Fulminant onset COVID-19: predictors and outcome.

PURPOSE: During COVID-19 infection, organ dysfunction such as respiratory failure tends to occur towards the second week of illness; however, in a subset, there may be rapid onset of organ dysfunction as early as symptom onset. We define fulminant onset COVID-19 as rapid onset of organ dysfunction such as acute respiratory failure, acute kidney injury, acute encephalopathy or shock within 4 days of symptom onset. Fulminant onset COVID-19 has not yet been systematically studied. We aimed to identify predictors and prognosis of fulminant onset COVID-19. METHODS: This retrospective study was carried out on patients admitted to a single referral hospital in South India between June 2020 and January 2022. Patients were categorised into fulminant and non-fulminant onset COVID-19. Candidate predictors for fulminant onset were chosen by an intuitive approach and analysed using logistic regression. Then, the outcome of fulminant onset COVID-19 at 30 days was studied. RESULTS: Out of 2016 patients with confirmed COVID-19, 653 (32.4%) had fulminant onset COVID-19. Age>60 years (a-OR 1.57, 95% CI 1.30 to 1.90, p<0.001), hypertension (a-OR 1.29, 95% CI 1.03 to 1.61, p=0.03) and immune-suppressed state (a-OR 5.62, 95% CI 1.7 to 18.7, p=0.005) were significant predictors of fulminant onset COVID-19. Complete vaccination lowered the odds of fulminant onset COVID-19 significantly (a-OR 0.61, 95% CI 0.43 to 0.85, p=0.004). At 30 days, the fulminant onset COVID-19 group had higher odds of mortality and need for organ support. CONCLUSION: Fulminant onset COVID-19 is not uncommon and it carries poor prognosis and deserves recognition as a distinct phenotype of COVID-19.

An Improved Ion Chromatographic Method for Fast and Sensitive Determination of Hexavalent Chromium and Total Chromium Using Conductivity Detection.

Chromium exists in its two stable oxidation states including trivalent chromium (Cr (III)) and hexavalent chromium (Cr (VI)) in natural waters. Chromium is an essential micronutrient in the trivalent form; however, the hexavalent form of chromium is considered to be a carcinogen. It is important to determine the chromium content along with speciation. There are a number of methods available for chromium determination. Speciation of chromium is essential to know the exact composition of chromium. Ion exchange chromatography is one of the techniques used to determine Cr (VI). The proposed method can be used to perform the speciation of Cr (III) and Cr (VI). It is a two-step process: first Cr (VI) is determined, followed by total chromium determination by treating the sample with potassium permanganate solution to oxidize the Cr (III) present in the sample to Cr (VI) and determining it as Cr (VI). Conductivity detector is used for the detection. Addition of potassium permanganate solution to the ground water samples for oxidizing the Cr (III) to Cr (VI) is the newly adopted sample preparation technique. The effect of potassium permanganate oxidation is studied in detail in the proposed method. This method can be used for chromium speciation in river water and ground water samples.

Speciation of Arsenic in Ground Water Samples by Ion Exchange Chromatography with Improved Sample Preparation Technique.

Arsenic exists in the form of various chemical species differing in their physicochemical behavior, toxicity, bioavailability and biotransformation. The determination of arsenic species is an important issue for environmental, clinical and food chemistry. However, differentiation of these species is a quite complex analytical task. Numerous speciation procedures have been studied that include electrochemical, chromatographic, spectrometric and hyphenated techniques. Ion exchange chromatography is one of the techniques used to speciate inorganic arsenic i.e., arsenic (III) and arsenic (V). Both of these arsenic species are stable and exist as anions, arsenic (III) as arsenite (AsO33-) and arsenic (V) as arsenate (AsO43-). The proposed method can be used to perform the speciation of arsenic (III) and arsenic (V). It is a two-step process, first arsenic (V) is determined, followed by total arsenic determination by treating the sample with potassium permanganate solution to oxidize the arsenic (III) present in the sample to arsenic (V) and determining it as arsenic (V). Addition of potassium permanganate solution to the ground water samples for oxidizing the arsenic (III) to arsenic (V) is the newly adopted sample preparation technique and further determining it by ion exchange chromatography with conductivity detection. This method can be used for arsenic speciation in water samples from rivers and under the ground. Analytical validation and performance of the method is also discussed.