Comparison of T Lymphocyte Subsets and Natural Killer Lymphocytes in Moderate Versus Severe COVID-19 Patients.

Severe respiratory involvement that follows a process of immune dysregulation and intense cytokine production remains to be the most dreaded complication of Coronavirus Disease-2019 (COVID-19) infection. The aim of this study was to analyze T lymphocyte subsets and natural killer (NK) lymphocytes in moderate and severe cases of COVID-19 infection and assess their significance in disease severity and prognosis. Twenty moderate cases and 20 severe cases of COVID-19 were studied and compared regarding blood picture, biochemical markers, T lymphocyte population subsets, and NK lymphocytes, which were determined by flow cytometric analysis. On analyzing the flow cytometric data of T lymphocyte cells and their subsets and NK cells in two groups of COVID-19 infection (one group moderate and the other severe cases), some immature NK lymphocyte relative and absolute counts were higher in the severe patients with worse outcome and death, while some mature NK lymphocyte relative and absolute counts were depressed in both groups. Also, interleukin (IL)-6 was significantly higher in severe cases when compared to moderate cases, and there was a positive significant correlation between immature NK lymphocyte relative and absolute counts and IL-6. There was no statistically significant difference between T lymphocyte subsets (T helper and T cytotoxic) with disease severity or outcome. Some immature NK lymphocyte subsets contribute to the widespread inflammatory response that complicates severe cases of COVID-19; therapeutic approaches directed to enhancing NK maturation or drugs that block NK cell inhibitory receptors have a potential role in controlling COVID-19 induced cytokine storm.

Psychological Impact of COVID-19 in Hemodialysis Patients

BACKGROUND AND AIMS The COVID-19 pandemic has required containment measures in Morocco, as well as practice changes in haemodialysis centres. Haemodialysis patients are at risk of aggressive symptoms of COVID-19, which significantly increases mortality. This particular situation creates psychological disorders in those patients, such as anxiety, sleep disorders and irritability. The objective of our study is to assess the mental health status of haemodialysis patients during the pandemic and the psychological impact of confinement. This assessment will allow the adaptation of a supportive relationship with the patient through adequate psychological management. METHOD This is a mono-centric, non-interventional study that included all haemodialysis patients at the haemodialysis centre of the nephrology department at Ibn Rochd University Hospital during the confinement period (March 2020–June 2020).This study is based on a pseudonymized paper questionnaire, during confinement, based on two psychiatric scores (GAD-7, PHQ-9) that assess anxiety, depression as well as sleep disorders, which allowed us to collect socio-demographic data, anxiety depressive symptomatology and an assessment of sleep disorders. RESULTS The average age of our population is 47.4 years old, 54% of whom are men. Almost 34.54% have a primary level of education The higher level of education was 14.45%, while 14.54% are illiterate. Regarding family status, 45% are married. Those who are living alone accounted for 55%. Before confinement, 57.15% patients were daily workers;10 others had no work, among 3 of them were students;the 5 others were managers. After starting haemodialysis, 65.7% patients stopped their work. We noted that 38% of patients had a feeling of nervousness and anxiety for several days, while 9% had the same symptoms for more than half of the day. Concerning excessive anxiety, it was noted in 34% of patients for several days, while 16% showed excessive anxiety for more than half of the days. Concentration difficulties were noted in 41% of the patients for over several days and 5% more than half of days, while 58% of patients never had difficulties of concentration. The irritability feeling over several days was noted in 43% of patients, while 5.4% presented a feeling of irritability more than half of the days. Difficulty falling asleep is noted in 49% of patients, while 51% of patients have no difficulty falling asleep. The feelings of sadness, depression and despair are noted in 49% of patients for several days and 5% for more than half of the days. Sleep disorders were noted in 60% of patients on several days, while 40% had sleep disorders on more than half of the days. Loss of appetite was noted in 65% of patients. A lack of self-confidence was noted for several days in 43% of patients. 29% of patients lost the pleasure of having fun for several days. A total of 36% were slow or restless for several days. None of our patients expressed a desire to end their life, and 49% did not lose the pleasure of doing their daily activity. CONCLUSION The mental health of dialysis patients assessed appears to be unaffected during this first wave of the pandemic. This could be due to high resilience, higher unemployment among dialysis patients, a reduced impact of social distancing on the haemodialysis population, strict precautionary measures and perceived support from health workers, who can all contribute to addressing this pandemic.

Profile Of COVID-19 Patients who Developed Acute Kidney Injury in Intensive Care: Multicentre Study

BACKGROUND AND AIMS The SARS-COV-2 acute respiratory distress fyndrome, which is the source of the infection known as coronavirus disease (COVID-19), spread rapidly, causing a pandemic that not only severely affected human health but also restricted the activities of daily living and weakens the global economy. Organs other than the lungs can be affected, including the kidneys. The incidence of acute kidney injury (AKI) in hospitalized patients with COVID-19 disease has been reported to range from 0.5% to 80%;thus, a better understanding of the pathophysiology of AKI during COVID-19 is crucial to manage and improve the survival of patients who develop an acute kidney injury (AKI) attributed to COVID-19 is a common complication of severe cases and is further associated with high mortality;and there is glomerular involvement associated with COVID-19, characterized in some cases by collapsing glomerulopathy or by tubular necrosis in other cases. The objectives of our study are to determine the incidence and describe the risk factors as well as the evolution of AKI in patients admitted for pulmonary infection with COVID-19 in intensive care unit. METHOD This is a retrospective and descriptive study, spanning a period from March 2020 to December 2020. In this study, we were collected all patients hospitalized in intensive care unit for a COVID-19 infection who have developed an AKI in the different regions of the Kingdom of Morocco: ✓ Northern region (Tangier) ✓ Central region (Fez) ✓ Southern region (Marrakech) ✓ North East region (Rabat-Salé) ✓ South East region (Grand Casablanca) Western region (Oujda). Inclusion criteria: All patients hospitalized in intensive care for COVID-19 infection and having developed an AKI (creatinine increase of 25% compared with baseline creatinine). Exclusion criteria: patients known ESKD before admission. RESULTS Our study included 4261 patients hospitalized in intensive care in the different cities of Morocco;among them, 1495 (1/3) presented an AKI or 35.09%, the average age of our patients was 68.5 years or (25–99), with a male predominance or a sex ratio of 3 men to a woman. The clinical characteristics in patients hospitalized in intensive care having presented an AKI on COVID-19. There is hypertension in 80% of cases, diabetes in 75% of cases, the association of hypertension and diabetes in 63% of cases, coronary heart disease in 10%, epilepsy in 1% and lymphoma in 0.5% of cases. The biological characteristics of these patients: We found hypernatremia with an average of 145 mmol/L, an elevated CRP with an average of 199.25, an average of creatinine at 69.9 mg/L and an average of urea at 1.8 g/L. Incidence and severity of AKI: ➢ In our study, which included 4261 patients, a third of them developed an AKI, i.e. 1495 patients. ➢ In addition, the time between admission and diagnosis of AKI is 4 days, i.e. a median time between (2 and 15), while the time between diagnosis of AKI and dialysis is 3.8 days or (1–15). ➢ The median peak of plasma creatinine in non-dialysis patients is 29 mg/L, i.e. (15–67), while the median peak of plasma creatinine in patients requiring dialysis is 69 mg/L, i.e. (15–175). Mortality: The outcome was fatal in all patients requiring extra renal treatment, with 100% mortality. CONCLUSION AKI is a complication that appears to be common in patients with severe SARS-CoV-2 infection, associated with a poor prognosis. Nephroprotection measures should be put in place to prevent the occurrence of AKI. Any patient hospitalized with SARS-CoV-2 should undergo an initial nephrologic evaluation, including proteinuria and urine sediment examination.