Elevated plasma level of the glycolysis byproduct methylglyoxal on admission is an independent biomarker of mortality in ICU COVID-19 patients.

Biomarkers to identify ICU COVID-19 patients at high risk for mortality are urgently needed for therapeutic care and management. Here we found plasma levels of the glycolysis byproduct methylglyoxal (MG) were 4.4-fold higher in ICU patients upon admission that later died (n = 33), and 1.7-fold higher in ICU patients that survived (n = 32),compared to uninfected controls (n = 30). The increased MG in patients that died correlated inversely with the levels of the MG-degrading enzyme glyoxalase-1 (r2 = - 0.50), and its co-factor glutathione (r2 = - 0.63), and positively with monocytes (r2 = 0.29). The inflammation markers, SSAO (r2 = 0.52), TNF-α (r2 = 0.41), IL-1ß (r2 = 0.25), CRP (r2 = 0.26) also correlated positively with MG. Logistic regression analysis provides evidence of a significant relationship between the elevated MG upon admission into ICU and death (P < 0.0001), with 42% of the death variability explained. From these data we conclude that elevated plasma MG on admission is a novel independent biomarker that predicts mortality in ICU COVID-19 patients.

Relation Between Renin-Angiotensin-Aldosterone System Inhibitors and COVID-19 Severity.

BACKGROUND: Angiotensin-converting enzyme 2 (ACE2) receptor serves as a receptor for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus causing COVID-19, to enter the lungs. Angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) may increase the expression of ACE2, resulting in concerns that patients with COVID-19 who are receiving these agents may be at increased risk of severe disease. This study was conducted to further investigate the effects of ACEIs and ARBs on the severity of COVID-19 in hospitalized hypertensive patients. METHODS: The study was a retrospective observational study. The medical records of all adult hypertensive patients who were hospitalized at Dammam Medical Complex (DMC) between March 1, 2020, and December 31, 2020, due to COVID-19 were reviewed. The hypertensive patients who were receiving ACEIs or ARBs were compared with the other hypertensive patients who were not on ACEIs or ARBs. RESULTS: A total of 148 hypertensive patients were included in the analysis. They consisted of 106 male and 42 female patients (72% and 28%, respectively). Nearly half of the patients were Saudi (75 patients, 50%). A total of 81 patients were in the ACEI/ARB group, and 67 patients were in the control group. There were no differences between the two groups in age, diabetic status, history of chronic kidney disease, initial blood pressure measurements, and initial oxygen requirements, but the control group contained fewer female patients (18% versus 37%) and Saudi patients (36% versus 63%) than the ACEI/ARB group (p-values = 0.017 and 0.002, respectively). The use of ACEIs or ARBs was associated with significant reductions in ICU admission (9% versus 31%, p-value = 0.001), need for intubation (7% versus 28%, p-value = 0.002), and death (2% versus 24%, p-value = 0.000). A significant negative association between the use ACEIs or ARBs and mortality was also observed in the multivariate analysis after the adjustment for the possible confounders, with an odds ratio (OR) of 0.087 and a 95% confidence interval (CI) of 0.017-0.449. CONCLUSIONS: ACEIs and ARBs have no adverse effects on the clinical prognosis of COVID-19 patients with hypertension. Their use might be even beneficial and protective, but future larger studies are needed to confirm these effects. In the meanwhile, they should be continued in COVID-19 hypertensive patients unless their use is contraindicated for other reasons (e.g., hypotension, hyperkalemia, or acute kidney injury (AKI)).

Complementary and alternative medicine practice and perceptions of attendees of primary care centers in Eastern Saudi Arabia.

BACKGROUND: Complementary and alternative medicine (CAM) refers to the use of nonconventional medical practices together with standard medical care. Specific forms of CAM included in this study are the use of honey, dry and wet Hijama, Quran, Zamzam water, Nigella sativa (black seed), and others. The objective was to determine the prevalence of the use of different CAM modalities by the attendees of primary health-care centers (PHCCs) and assess the reasons behind their use. MATERIALS AND METHODS: A cross-sectional study was conducted at PHCCs in the cities of Dammam and Al Khobar, over a period of 12 months. The study population was patients and their accompanying relatives attending the PHCCs, aged 18 years and above. Data were collected using a self-administered questionnaire in Arabic designed by the investigators after a review of the literature on the use of CAM. Questionnaire was modified after pilot testing among 200 medical students, and was validated by two expert consultants of the family and community medicine department at the university. The questionnaire was administered and supervised by the 3rd and 4th year medical students. Data were entered and analyzed using the SPSS version 16 (SPSS Inc., Chicago, IL, USA) statistical software. Descriptive statistics were computed, and odds ratios were calculated for associations between CAM use and various independent factors. Logistic regression analysis was used to determine the factors which predict the use of CAM by attendees. All the analyses were performed at α =0.05. RESULTS: The total number of attendees interviewed was 2114; 52.5% of whom reported using CAM. The types of CAM varied in their popularity of use, the majority of users favoring honey and Quran, 24.6% and 20.5%, respectively. Recommendations by relatives and friends were reported as the most common reason in this sample for using CAM (56.1%). Age, awareness of CAM, perceptions that use of CAM is better, use of CAM helps, herbs had no side effects, CAM was easy to obtain, and the attendee currently suffers from a disease were significantly associated with higher CAM use. CONCLUSION: More than 50% of the participants reported using CAM; honey and Quran were the most widely used modalities. For people to make informed decisions on the use of complementary medicine, physicians should impress on their patients to inform their doctors of their use of complementary medicine modalities so that encouragement could be given where appropriate.