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Background: It is well knowledge that various viral illnesses may interfere with a man's ability to father children. Through the angiotensin-converting enzyme-2 receptor, which is highly concentrated in testicular tissue, the corona virus illness known as COVID-19 may cause harm to several organs. On the other hand, there is a paucity of data about the transmission of severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) in sperm, as well as the virus's influence on spermatogenesis and the capacity for fertility. We intended to look into whether or not COVID-19 guys' sperm contained SARS-CoV-2 as well as examine how COVID-19 affected the overall quality of the sperm and the degree to which it's DNA was fragmented. Material(s) and Method(s): The survey was conducted between May 2022 to October 2022, with the participation of 40 male COVID-19 patients who were between the ages of 19 and 45 and enrolled at the RSDKS, Government Medical College, Ambikapur, Chhattisgarh. We tested each sample of sperm with a real-time reverse transcriptase and found no abnormalities. At the time of the initial sample, which took place during COVID-19, a comprehensive examination of the sperm was carried out. This analysis included the calculation of the sperm DNA Fragmentation Index. After 74 days had passed since the first sample, we were able to get the second specimen and carried out the aforementioned tests once again. Result(s): All of the sperm samples that were examined using real-time reverse transcription-polymerase chain reaction (RT-PCR) came back negative for SARS-CoV-2. These samples were taken during the first and second sampling. The initial sample had considerably lower levels of fructose, semen volume, vitality, total motility, sperm concentration, total sperm count, percentage of normal morphology, and cytoplasmic droplet percentage than the subsequent samples. On the other hand, the agglutination of the semen, the percentage of head defects, the DNA Fragmentation Index, the liquefaction time, the viscosity of the semen, and the number of leukocytes all rose. At the second sample, these results were inverted, but not to the level that would be considered optimal. These results all had a p-value less than 0.05, meaning they were statistically significant. As a result, COVID-19 has a detrimental impact on the characteristics of the sperm, including the sperm DNA fragmentation index. Conclusion(s): The quality of the semen remained low up until the second time it was sampled, despite the fact that we were unable to discover SARS-CoV-2 in the sample. It is recommended that assisted reproductive technology (ART) clinics and sperm banking facilities evaluate the quality of the sperm produced by males infected with COVID-19 and exclude men who have a history of being infected with SARS-CoV-2 until the men's sperm quality recovers to normal.Copyright © 2023 Ubiquity Press. All rights reserved.
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Background ACE is a potent pro-inflammatory modulator that controls chemokines and adhesion molecules, and elevated ACE activity associated with immunoinflammatory conditions, including cardiovascular diseases (CVD) and diabetes. The ACE inhibitors are recommended as primary treatment for these illnesses. ACE is a peptidyl-dipeptidase that catalyses Angiotensin I to Angiotensin II, whilst inactivating bradykinin during blood pressure regulation via the Renin-Angiotensin System. The purpose of this study is to establish a reference interval (RI) for ACE in the Irish population after COVID, and to examine if there is an underlying correlation between ACE concentrations and a range of biomarkers. Methods Serum samples of 200 randomly selected patients were obtained from several Irish hospitals in March 2022 (in compliance withGuidance on Anonymisation and Pseudonymisation, June 2019). We analysed for ACE (Buhlmann reagents), HBA1C, 25OHD and other biomarkers on the Abbott Architect ci8200. Full Blood Count was measured on Sysmex CS-2500. The statistical analysis used the EP Evaluator 11.3.0.23 and SPSS 22.0 software. Results The RI based on the central 95% of data was 8-78 U/L. This is higher than the RI proposed by the manufacturer (20-70 U/L) but is very close to our RI (5-79 U/L) from 2019. We found a significant positive correlation between ACE concentration and HBA1c, Urea, Creatinine, White Blood Cells (p<0.0001), Glucose (p=0.02), LDL (p=0.03), Neutrophils (p=0.003), Lymphocytes (p=0.001). A significant negative correlation was observed with 25OHD (p<0.0001). Conclusions This study did not show any notable change in the RI for ACE after COVID in Ireland. The significant positive correlations with HBA1c and other biomarkers may indicate the importance for ACE testing for diabetic management and progression, but further studies will be needed. Patients' overall health and medical history should always be considered when evaluating ACE results, including Vitamin D levels.
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Background: Dysfunctional breathing (DB) is increasingly recognized in long COVID. Associated symptoms, functional impact and quality of life (QoL) have not been systematically studied. Objective(s): We aimed to measure symptoms, functional impact and QoL in long COVID patients with new onset DB. Method(s): We included 55 patients (47.9 yr (14.4), female sex 72.7%) from our long COVID clinic with DB diagnosis based on compatible symptoms and abnormal breathing pattern during CPET. Questionnaires including mMRC scale, Nijmegen, short form 36 (SF-36), hospital anxiety and depression scale (HADS), post COVID functional scale (PFCS) and specific long COVID symptoms were administered. Result(s): Most patients had mild acute COVID-19 (admission rate 16.4%). Median time from SARS-CoV-2 diagnosis to CPET was 213 days (IQR 127), mean V'O2 was 90.4% (SD 20.2) pred. Hyperventilation, periodic sigh breathing and mixed types of DB were diagnosed in respectively 21.8%, 47.3%, 30.9% of patients. Mean (SD) Nijmegen score, PCFS and global HADS were 27.9 (11.9), 2.1 (0.8) and 16.6 (7.8) respectively. In addition to dyspnoea, most frequent symptoms on Nijmegen scale (cut-off >=3) were: faster or deeper breath (75.6%), unable to breath deeply (48.9%), sighs (53.5%), yawning (46.5%) and tight feeling in the chest (40.0%). SF36 scores were lower than population reference value. Conclusion(s): Long COVID patients living with DB have a high burden of symptom, functional impact and a low QoL despite normal exercise capacity.
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Background: Zonulin is a protein, reversibly increasing the permeability of the intestinal wall by changing the structure of tight junctions of the lateral surfaces of intestinal epithelial cells. Fecal zonulin is used for noninvasive assessment of increased intestinal permeability. Normal values of zonulin in stool (<= 110 ng/ml) indicate the absence of damage of the intestinal villous mucosal surface and normal density of intercellular contacts. The aim of the study was to determine the level of fecal zonulin (FZ) in the feces of ulcerative colitis (UC) patients with exacerbation of the disease and the presence of COVID-19 in the acute period and without COVID-19 to assess the degree of intestinal permeability. Method(s): 46 patients with IBD without COVID-19 (Me age - 36 years) and 31 patients with UC with the presence of COVID-19 infection in the acute period (Me age - 42 years) were examined. Untreated stool samples of patients were frozen and stored at a temperature of 80 degreeC. FZ was measured by ELISA (IDK Zonulin ELISA Kit, Immunodiagnostik AG, Germany) in ng/ml. Reference values: < 83.15 ng/ml - a variant of the norm, 83.15-110 ng/ml - an elevated level, 110 ng/ml - a high level Results: In the stool samples of patients with UC exacerbation without COVID-19 FZ was detected from 172.6 to 460.8 ng/ml (Me - 316), the average value was 322.4+/-14.6 ng/ml. In the stool samples of patients with UC exacerbation and COVID-19 infection, FZ was detected from 354.8 to 628.3 ng/ml (Me - 489.9), the average value was 472.9+/-18.4 ng/ml (p=0.000001). Conclusion(s): FZ concentration in the feces of UC patients is significantly higher in UC patients with the presence of COVID-19 infection in the acute period, which indicates a higher permeability of the intestinal wall.
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Introduction: Remaining respiratory symptoms is common after covid-19. The pathophysiology behind this is unclear, with spirometry often within the normal range. We hypothesised that impairment in the small airways can be an explanation. Aim(s): To investigate if the function of the small airways is impaired after covid-19. Method(s): 28 (18 females) post covid-19 subjects aged 27-63 yrs performed spirometry, DLCO, nitrogen (N ) multiple breath washout (MBW) and impulse oscillometry (IOS). Three out of 28 were hospitalized due to covid-19. Median (IQR) days between first symptom and participation was 216 (108;372). Results were compared to findings in 10 (7 females) non-covid-19 subjects, aged 29-63 yrs, and reported in z-score (z) related to GLI reference equations for spirometry and DLCO, while two healthy cohorts (n=400 and n=158) provided local reference values for N MBW and IOS, respectively. Result(s): IOS derived frequency dependence of resistance (FDR) and MBW derived Sacin were the only outcomes significantly different in post covid-19 subjects, median (IQR), 0.01 kPa/L/s (0.00;0.02) vs 0.04 kPa/L/s (0.01;0.06), p=0.028 for FDR and 0.070 (0.046;0.076) vs 0.009 (0.075;0.121), p=0.017 for Sacin. FDR was >1.96 z in 2/28 whileS >1.96 z was found in 14/28. In post covid-19 subjects with S >1.96 z, dyspnea were more common than in those with normal Sacin, (8/14 vs 2/14, p=0.049). FEV1 and DLCO were > -1.96 z in all but one subject. Conclusion(s): Ventilation heterogeneity at the entrance to the acinar airways were common in this small sample of post covid-19 subjects, as assessed by Sacin, and may explain the experience of dyspnea in these subjects, despite normal spirometry and DLCO. A larger study is ongoing.
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An 86-year-old woman presented to the emergency department with acute shortness of breath. She was treated with intravenous furosemide for acute-on-chronic heart failure. Her past medical history included atrial fibrillation, hypertension, diverticulosis and hypothyroidism. Rivaroxaban and levothyroxine were her only long-term medications. On day 5 of hospital admission, she developed painful haemorrhagic and purulent bullae on her dorsal hands, head and neck. These evolved to large suppurative, vegetative plaques over a 72 h period and she developed additional lesions on her trunk, upper back and thighs. The patient had routine blood tests, which showed a raised C-reactive protein at 260 mg L-1, and an acute kidney injury with a glomerular filtration rate of 54 mL-1 min-1. She had a negative COVID-19 swab, and swabs from the lesions for bacterial culture and viral polymerase chain reaction were negative. She had a normal serum protein electrophoresis, immunoglobulin, antinuclear antibody and antineutrophil cytoplasmic antibody. She had computed tomography of her chest 24 h prior to the onset of her lesions, which showed mild bilateral pleural effusions in keeping with fluid overload secondary to heart failure. A biopsy taken from her hand showed orthokeratosis and parakeratosis, and there was bulla formation subepidermally. There was a dense neutrophilic infiltrate with microabscess formation with scattered eosinophils and lymphocytes. There was no evidence of vasculitis. Direct immunofluorescence was negative and a tissue culture for atypical mycobacteria was negative. The patient was commenced on high-dose intravenous methylprednisolone at 500 mg for 3 days followed by 40 mg prednisolone orally for 1 week, but there was a limited response. Our initial differential was Sweet syndrome or pyoderma vegetans;however, the patient had no fevers and no risk factors (malignancy, inflammatory disease, infection, etc.). She also had no response to high-dose oral prednisolone. Given the timing of her CT examination in relation to her acute dermatosis and the use of radioiodine for contrast, we assessed the patient's serum iodine and urine iodine. These were both high at 1.02 mmol L-1 (reference interval 0.32- 0.63) and 3.46 mmol L-1 (reference interval 0.0-2.43), respectively. A diagnosis of iododerma was made. The patient's eruption slowly resolved and at 12 weeks there was evidence of postinflammatory skin changes only. Her urine and serum iodine were rechecked, and both had normalized. In the last 20 years there have been approximately 20 case reports of iododerma. Most have been following iodine contrast use in patients with abnormal kidney function, like our patient. Most describe an acneiform eruption that subsequently evolves to vegetative plaques (Chalela JG, Aguilar L. Iododerma from contrast material. N Engl J Med 2016;374: 2477). Iododerma is largely a diagnosis of exclusion, but histopathology and urine and serum iodine levels can help support diagnosis.
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Background: To determine the association between various demographic indicators and biochemical markers in COVID-19 patients in Western-Punjab. Material(s) and Method(s): An observational cross-sectional study was done on one hundred and fifty cases of all ages admitted in Isolation ward, reporting to Adesh Institute of Medical Sciences and Research, Bathinda, India with COVID-19(RT-PCR/ or RAT) from January 2022 to March 2022 were included. Clinical features like fever, cough and shortness of breath were recorded. Blood sample was collected in plain tube for biochemical markers like serum albumin, creatinine, ferritin, LDH, CRP and urea, SGOT, SGPT, procalcitonin, D-dimer, ESR, IL-6, ALP, bilirubin were analysed. Association of the clinical features and these biochemical markers were determined. Result(s): Patients were divided into 3 groups according to different ages (<40 years, 40-60 years, >60 years). Out of 150 patients 26 (17.3%) belonged to age group < 40, 60 (40.0%) belonged to age group 40-60 years and 64 (42.7%) belonged to age group >60 years. Mean age was 55.93 + / - 14.91. Out of 150, 39 (26.0%) were females and 111(74.0%) were males. 44 (29.3%) cases had hypertension and 59(39.3%) cases had diabetes mellitus. Urea levels in 118 (78.7%) patients were above normal reference values e and was statistically significant (p<0.015). 73 (48.7%) had SGOT levels above normal range [statistically significant (p<0.025)] while as 63 (42%) had SGOT above normal range [statistically significant (p<0.001)]. 98 (65.3 %) had IL-6 above normal range [statistically significant (p<0.003)]. While as albumin levels in 38 (25.3%) patients were within normal range and 112 (74.7%) patients had albumin below normal range [statistically significant (p<0.014)]. ESR (100%), D-dimer (100%), procalcitonin (100%), LDH (94%) were uniformly raised in almost all patients. Rest of the markers like ferritin (74%), bilirubin (6%), CRP (90%), creatinine (15.3%), ALP (14.7%) was also raised but was not statistically significant. Conclusion(s): Indian patients with COVID-19 disease showed variable pattern of clinical features.Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
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Chronic heart failure despite the development of new treatment methods, remains the most common and prognostic adverse complication of all cardiovascular diseases. Studies conducted in different countries over the past decades have convincingly proved that vitamin D deficiency is one of the important factors in the development of CCC diseases. Vitamin D (VDR) receptors were detected in more than 40 target tissues, including cardiomyocytes, smooth muscle and endothelial vascular cells and have convincingly proved, that eliminating vitamin D deficiency improves blood pressure in hypertension and also reduces myocardial hypertrophy. The above studies also confirmed the effect of vitamin D on the development of prediabetes, diabetes, metabolic disorders. The effect of vitamin D on the prevention of atherosclerosis has also been confirmed. One of the mechanisms for the development of atherosclerosis is currently considered an inflammatory process. The effect of vitamin D on the course of inflammatory processes in the body was clearly manifested during the pandemic caused by the new coronavirus infection COVID-19. There was a clear correlation between vitamin D levels and the severity of infection. In severe COVID-19, as a rule, either a deficiency or a lack of vitamin D in the body was determined. In addition, low vitamin D levels increase the risk of developing severe forms of coronary heart disease. The study involved 30 patients <n = 30>diagnosed with heart failure(I-III NYHA) In 12 < 40%> patients out of 30, vitamin D levels were below 20.0 ng/mL, consistent with this vitamin deficiency. In 14 < 46,67%>the level of vitamin D in the blood was between 20.0 ng/mL and 30.0 ng/mL and this corresponded about the lack of vitamin D. Only 4 < 13,33%> patients has level of vitamin D in reference values and this was due to the use vitamin D due to comorbid pathology: thyroid disease, autoimmune diseases or previously identified vitamin D hypovitaminosis. Vitamin D partially enters the body with food mainly found in animal productsliver, milk, eggs, butter, etc and is formed in the skin under the influence of ultraviolet rays. However, patients with CHF often have concomitant diseases:kidney disease, diabetes, disorders and others, forcing them to adhere to a strict diet poor in vitamin D. Also, due to CHF, these patients mainly lead a sedentary lifestyle, and, as a result, receive little ultraviolet rays. This explains the frequently detected deficiency and deficiency of vitamin D in patients with CHF, if, they do not receive drugs that compensate for its deficiency.
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Background and Aims Sarcopenia can be defined as loss of muscle mass, strength and function and has been shown to be associated with increased morbidity and mortality in the adult population. Sarcopenia has been assessed by decreased psoas muscle surface area (PMSA) on Computer tomography (CT) and has been validated in paediatric studies. The impact of Sarcopenia in children with end stage liver disease and oncological conditions is now being recognised. There is scarce literature on the effect of sarcopenia on motor function. CT imaging exposes children to radiation and hence is done in a select group of children at the time of transplant assessment. The aim of this audit was to assess the prevalence of Sarcopenia in children undergoing liver transplant assessment and its relationship on laboratory variables, functional activity and clinical outcomes. Methods Retrospective single centre case review of patients with liver disease undergoing transplant assessment and CT imaging between 2018-2020. Psoas muscle was analysed at the level of L4/L5. The z-Scores were calculated using ageand gender-specific reference values. Sarcopenia was defined as tPMA z score less than -2. We assessed the relationship of Sarcopenia to the biochemical parameters, nutritional status, effect on motor delay/physical abilities (assessed by a range of age appropriate standardised developmental and physical assessments due to COVID pandemic isolation restrictions) and post-transplant complications. Results Thirty one children that met the inclusion criteria were included. Sarcopenia was prevalent in 17 children (6 males: 11 females), with a median age of 3.5 years (SD = 4.9). The common conditions were biliary atresia (n= 11, 35%), hepatoblastoma (n=6, 19%), Autoimmune hepatitis (n=3) etc. Twenty- four patients required additional nutritional support (77% nasogastric feeding, 13% PN and 6% oral supplementation). Mean tPMA z-score was -2.27. Data for the assessment of physical abilities/functional activity was available in 21 children. Impairment of motor skills/physical abilities was overall noted in 14/21 children (67%);9/13 (69%) in the sarcopenic group (6 significant impairment) vs 5/8 (63%) in non sarcopenic group (4 significant impairment). Sarcopenia was associated with increased complications (27 vs 7, p = 0.005) and hypoalbuminaemia (p=0.01), but was not statistically significant (p> 0.05) for the overall length of stay (total and intensive care). Discussion Sarcopenia was commonly identified in children with liver diseases undergoing transplant assessment. Reduction in physical abilities/functional activity was observed in both groups which may be a consequence of loss of muscle mass in children secondary to liver diseases or underlying oncological conditions leading to delay in gross motor skills. Although there was no statistical difference in the duration of stay or impairment of motor skills, complications were higher in the sarcopenic group. Conclusion In this pilot study, sarcopenia is prevalent in children being assessed for liver transplantation and was associated with increased complications. Better non-invasive methods (aside from CT scan) of assessing sarcopenia needs to be developed and validated for the paediatric age group, which would help to better characterise the true incidence and prevalence of sarcopenia in children with chronic liver disease. There is a need to offer nutritional support and assess physical function early in the pre transplant period in order to initiate appropriate physiotherapy interventions to halt and even reverse the progression of sarcopenia.
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In the context of the COVID-19 pandemic, scientific interest is growing in studying the impact of the proposed vaccination on women's reproductive health. As is known, alterations in the state of the immune system and activation of an autoimmune response can lead to reproductive failure in women and potential complications of subsequent pregnancy. Objective(s): to evaluate the effect of the "Gam-COVID-Vac" on the immune status parameters, the relationship of their changes and the specific immune response to vaccination with the dynamics of the level of autoantibodies in women of reproductive age. The prospective study included 120 women who were vaccinated against COVID-19 with the "Gam-COVID-Vac". The criteria for inclusion in the study were: the age from 18 to 49 years, the absence of COVID-19 in the anamnesis, a negative result of a study on SARS-CoV-2 by PCR and negative results of tests for antibodies of classes G and M to SARS-CoV-2 before vaccination, the absence of pregnancy and serious somatic diseases. The patients were examined twice: immediately before vaccination and 90-100 days after the introduction of the 1st component of the vaccine. The level of IgG antibodies to SARS-CoV-2 after vaccination was assessed using ELISA. Before and after vaccination, the levels of antiphospholipid, anti-nuclear, organ-specific and antihormonal autoantibodies were determined, peripheral blood lymphocytes were immunophenotyped to determine the main subpopulations (CD3, CD4, CD8, CD19, CD5, CD16, CD56), as well as the expression of activation markers of lymphocytes (HLA-DR, CD25, CD147) using monoclonal antibodies. The effectiveness and safety of the combined vector vaccine against COVID-19 were high. Specific IgG antibodies to SARS-CoV-2 were produced in 98.3% of vaccinated women, no serious adverse reactions were observed. After vaccination, there was an increase in the level of some autoantibodies within the reference ranges, only IgM antibodies to phosphatidylethanolamine (PE) and IgG antibodies to DNA increased above the reference values. However, this increase was transient. After vaccination, the following changes in the parameters of the immunogram were observed: an increase in the content of cells with CD3+CD25+, CD19+ phenotype in peripheral blood and a decrease in the content of cells with CD56+CD16+ phenotype within the reference ranges, a decrease in CD147+/CD3+. Weak correlations were noted between these changes in immunogram parameters and the levels of some autoantibodies. The specific antiviral immune response to vaccination did not correlate with the autoimmune response. Vaccination with "Gam-COVID-Vac" is effective and safe and does not lead to disorders in the immune system. The observed increase in the level of autoantibodies to PE and DNA is transient. Changes in the parameters of the immune status within the reference ranges may be due to vaccination and the development of a specific antiviral immune response. Copyright © 2022, SPb RAACI.
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Background and Aim: An infection with SARS-CoV-2 is associated with systemic inflammation, that also affects the endothelium. This may result in endothelitis, which can influence vascular regulation and morphology. Until now, the specific mechanism of vessel damage after a SARS-CoV-2 infection is still unclear, especially in children and adolescents. The LICO Study (Long term impact of COVID-19) aims to investigate the long-term effects of a SARS-CoV-2 infection on vascular structure and function in chil-dren and adolescents. Method(s): Children and adolescents with confirmed evidence of survived SARS-CoV-2 infection are screened 6 +/- 3 months post-infection. Vascular function is assessed by flow-mediated vas-odilation (FMD) and aortic pulse wave velocity (PWV). Carotid intima-media thickness (cIMT) and retinal diagnostics (arteriove-nous ratio-AVR) are used to examine vascular structure. The matched control group without prior SARS-CoV-2 infection undergoes the same examination procedure. Result(s): So far, we have been able to evaluate 24 (9 post-covid) subjects (13.5 +/- 1.9 years;9 girls). Compared to the mean refer-ence values of the control group, 5 post-covid subjects have higher cIMT (0.49 +/- 0.01 mm vs. reference value 0.46 +/- 0.03 mm). Of these, 3 post-covid subjects even deviate from the norm PWV (4.96 +/- 0.16 m/sec vs. reference value 4.63 +/- 0.29 m/sec). The same 3 post-covid subjects are also below the norm FMD (2.06 +/- 1.05 % vs. reference value 4.18 +/- 7.04 %). None of the post-covid subjects deviates from the norm AVR values (refer-ence value 0.85 +/- 0.07). Conclusion(s): It is shown that infection with SARS-CoV-2 has the potential to impair vascular regulation. These initial results provide trends for early vascular changes among children and adolescents after recovered SARS-CoV-2 infection. Due to that this is an ongoing study, the results are constantly being expanded and may still change. To determine lasting changes in morphology, the examination is repeated after 6 months and the further results of this longitudinal study must be awaited.
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Coronavirus disease 2019 (COVID-19) in patients with underlying diseases, is associated with high infection and mortality rates, which may result in acute respiratory distress syndrome and death. Mucopolysaccharidosis (MPS) type II is a progressive metabolic disorder that stems from cellular accumulation of the glycosaminoglycans, heparan, and dermatan sulfate. Upper and lower airway obstruction and restrictive pulmonary diseases are common complaints of patients with MPS, and respiratory infections of bacterial or viral origin could result in fatal outcomes. We report a case of COVID-19 in a 16-year-old adolescent with MPS type II, who had been treated with idursulfase since 5 years of age. Prior to infection, the patient’s clinical history included developmental delays, abdominal distension, snoring, and facial dysmorphism. His primary complaints at the time of admission included rhinorrhea, cough, and sputum without fever or increased oxygen demand. His heart rate, respiratory rate, and oxygen saturation were within the normal biological reference intervals, and chest radiography revealed no signs of pneumonia. Consequently, supportive therapy and quarantine were recommended. The patient experienced an uneventful course of COVID-19 despite underlying MPS type II, which may be the result of an unfavorable host cell environment and changes in expression patterns of proteins involved in interactions with viral proteins. Moreover, elevated serum heparan sulfate in patients with MPS may compete with cell surface heparan sulfate, which is essential for successful interaction between the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike protein and the host cell surface, thereby protecting against intracellular penetration by SARS-CoV-2.
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Introduction: The lack of a history of the course of a new coronavirus infection and the lack of data from randomised trials makes it difficult to choose the right treatment tactics and prescribe adequate prophylaxis in patients who have suffered from COVID-19. Comorbid patients with cardiovascular diseases and endothelial dysfunction have a high risk of a severe course of COVID-19 and subsequent thrombotic complications, which manifest clinically as cardiomyopathy;venous thrombo-embolism (deep vein thrombosis and pulmonary embolism);pulmonary thrombosis in situ;stroke;arterial thrombangiitis;rarely, arterial peripheral thrombosis and microvascular thrombosis, in the lungs, liver, kidneys, brain, etc.;and mild disseminated intravascular coagulation syndrome. The role of endothelial dysfunction in the development of severe complications is underestimated. In the pathogenesis of COVID-19, the defeat of the microcirculatory bed plays a crucial role. The SARS-CoV-2 virus causes associated endotheliitis damage to the endothelium due to virus entry and cytokine storm. Endotheliitis leads to the release of tissue factor, which leads to the formation of an excess of thrombin and fibrin;the body tries to cover the virus with these and prevent its spread, which entails negative side effect such as thrombosis Methods: Sixty-six patients who had COVID-19 were examined (42 women and 24 men;mean age 48 years [range 20 – 80 years]). Patients complained of a feeling of paraesthesia, mainly in the lower extremities, a feeling of heaviness, stiffness in the popliteal region, an increased vascular pattern on the entire surface of the skin, a burning sensation in all vessels, and a feeling of weakness. Ultrasound colour duplex scanning showed no signs of thrombosis in the large vessels. Using a high frequency ultrasound Doppler and a 25 MHz sensor, the nailbed of the first finger of the upper limb was examined. The microcirculatory images were analysed by the shape and spectrum of the curves. Twenty patients received prophylaxis with rivaroxaban 10 mg daily (group 1) and 46 patients did not (group 2). The control examination was carried out four weeks after the start of therapy: sulodexide one capsule twice daily. The coagulogram parameters were also studied. Results: A depletion in spectral characteristics was seen in patients after COVID-19 disease, in comparison to microcirculatory images recorded in healthy individuals. Predominantly, the red part of the spectrum was recorded in patients after COVID-19, the lighter part of the spectrum was not recorded. Group 1 patients had higher amplitude parameters than group 2, but they also registered a depletion in spectral characteristics. Soluble fibrin monomer complexes were increased 4 – 5 times, D-dimer 2 – 2.5 times, and antithrombin III 1.5 times. The international normalised ratio, activated partial thromboplastin time, fibrinogen, prothrombin according to Quick, prothrombin time, clotting time, and bleeding time were within the reference intervals both before and after treatment. Upon repeat examination four weeks after the course of sulodexide therapy, the spectral characteristics were normalised, and the coagulogram parameters were also normalised. Conclusion: The red part of the spectrum, according to the Doppler criteria, corresponds to the fastest particles moving in the middle of the stream. The lighter part of the spectrum corresponds to particles moving more slowly. The reduction in spectral characteristics in patients after COVID-19 disease corresponds to parietal stasis and readiness for thrombosis, which was confirmed by the coagulogram data. Examination of the nailbed using high frequency ultrasound Doppler in patients who have COVID-19 allows the identification of stasis of the parietal blood flow, which corresponds to a prethrombotic state. The prescription of sulodexide allows for an improvement in the condition of patients and normalisation of microcirculation indicators
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The article describes a COVID-19 patient with several biomarkers of systemic cytokine storm (including multiple excess over the reference values of C-reactive protein, ferritin and D-dimer) and increased level of autoantibodies (aPL and anti-CCP). At the same time contrast-enhanced CT and US failed to detect pulmonary embolism or lower limb deep vein thrombosis. Three months after discharge from the hospital, a high level of antiphospholipid antibodies and D-dimer remained. The relationship between infection with SARS-CoV-2 and autoimmunity has been discussed.
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Background and Aims: Long COVID is a syndrome affecting patients infected with SARSCoV- 2 who show a broad spectrum of symptoms, such as fatigue and dyspnoea, persisting for several months after the initial infection. Patients with type 2 diabetes (T2D) have frequent co-morbidities affecting multiple organs. Both long COVID and T2D are multi-system conditions associated with abnormalities in organ structure and function. Therefore, multi-organ assessment is critical for monitoring organ health and early detection of co-morbidities in both conditions. This study aimed to define the prevalence of multi-organ abnormalities in patients with long COVID and patients with T2D with a rapid, non-contrast, magnetic resonance imaging (MRI) scan. Methods: Overall, 135 long COVID patients without diabetes were recruited in the COVERSCAN study (NCT04369807) at a median of 183 days since first COVID-19 symptoms. 135 patients with established T2D were recruited in the MODIFY study (NCT04114682). MRI data were acquired to derive abdominal organ-specific measures of size, fat deposition and fibroinflammation (CoverScan®, Perspectum Ltd.). Reference values of MRI metrics were based on 92 healthy volunteers and published literature. The prevalence of abnormalities for each measure was assessed using Fisher's exact tests in the whole cohort and in a subset of patients with obesity (BMI≥30 kg/m2). Results: The demographics of the three cohorts were as follows: long COVID: median age 54 yrs [interquartile interval 46–60], 56% male, BMI 27 kg/m2 [26–31];T2D: 62 yrs [54–70], 59% male, BMI 32 kg/m2 [28–35], median T2D duration 11 yrs;healthy volunteers: 44 yrs [32–53], 66% male, BMI 23 kg/m2 [21–25]). There was a high prevalence of abdominal organ abnormality in both long COVID and T2D patient groups (Figure, left), including increased fat deposition (steatosis) in the liver, pancreas, and kidney (Figure, right). 35% of patients with T2D had clustering of abnormalities involving at least 2 organs, compared to 23% in long COVID. Abnormalities affecting the liver (steatosis, fibroinflammation and hepatomegaly) and renomegaly were more common in T2D than in long COVID (p<0.001). Considering only patients with obesity, liver fibroinflammation, hepatomegaly, and renomegaly remained significantly more prevalent in T2D than in long COVID (p<0.05). Conclusion: Long COVID and established T2D have distinct profiles of multi-organ impairment, more prevalent with obesity but not fully explained by it. Multi-organ MRI assessment can enrich the current blunt assessment of multi-system/multi-organ abnormalities in diverse disease states to inform earlier intervention and treatments. (Figure Presented) Left: Prevalence (%) of organ abnormalities in long COVID patients (black numbers) and T2D patients (grey numbers) (liver, pink;pancreas, yellow;kidney, green;spleen, blue). Right: Prevalence of organ steatosis, fibroinflammation and increased organ size by patient group. Colour per organ as in left figure.
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OBJECTIVE: To evaluate the effect of COVID-19 in sperm cryopreservation processes, including functional parameters evaluated pre-cryopreservation and post-thaw, and to compare post-thaw results from COVID-19 patients to samples from others systemic and andrological Disease MATERIALS AND METHODS: In this cross-sectional study, 37 semen samples of male patients aged 18 to 45 years at Division of Urology, Department of Surgery, Hospital das Clinicas of the University of Sao Paulo or at Androscience- Science and Innovation Center in Andrology, High-Complex Clinical and Research Andrology Laboratory, were initially recruited from April 2020 to April 2021. Patients were categorized as acute COVID-19 (n=15), confirmed by RT-PCR (COVID-19 group), and healthy individuals with normozoospermic semen samples (n=22;Control group). Were evaluated seminal parameters, cryosurvival rates (%), mitochondrial activity (%;3,30 -diaminobenzidine stain), reactive oxygen species levels (ROS;chemiluminescent technique) and DNA fragmentation (%;SCSA method) in precryopreservation and post-thaw samples. Samples were cryopreserved by the slow freezing technique. A complementary retrospective study was performed comparing post-thawed samples from COVID-19 group with data from patients with others male diseases: Male infertility (n=35);Severe infertility (n=62), caused severe oligozoospermia, grade 3 varicocele, gonadal dysgenesis, testicular nodule, testicular hypotrophy;testicular cancer (n=55);and other malignant diseases (leukemia, lymphoma, sarcoma, multiple myeloma;n=30). Was used T-test to statistical analysis (p<0.05). RESULTS: Macroscopy analysis of COVID-group revealed abnormal viscosity in 53.33%, semen volume = 4.50 ± 1.72 ml and pH = 8.13 ± 0.23. COVID-19 fresh samples demonstrated mean of progressive motility = 29.07±16.83%, sperm morphology = 2.07±1.58%, and DNA fragmentation index = 42.91±33.38%. Cryopreservation decreased progressive motility (to 5.39±7.92%;p=0.02), sperm vitality (70.46±8.50 vs. 72.20±23.27;p=0.042) and ROS (0.516±0.978 vs. 4.393±9.956 x 104 cpm;p=0.018). When we compared with cryopreserved normozoospermic samples, there was observed a significant difference in HDS (p=0.002). Cryosurvival rate from COVID-19 samples was 19.93;19.71%, and had significant difference when compared with severe infertility (40.16;31.05%;p=0.003), and other malignant diseases (53.14;28.55%, <0.001). CONCLUSIONS: Seminal samples from patients with COVID-19 showed reduced fertile potential, especially when compared to the reference values. In the comparisons performed with samples from patients with different andrological diagnoses, common in the specialized andrology laboratory routine, we can suggest that samples from patients with the acute form of COVID-19 had the worst quality, with low cryosurvival rates. This information contribute to the conduct of these patients during assisted reproduction routines and preservation of male fertility. IMPACT STATEMENT: It will contribute to conducts in the cryopreservation of sperm in patients with acute COVID-19.
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Background: Coronavirus disease 2019 (COVID-19) became pandemic in 2020 and recently, mutated coronaviruses have emerged in many countries. The aim of this study was to identify the clinical characteristics and risk factors for critical illness in hospitalized COVID-19 patients in Zhengzhou for clinical prevention and management. Materials and methods: A total of 70 patients hospitalized with COVID-19 were enrolled between 21 January and 29 February 2020, in Zhengzhou, China. Clinical characteristics, hematological findings, neutrophil lymphocyte ratio (NLR), platelet lymphocyte ratio (PLR), and inflammatory index on admission were obtained from medical records, COVID-19 patients with different outcomes were compared. Results: The median age was 55 years. Forty-three (61.0%) patients were classified as having severe or critical cases. Eighteen (25.7%) patients died in hospital and the remaining 52 were discharged. Patients who died tend to be old with expectoration and chronic obstructive pulmonary disease. Compared to survivor, non-survivor had significantly higher numbers of leucocytes and neutrophils, NLR, aspartate aminotransferase (AST), γ-glutamyl transpeptidase, total bilirubin, direct bilirubin, lactate dehydrogenase (LDH), prothrombin time, D-dimer, C-reactive protein, and decreased platelets, lymphocytes, uric acid, and albumin (ALB). Logistic regression analysis identified leucocytes, platelets, PLR, NLR, AST, and ALB as independent predictive factors for poor outcomes. The area under curve of the combination of leucocytes, PLR, NLR, and AST was 0.87, with a sensitivity of 0.83 and specificity of 0.81. Conclusion: Our results identified risk factors among COVID-19 patients for in-hospital mortality. Leucocytes, PLR, NLR, and AST could have important reference value for predicting prognosis, especially in low-resource countries.
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Aim: To evaluate the cardiovascular changes associated with covid-19 Methods: One hundred consecutive patients diagnosed with COVID-19 infection underwent complete echocardiographic evaluation within 24 hours of admission and were compared with reference values. Echocardiographic studies included left ventricular (LV) systolic and diastolic function and valve hemodynamics and right ventricular (RV) assessment, as well as lung ultrasound. A second examination was performed in case of clinical deterioration. Results: Clinical data were collected in 120 consecutive patients hospitalized with COVID-19 infection. A total of 20 patients were excluded because they did not undergo echocardiographic assessment. The reasons for not performing the echocardiogram were as follows: hospital discharge within 24 hours of admission (8 patients), patient refusal (2 patient), and death shortly after hospitalisation (8 patients, all >80 years of age and with a “do not resuscitate” status). Conclusions: patients presenting with clinical deterioration at follow-up, acute RV dysfunction, with or without deep vein thrombosis, is more common, but acute LV systolic dysfunction was noted in ≈20%.
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Objective: This paper screened the factors that may influence the spatial differentiation of Neutrophil-to-lymphocyte ratio (NLR) reference values in healthy adults in China and explored the trend of NLR reference values in China. Methods: For this research, we collected the NLR of 162 681 healthy adults from 62 cities in China. Spearman regression analysis was used to analyze the correlation between NLR and 25 geography secondary indexes. We extracted 9 indexes with significant correlation, built a random forest (RF) model, and predicted the country's urban healthy adults' NLR reference value. By using the disjunctive Kriging method, we obtained the geographical distribution of NLR reference value of healthy adults in China. Results: The reference value of NLR of healthy adults in China was significantly correlated with the 9 secondary indexes, namely, altitude, sunshine duration, annual average temperature, annual average relative humidity, annual temperature range, annual average wind speed, content of organic matter in topsoil, cation exchange capacity in topsoil (clay), and total amount of CaSO4 in soil. The geographical distribution of NLR values of healthy adults in China showed a trend of being higher in Southeast China and lower in Northwest China, higher in coastal areas and lower in inland areas. Conclusion: This study lays a foundation for further research on the mechanism of different influencing factors on the reference value of NLR index. A random forest model composed of significant influencing factors has been established to provide the basis for formulating reference criteria for the prognostic factors of the novel coronavirus using NLR reference values in different regions.
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BACKGROUND AND AIM: Zinc is a multifunctional trace element. Due to its positive effects on the immune system, the use of zinc supplements has become widespread during the COVID 19 pandemic Both zinc deficiency and excess intake can lead to significant health problems. In this study;we aimed to compare serum and intra-erythrocyte zinc levels to determine most appropriate matrice in requirement and follow-up of zinc replacement. METHODS: Simultaneously measured serum and intra-erythrocyte zinc levels obtained from 285 patients admitted to our laborotory between 2000-2021 were scanned retrospectively. Atomic absorption spectroscopy method had been used for measurements. Quantitative results of the two different matrices were analyzed by simple linear regression analysis. The agreement between the classifications obtained according to the reference interval was evaluated with kappa statistics. RESULTS: A very weak agreement was observed between intra-erythrocyte and serum zinc measurements according to classification agreement (Kappa statistic=0.000;p=0.994). 149 (59.6%) of 250 results in serum were normal, whereas low in intra-erythrocytes. 6 of results were low in intra-erythrocytes, whereas were high in serum and 2 of results were high in intra-erythrocytes whereas were low in serum samples. The relationship between the measurements of the two matrices was not significant in the linear regression analysis (B=0.011;r=0.106;p=0.073). CONCLUSIONS: These findings indicate that serum measurement may be insufficient to detect zinc deficiency. In the light of these findings, it was decided to study both matrices together in terms of functional target and to follow the clinical correlation in the follow-up of zinc replacement therapy in our laboratory.