Characterization and predictive risk scoring of long COVID in a south indian cohort after breakthrough COVID infection; a prospective single centre study.

BACKGROUND: With the World Health Organization (WHO) declaring an end to the COVID-19 pandemic, the focus has shifted to understanding and managing long-term post-infectious complications. "Long COVID," characterized by persistent or new onset symptoms extending beyond the initial phase of infection, is one such complication. This study aims to describe the incidence, clinical features and risk profile of long COVID among individuals in a South Indian cohort who experienced post-ChAdOx1 n-Cov-2 vaccine breakthrough infections. METHODS: A single-centre hospital-based prospective observational study was conducted from October to December 2021. The study population comprised adult patients (> 18 years) with a confirmed COVID-19 diagnosis who had received at least a single dose of vaccination. Data was collected using a specially tailored questionnaire at week 2, week 6, and week 12 post-negative COVID-19 test. A propensity score based predictive scoring system was developed to assess the risk of long COVID. RESULTS: Among the 414 patients followed up in the study, 164 (39.6%) reported long COVID symptoms persisting beyond 6 week's post-infection. The presence of long COVID was significantly higher among patients above 65 years of age, and those with comorbidities such as Type II Diabetes Mellitus, hypertension, dyslipidemia, coronary artery disease, asthma, and cancer. Using backwards selection, a reduced model was developed, identifying age (OR 1.053, 95% CI 0.097-1.07, p < 0.001), hypertension (OR 2.59, 95% CI 1.46-4.59, p = 0.001), and bronchial asthma (OR 3.7176, 95% CI 1.24-11.12, p = 0.018) as significant predictors of long COVID incidence. A significant positive correlation was observed between the symptomatic burden and the number of individual comorbidities. CONCLUSIONS: The significant presence of long COVID at 12 weeks among non-hospitalised patients underscores the importance of post-recovery follow-up to assess for the presence of long COVID. The predictive risk score proposed in this study may help identify individuals at risk of developing long COVID. Further research is needed to understand the impact of long COVID on patients' quality of life and the potential role of tailored rehabilitation programs in improving patient outcomes.

Association of Mean Platelet Volume with Grades of Hypertensive Retinopathy.

OBJECTIVE: Hypertension is the most prevalent non communicable disease causing deaths even before evidence of target organ damage. Platelet activation is associated with risk of vascular events. Identification of mean platelet volume (MPV) values in patients with hypertensive retinopathy (HR) can help in prognostication and risk stratification of possible complications. MATERIALS AND METHODS: Patients presenting to the outpatient department over a period of 18 months underwent clinical examination, blood sampling, direct ophthalmoscopic examination, and two-dimensional echocardiography. RESULTS: Out of 104 subjects, there were a total of 25 females and 79 males. Patients with grade 1HR had a mean MPV value of 9.4, those with grade 2 HR had a mean MPV of 9.8, among people with grade 3 HR the mean MPV was 10.1, and those with grade 4 HR had a mean MPV of 10.9. CONCLUSION: In our study, we have seen that MPV increases with increasing severity of HR, thus implying that MPV probably plays a role in HR. Testing of MPV can be used to decide whether preventative treatments should be instituted to the prevent the severe complications of retinopathy and thus decrease the risk and occurrence of cardiovascular and cerebrovascular events.

Résumé Objectif:L'hypertension est la maladie non transmissible la plus répandue causant des décès avant même la preuve de lésions des organes cibles. L'activation plaquettaire est associée à un risque d'événements vasculaires. Identification des valeurs moyennes du volume plaquettaire (MPV) chez les patients atteints d'hypertension La rétinopathie (HR) peut aider au pronostic et à la stratification du risque de complications possibles.Matériel et méthodes:Les patients se présentant à le service ambulatoire a fait l'objet d'un examen clinique sur une période de 18 mois, d'un prélèvement sanguin, d'un examen ophtalmoscopique direct et l'échocardiographie bidimensionnelle.Résultats:Sur 104 sujets, il y avait un total de 25 femmes et 79 hommes. Patients de grade 1 HR avaient une valeur moyenne de MPV de 9,4, celles de grade 2 HR avaient une MPV moyenne de 9,8, parmi les personnes de grade 3 HR, la MPV moyenne était de 10,1, et celles avec un grade 4 HR avait un MPV moyen de 10,9.Conclusion:Dans notre étude, nous avons vu que la MPV augmente avec la gravité croissante de la FC, donc ce qui implique que le MPV joue probablement un rôle dans les RH. Le test de MPV peut être utilisé pour décider si des traitements préventifs doivent être instituts prévenir les complications graves de la rétinopathie et ainsi diminuer le risque et la survenue d'événements cardiovasculaires et cérébrovasculaires.

Long-term survival following medical management of Aspergillus endocarditis with dissemination as a consequence of steroid therapy in severe COVID-19 pneumonia.

A male in his 40's with no known comorbidities developed severe COVID-19 pneumonia and received a four-week course of methylprednisolone. The patient subsequently developed disseminated Aspergillus endocarditis, manifesting as multiple organ involvement including the heart, eyes, and brain. Despite the poor prognosis generally associated with fungal endocarditis, the patient survived following aggressive medical management with a combination of liposomal amphotericin b and voriconazole therapy and is now doing well for over two years and is off antifungal therapy for a year.

Predicting COVID 19-Associated Pulmonary Aspergillosis Risk in Low- and Middle-Income Countries: A Matched Case-Control Study.

Background: Coronavirus disease 2019 (COVID-19)-associated pulmonary aspergillosis (CAPA) is a life-threatening fungal infection. Studies focusing on CAPA in low- and middle-income countries are limited. Methods: This retrospective matched case-control study was conducted at a tertiary care center in South India. Cases of CAPA were classified using the 2020 European Confederation of Medical Mycology/International Society for Human and Animal Mycology consensus criteria. A total of 95 cases were matched 1:1 with COVID-19 patients without CAPA. Matching was done based on age and period of admission. Inverse probability weighting was used to account for imbalances in COVID-19 severity and intensive care unit (ICU) admission. Data on demographics, clinical details, microbiologic and radiologic data, and treatment outcomes were collected. A predictive score for CAPA was developed from baseline risk factors. Results: The predictive score identified lymphopenia, European Organisation for Research and Treatment of Cancer risk factors, and broad-spectrum antibiotic use as the main risk factors for CAPA. Positivity for bacterial pathogens in blood or bronchoalveolar lavage samples reduced the risk of CAPA. The predictive model performed well in cross-validation, with an area under the curve value of 82%. CAPA diagnosis significantly increased mortality and shift to ICU. Conclusions: The predictive model derived from the current study offers a valuable tool for clinicians, especially in high-endemic low- and middle-income countries, for the early identification and treatment of CAPA. With further validation, this risk score could improve patient outcomes.

Penicilliosis in a Non-HIV Patient: A Case Report.

A 68-year-old female, with a known case of mantle cell lymphoma, came with complaints of persistent cough with expectoration for three months, not responding to multiple courses of antibiotics. Bronchoscopy was done and bronchoalveolar lavage (BAL) culture revealed Penicillium species. She was started on IV liposomal amphotericin B for 14 days and then switched to oral itraconazole which showed a response to treatment. Early diagnosis of penicilliosis and prompt treatment are important as it is rare and associated with a high mortality rate.

Study of Endothelial Dysfunction in Patients With Non-alcoholic Fatty Liver Disease.

Background Metabolic syndrome (syndrome X) is the name for a group of risk factors that raises your risk for heart disease and other health problems, such as diabetes and stroke. Dilatation of blood vessels following stress is a function of vasodilators produced by the endothelium. Flow-mediated vasodilation assesses endothelial function. In the case of endothelial dysfunction, flow-mediated vasodilation is impaired, resulting in decreased or even absence of vasodilation following stress. The easy availability of ultrasound machines nowadays and the non-invasive nature of the test make this a practical test for assessing endothelial dysfunction and the risk of cardiovascular diseases. Various studies have confirmed the presence of impaired flow-mediated vasodilation in patients with coronary artery disease. However, the presence of impaired flow-mediated vasodilation in individuals with risk factors but no cardiovascular diseases can prove that this can be used to predict individuals at risk. This study tries to confirm the presence of endothelial dysfunction in patients with non-alcoholic fatty liver disease (NAFLD) attending a tertiary center hospital in Kochi. Objectives The study's main aim is to compare flow-mediated dilatation in patients with NAFLD and normal individuals. Materials and methods The comparative study was conducted among 50 patients attending various outpatient departments in Amrita Institute of Medical Sciences, Kochi. History and examination of cases and controls and relevant investigations were done after obtaining consent. In addition, both groups underwent measurement of flow-mediated vasodilation in the radiology department. Data were entered in Microsoft Excel and were analyzed using SPSS. Results Flow-mediated vasodilation was found to be less in patients with fatty liver (7.37 ± 2.75) when compared to individuals with normal liver (12.41 ± 3.71). In addition, flow-mediated vasodilatation was inversely proportional to BMI and age. Conclusion This study has proved that there will be endothelial dysfunction in NAFLD, as shown by the decrease in flow-mediated vasodilation when compared with normal liver.