Long-term persistent symptoms of COVID-19 infection in patients with diabetes mellitus.

Objective: The study aimed to assess the long-term persistent symptoms of patients with diabetes mellitus (DM) and COVID-19 infection at 9 months after acute infection. Methods: This single-center cross-sectional study was conducted from May 20 to June 1, 2021. Results: A total of 112 patients were included in the present study. The most frequently reported persistent symptoms among DM group were fatigue (p = 0.01), shortness of breath (p = 0.01), and chest pain (p = 0.02) compared to non-DM group. Sulfonylurea use was associated with persistent cough (p = 0.04). Conclusion: Long-term persistent symptoms of COVID-19 infection are common among patients with DM.

Blood indices, in-hospital outcome and short-term prognosis in patients with COVID-19 pneumonia.

The predictive role of blood indices in coronavirus disease 2019 (COVID-19) related in-hospital adverse outcomes and post-recovery status is not fully defined. The main aim was to assess the association of complete blood indices measured at baseline with COVID-19 related in-hospital clinical outcomes, including length of hospital and intensive care unit (ICU) stay, receiving mechanical ventilation, degree of lung injury and in-hospital death, and post-recovery status. This retrospective study included patients with newly diagnosed COVID-19 infection from August 20, to September 25, 2020. The initial study cohort included 127 patients with newly diagnosed COVID-19. Of whom 26 patients were excluded, leaving 101 patients for final analysis. low lymphocytes % [Odds ratio and confidence intervals = OR (CI)] [0.2(0.0-0.2, p=0.03] increased the odds of ICU stay length while high platelet mean volume (PMV) [0.9 (1.1-5, p<0.00], high platelet distribution width (PDW) [0.3(0.4-1.9), p<0.00], and low lymphocytes % [0.2 (0.0-0.2), p=0.02] increased the odds of length of hospital stay. Decreased lymphocytes % showed significant independent association with increased risk for mechanical ventilation use [0.9 (0.9-1), p=0.04], extensive degree of lung injury [0.2 (0.1-0.7), p<0.00], and in-hospital death [0.5 (0.3-0.8), p=0.01]. High lymphocytes %[0.9 (0.9-1), p<0.00] and high PMV [0.3 (0.3-0.8), p=0.02] were significantly associated with complete recovery while increased neutrophil % [1 (1-1.1), p=0.04] was associated with increased risk for post recovery fatigue. In conclusion, low lymphocytes % and high neutrophil % are useful markers for predicting adverse in-hospital outcome and post-recovery persistent fatigue, respectively. High PMV and lymphocyte % showed significant association with favorable short-term prognosis.

ECG markers of malignant arrhythmias and in-hospital outcome of COVID-19 pneumonia.

Background: ECG abnormalities associated with COVID-19 pneumonia and adverse outcome are undefined and poorly described in prior studies. Objectives: To assess the predictive role of baseline ECG markers of increased risk of malignant arrhythmias and cardiac death for adverse in-hospital outcomes. Patients and methods: A retrospective study included 93 patients of newly diagnosed COVID-19 with features consistent with pneumonia who were admitted to the hospital from August 20 to September 20, 2020. The main outcomes were defined as receiving mechanical ventilation, in-hospital cardiac arrest, length of ICU stay, and degree of lung damage according to computed tomography (CT) score. Results: Increased QTc (QT corrected) interval, Tp-e (T from peak to end) interval, and transmural dispersion of repolarization (TDR) were independent predictors of prolonged ICU stay (P < .0001) after adjustment for baseline clinical characteristics. Increasing age (P < .0001) followed by increased QTc interval (P = .02) and history of chronic lung disease (P = .04) were independent predictors of extensive lung damage. The independent predictors for in-hospital cardiac arrest were increased QTc (P = .02) followed by increasing age (P = .04) and increased Tp-e interval (P = .04). Conclusion: Repolarization abnormalities on baseline ECG may be useful prognostic markers in patients with COVID-19 pneumonia.

Electrocardiographic markers of increased risk of sudden cardiac death in patients with COVID-19 pneumonia.

BACKGROUND: Little is known about the role of ECG markers of increased risk of sudden cardiac death during the acute period of coronavirus disease 2019 ( COVID-19) pneumonia. OBJECTIVES: To evaluate ECG markers of sudden cardiac death on admission, including the index of cardiac electrophysiological balance (iCEB) (QTc/QRS) and transmural dispersion of repolarization (TDR) (T from peak to end (Tp-e) interval and Tp-e/QTc), in patients with COVID-19 pneumonia. PATIENTS AND METHODS: This cross-sectional study included 63 patients with newly diagnosed COVID-19 pneumonia who presented to the outpatient clinic or admitted to the respiratory care unit between August 20 and September 15, 2020. Forty-six persons matched for sex and age were selected from data collected before COVID-19 pandemic. RESULTS: QRS and QTc showed a significant prolongation in patients with COVID-19 pneumonia compared to the controls (87 vs. 78, p < .00, and 429 versus. 400, p < .00, respectively). After categorization of patients with COVID-19 pneumonia into 3 groups according to the severity of pneumonia as mild-moderate, severe, and critical groups, a decreased values of QRS were observed in the critical COVID-19 pneumonia group compared to severe and mild-moderate COVID-19 pneumonia groups (p = .04) while increased values of QTc and iCEB(QTc/QRS) were noted in critical COVID-19 pneumonia group compared to other 2 groups(p < .00). CONCLUSIONS: Patients with COVID-19 pneumonia showed significant changes in repolarization and conduction parameters compared to controls. Patients with mild to severe COVID-19 pneumonia may be at low risk for torsades de pointes development.

Predictors of adverse in-hospital outcome and recovery in patients with diabetes mellitus and COVID-19 pneumonia in Iraq.

BACKGROUND AND AIMS: There is limited data about the prognosis and impact of COVID-19 pneumonia on patients with diabetes mellitus (DM). We aimed to assess blood indices, ECG markers of sudden death and malignant arrhythmias on admission, and diabetes lowering drugs as possible predictors of adverse in-hospital outcome and COVID-19 pneumonia recovery status. METHODS: A retrospective study included patients with newly diagnosed COVID-19 pneumonia from August 20, to October 5, 2020. RESULTS: A total of 192 patients with COVID-19 pneumonia were included in the present study, of whom 67 patients had DM. Low lymphocytes % [0.4(0.1-0.9), P = .011] and QTc interval prolongation [0.4(0.1-0.8), P = .022] were associated with increased length of ICU stay. On the other hand, metformin use [0.3(0.2-4), P = .032] and DPP-4 inhibitors use [0.3(0.2-3), P = .040] were associated with decreased length of ICU stay. QTc interval prolongation [0.4(0.1-0.9), P = .017] was associated with increased length of hospital stay, while using metformin [0.4(0.2-3), P = .022] was associated with decreased length of hospital stay. Low lymphocytes % [0.5(0.4-1.6), P = .001], insulin use [0.4(0.3-5), P = .003], and old age [0.5(0.1-2.3), P = .025] were associated with extensive lung injury. The risk for in-hospital death was associated with high neutrophil% [1(1-1.4), P = .045], while metformin use was associated with decreased risk for in-hospital death [0.1(0.1-0.6), P = .025]. Insulin use [0.3(0.2-4), P = .013] was associated with partial recovery following acute COVID pneumonia. CONCLUSIONS: Metformin and DPP-4 inhibitors use were associated with favorable in-hospital outcomes, while insulin use was associated with extensive lung injury and post-acute COVID-19 pneumonia partial recovery.

Relación entre Nivel de 25 (OH) D Vitaminas y Deterioro Cognitivo en Enfermedad renal Crónica (ERC) en pacientes en diálisis y sin diálisis mediante el uso de la prueba B / Relationship between Level of 25 (OH) D Vitamins and Cognitive Impairment in Chronic Kidney Disease (CKD) in Dialysis and NonDialysis Patients Using Trial Making Test B

Deficiency in vitamin D and cognitive dysfunction commonly are associated together in patients suffering from chronic kidney disease (CKD) in both dialysis and non-dialysis patients, vitamin D develop new protective regulatory roles in the functions of CNS. Combination of low levels of vitamin D and CKD can be enrolled for devastating and lead to sever cognitive dysfunction. Patients with CKD mostly associated with Hypovitaminosisand moreover common in elderly patients and related with cognitive decline, one of the hypotheses that CKD patients commonly have a low level of vitamin D and have potential experience in accelerated cognitive decline which rarely link on this topic. Most of CKD patients particularly sensitive for developing in the deficiency of vitamin D. Reduce vitamin D intake, male absorption in compromised GIT patients, loosing of vitamin D binding protein with urine, and α-hydroxylase enzyme reduction in the kidney all are the risk factors included in the causes of 25(OH) D vitamin decrease production. Aim of study: assess cognitive function by using one validated score: trial making test B in patients with CKD in both dialysis and non-dialysis. Patients and methods: a total of 54 patients with CKD and 57 patients with ESRD on hemodialysis enrolled in this study, where CKD defined as GFR < 60 ml/min by MDRD study. Exclusion criteria include CVA, deaf and blind, and low education patients. Cognitive functions assessment done for patients who are on hemodialysis and non- dialysis by using trial B testing, this second assess spatial scanning concentration and executive function by time measuring that needed to connect the series of numbered that are sequentially and littered circles. Catastrophic shorter time completion with a maximum of 300 second indicates better performance. 25 (OH) D vitamins has assessed from each patients using direct immunoassay method, with assay at 4-110 ng/ml. Results: for patients on hemodialysis 27 (39.7%) has deficient 25(OH) D vitamin status 25 (36.7%) insufficient,20 (29.4%) had sufficient vitamin D levels, significant low level in patients on hemodialysis in comparison to those with non-hemodialysis. Trial making test B score was significantly lower in dialysis patients, significant correlation between cognitive function assessment (trial making test B) and low vitamin D level. Conclusions: the prevalence of deficiency in vitamin D in CKD especially hemodialysis patients associated with cognitive decline.