Predictors Associated with In-hospital Mortality among COVID-19 Patients during the Second Wave in a Tertiary Care Hospital, Gujarat, India: A Retrospective Observational Study.

BACKGROUND: Fatalities due to coronavirus disease 2019 (COVID-19) have already crossed to more than 5 million globally so far. Hence, it is crucial for us to identify the risk factors associated with hospital deaths starting from first contact which can help to give timely treatment to the targeted population. OBJECTIVES: This retrospective cohort study was conducted to identify various factors related to in-hospital mortality related to COVID-19 in our region. MATERIALS AND METHODS: The present study was a single-center, retrospective cohort study of 675 adult patients, admitted with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection between 1st April and 25th May 2021 in our tertiary care hospital. Baseline demographic profile, comorbidities, clinical characteristics, and investigatory findings were analyzed for increased odds of mortality. RESULTS: A total of 181 (26.8%) patients died and 494 (73.2%) survived. There were 65.4% of males and no difference was found between genders in terms of mortality. Comorbidities associated with in-hospital death in our cohort were age group ≥50 years (p<0.001), diabetes (p<0.0007), and renal injury (p<0.0001). More than half of the patients died during the first week of admission. Breathlessness (83%) was the most common symptom in non-survivors. Neutrophil-to-lymphocyte ratio (NLR), S. creatinine, D-dimer, ferritin, and C-reactive protein (CRP) were increased significantly among the patients who died. Multivariate logistic regression revealed age ≥50 years [adjusted odds ratio (AOR) 2.30, 95% confidence interval (CI) 1.45-3.64] and oxygen (O2) saturation <94% at the time of admission (AOR 2.62, 95% CI 1.75-3.93) were associated with mortality. CONCLUSION: Overall in-hospital mortality was 26.8%. Higher age and low O2 saturation were the major risk factors associated with in-hospital mortality.

Use of Ambulatory Glucose Profile for Improving Monitoring and Management of T2DM.

AIM: To demonstrate glycemic variability in type 2 diabetic patients and consequent control of the same. METHODS: 108 patients with type 2 diabetes with an HbA1c level of 7.5-8.5% were selected for the study. A Freestyle Libre Pro AGP sensor was applied to the patients after explaining the patient about the same. Next, they were called for follow up at 3rd, 7th, 11th and 14th days. Based on the readings and graph obtained, diet and treatment changes were made on various follow-up days. The sensor was removed at the end of 14 days. RESULTS: Out of the 108 subjects, 106 completed the study. There were no adverse device effects. 98 patients had therapy changes while the rest had diet and lifestyle modifications. The mean HbA1c decreased from 7.96% to 7.03% by the end of 15 days. The glycemic variability curves helped in recognizing and treating masked or asymptomatic hypoglycemic events. It also graphically shows intervals of optimal and sub-optimal glycemia. CONCLUSION: AGP is one of the most recent, innovative developments that are being used to monitor Glycaemic variability in DM patients. AGP is generated from the Flash Glucose Monitoring device which is like a CGM device attached to the patient for a maximum period of 14 days, which checks the ISF glucose at every 15 minutes. We are able to get a Glycaemic variability curve, a median, a modal, various percentiles and statistical data generated through this. AGP study in the patient provides the doctor with an opportunity to have a complete glycemic picture of the patient l. It offers a reliable, predictive, standardized visualization of the glucose data. We were able to not only reduce the Glycaemic variability but were also able to improve their Quality of Life by reducing the frequency of hypos. The data lead to breaking of the clinical inertia and provided a valuable insight into Glycaemic patterns. The achievement of near to normal Glycaemic status at the end of 14 days reflected the use of AGP as an interventional tool.

Thymoquinone with Metformin Decreases Fasting, Post Prandial Glucose, and HbA1c in Type 2 Diabetic Patients.

OBJECTIVE: Antihyperglycemic activity of Thymoquinone (TQ) was evaluated in diabetic mouse model and patients. METHODS: TQ (50 mg/kg) was orally administered daily for 21 days in combination with metformin in diabetic mice and a reduction on blood glucose level was monitored. In human, a 90-day randomized study was carried out in 60 Type 2 Diabetes mellitus patients to evaluate safety and efficacy of TQ administration with metformin in a 3-arm study. Patients in arm 1 (T1) received 1 tablet of metformin SR 1000 mg and 1 tablet of TQ 50 mg once daily. The second arm (T2) patients received 1 tablet of metformin SR 1000 mg and 2 tablets of TQ 50 mg once daily. Patients in arm 3 (R) received 1 tablet of metformin SR 1000 mg only. RESULTS: The diabetic mice treated with combination of TQ and metformin showed significant decrease in blood sugar compared to those treated with only metformin. In patients who completed the study, the glycated hemoglobin (HbA1c) values in T1, T2 and R decreased after 3 months from 7.2, 7.2 and 7.3 to 6.7, 6.8, and 7.1, respectively. A greater reduction in Fasting Blood Glucose and Post Prandial Blood Glucose was also observed in T1 and T2 arms compared to R. CONCLUSION: At dose levels of 50 and 100 mg of TQ combined with a daily dose of 1000 mg Metformin demonstrated a reduction in the levels of HbA1c and blood glucose compared to the standard treatment of diabetic patients with metformin alone.