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Aim: While recent evidence describes atypical outcomes of coronavirus disease 2019 (COVID-19) in elderly patients, the frequency of delirium and associated outcomes in elderly patients with COVID-19 (coronavirus disease 2019) infection undergoing emergency surgery are not well defined. This study aims to determine the effect of COVID-19 on postoperative delirium and postoperative death in elderly patients undergoing emergency surgery. Material(s) and Method(s): This descriptive and cross-sectional study was conducted in general surgery, orthopedics, and cardiovascular surgery clinics of a public hospital, including 30 days of follow-up between April 1 and May 1, 2021. All patients who were admitted to these clinics for emergency surgery intervention on these dates constituted the study population, while a total of 140 patients aged >=65 years, who met the study criteria, formed the sample of the study. Descriptive Characteristics Form and Nursing Delirium Screening Scale (Nu-DESC) were used as data collection tools in the study. SPSS 25.0 statistical program was used for data analysis. Result(s): Thirty (42.85%) of the SARS-CoV-2 positive (n=70) patients developed delirium in the study. 12.9% (n=18) of the patients died within 30 days of follow-up after surgery. There were 30 (69.8) of 70 SARS-CoV-2 positive patients who developed delirium, and 12 patients (25.5) died after testing positive for COVID-19, with a mean of 8.08T1.56 days within 30 days of admission. Discussion(s): These findings may lead to a poor clinical prognosis for COVID-19 infection delirium and postoperative death in patients over 65 years of age undergoing emergency surgery.Copyright © 2023, Derman Medical Publishing. All rights reserved.
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Introduction: Anakinra treatment is approved for the treatment of COVID-19 pneumonia in hospitalized adults in need of oxygen and at risk for progression into severe respiratory failure (SRF) defined as circulating concentrations of the biomarker suPAR (soluble urokinase plasminogen activator receptor) >= 6 ng/mL by the EMA and has been authorized for emergency use by FDA under an EUA [1]. This is based on the results of the randomized SAVE-MORE trial where suPAR >= 6 ng/ mL was used to select patients at risk for SRF [2]. The suPAR test is not commercially available in the USA and an alternative method of patient selection was needed. Method(s): In collaboration with the US FDA, an alternative method to select patients most likely to have suPAR >= 6 ng/mL based on commonly measured patient characteristics was developed. Patients with at least 3 of the following criteria are considered likely to have suPAR >= 6 ng/ ml: age >= 75 years, severe pneumonia by WHO criteria, current/previous smoking status, Sequential Organ Failure Assessment score >= 3, neutrophil-to-lymphocyte ratio >= 7, hemoglobin <= 10.5 g/dl, history of ischemic stroke, blood urea >= 50 mg/dl and/or history of renal disease. Result(s): The positive predictive value of this new score was 95.4% in SAVE-MORE population. However, a lower sensitivity meant a small proportion of patients with suPAR >= 6 ng/ml will not be identified by the new score. The adjusted hazard ratio for survival at 60 days for patients meeting this score and who receive anakinra is 0.45 (Fig. 1). Conclusion(s): The developed score predicts accurately patients with suPAR levels >= 6 ng/mL and may be used as an alternative to guide anakinra treatment in patients with COVID-19 pneumonia. Based on these subgroup results, patients in SAVE-MORE who met the new score appeared to show beneficial efficacy results with treatment of anakinra consistent with the overall studied population.
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Spontaneous pneumomediastinum (SPM) is a decisive complication reported to be associated with COVID-19. Here, we present a case of SPM in a COVID-19positive patient that was not caused by any iatrogenic or known reasons. At the time of admission, the patient was COVID-positive and distressed. He was immediately subjected to hematological and radiological investigations (chest X-ray, HRCT), which confirmed pneumomediastinum. The patient was hypoxic and hypotensive even after receiving ionotropic support. Considering the patient's critical condition, a mediastinal pigtail catheterization was performed instead of a thoracotomy, and the catheter was in situ for nine days. Arterial blood gas was monitored during the hospital stay, and supplementary oxygen therapy was provided accordingly. The patient subsequently recovered and was discharged. Hence, SPM in this COVID patient was treated by pigtail catheterization, and major surgical interventions were avoided.Copyright © 2023 LookUs Scientific. All rights reserved.
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Objectives: In this study, we aimed to investigate the prognostic value of the neutrophile-lymphocyte ratio and the effects of age, gender, and comorbidities on mortality. Method(s): In our study, 100 patients who had a ground-glass opacification on computed thorax tomography and who had a positive polymerase chain reaction test were included in our study. Demographic data, laboratory data and comorbidities of the patients were recorded. Result(s): Sixty-five (65%) of the patients participating in the study were male. The mean age of the patients was 66 (21.5). The mortality rate was found to be 27% (n=27) High neutrophile-lymphocyte ratio, low lymphocyte count, high urea, and creatin levels were significant in terms of mortality. In addition, advanced age, diabetes mellitus, and hypertension are other factors that have an impact on mortality. Conclusion(s): The neutrophile-lymphocyte ratio can solely be used as a prognostic marker because it is simple and economical.©Copyright 2022 by The Cardiovascular Thoracic Anaesthesia and Intensive Care.
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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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COVID-19 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has threatened every civilian as a global pandemic. The immune system poses the critical interactive chain between the human body and the virus. The current study aimed to assessment whether comorbidity with type 2 diabetes (T2D) affects the immunological response in COVID-19 patients. This case-control study (comparative) was carried out in Baghdad Al-karkh hospitals/ isolation units for Patients covid-19, which included 90 subjects from November 2021 to the end of April 2022, as of which 30 participants were with T2D patients, 30 were T2D patients suffer of covid-19, with positive RT-PCR for covid-19 and the remaining 30 were nondiabetic (NDM) of aged (50-85) years. To study concentrations of Interleukin 6( IL-6), Interleukin 2 Receptor Beta (IL-2R beta), Procalcitonin (PCT), Ferritin, D-dimer, HbA1c, blood urea(BU), and serum creatinine . The current study showed a significant increase in IL-6 (362.4+/-60.01pg/ml), IL-2R beta (8.8+/-2.7%), PCT (205+/-25.7mg/dl), Ferritin(), D-dimer(), HbA1c(), blood urea(58+/-12.7mg/dl), and serum creatinine (1.1+/-0.2mg/dl) in T2D with COVID-19 patients compared to the control group (222.8+/-30.7pg/ml, 4.6+/-1.3%, 99+/-15.1mg/dl, 35+/-9.6mg/dl, 0.65+/-0.03mg/dl respectively, at the probability value (P<0.05). The COVID-19 patients comorbid with T2D demonstrated distinguishable immunological parameters, which represented clinical relevancies with the predisposed disease severity in T2D.Copyright © 2022 Mohan R, et al.
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Arterial thrombosis encountered during sars-cov2 infections is a rare complication with a poor prognosis compared to venous ones. They generally occur in severe and critical clinical forms of covid19 [1,2]. The physiopathology of arterial thrombosis, even if not completely understood highlights hypercoagulability and excessive inflammation as risk factors with a major role of the endothelial lesions in their occurrence. The presence of cardiovascular risk factors in patients infected with covid19 is also discussed as a predisposing factor for arterial thrombosis [2,3]. We report the case of a North African male patient hospitalized for acute respiratory distress syndrome (ARDS) secondary to covid19 pneumonia, complicated by the occurrence of multiple arterial thrombosis of the aorto-iliac axis with the rare finding of two free floating thrombus in the aorta and the right common iliac artery. Clinically, the patient had developed acute bilateral lower limb ischemia and multi-organ failure and the evolution was dramatic with rapid worsening of the patient…s health and eventually his death. Thromboembolic complications are frequent during covid19 infection but the aortic localization is very rare. Its diagnosis is difficult and it has a poor prognosis. Our objective through this case report is to increase knowledge about arterial thromboembolic events while discussing their link to the sars-cov2 viral infection. © 2022
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Background: Various risk factors have been proposed for severe coronavirus disease 2019 (COVID-19);nonetheless, the prognostic role of serum electrolytes has not been widely studied. Objectives: The present study aimed to identify the potential prognostic role of electrolyte imbalance in hospitalized COVID-19 patients. Methods: This retrospective study was conducted in Imam Reza Hospital, Mashhad, Iran. The medical records of all COVID-19 patients admitted to the emergency department from May to August 2020 were evaluated. Demographic data and clinical findings upon admission were collected. Disease severity, lung involvement severity on imaging, inflammatory serum biomarkers, admission to the intensive care unit, and serum levels of sodium, potassium, magnesium, calcium (corrected by serum albumin level), and phosphorus were documented. Results: Most patients (60%) were male, and the mean age of the total population was 58.87 ± 1.82 years. Severe COVID-19 was detected in most cases (94.9%) who were significantly older (P = 0.037), had hypertension (P = 0.032), ischemic heart disease (P = 0.033), and higher serum urea (P = 0.001) and serum potassium (P < 0.001). Patients with poor prognosis based on computed tomography (CT) scores had significantly higher serum urea (P = 0.002) and magnesium (P = 0.035) than patients with good prognosis, while serum calcium was significantly higher in the latter group (P = 0.007). Furthermore, there was a significant relationship between COVID-19 severity and serum potassium (P < 0.001). Conclusions: Abnormal serum electrolytes are correlated with COVID-19 severity. Moreover, serum potassium level is a predictor of severe disease.
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Introduction: Evidence regarding thrombotic microangiopathy related to covid-19 is reported in the literature, particularly in severe cases. We describe a case recovered from previous asymptomatic covid-19, presenting with acute renal failure, hemolytic anemia, and low platelets. Thrombotic microangiopathy (TMA) was confirmed by renal biopsy, without immunofluorescence staining for C3c and C1q, suggesting this case is not complement-mediated. Anticoagulant therapy led to kidney function improvement. Methods: Case report. Results: A 72-year-old women with a past medical history of primary hypertension was referred to the hospital for the diagnosis of acute renal failure. Three days prior to admission, she suffered abdominal pain, decreased urine output, her blood test revealed elevated serum creatinine of 393 umol/L, and low platelets of 43.6 K/uL. She denied history of hematologic or renal disorders, yet mentioned that she found asymptomatic covid-19 one month before admission. On admission, the vital signs was significant for a blood pressure of 140/80 mmHg. Physical examination was noted with facial oedema, upper abdominal pain, otherwise unremarkable. Laboratory test confirmed acute renal failure with the ongoing increase of serum urea 30.4 mmol/L and creatinine 575 umol/L. Her total blood count discovered thrombocytopenia and anemia, with the platelet count of 50 k/uL, and the hemoglobin of 94 g/L. Lactate dehydrogenase was in upper limit of 434 U/L, and the bilirubin level was in normal range. The peripheral blood smear showed “fragmented” RBCs. Coombs’ test was negative for both direct and indirect method. Stool examination failed to detect either red or white blood cell. Haptoglobin level was 1.14 g/L, which was in normal range (0.41-2.58 g/L). Ddimer was elevated 1376 ng/mL, and the fibrinogen 6.37 g/L. Immunology investigation was conducted with the result of normal level for both complement C3 and C4, negative reaction for anti-cardiolipin IgM and IgG, anti MPO, anti PR3, RF, anti-streptolysin O. Bone marrow aspiration did not show abnormalities. There were Forrest III gastric ulcers found by gastric endoscopy (two ulcers with diameter of 9mm and 10mm, with pseudo-membrane covered). Initially she was treated symptomatically with amlodipin, intravenous PPI, and IV furosemide. As the kidney function was getting worse, hemodialysis was initiated at day 1, day 3, day 6, and day 10 of admission. Renal biopsy was performed and showed active thrombotic microangiopathy. Given the normal complement profile, and negative C3c staining on immunofluorescence of renal biopsy investigation, complement mediated TMA may not be the pathogenesis of this case. The patient was started for anticoagulant therapy, initially subcutaneous low molecular weight heparin and then oral anti-vitamin K. She obtained dramatic recovery with dialysis off, increased urine output, normalized platelets and red cell count, and serum urea and creatinine back to nearly normal range at discharge. Conclusions: Complement related thrombotic microangiopathy is a rare and severe condition. This case of TMA after covid-19 reveals a non-complement mediated pathogenesis, with different treatment. Anticoagulation is an effective therapy in hypercoagulation induced TMA. No conflict of interest
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Objectives: The aim of the study was to evaluate the adverse drug reactions (ADR) following Remdesivir therapy in patients of COVID-19. Methods: All patients more than 18 years of age of any gender, diagnosed with COVID-19 infection receiving remdesivir therapy and fulfilling the selection criteria were included in the study after informed consent. They were monitored for ADRs till end of treatment and analyzed for characteristics of the ADRs: Causality, severity, and preventability. Results: Out of 80 patients (mean age of 49.27±16.22 years) enrolled, 51 (63.75%) developed 84 ADRs. Most common ADRs included increased aspartate transaminases, (20.23%), increased bilirubin (19.04%), increased alanine transaminases (13.09%), increased creatinine (11.90%), and increased blood urea (9.52%). Causality assessment using WHO-UMC scale showed, 85.71% possible, 13.09% probable, and 1% certain causal association of the ADRs with remdesivir. A total 75% ADRs were mild in severity and 45% patients recovered from the event at the end of treatment. Conclusion: Hepatic and Renal dysfunctions are observed with remdesivir in COVID-19 patients. Intensive monitoring of ADRs with newer drugs with EUA such as remdesivir is warranted to ensure safer use in patients.
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Symptoms of COVID-19 vary and range from mild symptoms to serious illness. Common symptoms include cough, fever, loss of smell and tastes. The aim of this study is to measure some biochemical parameter in covid-19 patients 2 weeks after recovery.. Method: The study included 50 patients suffering from infection with the emerging corona virus and 30 samples of healthy people as a control group, and both groups ranged in age from 27-77 years and of both sexes, collected from Kirkuk General Hospital. A number of biochemical variables were measured in the blood serum of the groups under study, including blood urea and creatinine, two weeks after infection. The study revealed that the risk of infection with the Covid-19 virus increases with age, the most affected are the elderly, as the study found that 48% of patients were older than 55 years of age and 15% within the age group 41-55 years. The study also found that males were more affected by the virus than females (52% males and 48% females.
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The current study was performed at Baqubah General Hospital /Diyala which included 60 patients with CoV-19 distributed on 27 males and 33 females, while 30 individuals not infected with CoV-19 (control group) who were aged between 20-65 and from a period between September 5 to December 15 /2021. All samples were already diagnosed with CoV-19 infection by using RT-PCR and IgM/IgG Rapid Test Kit. Blood samples and a nasopharyngeal swab were taken from the patients and control group to test for;iL-6, iL2, blood urea, serum creatinine and LDH. The study revealed the infection with CoV-19 showed the highest levels of iL-6 and iL2 were(71.88 and177.50) pg/ml levels respectively, the biochemical analysis also showed the highest levels of each blood urea, serum creatinine and LDH were (35.40, 0.80, 330.95) respectively.
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BACKGROUND AND AIMS: During a 2-year pandemic, COVID-19 proved to be a condition with a high potential to affect various organs other than the lungs. Acute kidney injury (AKI) in hospitalized COVID-19 patients is associated with a poor prognosis. The aim of this study was to identify factors influencing in-hospital mortality. METHOD: In a retrospective analysis, we included 268 adult patients with RT-PCRconfirmed SARS-CoV-2 infection and AKI admitted to two Emergency University Hospitals during a 6-month period, between 1 November 2020 and 30 April 2021. Data were retrieved from the electronic databases of the two hospitals. We analysed kidney and patient outcomes at discharge and the potential risk factors for mortality in AKI patients. We defined and staged AKI according to KDIGO 2012 creatinine criteria. RESULTS: In our cohort the mean age was 72.28 years, 169 (63%) patients were men, and 111 (41.4%) had previously known chronic kidney disease. 81 patients were classified as having stage 1 AKI, 79 patients had stage 2 AKI and 108 had stage 3 AKI. A total of 135 (50.37%) patients died during hospitalization. Statistic analysis using the Mann-Whitney U-test revealed significant differences (P < .01) between survivors and non-survivors regarding peak values of serum urea (137.9 versus 190.9 mg/dL), creatinine (2.88 versus 3.94 mg/dL), procalcitonin (3.56 versus 15.86 ng/mL), C-reactive protein (92.32 versus 176.09 mg/L), interleukin-6 (243 versus 9552 pg/mL), ferritin (1331 versus 5189 ng/ml) and d-dimers (3.68 versus 6.88 mcg/ml). No significant differences were found between survivors and non-survivors regarding peak values of erythrocyte sedimentation rate (69 versus 71 mm/1 h;P = .35) and fibrinogen (629 versus 645 mg/dL;P = .24) and also regarding the lowest lymphocyte count during hospitalization (519 versus 649/mmc;P = .80). The analysis using Fisher's exact test showed that deceased patients were significantly more associated with AKI KDIGO stage 2 or 3 (51.9%/63% versus 32.1%), with higher need for renal replacement theraphy (RRT) (68.8% versus 47.9%), with ICU (intensive care unit) admission (90.1% versus 22.3%) (Table 1). Moreover, death was associated more frequently with partial or absent renal function recovery (20%/50% versus 6.4%) (P < .05) (Table 1). In a logistic regression model (using KDIGO stages, serum urea and need for RRT), it was proved that only serum urea had a significant prediction power (P = .001): every increase of serum urea with 1 unit increases the risk of death by 1.007 times (95% confidence interval 1.003-1.011). CONCLUSION: Mortality of COVID-19 patients associating AKI is proportionally augmented by both markers of severity of SarS-CoV-2 and also by severity of AKI. In our study, the peak value of serum urea during hospitalization was the best predictor for death in COVID-19.
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BACKGROUND AND AIMS: Renal manifestations are common in hospitalized patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We report here the case of a patient with confirmed SARS-CoV-2 infection with the clinical picture of atypical haemolytic uremic syndrome (aHUS). METHOD: Case report RESULTS: Our case is a 31-year-old man with a nasopharyngeal swab with real-time reverse-transcriptase polymerase chain reaction (RT-PCR) for SARS-CoV-2 positive, who was hospitalized in the Clinic of Infectious Diseases. His medical history had a respiratory illness of 7-day evolution characterized by cough, fever, dyspnoea, muscle pain, nausea, vomiting and non-bloody diarrhoea, and decreased urine output with dark colour urine. The chest computed tomography (CT) scan showed few rounded ground-glass opacities. Laboratory tests at admission revealed the following: (i) acute kidney injury stage 3 with a serum creatinine of 3.85 mg/dL (basal value 0.9 mg/dL);serum urea 221 mg/dL. His urinary volume in the first 24 h of hospitalization was 800 mL. (ii) Severe haemolytic anaemia with haemoglobin (Hgb) level of 3.7 g/dL, and peripheral smear showing large number of schistocytes, haptoglobin <10 mg/dL and indirect bilirubin 9.7 mg/dL, direct coombs testing was negative;reticulocyte count 8.9%. (iii) Severe thrombocytopaenia with platelet count of 25 000/μL, prothrombin time 45%, international normalized ratio 1.7, D-dimer 1082 ng/dL and fibrinogen 880 mg/dL. Increased blood levels of enzymes and inflammatory markers were present: lactate dehydrogenase 1867 U/L and protein C reactive 9.1 mg/dL. Electrolyte disturbances characterized by hyperkalaemia, hyperphosphatemia, hypocalcaemia and severe metabolic acidosis. Dynamic changes of laboratory data are presented in Table 1. The usual liver panel tests, alkaline phosphatase, γ -glutamyl transferase and albuminemia were normal. Toxic hepatitis was excluded. Hepatobiliary and spleen imaging (ultrasonography) was normal. ELISA serologic tests for HIV, hepatitis B, hepatitis C virus and cytomegalovirus were negative. Serological and virological tests for hepatitis A, B, C, HIV and CMV were negative. Stool was negative for Shiga toxin-producing Escherichia coli (STEC). The results of antinuclear antibodies and anti-smooth-muscle antibodies were negative, C3 serum level was mildly depressed (82 mg/dL;normal range 88- 201 mg/dL) and C4 serum level was normal (20 mg/dL;normal range 10-44 mg/dL). ADAMTS13 activity was 90% on day 10. He was treated with broad spectrum antibiotics, intravenous dexamethasone and supportive therapy. One week from admission, renal function recovered, and 1 week after intravascular haemolysis and thrombocytopaenia recovered. The patient was hospitalized for 21 days. CONCLUSION: Close monitoring and early intervention can help for a better outcome of SARS-CoV-2 patients complicated with aHUS.
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Background: Coronavirus disease 2019 (COVID-19) first appeared in China in December 2019, and has become a global pandemic. Because the clinical progression of the disease is highly variable, better prediction of prognosis and mortality is important. In the present study, we investigated the role of procalcitonin/albumin ratio (PAR) as a new biomarker in predicting mortality in patients with COVID-19 infection. Methods: In this study, patients with COVID-19 diagnosis were enrolled from Sakarya Yenikent State Hospital and Ayancık State Hospital between 09.11.2020 and 04.05.2021. The demographic characteristics, biochemical and hematological parameters such as age, gender, length of hospital stay, and comorbidities of the patients were collected retrospectively from medical records. Results: Of the 105 patients, 51 were mild and 54 were critically ill. Between mild and critical cases, age, lymphocyte count, red cell distribution width, neutrophile count, mean corpuscular volume (MCV), monocyte count, albumin, C-reactive protein, ferritin, procalcitonin, D-dimer, and PAR were statistically different (p<0.001 for all). All patients in the critical group and only 2% of the mild group died. PAR showed the largest area under the curve (0.949) for the prediction of mortality (p<0.001). Conclusion: We report that PAR, a simple, cheap, and easily accessible biomarker, can be used to predict the prognosis in patients with COVID-19 infection.
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Background: Acute kidney injury (AKI) is one of the most common complications associated with mortality. Aim: This study aims to find the correlation between renal dysfunction and inflammatory markers and their outcome in COVID-19 patients. Methods: The study was carried out in 100 patients whose inflammatory markers were available on the day of admission among the 814 patients with COVID-19. Results: Fifty-six percent of patients had moderate, and 36% of patients had severe disease outcomes including mortality in nine patients. Out of all the factors studied, advanced age, presence of chronic liver disease, increased levels of blood urea, serum creatinine and lactate dehydrogenase (LDH), decreased creatinine clearance were found to be significantly associated with risk of mortality (P < 0.05). Out of all the factors studied, advanced age increased interleukin (IL)-6 values, increased serum ferritin values, and known cases of hypertension (HTN) were found to be significantly associated with the occurrence of AKI (P < 0.05). The death rate among those with AKI was more than double, i.e., 13.3% compared to only 5.5% without AKI. It was found that only IL-6 was significantly more in those who died having AKI compared to those who recovered with AKI (P < 0.05) but other inflammatory markers were not significantly associated with this (P > 0.05). Conclusion: Significant risk factors of AKI were advanced age, increased IL-6 values, increased serum ferritin values, and known cases of HTN. Significant risk factors for mortality were advanced age, presence of chronic liver disease, increased levels of blood urea, serum creatinine and LDH, decreased creatinine clearance.
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Background: Novel coronavirus disease caused by SARSCoV- 2, primarily manifest as an acute respiratory illness;however, it can also affect multiple organs, such as kidneys, heart, digestive tract, hematological and the nervous system. Acute kidney injury (AKI) has been reported in up to 25% of critically-ill patients with SARS-CoV-2 infection, especially in those with underlying comorbidities. Aim of the Study: To study the incidence of Acute Kidney Injury in hospitalized COVID-19 patients. Methods: This is a retrospective study conducted in Dept of Respiratory Medicine, KIMS Hospital and Research Centre, Bengaluru. A total of 1000 COVID patients were taken in the order of their admission to the hospital from Jan -May 2021. Blood urea and serum creatinine levels at the time of admission was collected. Ethical clearance was obtained from the institutional ethical committee. Results: Statistically significant correlation was found between the incidence of AKI and the COVID-19 disease severity and mortality. Correlation by Pearson 2 tailed shows a positive correlation with a value of 0.713. Patients with renal involvement had higher overall mortality compared with patients without renal involvement. Adverse short-term outcomes of renal involvement were associated with severity of COVID-19 pneumonia Conclusion: AKI could be used as a clinical characteristic in severity classification and risk stratification. Further investigation of the underlying mechanism of renal disease in COVID-19 would be needed to clarify possible therapeutic targets.
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As cardiovascular diseases are still a major cause of death in most countries, it is still relevant to look into treatment of such diseases. Dyslipidemia is one of the important identified risk factors for cardiovascular diseases. As this is largely driven by lifestyle and diet, it may be difficult to control it with lifestyle modifications alone. Currently, Statins remains to be the mainstay therapy for dyslipidemia but this is also met by problems within certain patient population. The drug may be contraindicated in certain patient groups;some patients tend to not respond to Statins;while certain patients may not tolerate the adverse events. This study looked into available literature on studies done on dyslipidemia using plant-based formulations using randomized clinical trial. Based on the review conducted, there are several plant-based formations with potential to be similar in efficacy to Statins. Some of the plants used are abundant or may be easily sourced. With the increasing popularity of food supplements or nutraceuticals, exploration on the potential of plant-based products is attractive. Despite the promising results of some studies, these will need further investigations and targeting a larger population size. Formulation options may need to be explored also focused on its stability. © RJPT All right reserved.
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Prevalence of pulmonary thromboembolism (PTE) is very high when we compare the coronavirus disease 2019 positive patients with the other patients who are admitted in intensive care unit for other different infection. Thorough evaluation of the different causative factors for PTE should be better evaluated and prevention can be tried accordingly. Incidence of subclinical PTE that can give rise to future cardiac disease needs to be studied and plan of action can be done accordingly. Newer modalities of detecting PTE using non-invasive or simple invasive techniques need to be investigated to cope up in pandemic situation.
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Background:As the knowledge about the risk factors and treatment options of COVID 19 is still evolving, we attempted to study the clinical characteristics, comorbidities and laboratory markers in 98 COVID nonsurvivors from a tertiary care centre in Tamilnadu. Methods: In this retrospective observational study, we included 98 cases of laboratory confirmed COVID non survivors in Velammal medical College Hospital and Research Institute, Madurai between June 20, 2020 to October 10, 2020. Information on demography, clinical features, risk factors, laboratory and radiological findings and treatment details was extracted from medical records. Results:A total of 98 patients (Median age 63 years, 73.5% males) were included. Comorbidities were present in nearly 80% of pa- tients, with hypertension being the most common comorbidity, followed by diabetes and coronary heart disease. The most common symptoms on admission were fever, cough and breathlessness. Biochemical and hematological markers taken at the time of admis- sion and 24 hours before death were analysed. Initial laboratory findings of non-survivors demonstrated higher WBC count, neutro- philia, lymphopenia, raised AST, ALT, ferritin, IL6 and procalcitonin. Throughout hospitalization, there was consistent rise in inflamma- tory markers and rise in blood urea and low serum albumin was observed. Low molecular weight Heparin, steroids, antiviral fabipiravir, azithromycin and noninva- sive ventilation was given in 70% patients. Patients who were intubated were ad- ministered tocilizumab in addition to the above treatment. Mean days of hospitali- zation was 9 days. Average survival time was 13 days. Most common cause of death was ARDS and respiratory failure. [Formula presented] Conclusions:This retrospective study identified the important laboratory markers which predicts mortality in adults. Progressive high neutrophil count, lymphocyto- penia, low serum albumin, elevated ALT, blood urea, raised LDH, D-dimer, ferritin and procalcitonin are significantly associated with mortality