COVID-19 Vaccine: Knowledge and Acceptance among Obstetric Population in Garhwal Region of Uttarakhand

Background: Coronavirus disease-2019 (COVID-19) poses expectant mothers to a higher risk of serious complications and mortality. Following a risk-benefit review, a number of governmental and professional bodies from across the globe recently approved the COVID-19 vaccination during pregnancy. Aim(s): This study aimed to investigate knowledge, actual acceptance, and concerns about the COVID-19 vaccine among the obstetric population. Material(s) and Method(s): Participants were selected from among the expecting women who came for antenatal checkup during the study period (October 1, 2021-November 30, 2021). About 150 pregnant women who met the inclusion criteria and consented were recruited into the study. Data related to socio-demographic and clinical characteristics as well as knowledge, actual acceptance, and concerns about COVID-19 vaccine were collected through in-person interviews using a prestructured questionnaire. The SPSS version 23 was used to analyze data. The association between the attitude (acceptance and hesitance) of participants toward the COVID-19 vaccine and their sociodemographic and clinical profile was found by Fisher's exact test. Result(s): The actual acceptance of the COVID-19 vaccine among expecting women was 52.0%. The primary motive for accepting COVID-19 immunization was to protect the fetus, followed by the protection of one's own health. A significant association was found between COVID-19 vaccine acceptance and the level of education, socio-economic status, and presence of comorbidities. The leading causes for vaccine reluctance were concerns about the efficacy and safety of the vaccines and lack of awareness about their usage during pregnancy. Conclusion(s): Multifaceted activities are required to promote the effectiveness and safety profile of the COVID-19 vaccine as well as disseminate knowledge about its usage during pregnancy. Clinical significance: Unlike numerous other studies that have investigated the accepting attitude only, the present one has investigated the actual COVID-19 vaccine uptake among the obstetric population.Copyright © The Author(s).

Sonographer led one-stop neck lump clinic - 3 year review

A sonographer led one-stop neck lump clinic was introduced three years ago to support patient flow, improve two week wait times and provide quicker access to fine needle aspiration (FNA). The clinic was designed with a biomedical scientist support to provide immediate results regarding FNA adequacy. The objective of the audit was to provide an overview of the service and to identify any further areas of development. A retrospective audit was performed of all patients who attended the one-stop neck lump clinic within the 3-year period. CRIS records were used to obtain details of the scan type, any pathology identified, who performed the scan and whether FNA was performed. Histology of all FNAs was reviewed to form part of the final diagnosis and provide results on adequacy. Each 12-month period was reviewed and compared;special consideration was made to see if the service had been affected by COVID-19. Numbers attending the clinic over the 3-year period have remained similar with no impact due to COVID-19 other than the initial reduction in the first two weeks of the first 'lockdown'. The number of patients attending who had significant/malignant pathology also remained stable over the three years (approx. 20% of all attendees) although there seems to have been a shift with more thyroid pathology in year 3. The clinic was not significantly impacted by COVID-19 and is continuing to provide a good level of service to support the ENT team with quick access to FNA also enabling discharge of patients with benign findings at the same appointment.

Coronavirus Disease 2019 and Thyroid Diseases.

Since the outbreak of coronavirus disease 2019 (COVID-19), a number of COVID-19 related thyroid disorders have been reported, including subacute thyroiditis, autoimmune thyroid disease, non-thyroidal illness syndrome and some unexplained thyroid dysfunction. This review aimed to summarize clinical characteristics of COVID-19 related thyroid disorders and to discuss some possible mechanisms.Copyright © 2022, Peking Union Medical College Hospital. All rights reserved.

Italian Association of Clinical Endocrinologists (AME) 20th National Congress

The proceedings contain 9 papers. The topics discussed include: dulaglutide and NAFLD risk reduction;correlation between plasmatic long pentraxin PTX3 and nodular thyroid disease: a preliminary report;the fructose-bisphosphate aldolase a act as autoantigen in primary autoimmune hypophysitis;cortisol deficiency in Lenvatinib treatment;side effects of mitotane treatment: a retrospective study in 35 patients with adrenocortical carcinoma in adjuvant therapy;non-functioning pituitary adenoma: do predictor factors exist?;incidence and features of adrenal crisis in a series of 133 patients with Addison's disease;serological evidence and self-reported outcomes in patients with adrenal insufficiency during the first waves of COVID-19 in the North-East Italy;and persistent effects of spironolactone after its withdrawal in patients with hyperandrogenic skin disorders.

Emergency visits of otorhinolaryngology department during COVID-19 pandemic, Saudi Arabia, 2020

Aim: In this study, we aimed to assess the frequency of patient emergency visits to the Otorhinolaryngology (ORL) Department during coronavirus COVID-19 pandemic and compare it with that before coronavirus COVID-19. Material(s) and Method(s): A retrospective comparative study was performed at Al-Al-Hada Armed Forces Hospital, Taif (Saudi Arabia), and data regarding various diagnoses of ORL cases were collected from medical records of patients who visited/admitted to ORL-ED during the lockdown (Group 1) and those who visited/ admitted to ORL-ED before the pandemic (Group 2). Result(s): Group 2 had a significantly higher percentage of cases who had no ENT-related disorders, hypertrophy inferior turbinate (HIT), stridor, obstructive sleep apnea (OSA), epistaxis and who had no complications, had general ENT, foreign body ingestion-aspiration, trauma, otology and who had more than one disorder and Group 1 had a significantly higher percentage of those having nasal obstruction, tonsil hypertrophy grade 3, had emergency head and neck cancer, had deep neck space infections and who had complicated. Discussion(s): During coronavirus COVID-19 pandemic period, cold ENT visits were much less and foreign body ingestion remains the highest reason for ENT visits. Additionally, telemedicine has been shown to be effective in reducing ED visits during the pandemic period. Furthermore, older cases with chronic ENT problems who had regular follow-up ENT visits were less likely to visit ED during the pandemic.Copyright © 2022, Derman Medical Publishing. All rights reserved.

Analysis of Prolonged Caesarean Section Response Time in True Emergency Obstetric Care during Covid-19 Pandemic Era: Study at Kariadi Tertiary Hospital Indonesia

Intro: COVID-19 pandemic era makes quality of obstetric triage care including caesarean section in obstetric true emergency cases delayed. Maternal fetal triage index (MFTI) score is an instrument used to define true emergency in obstetric cases. Decision to delivery interval (DDI) is time interval from caesarean section decision to delivery within <30 minutes standard in emergency cases.This study was designed to evaluate the decision to delivery time interval and its effect on perinatal outcomes and the associated factors during category-1 emergency caesarean section deliveries. Method(s): A prospective observational descriptive study was conducted from 2020-2022 at Kariadi tertiary Hospital. A total of 40 clients who were undergone category-1 emergency caesarean section were included in this study. This is a indepht analysis pregnant women confirmed with COVID-19 infection and had true emergency cases based on MFTI score (stat-priority 1). Finding(s): Among 346 pregnant women with COVID-19, total 160 C-section cases with 40 eligible data were included in this study. Gestational age mostly in their second and third trimester. Maternal comorbidities were diabetes in pregnancy, HIV, pre eclampsia, SLE and thyroid disease. This study showed that DDI <30 minutes were found in 34 cases (85%), DDI 30-60 minutes as many as 6 (15%), and no (0%) DDI >60 minutes. Emergency cases with the shortest DDI were umbilical cord prolapse 3 (100%), fetal distress 14 (93%), placental abruption 5 (83%), impending uterine rupture 5 (83%), and antepartum hemorrhage 7 (70%). Perinatal outcome were Apgar score lower than 7 at 1 minutes (25%) and stillbirth (5%). Conclusion(s): Most of DDI in this study met the recommendation of <30 minutes, but some cases did not meet the standard. This can be caused by multifactorial factors such as advice from the doctor in charge, patient transfer distance, operating room preparation, and anesthetic preparation due to COVID-19.Copyright © 2023

A Case of Primary Biliary Cirrhosis With New Onset Hyperthyroidism and Supratherapeutic INR

Introduction: Hyperthyroidism is known to increase catabolism of vitamin-K-dependent clotting factors (II, VII, IX, X) and increase the response of vitamin K antagonists, usually warfarin. Primary biliary cirrhosis (PBC) has been associated with thyroid dysfunction (TD), especially with autoimmune thyroid disease. In the below case, a patient with known PBC on warfarin is found to have severely elevated INR related to new-onset hyperthyroidism with clinical consequences of hemorrhage including upper GI bleed. Case Description/Methods: A 64-year-old female with PBC and antiphospholipid antibody syndrome on warfarin was admitted for hemorrhagic epiglottitis requiring emergency intubation and supratherapeutic INR. Her PBC was diagnosed as stage II on biopsy 23 years ago and has remained clinically stable on ursodiol therapy. On presentation, the patient was tachycardic, tachypneic, and had O2 saturations <90% on HFNC prior to intubation. Physical exam significant for larger goiter with diffuse upper airway swelling. She was admitted and found to have COVID-19 infection, INR .16.0 and PT>200.0 (limit of lab), WBC of 22.8, and lactate of 2.5. LFTs WNL aside from albumin of 2.0. TSH was <0.0017 (limit of lab) and free T4 of 3.4, free T3 of 5.3. TSH receptor antibody (TRAB) and thyroid stimulating immunoglobulin (TSI) levels were normal. Her last TSH was normal a year ago. CTA chest found a 5.7cm heterogeneous, partially calcified superior mediastinal mass consistent with multinodular thyroid goiter. Patient was initially given prothrombin complex concentrate and vitamin K with correction of INR over the following few days. She was extubated and started on methimazole. During the hospital course, she was found to have coffee ground emesis for which an EGD was done with findings of non-bleeding gastric ulcer (Forrest Class IIc) and LA Grade D esophagitis with adherent clot and bleeding for which hemostatic spray was applied. Patient was discharged a few days later following resumption of warfarin and on pantoprazole and methimazole. Discussion(s): The above case demonstrates a rare case of PBC and new-onset hyperthyroidism due to multinodular thyroid goiter causing significantly elevated INR in the setting of warfarin use with hospital course complicated by GI bleed. PBC is associated with TD - hyperthyroidism, hypothyroidism, and thyroid cancer. Hyperthyroidism is less commonly associated with PBC compared to other TDs but should be considered especially with a finding of elevated INR.

Subacute Thyroiditis Following Vaccination with COVID-19 mRNA Vaccine

Introduction: Subacute thyroiditis is a self-limiting post-viral inflammatory disorder occurring in 3 phases (hyper-, hypo-, and euthyroidism) Post-vaccine thyroiditis has also been reported, but is rare. Case Description: A 36-year-old Emirati female presented to our clinic with generalized fatigue, mild to moderate vague neck pain, intermittent palpitations, and loss of appetite 2 weeks after receiving her first dose of Pfizer-BioNTech mRNA vaccine against COVID-19. Clinical examination findings and laboratory test results were consistent with subacute thyroiditis. Patient is a mother of 5 healthy children, youngest is breast-fed infant (11 months old). There was no history suggestive of postpartum thyroiditis and no family history of thyroid dysfunction. Physical examination at initial visit showed mild tachycardia, and a normal blood pressure. She weighed 66 kg. Thyroid function tests revealed a suppressed TSH of 0.011 muIU/mL, high Free T4 of >100 pmol/l), and Free T3 FT3 of 29.6 pmol/L. Both TSH receptor antibodies, and Thyroid antibodies (TPO) were negative. Thyroid scintigraphy showed decreased uptake in both lobes. Thyroid ultrasound showed hypoechoic heterogeneous echotexture of the thyroid gland with vascular conglomerate and micro-calcification, along with normal sized reactive lymph nodes at sternal angle. Symptoms aggravated through the next week;patient dropped 3kg of her body weight and her palpitations increased, with a recorded resting heart rate between 120-130 beats/min. TSH decreased to 0.001muIU/mL while FT4 remained high, with an improvement to 90 pmol/L. Subsequently, the patient started to regain weight. Palpitations improved within a month. She developed a biochemically hypothyroid picture followed by clinical and biochemical euthyroidism after one more month. Second dose of the vaccine was uneventful. Last evaluation was 10 months later;TSH, FT3 and FT4 were all in normal range, acute-phase reactants were completely normal and in complete remission. Discussion(s): The exact mechanism for post-vaccination subacute thyroiditis remains unknown, vaccine adjuvants may induce diverse autoimmune and inflammatory reaction. Subacute thyroiditis has rarely been reported with other COVID-19 vaccines contains no Polyethylene glycol (PEG). A possible cross-reactivity between thyroid cell antigens and spike protein of the coronavirus produced by mRNA vaccines might be responsible. Further research is needed to investigate the incidence of subacute thyroiditis in COVID-19 pandemic days.Copyright © 2023

Thyroiditis Post COVID-19 mRNA Booster Dose Vaccination

Introduction: SARS-CoV-2 vaccines have been associated with thyroid dysfunction including thyroiditis and Graves' disease. We report a patient who developed thyrotoxicosis secondary to thyroiditis after COVID-19 mRNA booster dose vaccination. Case Description: A 74-year-old man with no known personal or family history of thyroid disorders went to his primary care physician with symptoms of palpitations. Of note, he had the first booster (third dose) of the Pfizer/BioNTech vaccine about 1 week before. He did not recall any similar symptoms after the first two doses of the same vaccine. There were no other symptoms of thyrotoxicosis such as hand tremors, weight loss or mood change. There was no family history of thyroid disorders. He was not on any medications such as amiodarone and was not taking any herbal supplements. He did not have any symptoms of upper respiratory tract infection. There was no neck pain. Physical examination was unremarkable with no goiter or thyroid eye manifestations. Thyroid function: free T4 elevated at 46.7 pmol/L (11.5-22.7) and TSH suppressed at 0.01 mIU/L (0.5-4.5). Thyroid stimulating immunoglobulin was positive at 200% (50-179). He was initially started on carbimazole 15mg daily. However, the patient became rapidly hypothyroid despite dose reduction and subsequent discontinuation of carbimazole with free T4 of 8 pmol/L and TSH of 36.4 mIU/L. An ultrasound of the thyroid gland showed vascularity with no discrete nodules. No thyroid uptake scan was done. The diagnosis was revised to thyroiditis post vaccination. Hypothyroidism persisted despite discontinuation of carbimazole before recovery 8 months later. Patient was well and did not require any thyroxine supplementation. Discussion(s): It is postulated that COVID-19 vaccines triggered thyroiditis via an autoimmune inflammatory syndrome caused by the vaccine adjuvants. A high index of suspicion is necessary and a thyroid uptake scan may be useful in making the diagnosis. Thyroiditis is a self-limiting condition and recognising it is important as no specific thyroid treatment is necessary in most patients. Patients should not be deterred from subsequent vaccination as COVID-19 infection has higher mortality risk than thyroiditis.Copyright © 2023

Knowledge and Practices of Disinfectants and Sanitizers Use during COVID-19 Pandemic in Jordan

Background: The use of antimicrobials has been expanded during the COVID-19 pandemic. This study aims to assess the knowledge and practices of disinfectants and sanitizers use among Jordanian people during the (COVID-19) pandemic. Methods: A web-based cross-sectional descriptive questionnaire was distributed across Jordan between August and September 2020. The questionnaire consisted of three sections inquiring about demographics and general characteristics of the surveyed sample, evaluating the respondents' knowledge about disinfectants, as well as respondents' practices. The questionnaire was completed by 403 literate adult respondents. Results: Our results indicate that Jordanian adults have used disinfectants increasingly during the COVID-19 outbreak. Knowledge of our study sample was considerably affected by gender (p=0.044), income (p=0.001), and profession (p<0.001). 80.8% of those participants reported skin-related side effects due to disinfectant use during the pandemic. The most used disinfectants were ethanol, followed by soap and water. Generally, study respondents showed positive practices toward the use of disinfectants during the time of the pandemic with few high-risk practices reported. Interestingly, the positive practices applied by Jordanian adults were minimally and not significantly affected by the knowledge about antimicrobials' safe and effective use. Conclusions: There is an urgent need for a structured effort to increase public awareness regarding the safe and effective use of disinfectants against SARS-CoV-2 transmission. © 2023 DSR Publishers/The University of Jordan.

ANTIBODIES TO ANGIOTENSIN-CONVERTING ENZYME 2 IN INFERTILE PATIENTS WITH A HISTORY OF COVID-19 AND IN FERTILE WOMEN.

Angiotensin-converting enzyme 2 (ACE2) is a key component of the renin-angiotensin system (RAS) that affects fertility in women. Antibodies against ACE2 have predictive value for COVID-19 and may contribute to RAS dysregulation and reproductive failure. Objective(s): To investigate the prevalence and levels of anti-ACE2 autoantibodies in infertile patients with a history of COVID-19 and in fertile women. Material(s) and Method(s): Serum anti-ACE2 autoantibodies (M, G) were determined by ELISA in infertile patients with a history of COVID-19 (group 1, n=121), without a history of COVID-19 (group 2, n=79), and in fertile women (group 3, n=80). The association between antibodies against ACE2, SARS-CoV-2, thyroid antigens, and hormones was investigated. Result(s): Patients in groups 1 and 2 had higher rates of inflammatory gynecologic diseases, pelvic surgery, spontaneous miscarriages, and thyroid pathology than those in group 3. Anti-ACE2 antibodies were detected more frequently (40.5% and 38.8 %) and had higher levels in infertile patients than in fertile women (20%). Women with a history of COVID-19 were more likely to have anti-ACE2 IgG. Antibodies against ACE2 were significantly correlated with those against FSH. Conclusion(s): Patients with infertility, irrespective of a history of COVID-19, have a higher prevalence and higher anti-ACE2 antibody levels than fertile women. Anti-ACE2 antibodies are associated with primary and secondary infertility, and may be involved in the pathophysiology of infertility.Copyright © A group of authors, 2023.

Subacute thyroiditis following recovery from COVID-19 infection: novel clinical findings from an Eastern Indian cohort.

OBJECTIVE: Recent reports have suggested a link between COVID-19 infection and subacute thyroiditis (SAT). We aimed to describe variations in clinical and biochemical parameters in patients developing post-COVID SAT. DESIGN: Ours was a combined retrospective-prospective study on patients presenting with SAT within 3 months of recovery from COVID-19 infection, who were subsequently followed up for a further 6 months since diagnosis of SAT. RESULTS: Out of 670 patients with COVID-19, 11 patients presented with post-COVID-19 SAT (6.8%). Those with painless SAT (PLSAT, n = 5) presented earlier, had more severe thyrotoxic manifestations and exhibited higher C-reactive protein, interleukin 6 (IL-6), neutrophil-lymphocyte ratio and lower absolute lymphocyte count than those with painful SAT (PFSAT, n = 6). There were significant correlations of total and free T4 and total and free T3 levels with serum IL-6 levels (pall <0.04). No differences were observed between patients with post-COVID SAT presenting during the first and second waves. Oral glucocorticoids were needed for symptomatic relief in 66.67% of patients with PFSAT. At 6 months of follow-up, majority (n = 9, 82%) achieved euthyroidism, while subclinical and overt hypothyroidism were found in one patient each. CONCLUSIONS: Ours is the largest single-centre cohort of post-COVID-19 SAT reported until, demonstrating two distinct clinical presentations-without and with neck pain-depending on time elapsed since COVID-19 diagnosis. Persistent lymphopaenia during the immediate post-COVID recovery period could be a key driver of early,painless SAT. Close monitoring of thyroid functions for at least 6 months is warranted in all cases.

The prognostic properties of thyroid disorders, hypothyroidism, and hyperthyroidism in predicting COVID-19 poor outcomes: A systematic review and diagnostic meta-analysis

Purpose: The relationship between thyroid metabolism and coronavirus disease 2019 (COVID-19) inflammation has been extensively investigated. This meta-analysis aimed to evaluate the prognostic properties of unspecified thyroid disorders, hypothyroidism and hyperthyroidism for predicting poor COVID-19 outcomes. Method(s): We conducted systematic literature searching through multiple databases-PubMed, EBSCO and CENTRAL up until 27 September 2021. The main exposure was unspecified thyroid disorders, hypothyroidism or hypothyroidism on-admission status. The outcome of interest was the COVID-19 composite poor outcome that comprises severity, mortality, ICU admission and hospitalisation. Result(s): There were 24517 patients from 20 studies. Meta-analysis showed that thyroid disorder, regardless of its type, was associated with COVID-19 poor outcome (OR 2.92 (95% CI 2.09 - 4.08), P < 0.001;I 2 = 71%, P < 0.001). Unspecified thyroid disorder has a sensitivity of 0.17 (0.08-0.33), specificity of 0.94 (0.88-0.97) and Area Under Curve (AUC) of 0.66. Hypothyroidism has a sensitivity of 0.24 (0.12-0.42), specificity of 0.92 (0.87-0.96) and AUC of 0.77. Hyperthyroidism has a sensitivity of 0.05 (0.02-0.11), specificity of 0.98 (0.88-1.00) and AUC of 0.36. In this pooled analysis, the posttest probability of unspecified thyroid disease, hypothyroidism and hyperthyroidism were 42%, 27% and 8% for poor outcomes, respectively. Conclusion(s): Thyroid disorders are associated with poor COVID-19 prognosis.Copyright © 2022 Authors. All rights reserved.

The Relationship of Hyponatremia with Il-6 and Implications on Clinical Outcomes in Covid-19 Patients Admitted at University Santo Tomas Hospital, January to August 2021

Introduction: COVID-19 is a droplet-transmitted infection with clinical manifestation ranging from mild disease to cytokine storm. The cytokine storm is an exaggerated response of the human body in which excessive amounts of inflammatory markers are released leading to multiple organ failure. In COVID-19, the most common electrolyte disorder noted is hyponatremia. Hyponatremia results from an increase in cytokines including IL-6 can result in the release of anti-diuretic hormone causing a decrease in serum sodium. Hyponatremic patients were observed to have increased risk for ICU admission, mechanical ventilation and mortality as compared to normonatremia. The inflammatory markers including serum ferritin, procalcitonin, IL-6, HsCRP, LDH, and D-dimer have been imperative as prognostic markers to help guide healthcare workers in the classification of severity, thereby guiding management. This study aims to investigate the association between serum sodium and serum IL-6 and aims to establish the role of serum sodium as an alternative cost-effective prognostic marker for COVID-19. Method(s): This is a retrospective cohort study done at the University of Santo Tomas Hospital via chart review of all confirmed COVID-19 patients admitted from January to August 2021. Data gathered included patient's age, gender, pertinent co-morbidities, day of illness on arrival, serum Na, PF ratio, chest radiograph, IL-6 levels on admission. The outcome of each case was recorded: oxygen supplementation, need for hemoperfusion, need for tocilizumab, COVID classification, days until clinical recovery, discharged, or expired. Corrected serum was used to account for effect of serum glucose on serum sodium. Serum sodium and IL-6 levels were compared to check the relationship between the two. Hyponatremia was studied in line with the poor outcomes. COVID-19 patients admitted at the COVID ward of USTH, January to August 2021 was the target population of the study. Those excluded were patients with chronic kidney disease patients, chronic hyponatremia, malignancy, uncontrolled thyroid disease, liver cirrhosis, on diuretics, with gastrointestinal losses and incomplete records. [Formula presented] Results: Of the 322 admitted COVID-19 patients, 154 were included with 89 (58%) having poor outcomes. Hyponatremia was seen in 60 (38.9%) of the population while 48 (53.93%) had poor outcomes. Serum sodium and IL-6 have an inverse relationship is not statistically significant. Patients with hyponatremia were 4.46 times more likely to require high oxygen support, 4.16 times more likely to need hemoperfusion, and 60.71% times more likely to have ICU admission. Hyponatremia was shown to have a 94.12% likelihood need for tocilizumab, 3.87 times more likely to result in severe or critical COVID-19 and 3.78 times more likely to expire. Overall, hyponatremia was 5.17 times more likely to have poor clinical outcome in comparison to normonatremia. Conclusion(s): Serum sodium cannot replace serum IL-6 as an inflammatory marker, but could be considered as a potential prognostic marker for COVID-19 when inflammatory markers are not available. COVID-19 patients with hyponatremia have a higher predisposition to increased disease severity. Including serum sodium in scoring systems could help signal to the health care providers that a more aggressive treatment approach would be indicated, thus aiding physicians in managing patients more effectively. No conflict of interestCopyright © 2023

'Long covid' is more common, underestimated, and 'core' health issue in post covid care setting: study of 6000 cases in tertiary care setting in India

Methods: observational study, included 6000 COVID-19 indoor cases confirmed with RT-PCR. Retrospective analysis with treatment records, laboratory markers as IL-6, D-dimer, Ferritin, LDH, BSL, HBA1C. All cases undergone thorough interview in 'post covid care' outdoor setting regarding symptomatology, documnted vital signs abnormality, & workup as HBA1C, BSL, TFT, KFT, ECG, chest x-ray, HRCT thorax, BMD, Echocardiography, MRI brain whichever is necessary. Statistical analysis by using Chi square test and ANOVA. Observations: Long covid manifestations were documented in 36.06% (2517/6000) post COVID cases as- Fatigue 41.95%, dyspnea 35.98%, cough 31.96%, chest discomfort 26.95%, anosmia 8.76%, joint pain & headache 11.96% , dizziness, vertigo&insomnia 22.95% &alopecia 4.18% cases, Lung fibrosis in 16.66%, minimal lung abnormality 23.65%, pulmonary embolism 7.18% cases, palpitations 25.56%, chest pain 11.3%, arrythmias 5.53%, cardiac dysfunction 24.31%, PTSD 28%, Impaired memory with or without poor concentration (brain fog) 24.03%, Anxiety and or depression 6.33%, Reduction in quality of life 33%, Diabetes mellitus-new onset26%, transient34%, uncontrolled27%, Osteoporosis38.08%, thyroid dysfunction12.1%. CT severity score, Intensive care treatment with or without oxygen and or ventilator use & Laboratory parameters (D-dimer, IL6, LDH, Ferritin) during hospitalization has significant association with long covid manifestations (p<0.00001) Conclusion(s): Long covid in underestimated, improperly evaluated and halfheartedly treated during follow-up. All treated cases needs prompt evaluation, more awareness regrding its manifestations and its impact on quality of life is must.

ANTIBODIES TO ANGIOTENSIN-CONVERTING ENZYME 2 IN INFERTILE PATIENTS WITH A HISTORY OF COVID-19 AND IN FERTILE WOMEN.

Angiotensin-converting enzyme 2 (ACE2) is a key component of the renin-angiotensin system (RAS) that affects fertility in women. Antibodies against ACE2 have predictive value for COVID-19 and may contribute to RAS dysregulation and reproductive failure. Objective(s): To investigate the prevalence and levels of anti-ACE2 autoantibodies in infertile patients with a history of COVID-19 and in fertile women. Material(s) and Method(s): Serum anti-ACE2 autoantibodies (M, G) were determined by ELISA in infertile patients with a history of COVID-19 (group 1, n=121), without a history of COVID-19 (group 2, n=79), and in fertile women (group 3, n=80). The association between antibodies against ACE2, SARS-CoV-2, thyroid antigens, and hormones was investigated. Result(s): Patients in groups 1 and 2 had higher rates of inflammatory gynecologic diseases, pelvic surgery, spontaneous miscarriages, and thyroid pathology than those in group 3. Anti-ACE2 antibodies were detected more frequently (40.5% and 38.8 %) and had higher levels in infertile patients than in fertile women (20%). Women with a history of COVID-19 were more likely to have anti-ACE2 IgG. Antibodies against ACE2 were significantly correlated with those against FSH. Conclusion(s): Patients with infertility, irrespective of a history of COVID-19, have a higher prevalence and higher anti-ACE2 antibody levels than fertile women. Anti-ACE2 antibodies are associated with primary and secondary infertility, and may be involved in the pathophysiology of infertility.Copyright © A group of authors, 2023.

ANTIBODIES TO ANGIOTENSIN-CONVERTING ENZYME 2 IN INFERTILE PATIENTS WITH A HISTORY OF COVID-19 AND IN FERTILE WOMEN.

Angiotensin-converting enzyme 2 (ACE2) is a key component of the renin-angiotensin system (RAS) that affects fertility in women. Antibodies against ACE2 have predictive value for COVID-19 and may contribute to RAS dysregulation and reproductive failure. Objective(s): To investigate the prevalence and levels of anti-ACE2 autoantibodies in infertile patients with a history of COVID-19 and in fertile women. Material(s) and Method(s): Serum anti-ACE2 autoantibodies (M, G) were determined by ELISA in infertile patients with a history of COVID-19 (group 1, n=121), without a history of COVID-19 (group 2, n=79), and in fertile women (group 3, n=80). The association between antibodies against ACE2, SARS-CoV-2, thyroid antigens, and hormones was investigated. Result(s): Patients in groups 1 and 2 had higher rates of inflammatory gynecologic diseases, pelvic surgery, spontaneous miscarriages, and thyroid pathology than those in group 3. Anti-ACE2 antibodies were detected more frequently (40.5% and 38.8 %) and had higher levels in infertile patients than in fertile women (20%). Women with a history of COVID-19 were more likely to have anti-ACE2 IgG. Antibodies against ACE2 were significantly correlated with those against FSH. Conclusion(s): Patients with infertility, irrespective of a history of COVID-19, have a higher prevalence and higher anti-ACE2 antibody levels than fertile women. Anti-ACE2 antibodies are associated with primary and secondary infertility, and may be involved in the pathophysiology of infertility.Copyright © A group of authors, 2023.

Prevalence of Ophthalmic Manifestations in COVID-19 Positive Indoor Patients during Second Wave at Rural Tertiary Care Hospital of Gujarat: A Prospective Observational Study

Introduction: Coronavirus Disease-2019 (COVID-19) can affect multiple system of body including eye. In eye, it can cause mild conjunctivitis, posterior segment involvement, neurosensory involvement and lethal opportunistic infection like mucormycosis. Associated co-morbidities, severity of COVID-19 infection and corticosteroids used in its management can affect ophthalmic involvement. Aim(s): To determine the frequency and various types of ophthalmic manifestation of patients with COVID-19. Material(s) and Method(s): This prospective observational study was conducted on indoor patients of Shree Krishna Hospital, a rural, tertiary care hospital affiliated with Pramukh Swami Medical College, Karansad, Gujarat, India, from 1st May 2021 to 1st January 2022. Second wave of COVID-19 was from 13th March 2021 to 19th June 2021. Patients' demographic data, details of COVID-19 infection severity score, oxygen requirement, use of corticosteroids, history of various co-morbidities and stages of Rhino-Orbital-Cerebral Mucormycosis (ROCM) (if present) were noted. Bedside ophthalmic examination was done with torch light, fluorescent strip, cobalt blue light of direct ophthalmoscope and fundus examination with indirect ophthalmoscopy under institutional COVID-19 guidelines. Descriptive Statistics {Mean, (SD), Frequency, (%)} were used for analysis of the collected data. Result(s): Out of 649 COVID-19 patients, 368 were male and 281 were female with mean age of 52.58 (+/-15.38) years. All over prevalence of ophthalmic manifestations was 9.86% (n=64 out of 649 patients). A total of 63 patients (9.71%) did not require any oxygen supplement, 352 patients (54.24%) required nasal prongs, 201 patients (30.97%) required non invasive ventilator support and 33 patients (5.08%) required mechanical ventilation. The 378 patients (58.24%) received cortico-steroids in oral or intravenous form. A total of 325 patients (50.1%) had diabetes,267 patients (41.1%) had hypertension, 29 patients (4.5%) had chronic kidney disease and 15 patients (2.3%) had thyroid disease. A total of 52 patients (8.01%) had conjunctivitis. Mean age of patients with conjunctivitis was 50.04 (+/-15.28) with male preponderance (n=30, 57.7%). Most common systemic presentation was fever (n=29,55.8%). Patients with conjunctivitis had high D-dimer (>500 ng/mL) (n=42;80.8%) and C-Reactive Protein (CRP) values (>3 mg/L) (n=39;75%). A total of 144 patients (22.2%) were vaccinated with COVID-19 vaccine first dose while ten patients (19.23%) out of 52 patients having conjunctivitis were vaccinated. Out of 649 patients, prevalence of ROCM was 1.85% (n=12) with mean age 58.58 years (+/-9.71 years) and male preponderance (n=8, 66.66%). Nine out of twelve patients had high blood sugar levels (mean level 340 mg/ dL) at the time of admission. Out of twelve, eight patients had received corticosteroids for management of COVID-19 infection. Six patients of ROCM (50%) did not require any oxygen support while two patient (16.7%) required nasal prongs for mean 7.50 days and four patient (33.3%) required non invasive ventilator support for mean 7.33 days (+/-2.5 days). One patient had stage 2C disease, one had stage 3B, five patients had stage 3C while five patients had stage 4C disease. Conclusion(s): Ocular manifestations of COVID-19 range from conjunctivitis to ROCM. Conjunctivitis has mild and self-limited course while ROCM is sight threatening and life-threatening condition, if not treated appropriately.Copyright © 2023 Journal of Clinical and Diagnostic Research. All rights reserved.

Thyroid dysfunction reflects severity of COVID-19 pneumonia in hospitalized patients

Introduction: Coronavirus disease 2019 COVID-19 is clearly the pandemic of the new millennium. COVID-19 determines multi organ dysfunction including the inflammatory immune responses of thyroid gland. Objective(s): To determine whether the involvement of the thyroid gland by COVID-19 manifests as thyroid hormonal changes and development of thyroid disorders. Method(s): We studied prospectively 60 patients with COVID-19 pneumonia,without previous known history of thyroid disease nor pre-existing endocrine disorders, hospitalized between May and July 2021, and we performed serum thyroid hormonal analysis within the first 24 hours after admission, including TSH, Free T3, Free T4 and their antithyroglobulin antibodies (Anti-TG and Anti-TPO), and correlate them with clinical and laboratory data. Result(s): Samples were collected from 60 patients (31 males, 51.7%). 32 out of 60 (53.3%) showed significantly lower values of TSH (0,29 +- 0,07 mIU/mL) with decreased Free T3 serum levels (2,07 +- 0,131 pmol/L) and the thyroid autoantibodies (both Anti-TG and Anti-TPO) were positive. These 32 patients (27 males) demonstrated moderate to critical illness and they needed high oxygen flow. The other 28 patients with no evidence of thyroid abnormalities showed mild to moderate COVID-19 pneumonia and none needed high oxygen flows. Conclusion(s): In our study, 32/60 (53.3%) patients with moderate to severe COPVID-19 pneumonia were diagnosed with thyroid abnormalities. Thus, the development and the progression of respiratory failure due to SARS-COV-2 may affect the thyroid function.

COVID-19 Could Be More Severe and Fatal in the Octogenarian and Nonagenarian Population in Intensive Care Unit

Objectives: In this study, it was aimed to determine demographic and clinical characteristics, supportive treatments in intensive care unit (ICU), mortality rates and factors affecting mortality by grouping COVID-19 intensive care patients as octogenarian and nonagenarian groups, and patients younger than 80-years-old. Method(s): The patients aged >=18 years diagnosed with COVID-19 with PCR positivity in ICUs between March 19, 2020 and March 31, 2021 were included in this retrospective observational study. Result(s): Of the 1004 PCR positive patients, 58.7% were male. The youngest patient was 20, the oldest patient was 100-years-old. There were 738 patients in Group 1 (20-79 years) and 266 patients in Group 2 (>=80 years). Between the two groups, gender, APACHE II score, need for intubation, need for vasopressor/inotrope, and patients in need of care were higher in Group 2 (p<0.001 for all). Only the patients in Group 1 were established ECMO. Hypertension (HT), cardiovascular, respiratory and neurological diseases, number of comorbidity, and mortality rate were higher significantly in Group 2 (p<0.001, p=0.001, p=0.006, p<0.001, p<0.001, and p<0.001;respectively). Age, male gender, HT, intubation, and vasopressor/inotrope requirement were found to be predictors of mortality. Conclusion(s): COVID-19 may have a more severe and fatal course in the octogenerian and nonagenerian age group with high comorbidity in the ICU.©Copyright 2022 by The Cardiovascular Thoracic Anaesthesia and Intensive Care.