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1.
J Am Coll Emerg Physicians Open ; 3(3): e12621, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1881406

ABSTRACT

Objective: During the winter, many patients present with suspected infection that could be a viral or a bacterial (co)infection. The aim of this study is to investigate whether the optimal use of procalcitonin (PCT) is different in patients with and without proven viral infections for the purpose of excluding bacteremia. We hypothesize that when a viral infection is confirmed, this lowers the probability of bacteremia and, therefore, influences the appropriate cutoff of procalcitonin. Methods: This study was conducted in the emergency department of an academic medical center in The Netherlands in the winter seasons of 2019 and 2020. Adults (>18 years) with suspected infection, in whom a blood culture and a rapid polymerase chain reaction test for influenza was performed were included. Results: A total of 546 patients were included of whom 47 (8.6%) had a positive blood culture. PCT had an area under the curve of 0.85, 95% confidence interval (95% CI) 0.80-0.91, for prediction of bacteremia. In patients with a proven viral infection (N = 212) PCT < 0.5 µg/L had a sensitivity of 100% (95% CI 63.1-100) and specificity of 81.2% (95% CI 75.1-86.3) to exclude bacteremia. In patients without a viral infection, the procalcitonin cutoff point of < 0.25 µg/L showed a sensitivity of 87.2% (95% CI 72.6-95.7) and specificity of 64.1 % (95% CI 58.3-69.6). Conclusion: In patients with a viral infection, our findings suggest that a PCT concentration of <0.50 µg/L makes bacteremia unlikely. However, this finding needs to be confirmed in a larger population of patients with viral infections, especially because the rate of coinfection in our cohort was low.

2.
Topics in Antiviral Medicine ; 30(1 SUPPL):175, 2022.
Article in English | EMBASE | ID: covidwho-1880683

ABSTRACT

Background: There is currently no approved treatment for patients with COVID-19 who have not been hospitalized, a setting in which early intervention may curb progression to more severe disease requiring hospitalization. We report longitudinal biomarker sampling from a Phase III (PINETREE) clinical trial to evaluate prognostic biomarkers of COVID-19 and to better understand the early remdesivir (RDV) treatment response. Methods: A Phase III, randomized, double-blind, placebo controlled, multicenter study was conducted to evaluate the efficacy and safety of RDV for outpatients with early stage COVID-19 who are at higher risk of disease progression (NCT04501952). Inclusion criteria were ≥60 years of age or ≥12 years of age with at least one risk factor for severe COVID-19 disease. All individuals had ≤7 days of symptoms prior to randomization. A total of 562 participants were randomized 1:1 to RDV or placebo. Serum and plasma were collected for biomarker analyses in 312 patients at days 1, 3, and 14 post-treatment. All biomarker values were adjusted for baseline age and stratified by sex. Results: RDV demonstrated an 87% reduction in risk for the primary composite endpoint of COVID-19-related hospitalization or all-cause death by day 28 (0.7% [2/279]) compared with placebo (5.3% [15/283]) (p=0.008). RDV treatment was associated with improved clinical outcomes in participants with higher risk of hospitalization or death from COVID-19, including individuals ≥60 years of age, males, and/or those with diabetes, obesity, and hypertension. Furthermore, we found that biomarkers associated with inflammation and coagulation, including lactate dehydrogenase (p<0.001) and procalcitonin (p<0.001), were prognostic for COVID-19 related hospitalization or all-cause death by day 28. Finally, we found that RDV improved some biomarkers associated with COVID-19 severity by day 3 of treatment, including peripheral lymphopenia, monocyte count, and decreased neutrophil-to-lymphocyte ratio compared to placebo (pWilcox<0.05). Conclusion: Our findings suggest that RDV treatment improves COVID-19 outcomes in high-risk SARS-CoV-2 infected individuals, particularly in those ≥60 years of age, male, and/or with diabetes, obesity, and hypertension. Biomarkers of COVID-19 severity that were prognostic for poor outcomes were identified in early infection. Furthermore, our results suggest that RDV treatment leads to more rapid recovery in the lymphopenia that is commonly associated with more severe COVID-19.

3.
Journal International Medical Sciences Academy ; 34(4):247-256, 2021.
Article in English | EMBASE | ID: covidwho-1880480

ABSTRACT

Background: Data on demographics, clinical presentation and outcome of COVID-19 in children is increasing day by day. Studies done in Europe states infected children develop less severe disease with a low case fatality rate, no such review is available from Asia. Methods: Adhering to the PRISMA (Preferred reporting items for systematic reviews and meta-analyses) guidelines a systemic review of the literature was performed looking for clinical characteristics of COVID-19 in the Asian pediatric population searching (PUBMED, SCOPUS, MEDLINE, and WHO -19 databases) from 01 January 2020 to 15 September 2020 to find any relevant article with medical subject headings (MeSH) terms like COVID-19, clinical characteristics, children, Asia, demography, outcome, management were used in different combinations. Results: We identified 26 case series across Asian countries consisting of 1664 pediatric patients. Asymptomatic children were 14.9 %. Fever 45.65 % and cough 32.62% were the most common symptoms. Contact history with confirmed COVID-19 positive children was 70.21%. Respiratory coinfection and other co morbidities were present in was present at 36.49 % and 14.09 % children respectively. Abnormal x-ray was observed in 52.1% children and ground-glass opacity were seen among 43.71% of abnormal CT scans. Abnormal laboratory data noted were leucocyte and lymphocytes count, C-reactive protein (CRP), Lactate dehydrogenase (LDH) and Procalcitonin. One death from COVID-19 was reported from our review. Conclusion: Children mostly acquired infection from adults, the course of the disease is usually milder, they have a good prognosis even with associated respiratory infections and co morbidities, and mortality rate is almost nil from Asia due to COVID -19 in our review.

4.
Topics in Antiviral Medicine ; 30(1 SUPPL):77-78, 2022.
Article in English | EMBASE | ID: covidwho-1880028

ABSTRACT

Background: A cytokine storm drives the pathogenesis of severe COVID-19 and has therefore prompted the use of cytokine/transduction pathway inhibitors in the treatment of disease. However, numerous markers with different mechanisms of action have been linked to mortality, complicating the understanding of disease pathogenesis and the elaboration of therapeutic strategies. Methods: Retrospective study on COVID-19 hospitalized subjects in the acute phase of disease. A broad range of cytokines (CD25, IL-18, TNF-α, TNF RI, TNF RII, GDF-15, IL-7, LIF, IL-6, CHITINASE3-LIKE1, RAGE and Pentraxin-3) was assessed on plasma samples (Luminex, ELISA) collected upon hospitalization. Subjects were divided into two groups according to their clinical in-hospital death (Survivors: S;Non-Survivors: NS). Comparisons between groups were performed by Fisher's exact test or Mann-Whitney U test as appropriate. The association between each variable and mortality was analysed through univariate and multiple logistic regression models. Subsequently, survival analysis was conducted with Cox proportional hazard models. Results: 77 hospitalised Covid-19 patients were enrolled: 42 S and 35 NS (Figure 1A). As expected, in the NS group we found a higher proportion of subjects with fever and dyspnoea upon admission, development of ARDS and need of PEEP respiratory support (Figure 1A). NS also displayed significantly higher blood neutrophils/lymphocytes, C-reactive protein, LDH and procalcitonin as well as lower PaO2/FiO2 and peripheral O2 saturation values at admission (Figure 1A). In keeping with these findings, CD25, IL-18, IL-6, TNF-α, TNFRI, TNFRII, GDF-15, IL-7, LIF and Chitinase3-Like1, Pentraxin-3 and RAGE were significantly higher in NS than S (Figure 1B) and were associated to mortality in univariate regression models. In the multivariate regression model GDF-15 and fever were the two more relevant features associated with mortality (Figure 1C). In the survival analysis GDF-15 was the strongest predictor of mortality (HR 2,26, 1,55-3,31;p<0,01 reference group bottom quartile Figure 1D, E). Conclusion: Our in-depth characterization of the cytokine storm demonstrates that GDF-15 is an independent predictor of Covid-19 mortality. Given the reported increase of this cytokine with age and its possible mechanistic role in various pathological conditions, our findings suggest that GDF-15 signalling pathway inhibitors may be included as possible therapeutic candidates for Covid-19.

5.
European Journal of Molecular and Clinical Medicine ; 9(3):2925-2930, 2022.
Article in English | EMBASE | ID: covidwho-1880008

ABSTRACT

Background: The incidence of mother-to-newborn Covid 19 transmission is low. However, data are limited on the factors associated with neonatal clinical or viral testing outcomes. This study aims at evaluation of clinical profile of neonates born to COVID positive mothers. Objective: To determine the number of neonates from 01 April 2020 to 30 August 2021 with lab confirmed COVID-19 infection born to Covid 19 positive mothers. To assess the clinical features of neonates born to Covid 19 positive mothers. Methods & Materials: Study design: Retrospective cohort study Study period: 01 April 2020 to 30 August 2021 Study Place: Gulbarga institute of medical science kalaburagi, Karnataka India. Conclusions: Perinatal covid 19 infection may have adverse effects on newborns causing problems such as fetal distress, premature labour, Hyperbilirubinemia, respiratory distress, oxygen requirement, sepsis, birth asphyxia and even death. However vertical transmission of Covid 19 is yet to be confirmed Aims and objectives: To determine the number of neonates from 01 April 2020 to 30 August 2021with RTPCR confirmed COVID-19 infection born to Covid 19 positive mothers. To assess the clinical features of newborns born to Covid 19 positive mothers. Inclusion criteria: All neonates born to Covid 19 positive mothers METHODS: Manual medical records of mother and baby were reviewed. Data on maternal demographic factors (age, residence, socioeconomic status), co morbidities, symptoms of COVID 19, Data on newborn demographic factors (gestational age, sex, birth weight, mode of delivery, Apgar score) were collected . All neonates born to covid 19 positive mother were reviewed for clinical and lab data till time of discharge. Clinical data such as respiratory distress, oxygen desaturation, poor feeding, apnea, seizures, tachycardia, fever, hypothermia, jaundice in those neonates was reviewed. Associated morbid factors such as Birth asphyxia, prematurity, relative sepsis were analysed. Lab data such as TLC, CRP, Sr Ferritin, Sr LDH, D-Dimer, Procalcitonin, RTPCR analysis of nasopharyngeal and throat swab of neonates born to covid positive mothers were reviewed. Chest x ray was reviewed. Those having clinical symptoms/ signs were admitted in NICU. Asymptomatic hemodynamically stable Covid19 negative neonates were isolated on mother side. Sample size: 200 neonates born to covid19 positive mothers. Sample size was determined based on the incidence of covid19 positive rates of neonates born to covid positive mothers, using formula 4PQ/L2. Results: Among these 200 pregnant women with confirmed Covid 19 infection, fever and cough were the common symptoms noted. Of the newborns born to these mothers, 92 were male neonates and 108 were female neonates, 153 were full-term neonates and 32 were born premature;15 were small-for-gestational-age (SGA) neonates. Clinically, the initial presentations in the neonates were respiratory distress(n=5) and failure to breathe at birth(n=4), but other presentations such as fever(n=1), poor feeding(n=3),rapid heart rate(n=4), hyperbilirubinaemia (n=5) abnormal Xray(n=3) and oxygen requirement(n=4) were also observed. All neonates were improved and discharged. Nasopharyngeal and throat swab specimens were collected from these neonates 2to3days after birth for Covid 19 RT-PCR tests, out of which 02 neonates showed positive results. One COVID-19 positive baby presented with failure to breathe at birth was treated with antiviral and antibiotics. The other baby also had similar presentation was treated with antiviral and oxygen. Both neonates improved and discharged.

6.
Bull Natl Res Cent ; 46(1): 54, 2022.
Article in English | MEDLINE | ID: covidwho-1875036

ABSTRACT

Background: COVID-19 outbreak has engulfed different parts of the world, affecting more than 163 million people and causing more than 3 million deaths worldwide due to human transmission. Thus, it has become critical to identify the risk factors and laboratory parameters to identify patients who have high chances of worsening clinical symptoms or poor clinical outcomes. Therefore, the study aims to identify inflammatory markers that can help identify patients at increased risk for progression to critical illness, thus decreasing the risk of any mortality. Our study focussed on the predictive utility of C-reactive protein, Interleukin-6, D-dimer and Procalcitonin in assisting the management of COVID-19 patients with adverse clinical effects. Through literature search in electronic databases, we included the retrospective studies that evaluated the biomarkers among confirmed COVID-19 patients before initiation of treatment and who had a definite outcome (dead or discharged). Biomarkers were expressed in standardized difference in mean value, calculated based on study sizes and mean values between survivors and non-survivors considered the effect size. We carried out a meta-regression analysis to identify the causes of the heterogeneity between the studies. Results: Number of studies eligible for C-reactive protein, D-dimer and Interleukin-6 markers were eight, seven and four, respectively. Using random effect model revealed that the overall effect size with 95% confidence interval (CI) for C-reactive protein, D-dimer and Interleukin-6 were 1.45 (0.79-2.12) milligrams/litre, 1.12 (0.64-1.59) micrograms/millilitre Fibrinogen Equivalent Units and 1.34 (0.43-2.24) picograms/millilitre respectively was statistically significant (P < 0.05) inferring that the mean scores of these marker were significantly higher among the non-survivors compared to the survivors. Two studies were eligible for Procalcitonin marker and there was no heterogeniety (I 2-statistics = 0) between these studies. Therefore, fixed-effect model revealed that the overall effect size (95% CI) for Procalcitonin was 0.75 (0.30-1.21) Nanograms/millilitre was also high among non-survivors. Conclusions: The study found that serum levels of C-reactive protein, Interleukin-6 and D-dimer showed significant elevation in non-survivors compared to survivors. Raised inflammatory markers aid in the risk stratification of COVID-19 patients and their proper management.

7.
Saglik Bilimleri Tip Dergisi, Firat Universitesi ; 36(1):19-24, 2022.
Article in English | GIM | ID: covidwho-1870600

ABSTRACT

Objective: In cases with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease clinical usefulness of serological tests remains uncertain. The study aimed to evaluate anti-SARS-CoV-2 antibody and some biochemical parameters such as leukocyte (WBC), neutrophil (NEU), lymphocyte (LYM), thrombocyte (PLT), erythrocyte (RBC), hemoglobin (Hb), ferritin, procalcitonin (PCT), C-reactive protein (CRP) and D-dimer in the patient specimens sent from the polyclinic and service/intensive care unit. Materials and Methods: A total of 110 patients' specimens sent from the polyclinic and from the service/intensive care unit were used. SARS-CoV-2 RT PCR, immunoassay SARS-CoV-2 antibody and other biochemical tests were assessed.

8.
Medicina (Kaunas) ; 58(6)2022 May 28.
Article in English | MEDLINE | ID: covidwho-1869705

ABSTRACT

Background and Objectives: Acute kidney injury (AKI) is a common complication in patients with coronavirus disease 2019 (COVID-19). We investigated the values of procalcitonin (PCT) and presepsin (PSS) for predicting AKI and 30-day hospital mortality in patients with COVID-19. Materials and Methods: We retrospectively evaluated 151 patients with COVID-19 who were admitted to the hospital via the emergency department. The diagnosis of AKI was based on the Kidney Disease: Improving Global Outcomes clinical practice guidelines. Results: The median patient age was 77 years, and 86 patients (57%) were male. Fifty-six patients (37.1%) developed AKI, and 19 patients (12.6%) died within 30 days of hospital admission. PCT and PSS levels were significantly higher in patients with AKI and non-survivors. The cutoff values of PCT levels for predicting AKI and mortality were 2.26 ng/mL (sensitivity, 64.3%; specificity, 89.5%) and 2.67 ng/mL (sensitivity, 68.4%; specificity, 77.3%), respectively. The cutoff values of PSS levels for predicting AKI and mortality were 572 pg/mL (sensitivity, 66.0%; specificity, 69.1%) and 865 pg/mL (sensitivity, 84.6%; specificity, 76.0%), respectively. Conclusion: PCT and PSS are valuable biomarkers for predicting AKI and 30-day hospital mortality in patients with COVID-19.

9.
Pakistan Journal of Medical and Health Sciences ; 16(4):343-345, 2022.
Article in English | EMBASE | ID: covidwho-1870357

ABSTRACT

Background: In individuals with coronavirus, a cytokine storm is an important cause of illness and demise. The purpose of the study was to assess whether pro-inflammatory cytokines had an impact on progression and risk of mortality in patients with COVID-19. Study Design: Retrospective study Place and Duration of Study: Intensive Care Unit (ICU) and Medical Wards, Bahria Town International Hospital from 21st August 2020 to 17th September 2021. Methodology: One hundred and thirty-six patients of confirmed cases of COVID-19 disease were enrolled. Their demographic, blood and biochemical parameters were collected within 48 hours after admission from the medical record of patients. Patients were divided into two groups according to the final outcome, the survivors and non survivors. The data were investigated to assess the prognostic importance of the blood marker and inflammatory variables for the prognostic importance. Results: The mean age and body mass index (BMI) were statistically higher in the non-survivors than in the survivors (p=0.017 and 0.03 respectively). For those with asthma and chronic obstructive pulmonary disease, the number was statistically higher in non-survivors (p = 0.002 and 0.04, respectively). The inflammatory markers concentrations of CPR, D. Dimer, serum ferritin, procalcitonin, and interleukin-6 were significantly higher within 48 hours of admission for non-survivors (p = 0.003, 0.007, <0.001, 0.015, and <0.001 respectively). Except ferritin levels, multi-variate logistic regression analysis exhibited that the CRP, D. Dimer, Procalcitonin and IL-6 were associated statistically significant higher risk of mortality (OR 1.235, p=0.007, 95% Cl 5.621-42.652, OR 1.906, p=0.003, 95% Cl 1.481-1.982, OR 3.967, p=<0.001, 95% Cl 4.256-23.981, and OR 7.589, p=0.009, 95% Cl 4.561-113.852 respectively). Conclusion: The inflammatory markers have the prognostic importance in patients suffering from covid-19 infection as we found higher levels of these markers were related with the poor prognosis.

10.
Vestnik Rossiiskoi Akademii Meditsinskikh Nauk ; 77(1):33-42, 2022.
Article in Russian | EMBASE | ID: covidwho-1870167

ABSTRACT

Background. The COVID-19 pandemic is associated with significant number of complications and mortality and a burden on the healthcare system. In 10–15% of hospitalized patients, the invasive and non-invasive mechanical ventilation (IMV/NIMV) is required. At the same time, it is important to stratify the risk of mechanical ventilation upon admission to the hospital. Aims — to identify clinical and laboratory risk factors for transfer to IMV and NIMV in hospitalized patients with COVID-19-associated pneumonia. Methods. A retrospective one-center nonrandomized study of 386 consecutive hospitalized patients with COVID-19-associated pneumonia was performed. The primary endpoints were IMV (n = 22) and NIMV (n = 28). Risk factors of artificial ventilation were considered for periods up to 14 and 28 days for both variants. To select a risk predictor, a univariate analysis based on Cox survival regression was performed, followed by multivariate analysis to determine risk factors at these time points. Results. After 28 days from admission the mortal exit was registered in 20 patients from 386 patients (5.2%). 22 patients (5.7%) were transferred to IMV, and 28 patients (7.3%) — to NIV, and 9 of the latter were transferred later to IMV. As a result of univariate and multivariate analyzes, the risk factors for transfer to mechanical ventilation on 14th day were: age > 65 years (OR = 5.91), a history of stroke (OR = 17.04), an increased serum level of urea (OR = 6.36), LDH (OR = 7.39), decreased sodium (OR = 12.32), GFR < 80 mL/min/1.73 m2 (OR = 13.75) and platelets (OR = 4.14);on the 28th day — age > 65 years (OR = 4.58), J-wave on the ECG (OR = 2.98), an increase of LDH (OR = 9.99) and a decrease in albumin (OR = 2.77) in serum. Predictors of the transfer of patients with COVID-19 to NIV within the period up to 14 days from the beginning of hospitalization were the age > 65 years (OR = 5.09), procalcitonin level in the blood > 0.25 ng/ml (OR = 0.19), leukocytes > 11×109 (OR = 19.64) and increased LDH (OR = 3.9). Conclusions. In patients with COVID-19, the risk factors for transfer to IMV/NIVL in the period of 14 and 28 days from the beginning of hospitalization were identified, which enable patient’s mechanical ventilation stratification and to plan respiratory support resources.

11.
Journal of Pioneering Medical Sciences ; 11(1):3-7, 2022.
Article in English | Web of Science | ID: covidwho-1865922

ABSTRACT

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 Ayancik 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), monocvte 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.

12.
Archives of Rheumatology ; 37(1):150-152, 2022.
Article in English | EMBASE | ID: covidwho-1863739
13.
Lung India ; 39(SUPPL 1):S235, 2022.
Article in English | EMBASE | ID: covidwho-1857809

ABSTRACT

Introduction: In 1977 Birt, Hogg and Dube described Birt-Hogg-Dubé syndrome (BHDS)as an dermatological syndrome.It is an autosomal dominant inherited disease, the gene responsible for the syndrome was cloned in 2002. Only 663 affected families have been reported in literature, To date, 152 unique pathogenic FLCN gene mutations in 616 families have been reported in worldwide;approximately 90% of these mutations were reported in Europe and the United States. It consists of the typical triad - skin lesions, pulmonary cysts, and renal tumors. This syndrome usually goes underdiagnosed since all these different clinical features treated by different specialities. This leads to longdelay in making the correct diagnosis from the first onset of the symptoms. There are many studies which have shown that the prevalence spontaneous pneumothorax ,bullous emphysema, thin-walled cysts are increased in these patients. Case report: A 39 year old male presented with complaints of mild fever for 5 days duration and shortness of breath for 1 day. Fever was continuous in nature, not associated with chillls and rigor. He denied history of diabetes mellitus, hypertension, tuberculosis , bronchial asthma .He was evaluated for covid 19. RT PCR for covid 19 came positive. HRCT chest was done. HRCT showed bilateral peripheral and peribronchovascular non lobar distribution of ground glass opacities with septal thickening in bilateral lung parenchyma. The CT severity score was 14/25. HRCT also showed multiple thin walled cyst in both lungs, largest measuring 22 X 27mm. Few subcentrimetric pre/paratracheal , prevascular and sub carinal lymph nodes was noted.His oxygen saturation was 89% on room air. He was admitted and started on oxygen inhalation via face mask and was managed medically. Relevant blood investigation and bio markers for COVID 19 were done. Reports were total count 3570, differential count N51L35M11E1.8B0.6., Hb 15.4 G/dl, platelet count of 2.14 lakhs/mm3, ESR 16 mm/hr, d dimer 0.77mg/l, LDH 203 U/L, CRP 21.774mg/l, procalcitonin 0.122ng/ml. 3 days later dyspnea aggravated and he was started on non invasive ventillation ( BiPAP). His clinical condition was stable on NIV. On the fifth day of NIV, he started developing subcutaneous surgical emphysema. HRCT chest was done, showed gross left and mild right pneumothorax, moderate pneumomediastinum, multiple focal patchy and confluent ill defined areas of ground glass and reticular densities predominant in basal and peripheral distribution involving bilateral lung parenchyma, diffuse subcutaneous emphysema extending into neck spaces.CT severity had increased to 17/25. He was managed by Intercostal chest tube insertion on left 5th intercostal space in mid axillary line connected to a underwater seal. He improved clinically with subcutaneous emphysema resolving in the next 3 days. He was later discharged and his chest tube was removed on followup. We conclude that Birt-Hogg-Dubé syndrome can be a rare cause of secondary pneumothorax in a patient with multiple skin follicles and having multiple cyst in HRCT.

14.
Lung India ; 39(SUPPL 1):S244-S245, 2022.
Article in English | EMBASE | ID: covidwho-1857745

ABSTRACT

Objectives: This study aims to evaluate different clinical and blood biochemical characteristics of 100 post-COVID patients admitted in Department of Pulmonary Medicine MLN Medical College Prayagraj. Methods: In this single centre post-COVID observatory study, 100 patients were included and divided to mild, moderate and severe/critical groups. Their clinical sign and symptoms and blood biochemical markers were analyzed. Results: Our findings suggested that post-COVID patients had varying degree of breathlessness requiring specific oxygen therapy. Other clinical features include marked muscle weakness, lethargy, sleeplessness and forgetfulness. Majority of them had uncontrolled diabetes and hypertension in terms of co-morbidities. In blood biochemical characteristics we observed that majority of patients had raised levels of D-Dimer, S.ferritin, S.LDH, S.procalcitonin, ESR and CRP. Maximum of them had raised PT-INR, TLC, SGOT, SGPT, RBS, urea and creatinine level. Some of them also had electrolytes disturbances in terms of deranged sodium and potassium levels. Conclusion: POST- COVID patients had different clinical and blood biochemical characteristics which indicates multiple organ dysfunction. Severe patient's group had age > 50 years, co-morbidities in terms of uncontrolled diabetes and hypertension, markedly increased D-Dimer, S.LDH, S.ferritin, ESR, CRP, PTINR levels and deranged liver and kidney function of varying degrees. These blood biochemical indicators could reflect the severity of disease to a certain extent and should be considered in clinical management of the disease. Some of the parameters like D-Dimer, S.LDH, S.Procalcitonin, lymphopenia may also be a prognostic indicator.

15.
Arab Gulf Journal of Scientific Research ; 39(Special Issue):48-59, 2021.
Article in English | Scopus | ID: covidwho-1857350

ABSTRACT

Background: Coronavirus disease 2019 (COVID-19) associated inflammatory cytokine storm that worsens COVID-19, relies heavily on the inflammatory response. IL-6, a TH1 cytokine, PCT and CRP have been linked to serious illness and a higher mortality rate. We further tried to evaluate the role of these indicators and their association with clinical severity in COVID-19 patients. Material and Methods: Eighty-three consecutive patients with age ≥18 years with RT-PCR test positive for SARS-CoV-2 were included in the study. Demographic characteristics (age and sex), underlying co-morbidities, symptoms, physical findings, and laboratory tests of the patients were recorded. All patients were categorized as having mild, moderate, and severe COVID-19 disease, according to the Indian Council of Medical Research (ICMR). The levels of IL-6 and PCT were estimated by electrochemiluminescence immunoassay (ECLIA) using Cobas-e411 Immunoassay System, and Quantitative CRP was done by Unicorn-230 automated biochemistry analyzer to find out their correlation with disease severity and outcome. Multiple Regression was performed to find out factors associated with the adverse outcome of the disease. Result: Mean age of patients was 51 years. IL-6, CRP, and PCT levels increased in 73 %, 68.0 %, and 8.2 % patients on admission, respectively. The most common co-morbidity associated with the disease was hypertension (25%), followed by diabetes (24%) and respiratory disease (15%). Increased IL-6, CRP, and PCT levels were found in 77 percent, 79 percent, and 20 percent of patients, respectively. We found that IL-6 (P≤0.05), CRP (P≤0.05), and PCT (P≤0.05) were significantly raised in COVID-19 patients with increasing severity of the disease. The Area under the receiver operating characteristic (AUROC) of these parameters ranged between 0.65 and 0.8 (IL-6, 0.828;CRP, 0.809;and PCT, 0.658), indicating a reliable biomarker to assess clinical severity. Conclusion: Sequential measurement of blood levels of IL-6, CRP, and PCT levels is useful in determining the severity and predicting the outcome of the patients with severe disease. IL-6 and CRP have an independent prognostic value. On the other hand, the importance of normal PCT concentrations in patients with viral pneumonia needs to be studied further. © 2021, Arabian Gulf University. All rights reserved.

16.
Pakistan Armed Forces Medical Journal ; 71(6):2131-2134, 2021.
Article in English | Scopus | ID: covidwho-1841855

ABSTRACT

Objective: To explore the relation of Interleukin-6 and Procalcitonin with COVID-19 severity on high resolution computerized tomogram (HRCT) chest. Study Design: Randomized Control Trial (NCT04945811). Place and Duration of study: Pathology Department, Combined Military Hospital Quetta, from April 2020 to May 2021. Methodology: Serum Interleukin-6 and Procalcitonin of 100 consenting COVID-19 positive patients from April 2020 to May 2021 were assessed at Pathology department Combined Military Hospital Quetta and their levels were correlated with severity of lung involvement on HRCT Chest Results: Serum Interlukin-6 levels were significantly raised in 97 patients with mean levels of 20.43 ± 19.66 (pg/ml). Serum procalcitonin levels were also significantly raised in 95 patients with mean levels of 0.43 ± 0.24 (ng/ml). Conclusion: Interlukin-6 and procalcitonin are important biomarkers for diagnosis and predicting severity of COVID-19 pneumonia. © 2021, Army Medical College. All rights reserved.

17.
Pakistan Journal of Medical Sciences ; 38(5), 2022.
Article in English | EMBASE | ID: covidwho-1822610

ABSTRACT

Objectives: To determine the association between the laboratory biomarkers (C-reactive protein (CRP), Ferritin, lactate dehydrogenase (LDH), Procalcitonin, and D-dimer) with complications and in-hospital mortality in COVID-19 patients. Methods: This single-center, cross-sectional study was conducted at the Department of Emergency Medicine of Aga Khan University Hospital from April 01, 2020, to July 31, 2020. Descriptive statistics were presented as Mean±SD and Median along with Range. The frequencies and percentages were calculated for all categorical variables. Univariate and multivariate analysis was carried out to evaluate the significant association between the laboratory biomarkers and in-hospital mortality. Results: A total of 310 adult COVID positive patients were included. The most common complication was acute respiratory distress syndrome (ARDS) (37.1%), followed by myocardial injury (MI) (10.7%), deep vein thrombosis (DVT) (0.6%), and pulmonary embolism (PE) (0.3%). In-hospital mortality was 15.2%. In univariate analysis, it was observed that increased values of all biomarkers were significantly associated with the prediction of in-hospital mortality using binary logistic regression analysis (OR > 1.0, P <0.05). In multivariate analysis, increased levels of LDH and D-dimer at admission were significantly associated with increased odds of mortality (P <0.05). Conclusion: Serum CRP, ferritin, Procalcitonin, LDH, and D-dimer levels at the time of admission can predict complications like ARDS and MI and also predict mortality in COVID-19 infection. Serum LDH and D-dimer are the best amongst them for predicting mortality.

18.
Open Forum Infect Dis ; 9(5): ofac179, 2022 May.
Article in English | MEDLINE | ID: covidwho-1821760

ABSTRACT

Admission procalcitonin measurements and microbiology results were available for 1040 hospitalized adults with coronavirus disease 2019 (from 48 902 included in the International Severe Acute Respiratory and Emerging Infections Consortium World Health Organization Clinical Characterisation Protocol UK study). Although procalcitonin was higher in bacterial coinfection, this was neither clinically significant (median [IQR], 0.33 [0.11-1.70] ng/mL vs 0.24 [0.10-0.90] ng/mL) nor diagnostically useful (area under the receiver operating characteristic curve, 0.56 [95% confidence interval, .51-.60]).

19.
Diagn Microbiol Infect Dis ; 103(4): 115721, 2022 May 04.
Article in English | MEDLINE | ID: covidwho-1819473

ABSTRACT

Our objectives were to evaluate the role of procalcitonin in identifying bacterial co-infections in hospitalized COVID-19 patients and quantify antibiotic prescribing during the 2020 pandemic surge. Hospitalized COVID-19 patients with both a procalcitonin test and blood or respiratory culture sent on admission were included in this retrospective study. Confirmed co-infection was determined by an infectious diseases specialist. In total, 819 patients were included; 335 (41%) had an elevated procalcitonin (>0.5 ng/mL) and of these, 42 (13%) had an initial bacterial co-infection. Positive predictive value of elevated procalcitonin for co-infection was 13% while the negative predictive value was 94%. Ninety-six percent of patients with an elevated procalcitonin received antibiotics (median 6 days of therapy), compared to 82% with low procalcitonin (median 4 days of therapy) (adjusted OR:3.3, P < 0.001). We observed elevated initial procalcitonin in many COVID patients without concurrent bacterial co-infections which potentially contributed to antibiotic over-prescribing.

20.
Pakistan Journal of Medical and Health Sciences ; 16(3):289-291, 2022.
Article in English | EMBASE | ID: covidwho-1819182

ABSTRACT

Introduction: Corona virus disease 2019 (COVID-19) is currently diagnosed mainly using reverse transcriptase polymerase chain reaction (RT-PCR). Yet a significant proportion of patients have negative RT-PCR result. A comparative study of RT-PCR negative patients with RT-PCR positive patients will help understand clinical characteristic and differences of this diseased population. Objective: To compare the clinical and laboratory features of RT-PCR Positive and RT-PCR negative patients admitted in high dependency unit. Patients and methods: In this retrospective cohort study, the data of 128 patients (59 patients with RT-PCR positive result and 69 patients with RT-PCR negative results) was obtained. These patients had been admitted in high dependency unit of a community hospital. Demographics, clinical characteristics and laboratory abnormalities were noted and a comparison was done using statistical analysis. Results: In our study-total 128 patients were enrolled out of which 68 (53.1%) were males and 60 (46.9%) were females. 59 (46.1%) patients were RT-PCR positive and 69 (53.9%) patients were RT-PCR negative. Median age was 55.34 years (18 to 95). No significant difference was noted in most of clinical symptoms (fever, sputum production, rhinorrhea, dyspnea, myalgia, nasal congestion, vomiting, diarrhea, urinary symptoms, altered level of consciousness), comorbidities (diabetes mellitus, hypertension, prior lung disease, prior ischemic heart disease, prior kidney disease), laboratory abnormalities (elevated creatinine, elevated liver enzymes, elevated ferritin, elevated C-reactive protein, elevated d-dimers, elevated procalcitonin, abnormal electrocardiogram). Cough was significantly found to be more prevalent in RT-PCR positive patients (p=0.042) and severe disease was also more prevalent in these patients significantly (p=0.000). Conclusion: Our study shows that patients admitted and diagnosed to be suffering from COVID-19 infection had remarkable similarities in clinical features and laboratory parameters regardless of RT-PCR status, however RT-PCR positive patients suffered from more severe pneumonia as compared to RT-PCR negative patients.

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