Impact of age dominating over the pre-existing comorbidities influencing the D-Dimer levels in SARS-COV-2 infection

COVID-19-related disease severity is more commonly seen in elderly patients with comorbidities, and hypercoagulability has been demonstrated to be involved in the disease progression. This study aimed to evaluate the level of D-Dimer in hospitalized SARS-COV-2 infected patients and to determine the influence of age, gender, Body Mass Index (BMI), and comorbidities on Ddimer value and correlate it with disease severity. This case-control retrospective study retrieved patient data on demographic characteristics, vital functions, comorbidities, disease severity [National Institutes of Health (NIH) classification], and D-dimer from medical records of Thumbay University Hospital, Ajman, United Arab Emirates. SPSS-Version-28 was used for data analysis;a Chi-Square test was done to compare the distribution of comorbidities and disease severity between demographic categories. An independent sample t-test and one-way ANOVA were done to compare mean levels of D-Dimer between two or more categories, respectively. The majority of patients were males, >40 years of age, overweight/obese, with 30% having one comorbidity and 20% having ≥2 comorbidities. Among the total, three-quarters had moderate, and one-quarter had severe disease conditions, irrespective of gender or BMI, with an increasing trend of severe cases in the older age group and with comorbidities. Increased D-dimer levels were seen in the majority of SARS-COV-2-infected hospitalized patients, with age as the primary determinant, irrespective of absence or presence of comorbidity, though the trend of higher prevalence of elevated D-dimer value in the multiple comorbid groups and more severe condition was observed. Supporting SAR-COV-2 as a coagulopathic condition, D-dimer concentrations can be a helpful marker of disease progression and can be considered to guide the clinical treatment. [ FROM AUTHOR] Copyright of Journal of Applied & Natural Science is the property of Applied & Natural Science Foundation 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.)

COVID-19 Associated Illnesses From Alveoli to Glomeruli: A Case Report.

Hypoxemic respiratory failure is the most frequent complication of severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) infection. Coronavirus disease-19 (COVID-19) is no longer considered a standalone respiratory infection. It can involve other organs, including kidneys by direct invasion or indirectly through immune activation, cytokine storm, microthrombi and hemodynamic instability. Multiorgan involvement carries a worse prognosis in COVID-19. Tubulopathy is the most frequently reported renal pathology, followed by glomerulopathies. Among the glomerulopathies, immunoglobulin A (IgA) nephropathy is less often reported. Differentiating tubulopathy from glomerulopathy is important from the management and prognostic point of view. Laboratory investigations, including urine microscopy, cannot predict glomerulopathy as a cause of renal involvement. Therefore, it is important to proceed with renal biopsy early to make a definite diagnosis. We report a case of a 33-year-old male who presented three weeks after recovery from COVID-19 with proteinuric acute kidney injury. Subsequent renal biopsy revealed IgA nephropathy.

Placental Ultrasonographic Findings Due to COVID-19 Infection During Pregnancy: A Case Report.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during pregnancy can lead to several adverse events. Here, we report a case of a 40-year-old Caucasian female, gravida 1, para 0, with a spontaneous singleton pregnancy, who presented to the emergency room during her 17th week of gestation with fever (38.8ºC), fatigue, shortness of breath, and palpitations. She tested positive for coronavirus disease 2019 (COVID-19). Ultrasonography examination revealed signs of placental involvement compatible with malperfusion, chorangiosis, deciduitis, and subchorionitis. Findings remained stable until the 20th week and gradually resolved around the 32nd week of pregnancy. A normal male neonate was delivered via elective caesarian section during the 39th week, weighing 2830 gm. The present report points toward a correlation between clinical symptomatology of COVID-19 during pregnancy and ultrasonographical features. Early detection of placental damage through the use of specific ultrasound findings could indicate which pregnancies are at increased risk for complications; however, further studies including a larger population are required to confirm these findings.

Two Adults With Multisystem Inflammatory Syndrome Post-COVID-19 in a Lebanese Hospital: A Case Report.

COVID-19 is a respiratory illness with multiple extra-pulmonary complications. The multisystem inflammatory syndrome (MIS) is one of its complications that usually affects children and is known as MIS-C, but several cases have been reported in adults, symbolized by MIS-A. Thus, the Centers for Disease Control and Prevention (CDC) developed a working case definition of MIS-A, which includes several criteria. Here we report two cases of adult male patients with clinical and laboratory symptoms consistent with MIS-A. Case one patient presented at a late stage after two weeks post the onset of symptoms. His health deteriorated rapidly, and eventually, he passed away. However, the second patient presented a few days after the symptoms' onset and took a course of steroids. He was discharged home.

Can Mediastinal Lymphadenopathy Signal Pericarditis, Pericardial Effusion, and Severe Disease in a COVID-19 Patient?

Severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) has created a global pandemic. As we try to understand the virus, we are learning that it can affect many organ systems. Most commonly coronavirus disease 2019 (COVID-19) virus affects the respiratory tract and the lungs impairing oxygen transport to the systemic circulation. Its effect on the cardiovascular system can be equally as devastating. Patients can develop pericarditis, myocarditis, and pericardial effusion that can at times lead to tamponade. Here we present an unusual case of a patient with COVID-19 pneumonia who presented with pericardial effusion along with enlarged mediastinal lymph nodes.

Cardiac Arrest and Hypoxic-Ischemic Encephalopathy Following an Emergency Caesarean Section in a COVID-19 Patient.

While young, healthy individuals without underlying medical conditions have generally not suffered catastrophic health consequences from the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), gravid patients appear to be at much higher risk of complications from this virus. A 29-year-old G3P2 patient at 30 weeks and three days presented with worsening dyspnea and chest pain after testing positive for coronavirus disease 2019 (COVID-19) infection two days prior. Notably, she had not received COVID-19 vaccination. A non-reassuring fetal tracing and fetal bradycardia were discovered on routine prenatal monitoring during admission, and an urgent caesarean section was performed. She subsequently required supplemental oxygen due to respiratory distress and remained hospitalized. She clinically deteriorated from a respiratory standpoint. Several days later, she experienced cardiac arrest with a return of spontaneous circulation (ROSC) in nine minutes. While the baby was discharged home and is doing well, the patient, unfortunately, expired from hypoxic encephalopathy secondary to COVID-19 pneumonia and complications of cardiorespiratory arrest. This case highlights the severe sequelae of COVID-19 infection in a postpartum patient, including ventilator-dependent respiratory failure, sudden cardiac death, hypoxic encephalopathy, and coma.

A Case of Intracardiac Thrombus in a Recovery Coronavirus Disease 2019 (COVID-19) Patient.

Coronavirus disease 2019 (COVID-19) was thought to mainly affect the respiratory system. However, studies have shown that it can be associated with hypercoagulability leading to thromboembolism. Although venous thromboembolism is a common complication associated with COVID-19, arterial thrombosis and intracardiac thrombosis are not frequently described. We herein report a case of a 54-year-old male with a past medical history of end-stage renal disease, diabetes mellitus, hypertension, heart failure, chronic obstructive pulmonary disease who presented to the emergency department with shortness of breath and was found to have intracardiac thrombus in post-recovery COVID-19 state.

Evaluating the Clinical Outcomes of Remdesivir Among Patients Admitted With COVID-19 in a Tertiary Care Hospital.

INTRODUCTION: This study was conducted to determine whether remdesivir administration for treatment of coronavirus disease 2019 (COVID-19) is associated with reducing deaths among COVID-19 hospitalized patients. METHODOLOGY: It was a retrospective study, and the data was acquired at Ziauddin Hospital in Karachi, Pakistan. All patients admitted between February and May 2021 with severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) infection confirmed by polymerase chain reaction testing from nasopharyngeal samples were included in the study, including those who received at least five-day treatment of remdesivir and who did not receive even a single dose of remdesivir. RESULTS: Data of overall 174 patients were used, out of which 71 (40.80%) received remdesivir. After propensity score matching, 71 patients in the remdesivir group were successfully matched with the non-remdesivir patients on the basis of age, gender, and disease severity. Results of multivariable logistic regression showed that there is no significant difference in deaths between patients who received remdesivir and patients who did not receive remdesivir (p-value=0.122). However, the length of hospital stay was significantly lower in the remdesivir group than in the control group (p-value=0.001). CONCLUSION: Results of this study can provide evidence that remdesivir can be efficient in reducing the duration of COVID-19 illness, and a five-day course of treatment is sufficient for patients to get clinical benefits.

Cardiovascular Risk Factors and the Severity of COVID-19 Disease.

Background and objective Several cardiovascular risk factors have emerged as important determinants of severe illness and death among coronavirus disease 2019 (COVID-19) patients. However, the full impact of these cardiovascular risk factors is still under investigation. This study aimed to investigate the association between patients' level of cardiovascular risk and the severity of COVID-19. Materials and methods This observational study included all adult patients with COVID-19 hospitalized at Sheikh Khalifa Ibn Zaid International University Hospital from March 20 to May 10, 2020. The cardiovascular risk level was assessed by the doctor responsible for each patient based on the 2019 European Society of Cardiology (ESC), the European Atherosclerosis Society (EAS), and the European Association for the Study of Diabetes (EASD) guidelines. We examined the association between the patients' level of cardiovascular risk and their severity of COVID-19 disease by using a logistic regression model. Results Among 133 patients with confirmed COVID-19, 46.6% had a low cardiovascular risk level, 19.5% had a moderate risk level, 15.8% had a high risk level, and 18.1% was found to have a very high risk level. Patients with different cardiovascular risk levels had significantly different rates of complications including secondary infection (p-value: <0.001), acute respiratory distress syndrome (ARDS) (p-value = 0.017), intensive care unit (ICU) admission (p-value: <0.001), and death (p-value: <0.001). A patient's very high cardiovascular risk level versus low, moderate, or high cardiovascular risk level was independently associated with ICU admission [OR = 6.42, 95% CI: (1.45-28.30)]. Conclusion Based on our findings, an increased level of cardiovascular risk among patients was strongly associated with the severity of COVID-19. This study also highlights the need for assessing cardiovascular risk factors in all patients with COVID-19.

ST-Elevation Myocardial Infarction in a 23-Year-Old Female: The Mystery of Thrombus Formation.

Acute ST-elevation myocardial infarction (STEMI) is rarely seen in young adults, however, when encountered, the underlying cause is either a genetic condition leading to early-onset coronary artery disease (CAD), an acquired pro-thrombotic condition, or an idiopathic condition like spontaneous coronary artery dissection (SCAD). Our case describes a healthy 23-year-old female who presented with sudden onset severe angina and was found to have a laminated thrombus in the left anterior descending coronary artery (LAD), with no evidence of intraluminal dissection or plaque rupture. Although the underlying etiology of thrombus formation remains unknown, coronavirus disease 2019 (COVID-19) related thrombotic event is the prime suspect. In addition, another culprit that cannot be excluded is phentermine-induced coronary vasospasm, a commercially available medication for weight loss. This report addresses current literature on acute coronary syndromes in young adults and reviews the potential etiologies for coronary artery thrombosis, which led to a near-fatal acute coronary syndrome in our patient.

COVID-19 and Diabetic Ketoacidosis: Report of Eight Cases.

Aim To describe the clinical characteristics and outcome of hospitalized COVID-19 patients with diabetic ketoacidosis (DKA). Methods We report eight cases of diabetic ketoacidosis in COVID-19 who presented to our institution in New Jersey, USA. COVID-19 was diagnosed by nasopharyngeal swab reverse transcription polymerase chain reaction (RT-PCR). The patients' electronic medical records were reviewed. Data on patients' age, sex, ethnicity, laboratory values, glycosylated hemoglobin level, oral antihyperglycemic agents (OHAs), insulin, and clinical outcomes were collected. Results The median age of the patient was 42.5 years, and seven were males and one was female. Out of eight patients, five had type 2 diabetes mellitus (DM), two had undiagnosed DM, and one had type 1 DM. Median value of initial glucose on presentation was 454 mg/dL. Median value of HbA1c on presentation was 11.4% and of anion gap was 26.5 mEq/L. Four patients had large ketonemia, one patient had moderate ketonemia, and three patients had small ketonemia. All the patients were started on standard treatment protocol for DKA with intravenous fluids and IV insulin infusion. Acute kidney injury (AKI) was seen in four patients, and one patient required renal replacement therapy. Out of eight patients, three required mechanical ventilation, and the same three patients died. Conclusion Our case series shows that COVID-19 infection can precipitate DKA in patients with known diabetes mellitus patients or as a first manifestation in undiagnosed DM patients; COVID-19 with DKA is associated with substantial mortality. Further studies are needed to characterize poor risk factors associated with mortality in these patients.