Risk factors for COVID-19 incidence and mortality in patients on maintenance hemodialysis

Patients on maintenance hemodialysis (MHD) are highly susceptible to SARS-CoV-2 and with high mortality rates due to Coronavirus disease 2019, mainly because of the older age in this group of patients, comorbidities, compromised immune status due to uremia, as well as inability to keep social isolation because of the necessity for regular physical presence in dialysis facility. Several retrospective studies of patients on MHD in Europe, America and Asia, show high susceptibility to SARS-CoV-2 in this group of patients with very high rates of critical course of the disease and high mortality rates, reaching more than 40% The aim of this retrospective observational study was to identify risk factors among patients on intermittent hemodialysis for infection with SARS-CoV-2 as well as predictors of severe COVID-19 and fatal outcome. Materials and methods. We analyzed 69 patients receiving intermittent dialysis in Aleksandrovska University Hospital - Hemodialysis Unit. 34 of them have been tested positive for SARS-CoV-2 in the period from September 2020 (when the first case of the disease was registered for our dialysis center) up to March 2022, and are compared with a control group of 35 dialysis-dependent patients without COVID-19. Data about comorbidities, main laboratory and radiologic findings, need of hospitalization and treatment in ICU, as well as data for conducted treatment, are collected from electronic medical records. To identify predictors of severe COVID and poor outcome we compared the group of survivors with the one of non-survivors. Results. There are no significant differences between patients on MHD with and without COVID-19 except higher frequency of COPD and hypoproteinemia in the positive group. Older age, female gender, history of smoking, lymphopenia with neutrophilia, treatment in ICU and need of mechanical ventilation, signs of malnutrition - hypoproteinemia and lower levels of serum creatinine, are risk factors for severe disease and fatal outcomes. Conclusions. The course of COVID infection in dialysis-dependent patients is severe and with high mortality rate, in line with other studies worldwide. Malnutrition is the main risk factor for COVID and also main predictor for poor outcomes.

Major neurological syndromes with COVID-19: lessons to learn

Objective: Covid-19 is a highly infectious viral disease, and our understanding of the impact of this virus on the nervous system is limited. Therefore, we aimed to do a systematic analysis of the neurological manifestations. Methods: We retrospectively studied the clinical, laboratory, and radiological findings of patients with major neurological syndromes (MNS) in Covid-19 over 6 months. Results: We had 39 patients with major neurological syndromes (MNS). The most common MNS was cerebrovascular disease (CVD) (61.53%), in which ischemic stroke (83.33%), cortical sinus thrombosis (12.50%), and haemorrhagic stroke (4.16%) were seen. Among ischemic stroke patients, 50% had a large vessel occlusion, and 66.66% of patients with CVD had a significant residual disability. Cranial neuropathy (15.38%), GBS (10.26%), encephalitis (7.26%), and myelitis (5.12%) were the other MNS. Among the three encephalitis cases, two had CSF-Covid-19 PCR positivity and had severe manifestations and a poor outcome. Associated comorbidities included hypertension (30.76%), diabetes mellitus (12.82%), chronic kidney diseases (7.69%), and polycythaemia vera (2.56%). Lung involvement was seen in 64.1% of patients. Mortality was 17.94% in MNS with Covid-19. Conclusions: The most common major neurological syndrome associated with Covid-19 is CVD with increased frequency of large vessel occlusion causing significant morbidity and mortality. Simultaneous lung and other systemic involvement in MNS results in a deleterious outcome.

Predictors of non-invasive ventilation failure in adult patients with cardiac dysfunction presenting with community-acquired pneumonia: an Egyptian multicenter prospective study

Non-invasive ventilation (NIV) might be successful if carefully selected in adult patients with cardiac dysfunction presenting with community-acquired pneumonia. The main objective of this study was to identify the early predictors of NIV failure. Adult patients with left ventricle ejection fraction (LV EF) <50% admitted to the intensive care unit (ICU) with community-acquired pneumonia and acute respiratory failure were enrolled in this multicenter prospective study after obtaining informed consents (study registrationID: ISRCTN14641518). Non-invasive ventilation failure was defined as the requirement of intubation after initiation of NIV. All patients were assessed using the Acute Physiology and Chronic Health Evaluation II (APACHE II) and sequential organ failure assessment (SOFA) scores at admission, while their Heart rate Acidosis Consciousness Oxygenation and Respiratory rate (HACOR) and lung ultrasound (LUS) scores in addition to blood lactate were assessed at NIV initiation and 12 and 24 hours later. A total of 177 patients were prospectively enrolled from February 2019 to July 2020. Of them, 53 (29.9%) had failed NIV. The mean age of the study cohort was 64.1+or- 12.6 years, with a male predominance (73.4%) and a mean LV EF of 36.4 +or- 7.8%. Almost 55.9% of the studied patients had diabetes mellitus, 45.8% had chronic systemic hypertension, 73.4% had ischemic heart disease, 20.3% had chronic kidney disease, and 9.6% had liver cirrhosis. No significant differences were observed between the NIV success and NIV failure groups regarding underlying morbidities or inflammatory markers. Patients who failed NIV were significantly older and had higher mean SOFA and APACHE II scores than those with successful NIV. We also found that NIV failure was associated with longer ICU stay (p < 0.001), higher SOFA scores at 48 hours (p < 0.001) and higher mortality (p < 0.001) compared with the NIV success group. In addition, SOFA (Odds Ratio (OR): 4.52, 95% Confidence Interval (CI): 2.59-7.88, p < 0.001), HACOR (OR: 2.01, 95% CI: 0.97-4.18, p = 0.036) and LUS (OR: 1.33, 95% CI: 1.014-1.106, p = 0.027) scores and blood lactate levels (OR: 9.35, 95% CI: 5.32-43.26, p < 0.001) were independent factors for NIV failure. High initial HACOR and SOFA scores, persistent hyperlactatemia and non-decrementing LUS score were associated with early NIV failure in patients with cardiac dysfunction presenting with community-acquired pneumonia, and could be used as clinical and paraclinical variables for early decision making regarding invasive ventilation.

Investigating factors affecting hospitalization of patients with mucormycosis after contracting COVID-19: a systematic review

Regarding the investigation of the factors related to the hospitalization of patients with Mucormycosis after being infected with Covid-19, several preliminary studies have been conducted in the hospital, but these studies were conducted in a small environment and have a smaller sample size. Therefore, the aim of the present systematic review study is to examine the factors affecting the hospitalization of patients with mucormycosis after being infected with covid-19. Methods: The current systematic review study was conducted according to PRISMA guidelines (preferred reporting items for systematic seviews and meta-analyses). For this study, the keywords "2019-nCoV", "COVID-19", "SARS-CoV-2", "Coronaviruses", "Hospitaliz", "Factor" and "Mucormycosis" in MagIran, SID, ISI, embase databases, ProQuest, PubMed, scopus were searched. Results: diabetes mellitus, old age, high body mass index, kidney disease, high blood pressure and smoking significantly increase the need for hospitalization in patients with mucormycosis after contracting covid-19. Conclusion: The results of the present study showed that the risk of hospitalization due to Mucormycosis after the covid-19 disease is significantly related to obesity, old age and underlying diseases..

Abdominal imaging findings in patients with COVID-19 part 2: solid organs

Since Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) first appeared in China in December 2019, the globe has been dealing with an ever-increasing incidence of COVID-19 (Corona Virus Disease 2019). In addition to respiratory disorders, 40% of patients present with gastrointestinal (GI) involvement. Abdominal pain is the most common indication for computed tomography (CT) and ultrasonography. After GI tract involvement, solid visceral organ infarction is the most prevalent abdominal abnormality in COVID-19. This review aims to gather the available data in the literature about imaging features of solid abdominal organs in patients with COVID-19. Gallbladder wall thickening and distension, cholelithiasis, hyperdense biliary sludge, acalculous cholecystitis, periportal edema, heterogeneous liver enhancement, and liver hypodensity and infarction are among hepatobiliary imaging findings in CT, particularly in patients admitted to ICU. Pancreatic involvement can develop as a result of direct SARS-CoV2 invasion with signs of acute pancreatitis in abdominal CT, such as edema and inflammation of the pancreas. Infarction was the most prevalent renal and splenic involvement in patients with COVID-19 who underwent abdominal CT presenting with areas of parenchymal hypodensity. In conclusion, although solid abdominal organs are rarely affected by COVID-19, clinicians must be familiar with the manifestations since they are associated with the disease severity and poor outcome.

Outcomes, risk factors, and incidence of acute kidney injury in hospitalized COVID-19 patients

Background: Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV2) is the virus causing Coronavirus Disease 2019 (COVID-19). Apart from respiratory disease, this virus can affect different organs. Objectives: Therefore, multiple mechanisms have been hypothesized for Acute Kidney Injury (AKI) in COVID-19. In this study, we evaluate the incidence and prognosis of AKI in COVID-19 patients. Methods: This retrospective cohort study assessed 397 COVID-19 patients hospitalized between April 1, 2020, and September 30, 2021. Patients with a sudden rise of serum creatinine level, more than 0.3 mg/dl in two days or more than 50% of the initial level in one week, were diagnosed with AKI. Demographic, laboratory, and clinical features were compared in AKI patients with patients without AKI. Results: A total of 397 patients with a mean age +or- standard deviation of 55.42 +or- 15.26 years were included in the study. According to diagnostic criteria, 48 (12.1%) patients developed AKI. Old age, a history of hypertension, and chronic renal failure were suggested as risk factors for AKI. High levels of C-Reactive Protein, Erythrocyte Sedimentation Rate, Lactate Dehydrogenase, D-dimer, and serum phosphorus upon arrival were also associated with an increased risk of AKI. In addition, the incidence of hypernatremia and hyperkalemia increased mortality in patients with AKI. Conclusion: The incidence of AKI in admitted COVID-19 patients affects the duration of hospitalization, the chance of ICU admission, and mortality. It is important to limit the use of nephrotoxic drugs and to maintain water-electrolyte balance to prevent the incidence of AKI and improve the outcome.

Assessment of risk factors for thrombosis in ICU patients with COVID-19

Introduction: According to scientific studies, a high incidence of thrombotic events is known in hospitalized patients with COVID-19. Less than 50% of pulmonary embolisms (PE) are associated with signs of deep vein thrombosis (DVT) of the lower extremities. Background: To identify significant risk factors for thrombosis thrombosis (DVT) in intensive care patients with COVID-19. Materials and methods: We conducted a prospective cross-sectional study that included 465 adult patients with laboratory-confirmed COVID-19 admitted to the intensive care unit. All patients underwent computer tomography of the chest organs, ultrasound angioscanning of lower extremities, body mass index was calculated, the presence of comorbotity diseases and indicators of volumetric blood saturation were considered. The level of D-dimer in blood plasma, coagulation parameters (fibrinogen, factor VIII) were taken from laboratory parameters in calculations. For subgroups with 5 or fewer people, the chi-square test and Fisher's exact test were used. For quantitative variables, analysis of variance (ANOVA) and the Pearson and Spearman correlation coefficient were used. For multiple variables, ordered logistic regression models were built, with likelihood ratio tests performed to compare the models. Results: A total of 465 patients were included in the study. Comorbidities were present in 435 of 465 patients (93.55%) had at least one comorbidity. The most common was arterial hypertension - 370 (79.57%), followed by chronic heart failure - 196 (42.15%), obesity - 161 (34.62%), diabetes mellitus - 144 (30.97%), chronic renal failure (CRF) -58 (12.47%) and oncological diseases -25 (5.38%). The average body mass index was 29.7 kg/m2. In patients with DVT and venostasis, the body mass index (BMI) was more than 30 kg/m2 than without DVT (32.57+or-10.92 kg/m2, and 30.24+or-6.85 kg/m2, versus 29.22+or-6.46 kg/m2, respectively). Ultrasound angioscanning (USAS) confirmed deep vein thrombosis in 60 patients (13.8%) and was associated with older age (71.12+or-13.98 versus 67.20+or-11.16, p < 0.006), venous stasis was detected in 56 patients (12%) no DVT was detected in the rest of the studied patients. In the majority of cases, DVT was detected in the tibial segment -26 (43.33%), in 18 (30%) patients it was diagnosed in the popliteal veins and in 14 (23.33%) cases in the femoral segment. Diabetes mellitus (p=0.041), obesity (p=0.01) and CRF (p=0.028) were also significant risk factors for DVT. Conclusions: Significant risk factors for deep vein thrombosis in intensive care patients with COVID-19 are high levels of D-dimer (>=2.33 g/ml) and comorbidities such as obesity, chronic kidney failure, and diabetes mellitus.

Acute kidney injury in severe pneumonia associated with COVID-19

The clinical and epidemiological features of acute kidney injury in severe and extremely severe pneumonia associated with coronavirus disease-2019 (COVID-19) are considered. An observational prospective study was conducted with the inclusion of 117 patients, including 75 men and 42 women, suffering from severe and extremely severe pneumonia associated with COVID-19, who were treated in the intensive care unit of the 1586th Military Clinical Hospital in 2020-2022. Acute kidney injury was diagnosed in 21 (17.9%) patients (stage 1 in 10, stage 2 in 4, and stage 3 in 7 patients), kidney dysfunction was recorded in 22 (8.8%) patients (serum creatinine was higher than normal, but does not reach the diagnostic criteria of Kidney Disease Improving Global Outcomes). Four patients underwent renal replacement therapy. The probability of kidney damage increases with age (the average age of the patients with acute kidney damage is 65 (58;71) years, and those without acute kidney damage was 47.5 (41;55) years;p = 0.0001). Compared with patients without acute kidney injury, patients with acute kidney injury scored higher on the scales NEW (p = 0.000975), SMRT-CO (p = 0.011555), and Sequential Organ Failure Assessment (p = 0.000042). Among those suffering from acute kidney injury, significantly more pronounced manifestations of systemic inflammation were determined (leukocytes, p = 0.047324;platelets, p = 0.001230;ferritin, p = 0.048614;and D-dimer, p = 0.004496). In the general cohort, the mortality rate was 22.2%, whereas a significant intergroup difference in mortality was observed, i.e., 52.4% in patients with acute kidney injury and 15.62% in those without acute kidney injury (Chi-squared criterion, 13.468;p < 0.001). Invasive artificial lung ventilation was performed in 19.66% of the patients, and a significant intergroup difference was identified, with 66.7% in patients with acute kidney injury and 9.38% in patients without acute kidney injury (Chi-squared criterion, 35.810;p < 0.001). The durations of treatment in the intensive care unit in patients with and without acute kidney injury were 9 (7;14) and 6 (4;10) days, respectively. After the treatment, all patients with acute kidney injury had fully recovered kidney function upon discharge. In general, acute kidney injury occurs in almost every fifth patient with severe and extremely severe pneumonia associated with COVID-19, aggravates the condition of patients, and increases mortality. The alertness of doctors regarding acute kidney injury and early diagnosis and timely nephroprotective treatment may reduce the possibility of adverse disease outcomes.

A hospital based observational study of clinical spectrum and outcome of mucormycosis during the COVID pandemic

Background : Mucormycosis is a life threatening fungal disease caused by the filamentous fungi mucormycetes. Though a known entity for decades, it began to manifest in an unprecedented manner in the COVID scenario specially with the second wave in India. The objectives were to describe the demographic characteristics, clinical presentations, risk factors, therapy and in-hospital mortality of patients with Mucormycosis. Material and Methods : We conducted a retrospective observational study for a period of six months from March 2021 to August 2021. The data was collected for cases of mucormycosis from multiple centres all over West Bengal and analysed. All consecutive individuals with confirmed mucormycosis were enrolled in this study. The data documenting demographic particulars, presentation, predisposing factors and comorbiditieswere recorded in a pre validated case report form Details of investigation recording site and extent of disease, therapeutic intervention and outcome was mentioned . Statistical analysis was done using SPSS 21.0 for MS-Windows. Results : The total number of cases from March to August 2021 was 263 . There were 171 males and 92 females and the mean age of occurrence was 50.8+or-0.4 years .In West Bengal clusters of cases were being reported most commonly from the districts of North 24 Parganas, Kolkata, Jalpaiguri, Darjeeling and Hooghly. Some cases admitted here hailed from outside states like Bihar, Jharkhand, Odisha and Assam. The majority of the cases 74.22% (196)were COVID Associated Mucormycosis (CAM) while only 25.78% were non COVID associated. Diabetes mellitus was associated in 78.7% and history of prolonged steroid therapy in 57.4% of cases. We encountered rhino orbital mucormycosis in 99.24% of cases and cerebral involvement in 47.3%. They were treated with Amphotericin B deoxycholate along with endoscopic debridement. The most common side effects of Amphotericin B Deoxycholate were hypokalemia (93%), hypomagnesemia (32%) and AKI (74%) of the cases . The number of patients discharged was 16.7% and 10 left against medical advice (LAMA) . In hospital deaths were recorded to be 26.7%. Cause of death was commonly -AKI, septic shock and multiorgan failure . Conclusion : Prevention is better than cure of this devastating disease which is difficult todiagnose and treat . Awareness about mucormycosis and careful clinical evaluation of post-COVID patients is mandatory in this era in order to rapidly diagnose and treat mucormycosis.

Telemedicine in paediatric subspecialty: a low cost model for developing countries during the COVID-19 pandemic

Background: Telemedicine is the delivery of Health Care Services using information and communication technologies. Most models of Telemedicine in developed countries involve high-cost infrastructure. The COVID-19 pandemic imposed lockdowns and travel restrictions have highlighted the importance and the necessity of an economically viable model of telemedicine for resource-poor countries like India. Methods: We conducted a prospective study to assess the feasibility, acceptability and effectiveness of low-cost model of Telemedicine services for regular follow-up as well as for triaging. A combination of WhatsApp/email using smartphones and Electronic Medical Records (EMR) system was used to provide Telemedicine services. At the end of the e-consult, the patient/ parents were asked to rate their experience on a scale of 0 to 10. Results: A total of 155 children and 865 consults were included. The mean age of the children was 8.5 years. Forty-four consultations were given to 12 (7.7%) International patients. Thirty-eight (24.5%) patients were seen for the first time via Teleconsultation and the remaining 117 (75.5%) were follow-up patients. The most common diagnosis was Nephrotic Syndrome (51.6%) followed by Chronic Kidney Disease (21.9%), Urinary Tract Infection (10.3%), Kidney-transplant follow-up (6.4%), Acute Glomerulonephritis (3.8%), and Acute Kidney Injury (2.6%). Twenty-three patients were advised admission after the Teleconsultation and the remaining 122 children were advised follow-up e-consults. The mean satisfaction score reported for e-consults was 9.4. Conclusion: Our low-cost Telemedicine model offered a viable modality for delivery of Paediatric Nephrology Services during lockdown period and can be replicated by pediatricians practicing other subspecialties as well.

Investigation of long-term follow-up results of COVID-19 disease in kidney transplant patients and the effect of inactive COVID-19 vaccine

Objective: We aimed to evaluate the long-term graft functions of kidney transplant recepients (KTR) who have been cured of the COVID-19 and to investigate the role of inactivated COVID-19 vaccine in the clinical course of the disease. Materials and Methods: KTR who had COVID-19 pneumonia between March 2020 and September 2021 were included in the study.. The clinical course of the disease was evaluated in vaccinated patients and compared with those who were not vaccinated. The laboratory information of the patients at the time of admission to the hospital, 6 months and 12 months after the disease was recorded. Results: Of the 83 patients included, 67.5% were male. COVID-19 disease developed in 20 patients after vaccination. Vaccine;it decreased the development of acute kidney injury (AKI) 5.9 fold and hospitalization in the intensive care unit (ICU) 1.4 times fold (p < 0.05). In the follow-up, 10 patients died at the first admission to the hospital and no late death was recorded in the first year. Dialysis treatment was started in 5 patients due to graft loss. Conclusion: In kidney transplant patients, graft dysfunction may develop after COVID-19 infection. However, the inactivated COVID-19 vaccine;it can reduce the risks of hospitalization, AKI, and ICU admission.

Clinical significance of serum interleukin 6 in elderly patients infected with severe acute respiratory syndrome Coronavirus 2 Omicron variant and its correlation with underlying diseases

Objective: To investigate the clinical significance of serum interleukin 6 (IL-6) in elderly patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) omicron variant and its correlation with underlying diseases. Methods: A total of 22 elderly patients (> 80 years old) infected with omicron variant, who were admitted to Department of Infectious Diseases, The First Affiliated Hospital of Naval Medical University (Second Military Medical University) from Apr. to Jun. 2022 and tested positive for SARS-CoV-2 RNA, were included. The level of serum IL-6 was measured by flow cytometry, and the level of serum C reactive protein (CRP) was measured by immunonephelometry. Patients were divided into pneumonia group (16 cases) and non-pneumonia group (6 cases) according to the imaging examination results, and were divided into severe group (severe and critical type, 5 cases) and non-severe group (mild and normal type, 17 cases) according to the condition. Binary logistic regression model and receiver operating characteristic (ROC) curve were used to analyze the correlation between serum IL-6 and CRP levels and the severity of the disease and whether it would progress to pneumonia. Meanwhile, the relationships between underlying diseases and serum IL-6 level were explored. Results: Among the 22 patients, 6 were mild, 11 were normal, 3 were severe, and 2 were critical. The baseline serum IL-6 level in the pneumonia group was significantly higher than that in the non-pneumonia group ([20.16+or-12.36] pg/mL vs [5.42+or-1.57] pg/mL, P=0.009), and there was no significant difference in baseline serum CRP level between the 2 groups (P > 0.05). There were no significant differences in baseline serum IL-6 or CRP levels between the severe group and the non-severe group (both P > 0.05). Logistic regression analysis showed that the baseline serum IL-6 and CRP might be related to pneumonia after infection with omicron variant (odds ratio [OR]=2.407, 95% confidence interval [CI] 0.915-6.328;OR=1.030, 95% CI 0.952-1.114). ROC curve analysis showed that the area under curve values of serum IL-6 and CRP in predicting the progression to pneumonia were 0.969 (95% CI 0.900-1.000) and 0.656 (95% CI 0.380-0.932), respectively, with statistical significance (Z=2.154, P=0.030). There were no significant differences in the baseline serum IL-6 level or proportions of severe patients or pneumonia patients among patients with or without hypertension, diabetes mellitus, coronary heart disease, chronic kidney disease or chronic obstructive pulmonary disease (all P > 0.05). The baseline serum IL-6 levels of the omicron variant infected elderly patients with 1, 2, and 3 or more underlying diseases were 12.50 (9.15, 21.75), 23.55 (9.63, 50.10), and 10.90 (5.20, 18.88) pg/mL, respectively, with no statistical significance (P > 0.05). Conclusion: For omicron variant infected patients, serum IL-6 level is significantly increased in patients with pneumonia manifestations and is correlated with disease progression. Serum IL-6 level is of great guiding significance to judge disease progression and evaluate efficacy and prognosis of elderly coronavirus disease 2019 patients.

Clinical profile of scrub typhus patients during COVID pandemic: a sub-Himalayan single center experience

Introduction: Scrub typhus is tropical zoonotic disease, commonly presented with multi organ dysfunction and high mortality rate in untreated patients. This study was done to identify clinical features commonly associated with scrub typhus during COVID pandemics, parameters associated with severe scrub typhus and mortality. Methods: This retrospective study was done in a tertiary care hospital with a total of 52 admitted scrub typhus positive patients in October 2020 to February 2022. Diagnosis was established by scrub IgM ELISA or Rapid antigen test. The clinical and laboratory data, duration of hospital stay and outcomes were collected. Common clinical and laboratory findings were of descriptive analysis. Factors associated with mortality were analysed using Chi-square test. Results: Fever was the most common presenting symptoms on admission (94.2%) followed by respiratory abnormalities (38.46%). Acute kidney injury was the most common organ failure on admission (67.3%), followed by acute liver injury (46.2%) and thrombocytopenia (32.7%). MODS was seen in 46.15%. Of the total, 30.8% were admitted in ICU. Mortality was seen in 7.7% of all patients. On Chi-square analysis, altered mental status and coagulopathy were associated with significant mortality with p value <0.05. Conclusion: Scrub typhus can manifest with potentially life-threatening complications such as acute kidney injury, acute liver injury, thrombocytopenia and MODS. The overall case-fatality rate was 7.7%, and presence of altered mental status and coagulopathy were associated with higher mortality. As per literature, COVID has changed few clinical profiles of scrub typhus compared to same center experience before.

Evaluation of the outcome of Covid-19 disease in patients under mechanical ventilation hospitalized in Al-Zahra Hospital, Isfahan in 2019

Background: Coronavirus in 2019 was recognized as one of the leading causes of death worldwide. According to reports, the mortality rate in people who need mechanical ventilation varies from 50 to 97 percent. The aim of this study was to evaluate the outcome of Covid-19 disease based on different characteristics in patients and mechanically ventilated variables. Methods: This descriptive-analytical study was conducted on 160 patients with a definite diagnosis of Covid-19 who were under mechanical ventilation and admitted to the intensive care unit of Alzahra Hospital in Isfahan from March 2020 to March 2021. Data was collected by checklist. The checklist included demographic information, including age, gender, as well as information such as underlying diseases, disease outcome, length of hospitalization, etc. After collecting the data, they were analyzed in SPSS software version 22 and at a significance level of less than 0.05. Results: In this study, the overall mortality rate among mechanically ventilated patients was 62.5%. The mean age of patients was 69.99+or-17.87 years and the mean duration of hospitalization in surviving patients was 15.47+or-11.73 days and for deceased ones was 55.21+or-69.14 days. The mean age of the deceased group (65.71+or-16.59) was significantly higher than the surviving group 53+or-21.17 was (P=0.0001). The length of hospital stay in the deceased group was significantly longer than the surviving group (P=0.005). As a result, ventilator mode and inotropic agent intake during treatment increased the chance of mortality in patients under mechanical ventilation (P=0.001). There was a significant relationship between underlying diseases of hypertension, kidney disease and autoimmune disease with mortality in patients (P<0.05). Conclusion: Various factors including the length of stay in the hospital, comorbidities such as hypertension, renal disease and autoimmunity may affect the outcome of critically ill ICU patients under mechanical ventilation. Patients who require long-term invasive ventilation and the use of inotropic drugs to maintain their cardiovascular status while hospitalized in the ICU are at higher risk for mortality.

Impact of acute kidney injury in COVID 19 infected patients

Background: Corona virus disease 2019 (covid-19) is a novel disease caused by a newly identified virus, severe acute respiratory syndrome corona virus 2 (sars-cov-2). The novel disease which begun in Wuhan, China in Dec 2019 was declared pandemic by world health organization on 11 march 2020. The most common reported reasons for intensive care unit admission for patients with severe corona virus disease 2019 (covid-19) are either hypoxemic respiratory failure leading to mechanical ventilation or hypotension requiring vasopressor support. Data on AKI are either lacking in this perspective, we emphasize that AKI can be a severe complication of covid-19 and highlight the importance of assessing, defining, and reporting the course of AKI in patients admitted in intensive care unit. Methods: This is a single centre retrospective observational study. 542 patients with real time-PCR and rapid antigen test confirmed COVID 19 infection admitted in KIMS intensive care unit, Hubballi were taken for study. Patients with chronic kidney disease were excluded from the study. Clinical examination and laboratory investigations including renal function test, liver function test, complete blood count, chest x-ray, d-dimer, ferritin, LDH, CRP was done for all the patients. Duration: 1 year (2020 August -2021 July) Results: Out of 542 patients, 166 patients developed acute kidney injury accounting for 30.62%. 145 patients died (87.47) who had acute kidney injury. And 27 patients were discharged (12.6%) who recovered from acute kidney injury. Results: Among the patients who did not developed AKI(376) .300(79.81) died and 76(20.2) got discharged. The p value was 0.034 which was significant for increase in mortality among patients who developed AKI. The incidence of mortality among COVID patient admitted to KIMS ICU was 82.1%. Conclusion: The mortality was significantly higher in COVID patients developing AKI. So we can predict the outcome in COVID infected patients who develops acute kidney injury. AKI is one of manifestation in COVID patients due to tropism of corona virus to ace receptors present in kidney.

Observational study of imaging findings in COVID -19 related rhino-orbito-cerebral mucormycosis - a tertiary care center study

Background: There has been a tremendous increase in number of cases of rhino-orbitocerebral involvement with mucor in the COVID era, as reported from India. It is well established that management of ROCM involves early clinical and radiological diagnosis, reversal of underlying risk factors, prompt antifungal therapy and surgical debridement when indicated. Materials &Methods: Multiplanar MR imaging and CT scan were performed for brain, orbit and paranasal sinuses. All the cases were assessed for involvement of the paranasal sinuses, nasal cavities, orbits and brain. Results: 25 cases with ROCM were identified over 8 months. The mean age of the cases was 56.1 years. 18 of the 25 cases had a positive RT-PCR test result at the time of diagnosis with ROCM. 20 cases had poorly controlled diabetes mellitus, 2 had a hematological malignancy, 2 had chronic kidney disease and 1 had ischemic heart disease. There was involvement of the paranasal sinuses, nasal cavities, orbits and brain inclusing necrosis in most of the cases. The number of cases identified during the interval is much higher than the numbers presenting in the prior 2 years during equivalent intervals than those reported in the literature in different settings in the pre-pandemic era. Conclusions: Rhino-orbito mucormycosis can have aggressive necrosis of the involved paranasal sinuses and orbits with or without cerebral extension. Hence, the correct diagnosis is imperative as prompt antifungal drugs and surgical debridement can significantly reduce mortality and morbidity.

Emergency department visits by adults with chronic conditions associated with severe COVID-19 illness: United States, 2017-2019

Objective: This report describes emergency department (ED) visits made by adults with selected chronic conditions associated with severe COVID-19 illness. Methods-Estimates in this report are based on data collected in the 2017-2019 National Hospital Ambulatory Medical Care Survey. Sample data were weighted to produce annual national estimates. Patient characteristics, including age, sex, expected source of payment, medication prescriptions, and hospital admission status, are presented by number of chronic conditions. Selected chronic conditions associated with severe COVID-19 illness include Alzheimer disease or dementia, asthma, cancer, cerebrovascular disease, chronic kidney disease, chronic obstructive pulmonary disease, depression, diabetes, heart disease, HIV, hypertension, obesity, pulmonary embolism, and substance use disorders. Results-For 2017-2019, 59.5% of ED visits made by adults were among those with one or more chronic conditions. The percentage of ED visits made by adults with three or more chronic conditions was highest among those aged 45-64. Medicare was the most frequently observed expected source of payment among adults with three or more chronic conditions. The percentage of ED visits that resulted in a hospital admission increased with the number of chronic conditions. Overall, hypertension was the most frequently observed chronic condition (33.8% of ED visits by adults) and hypertension and diabetes was the most frequently observed dyad, or pair (33.2% of ED visits by adults with at least two chronic conditions). Conclusion-Patients with at least one chronic condition made up 59.5% of adult ED visits. These data provide national estimates of ED visits by the number and type of chronic conditions in the adult population pre-COVID-19. Given that the presence of chronic conditions increases the risk of hospital admission among patients with COVID-19, these data may represent a useful baseline to quantify prevalence and association of chronic conditions associated with COVID-19 with hospitalization experience and outcomes.

Predictors of in-hospital mortality in COVID-19: a study across two peripheral district general hospitals in UK

Aim: The mortality from Coronavirus Disease 2019 (COVID-19) has remained a significant medical challenge. Internationally, patient demographics and pre-existing co-morbidities are significant determinants of mortality from COVID-19. The mortality-risk in a local population is difficult to determine. The objective of our study is to examine the risk posed by epidemiological and demographic variables, and co-morbidities in our local population. Method: A retrospective, observational study was conducted on confirmed COVID-19 patients, identified from the local microbiology database. A search of the electronic patient records was performed to collect demographic details and co-morbidities. Chi-square test and logistic regression analysis of the demographic variables and co-morbidities were utilised to calculate the predictive-risk for in-hospital mortality of adult COVID-19 patients. Results: Final analysis included 263 samples. Univariate logistic regression analysis was performed using age as an independent categorical predictor with two cohorts - those <60 and those 60 years old. Age (X2 =17.12, p<0.001) was found to be an independent predictor of mortality - this was independent of sex (X2 =1.784, p<0.182). Charlson Comorbidity Index (CCI) score was found to be a significant predictor of adverse outcome. The odds of death for patients with CCI scores 0-4 was less than half (44.8%) of those with CCI scores 5 (p=0.005). Patients with no pre-existing medical conditions had a lower mortality-risk (OR=0.181, p=0.022) than those with known medical conditions. Pre-existing renal disease predicted a poor outcome (OR=1.996, p=0.027). The odds of death for the patients coming from their own-home was only 26% of the odds for those from a longterm care-home. Long-term care facility, advanced age (OR=1.058, p <0.001), and long-term oral steroid (OR=3.412, p=0.016) use were all associated with a poor prognosis. Conclusion: People aged 60 years, residence in a long-term care-home, pre-existing renal diseases, a high CCI score and long-term oral steroids use were associated with an increased mortality-risk.

Clinical characteristics of 95 patients with severe coronavirus disease 2019

Objective: To retrospectively analyze the clinical characteristics of 95 patients with severe coronavirus disease 2019 (COVID-19) admitted to Hankou Hospital of Wuhan, and provide evidence for clinical diagnosis and treatment of severe cases. Methods: From January to March 2020, 95 patients with severe COVID-19 were admitted to a designated Hankou Hospital of Wuhan. The clinical manifestations, laboratory examinations, chest CT, respiratory support, drug treatment, and outcomes were collected and analyzed. Results: Among the 95 patients, there were 76(80.0%) severe cases (severe group) and 19 (20.0%) critically ill cases (critically ill group);the average ages of the two groups were (56.9 .. 14.0) and (66.2 .. 14.1) years old, respectively. The main symptoms included fever [85 (89.5%)], cough [73 (76.8%)] dyspnea [57 (60.0%)], sputum expectoration [32 (33.7%)], diarrhea [20 (21.1%)], etc. The initial symptom was fever [64 (67.4%)], followed by cough [17 (17.9%)]. The main comorbidities were hypertension [29 (30.5%)], diabetes [18 (18.9%), coronary heart disease [12 (12.6%)], etc. Liver injury was the most frequently seen complication which occurred in 35 patients (36.8%), while myocardial damage in 20 patients (21.1%), heart failure in 10 patients (10.5%), and renal damage in 8 patients (8.4%). The level of urea nitrogen [7.5 (3.1-36.6) mmol/L], creatinine [88.0 (46.0-681.0) mol/L], aspartate aminotransferase (AST) [49.0 (8.0-2 290.0) U/L], total bilirubin [12.4 (6.8-112.4) mol/L], white blood cells [8.7 (2.7-16.3) .. 109], neutrophil count [7.9 (1.0-14.6) .. 109/L], high-sensitivity C-reactive protein (hsCRP) [35.6 (0.1-37.9) mg/L] and procalcitonin (PCT) [0.3 (0.1-9.6) ng/mL] in the critically ill group were higher than the severe group [4.5 (1.5-14.6) mmol/L, 70.0 (34.0-149.0) mol/L, 30.5 (10.0-184.0) U/L, 7.8 (1.4-24.5) mol/L, 4.5 (1.7- 10.7) .. 109/L 3.1 (0.6-9.1) .. 109/L, 31.8 (0.1- 40.4) mg/L, 0.1 (0.0- 1.2) ng/mL], and the difference were statistically significant (P all < 0.05);the albumin level reflecting nutritional status [30.2 (24.6-36.4) g/L] was lower than the severe group [35.2(23.5-44.5)g/L], and the difference was statistically significant (P < 0.001). Chest computed tomographic scans showed bilateral ground glass opacity or patchy shadows in the lungs of all patients. A total of 77 patients (82.1%) were discharged, and 13 patients (13.7%) died;of which, the mortality of the critically ill group was 68.4% (13 out of 19). Conclusions: The majority of patients with severe COVID- 19 were elderly. The main clinical manifestations were fever, cough, and dyspnea. Most patients had underlying diseases such as hypertension, diabetes and coronary heart disease. The occurrence of organ dysfunctions such as liver injury, cardiac damage, heart failure and kidney injury might be an important cause of death. The mortality of severe patients with COVID-19 was high, and treatment was even tough.

The Clinical Significance of Urinary Retinol-Binding Protein 4: A Review.

Effective biomarkers for early diagnosis, prognostication, and monitoring in renal diseases (in general) comprise an unmet need. Urinary retinol-binding protein 4, which is the most sensitive indicator of renal tubular damage, holds great promise as a universal biomarker for renal pathologies, in which tubular injury is the driving force. Here, we summarize the most important existing data on the associations between urinary retinol-binding protein 4 and renal diseases and highlight the untapped potential of retinol-binding protein 4 in clinical use.