ABSTRACT
Objectives: Severe acute respiratory syndrome-coronavirus 2/COVID-19 infection is still a global concern, with pregnant women are considered as vulnerable population. Until now, the characteristics of pregnant women in Indonesia who are infected with COVID-19, as well as pregnancy and neonatal outcomes, are still unknown. This study aims to obtain national data, which are expected to be useful for the prevention and management of COVID-19 in pregnant women in Indonesia. Method(s): There were 1,427 patients recruited in this retrospective multicenter study. This study involved 11 hospitals in 10 provinces in Indonesia and was carried out using secondary patient data from April 2020 to July 2021. COVID-19 severity was differentiated into asymptomatic-to-mild symptoms and moderate-to-severe symptoms. The collected data include maternal characteristics, laboratory examinations, imaging, pregnancy outcomes, and neonatal outcomes. Result(s): Leukocyte, platelets, basophil, neutrophils segment, lymphocytes, monocytes, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, alanine aminotransferase (ALT), aspartate aminotransferase (AST), C-reactive protein (CRP), urea, and creatinine were found to be significantly associated with severity differences (p < 0.05). Moderate-severe symptoms of COVID-19 also shown to have suggestive pneumonia findings on chest X-ray findings. Patients with asymptomatic-to-mild symptoms had significantly (p < 0.001) higher recovery rate, shorter hospital stay, less intensive care unit (ICU) admission, and had more vaginal delivery. Neonates from mother with mild symptoms also had significantly (p < 0.001) higher survival rate, higher birth weight, and higher APGAR score. Conclusion(s): Several laboratory and radiology components, as well as maternal and neonatal outcomes are related to the severity of COVID-19 in pregnant women in Indonesia.Copyright © The Author(s). 2023.
ABSTRACT
Aim: To study the characterization of the CT Brain in COVID 19. Material(s) and Method(s): Patients of COVID 19 who had neurological signs either before they were admitted or while they were in the hospital had a CT brain plain once during their time in the hospital. CT Brain plain presentations were shown to correspond with CNS symptoms, progression throughout the patients' hospital stays, and outcomes. Several tests, such as RT-PCR for COVID 19, CT Brain plain, complete blood count, liver function tests, renal function tests with electrolytes, and others were performed. Result(s): In the current investigation, there were a total of 50 patients, 46 (92%) of whom were male, while just 4 (8%), on the other hand, were female. The patients' ages ranged anywhere from 35 to 82 years old, with a mean of 65.85+/-8.69 years. NLR was 14.98+/-2.69 (range 1.31-47.5), mean LDH 992.17+/-25.69 (range 221-5125), and Hs-CRP was 171.22+/-22.69 (range 2.9-321.5). Mean haemoglobin of the patients was 11.12+/-1.85 (range 4-15 g/dl), total leukocyte count was 16580.63+/-5896.45, mean platelet count was 2.11+/-1.02 / lacs (0. 27 patients, or 54%, were discovered to have had an ischemic stroke, whereas 5 patients, or 10%, were found to have had a hemorrhagic stroke. The CT brain results were found to be abnormal in 30 individuals (or 60%), whereas in 20 patients (or 40%), they were determined to be normal. 11 (22%) of the patients required the assistance of a ventilator, 6 (12%), of the patients used a BiPAP, 2 (4%), of the patients used a Hudson mask, and 10 (20%) of the patients had NRM. Conclusion(s): In conclusion, we were surprised to find that the proportion of patients with severe COVID-19 infection who had abnormal brain CT scans was rather significant. Ischemic stroke was the most common kind of stroke that occurred in conjunction with aberrant CT results. We believe that the connection between aberrant brain CT and the fate of patients warrants further validation in a wider patient population.Copyright ©2022Int. J. Life Sci. Biotechnol. Pharma. Res.
ABSTRACT
Background: Post-Covid retropharyngeal mucormycosis is a rare presentation, and no case has been reported in literature until date. Case presentation: A-32-year-old female post Covid presented to our OPD with history of dysphagia and with a history of steroid intake. Radiology confirmed it as retropharyngeal abscess. Endoscopic-guided aspiration was done. HPE (histopathological examination) revealed classic broad aseptate hyphae of mucormycosis. Patient was managed conservatively with broad-spectrum antifungal. Conclusion(s): Retropharyngeal mucormycosis is a rare entity in Covid era. Rapid diagnosis and management are needed to save life of an individual, or results could be fatal.Copyright © 2022, The Author(s).
ABSTRACT
Background and Aim: The new type of Severe Acute Respiratory Syndrome Coronavirus 2 (Coronavirus 2019-COVID-19) infection is the largest pandemic in the last decade. Acute respiratory distress syndrome is the complication with the highest mortality rate of this infection and there is no adequate treatment with proven efficacy to reduce mortality. This multi-center, retrospective study aimed to determine the effect of high-dose vitamin C on survival and other endpoints in invasively ventilated ARDS patients. Method(s): This multi-center, observational retrospective cohort study was performed at five ICU centers between March 2020 and July 2020. Patients with ARDS due to COVID-19 who required IMV were included. High-dose vitamin C group was defined as patients who were treated with vitamin C over 200 mg/kg for four days. Patients who were not given vitamin C treatment were defined as the control group by using propensity score match analysis, as well. The groups were compared about the effects of high-dose vitamin C treatment on ICU mortality. Result(s): A total of 86 patients with a mean age of 67.85 +/- 10.38 were included in the study. 72.1% of the patients were male. Forty-two (49%) patients were in the high dose vitamin C group, and 44 (51%) were in the control group. The mean PaO2/FiO2 at the time of admission to the ICU was 128.27+/-58.69 mmHg (133.63+/-56.51 mmHg in the control group, 122.36+/-61.18 mmHg in the study group, p=0.389). The mortality rate of high dose vitamin C group was lower than the control group (73.8% vs. 90.9%, p = 0.037,respectively). Conclusion(s): As an adjunctive therapy in invasively ventilated patients with COVID-19-associated ARDS, high doses of vitamin C may reduce mortality and development of organ damage. Prospective, randomized controlled studies with larger numbers of patients are needed to confirm these findings.Copyright © 2023, Society of Turkish Intensivists. All rights reserved.
ABSTRACT
The COVID-19 pandemic is raging across the globe, with the total active cases increas-ing each day. Globally over 63 million COVID-19cases and more than 1.4 million deaths have been reported to WHO. Throughout the world, academicians, clinicians and scientists are working tirelessly on developing a treatment to combat this pandemic. The origin of novel SARS-CoV-2 virus still remains foggy but is believed to have originated from a bat coronavirus RaTG13 with which it shares approximately 96% sequence similarity. In the present review, the authors have pro-vided an overview of the COVID-19 pandemic, epidemiology, transmission, developments related to diagnosis, drugs and vaccines, along with the genetic diversity and lifecycle of the SARS-CoV-2 based on the current studies and information available.Copyright © 2022 Bentham Science Publishers.
ABSTRACT
Seborrhoeic keratosis is a benign brownish-black skin lesion that is almost always seen in middle-aged and elderly populations. The sudden onset and rapid increase in size and/ or number of seborrhoeic keratoses is called the Leser-Trelat sign, suggesting a paraneoplastic manifestation of internal malignancy. However, eruptive seborrhoeic keratoses are also described in some nonmalignant conditions such as human papillomavirus infection and HIV infection. Herein, we report a case with Leser-Trelat sign in a patient following COVID-19 infection. A 50-year-old man presented to our dermatology clinic complaining of the sudden appearance of multiple warty-like lesions on his back, which had occurred 2 months after recovery from COVID-19 infection. According to his medical history, the patient presented with cough, fever and dyspnoea about 2 months prior to the appearance of his skin lesions. He was referred to a health centre, where a nasopharyngeal swab was taken, and his polymerase chain reaction test for COVID-19 was positive. In addition, bilateral patchy ground-glass infiltration was reported in his high-resolution computed tomography (HRCT) scan, all in favour of COVID- 19 infection. The patient was then treated with acetaminophen, dexamethasone (intramuscular injection), salmeterol and a fluticasone inhaler, and his symptoms improved. Two months after recovery from his mild COVID-19 infection, several small asymptomatic pigmented verrucous papules appeared on his back. Physical examination revealed multiple rough, oval-shaped, brownish papules of varying size. Dermatoscopy of the lesions was also performed. Both clinical and dermoscopic findings were in favour of seborrhoeic keratosis. In order to reach a final diagnosis, a skin biopsy was performed, and microscopic examination of the biopsy specimen showed hyperkeratosis and well-defined epidermal hyperplasia composed mainly of the proliferation of benignlooking basaloid cells and fewer squamoid cells and horn cysts and increased melanin, mostly at the dermoepidermal junction. The dermis showed no significant change. Based on the above findings, the patient was diagnosed with eruptive seborrhoeic keratosis. To determine the possible cause of this eruption, the patient was further evaluated. In his past medical history, he was generally healthy before his COVID-19 infection and had no history of comorbidities. The patient underwent a workup to rule out any internal malignancies. Laboratory tests revealed normal results and included a complete blood count, liver and kidney function tests, electrolytes, prostate-specific antigen and urine analysis. Gastrointestinal endoscopy and colonoscopy ruled out any gastrointestinal malignancy. Chest X-ray and HRCT revealed no malignant lesion. In addition, the patient's abdominopelvic sonography was normal. The patient had no family history of similar skin lesions and gave no history of any chronic inflammatory skin diseases or viral conditions. Therefore, the appearance of the Leser-Trelat sign after COVID- 19 infection was a possibility in this patient. The role of transforming growth factor-alpha and tumour necrosis-alpha in eruptive seborrhoeic keratoses, as well as in COVID-19 infection, can be a common area of interest to explore in the aetiology of this entity.
ABSTRACT
Introduction: In critically ill patients with AKI, unacceptably high mortality rates reaching up to 50-80% in all dialyzed ICU patients are seen despite the availability of intensive renal support. At present there is no specific or targeted therapy for AKI. Pathophysiology of AKI is multifactorial. Systemic inflammation, mediated in part by cytokines, might be contributing majorly to the development of AKI. This mandates a multipronged approach to the treatment of AKI. There are hardly any studies on the use of ulinastatin in AKI. Our premise regarding the use of molecule in AKI was based on the fact that this molecule acts at multiple levels in the sepsis and can act to stop the cascade and thereby stop the "storm." Methods: We studied a total of 200 patients with AKI who needed ICU care in our hospital in the period between June 2017 - Jan 2020. Out of these, 100 patients received Injection ulinastatin 3 doses a day for 5 days, against a similar number of control patients. We included those patients with AKI who had SOFA scores more than 8. None of the patients had COVID 19 infection. We compared the same number of patients who had received ulinastatin with controls. Injection ulinastatin 1,50,000IU was given three times a day for 5 days. All the patients included had received dialytic therapy. We recorded the age of the patients, it varied from 11-94 years (mean age 52 years), > 60 % (120) of the patients being in the age group of 26-40 years. The ratio of males to females 1.8:1 (M: F 129:71). The etiologies were as follows: Malaria - complicated - P vivax, P falciparum (n= 76) 38% Enteric fever (n= 40) 20% UTI (n=30) 15% Post-partum (n=20) 10% Dengue (n = 14) 7% Acute gastroenteritis/diarrheal diseases (n= 12) 6% Pancreatitis (n= 6) 3% Obstructive uropathy (n= 3) 1.5% 33 % (n= 66) patients had diabetes as a co morbid condition. The renal function tests of all the patients along with liver function tests, sepsis parameters like d-dimer, serum procalcitonin levels, CRP-hs levels, coagulation tests, complete blood counts, and arterial blood gas analysis were done We recorded the length of stay, need and duration of renal replacement therapy, time to stoppage of renal replacement therapy, need for mechanical ventilation, mortality and post AKI recovery and progression to CKD. Result(s): The patients who received ulinastatin had a shorter stay in the ICU (p <0.01 vs control group);also, the time to stoppage of renal replacement therapy was shorter (p < 0.05). The recovery of renal function was seen in 84% (n=168). The progression to CKD was seen in 11% (n=22) of patients. The average number of sittings of dialysis needed were 11 (range3-20), lesser number of dialysis were needed in the ulinastatin group. The overall mortality was 36 %(n=72).The average follow up period post discharge has been 141 days (21 - 240 days) Conclusion(s): There definitely seem to be advantages in using ulinastatin and results look promising. But there are limitations to this study - this was a retrospective analysis hence not all the patients received ulinastatin. Moreover, the drug is expensive. This study was done in a semi urban set up where causes for AKI are predominantly infective. A larger prospective double-blind study will be needed to consider ulinastatin as a routine option for treating AKI. Till then preventing AKI should be the aim for us. No conflict of interestCopyright © 2023
ABSTRACT
Corona virus pandemic started in 2019, is due to severe acute respiratory syndrome coronavirus 2 (SARS-Co V-2), that belongs to the family of coronaviruses and primarily affects the respiratory system. This disease affected millions of people across the world since 2020. This has wide spectrum clinical infection leading to affect in liver and Kidney. So, this study was conducted to illustrate severity of affect of this virus to liver in kidneys in CO VID-19 patients. Blood samples was collected from COVID-19 patients after their consent and access for Liver and Kidney function test in hospital laboratory. The obtained data was statistically analysed with control subjects. Two sample unpaired t-test was done for comparing data with control values obtained. The study was conducted on 50 non co-morbidity COVID-19 patients arriving at tertiary care hospital, Bareilly. And it is compared with LFT & KFT values of 50 healthy subjects. It was obtained that ALT, AS T & BUN values are significantly (P<=0.05) higher in COVID-19 patients. Though the mean values were not high at critical level.By this study we conclude that patients of COVID-19 without co-morbidity don't have critical severity on liver and kidney damage. ALT, AST and BUN could be independent factors for predicting the severity of CO VID-19. Further studies need to be done on these factors.
ABSTRACT
Coronavirus disease 2019 (COVID-19) emerged in China and then has spread worldwide. It has been seen in Turkey since March. Brucellosis is a zoonotic disease which is observed in Turkey endemically. Here, we report the firstcase of Brucellosis relapse in a COVID-19 patient. A 39-year-old female had cough, dispnea, fatigue and backpain and miyalgia for one week was admitted. She had leucopenia and lymphopenia in whole blood count. She had a contact history with her COVID-19 positive sister. COVID-19 polymerase chain reaction (PCR) test resulted positive. She received hydroxychloroquine treatment for five days. Her COVID-19 PCR became negative and laboratory improved. Her miyalgia, back pain and fatigue got worse. When her medical history was elaborated, she had a brucellosis history seven years ago. She was completely treated and her Brucella serology tests were negative in 2015. She stated that she didn't consume any unpasteurized milk product recently. Rose-Bengal and Coombs agglutination tests were positive (1:320 titers). She was initialized on treatment and symptoms started to resolve after 15 days of treatment. Severe COVID-19 patients show lymphopenia, particularly reduction of T-cells. Cell mediated immunity is crucial against brucellosis. During pandemic, endemic infections like brucellosis can be observed in patients due to lymphopenia. Further immunological studies are needed.Copyright © 2022, Kuwait Medical Association. All rights reserved.
ABSTRACT
Introduction: The COVID-19 infection amongst the renal transplant recipients (RTR) has a varied presentation and severity of illness. The overall mortality amongst RTR was found to be 11.6%- 27% compared to the mortality rate of 2-3% amongst the COVID-19 infected general population. The incidence of acute kidney injury(AKI) in RTR was also found to be higher compared to general population with Covid 19 (27.5% versus 13.3%). We assessed the clinical outcomes of COVID 19 infection among RTR and its impact on the graft function along with predictors of poor clinical outcomes. Method(s): Ours is a single centre observational cohort study of 83 RTR with Covid 19 infection with a follow up period of 6 months. The data pertaining to demographics, renal transplantation, maintenance immunosuppression, baseline allograft function prior to Covid 19 infection and comorbidities was recorded in both hospitalised and outpatient RTR. Lab investigations including renal function tests and inflammatory markers were noted. Renal allograft function was assessed by estimated glomerular filtration rate(eGFR) using CKD-EPI equation prior to admission, hospital stay and 6 months follow up. The need for oxygenation, invasive ventilation;presence of hypotension, acute kidney injury(AKI),acute respiratory distress syndrome(ARDS) and need for renal replacement therapy(RRT) was noted. Modification of immunosuppressant medications with respect to dose reductions and withdrawal was recorded. The primary endpoint was mortality and presence of acute kidney injury during Covid 19 infection. Result(s): The mean age was 47.67+/-13.7 years and 75.91 % were males. Around 81.9%(68/83) RTR were hospitalised & 18.9%(15/83)were managed as outpatients. Out of 83 patients,43 (51.8%), 23(27.7%),17(20.5%) had mild, moderate and severe COVID 19 illness respectively. The mortality rate amongst COVID 19 infected RTR was 19.3%(16/83). Out of 83 RTR,17 required inotropic support owing to hypotension. The baseline eGFR(ml/min) prior to Covid 19 infection was 66.3 +/- 30.66. The eGFR(ml/min) during Covid 19 was 44.27 +/- 31.53.Acute kidney injury(AKI) was seen in 72.3%(60/83) of RTR.19.28%(16/83) required RRT.The percentage change in eGFR from baseline during COVID-19 was found to be statistically significant(p=0.003)and correlated with mortality(p=0.003).At 6 months of follow up,55/83 RTR had stable allograft function with mean eGFR(ml/min) of 51.74 +/- 29.92 and 8/83 patients(9.6%) patients were on maintenance haemodialysis. In contrast to the survivors, the non survivors had a higher mean age(67+/-13 vs 57+/-12 years), number of years of hypertension(15+/-9 vs 8.5 +/-7 years),body mass index(27.05+/-4.7 vs 23.11+/- 7.8), percentage change in eGFR from baseline(114.1 +/-81.7% vs 58.8 +/-61.4%), serum Interleukin levels (120.7 vs 10 pg/ml) and D dimer(145 vs 21.3 mcg/ml) levels (p<0.05).Other risk factors which correlated significantly with outcome of mortality and reduced renal recovery include presence of hypoxia at presentation and ARDS(87.5 Vs 28.1%),presence of hypotension requiring inotropes(81.3% vs 6%) and AKI and the need for RRT(56.7% vs 10.4%). [Formula presented] [Formula presented] Conclusion(s): The mortality rate amongst the RTR with COVID 19 infection was found to be 19.3%.AKI was found in 72% of patients during the illness and about 9.6% developed graft loss by 6 months. RTR needs a close supervision and follow up as they are prone to acute kidney injury and may develop allograft failure. No conflict of interestCopyright © 2023
ABSTRACT
Ventricular tachycardia (VT) is a type of broad complex tachycardia originating from a focus in the ventricle. It is one of the four important rhythms which can lead to cardiac arrest. Accurate and timely diagnosis of true VT is the cornerstone for proper management in the emergency department (ED). We present an interesting case of an electrocardiographic artifact mimicking VT, which led to a diagnostic dilemma in the ED.Copyright © 2023 Rehman, Albaroudi, Akram, Ahmad, licensee HBKU Press.
ABSTRACT
Background: Lactic dehydrogenase (LDH) is considered an inflammatory biomarker and its levels rise in many illnesses. Inflammation plays a critical rol in the progression of kidney damage leading to lowering of glomerular filtration rate (GFR) and altering of kidney function tests including creatinine, blood urea nitrogen (BUN) and urea. The following trial has as its main goal to identify the degree of association between LDH levels and kidney function tests. Method(s): A retrospective, transversal study that took place in Tacuba General Hospital. Adults hospitalized with SARS CoV2 infection from May 2020 to December 2021 were included. Descriptive statistical analysis was made using Mann-Whitney U test. A boxplot graph was drawn comparing subjects that developed acute kidney injury (AKI) with those who did not (Figure 1A). Spearman's rank correlation coefficient was calculated. The risk of developing AKI with LDH above its cutoff value was calculated with logistic regression. The analysis was made using the STATA 14 program. Result(s): 295 subjects, 64% men, mean age 61 +/- 14 years. We obtained the following correlation using LDH as dependent variable: for GFR a rs= -0.497;for creatinine a rs= 0.539;urea rs= 0.625;BUN rs= 0.636 (Figure 1B). The risk of developing AKI with LDH above its cutoff value had an odds ratio of 3.64 [CI 95% (1.57-8.43)]. Statistical significance was considered with p=<0.05. Conclusion(s): Our results suggest that LDH serum levels are associated with every kidney function test.
ABSTRACT
Sickle Cell Disease (SCD) is an inherited disorder with variable clinical presentation and low immunity. Coronavirus Disease-2019 (COVID-19)is a pandemic disease with a high-risk in chronic disease patients and older adults. SCD is widely distributed in Sudan;many SCD patients are infected with COVID-19. Despite this, no published data is available. This case report demonstrated the haematological and clinical course of a Sudanese sickle cell anaemia patient with COVID-19. A 20-year-old male patient was admitted to a hospital for 15 days. Demographic and clinical data were obtained from his medical records. A blood sample was taken at the time of admission and during hospitalisation. Tests were performed during admission, including Complete Blood Count (CBC), liver function test, renal function test, coagulation studies, viral screening, and urine general. The patient was diagnosed with COVID-19 using the Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) test based on the nasopharyngeal swab and COVID-19 IgG and IgM using Enzyme Linked Immunosorbent Assay (ELISA) for the previous infection. The patient received intravenous fluids, antibiotics, analgesia, oxygen supplementation, and blood transfusion two times during hospitalisation, and there was no need for Intensive Care Unit (ICU) admission. The patient's prognosis was good;he was discharged on day 16 with no symptoms and a negative result of the COVID-19 PCR test. A severe illness was expected because he was infected twice by COVID-19, the patient showed mild clinical symptoms with a good prognosis, so further studies are required to understand COVID-19 among Sudanese SCD patients.
ABSTRACT
Background and Aim: Metronidazole is commonly prescribed drug for amoebiasis and is usually well tolerated, and safe but can cause serious neurological adverse events including peripheral neuropathy which is relatively common but CNS toxicity is rare. We report a case of cerebellar ataxia who had taken metronidazole inadvertently for amoebic liver abscess. Case summary: Young male with history of toddy inking admitted for management of amoebic liver abscess. He was managed with percutaneous ain and intravenous metronidazole. He was discharged on oral metronidazole tablet for a total duration of 10 days. Due to COVID-19 pandemic, he did not turn up and continued taking metronidazole. Two months’ later patient presented with progressive slurring of speech and unsteady gait. On examination, cerebellar sign was present with normal motor and sensory system. Blood investigations including complete blood count, liver function test, kidney function test and thyroid profile were normal. Vitamin B12 and fasting blood sugar levels were normal. Non-contrast computed tomographic (NCCT) scan of brain was normal. Magnetic resonance imaging (MRI) scan of the brain showed areas of hyperintense signal change in dentate nucleus of cerebellum, two small foci in dorsal pons and splenium of corpus callosum with no restriction in T2 FLAIR, DWI and ADC sequences suggestive of interstitial edema. On stopping metronidazole, his sign and symptoms started waning and was symptom free after 10 days. Conclusions: Neurological toxicity may be related to prolonged administration, high doses, or high cumulative doses of metronidazole and prompt identification of neuropathy and cerebellar ataxia is essential to avoid permanent damage. Clinicians should avoid the use of metronidazole for more than 2 weeks in case of amoebic liver abscess.
ABSTRACT
Introduction BHIVA guidelines recommend that those prescribed pre-exposure prophylaxis (PrEP) have 3-monthly HIV testing and appropriate monitoring of renal function. The aim of this audit was to assess if these tests were being reliably completed, despite restricted access to Sexual Health Services during COVID restrictions. Methods Service-users prescribed ongoing PrEP June-August 2021 were identified via the electronic patient record (EPR). Those initiating PrEP were excluded. It was noted whether an HIV test result was recorded at time of prescription (or within 4 weeks), and if renal function was performed as per recommendations. STI diagnoses were noted. Results 82 PrEP-users were included. 31% used postal testing and 69% had tests in clinic. 95% had an HIV test within 4 weeks of PrEP prescription (87% of those using postal kits and 94% of those performing tests in clinic). No one missed renal function testing when required. STI rates were low. Discussion Whilst remote delivery of many services, including PrEP, will be retained beyond COVID restrictions, it is vital that those accessing PrEP also engage with testing and other health promotion activities. This audit has reassuringly demonstrated that those prescribed PrEP during this period had appropriate HIV and renal function follow-up (whether in-person or by post). Most not testing were low-risk due to behaviour change during COVID restrictions. When designing future PrEP delivery, we plan to perform a re-audit (during a period of no restrictions), and learn from the literature and other services how to ensure PrEP-users engage with testing despite a reduction in face-to-face services.
ABSTRACT
Objectives: This present study was to evaluate the role of biomarkers for diagnosis and management of COVID-19 patients. Methods: Throat-swab upper respiratory specimens were obtained from 100 patients and real-time PCR (polymerase chain reaction) was used to confirm SARS-CoV-2 infection. Clinical characteristics and blood biochemical tests of COVID-19 patients were examined and recorded. Venous blood (4.5 mL) was obtained. Blood samples were dispensed into a gel tube. All tubes were allowed to stand for 30 minutes at room temperature, followed by centrifugation for 10 minutes at 3500 rpm to get the serum. Liver and kidney function test were performed to all patients. Results: In this present study, out of 100 COVID-19 patients, they had 20(20%) diabetic, 29(29%) smokers, 04(04%) cancerous and 15(15%) hypertensives. Mean age of COVID-19 patients was 42.4±13.18 years. Conclusions: Abnormalities in biochemical markers play a pivotal role in the SARS-CoV-2 pandemic, it is not only from a diagnostic point of view but also in terms of the management and prognosis of COVID-19 patients. It helps for clinical decision making in order to adjust the therapy to the biological changes experienced by the subjects. Changes in the biochemical markers indicate abnormalities in various tissues and organs, indicating the development of COVID-19. Urea, CK, and LDH show the most predictive parameters of severe COVID-19 patients. LDH as an important biomarker is associated with poor outcomes in COVID-19 patients.
ABSTRACT
Aim: To assess the baseline renal profile of patients with COVID-19. Methods: It was a cross sectional study, conducted in hospitals of Rawalpindi Medical University from March to August 2020. Consecutive 169 confirmed cases of COVID-19 were enrolled. Patients with history of kidney disease were not included. Peripheral blood samples were analysed for renal functions on fully automated chemistry analyser. Estimated glomerular filtration rate (eGFR) for every patient was calculated using two equations for chronic kidney disease epidemiology collaboration (CKD-EPI) and modification of diet in renal disease (MDRD). Results: Out of total 169 COVID-19 patients, 97(57%) were males 72(43%) were females. The mean age was 54.1±16.30 (18 to 92) years. A total of 96(57%) patients were below 60 years of age. Mean Urea, serum creatinine (Scr) and blood urea nitrogen (BUN) were found to be elevated in this study cohort with no statistically significant difference with respect to age and gender (P value >0.05). Scr was raised in 46(27%) while 113(67%) and 103 (62%) patients had elevated serum Urea and BUN respectively. eGFR of <60mL/min/1.73m2 was observed in 50(30%) of patients. Conclusion: Elevated mean Urea, Scr and BUN were observed in COVID 19 patients without any significant difference according to age and gender. Moderate to severe derangement in eGFR was noted in one third of COVID 19 patients.
ABSTRACT
Aim The aim was to assess the efficacy of ivermectin in the treatment of patients with coronavirus disease 2019 pneumonia with severe and critically ill status. Patients and methods This retrospective study was performed on 50 patients admitted in ICU and high-dependency unit of Ibrahim Bin Hamad Hospital, United Arab Emirate. All patients were subjected to the following on admission: careful history taking, general and local examinations, routine laboratory studies (complete blood count, liver function tests, and kidney function tests), other laboratory tests such as C-reactive protein and D-dimer, and chest radiography. All patients received ivermectin in doses of 0.2 mg/kg on first and third days. Results The age range of the studied group was from 35 and 107 years, with a mean age of 61.8±14.07 years. The sex distribution of the studied group was 29 (58%) males and 21 (42%) females. The clinical condition deteriorated in 18 (36%) patients, improved in eight (16%) patients, and remained the same in 24 (48%) patients. Three (6%) patients had bronchial asthma, eight (16%) patients had chronic kidney disease, 20 (40%) patients had diabetes mellitus, 20 (40%) patients had hypertension, two (2%) patients had hypothyroidism, seven (14%) patients had ischemic heart disease, and 14 (28%) patients did not have any comorbidities. Regarding the progress of patients' symptoms, shortness of breath deteriorated in 18 (36%) patients, improved in eight (16%) patients, and remained the same in 24 (48%) patients. The cough symptom deteriorated in 18 (36%) patients, improved in eight (16%) patients, and remained the same in 24 (48%) patients. Radiology (chest radiograph) showed deterioration in 18 (36%) patients, improvement in eight (16%) patients, and remained the same in 24 (48%) patients. There was no statistically significant difference before and after using ivermectin with respect to temperature (P=0.058), pulse (P=0.101), respiratory rate (P=0.054), white blood cell count (P=0.058), lymphocyte count (P=0.09), C-reactive protein (P=0.177), and D-dimer (P=0.087). Conclusion The use of ivermectin did not significantly improve resolution of symptoms, outcome, radiology, or laboratory markers. The findings do not support the use of ivermectin for treatment of severe coronavirus disease 2019.
ABSTRACT
Background: Corona virus causes severe pneumonia of idiopathic nature. The clinical manifestation ranges from mild to severe respiratory problems. Due presences of target receptors and the release of chemical mediators, it also affect other organs including the liver and kidney. Objective: The purpose of this study was to determine the effect of COVID-19 infection on hematological parameters, liver function and renal function. Methods: This multicenter case-control observational study was conducted at Lady reading hospital, Hayatabad medical complex and Khyber teaching hospital Peshawar. A total of 340 samples were processed including 170 COVID-19 patients and 170 control groups. Complete blood count, liver function tests and renal function tests were performed to determine the effect of COVID infection on these parameters. The data were statistically analyzed using SPSS version 22.0. Results: In complete blood count, the mean WBC count was 16632.34±7339.94 which was statistically significant with p value less than 0.05. In differential leukocyte count, the mean neutrophil values were 87.79±7.36 which was statistically significant (p=0.00). The mean value of ALT and ALP were 49.47±100.08, 114.43±64.71 respectively which were higher than the control group. Mean value of urea and creatinine were 70.58±41.89, 1.31±1.12 respectively and was statistically significant (p=0.00). Conclusion: it is concluded that COVID-19 infection affects hematological and biochemical parameters including ALT, ALP, urea and creatinine. Hence these manifestations can be used collectively as a diagnostic and prognostic biomarker.
ABSTRACT
Background: The current pandemic of Coronavirus disease 2019 (COVID-19) and severity of the infection and high mortality have almost unprecedented challenges in the health systems of most countries around the world. Objective: The present study aimed to evaluate the effect of Iranian traditional polyherbal medicine (Imfluna) containing a mixture of echinacea, stachys, artemisia, hyssopus, polybody, alpinia, ginger, and ginseng extract on symptoms of COVID-19 infected patients. Methods: In this placebo-controlled and double-blind clinical trial, a total of 60 voluntarily approved patients with COVID-19 were randomly assigned to the placebo and Imfluna groups. Patients in each group, in addition to receiving standard medications, took two 500 mg capsules of Imfluna or placebo every 8 hours for 2 weeks. The patient's vital signs, including the severity of shortness of breath, cough, and body temperature, were recorded during the study. Also blood ESR, liver and kidney function tests were performed at baseline and endpoint. Results: The results showed that patients in the Imfluna-treated group had significantly greater improvement in daily cough, shortness of breath and ESR compared with the placebo group. In addition, lung lesions improved in the Imfluna-treated group, although not significantly. Conclusion: Patients with COVID-19 who were treated with Imfluna for 2 weeks had better comfort and fewer symptoms associated with the disease with no any drug side effects.