID-19 Symptoms Based on the MEWS and Predicting the Risk of Mortality.

Introduction: Various diagnostic tools are used to assess the severity of COVID-19 symptoms and the risk of mortality, including laboratory tests and scoring indices such as the Modified Early Warning Score (MEWS). The diagnostic value of inflammatory markers for assessing patients with different severity of COVID-19 symptoms according to the MEWS was evaluated in this study. Materials and Methods: The concentrations of CRP (C-reactive protein) (immunoassay) and IL6 (interleukin 6) (electrochemiluminescence assay) were determined, and CRP/IL6, CRP/L, and LCR ratios were calculated in blood serum samples collected from 374 COVID-19 patients. Results: We demonstrated that CRP, IL6, CRP/IL6, CRP/L, LCR inflammatory markers increase significantly with disease progression assessed based on the MEWS in COVID-19 patients and may be used to differentiating patients with severe and non-severe COVID-19 and to assess the mortality. Conclusion: The diagnostic value of inflammatory markers for assessing the risk of mortality and differentiating between patients with mild and severe COVID-19 was confirmed.

The Impact of Therapeutic Plasma Exchange on Inflammatory Markers and Acute Phase Reactants in Patients with Severe SARS-CoV-2 Infection.

Background and Objectives: Due to the poor prognosis and the very high mortality rate associated with severe SARS-CoV-2 infections, various regimens have been tried to stop the evolution of the inflammatory cascade, such as immunomodulatory therapy and plasma clearance of the acute phase reactants involved. Therefore, the objective of this review was to analyze the effects of using therapeutic plasma exchange (TPE), also known as plasmapheresis, on the inflammatory markers of critically ill COVID-19 patients admitted to the intensive care unit (ICU). Materials and Methods: A thorough scientific database search was performed, and it included a review of articles published on PubMed, Cochrane Database, Scopus, and Web of Science from the beginning of the COVID-19 pandemic in March 2020 until September 2022 that focused on the treatment of SARS-CoV-2 infections using plasma exchange for patients admitted to the ICU. The current study included original articles, reviews, editorials, and short or special communications regarding the topic of interest. Results: A total of 13 articles were selected after satisfying the inclusion criterion of three or more patients enrolled with clinically severe COVID-19 that were eligible for TPE. From the included articles, it was observed that TPE was used as a last-resort salvage therapy that can be regarded as an alternative treatment method when the standard management for these patients fails. TPE significantly decreased the inflammatory status as measured by Interleukin-6 (IL-6), C-reactive protein (CRP), lymphocyte count, and D-dimers, as well as improving the clinical status measured with PaO2/FiO2 and duration of hospitalization. The pooled mortality risk reduction after TPE was 20%. Conclusions: There are sufficient studies and evidence to show that TPE reduces inflammatory mediators and improves coagulation function and the clinical/paraclinical status. Nevertheless, although it was shown that TPE decreases the severe inflammatory status without significant complications, the improvement of survival rate remains unclear.

SARS-CoV-2 Antibody Responses in Pediatric Patients: A Bibliometric Analysis.

The characteristics, dynamics and mechanisms/determinants of the immune response to SARS-CoV-2 infection are not fully understood. We performed a bibliometric review of studies that have assessed SARS-CoV-2 antibody responses in the pediatric population using Web of Science online databases, VOSviewer and Bibliometrix tools. The analysis was conducted on 84 publications, from 310 institutions located in 29 countries and published in 57 journals. The results showed the collaboration of scientists and organizations, international research interactions and summarized the findings on (i) the measured titers of antibodies (total antibody and/or individual antibody classes IgG, IgM, IgA) against different antigens (C-terminal region of N (N CT), full-length N protein (N FL), RBD, RBD Alpha, RBD Beta, RBD Gamma, RBD Delta, spike (S), S1, S2) in the case of different clinical forms of the disease; and (ii) the correlations between SARS-CoV-2 antibodies and cytokines, chemokines, neutrophils, C-reactive protein, ferritin, and the erythrocyte sedimentation rate. The presented study offers insights regarding research directions to be explored in the studied field and may provide a starting point for future research.

The Prophylactic Effect of Vitamin C and Vitamin B12 against Ultraviolet-C-Induced Hepatotoxicity in Male Rats.

Ultraviolet C (UVC) devices are an effective means of disinfecting surfaces and protecting medical tools against various microbes, including coronavirus. Overexposure to UVC can induce oxidative stress, damage the genetic material, and harm biological systems. This study investigated the prophylactic efficacy of vitamin C and B12 against hepatotoxicity in UVC-intoxicated rats. Rats were irradiated with UVC (725.76, 967.68, and 1048.36 J/cm2) for 2 weeks. The rats were pretreated with the aforementioned antioxidants for two months before UVC irradiation. The prophylactic effect of vitamins against UVC hepatotoxicity was evaluated by monitoring the alteration of liver enzyme activities, antioxidant status, apoptotic and inflammatory markers, DNA fragmentation, and histological and ultrastructural alterations. Rats exposed to UVC showed a significant increase in liver enzymes, oxidant-antioxidant balance disruption, and increased hepatic inflammatory markers (TNF-α, IL-1ß, iNOS, and IDO-1). Additionally, obvious over-expression of activated caspase-3 protein and DNA fragmentation were detected. Histological and ultrastructural examinations verified the biochemical findings. Co-treatment with vitamins ameliorated the deviated parameters to variable degrees. In conclusion, vitamin C could alleviate UVC-induced hepatotoxicity more than vitamin B12 by diminishing oxidative stress, inflammation, and DNA damage. This study could provide a reference for the clinical practice of vitamin C and B12 as radioprotective for workers in UVC disinfectant areas.

Clinical Characteristics and Outcomes of Vaccinated VS Non-Vaccinated Critically Ill COVID-19 Patients: Retrospective Observation Study.

Objective: We aim to identify the clinical characteristics and outcome of vaccine breakthrough infection in critically ill COVID-19 patients and to compare the clinical course of disease between vaccinated and non-vaccinated patients. Methods: A retrospective review of all adult patients aged ≥18 years admitted to the ICU in King Fahd Hospital of the University in Saudi Arabia with positive COVID-19 RT-PCR test between the period of January 1st to August 31st, 2021, were included. The recruited patients were grouped in to "vaccinated and non-vaccinated group" based on their immunization status. The demographic data, co-morbidities, modality of oxygen support, ICU length of stay (ICU LOS) and mortality were collected and analyzed. Results: A total of 167 patients were included. Seventy-two patients (43%) were vaccinated. Cardiovascular diseases were higher among the vaccinated group (33.3% vs 12.6%, p value <0.001). Requirements of Non-invasive ventilation was significantly lower in vaccinated group compared to non-vaccinated group (73.6% vs 91.6%, p value <0.011). The rates of intubation were similar between both groups. The total intubation days was longer in non-vaccinated patients compared to vaccinated patients and the median duration of intubation was 8 days vs 2 days, respectively (p value 0.027). In subgroup analysis, the P/F ratio was significantly higher in patients who received two doses of vaccine compared to single dose (p value <0.002). Conclusion: In critically ill COVID-19 patients, the vaccinated group has significantly less need for Non-invasive ventilation, fewer intubation days and less hypoxia compared to non-vaccinated patients. We recommend more policies and public education nationwide and worldwide to encourage vaccination and raise awareness of the general population.

The Effects of 10,000 IU Vitamin D Supplementation on Improvement of Clinical Outcomes, Inflammatory and Coagulation Markers in Moderate COVID-19 Patients: A Randomized-Controlled Trial

Background & aims: Vitamin D supplementation as an immunomodulator has been identified as a potential strat-egy to prevent and treat Coronavirus disease 2019 (COVID-19). We aimed to analyze the effect of 10,000 IU vitamin D3 supplementation on 25(OH)D levels on primary clinical out-comes (conversion length), inflammatory markers (Total Lymphocyte Count (TLC), Neutrophil-to-Lymphocyte Ratio (NLR), Platelet-to-Lymphocyte Ratio (PLR)) and coagulation marker (D-Dimer) in moderate COVID-19 patients at Wahidin Sudirohusodo Hospital, Makassar, Indonesia.Methods: We conducted a single-blind randomized -con-trolled trial on the confirmed moderate COVID-19 patients above 18 years old and low vitamin D status. Each of inter-vention and control groups were supplemented of 10,000 IU and 1000 IU cholecalciferol that taken daily for 2 weeks. Levels of 25(OH)D were analyzed for the primary endpoint (conversion length), then correlated to secondary endpoints (Length of Stay (LOS)), clinical manifestations improvement, and markers TLC, NLR, PLR, and D-Dimer serum, handgrip strength (HGS) as functional capacity measurement, after ad-justed to age, sex, nutritional status based on body mass in- dex (BMI) and Subjective Global Assessment (SGA) tool, co -morbidities, and anti-coagulant administration. Medical nutri-tional therapy was given and presented as energy, protein, carbohydrate, and fat achievement, and vitamin D intake was also calculated.Results: A significant effects was found in 60 samples with pre-intervention vitamin D deficiency (61.7%) and insuffi-ciency (38.3%) status, and 10,000 IU of vitamin D3 supple-mentation could increase 25(OH)D levels within 2 weeks to reach sufficiency status (16.7%). The Vitamin D3 supplemen-tation of 10,000 IU and 1000 IU could significantly increase 25(OH)D levels compared to the control group of 1000 IU (4.61 +/- 5.43 vs.-0.29 +/- 2.72;P <0.0001) and it was correlated to primary clinical outcome, which is length of conversion (6.53 +/- 1.17 vs 10.47 +/- 2.56;P < 0.0001). The increase in HGS (6.61 +/- 3.01 vs. 4.04 +/- 4.44;P = 0.011), LOS (11.63 +/- 2.5 vs. 14.73 +/- 3.45;P = 0.001), and improvement in clinical mani-festations were found to be significant in both groups. We an-alyzed changes the effect of vitamin D supplementation in TLC, NLR, and D-Dimer as marker of coagulopathy associated COVID-19 on both groups that showed were not significant. Positive and significant correlation was only showed on PLR levels after intervention (r=0.368;P=0.045).Conclusion: Supplementation of vitamin D3 10,000 IU in moderate COVID-19 patients had a significant effect on 25(OH)D level, length of conversion, LOS, functional capacity, and PLR levels, but it has negative correlation in TLC, NLR, and D-Dimer levels.This study has been registered in the ClinicalTrial.gov data-base with the identification number NCT05126602.

Analysis of the laboratory and CT radiological findings in covid-19 patients on admission in comparison with their clinical severity status

Purpose: To retrospectively analyse the clinical status of COVID 19 patients with CT and laboratory findings Method: A total of 250 RT PCR test positive patients data were collected during the period of March 2020 to June 2021. Results: Present study showed that patients who did not need oxygen on admission, 9% of patients had a severe CT score, 41% with moderate CT score and 51% with mild CT score. Those who needed oxygen 17% of patients had a severe CT score, 40% with moderate CT score and 43% with mild CT score. Study also showed that in those who needed ICU admission, 27% of patients had a severe CT score, 56% with moderate CT score and 17% with mild CT score. Laboratory parameters such as Lactate Dehydrogenase (LDH), Ferritin, C Reactive Protein (CRP) and D-Dimer showed a significant p value between severity categories. Conclusion: This study has shown that the CT severity score alone does not always have quantifiable relation to the clinical severity of the patient. In present study found laboratory parameters has no positive correlation between mild CT score, but with moderate and severe CT score scans, a significant correlation was found. [ FROM AUTHOR] Copyright of Journal of Cardiovascular Disease Research (Journal of Cardiovascular Disease Research) is the property of Journal of Cardiovascular Disease Research and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Critical Damage of Lung Parenchyma Complicated with Massive Pneumothorax in COVID-19 Pneumonia.

It is already known that Coronavirus disease 2019 (COVID-19) may lead to various degrees and forms of lung parenchyma damage, but some cases take a strikingly severe course that is difficult to manage. We report the case of a 62-year old male, non-obese, non-smoker, and non-diabetic, who presented with fever, chills, and shortness of breath. The infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was diagnosed by real-time Polymerase Chain Reaction. Although the patient had been vaccinated with 2 doses of Pfizer-BioNTech COVID-19 vaccine 7 months earlier and had no risk factors for a severe outcome, serial computed tomography (CT) scan revealed lung involvement progressively extending from an initial 30% to 40% to almost 100% 2.5 months later. The spectrum of lung lesions included at first only ground-glass opacities and some tiny emphysema bullae, but later also bronchiectasis, pulmonary fibrosis, and large emphysema bullae as post-COVID-19 pulmonary sequelae. For fear of severe evolution of superimposed bacterial infection (Clostridoides difficile enterocolits and possibly bacterial pneumonia) the administration of corticosteroids was intermittent. Massive right pneumothorax secondary to bulla rupture, possibly favored by the indispensable high flow oxygen therapy, led to respiratory failure compounded by hemodynamic instability, and ultimately to the patient's final demise. COVID-19 pneumonia may cause severe lung parenchyma damage which requires long-term supplemental oxygen therapy. Beneficial or even lifesaving as it might be, high flow oxygen therapy may nonetheless have deleterious effects too, including the development of bullae that may rupture engendering pneumothorax. Corticosteroid treatment should probably be pursued despite superimposed bacterial infection to limit the viral induced damage to lung parenchyma.

Inflammatory markers for predicting severity, mortality, and need for intensive care treatments of a patient infected with covid-19: a scoping review

Introduction: Numerous types of inflammatory markers are used by health workers to predict the patients infected with COVID-19 condition. However, fewer studies have identified the specific inflammatory markers to predict the severity, mortality, and need for intensive care treatments among patients infected with COVID-19. Thus, this scoping review aimed to evaluate and grouping the inflammatory markers related to severity, mortality, and need for intensive care treatments. Methods: Electronic databases were discovered for studies by elaborating specific proposed keywords related to types of inflammatory markers for predicting the severity, mortality, and need for intensive care treatments of patients infected with COVID-19. Authors independently comprised the literature search, evidence evaluation, and article extraction until the types of inflammatory markers for predicting the severity, mortality, and need for intensive care treatments of patients infected with COVID-19 are discovered. Results: 8 of 133 identified articles were included. These articles summarized that the mean of thrombocyte volume-to-platelet count ratio (MPV/PLT), the C-reactive protein/albumin ratio (CAR), prognostic nutritional index (PNI) and lymphocyte to C-reactive protein ratio (LCRP) were significant in predicting mortality. Lymphocyte-to-monocyte ratio (LMR) and Lymphocyte-to-CRP ratio (LCR) were inversely correlated with disease severity. The systemic-immune-inflammation index (SII) and platelet-to-lymphocyte ratio (PLR) findings were statistically significant in predicting disease severity and the need for intensive care treatments. Moreover, Elevated C-reactive protein (CRP), lymphocyte-to-CRP ratio (LCR), and neutrophil-to-lymphocyte ratio (NLR) were statistically significant in predicting the disease severity, need for intensive care treatment, and mortality. Conclusion: Each of the inflammatory markers has specificity in predicting the severity, mortality, and need for intensive care treatments among patients infected with COVID-19. These predictors can be used by health professionals, particularly nurses in providing the best clinical decisions and nursing care to COVID-19 patients. © 2023, Sanglah General Hospital. All rights reserved.

Computed Tomography Severity Score in COVID-19: Association with Inflammatory Markers and Patient Outcome

Objective: To associate CT severity score with inflammatory markers and to determine outcomes of COVID-19 patients admitted to CMH Lahore. Study Design: Comparative cross-sectional study. Place and Duration of Study: Combined Military Hospital, Lahore Pakistan, from Mar to Jun 2021. Methodology: Patients of COVID-19 age 18 and above, with a positive RT-PCR, were included in the study Clinical and radiological data of 200 patients was retrieved and analysed from the hospital registry. Results: In the present study, we studied the role of inflammatory markers in predicting the severity of COVID-19. We have compared the levels of LDH, CRP, IL-6 and serum Ferritin between the two groups. LDH (p=0.015), IL-6 (p=0.001) and Ferritin (p=0.001) were significantly different between the two groups, but CRP was not (p=0.811) significant. Conclusion: CT severity score associates well with the COVID-19 clinical severity. Our data suggest that the chest CT scoring system can predict the severity of COVID-19 disease and significantly associates with inflammatory markers.

Compromiso cardiologico y marcadores inflamatorios en ninos con Sindrome Inflamatorio Multisistemico relacionado a la infeccion por COVID-19

Coronavirus 2 (SARS-CoV-2) infection has spread rapidly. In pediatrics, a condition similar to shock is described named multisystem inflammatory syndrome in children (MIS-C) or pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS). The mechanisms of cardiological involvement are not clear. Objective: To describe cardiological in-volvement and inflammatory markers in hospitalized patients with MIS-C in a tertiary hospital. Patients and Method: Observational, retrospective study in children under 15 years of age with MIS-C. Demographic, clinical, and laboratory variables were collected from an electronic plat-form, including troponin, B-type natriuretic peptide (proBNP), ultrasound, and electrocardio-gram. Patients with / without cardiological involvement (CCC / SCC) were compared. GraphPad QuickCalcs (c) 2018 Software was used for statistical analysis, considering p < 0.05. Results: Thir-teen patients diagnosed with MIS-C, 9 males, median age 9.5 years. All presented with fever and abdominal pain, adding one or more of the following symptoms: vomiting, exanthema, diarrhea, altered mucous membranes and/or edema. Five patients had hemodynamic compromise, 9/13 were categorized as CCC. Troponins were elevated 4.1 times in CCC (p < 0.05), median ProBNP CCC 6940 pg/ml vs 921 pg/ml in SCC (p < 0.05), median Ferritin CCC 482 vs 154 ng/ml in SCC (p < 0.01), platelets CCC 106,000 vs SCC 207,000/mm3 (p < 0.05). Echocardiogram showed pe-ricardial effusion (N = 6), mild systolic dysfunction (N = 4), moderate dysfunction (N = 1) and coronary alterations (N = 3). In the ECG, 3 patients presented transient repolarization disturbance and 1 first-degree atrioventricular block. None required support with extracorporeal membrane oxygenation, with no deaths. Conclusion: cardiological involvement in hospitalized children with MIS-C is frequent. Our series showed nonspecific and transitory symptoms, and hemodynamic compromise which responded early to medical treatment, with a favorable evolution. The markers in CCC patients were troponin, ProBNP, ferritin, and thrombocytopenia. The most frequent ul-trasound finding was pericardial effusion. The importance of both clinical and laboratory cardio-logical evaluation in these patients is evident.

Hematological and Biochemical Parameters at Admission as Predictors for Mortality in Patients with Moderate to Severe COVID-19

BACKGROUND: Timely diagnosis and effective use of available resources are urgent to avoid the loss of time, medical, and technological resources, particularly in COVID-19 pandemic. This study aimed to identify the most dominant predicting factor for mortality in moderate-severe COVID-19 patients.METHODS: This retrospective cohort study included a total of 253 patients diagnosed with moderate-severe COVID-19. The primary outcome measure was mortality during hospitalization. The receiver operating characteristic (ROC) curve was used to determine cut-off points. The data were categorized according to the cut-off points in ROC curve and analyzed using Chi-square and by binary logistic regression test to identify the independent predictors associated with mortality.RESULTS: The mean number of leukocytes (/mu L), neutrophils (%), neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), C-reactive protein (CRP, mg/L), and D-dimer (mg/L) in the non-survived group was significantly higher than those of the survived group. Meanwhile, the mean number of platelet count/mu L, absolute lymphocyte count (ALC), in the non-survived group was significantly lower than those of the survived group. CRP level predicted mortality with a cut-off point of >= 8.41 mg/L, sensitivity of 98.1%, and specificity of 72.0% (P = .000).CONCLUSIONS: High leukocyte count, low platelet count, high NLR, high CRP level, and high D-dimer on admission predicted mortality of COVID-19 patients. In addition, CRP was found to be the most dominant predicting factor of mortality in moderate-severe COVID-19 patients.

A comparative study of inflammatory markers between cases of severe and non-severe COVID-19 infection at admission

A "cytokine storm" is characterized by an increase in the release of many cytokines that cause lung tissue fibrosis and long-term damage. This disorder is distinguished by a rise in the total quantity of cytokines that are discharged into the bloodstream. It is not quite obvious if these changes occurred as a consequence of the immunomodulation that the medication provided or of the disease process itself. In addition, additional study is necessary to shed light on the possible connection that exists between these inflammatory markers and the development and severity of COVID-19. The current analysis was to report changes in the inflammatory markers in symptomatic COVID-19 patients and to link such changes with severity and prognosis. [ FROM AUTHOR] Copyright of Journal of Cardiovascular Disease Research (Journal of Cardiovascular Disease Research) is the property of Journal of Cardiovascular Disease Research and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

C-Reactive Protein (CRP): A Potent Inflammation Biomarker in Psychiatric Disorders.

An increasing number of studies have investigated the role of inflammation in psychiatric disorders, by demonstrating how an altered/dysfunctional immunological and inflammatory system may underpin a psychiatric condition. Particularly, several studies specifically investigated the role of a neuroinflammatory biomarker, named C-reactive protein (CRP), in psychiatric disorders. Overall, even though scientific literature so far published still does not appear definitive, CRP is more likely reported to be elevated in several psychiatric disorders, including schizophrenia, mood disorders, anxiety disorders and post-traumatic stress disorder. Moreover, a low-grade inflammation (CRP >3 mg/L) has been more likely observed in a subgroup of patients affected with a more severe psychopathological symptomatology, more treatment resistance and worst clinical mental illness course, strengthening the hypothesis of the need for a different clinical and prognostic characterization based on this concomitant neuroinflammatory predisposition. However, even though further research studies are needed to confirm this preliminary evidence, CRP may represent a potential clinical routine biomarker which could be integrated in the clinical routine practice to better characterize clinical picture and course as well as address clinicians towards a personalized treatment.

Cross-sectional study of COVID-19 infection in patients with rheumatic diseases in a sample of a Damascene population, Syria.

Coronavirus infections have been responsible since 2019 for respiratory illnesses with varying severity worldwide. Worst outcomes from coronavirus (COVID-19) have been reported in older patients andthose with comorbidities like rheumatic diseases. Some drugs used for treating rheumatic diseases are used in patients with COVID-19. Based on the limited data, rheumatic diseases do not seem to affect the disease course of COVID-19. We aimed to analyze the course of COVID-19 infections in patients with rheumatic diseases. Methods: A self-reported questionnaire was distributed online and to patients admitted with respiratory involvement. Data included demographic information, clinical presentation, severity, comorbidities, and laboratory parameters. Cases were matched by age, sex, the month of admission, and COVID-19 respiratory injury for patients with rheumatic diseases and patients without rheumatic diseases. Results: Twenty-two patients (4.4%) had rheumatic diseases before the COVID-19 infection. There were no differences in the use of treatment for COVID-19 infections in previous or present therapy or comorbidities. We found no significant difference in the duration of COVID-19 symptoms before admission, duration of hospital stay, or chest Xray Brixia score between the two groups. The lymphocyte count was lower in the patient group, while lactate dehydrogenase, ferritin, and D-dimer concentrations were higher compared to the control group. Thrombotic events were similar in rate. Conclusion: The poorer outcome from COVID-19 infections in patients with rheumatic diseases is related to older age and the presence of comorbidities rather than the rheumatic disease type or its treatment.

Clinical and Laboratory Predictors of Mortality in Severe COVID-19 Pneumonia: A Retrospective Study from India

OBJECTIVE: Wide arrays of laboratory parameters have been proposed by many studies for prognosis in COVID-19 patients. In this study, we wanted to determine if the International Severe Acute Respiratory and Emerging Infections Consortium-Coronavirus Clinical Characterization Consortium score in addition to certain clinical and laboratory parameters would help in predicting mortality. We wanted to determine if a greater severity score on chest x-ray at presentation translated to poor patient outcomes using the COVID-19 chest radiography score. MATERIAL AND METHODS: This retrospective study was conducted at SDS TRC and Rajiv Gandhi Institute of chest diseases, Bangalore from March 2021 to June 2021. This study included 202 real-time-polymerase chain reaction-positive COVID-19 patients aged above 18 years admitted to the intensive care unit of our hospital. Demographic characteristics and baseline hematological and inflammatory markers (serum C-reactive protein, lactate dehydrogenase, troponin-I, ferritin, and d-dimer) were collected. Radiological severity on a chest x-ray was assessed using the validated COVID-19 chest radiography score. The International Severe Acute Respiratory and Emerging Infections Consortium-Coronavirus Clinical Characterization Consortium score was assigned to each patient within 24 hours of intensive care unit admission. Outcome studied was in-hospital mortality. RESULT(S): The overall mortality was 54.9% (111 cases). Age more than 50 years, >4 days of symptoms, peripheral oxygen saturation/ fraction of inspired oxygen ratio less than 200, elevated serum lactate dehydrogenase >398.5 IU/L, and hypoalbuminemia (<2.95 g/dL) were detected as independent predictors of mortality. A significant correlation of risk stratification with mortality (P = .057) was seen with International Severe Acute Respiratory and Emerging Infections Consortium-Coronavirus Clinical Characterization Consortium score. There was no significant correlation between the COVID-19 chest radiography score and mortality. CONCLUSION(S): Age >50 years, peripheral oxygen saturation/fraction of inspired oxygen ratio <200, mean symptom duration of >4 days, elevated serum lactate dehydrogenase, and hypoalbuminemia are independent predictors of mortality in severe COVID-19 pneumonia. International Severe Acute Respiratory and Emerging Infections Consortium-Coronavirus Clinical Characterization Consortium score was different in the survivors and deceased.Copyright © Author(s).

CLINICAL AND GENETIC DETERMINANTS OF SEVERE COURSE OF COVID-19 IN PREGNANT WOMEN.

Objectives: to determine the clinical and genetic determinants of the severe course of COVID-19 in pregnant women in order to identify a risk group and search for therapeutic targets. Materials and methods. 21 patients (group 1) with a severe course of COVID-19 who required intensive care in the Anesthesiology and Intensive Care Unit (AICU) and 126 pregnant women with moderate severity treated in the Infectious-Obstetrics Unit (IOCU) were examined (group 2). Genomic DNA for molecular genetic analysis of gene variants ACE (I/D, rs 4340), PGR (Alu insertion), ESR1 (A351G, rs 9340799), PON1 (C108T, rs 705379) was isolated from the peripheral blood of patients using a commercial Quick-DNA Miniprep Plus Kit (Zymo Research, USA). Variants of ACE and PGR genes were determined using allele-specific polymerase chain reaction;polymerase chain reaction followed by restriction analysis was used to determine ESR1 and PON1 gene variants. Results. Severe course of COVID-19 is observed in 18.2% of pregnant women, critical condition in 7.5%. A third of AICU patients are over 35 years old. Somatic anamnesis was complicated in 23.8% of patients;thyroid gland pathology (14.3%) and varicose disease (19.0%) prevailed. A significant factor in the severe course of COVID-19 is obesity of the III-IV degree in 28.5% cases. The severe course of the disease was associated with complications of pregnancy (oligohydramnios - 52.4%, ahydramnios - 14.3%, fetal growth retardation syndrome - 33.3%, circulatory disorders - 57.1%, fetal distress - 47.6%, preeclampsia - 14.3%), labor (caesarean section - 57.1%, premature birth - 28.6%), disorders of newborns state (asphyxia - 35.6%). These patients are characterized by anemia (58.7%), thrombocytopenia (23.8%), leukocytosis (33.3%), lymphopenia (90.5%), a shift of the leukocyte formula to the left (an increase of rod-nuclear leukocytes by 85.7%). There were significantly increased levels of transaminases: alanine aminotransferase in 47.6%, aspartate aminotransferase in 76.2%. Prothrombotic changes are indicated by a decrease in prothrombin time and activated partial thromboplastin time in 66.7%, which is confirmed by an increase in D-dimer in 85.7% of patients up to the maximum 15,000 ng/ml in 9.5% of women. An increase in inflammation markers (C-reactive protein and interleukin-6 in all AICU patients, procalcitonin in 66.7%) is a reflection of the destructive effect of inflammatory processes. The genetic determinants of the severe course of COVID-19 in pregnant women can be the ID genotype of the ACE I/D rs4340 polymorphism (81.0%), the T2/T2 PROGINS genotype (19.0%), the ESR1 A351G rs9340799 GG genotype (28.5%). Conclusions. The use of separate clinical, laboratory and genetic indicators in pregnant women with COVID-19 will contribute to the selection of the risk group of a coronavirus severe course and the determination of targets of therapeutic impact.Copyright © 2022 Trylyst. All rights reserved.

Diagnostic des pneumonies aiguës communautaires aux urgences et distinction entre étiologie virale ou bactérienne

La pandémie actuelle liée à l'émergence du SARSCoV-2 en 2019 a considérablement modifié la perception des médecins de l'impact des virus respiratoires et de leur rôle dans les pneumonies aiguës communautaires (PAC). Alors que plus de 25 % des tableaux de PAC chez l'adulte étaient d'origine virale, les virus respiratoires étaient souvent perçus comme des agents pathogènes peu graves. Devant le défi que représente encore à nos jours la documentation microbiologique d'une PAC, l'instauration d'un traitement empirique par antibiotiques est souvent réalisée aux urgences. La pandémie de COVID-19 a surtout mis en exergue le rôle déterminant de la biologie moléculaire et du scanner thoracique dans l'algorithme diagnostique de la PAC. En effet, un diagnostic rapide et fiable est la clé pour améliorer les mesures de précaution et réduire la prescription inutile d'antibiotiques. Du fait de prises en charges très différentes, il est nécessaire de distinguer l'étiologie virale de la bactérienne d'une PAC.Alternate : The current pandemic linked to the emergence of SARS-CoV-2 in 2019 has considerably changed the perception of doctors of the impact of respiratory viruses and their role in community-acquired acute pneumonia (CAP). While more than 25% of CAP in adults were of viral origin, respiratory viruses were often perceived as harmless pathogens. Faced with the challenge that the microbiological documentation of a CAP still represents today, the establishment of empirical antibiotic treatment is often carried out in the emergency room. The COVID-19 pandemic has primarily highlighted the decisive role of molecular biology and chest CT in the diagnostic algorithm of CAP. Indeed, a rapid and reliable diagnosis is the key to improve isolation decisions and reducing the unnecessary prescription of antibiotics. Due to significantly different treatments, it is necessary to distinguish the viral etiology from the bacterial of a CAP.

The incidence, risk factors, and outcome of new-onset diabetes among post-COVID-19 patients: A single-center study

Background: Coronavirus disease 2019 (COVID-19) infection may elevate the risk of hyperglycemia and other complications in patients with and without prior diabetes history. It is not clear whether the virus induces type 1 or type 2 diabetes or instead causes a novel form of diabetes. Precise mechanism of diabetes onset in COVID-19 patients remains unresolved. Aims and Objectives: The aims of this study were to know the incidence, risk factors, and outcome of new-onset diabetes among post-COVID-19 patients and association of disease severity and occurrence of new-onset diabetes in post-COVID-19 Patients. Materials and Methods: Patients age more than 18 years, not known diabetic, tested positive with rapid antigen test or reverse transcription polymerase chain reaction admitted to a tertiary care hospital were included in the present prospective observational study. The patients who developed new-onset diabetes during the 3 months follow-up and, the risk factors associated with new-onset diabetes are assessed. Patients with hemoglobin (HbA1c) >6.5% were diagnosed with new-onset diabetes. Results: Total 246 patients were non-diabetics at admission, at 1 week 188 were non-diabetics and 49 were diabetics, and nine were prediabetics. Patients were within the age range of 21-- 95 years with mean age of 49.46±17.02 years and male predominance (59.76%). Out of 188 non-diabetics, 19 (10.10%) developed new-onset diabetes, and 2 (1.06%) developed new-onset prediabetes after 3 months. Out of 49 diabetics, 19 (38.77%) became non-diabetic, 30 (61.22%) remained diabetic, and out of nine prediabetes 2 (22.22%) developed new-onset diabetes, 5 (55.55%) reversed to non-diabetic, and 2 (22.22%) remained prediabetic after 3 months. In total, from HbA1c at admission and 3 months, 51 subjects had new-onset diabetes (20.73%). Most common risk factors found with occurrence of new-onset diabetes were those on high dose of steroid (P=0.0001), family history of diabetes mellitus (DM) (P=0.001), over weight and obesity (P=0.0001), fungal infection (P=0.0001), and need of oxygen and intensive care unit requirement (P=0.0001). The patient with increased laboratory markers of inflammation such as ferritin, neutrophil leukocyte ratio, lactate dehydrogenase, and C-reactive protein D-dimer had strong association with occurrence of new-onset diabetes (P=0.0001). Conclusion: COVID-19 infection confers an increased risk for type 2 diabetes. Patients of all ages and genders had an elevated incidence and risk for occurrence of new-onset diabetes. Moreover, it was strongly associated with overweight and obesity, steroid dosage, and its duration, disease severity, positive family history of DM, and increased laboratory markers of inflammation. Hence, particular attention should be paid during the first 3 months after COVID-19 infection and patients need to be under follow-up for blood glucose monitoring. [ABSTRACT FROM AUTHOR] Copyright of Asian Journal of Medical Sciences is the property of Manipal Colleges of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)