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Introduction There is currently a lack of evidence on clinical nutrition in Covid-19. Aim of the work: Systematic overview of clinical nutrition in Covid-19. Material and methods A systematic literature search: 2 meta-analyses, 12 systematic reviews and meta-analyses, 9 prospective randomized controlled trials, 3 prospective observational studies, 7 retrospective studies, 25 narrative reviews. Results a) Obese patients have an increased risk of a severe course of the disease, b) there is a connection between obesity and an increased risk of death, c) Covid-19 mortality increases from a BMI>27 kg/m2, in all BMI classes 1,6% per 1 kg/m2 in the event of weight gain, in the case of severe obesity (> 40-45 BMI) by a factor of 1,5 to 2 and per 5 kg/m2, d) the risk of a severe course of Covid-19 increases also with increased visceral fat tissue percentage, total body fat mass and upper abdominal circumference, e) the mortality rate can be 10 times higher in malnourished Covid-19 patients, f) serum albumin provides evidence of a poor course of the disease, g) enteral omega-3 fatty acid intake could stabilize kidney function and improve the outcome, h) foods with a low glycemic index should be preferred, i) vitamin D deficiency should be avoided, daily vitamin D and zinc supplementation can be beneficial, j) one-time high dose vitamin D and enteral vitamin C provide no benefit, but the risk of thrombosis could be reduced and the antibody response enhanced with zinc, k) nutritional intervention reduces mortality. Conclusion Screening and assessment of nutritional status are important in Covid-19 patients. Overall, there are insufficient clinical results on specific nutritional therapy.Copyright © 2022 Georg Thieme Verlag. All rights reserved.
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Feline Infectious Peritonitis (FIP) is highly mortality disease in cats. The reliable and fast diagnosis is crucial to the best prognosis. The aim of this study to evaluate the hemogram profile in cats infected with effusive FIP. Twenty cats had been diagnosed effusive FIP at Animal Clinic Department of Internal Medicine, Faculty Veterinary Medicine, Universitas Gadjah Mada were used in the study. The diagnosis were based on clinical examination, ultrasound, x-ray, rivalta test, and rapid test. The hemogram profile were analyzed include routine hematology and serum biochemistry. Hemogram profile in effusive FIP showed the decreased hematocrit, hyperproteinemia, and leukocytosis with an average 22.9+or-7.4%;9.0+or-2.2 g/dL;22425+or-4116 cells/mm3 respectively. Erythrocyte, hemoglobin and fibrinogen levels were still in the normal range. The results of differential leukocytes revealed that 90% cats had neutrophilia and 75% lymphopenia with an average 20066+or-3337 cells/mm3 and 1861+or-1818 cells/mm3 respectively. The blood chemistry profile showed 60% of cats experienced increase in SGPT and SGOT with an average 138.4+or-72.3 IU/L and 101+or-60.5 IU/L respectively. Hyperglobulinemia was found in 90% samples with an average 6.7+or-0.8 g/dL. All cats have a low albumin:globulin ratio with an average 0.3+or-0.1. The hemogram profile of effusive FIP were: leukocytosis, neutrophilia, lymphopenia, hyperglobulinemia, and decreased albumin-globulin ratio..
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Background: COVID-19 (Corona Virus Disease-2019) pandemic has a high mortality rate especially in Medan, Indonesia. Serum albumin and liver function tests are believed to be predictive biomarkers for prognosis in patients with infectious diseases, including COVID-19. This study aimed to investigate the association between the mortality events and severely ill COVID-19 patients' serum albumin and liver enzymes. Method: This is a cross-sectional study using secondary data from the medical records of H. Adam Malik Hospital patients with COVID-19 who were confirmed by RT-PCR from August to December 2020. All patients were analyzed for age, sex, hypoalbuminemia, increased liver enzymes and outcome using Chi-square tests (P <0.05). Results: The average age of severe COVID-19 patients at H. Adam Malik Hospital ranged from 41 to 60 years, with more women prevalence than men. Most of the patients had hypoalbuminemia (84.2%), an increase in AST (59.4)% and ALT (45.5%). There was no significant association between hypoalbuminemia and the disease outcome (P =0.12). There was a significant association between elevated liver enzymes and mortality in severely ill COVID-19 patients (P <0.001). Conclusion: We found that hypoalbuminemia is common in patients with severe COVID-19. However, we found that albumin levels had no association with the patients' mortality rate. Liver enzymes levels appear to be a predictive biomarker for outcomes in COVID-19 patients of H. Adam Malik Hospital. We found that higher ALT and AST levels were associated with significantly higher mortality.
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Background: It is unknown whether individuals with neurological post-acute sequelae of COVID-19 (NeuroPASC) display altered levels of neuroimmune activity or neuronal injury. Method(s): Participants with new or worsened neurologic symptoms at least 3 months after laboratory-confirmed COVID-19 were enrolled in The COVID Mind Study at Yale. Never COVID controls (no history of COVID-19;nucleocapsid (N) antibody negative) were pre-pandemic or prospectively enrolled volunteers. CSF and plasma were assessed for neopterin and for IL-1beta, IL-1RA, IL-2, IL-4, IL-5, IL-6, IL-8, IL-10, IL-12p40, IL-12p70, IL-13, MCP-1, TNFalpha by bead-based multiplex assay;and for anti-SARS-CoV-2 N antibodies by Luminex-based multiplex assay in technical replicate, normalized against bovine serum albumin conjugated beads. Plasma concentrations of D-dimer, C-reactive protein, neurofilament light chain (NFL), and glial fibrillary acid protein (GFAP) were measured using high-sensitivity immunoassays. Group comparisons used non-parametric tests. Result(s): NeuroPASC participants (n=38) were studied 329 (median) days (range 81-742) after first positive test for acute COVID-19. Cognitive impairment (84%) and fatigue (82%) were the most frequent post-COVID symptoms. NeuroPASC and controls (n=22) were median 49 vs 52 yrs old (p=0.9), 74% vs 32% female (p< 0.001), 76% vs 23% white race (p< 0.001), and 6% vs 57% smokers (p< 0.001). CSF white blood cells/mL, CSF protein, and serum:CSF albumin ratio were normal in both groups. CSF TNFalpha (0.66 vs 0.55 pg/ul) and plasma IL12p40 were higher (103.3 vs 42.7);and MCP-1 (503 vs 697 pg/ul) and IL-6 (1.32 vs 1.84 pg/ul;p < 0.05 for IL-6) were lower in NeuroPASC vs controls (p< 0.05);but none of these differences were significant after adjusting for multiple comparisons. Plasma GFAP was elevated in NeuroPASC vs controls (54.4 vs 42.3 pg/ml;adjusted p< 0.03). There were no differences in the other biomarkers tested. 10/31 and 7/31 NeuroPASC had anti-N antibodies in CSF and plasma, respectively. Conclusion(s): When comparing NeuroPASC to never COVID controls, we found no evidence of neuroinflammation (normal CSF cell count, inflammatory cytokines) or blood-brain barrier dysfunction (normal albumin ratio), and no support for ongoing neuronal damage (normal plasma NFL). Future studies should include better gender and race matched controls and should explore the significance of a persistent CNS humoral immune response to SARS-CoV-2 and elevated plasma GFAP after COVID-19. (Figure Presented).
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Background Coronavirus disease 2019 (COVID-19), a global pandemic that has spread worldwide in a dramatic manner since its first emergence in December 2019 from Wuhan, China. To date, there is still lack of an appropriate protocol that predicts cases who are impending to develop severe COVID-19. Hence, this work was an attempt to determine the potential association of the clinical, laboratory, and radiological parameters with the severity of COVID-19 and the ability of these parameters to predict the severe cases. Patients and methods This is a retrospective study that was based on recruiting the data from the files of patients who attended the chest outpatient clinic, or admitted to the chest department or the ICU of our institution. The study included adult patients who were diagnosed with COVID-19. Patients were categorized into two groups: severe/critical cases and mild/moderate disease cases. Data concerning the patient history, clinical picture, and radiological data were obtained and analyzed. Results Eighty adult patients with COVID-19 were included in this study. They were classified into severe/critical (40 patients) or mild/moderate disease (40 patients). Patients with severe/critical COVID-19 disease were significantly older in age and had higher comorbidities, prevalence, higher incidence of cough, dyspnea, gastrointestinal tract symptoms and fatigue, elevated total leukocyte count, lower relative lymphocytes, lower absolute lymphocytes and higher neutrophils, higher blood glucose levels, higher alanine transaminase, higher aspartate aminotransferase and lower serum albumin, reduced Ca levels, elevated lactate dehydrogenase, serum ferritin, D-dimer, and C-reactive protein levels. They had significantly higher computed tomographic (CT) scores and CT chest with greater than 50% lesions or progressive lesions. The mortality rate was 10%, all of which were from the severe disease group. Conclusion The current study is confirming an overall substantial association between severe COVID-19 and older age, chronic diseases, CT imaging pattern, and severity score, leukocyte count, lymphopenia, blood glucose, serum albumin, alanine transaminase, aspartate aminotransferase, calcium levels, C-reactive protein, D-dimer, lactate dehydrogenase, and ferritin. These results highlighted the importance of using clinical, laboratory, and radiological features for monitoring of COVID-19 patients.Copyright © 2023 The Egyptian Journal of Chest Diseases and Tuberculosis.
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As human beings, we communicate with each other just like other creatures. In the same way we need to communicate, COV-ID-19 has to communicate with other viruses. Following the latest Pandemic, combating COVID-19 has become a major need today. Several theories are being formulated and tested for the efficient prevention and treatment of the virus. Vaccination is the ultimate solution but access to the vaccine and getting vaccinated is limited. The purpose of this review paper is to present a new approach. This approach is based on the Quorum sensing of viruses like bacteria. Bacteria use this for communication and it has recently been proven for viruses too. It can be used as a new way or strategy to stop viral communication, therefore restricting the viral spread will possibly help people around the world or reduce the disease's side effects. This new tactic in-volves the use of functionalized Quantum dots nanoparticles, and when they are coupled with carbon atoms and put to use in different delivery forms, these will be useful for maximum efficacy. The use of carbon quantum dots can be useful to minimize certain possible toxic effects. This may be greatly enhanced by doping boron atoms to the structure to trigger their synergistic effects. We suggest here that the inhaler form of this proposed drug delivery system should simultaneously provide a fairly high efficiency and a less toxic solution.
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Malaria and cancer have been considered deadly diseases around the world. Cancer and malaria both have high incidence rates despite numerous research efforts to develop effective strategies for mitigating the burden of these two distinct ailments. Herein, pH-responsive nanogel based on methacrylic acid-functionalized with bovine serum albumin (PMAA-BSA) with an average diameter of similar to 75 nm was fabricated for smart delivery of chloro-quine (CQ). These nanoplatforms exhibited high drug loading efficacy (26.42%). Also it displayed a higher CQ release rate (92.03%) under simulated acidic microenvironment of the digestive vacuole (DV) and tumor tissue whereas 40.01% CQ was released under a neutral physiological environment. More importantly, this unique pH -responsive nanogel lowered the IC50 of CQ by approximately 2.8-fold and 1.9-fold in MCF-7 cells at 24 and 48 h, respectively. Interestingly, blank PMAA-BSA nanogels displayed anti-plasmodial activity and no one to the best of our knowledge has developed a drug vehicle with inherent antimalarial features. PMAA-BSA-CQ through its synergistic effects exhibited great anti-plasmodial activity under both in vitro and in vivo conditions. Furthermore, PMAA-BSA-CQ fully eradicate the parasites in Plasmodium berghei infected mice and prolonged their survival rate. In conclusion, such pH-responsive nanogel with targeting ability and non-toxicity could be used as a very promising nanoplatform for intracellular and tumor trigger release of antimalarial/anti-cancer drugs.
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Background: Growing evidence focuses on the role of hypoalbuminemia in the COVID-19 course and the role of vascular inflammation in the progression to Capillary Leak Syndrome (CLS). CLS may be mediated by a derangement of endothelial barrier following vascular endothelial dysfunction. We investigated the role of cardiometabolic risk factors in the association of hypoalbuminemia with endothelial dysfunction of hospitalized COVID-19 patients. Method(s): In this cross-sectional study, patients hospitalized for COVID- 19 at the medical ward or Intensive Care Unit (ICU) were enrolled. Medical history and laboratory examinations were collected while the endothelial function was assessed by brachial artery flow-mediated dilation (FMD) between the first 24-72 hours of their admission to the hospital. According to the body mass index, history of hypertension, dyslipidemia, and diabetes mellitus, COVID-19 patients were categorized in those with Cardiometabolic Risk Factors (CRFact) or without CRFact (no-CRFact). From the study population, we excluded subjects with established cardiovascular disease. Result(s): Sixty-six patients with COVID-19 (37% admitted in ICU) were recruited. From the study population, 41 were in the group of CRFact and 25 in the no-CRFact. Patients with CFRact were older (65+/-9 years vs. 53+/-14 years, p<0.001), had more impaired FMD (1.16+/-2.13% vs. 2.60+/-2.44%, p=0.01), and lower serum albumin levels (3.10+/-0.68 g/dL vs. 3.52+/-0.26 g/dL, p=0.006) compared to the no-CRFact group. Between CRFact and no-CRFact, there was no difference in CRP and IL-6 levels. Interestingly, serum albumin in patients with CRFact was significantly lower than the lower reference limit (LRL) (=3.5 g/dl) of albumin (p=0.001), while no such finding was noted in subjects with no CRFact (p=0.64). Furthermore, regression analysis revealed that, even after adjustment for age, the presence of CRFact was associated with decreased serum albumin levels by 0.31mg/dl (95% CI 0.08 to 0.63, p=0.04). In the CRFact population, there was a correlation of albumin with FMD (R=0.29, p=0.05) and an inverse correlation with CRP (rho=-0.48, p=0.02) and IL-6 (rho=-0.66, p<0.001), while in the no-CRFact group no such correlation were observed (p=NS for all). Conclusion(s): COVID-19 patients with cardiometabolic risk factors present with low serum albumin levels early at the course of the disease, which may be driven by endothelial dysfunction and vascular inflammation. This data gives insights into the potential association of a dysfunctional endothelial layer and the progression to capillary leak syndrome. (Figure Presented).
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Viral infections cause significant health problems all over the world, and it is critical to develop treatments for these problems. Antivirals that target viral genome-encoded proteins frequently cause the virus to become more resistant to treatment. Because viruses rely on several cellular proteins and phosphorylation processes that are essential to their life cycle, drugs targeting host-based targets could be a viable treatment option. To reduce costs and improve efficiency, existing kinase inhibitors could be repurposed as antiviral medications; however, this method rarely works, and specific biophysical approaches are required in the field. Because of the widespread use of FDA-approved kinase inhibitors, it is now possible to better understand how host kinases contribute to viral infection. The purpose of this article is to investigate the tyrphostin AG879 (Tyrosine kinase inhibitor) binding information in Bovine Serum Albumin (BSA), human ErbB2 (HER2), C-RAF1 Kinase (c-RAF), SARS-CoV-2 main protease (COVID 19), and Angiotensin-converting enzyme 2 (ACE-2).Communicated by Ramaswamy H. Sarma.
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Introduction: Protein energy wasting (PEW) is an established entity in adults with CKD but is not well studied in children. The burden of PEW has been observed to be higher in Indian children with CKD compared to the chronic kidney disease in children (CKiD) cohort. The impact of PEW on outcomes needs to be addressed in these children with CKD. This prospective longitudinal study was undertaken in children with CKD 2-5D to assess the association of PEW with clinical outcomes of infection related hospital admissions (IRHA). Method(s): Children (age 2-18 years) with CKD 2-5D, from a tertiary care center were recruited for PEW assessment from January 2017 following ethical committee approval and informed consent. Children with evidence of infection in the last month and those on dialysis for less than a month were excluded. Demographic characteristics and clinical outcomes of hospital admissions were recorded till June 2022. Based on the CKiD study, PEW was diagnosed and categorized using 5 criteria: 1. Muscle mass (Mid arm muscle circumference);2. Body mass (body mass index);3. Biochemical parameters (serum cholesterol, serum albumin, serum transferrin, and C-reactive protein);4: Appetite and 5. Short stature. PEW was further categorized as mild (> 2 criteria), standard (> 3 criteria), and modified (> 3 criteria with short stature). Infections that needed hospitalization included viral hemorrhagic fever, COVID-19 infection, sepsis, urinary tract infection, lower respiratory tract infection, peritonitis, and catheter-related blood stream infection. Result(s): Among 136 children (45 on dialysis, mean age 122 + 46 months, 70% males) 72 (53%) had PEW. The proportions of those with mild, standard, and modified PEW were 8%, 13%, and 32% respectively. Over a mean follow-up of 38 + 21 months, 104 (76%) children required hospital admissions of which 69% were due to infections. Death was noted in 2%, and 12% got transplanted. The proportion of children needing hospital admissions was significantly higher in those with PEW compared to those without PEW (85% vs 66% respectively, p=0.011). IRHA was observed in 68% of children with PEW compared to 36% without PEW (p<0.001). The proportion of IRHA in those with dialysis with or without PEW ((87% vs 50%, p=0.001) was significantly higher compared to those with CKD 2-5 (54% vs 32%, p= 0.03). In the overall cohort, the proportion of IRHA was significantly higher with modified PEW compared to other PEW categories (p<0.001), [modified: 74.4%, standard: 58.0%, mild: 59%, no PEW: 36%]. On multivariable analysis, by adjusting for age, gender, etiology of CKD, and dialysis, the presence of PEW and dialysis status were independent factors associated with IRHA [Adjusted OR 3.58 (1.62,7.89), p=0.002] and [OR 3.29 (1.4,7.75), p=0.006, respectively]. Similarly, the presence of inflammation was independently associated with IRHA [OR 3.93 (1.49, 10.3), p=0.002]. Figure 1 shows the risk factors associated with IRHA based on PEW categories and inflammation status. [Formula presented] Conclusion(s): In children with CKD 2-5D, the presence of PEW and inflammation were significantly associated with IRHA. Children with modified PEW had nearly 5 times more risk of developing IRHA, reinforcing the importance of growth as a unique parameter of PEW in these children. No conflict of interestCopyright © 2023
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Introduction: The patients with diabetic kidney disease (DKD) due to type 2 diabetes mellitus (T2DM) are at a high risk of adverse outcomes of COVID-19. In some cases, rapidly progressive kidney injury requires urgent initiation of renal replacement therapy (RRT) - hemodialysis de novo (HD de novo). The objective of this study is to identify risks factors of adverse outcomes and predictive value of HD de novo in patients with DKD due to T2DM and COVID-19. Method(s): The patients with chronic kidney disease 4-5 stages (CKD 4-5) with laboratory-confirmed COVID-19 were included in the retrospective observational study. The observation period 04.01-10.30.2020. Data were collected from electronic medical database. The following independent variables were analyzed at hospital admission: age, gender, body mass index (BMI), general comorbidity (Charlson Index, CCI), the insulin demand (InsD), fasting blood glucose (FBG), glomerular filtration rate (GFR), Plasma creatinine (Pcr), serum albumin (SA), proteinuria, time from onset to admission, NEWS2-scale points, pulmonary involvement (Chest CT), Hb, WBC, lymphocytes, platelet count, LDH, CPR, ferritin, D-dimer, procalcitonin, Interleukin-6. The observation group was divided into subgroups: 1 - HD not required (HD n/r), 2 - HD de novo. Result(s): A total of 55 patients were included. Mediana age was 69 y (IQR 64;80), fe-males 59%. The overall mortality - 38.2%. In 18 patients (32.7%) HD de novo was initiated due to rapidly progressive renal failure. The results of comparative analyses of demographic, initial clinical and laboratory data are presented in Tables (*Mann-Whitney U-test;IQR, interquartile range;Me, mediana). [Formula presented] [Formula presented] The mortality in both subgroups was 21.6 % vs 72.2 % respectively (p <0,001). HD de novo was determined as an independent predictor of adverse outcome (OR 9.42;95% CI, 2.58-34.4, p = 0.001). The analysis showed that FBG >= 10 mmol/L at admission (OR, 3.38;95% CI, 1.04-10.98, p = 0.050), SA at admission <= 35 g/L (OR 3.41;95% CI, 1.00-11.55, p = 0.050), News2 >4 points (OR 5.60;95% CI, 1.67-19.47, p = 0.006), GFR <= 20 ml/min/1,73m2 at admission (OR 4.24;95%;CI 1.29-13.99, p = 0.020) were independent predictors of HD de novo. Cumulative survival in subgroup HD de novo was 10% (significantly less, than in patients HD n/r) (Fig.). [Formula presented] Conclusion(s): Approximately every third patient with advanced nondialysis DKD required new onset RRT.New onset RRT is an independent predictor of lethal outcome of COVID-19. High FBG, low SA, low GFR and high NEWS2 score at admission are the risk factors of HD initiation during hospitalization. No conflict of interestCopyright © 2023
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Aim: Data on the outpatient follow-up of COVID-19 cases is still scarce. Also, the significance of the ROX index in decision-making for hospitalization in the ambulatory COVID-19 cases remains unknown. The aim of this study is to determine the general characteristics of COVID-19 patients treated as outpatients and to investigate whether the ROX index is applicable in hospitalization decisions. Material(s) and Method(s): This retrospective cohort study was conducted in confirmed adult COVID-19 cases between 15 October 2020 and 01 March 2021. A total of 5240 confirmed COVID-19 patients were included in the present study. Factors affecting hospitalization were investigated. Result(s): The study population was divided into two groups as those who require hospitalization (n=672) and those who did not (n=4568). The number of male patients and the mean age of the patients were significantly higher in hospitalized patients group (p=0.046, p<0.001). ROX index that was calculated at the home visit on the third day of disease was found significantly lower in the group of hospitalized patients (p<0.001). There was a significant correlation between ROX index and inflammatory biomarkers in the present study (p<0.001). The ROX index was found the most accurate parameter for decision-making for hospitalization in ambulatory COVID-19 patients (AUC=0.794 CI=0.773-0.814, p<0.001). Discussion(s): The ROX index can be a useful and objective clinical tool for decision making for hospitalization in the ambulatory COVID-19 cases.Copyright © 2022, Derman Medical Publishing. All rights reserved.
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Introduction: Covid-19 affects multiple organs including the kidneys. Mortality from covid-19 is found in those with co-morbid conditions, including end-stage kidney disease. Patients on maintenance hemodialysis appear vulnerable to SARS-CoV 2 infection due to uremia-related immune system dysfunction which consist in both impaired immune defense and pro-inflammatory stated, increased comorbidity burden, frequent hospital admissions and the risk of cross-contamination in the dialysis centers. Mortality risk is associated with covid-19 severity. In non-covid hemodialysis patients, age, diabetes, hypertension, coronary artery disease, smoking history, and frequency of hemodialysis were correlated with mortality. Little is known on the impact of covid-19 in these hemodialysis patients and their clinical and laboratory features. Method(s): This is a retrospective study of adult patients on chronic hemodialysis admitted for covid-19 from March 2020 to December 2021 in a tertiary public hospital in Manila. Data extracted included demographic profile, clinical characteristics, etiology of chronic kidney disease, baseline chest x-ray, and laboratory tests such as white blood cell count, erythrocyte sedimentation rate, c-reactive protein, serum albumin, alanine transaminase, aspartate aminotransferase, lactate dehydrogenase, d-dimer, and ferritin. Also included were the frequency of hemodialysis, covid-19 severity and outcome, whether discharged or died. Descriptive statistics, comparative analysis, and one-way ANOVA were used to analyze the data. Cramer's V was used to test the association of covid severity to a nominal variable. Result(s): The study included 48 patients. There were 19 moderate patients (39.58%), 14 severe patients (29.17%) and 15 critical patients (15%). Among the included patients, 77% improved and were discharged from the hospital. However, 10 patients (20%) expired, particularly those who had severe pneumonia upon hospitalization and critical covid-19. Among the variables analyzed, only elevated lactate dehydrogenase (LDH) significantly predicted the risk for critical covid-19 (p=0.0204). One unit of increase in LDH increases the relative risk for developing critical covid-19 by one-fold. An increase in LDH increases the chance of having critical covid-19 than having moderate covid-19. Conclusion(s): An elevated LDH in hemodialysis patients was associated with risk of developing critical covid-19. A majority of end-stage renal disease patients on maintenance hemodialysis died from cirtical covid-19 with mortality rate of 20% which was higher than that observed in general population. Other variables has no association between the composite outcome or mortality and risk factors previously identified in the general population such as age, diabetes, hypertension, coronary artery disease and history of smoking. No conflict of interestCopyright © 2023
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Introduction: The gold standard method in the diagnosis of COVID-19 is real-time reverse transcriptase-polymerase chain reaction (RT-PCR) however, its sensitivity is reported to be between 42-83% in different studies. Aims and objectives: In this study, we aimed to examine the relationship between CO-RADS levels and prognosis in patients followed in the intensive care unit with the diagnosis of COVID-19. Method(s): All consecutive adult patients with clinically, radiologically, and/or laboratory positive COVID-19 admitted to the Intensive Care Unit between January 2020 and October 2021 were evaluated. Clinical and laboratory data of the patients include characteristics, comorbidities, treatment protocol, respiratory support, hospital stay, RT-PCR status, laboratory test, CO-RADS scores, complications, and prognosis collected from the electronic hospital record system. Result(s): 375 patients were included in the study. In univariate analysis, age, intubation status, serum albumin, CRP, D-dimer, and CO-RADS score were found to be effective variables on mortality. In multivariate analysis, CO-RADS score, and serum albumin levels were found as independent variables affecting mortality (Figure 1). Conclusion(s): This study presents the prognostic value of the CO-RADS classification in patients with COVID-19.
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Introduction Procoagulant platelets (PLTs), a subpopulation of PLTs that is characterized by increased externalization of phosphatidylserine (PS), are increasingly identified to promote a prothrombotic environment in different diseases. Recently we observed that procoagulant PLT formation can be induced via engagement of immune receptor Fc-gamma-RIIA by COVID-19, VITT and HIT patient immunoglobulin subclass G (IgG) antibodies (Abs). Here, Fc-gamma- RIIA engagement by patient Abs resulted in significant formation of procoagulant PLTs and loss of mitochondrial potential that was associated with high thrombin formation as well as increased thrombus formation. In the cur- rent study, we aim to establish a PLT adhesion assay that allows investigation of PLT mitochondria during procoagulant PLT formation. Method PLTs were spread on human serum albumin, fibrinogen or collagen precoated glass slides. Adhesion and subsequent shape change of PLTs as well as procoagulant PLT formation were investigated in real time using immune fluorescence microscopy. For the detection of PLT shape change, mitochondrial dynamics and PS externalization, PLTs were double stained with MitoTracker green, a mitochondrial dye that binds to free thiol groups of cysteine residues in the mitochondrial membrane, and Annexin-V, respectively. For the visualization of mitochondrial release from PLTs intracellular compartment, a monoclonal Ab that binds to a subunit of the translocase of the outer membrane (TOM) complex on the mitochondrial membrane, namely TOM22, was used. Results During the observation period, a subgroup of PLTs that was spread on collagen became procoagulant as determined by an increased binding of Annexin- V on the PLT surface. Contrary, these changes were nearly absent in PLTs that adhered to fibrinogen (percentage [ %] of Annexin-V positive cells: 19.80 +/- 3.42 % vs. 1.92 +/- 0.62 %, p value 0.0357). Interestingly, procoagulant PLT formation was associated with a significant loss of MitoTracker green signal in PLTs while it remained constant in non-procoagulant PLTs attached on both extracellular matrix coatings. Loss of MitoTracker green signal was associated with translocation of mitochondrial proteins from intracellular to extracellular, as a higher count of TOM22 Ab-positive labelled structures, most likely extracellular mitochondria were detected on collagen but not on fibrinogen coated glass slides. Conclusion Our findings indicate, that the formation of procoagulant PLTs is associated with dramatic changes of the mitochondrial integrity in PLTs. Further attempts, that investigate the potential pathophysiological role of PLT mitochondrial release in Ab-mediated prothrombotic disorders may contribute to a further understanding of the role of PLT mitochondria in these complex diseases.
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Introduction: Acute kidney injury (AKI) in COVID-19 infection is common, especially in severe diseases, and is associated with worsening outcomes. Data from many countries demonstrate differences in the incidence and risk factors of AKI. However, there is limited data available for AKI among severe COVID-19 patients in Thailand. This study aims to investigate the incidence and identify AKI risk factors in patients with severe COVID-19 infection at tertiary care hospitals. Method(s): In this retrospective cohort study, we analyzed data of patients admitted to the intensive care unit with PCR-confirmed diagnoses of COVID-19 infection from electronic medical records at Thammasat University Hospital. All patients who were admitted between 1st January 2021 and 30th June 2022 were included. Result(s): Of the 215 severe COVID-19-infected patients included, 134 (62.33%) experienced AKI injury. 81 (60.45%), 19 (14.18%), and 34 (25.37%) patients had AKI KDIGO stage 1, 2, and 3, respectively. From the univariate logistic regression analysis, the risk factors of AKI in COVID-19 patients were female, older age, preexisting hypertension, dyslipidemia, coronary artery disease, chronic kidney disease (CKD), higher APACHE II score, low serum albumin, high serum potassium, low serum bicarbonate, presence of proteinuria from dipstick and used of vasoactive drugs. Multivariate analysis showed that pre-existing CKD [odds ratio (OR) 13.95, 95%CI 2.24-86.88;p = 0.005], presence of proteinuria (OR 7.33, 95%CI 1.5-35.78;p=0.014) and APACHE-II score (OR 1.78, 95%CI 1.02-1.36;p=0.024) were independently associated with developing AKI. Multivariate analysis showed that AKI was associated with 30-day mortality with an OR of 4.34;95%CI 1.63-11.51 (p=0.003). Among AKI-patient survivors, 27 patients (20.15%) fully recovered their renal function, 22 patients (16.42%) were not recovering, and 11 patients (8.21%) required kidney replacement therapy during admission. The most common dialysis indication was volume overload. Conclusion(s): AKI in severe COVID-19 patients was common. Pre-existing CKD, presence of proteinuria, and higher APACHE II score were independently associated with AKI. Only one-fifth of AKI survivors had full renal recovery. Thus, the COVID-19 patients with these risk factors should be closely monitored and treated cautiously in order to prevent AKI development. No conflict of interestCopyright © 2023
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Objective: To explore the value of liver function indexes on evaluation of the illness condition of coronavirus disease 2019 (COVID-19). Methods: 261 patients with confirmed COVID-19 which collected from Huangshi Hospital of Traditional Chinese Medicine from January to March 2020 were investigated and separated into:group of critical type, group of severe type and group of common type, and the data of the patients about age, gender, past medical history and the results of liver function test were collected. Chi-square test, analysis of variance, univariate and multivariate logistic regression analysis were adopted to explore the relationship between liver function indexes and illness condition of COVID-19. Results: 50.2% of COVID-19 patients had abnormal liver function. Compared with the group of severe type, the levels of serum alanine aminotransferase (ALT), aspartate aminotransferase(AST), alkaline phosphatase (ALP), P-glutamyl transferase (GGT) and total bilirubin (TBIL)in the group of critical type was significantly higher, while the level of albumin(ALB)was significantly lower, and the differences were statistically significant (all P < 0.05);compared with the group of common type, the levels of ALT, +AST, and GGT in the group of severe type were significantly higher, while the level of ALB was significantly lower, and the differences were statistically significant (all P < 0.05). The proportions of patients with abnormal liver function or liver damage in the group of critical type were significantly higher than those in the group of severe type (P < 0.05), and the proportions of patients with abnormal liver function or liver damage in the group of severe type was significantly higher than those in the group of common type (P < 0.05). The incidence ratio of abnormal liver function in patients with underlying disease was higher than that of without underlying disease (P < 0.05). ALT, AST, ALP, TBIL, and ALB were all risk factors for severe progress of COVID-19 disease (all P < 0.05);multivariate logistic regression analysis inidicating that TBIL (OR=10.862, P < 0.05) and ALB (OR=11.733, P < 0.05)were the independent risk factors. TBIL level was positively correlated with the severity of COVID-19 (r=0.367, P < 0.05), and ALB level was negatively correlated with the severity of COVID-19 (r=-0.613, P < 0.05). Conclusions: The abnormal liver function, especially the obvious abnormality of TBIL and ALB, could be used as the reference index of COVID-19 severity. The COVID-19 patients with underlying disease were easily suffered liver injury.
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Objective: To compare the clinical manifestations, liver function, and antibody levels between Omicron variant infection patients vaccinated and not vaccinated with COVID-19 vaccine. Methods: Totally 430 convalescent COVID-19 patients infected with Omicron variant in Tianjin were selected, including 150 patients vaccinated with Corona Vaccine(Sinovac group), 185 patients vaccinated with BBIBP-CorV(Beijing biological group), 41 patients vaccinated with Ad5-nCoV vaccine(CanSino group), 16 patients vaccinated with Anhui Zhifei, Changchun Bio, Lanzhou Bio, Shandong Bio, other adenovirus vector vaccines or mixed vaccination(other group), and 38 unvaccinated patients(unvaccinated group). The clinical manifestations, liver function indexes [alanine aminotransferase(ALT), aspartate aminotransferase(AST), total bilirubin(TB), albumin(ALB), total protein(TP), lactate dehydrogenase(LDH)], and antibody levels(IgG, IgM)were compared retrospectively. Results: There was no statistical difference in the sex composition ratio among groups(P > 0.05). The age of the Beijing biological group was significantly lower than that of other groups, and the proportion of time less than 3 months from the last vaccination to admission in the Beijing biological group and CanSino group was significantly higher than that in the Sinovac group and other groups(all P < 0.01). A total of 110 children aged less than 16 years were enrolled, including 7, 88, 0, 1 and 14 cases in the Sinovac group, Beijing biological group, CanSino group, other group, and unvaccinated group, respectively. There were 6 asymptomatic cases, 13 moderate cases, 91 mild cases and 0 severe case. There was no significant difference in the abnormal rate of ALT between Beijing biological group and unvaccinated group(P > 0.05), but the abnormal rates of ALT were higher in the Sinovac group and CanSino group than in the unvaccinated group and Beijing biological group(all P < 0.05). The abnormal rate of AST in the unvaccinated group was higher than that in other groups(P < 0.05). There were no significant differences in AST, TP or TB among the groups(all P > 0.05). The levels of ALT were higher in the Sinovac group and CanSino group than in Beijing biological Group and unvaccinated group, the level of ALB in the unvaccinated group was lower than that in the other groups, and the level of LDH in the Beijing biological group was higher than those in the Sinovac group and CanSino group(both P < 0.05). The IgG and IgM antibody levels of the unvaccinated group were significantly lower than those of the Sinovac group, Beijing biological group and CanSino group(all P < 0.05). Conclusions: Omicron variant infection patients vaccinated with BBIBP-CorV are younger and have a higher proportion of mild conditions, which can protect the liver function of patients to a certain extent. Patients vaccinated with different COVID-19 vaccines can produce higher levels of IgG and IgM antibodies than the unvaccinated patients.
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Introduction: The global pandemic with COVID-19 threatened hemodialysis (HD) patients as susceptible category with high risk for lethal outcome. The aim of the study was to determine the prevalence and risk factors for mortality in HD patients with confirmed COVID-19 and the effectiveness of vaccination against COVID-19. Method(s): The prospective observational multicentric cohort study included all HD patients over a period since March 2020 to March 2022. The outcome of patients with confirmed COVID-19 regarding infection timing and vaccination status was evaluated. The examined clinical parameters were: age, sex, HD duration, neutralizing S-antibody titer against COVID-19, serum albumin, comorbidities and hospital admission. Statistical analysis was performed by SPSS, continued variables with analysis of variance and categorical variables with Chi-square test and logistic regression, and survival analysis by Kaplan-Meyer test. Result(s): Over the observed period of total 629 HD patients 318 patients had COVID-19 infection (COVID-19 group) and 311 patients had no COVID-19 (Noninfected group). Vaccine coverage with 2 and 3 doses were significantly higher in the Noninfected group compared to COVID-19 group. In the COVID-19 group 214 patients had COVID-19 (4 patients reinfection) before vaccination (Prevaccination COVID-19 subgroup) and 104 patients had COVID-19 (15 patients reinfection) after vaccination (Postvaccination COVID-19 subgroup). The patients vaccinated with 3 doses had the lowest infection rate of 14,5%. Over the observed period overall 76 patients or 24% with COVID-19 deceased. The hospitalization rate and mortality were higher in the Prevaccination COVID-19 subgroup (51,9% and 26,2%) compared to Postvaccination COVID-19 subgroup (37,5% and 19,2%), but statistically significant only for hospitalization rate. In the COVID-19 group clinical parameters showed that deceased patients compared with survived patients had statistically significant higher age and lower s-albumin. Statistically significant predictive risk factors for lethal outcome were non-vaccination (HR=18,3), age over 80 years (HR=5,1) and cardiomyopathy (HR=2,5). Regarding S-antibody titer against COVID-19 after the second vaccine dose statistically significant higher titer had the Prevaccination COVID-19 subgroup and the Postvaccination COVID-19 Reinfection subgroup compared to Noninfected group and Postvaccination COVID-19 subgroup, and the Noninfected group compared to Postvaccination COVID-19 subgroup. After the third vaccine dose the Prevaccination COVID-19 subgroup had statistically significant higher titer compared to Noninfected group. In the Postvaccination COVID-19 subgroup after 2 vaccine doses deceased patients had statistically significant lower S-antibody titer compared with survived patients. The cumulative survival in the Postvaccination COVID-19 subgroup was 28,4% after the second vaccine dose and 100% after the third vaccine dose, that was statistically significant. Conclusion(s): Our study showed that mortality is high in HD patients with COVID-19 and amounts 24%. The mortality was associated with advanced age, low level of s-albumin, cardiomyopathy and low S-antibody titer against COVID-19. The vaccination protection against COVID-19 was the highest in patients after the third vaccine dose in whom the lowest infection rate and no lethal outcome after infection with COVID-19 was observed. No conflict of interestCopyright © 2023
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The airborne transmission of SARS-CoV-2 has been quickly suggested based on the stability of SARS-CoV-2 in aerosol for 3 hours. Nebulization, by a possible microorganisms contamination and/or by the aerosolization of contaminated particles, may expose health care workers. Thus, various guidelines on nebulization emerged during the SARS-CoV-2 pandemic to ensure a maximal protection. This study aimed to address the risk of airborne transmission in patients hospitalized with severe COVID-19. Ten severe COVID-19 patients were recruited at the admission in the hospital. They were treated by nebulization with a standard single-use jet nebulizer operating at 8 L/min with a T piece connected to a mouthpiece and a filter. Immediately after the first nebulization, the residual solution of each nebulizer was sampled. Then, the nebulizers were refilled with isotonic saline solution to complete the residual volume. The filter was replaced by a BioSampler (SKC 20-mL) loaded with 20 mL phosphatebuffered saline and 0.5% bovine serum albumin. The nebulizer was driven by a compressed air supply, and a 10minnebulization was performed again on the bench. The emitted aerosol was continuously collected during the nebulization. The nominal and emitted dose were sampled. The SARS-CoV-2 viral load was quantified in all samples by RT-PCR. No SARS-CoV-2 RNA was found in any sample for all nebulizations. The result of this study shows no SARS-CoV-2 nebulizers contamination by COVID-19 patients at hospital and does not support the role of nebulizers in terms of aerosol virus dissemination in air. Nevertheless, exhaled virus by the patient itself remains and must be considered independently to the nebulizer.