Comparison of aspartate aminotransferase platelet ratio index score and insulin resistance in type 2 diabetes mellitus with non-alcoholic fatty liver disease.

Objective. Nonalcoholic fatty liver disease (NAFLD) is a spectrum of liver diseases characterized by the presence of ectopic fat in the liver and steatosis, which cannot be explained by alcohol consumption. The association between NAFLD and type 2 diabetes mellitus (T2DM) is well established. As liver fibrosis progresses in a patient with NAFLD, insulin resistance (IR) increases and may worsen diabetes control. The aspartate aminotransferase platelet ratio index (APRI) score is a simple and inexpensive bedside marker that can detect liver fibrosis and cirrhosis. Several studies have shown an association between APRI and NAFLD. However, there is a gap in correlation with IR in patients with diabetes. In this study, we sought to correlate IR and NAFLD in diabetes using the APRI score. Methods. This observational hospital-based cross-sectional study was conducted in the Department of General Medicine, one of the tertiary care hospitals in North India, from February 2019 to July 2020. A total of 70 patients were taken for the study. Patients with T2DM, aged >30 years, who had no history of alcohol use and who had or were newly diagnosed with NAFLD were enrolled in the study. Results. Significant differences in mean HbAc1, AST, serum insulin, APRI score and homeo-static model assessment-2 (HOMA2) IR between NAFLD grade 1, grade 2, and grade 3 groups were found. Pearson correlation between APRI score and HOMA2 IR total values revealed a significant positive correlation between them. Conclusions. The data of the present study indicate that the APRI score can be used to assess the IR degree and provide important information for improving glycemic control in T2DM patients with NAFLD.

Role of Itolizumab in the Treatment of COVID-19 Patients, Admitted to ICU at a Tertiary Care Hospital.

BACKGROUND: Clinical studies have correlated severe deterioration of COVID-19 patients due to excessive and uncontrolled production of cytokines. There is a pressing need to explore therapies, which could prevent the cytokine storm rather than terminating it. AIMS AND OBJECTIVES: The aim of the study is to evaluate the effect of itolizumab on clinical outcomes of patients with moderate-severe COVID-19 disease admitted to ICU. The primary aim of the current study is to find out any mortality benefit in 14 days. The secondary aim is to assess the morbidity outcomes in terms of reduction in inflammatory markers and also the duration of hospital stays to assess the prognostication. MATERIALS AND METHODS: It is a retrospective case-control study in which laboratory-confirmed COVID-19 patients admitted to ICU were taken. A total of 62 patients were recruited, 31 patients received itolizumab (cases/treatment group) and 31 patients didn't receive itolizumab (designated as controls). RESULTS: Among the total patients recruited, 68% of the study population was male and 32% were female. A total of 12 patients expired among cases and 13 expired among controls. Overall mortality in both groups was noted to be almost similar. The control group showed mortality at lower computed tomography (CT) scores compared to the cases. There is a significant reduction in inflammatory markers, like interleukins-6 (IL-6) and D-dimer in cases compared to the control group. CONCLUSION: In conclusion, treating patients with cytokine storms before they require intubation/mechanical ventilation is crucial to preventing deaths. Itolizumab has shown no clinical benefit in critically ill COVID-19 patients, however, timely initiation of itolizumab therapy may serve as a key therapeutic option in preventing the mortality and morbidity outcomes in moderate-severe COVID-19 patients.

Assessing the Impact of Inflammatory Markers and CT Severity Score on Disease Severity of COVID-19 Patients Admitted to ICU at a Tertiary Hospital.

BACKGROUND: In December 2019, SARS-COV-2 infection emerged in Wuhan, China causing COVID-19 and subsequently spread throughout the globe. A great uncertainty is associated with the disease progression, as the risk of severe COVID-19 is not uniform among all the patients. Systemic inflammation has been reported as a predictor for COVID-19 outcomes. Elevated levels of inflammatory markers are shown to be associated with endothelial dysfunction, cytokine storm and coagulopathy in COVID-19. There is a growing body of evidence, that these findings exert influence in the causation of mortality in patients with severe Covid-19. The present study is carried out with an aim to evaluate the clinical outcomes of patients by interrelating their clinical severity with inflammatory markers and CT (Computed tomography) severity score (CTSS). OBJECTIVES: The aim of the study is to correlate COVID-19 severity with inflammatory markers and CT severity score. We also aim to determine the optimal cut-off values for inflammatory markers and CT severity scores in order to establish their interrelationship to the disease severity. MATERIALS AND METHODS: It is a hospital-based retrospective observational study. The study was conducted over a period of four months (July 2020 to October 2020) based on data obtained from the records of patients, admitted with a laboratory confirmed SARS-COV-2 infection. The current study included a total of 84 patients, admitted to ICU with the severe COVID-19.Study tools included serum CRP, serum ferritin, D-dimer, neutrophil-to-lymphocyte ratio (NLR), interleukin-6 (IL-6) and 25-point CT severity score obtained from HRCT (high resolution computerized tomography) chest. RESULTS: Out of 84 patients recruited, 54 patients were survivors and 30 patients were non-survivors (deceased). 78% of the study population was male and 22% was female. For survivors, average CTSS was 12.43 ± 5.7 and whereas average CTSS for non-survivors was 18.87 ± 4.68(p<0001). Average D-dimer was 2.5 ± 1.43 in the survivor group and 3.39 ± 0.95 for non-survivors (p<0.004). Correlation coefficient of CTSS with FiO2 is 0.685 (p<0.0001). The optimal cut-off value for predicting mortality for D-dimer is >2.4 (p<0.0012) and for CTSS is >15 (p<0.0001). CONCLUSION: The disease severity was significantly correlated with CTSS and D- dimer. Severe COVID-19 was also associated with a high NLR (neutrophil to lymphocyte ratio) and moderately elevated inflammatory markers (CRP, Ferritin, IL-6). CTSS >15 and D-dimer >2.4 correlate strongly with mortality. CTSS has the greatest diagnostic accuracy for stratifying the disease severity and predicting the mortality among the markers/ characteristics compared.