Catastrophic Outcomes Research Articles

Diaphragmatic perforation after transcatheter arterial chemoembolization of hepatocellular carcinoma via inferior phrenic artery: a case report

BackgroundTranscatheter arterial chemoembolization (TACE) via the inferior phrenic artery has been recognized to have its own therapeutic role without causing serious procedural complications. We report a case of diaphragmatic perforation after repeated TACE sessions conducted via the right inferior phrenic artery.Case presentationA 43-year-old man diagnosed with hepatocellular carcinoma was admitted to the hospital with a chief complaint of cough. The patient underwent TACE via the right inferior phrenic artery 3 months prior and was discharged without specific complications. Physical examination revealed decreased breathing sounds in the right lower lung zone. Chest radiograph demonstrated a small right pleural effusion. Chest CT scan revealed a small diaphragmatic perforation. The patient was unable to undergo surgical exploration, and a follow-up CT scan after 2 months revealed progression of the right diaphragmatic perforation with massive herniation of omental fat into the thoracic cavity.ConclusionsAlthough TACE via the inferior phrenic artery is a relatively safe procedure, it can be associated with rare but serious complications after repeated procedures. This is a rare case report of diaphragmatic perforation after TACE via the right inferior phrenic artery. Early recognition and prompt surgical management are essential to prevent catastrophic outcomes.

Comprehensive evaluation of intermittent mechanical valve obstruction: a retrieval study of 16 cases

Abstract Funding Acknowledgements Type of funding sources: None. Background The intermittent stuck valve is a rarely defined clinical situation, which can be life-threatening or benign, and the clinical features are not well-known. Purpose A thorough investigation of the intermittent mechanical stuck valve"s etiology, diagnostic and treatment methods, and identifying parameters are associated with clinical severity Methods Over 11 years (2010- 2021), 16 patients were subsequently selected from referrals to the Kosuyolu Training and Research Hospital"s echocardiography department. We collected the data retrospectively. Results The evaluated patients consisted of 12 bi-leaflet mitral valve replacements (MVR) and two mono-leaflet MVR. Etiologies were classified as follows; residual chord with four patients, obstructive thrombus (OT) with two patients, non-obstructive thrombus (NOT) with two patients, vegetation with two patients, pannus, and OT coexistence with one patient, solely pannus with one patient. One of the residual chord patients with the frequency one of three-beat severe intermittent mitral regurgitation (MR) presented in dyspnea and underwent redo MVR. The other residual chord patients were in the mild condition who had lesser entrapment frequency. One of the two patients with OT had an ischemic cerebrovascular accident (CVA) with intermittent severe mitral stenosis (MS), while the other was in severe dyspnea. These two patients also underwent redo-MVR. Intermittent stuck valve due to NOT (n:2) presented with dyspnea. Both patients presented with intermittent moderate MR. Two patients presented with endocarditis with severe intermittent MR. One patient had obstruction one of the three beats due to the pannus formation who underwent surgery. One patient who recovered with TT had pannus and NOT coincidentally with a stuck valve in one of the three beats. One of the patients with mono-leaflet MVR had pannus and OT. In the other patient with mono-leaflet MVR, a stuck valve was observed in one of 12 beats secondary to arrhythmia. In the collected data, there were two aortic valve replacements (AVR). One patient had moderate aortic regurgitation due to prominent calcification; the other had moderate obstruction due to pannus. We decided on follow-up medical treatment for these patients with the aortic valve. In the patient with pannus, stuck valve formation occurred one of six beats, and moderate aortic regurgitation arose one of two beats in the patient with calcification. Conclusions The intermittent stuck valve is rarely defined, may have catastrophic outcomes and necessitates a comprehensive approach. It requires elaborative examination in symptomatic patients with prosthetic valves. When making a treatment decision in these patients, as in other native or prosthetic valve patients, the degree of regurgitation or stenosis is essential. In particular, for intermittent stuck valves, the frequency of entrapment should play a fundamental role in making treatment decisions Abstract table 1 Abstract table 2

Low Shear Stress at Baseline is Associated with Aortic Expansion and Aneurysm Related Events in Patients with Abdominal Aortic Aneurysms

Introduction: Abdominal aortic aneurysms (AAAs) are a common incidental finding in elderly patients. Rupture is associated with a mortality rate approaching 90%, and treatment is geared towards preventing this catastrophic outcome. However, there is a requirement to improve risk stratification in patients with AAAs beyond aortic diameter alone. Computational fluid dynamics (CFD) have been used in small cohort proof of concept studies, and identified metrics such as shear stress as potential contributors to aneurysm growth and rupture.

A Case Report of Massive Intraperitoneal Hemorrhage from Rare Cornual Pregnancy.

IntroductionA cornual pregnancy describes a rare ectopic location positioned within the myometrium next to the fallopian tube, which can be difficult to find on traditional ultrasound imaging. Given its location and the stretch within the uterine wall, cornual pregnancies can progress for weeks prior to diagnosis. Ruptures can, therefore, be catastrophic with disproportionally high maternal mortality rates compared to other ectopic pregnancies.Case ReportA 34-year-old female recently treated with methotrexate for ectopic pregnancy presented to the emergency department (ED) for acute onset of lower abdominal cramping without vaginal bleeding. She arrived clinically stable and quickly decompensated with witnessed syncope in the ED, prompting point-of-care ultrasound showing free fluid in the abdomen. The patient was taken for emergent surgery by obstetrics while receiving transfusion of blood products for suspected ruptured ectopic pregnancy. A fetus estimated to be 10 weeks of age was discovered in the left cornual region. Approximately two liters of intraperitoneal blood were drained without complication.ConclusionCornual pregnancy is a difficult to diagnose but potentially disastrous type of ectopic pregnancy due to massive hemorrhage. Emergency clinicians should be aware of this condition given its rare occurrence but potentially catastrophic outcomes.

Massive fetomaternal hemorrhage: a case series and review of literature

Abstract Objectives Massive fetomaternal hemorrhage (FMH) is a rare and difficult to diagnose event that can have catastrophic outcomes. Although many etiologies have been associated with FMH, the majority of cases are idiopathic and affect uncomplicated pregnancies. The prevailing symptom is decreased fetal movements but some cases are asymptomatic. Changes in the fetal Doppler ultrasound, a sinusoidal cardiotocographic pattern, neonatal anemia, unexplained hydrops or stillbirth can raise suspicion that such an event has occurred. Case presentation This article presents a case series of severe FMH diagnosed in our center between 2011 and 2020 as well as a review of the current available literature. Conclusions We highlight the importance of the clinician’s awareness on detecting this rare but potentially life-threatening event.

Characterization of in-situ material properties of pouch lithium-ion batteries in tension from three-point bending tests

To understand the mechanisms of deformation and failure of lithium-ion batteries in case of a crash, it is necessary to accurately characterize their constitutive properties. Previous studies in the field mainly focused on the homogenized compression properties of the cells, which are dominant in load cases such as local indentations. However, in complex practical loadings, such as bending, tension properties play an equally important role. Such complex loads can lead to rupture of the electrode tabs and external short-circuits, which can cause catastrophic outcomes. In the current literature, tensile properties are characterized using specimens extracted from the cell, outside of their operational environment, which leads to unrealistic values. In this study, for the first time, an analytical characterization method is developed to extract the homogenized tensile properties of a cell from bending tests in in-situ conditions. In the next step, this data is used, along with an elaborative procedure, to calibrate a fully uncoupled anisotropic material model for the pouch cells. The material model is utilized to build a single homogenized finite element pouch cell model which is the first of its kind to be validated in all major loading cases; flat, hemispherical, and cylindrical punch indentations and specifically three-point bending, and in-plane compression. This material characterization and the modeling approach provide a universal tool in predicting the load-displacement, shape of deformation, buckling wavelength, and the trend of failure in complex crash scenarios for the safety assessments of Lithium-ion batteries.

APA Joins in Negotiations Over New Problematic Clozapine REMS

APA Joins in Negotiations Over New Problematic Clozapine REMS

Necrotizing Soft-Tissue Infections: A Retrospective Review of Predictive Factors for Limb Loss.

BackgroundEmergent diagnosis and treatment are important for the survival of patients with necrotizing soft-tissue infections (NSTIs). Death is the most catastrophic outcome, but limb loss is also one of the most important complications that can have a significant impact on the rest of the patient’s life. The purpose of this study was to identify predictive factors for limb loss caused by NSTIs.MethodsThe data of patients at our center who were diagnosed with NSTIs from May 2003 to January 2019 were analyzed retrospectively. The inclusion criteria were patients with a definite diagnosis of NSTI involving the upper or lower limb. A total of 49 patient records were analyzed in terms of demography, laboratory data, microbiological causes, treatment, and final outcome. Laboratory Risk Indicator for Necrotizing Fasciitis (LRINEC) scores at initial admission were also collected as laboratory data. Final outcomes were classified into survival with limb salvage and survival with limb loss.ResultsThe limb loss rate was 20.4% (10/49) in our study. On comparison between the limb salvage group and the limb loss group, independent risk factors of limb loss were as follows: presence of hypotension at admission (odds ratio [OR], 8.2; 95% confidence interval [CI], 1.7–38.3; p = 0.008); LRINEC score ≥ 9 (OR, 5.8; 95% CI, 1.3–25.6; p = 0.012), and glucose level > 300 mg/dL (OR, 4.5; 95% CI, 0.9–21.9; p = 0.041). Various microbiological organisms were isolated; the most prevalent specimen was streptococci (32.6%), followed by staphylococci (26.5%). Poor outcomes including limb loss and mortality had no correlation with microbiological organisms.ConclusionsFor patients with NSTIs, the presence of hypotension at admission, a high glucose level (> 300 mg/dL), and a high LRINEC score (> 9) were independent risk factors for limb loss.

Cerebral venous sinus thrombosis-associated hemorrhage in vaccine-induced immune thrombotic thrombocytopenia: Catastrophic outcome if delayed diagnosis and treatment

The authors reported the clinical course of a 58-year-old female suffering from cerebral venous sinus thrombosis associated with hemorrhage after the ChAdOx1 nCov-19 vaccination. Emergent decompressive craniectomy was performed, and aggressive blood transfusion was given. Nevertheless, progressive intracerebral hemorrhage and thrombocytopenia developed. A delayed diagnosis was made on a rare complication of vaccine-induced immune thrombotic thrombocytopenia (VITT) with a positive result of anti-platelet factor 4 antibodies (PF4 Ab). The patient died 4 days postoperative due to brainstem failure.

ТРАНСГЕНЕРАЦІЙНИЙ ХАОС НЕМЕЗИДИ У "АНТІГОНІ": КЛАСИЧНЕ ЗАСТЕРЕЖЕННЯ СОФОКЛА ГЕГЕМОНІСТАМ

If the multiple dualities in the Antigone are considered in an intragenerational context, i.e. as concordant conflicts in Antigone's lifetime, then the plot of the drama might be perceived as stochastic and rather unpredictable as to its catastrophic outcome, i.e. the destruction of all protagonists, while their polis is entrapped in a seemingly unstable equilibrium. But if the dualities are viewed in a transgenerational context, i.e. as the final episode in a chain of dramatic and intertwined events that span many a generation of conflict between the royal house of the Labdacids and the divine or cosmic order, then the plot might be considered as deterministic and rather predictable as to its tragic outcome. From such perspective, the downfall of the dynasty might have been predestined by divine providence or cosmic teleology: In a transgenerational period, the polis might have been converging to a stable equilibrium all along, in line with the natural order of the universe, i.e. an equilibrium preconditioned on the extinction of the hubristically aberrant dynasty. In this context, the underlying forewarning of Sophocles to hegemonists comes to the fore in the Antigone: Even the most powerful and self-righteous perpetrators of hubris may in fact act as unaware pawns of divine will or cosmic teleology – pawns entrapped in a predestined and dynamically chaotic course of action that ultimately, in a transgenerational period, leads to the absolute prevalence of invincible Nemesis.

Comparison of portal hypertensive gastropathy and gastric antral vascular ectasia: an update.

Portal hypertensive gastropathy (PHG) and gastric antral vascular ectasia (GAVE) are two distinct entities that are frequently mistaken with each other, because they present with similar manifestations. This issue may cause catastrophic outcomes, as each one of them has a unique pathophysiology, thereby making their management approaches completely different. There are clinical clues that help physicians distinguish these two. Direct vision via upper endoscopy is often mandatory to establish the diagnosis, and sometimes biopsy is required. In this review, we sought to discuss different aspects of both conditions and highlight clinical evidence that may help in identifying and managing the disease appropriately.

COVID-19 and the hidden threat of diabetic microvascular complications.

The coronavirus disease 2019 (COVID-19) pandemic affected at least 200 million individuals worldwide and resulted in nearly 5 million deaths as of October 2021. According to the latest data from the International Diabetes Federation (IDF) in 2021, the diabetes pandemic has affected 537 million people and is associated with 6.7 million deaths. Given the high prevalence of both diabetes and COVID-19 and common pathological outcomes, a bidirectional relationship could have a catastrophic outcome. The increased risk of COVID-19 in those with obesity and diabetes and higher morbidity and mortality has received considerable attention. However, little attention has been given to the relationship between COVID-19 and microvascular complications. Indeed, microvascular complications are associated with an increased risk of cardiovascular disease (CVD) and mortality in diabetes. This review assesses the evidence for an association between diabetic microvascular complications (neuropathy, nephropathy, and retinopathy) and COVID-19. It draws parallels between the pathological changes occurring in the microvasculature in both diseases and assesses whether microvascular disease is a prognostic factor for COVID-19 outcomes in diabetes.

Proteomic analysis of serum proteins in children with brain death.

BackgroundBrain death (BD) is a catastrophic physiological outcome that can occur in individuals with terminal illness and can adversely affect the graft quality after donation of their organs. As BD has no specific symptoms, it can be difficult to diagnose in a timely manner. The present study was designed to investigate the serum protein expression profiles of children affected by BD in an effort to define diagnostic biomarkers for this condition.MethodsBlood samples were collected from 8 patients with BD and 8 healthy controls during the same time period. Tandem mass tags and mass spectrometry were used to conduct a proteomic analysis of serum extracted from the samples. The potential regulatory roles of the top 5 upregulated and downregulated proteins identified through the analysis were then explored using bioinformatics analyses and a review of the related literature.ResultsThe top 5 upregulated proteins in the serum samples from patients with BD were lipopolysaccharide-binding protein (LBP), α1-acid glycoprotein (α1-AGP), α1-antichymotrypsin (α1-ACT), leucine-rich α1-glycoprotein (LRG1), and lactate dehydrogenase B heavy chain (LDHB), and the 5 most downregulated proteins in these samples were actin-binding protein 2 (transgelin-2), platelet basic protein (PBP), tropomyosin α4 chain (TPM4), tropomyosin α3 chain (TPM3), and peptidase inhibitor 16 (PI16). Literature searches indicated that several of the identified proteins influence the pathogeneses of various diseases, with LBP, α1-AGP, α1-ACT, LRG1, transgelin-2, and PBP all being related to inflammatory activity.ConclusionsThrough a proteomics-based analysis, several differentially expressed proteins were identified in patients with BD relative to healthy controls. Most of these proteins are associated with inflammatory responses that have the potential to persist after the occurrence of BD. Further clinical work is needed to clarify the functional roles of the identified proteins.

Bacterial uropathogens, their associated factors, and antimicrobial susceptibility pattern among adult diabetic patients in two health centers at Kombolcha town, Northeastern Ethiopia.

Urinary tract infection has catastrophic health outcome among diabetes mellitus patients. This study was conducted to investigate prevalence of bacterial uropathogens, their antibiogram, and associated factors among diabetes mellitus patients in Kombolcha town. Cross-sectional study was done from February to April 2020. A total of 282 study participants were involved and simple random technique was applied for enrollment of subjects. Well-constructed and pre-tested questionnaire was utilized to collect the data. Five to ten milliliters of mid-stream urine specimen was collected for microbiological data. Each sample was inoculated into cystine lactose electrolyte deficient medium, incubated overnight in aerobic atmosphere at 37°C for 24 h and finally biochemical tests were carried out. According to Kirby-Bauer disk diffusion method, the antimicrobial susceptibilities pattern of the bacteria was performed on Mueller-Hinton Agar. The data were analyzed with Statistical Package for Social Sciences version 23. Descriptive statistics, bi-variable, and multivariable logistic regression analyses were performed. For statistical significance association, p value ⩽ 0.05 with a 95% confidence interval was considered. The general prevalence of urinary tract infection among study participants was 20.2% (57/282). Being female and having merchant occupation had a statistically significant association. Gram-negative bacteria accounted for 70.2% (40/57) and the leading isolate was Escherichia coli, followed by Klebsiella pneumoniae and Coagulase negative Staphylococcus. About 57.5% gram-negative and 35.3% gram-positive bacteria showed multidrug resistance. The general prevalence of significant bacteriuria was found to be consistent with similar studies conducted in different areas. The higher multidrug resistance rate was observed for the isolated bacteria. Health-care professionals should give due attention and follow rational antibiotic prescription practices to treat these infections.

Nnovative Deep Learning-Based Medical Report Analysis for Timely Diagnosis and Improved Healthcare

In contemporary healthcare, a novel web-based platform harnessing the power of deep learning has been innovated to support frontline medical staff during critical emergencies, especially in the absence of expert consultation. This system is primed to swiftly analyze medical records, emphasizing early detection to curtail severe health risks, including potential fatalities. The foundation of this tool is rooted in deeplearning algorithms, which sift through vast medical data, revealing patterns often overlooked by human eyes. By augmenting precise disease identification, the system strengthens decision-making in clinical settings. Its design fosters synergy between the healthcare sector and specialized bodies, ensuring its adaptability to the evolving medical landscape. This fusion of artificial intelligence empowers healthcare practitioners by highlighting immediate risks, enriching patient care efficiency, and integrating fluidly with prevailing operational protocols. Thetool's proficiency in real-time anomaly detection aids clinicians in proactive decision-making, minimizing catastrophic health outcomes. Its pioneering application has demonstrated efficacy in early diagnostic evaluations for a spectrum of six predominantailments, encapsulating succinct insights for each. With an emphasis on processing medical images, including X-rays, the deep learning models display exemplary performance in training and diagnostics. The system, crafted with streamlit,is intuitively designed for emergency scenarios and is fortified for scalability through Docker containerization and cloud hosting. While this initiative underscores the transformative potential of deep learning in health analytics, it heralds the dawn of an era where medical verdicts become more pinpointed, timely, and instrumental in preserving life.© 2022 STAIQC. All rights reserved

Accidental and Late Diagnosis of Type A Aortic Dissection: Mimicking Unstable Angina Pectoris.

Aortic dissection is an infrequent diagnosis that usually presents with acute onset of sharp and severe tearing pain. It rarely presents with atypical symptoms, accompanied by a higher mortality risk that arises the delay in diagnosis. In this report, we discuss a type A aortic dissection case with a presentation of heaviness-like chest pain with no evidence of aortic dissection in his first echocardiography. The patient was treated for acute coronary syndrome (ACS), but on the follow-up, echocardiography aortic dissection was diagnosed accidentally. Differentiation between ACS and aortic dissection is critical in patient management. Each one has an entirely different treatment approach, and misdiagnosis can lead to catastrophic outcomes.

Clinical analysis for osmotic demyelination syndrome in patients with chronic hyponatremia

Background: Although osmotic demyelination syndrome (ODS) has been well known to be associated with a rapid correction of sodium (Na+) in patients with chronic hyponatremia, its risk factors and clinical outcomes have not been examined in Taiwan. Aim: The aim of the study was to analyze the underlying causes and overlooked risk factors in patients with ODS. Methods: We retrospectively collected chronic hyponatremic patients developing ODS and analyzed their clinical characteristics. Results: Fourteen patients (7 males and 7 females) with a mean age of 62.7 ± 17.9 years old were enrolled. Their underlying causes included gastrointestinal illness with poor intake (n = 7), chronic use of diuretics (n = 2), syndrome of inappropriate antidiuretic hormone (n = 2), pneumonia (n = 2), and hypopituitarism (n = 1). Their serum Na+ was 107.2 ± 1.2 mmol/L with mild hypokalemia (potassium 3.1 ± 7 mmol/L), hypoalbuminemia (albumin, 3.4 ± 0.6 g/dL), and hypophosphatemia (phosphorus, 2.3 ± 1.0 mg/dL). Their mean Na+ correction rate was 8.4 ± 9 mmol/L/day and most patients (60%) developed ODS in first 3 days. Their manifestations included delirium, seizures, unstable gait, aphasia, and drowsy consciousness. Brain magnetic resonance imaging demonstrated that 42.8% had isolated central pontine myelinolysis. Totally, 43% of ODS patients had unfavorable outcome with death and disability. In addition, patients with rapid Na+ correction rate (>12 mmol/L/day, n = 4) usually exhibited significant hypokalemia (2.5 ± 0.4 vs. 3.5 ± 0.7 mmol/L, P < 0.05) as compared with those without. Conclusion: Nutritional status and concurrent electrolyte deficiencies such as hypokalemia are major risk factors in patients with ODS. Clinicians should timely recognize these potential risks of ODS and reduce Na+ correction rate to avoid catastrophic outcomes.

The nature and sources of the emotional distress felt by intensivists and the burdens that are carried: A qualitative study

BackgroundWork in intensive care units is often traumatic and emotionally distressing, sometimes leading to growth but at other times to negative outcomes such as worker burnout and mental illness. The type and origin of distresses to intensivists has been poorly characterised in the literature. This evidence gap makes it difficult to develop tailored educational process or cultural interventions for all who work within the specialty. ObjectivesThe aim of this study was to elicit the nature and sources of workplace emotional distress in an international sample of intensivists. MethodInterviews were undertaken with experienced intensivists in Australia and Israel related to the basis of workplace distress. These were transcribed and qualitatively thematically analysed. ResultsIn 2018, 19 intensivists participated in the study. Several key themes emerged from data analysis, some relating to clinical work, such as catastrophic patient outcomes, and some relating to interpersonal and systems-level challenges. Navigating complex interpersonal dynamics with carers and staff, both within and outside the intensive care unit team, caused substantial emotional burden. ConclusionsMany factors contribute to workplace stress for doctors in the intensive care setting. In elucidating common reactions to these stressors, we have attempted to normalise responses. We further note that the skill sets relevant to the many challenges identified are generally missing in medical training curricula. It may be prudent to consider their inclusion in the future.

Overcoming Daddy: The Daughter’s Rite of Passage in Joyce Carol Oates’ Late Novels

ABSTRACT This essay considers three unexplored late novels by Joyce Carol Oates, namely, Man Crazy, The Gravedigger’s Daughter, and Little Bird of Heaven which powerfully represent negative father complex through fictional daughters who struggle to escape the shadow of their overbearing daddies. It examines how the daughters – Ingrid, Rebecca, and Krista – hailing from disenfranchised backgrounds and broken families endure traumatic circumstances as a result of their father fixation and often develop self-effacing and masochistic tendencies. Further, it analyses how the atrophied psyche of these daughters upon losing the father compels them to go searching for surrogate daddies and predictably invite catastrophic outcomes. It then turns its focus on how by reconnecting with their hitherto unavailable mothers, Oates’ daughters undergo an integral female rite of passage to eventually overcome their psychological conditioning and attain independence and self-actualization. By drawing upon Jungian theories and feminist psychoanalysis, this essay therefore treats negative father complex as a disturbing yet necessary element in Oates’ novels, especially her underrated late novels. Finally, this essay argues that by overcoming their daddies Oates’ fictional daughters not only conquer their psychological demons but also attest to the author’s liberal feminist sensibility by moving from chaos to clarity.

Hyperferritinemia and the Extent of Mucormycosis in COVID-19 Patients.

IntroductionCoronavirus disease 2019 (COVID-19) disease attributed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has shown associations with various fungal opportunistic infections such as mucormycosis, invasive candidiasis, and aspergillosis, which have contributed to the mortality of the disease. In India, the incidence of mucormycosis had risen rapidly during the second wave. There is ample literature demonstrating the role of iron in the pathogenesis of mucormycosis. The hyperferritinemia associated with COVID-19 may have played a significant role in promoting the invasion and extent of the fungus.Aims and objectivesThe study aimed to analyze the association between serum ferritin levels and the extent of involvement of mucormycosis in patients affected with COVID-19.MethodologyA single-center cross-sectional study was conducted using retrospective hospital record data. G*Power statistical analysis software was used to compute the sample size of 62 (31+31). The radiological data were used to determine the extent of involvement.ResultsA statistically significant difference was seen in levels of serum ferritin (p = 0.008) between the radiologically judged two groups of the mild extent of invasion of mucormycosis (rhinosinusitis) and severe extent of invasion (rhino-orbital/cerebral mucormycosis), with a severe extent seen with the group having higher levels of serum ferritin. Severe extent of invasion was seen in 53.6% of patients with diabetes mellitus and 62.5% of patients with both diabetes and hypertension.ConclusionThe hyperferritinemia not only presents as a marker of the systemic inflammatory process in COVID-19 but also indicates increased free iron, which thereby aids the growth and extent of involvement by the fungus (Rhizopus oryzae). In individuals with diabetes and hypertension, the severity was greater. Controlling catastrophic outcomes in individuals with high serum ferritin levels necessitates extra caution.