Tele-Urology in the Era of COVID-19: an Experience of the Reconstructive Urology Department in Iran.

INTRODUCTION: The outbreak of coronavirus has put additional pressure on the health care systems of many countries; but telemedicine can be an important way to deal with it, especially for people whose health has been affected by the virus. The present study aims to investigate the Implementation of a Tele-urology Program for Reconstructive Urologic Referrals: Initial Results and Patient Satisfaction. MATERIAL AND METHODS: All patients with a history of a urethral reconstructive surgery during last year was entered to our study and two nurses collected data of demographic and past medical history of patients by existed. Telephone visits:Fellowship of reconstructive urology was connected to patients during a phone call and filled the USS-PROM and COVID-19 questionnaires. Face to face visits: All patients were asked to answer the questionnaire about recent exposure and infection by corona virus, recent travel and other risk factors of COVID-19. RESULTS: Mean of USSPROM scale was calculated as 1.65 (+2.91) with a range of 0-15. Based on categorization for USSPROM scale, 74 patients (94.8%) had mild symptoms while 4 patients (5.1%) had moderate symptoms and needed further medical attention. Four patients with moderate USSPROM score were required to cystoscopic evaluation, which one patient with moderate USSPROM score had severe stricture and candidate for redo urethroplasty. Two other patients need for urethral stricture dilatation. Cost was calculated based on taxi-service fee. Accordingly, the average (+SD) cost for in-person visits to the physician was estimated as 4.80 + 4.32 million Rials. In terms of distance, the average distance for receiving medical services according to the patient`s residence area was 373.2 +348.79 kilometres.In terms of the patient`s opinion regarding virtual examination, inappropriateness of virtual visits for physical examination, and patient`s inability to explain the problem correctly, patient`s condition at the time of the virtual visit were the main challenges reported by the respondent. CONCLUSION: Considering that the present COVID-19 emergency will likely last for months, telehealth could be the safest way to deliver urological care for a large percentage of the patients, such as those who are more at risk of unfavorable outcomes of COVID-19.

Association between high-sensitive cardiac troponin level and coronary artery disease: A systematic review and meta-analysis.

Background and objectives: Previous studies suggest a link between high-sensitive cardiac troponin (hs-cTn) levels and coronary artery disease (CAD). However, the nature of this relationship is disputed. To address this, we conducted a study to gather and assess evidence on the association between hs-cTn and CAD prediction. Data sources: Studies were systematically searched and collected from four databases and different types of gray literature to cover all available evidence. After the screening, the selected articles' quality and risk of bias assessment were evaluated. Synthesis method: Meta-analysis calculated std. mean difference on the extracted data. Furthermore, heterogeneity, sensitivity, subgroups, and publication bias analyses were assessed. Results: Twenty-two studies were included in this systematic review, with a total of 844 cases and 2101 control people. The results of the meta-analysis on nine studies showed a significant and positive association between hs-cTn levels and CAD (pooled std. mean difference = 0.44; 95% confidence interval = 0.14-0.73; p < 0.003), with no publication bias (p = 0.9170). Among subgroups, std. mean differences were notably different only when the data were stratified by region or risk of bias; however, subgroup analysis could not determine the source of heterogeneity. Conclusions: Available prospective studies indicate a strong association of hs-cTn with the risk of CAD and significant improvements in CAD prediction. Further investigations in both molecular and clinical fields with proper methodology and more detailed information are needed to discover more evidence and underlying mechanisms to clear the interactive aspects of hs-cTn level in CAD patients.

The Clinical Effects of Laser Acupuncture on Hospitalized Patients With Severe COVID-19: A Randomized Clinical Trial.

Introduction: The coronavirus disease (COVID-19) was extended to the entire population in China and around the world, and its mortality rate was about 3.4%. The impact of laser therapy on chronic respiratory diseases has been shown in previous studies. This study was aimed at examining the effects of laser acupuncture (LA) on patients with severe COVID-19. Methods: In the present study, 60 patients with a positive reverse transcription-polymerase chain reaction (RT-PCR) test were assigned to the intervention and control groups (30 patients in each group). The intervention group was treated with LA, that is, laser light with low energy on acupuncture points, once a day for five consecutive days. Results: The participants' mean age in the intervention and control groups was 48.96±12.65 and 53.16±12.28 respectively; 70% of the patients were male and 30% of them were female. IL6 had a significant reduction in the intervention group (P value=0.038) in comparison with the control group (P value=0.535). Furthermore, the mean admission time in the control group was significantly higher than that in the intervention group (P value=0.047). However, the mortality rate in the intervention group was zero, but three patients in the control group died. Conclusion: Our study showed that LA can be used as supportive therapy for routine treatment in patients with severe COVID-19. Moreover, due to LA safety and it's low cost, it could be recommended as an adjuvant to conventional therapy in patients interested in treating their disease with such a method.

The Effect of SARS-Cov2 Infection on The Spermogram: A Prospective Study.

BACKGROUND: During the Coronavirus disease 2019 (COVID-19) pandemic, there was always concern about damage to different organs of the body. In this study, we aimed to determine if coronavirus 2 (SARS-CoV-2) could influence the sperm parameters in inpatient adult men with COVID-19. MATERIALS AND METHODS: In this prospective study during 2021, 22 patients with COVID-19 diagnosed with polymerase chain reaction (PCR) test and clinical symptoms and history of admission and 19 volunteer healthy men as the control group participated. They were asked to provide semen samples at 2 and 6 months after hospital discharge and the same time for the control group. The following parameters were measured in all semen samples and beside the demographic data, they compared between the two groups: volume (mL), sperm concentration (106/mL), total motile sperm percentage, progressive percentage, normal morphology percentage, and DNA fragmentation index (DFI). RESULTS: The mean ± SD age of the participants in the COVID and control groups was 46.36 ± 9.94 and 45.84 ± 10.21 years, respectively (P=0.869). The mean ± SD body mass index (BMIs) of the participants in the COVID and control groups were 28.6 ± 5.460 and 29.6 ± 6.092, respectively (P=0.579). The mean ± SD number of children was 1.41 ± 1.054 in the COVID group and 1.47 ± 1.073 in the control group (P=0.847). All the sperm parameters were significantly impaired after 2 months in the COVID group in comparison with the control group (P<0.05). After 4 months from first sampling, all the parameters were improved significantly (except normal morphology) but had not yet reached the level of the control group. CONCLUSION: SARS-CoV-2 affected semen parameters in patients admitted because of COVID-19, in the short term. It is expected that this will improve with time.

QTc is Prolonged in Patients with SSc and Associates with Skin Score.

Background: Systemic sclerosis is an autoimmune disease characterised by endothelial dysfunction and fibrosis of the skin and internal organs. Cardiac involvement during systemic sclerosis can be primary or secondary to pulmonary arterial hypertension and renal pathology. Among the disorders in systemic sclerosis, prolongation of QTc time is also associated with more anti-RNA polymerase III antibodies, longer duration, and severity of disease. Methods: This case-control study was performed on 35 patients with systemic scleroderma who filled in the American Society of Rheumatism (ACR / EULAR criteria) and 35 healthy subjects prior to entering the study. Then, the QTc distance was extracted from the electrocardiogram and calculated using the formula. The measured QTc distance in the electrocardiogram, QTc> 440ms in men and QTc> 460ms in women, was defined as QTc long. The patients and the control group then underwent echocardiography, and changes in QTc interval and their relations with echocardiographic findings were evaluated. Results: The results of this study indicated a significant relationship between QTc distance in patients with scleroderma compared with healthy controls. There was also a significant relationship between QTc and Skin Score of patients. However, there was no significant correlation between QTc distance and age, duration of disease, Anti-Centromere, Anti-Scl70, and pulmonary artery pressure. Conclusion: This study concludes that patients with scleroderma are at high risk for cardiac conduction impairment. The only factor that significantly correlated with QTc was the Skin Score of the patients.

Hands and feet radiologic involvements in systemic sclerosis.

AIM: Systemic sclerosis (SSc) is a rare autoimmune disorder characterized by vascular and fibrosing involvement of the skin and internal organs. In this study, we determined the prevalence and characteristics of radiological hands and feet involvements in Iranian SSc patients to identify the associations between clinical features and radiologic findings. METHODS: 43 SSc patients (41 women and 2 men), with a median age of 44.8 years (ranges 26-70 years) and a mean disease duration of 11.8 years (ranges 2-28 years) were studied in this cross-sectional study. RESULTS: 42 patients had radiological changes both in their hands and feet. Only one patient had alteration just in hand. The most frequent changes that we found in hand were Juxta-articular Osteoporosis (93%), Acro-osteolysis (58.2%), and Joint Space Narrowing (55.8%). The prevalence of joint space narrowing or acro-osteolysis was higher in subjects with active skin involvement [modified Rodnan skin score (mRSS) > 14] [16/21 vs. 4/16 for patients with inactive skin involvement (mRSS < 14); p = 0.002]. The most frequent changes that we found in the foot were Juxta-articular Osteoporosis (93%), Acro-osteolysis (46.5%), Joint Space Narrowing (58.1%), and subluxation (44.2%). The presence of anti-ccp antibody was detected in 4 (9.3%), while positive rheumatoid factor was found in 13 (30.2%) of SSc patients. CONCLUSION: This study corroborates that arthropathy is common in SSc patients. The introduction of the specific radiological involvements of SSc needs to be confirmed by further studies, in order to define the appropriate prognosis and treatment of patients.

On-admission and dynamic trend of laboratory profiles as prognostic biomarkers in COVID-19 inpatients.

This large-scale study aimed to investigate the trend of laboratory tests of patients with COVID-19. Hospitalized confirmed and probable COVID-19 patients in three general hospitals were examined from March 20, 2020, to June 18, 2021. The confirmed and probable COVID-19 patients with known outcomes and valid laboratory results were included. The least absolute shrinkage and selection operator (LASSO) and Cox regression were used to select admittance prognostic features. Parallel Pairwise Comparison of mortality versus survival was used to examine the trend of markers. In the final cohort, 11,944 patients were enrolled, with an in-hospital mortality rate of 21.8%, mean age of 59.4 ± 18.0, and a male-to-female ratio of 1.3. Abnormal admittance level of white blood cells, neutrophils, lymphocytes, mean cellular volume, urea, creatinine, bilirubin, creatine kinase-myoglobin binding, lactate dehydrogenase (LDH), Troponin, c-reactive protein (CRP), potassium, and creatinine phosphokinase reduced the survival of COVID-19 inpatients. Moreover, the trend analysis showed lymphocytes, platelet, urea, CRP, alanine transaminase (ALT), and LDH have a dissimilar trend in non-survivors compared to survived patients. This study proposed a novel approach to find serial laboratory markers. Serial examination of platelet count, creatinine, CRP, LDH, and ALT can guide healthcare professionals in finding patients at risk of deterioration.

Hybrid feature engineering of medical data via variational autoencoders with triplet loss: a COVID-19 prognosis study.

Medical machine learning frameworks have received much attention in recent years. The recent COVID-19 pandemic was also accompanied by a surge in proposed machine learning algorithms for tasks such as diagnosis and mortality prognosis. Machine learning frameworks can be helpful medical assistants by extracting data patterns that are otherwise hard to detect by humans. Efficient feature engineering and dimensionality reduction are major challenges in most medical machine learning frameworks. Autoencoders are novel unsupervised tools that can perform data-driven dimensionality reduction with minimum prior assumptions. This study, in a novel approach, investigated the predictive power of latent representations obtained from a hybrid autoencoder (HAE) framework combining variational autoencoder (VAE) characteristics with mean squared error (MSE) and triplet loss for forecasting COVID-19 patients with high mortality risk in a retrospective framework. Electronic laboratory and clinical data of 1474 patients were used in the study. Logistic regression with elastic net regularization (EN) and random forest (RF) models were used as final classifiers. Moreover, we also investigated the contribution of utilized features towards latent representations via mutual information analysis. HAE Latent representations model achieved decent performance with an area under ROC curve of 0.921 (±0.027) and 0.910 (±0.036) with EN and RF predictors, respectively, over the hold-out data in comparison with the raw (AUC EN: 0.913 (±0.022); RF: 0.903 (±0.020)) models. The study aims to provide an interpretable feature engineering framework for the medical environment with the potential to integrate imaging data for efficient feature engineering in rapid triage and other clinical predictive models.

Euglycemic diabetic ketoacidosis and COVID-19 management in a term pregnant patient; a case report.

In this case report, we report a Covid-19 infected female patient with gestational diabetes mellitus with primary manifestation of ketoacidosis at term pregnancy and discuss the management challenges with euglycemia and a high ketone burden.

Promising effects of corticosteroid treatment in combination with antifungal agents in a patient with Aspergillus meningitis.

Although Aspergillus meningitis is poorly responsive to current guidelines for treatment, we describe a dramatic response of Aspergillus meningitis in a patient to treatment using a combination of corticosteroids with guideline's suggested antifungal agents. Administration of corticosteroids in patients with Aspergillus meningitis is rarely reported in previous studies.

Effect of Sofosbuvir on Length of Hospital Stay in Moderate COVID-19 Cases; a Randomized Controlled Trial.

Introduction: Efforts to control the COVID-19 pandemic are still on. This study aimed to evaluate the effect of sofosbuvir on length of hospital stay and complications in COVID-19 cases with moderate severity. Methods: This randomized clinical trial was done on moderate COVID-19 cases, who were admitted to Shohadaye Tajrish Hospital, Tehran, Iran, from 4/2021 to 9/2021. Eligible patients were randomly allocated into two groups of intervention (sofosbuvir) and control, and their outcomes were compared regarding the length of hospital stay and complications. Results: 100 COVID-19 cases were randomly divided into two groups of 50 patients, as the intervention and control groups. The mean age of patients was 50.56 ± 12.23 and 57.1±14.1 years in the intervention and control groups, respectively (p = 0.02). The two groups were similar regarding distribution of gender (p = 0.15), underlying diseases (p = 0.08), the severity of COVID-19 (p = 0.80) at the time of admission, signs and symptoms (p > 0.05), and essential laboratory profile (p > 0.05). The length of hospital stay in the control and intervention groups was 7.7 ± 4.09 days and 4.7±1.6 days, respectively (p = 0.02). None of our patients needed ICU or mechanical ventilation. Conclusion: Sofosbuvir may decrease the length of hospital stay of COVID-19 cases with moderate severity, without a significant effect on the rate of intensive care unit (ICU) need and mortality.

Abnormal Transcript Levels of Cytokines Among Iranian COVID-19 Patients.

The pandemic caused by severe acute respiratory syndrome coronavirus 2 and the related disorder i.e. "coronavirus disease 2019" (COVID-19) has encouraged researchers to unravel the molecular mechanism of disease severity. Several lines of evidence support the impact of "cytokine storm" in the pathogenesis of severe forms of the disorder. We aimed to assess expression levels of nine cytokine coding genes in COVID-19 patients admitted in a hospital. We collected clinical data of patients from their medical reports. Then, we assessed expression of genes using real-time PCR. Expression levels of IFN-G, IL-2, IL-4, IL-6, IL-17, TGF-B, IL-8, and IL-1B were significantly higher in COVID-19 patients compared with healthy controls and in both female and male patients compared with sex-matched controls. However, expression level of TNF-A was not different between COVID-19 patients and healthy controls. Expression of none of these cytokines was different between ICU-admitted patients and other patients except for IL-6 whose expression was lower in the former group compared with the latter (ratio of means = 0.33, P value = 4.82E-02). Then, we assessed diagnostic power of cytokine coding genes in differentiating between COVID-19 patients and controls. The area under curve (AUC) values ranged from 0.94 for IFN-G to 1.0 for IL-2 and IL-1B. After combining the transcript levels of all cytokines, AUC, sensitivity, and specificity values reached 100%, 100%, and 99%, respectively. For differentiation between ICU-admitted patients and other patients, IL-4 with AUC value of 0.68 had the best diagnostic power among cytokine coding genes. Expression of none of cytokine coding genes was correlated with the available clinical/demographic data including age, gender, ICU admission, or erythrocyte sedimentation rate (ESR)/C-reactive protein (CRP) levels. This study provides further evidence for contribution of "cytokine storm" in the pathobiology of moderate/severe forms of COVID-19.

Androgenetic alopecia and COVID-19: Is there a clinical connection?

BACKGROUND: During the coronavirus disease 2019 (COVID-19) outbreak, multiple studies showed higher rates of severe infection in adults and specifically in male patients, which may be related to differences in androgen receptor (AR) expression. Androgenetic alopecia (AGA) is one of the AR expression manifestations. AIM: To explore AGA severity as a possible risk factor for COVID-19 severity in hospitalized patients. METHODS: A total of 164 subjects (116 men and 48 females) with confirmed COVID-19 in need of hospitalization were included in this study. An experienced dermatologist examined the correlation of clinical signs of COVID-19 severity with AGA types. For evaluation of the association between categorical variables and comparison of the mean age in three groups of COVID-19 patients, the Fisher's exact test and the analysis of variance were used. RESULTS: Our cross-sectional study included 116 male patients (70.7%) with a median age of 65.5 (age range: 22-97) years. Among them, 13.8% required intubation, 15.5% needed intensive care unit (ICU) care, and 70.7% required inward hospitalization. The Hamilton-Norwood Scale (HNS) was as follows: HNS I 14.7%, HNS II 12.1%, HNS III 20.7%, HNS IV 19.8%, HNS IV 29.8%, HNS V 17.2%, HNS VI 13.8%, and HNS VII 1.7%. Also, 29.3% of the patients were female, possessing a median age of 72 (age range: 23-98) years. In this group, 8.3% required intubation, 6.3% required ICU care, and 85.4% needed inpatient ward admission care. The Ludwig Scale (LS) was as follows: LS I 52.1%, LS II 35.4%, and LS III 12.5%. CONCLUSION: The severity of AGA type did not correlate with the severity of COVID-19 among hospitalized patients. Our results were in contrast with other research that suggested AGA severity as a marker of unfavorable outcomes of COVID-19.

Sulfasalazine-Induced Toxic Epidermal Necrolysis: A Challenging Case During the COVID-19 Pandemic.

COVID-19 is a major health issue, and patients with underlying conditions are more susceptible to catastrophic outcomes. Toxic epidermal necrolysis (TEN) is a severe systemic disease caused by an immune system hypersensitive reaction. We present a case of TEN induced following sulfasalazine administration that later on complicated with COVID-19, deep vein thrombosis, pulmonary emboli, and eventually death.

Neurological Manifestations and their Correlated Factors in COVID-19 Patients; a Cross-Sectional Study.

INTRODUCTION: COVID-19 might present with other seemingly unrelated manifestations; for instance, neurological symptoms. This study aimed to evaluate the neurologic manifestations and their correlated factors in COVID-19 patients. METHODS: This retrospective observational study was conducted from March 17, 2020 to June 20, 2020 in a tertiary hospital in Iran. The study population consisted of adult patients with a positive result for COVID-19 real-time reverse transcriptase polymerase chain reaction (RT-PCR) using nasopharyngeal swabs. Both written and electronic data regarding baseline characteristic, laboratory findings, and neurological manifestations were evaluated and reported. RESULTS: 727 COVID-19 patients with the mean age of 49.94 ± 17.49 years were studied (56.9% male). At least one neurological symptom was observed in 403 (55.4%) cases. Headache (29.0%), and smell (22.3%) and taste (22.0%) impairment were the most prevalent neurological symptoms, while seizure (1.1%) and stroke (2.3%) were the least common ones. Patients with neurological manifestations were significantly older (p = 0.04), had greater body mass index (BMI) (p = 0.02), longer first symptom to admission duration (p < 0.001) and were more frequently opium users (p = 0.03) compared to COVID-19 patients without neurological symptoms. O2 saturation was significantly lower in patients with neurological manifestations (p = 0.04). In addition, medians of neutrophil count (p = 0.006), neutrophil-lymphocyte ratio (NLR) (p = 0.02) and c-reactive protein (CRP) (p = 0.001) were significantly higher and the median of lymphocyte count (p = 0.03) was significantly lower in patients with neurological manifestations. CONCLUSION: The prevalence of neurological manifestations in the studied cases was high (55.4%). This prevalence was significantly higher in older age, grated BMI, longer lasting disease, and opium usage.

The effects of vitamin E on colistin-induced nephrotoxicity in treatment of drug-resistant gram-negative bacterial infections: A randomized clinical trial.

INTRODUCTION: Nephrotoxicity remains a major long-standing concern for colistin, and it is critical to find agents that can prevent it. The present study aims to investigate the effect of vitamin E on the prevention of colistin-induced nephrotoxicity based on its antioxidant and free radical scavenging properties. METHODS: A randomized clinical trial was designed for 52 patients taking colistin. These patients were categorized into two groups of equal size, receiving colistin or colistin plus vitamin E (α-Tocopherol). Vitamin E with doses of 400 units was administrated daily either orally or by a nasogastric tube if needed. The incidence of Acute Kidney Injury (AKI) and its duration was recorded based on RIFLE criteria. RESULTS: The Incidence of AKI based on RIFLE criteria was 42.3% and 46.2% in intervention and control groups, respectively. The analysis showed no significant difference in the prevalence of AKI for the two groups (P = 0.78). There was no significant difference in the duration of AKI neither (P = 0.83). CONCLUSION: Although vitamin E is a powerful biological antioxidant, the effects of Vitamin E prophylaxis on colistin-induced nephrotoxicity was not taken into consideration in this study.

SARS-CoV-2 and other coronaviruses negatively influence mitochondrial quality control: beneficial effects of melatonin.

Coronaviruses (CoVs) are a group of single stranded RNA viruses, of which some of them such as SARS-CoV, MERS-CoV, and SARS-CoV-2 are associated with deadly worldwide human diseases. Coronavirus disease-2019 (COVID-19), a condition caused by SARS-CoV-2, results in acute lung injury (ALI)/acute respiratory distress syndrome (ARDS) associated with high mortality in the elderly and in people with underlying comorbidities. Results from several studies suggest that CoVs localize in mitochondria and interact with mitochondrial protein translocation machinery to target their encoded products to mitochondria. Coronaviruses encode a number of proteins; this process is essential for viral replication through inhibiting degradation of viral proteins and host misfolded proteins including those in mitochondria. These viruses seem to maintain their replication by altering mitochondrial dynamics and targeting mitochondrial-associated antiviral signaling (MAVS), allowing them to evade host innate immunity. Coronaviruses infections such as COVID-19 are more severe in aging patients. Since endogenous melatonin levels are often dramatically reduced in the aged and because it is a potent anti-inflammatory agent, melatonin has been proposed to be useful in CoVs infections by altering proteasomal and mitochondrial activities. Melatonin inhibits mitochondrial fission due to its antioxidant and inhibitory effects on cytosolic calcium overload. The collective data suggests that melatonin may mediate mitochondrial adaptations through regulating both mitochondrial dynamics and biogenesis. We propose that melatonin may inhibit SARS-CoV-2-induced cell damage by regulating mitochondrial physiology.

Clinical and Epidemiological Characteristics of Postdischarge Patients With COVID-19 in Tehran, Iran: Protocol for a Prospective Cohort Study (Tele-COVID-19 Study).

BACKGROUND: COVID-19 was declared a pandemic on March 11, 2020. Given that the severe shortage of hospital beds has led to early discharge and insufficient patient education on home care routines and isolation protocols, the close follow-up of patients and their immediate relatives is an integral part of transitioning from hospital care to home care for patients with COVID-19. OBJECTIVE: We designed the Tele-COVID-19 prospective cohort to follow-up with COVID-19 patients in Tehran, Iran, and improve health care delivery and the recording of postdischarge patients' clinical profiles. METHODS: All adult patients who were admitted to the COVID-19 wards of teaching hospitals in Tehran, Iran were eligible to participate in this cohort study. At baseline, patients were recruited from 4 major hospitals from March 9, 2020 to May 20, 2020. Telephone follow-ups, which were led by volunteer medical students, were conducted on postdischarge days 1-3, 5, 7, 10, and 14. We collected data on a range of sociodemographic, epidemiological, and clinical characteristics by using a standard questionnaire. RESULTS: Of the 950 patients with confirmed COVID-19 who were approached, 823 (response rate: 86.6%) consented and were enrolled into the cohort. Of the 823 participants, 449 (54.5%) were male. The mean age of participants was 50.1 years (SD 12.6 years). During the initial data collection phase, more than 5000 phone calls were made and over 577 reports of critical patients who were in need of urgent medical attention were recorded. CONCLUSIONS: The Tele-COVID-19 cohort will provide patients with sufficient education on home care and isolation, and medical advice on care and the proper use of drugs. In addition, by preventing unnecessary hospital returns and providing information on household SARS-CoV-2 transmission as early as possible, this cohort will help with effective disease management in resource-limited settings. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/23316.

Association of vitamin D deficiency with COVID-19 severity and mortality in Iranian people: a prospective observational study.

BACKGROUND: As the coronavirus disease 2019 (COVID-19) pandemic continues to escalate, it is important to identify the prognostic factors related to increased mortality and disease severity. To assess the possible associations of vitamin D level with disease severity and survival, we studied 248 hospitalized COVID-19 patients in a single center in a prospective observational study from October 2020 to May 2021 in Tehran, Iran. METHODS: Patients who had a record of their 25-hydroxyvitamin D level measured in the previous year before testing positive with COVID-19 were included. Serum 25-hydroxyvitamin D level was measured upon admission in COVID-19 patients. The associations between clinical outcomes of patients and 25-hydroxyvitamin D level were assessed by adjusting for potential confounders and estimating a multivariate logistic regression model. RESULTS: The median (interquartile range) age of patients was 60 years (44-74 years), and 53% were male. The median serum 25-hydroxyvitamin D level prior to admission decreased with increasing COVID-19 severity (P=0.009). Similar findings were obtained when comparing median serum 25-hydroxyvitamin D on admission between moderate and severe patients (P=0.014). A univariate logistic regression model showed that vitamin D deficiency prior to COVID-19 was associated with a significant increase in the odds of mortality (odds ratio, 2.01; P=0.041). The Multivariate Cox model showed that vitamin D deficiency on admission was associated with a significant increase in risk for mortality (hazard ratio, 2.35; P=0.019). CONCLUSIONS: Based on our results, it is likely that deficient vitamin D status is associated with increased mortality in COVID-19 patients. Thus, evaluating vitamin D level in COVID-19 patients is warranted.

Transverse myelitis after SARS-CoV-2 infection: Report of two cases with COVID-19.

Transverse myelitis has been reported as a complication of COVID-19 in recent studies. Here, we report two cases of transverse myelitis related to COVID-19. Both patients underwent plasma exchange after being treated with antibiotics and corticosteroids which lead to the recovery of one of them.