ABSTRACT
The pandemic of coronavirus 19 (COVID-19) infection has presented the clinicians with a challenge never experienced on this scale before. Although coagulopathy has been well described in association with COVID-19 infection, some recommendations have emerged so far for the potential role of empiric anticoagulation in specific situations. We describe a case of a middle-aged male with extensive acute lower limb ischemia and severe pneumonia related to COVID-19 infection. This case highlights the role of prophylactic anticoagulation in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection regardless of co-morbidities and D- dimer levels.
ABSTRACT
Introduction Coronavirus disease 2019 (COVID-19) has become a global threat to public health. The current study investigates alterations in the biological estimates concerning the severity, recovery, mortality, and assessment of treatment-based outcomes. Methods A case series of 165 COVID-19 patients admitted to OMI Institute (a tertiary care hospital) was conducted between May and August 2020. The data regarding demographic characteristics, comorbid conditions, radiographic abnormalities, biological estimations, symptoms, treatment, disease progression, complications, and outcomes were recorded using a structured questionnaire. Laboratory estimations included complete blood count (CBC), renal and electrolyte profile, liver function tests (LFTs), hematological indices, and inflammatory markers. Chest X-ray, electrocardiogram (ECG), and a high-resolution computed tomography (HRCT) scan were also performed, and data were extracted from the medical records. Analysis was done using the Statistical Package for the Social Sciences (SPSS) version 22.0. Results Out of the 165 COVID-19 patients, 79.4% recovered and were successfully discharged, while 20.6% of inpatient died. The patients' mean age was 56.03 ± 15.96 years, with a male majority (55.1%). The most common comorbid conditions were diabetes and hypertension; fever and dry cough were among the most frequently reported symptoms. The chest imaging findings among the severe/critical COVID-19 patients showed extensive bilateral patchy opacities. The median laboratory investigations, including neutrophil-to-lymphocyte ratio (NLR) (14.83), C-reactive protein (CRP) (7.4 mg/dl), lactate dehydrogenase (LDH) (786 IU/L), ferritin (1401.15 mcg/ml), and mean oxygen saturation (88.25%), were significantly altered among cases with increased disease severity and those who expired (p<0.05). The proportion of acute respiratory distress syndrome (ARDS) and sepsis development was significantly high among severe/critical COVID-19 patients (p<0.05). Treatment with tocilizumab, remdesivir, doxycycline, ivermectin, enoxaparin sodium, and steroids was deemed to be potentially effective treatment options in terms of reducing COVID-19 severity and chances of recovery. Furthermore, age (OR 1.05; p=0.047), presence of comorbidity (OR 8.471; p=0.004), high NLR, LDH (final outcome) (OR 1.361 and 1.018; p<0.05), and CRP levels (midpoint) (OR 1.631; p=0.05) were identified as the strong predictors of death among COVID-19 patients. Conclusion The study identified several alterations in the clinical profile of the COVID-19 patients concerning severity during the hospital stay, affecting prognosis. Clinically, tocilizumab, remdesivir, doxycycline, ivermectin, enoxaparin sodium, and steroids were identified as potential therapeutic options for COVID-19 due to their ability to alter disease-associated severity and recovery rate.
ABSTRACT
The spectrum of coronavirus disease (COVID-19) continues to evolve as time passes. In the majority of those infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), apart from fever, respiratory and gastrointestinal symptoms, involvement of other systems, such as cardiovascular and neurological system has also been described. Association between COVID-19 disease and a multisystem inflammatory syndrome in children and adolescents (MIS-C) has now been well defined. However, in adults there are sparse case reports describing a similar phenomenon. This has led to the development of preliminary case definitions for this disease, based on clinical manifestations, laboratory criteria and recent SARS-CoV-2 exposure or infection. Here we present a case of 28-year-old man who presented with high grade fever, rash, gastrointestinal and neurological symptoms fulfilling the criteria of MIS-C with a prior COVID-19 infection and recovered completely in 6 weeks after receiving steroid therapy.
