Dysfunction In COVID-19 Patients Research Articles

Subclinical left ventricular dysfunction detected by speckle tracking echocardiography predicts mortality in COVID-19 patients

Abstract In COVID-19 patients, both preexisting cardiovascular disease and cardiac injury resulting from SARS-CoV-2 infection are associated with increased mortality. In this patient population the value of speckle tracking echocardiography (STE) for detecting high-risk patients has not been evaluated thoroughly. Aim The aim of study was to determine the prevalence of subclinical myocardial dysfunction revealed by STE and its association with in-hospital and two-year mortality in patients with COVID-19 and preserved left ventricular ejection fraction (LVEF). Methods The study group comprised 163 consecutive patients with preserved LVEF(>/=50%) and maintained right ventricular function evaluated by assessment of tricuspid annular plane systolic excursion (TAPSE >14 mm) hospitalized in the cardiology department due to COVID-19 in 2020 and 2021. All patients underwent transthoracic echocardiographic examination with off-line analysis using STE. Left ventricular global longitudinal strain(GLS), right ventricular global longitudinal strain (RV-GLS), right ventricular free wall strain(RV-FWS) and myocardial work parameters: global work index(GWI), global wasted work(GWW), global constructive work(GCW) and global work efficiency(GWE) were measured. The primary outcome was in-hospital and two-year mortality. Results 96 patients (mean age 66 years, 59 [61%] male) had adequate image quality to evaluate deformation-derived parameters.19 patients (19.8%) died during hospitalization and 9 (9,4%) patients died within two years after discharge. In-hospital non-survivors were older, had lower baseline oxygen saturation(SpO2) and had higher NTproBNP. In non-survivors STE revealed significant impairment of LV and RV function compared to the group of survivors(Table 1). The independent predictors of in-hospital death were: age (OR 1.1 [95% CI 1.01 – 1.19]), SpO2 on admission (OR 0.83 [95% CI 0.75 – 0.93]), NTproBNP (OR 1.0003 [95% CI 1.0001 – 1.0006]) and LV-GLS (OR 1.45 (1.06 – 1.99)]. Based on the analysis of the ROC curves, the cut-off points optimal for predicting in-hospital death were identified: age >71 years (sensitivity [sens.] 74%, specificity [spec.] 68%) , baseline SpO2 value ≤ 89% (sens. 89%, spec. 74%,) NTproBNP >951 pg/ml (sens. 79%, spec. 58%) and GLS >-16% (sens. 63%, spec. 89%). The independent predictors of two-year mortality were: age (OR 1.10 [95% CI 1.02 – 1.19]), Sp02 on admission (OR 0.82 [95% CI 0.73 – 0.91]) and NTproBNP (OR 1.0006 [95% CI 1.0001 – 1.0011]).Based on the ROC curve analysis, the cut-off points optimal for predicting death within 24 months after COVID-19 were also identified: age>71 years (sens. 71%; spec. 72%), Sp02 <89% (sens. 69%, spec. 73%), NTproBNP >520 pg/ml (sens. 89%, spec. 48%). Conclusions STE allows for the detection of subclinical myocardial dysfunction in COVID-19 patients with preserved LVEF. However, LV GLS is the only independent STE-based predictor of in-hospital mortality in this patient population.

Thyroid Function in the Time of COVID-19: A Systematic Review of Disease Progression and Vaccination Effect

Objectives: This systematic review sought to address three key questions: (1) what differences in abnormal thyroid function test results are observed between COVID-19 patients and healthy individuals? (2) How does the severity of COVID-19 infection influence the development of thyroid dysfunction? (3) What impact do COVID-19 vaccines have on thyroid function and autoimmune processes? Methods: A literature search was conducted in PubMed, Web of Science, and Scopus from December 2019 to April 2023 to identify studies on thyroid dysfunction in COVID-19 patients without pre-existing thyroid conditions. The search focused on observational and case-control studies. Results: The literature search yielded 329 reports, from which duplicates and unrelated publications were excluded. Ultimately, 21 studies met the inclusion criteria and were selected for review. A second literature search yielded 605 reports, from which 5 studies were selected for inclusion in the systematic review. Conclusions: The findings suggest that SARS-CoV-2 infection can induce transient and reversible thyroid dysfunction, possibly through direct viral effects on the thyroid gland or via indirect immune-mediated mechanisms. Clinicians should be mindful of the potential, albeit rare, thyroid-related adverse effects of COVID-19 vaccines and monitor thyroid function, particularly in high-risk individuals.

Unlocking the Secrets: Predictive Risk Factors for Long-term Olfactory Dysfunction in COVID-19 Patients

<b>Introduction:</b> COVID-19 is a multisystem disease that can severely impact overall health. It causes non-lethal complications that may significantly affect the quality of life, such as smell dysfunction, which has been identified as an essential and early indicator of infection. A substantial proportion suffer from prolonged or even permanent loss of smell.<b>Aim:</b> The study aims to identify key clinical and demographic risk factors that significantly predict the prognosis of such an olfactory loss in patients with COVID-19.<b>Materials and method:</b> A prospective, cross-sectional, descriptive study. Qualified patients were aged ≥ 18 years with a past COVID-19 infection confirmed by PCR. They all underwent thorough clinical assessments and nasoendoscopy to exclude other nasal pathologies. The Alcohol Threshold Test (ATT) was used to assess olfactory function and only patients with severe hyposmia and anosmia were included in the study. The Arabic version of the Kessler Psychological Distress Scale (K10) was used to assess the emotional impact on the patient.<b>Results:</b> The study included 100 patients suffering from severe smell loss. Sixty-two patients (62%) were ≥39 years and 38 (38%) were ≤ 40 years old. The mean age of the patients was 37.5 10.8 years. There were 62 females (62%). The mean duration of olfactory loss was 4.4 2.8 months. Sudden onset was reported in 98 patients. Only 2 patients (2%) had rhinorrhea. Eighty-one patients (81%) suffered from mild symptoms of COVID infection. There were 21 smokers (21%). Eighteen patients (18%) had comorbidities. Twenty-seven patients (27%) belonged to the low socioeconomic status. Severe hyposmia (TS of ATT = 4–5) was reported in 96 patients (96%) and anosmia (TS of ATT = 6) in 4 patients (4%). Kessler’s test indicated that 63 patients (63%) experienced moderate to severe distress.<b>Conclusions:</b> The following risk factors showed significant differences in the prognosis of olfactory loss: older age, long duration of loss, smoking, presence of comorbidities, low socioeconomic status, and increased severity of COVID-19. These factors may be important predictors of the persistence of olfactory loss. Factors like sex, onset type, nasal symptoms, severity of olfactory loss, and Kessler’s test score did not show significant differences.

An Increase in Aspartate Aminotransferase Can Predict Worsening Disease Severity in Japanese Patients with COVID-19.

The prognostic significance of liver dysfunction in COVID-19 patients remains unclear. In this study, we investigated the association between liver function test results and severe disease progression in COVID-19 patients. This retrospective study included consecutive Japanese COVID-19 patients admitted between February 2020 and July 2021. Predictive variables for severe disease progression were identified by multivariate logistic regression analysis. Severe disease-free survival was estimated with the Kaplan-Meier method and Cox regression analysis. Aspartate aminotransferase (AST) was divided into three grades: grade 1, AST < 30 U/L; grade 2, 30 U/L ≤ AST < 60 U/L; and grade 3, AST > 60 U/L. Among 604 symptomatic patients, 141 (23.3%) developed severe disease at a median of 2 days postadmission. The median hospital stay was 10 days, and 43 patients (7.1%) died during hospitalization. Multivariate regression analysis revealed that hypertension, decreased lymphocyte count, and elevated LDH, CRP, and AST levels (grade 2 and grade 3 relative to grade 1) were the significant predictive variables. Severe disease-free survival time was significantly different between the different AST grades (hazard ratio (HR): grade 2 vs. grade 1, 4.07 (95% confidential interval (CI): 2.06-8.03); grade 3 vs. grade 1, 7.66 (95% CI: 3.89-15.1)). The AST level at admission was an independent risk factor for severe disease in hospitalized Japanese patients with COVID-19.

Evaluation of Oxidative Stress and Endothelial Dysfunction in COVID-19 Patients.

Background and Objectives: Heat shock proteins (HSPs) are stress proteins. The endogenous nitric oxide (NO) synthase inhibitor asymmetric dimethyl arginine (ADMA) is a mediator of endothelial dysfunction. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus causes endothelial dysfunction and coagulopathy through severe inflammation and oxidative stress. Using these markers, we analyzed the prognostic value of serum ADMA and HSP-90 levels for early prediction of severe coronavirus disease (COVID-19) patients. Materials and Methods: A total of 76 COVID-19 patients and 35 healthy control subjects were included in this case-control study. COVID-19 patients were divided into two groups: mild and severe. Results: Serum ADMA and HSP-90 levels were significantly higher in the COVID-19 patients compared to the control subjects (p < 0.001). Additionally, serum ADMA and HSP-90 levels were determined to be higher in a statistically significant way in severe COVID-19 compared to mild COVID-19 (p < 0.001). Univariable logistic regression analysis revealed that ADMA and HSP-90, respectively, were independent predictors of severe disease in COVID-19 patients (ADMA (OR = 1.099, 95% CI = 1.048-1.152, p < 0.001) and HSP-90 (OR = 5.296, 95% CI = 1.719-16.316, p = 0.004)). When the cut-off value for ADMA was determined as 208.94 for the prediction of the severity of COVID-19 patients, the sensitivity was 72.9% and the specificity was 100% (AUC = 0.938, 95%CI = 0.858-0.981, p < 0.001). When the cut-off value for HSP-90 was determined as 12.68 for the prediction of the severity of COVID-19 patients, the sensitivity was 88.1% and the specificity was 100% (AUC = 0.975, 95% CI= 0.910-0.997, p < 0.001). Conclusions: Increased levels of Heat shock proteins-90 (HSP-90) and ADMA were positively correlated with increased endothelial damage in COVID-19 patients, suggesting that treatments focused on preventing and improving endothelial dysfunction could significantly improve the outcomes and reduce the mortality rate of COVID-19. ADMA and HSP-90 might be simple, useful, and prognostic biomarkers that can be utilized to predict patients who are at high risk of severe disease due to COVID-19.

Olfactory Dysfunction in COVID-19 Patients in a Tertiary Care Hospital; A Cross-Sectional Observational Study.

Sudden onset of olfactory dysfunction (OD) manifesting as hyposmia and/or anosmia occurred in many COVID-19 patients, with a frequency as high as 85.6%. Given the morbidity and mortality of COVID-19, it is important to recognize the symptoms early so that the infected person can be diagnosed, isolated and treated early. Hence, this study was undertaken to know the prevalence of Sino-nasal symptoms with special reference to olfactory dysfunction in COVID-19 patients. It is a cross sectional observational study involving 160 COVID-19 patients aged 18 to 100 years selected by universal sampling. OD was analyzed and compared with various inflammatory markers and Sino-nasal symptoms. Patients were followed up until their discharge from the hospital or until death due to COVID-19 related health issues. Out of 160 subjects included in the study, 61.88 % of the study participants were males and 38.13% were females. The mean age was 44.50 ± 16.43 years. A total of 51 patients (31.87%) developed OD. Fifty one (31.87%) patients developed OD (anosmia/hyposmia). Among the individuals with anosmia/hyposmia, majority of patients (n=26) (50.98%) complained of more than 75% loss of smell sensation. Mean duration of anosmia/hyposmia was 9.92 ± 3.71 days. OD correlated with serum ferritin levels (p=0.0453). Anosmia/hyposmia was found in significant proportion of patients with covid-19 which correlated with the disease severity and serum ferritin levels and hence can serve as surrogate marker of disease severity.

Prospective Multicenter Study on Early Proximal Tubular Injury in COVID-19–Related Acute Respiratory Distress Syndrome

IntroductionDuring COVID-19, renal impairment is the most frequent after lung impairment and is associated with poor prognosis particularly in intensive care unit (ICU). We aimed to assess the existence and incidence of early renal dysfunction and its prognostic value in patients with COVID-19-related acute respiratory distress syndrome (ARDS). MethodsIn this prospective multicenter study, patients aged over 18 years with invasive mechanical ventilation for ARDS were enrolled in 3 ICUs. Precise evaluation of renal dysfunction markers including urinary proteins electrophoresis (UPE) and quantification, was performed within 24 hours after mechanical ventilation onset. ResultsFrom March 2020 to December 2021, 135 patients were enrolled: 100 COVID-19 ARDS and 35 non-COVID-19 ARDS. UPE found more tubular dysfunction in COVID-19 patients (68% vs. 21.4%, p<0.0001) and more normal profiles in non-COVID-19 patients (65.0% vs. 11.2%, p=0.0003). COVID-19 patients significantly displayed early urinary leakage of tubular proteins like beta-2-microglobulin and free-light chains, tended to display more frequently acute kidney injury (AKI) (51.0% vs 34.3%, p=0.088), had longer mechanical ventilation (20 vs. 9 days, p<0.0001) and longer ICU stay (26 vs. 15 days, p<0.0001). In COVID-19 ARDS, leakage of free lambda light chain was associated with the onset of KDIGO ≥2 AKI (OR: 1.014, 95%CI [1.003-1.025], p=0.011). ConclusionsPatients with COVID-19-related ARDS display a proximal tubular dysfunction, prior to the onset of AKI, which predicts AKI. Proximal tubular damage seems an important mechanism of COVID-19-induced nephropathy. Analysis of urinary proteins is a reliable non-invasive tool to assess proximal tubular dysfunction in the ICU.

Systemic inflammation relates to neuroaxonal damage associated with long-term cognitive dysfunction in COVID-19 patients

Background and objectivesCognitive deficits are increasingly recognized as a long-term sequela of severe COVID-19. The underlying processes and molecular signatures associated with these long-term neurological sequalae of COVID-19 remain largely unclear, but may be related to systemic inflammation-induced effects on the brain. We studied the systemic inflammation-brain interplay and its relation to development of long-term cognitive impairment in patients who survived severe COVID-19. Trajectories of systemic inflammation and neuroaxonal damage blood biomarkers during ICU admission were analyzed and related to long-term cognitive outcomes. MethodsProspective longitudinal cohort study of patients with severe COVID-19 surviving ICU admission. During admission, blood was sampled consecutively to assess levels of inflammatory cytokines and neurofilament light chain (NfL) using an ultrasensitive multiplex Luminex assay and single molecule array technique (Simoa). Cognitive functioning was evaluated using a comprehensive neuropsychological assessment six months after ICU-discharge. ResultsNinety-six patients (median [IQR] age 61 [55–69] years) were enrolled from March 2020 to June 2021 and divided into two cohorts: those who received no COVID-19-related immunotherapy (n = 28) and those treated with either dexamethasone or dexamethasone and tocilizumab (n = 68). Plasma NfL concentrations increased in 95 % of patients during their ICU stay, from median [IQR] 23 [18–38] pg/mL at admission to 250 [160–271] pg/mL after 28 days, p < 0.001. Besides age, glomerular filtration rate, immunomodulatory treatment, and C-reactive protein, more specific markers of systemic inflammation at day 14 (i.e., interleukin (IL)-8, tumour necrosis factor, and IL-1 receptor antagonist) were significant predictors of blood NfL levels at day 14 of ICU admission (R2 = 44 %, p < 0.001), illustrating the association between sustained systemic inflammation and neuroaxonal damage. Twenty-six patients (27 %) exhibited cognitive impairment six months after discharge from the ICU. NfL concentrations showed a more pronounced increase in patients that developed cognitive impairment (p = 0.03). Higher NfL predicted poorer outcome in information processing speed (Trail Making Test A, r = −0.26, p = 0.01; Letter Digit Substitution Test, r = −0.24, p = 0.02). DiscussionProlonged systemic inflammation in critically ill COVID-19 patients is related to neuroaxonal damage and subsequent long-term cognitive impairment. Moreover, our findings suggest that plasma NfL concentrations during ICU stay may possess prognostic value in predicting future long-term cognitive impairment in patients that survived severe COVID-19.

Evaluation of Olfactory Dysfunction Among COVID-19 Patients in Baghdad, Iraq.

Background SARS‑CoV‑2 (COVID-19) causes olfactory dysfunction which is characterized by anosmia or hyposmia. Characterization of olfactory dysfunction has added value to the diagnosis and prognosis of the disease. Nevertheless, scarce information exists about COVID-19 patients suffering from olfactory dysfunction in Iraq. This study aimed to identify olfactory dysfunction (anosmia or hyposmia) in Iraqi COVID-19 patients and examine their response to smell exercise at Baghdad Medical City Complex, Baghdad, Iraq. Methodology This case series prospective study involving 300 patients (160 males and 140 females) with COVID-19 infection was conducted from June 1, 2020, to October 1, 2021. We recorded signs and symptoms of COVID-19 among patients by examining olfactory dysfunction, n-butanol olfaction test, and smell test exercise. Results Anosmia and hyposmia were found in 69.3% and 30.7% of the patients, respectively; of these, 65.7% were of sudden onset. The association between olfactory dysfunction and smoking was not significant. The most frequent signs and symptoms of COVID-19 were fatigue, fever, loss of taste, myalgia, headache, sore throat, cough, depressed appetite, dyspnea, nausea, abdominal pain, and diarrhea. The highest frequencies of occurrence of anosmia (30.7%) and hyposmia (13.3%) were in the age group of 31-40 years. The majority (47.7%) of patients with olfactory dysfunction recovered within one month of COVID-19 onset. The rest of the patients recovered within one month to 16 months. The most commonly encountered ear, nose, and throat symptoms were nasal obstruction, rhinorrhea, and facial/ear pain. The percentages of patients with anosmia and hyposmia recovering with smell exercise were significant at 64.7% and 25.3%, respectively. Conclusions The prognosis of olfactory dysfunction in COVID-19 patients was good as most cases recovered within a short period with concomitant smell exercise. Olfactory dysfunction in the majority of COVID-19 patients was self-limiting in young age groups, albeit in association with the non-severity of the disease. Being an important public health issue, examining olfactory dysfunction aspects should be considered in the diagnosis, prognosis, and treatment protocols of COVID-19 patients. In-depth exploration is needed to examine olfactory and gustatory dysfunction in patients suffering from severe COVID-19.

Assessment of Olfactory Dysfunction in COVID-19 Patients with Validated Quantitative Test: Sniffin' Sticks Test

Assessment of Olfactory Dysfunction in COVID-19 Patients with Validated Quantitative Test: Sniffin' Sticks Test

Assessment of anosmia/hyposmia in post-COVID-19 patients: a cross-sectional study in an eastern province of Saudi Arabia.

A cross-sectional study that was conducted in the Department of Physiology, College of Medicine, Imam Abdulrahman bin Faisal University, Khobar, Saudi Arabia. One hundred and forty-seven participants were included in this study, and sixty of them agreed to participate in the objective testing using the Connecticut Chemosensory Clinical Research Center (CCCRC) olfaction test. There was a significant correlation between the following factors: (1) Persistence of anosmia/hyposmia and the time of onset of anosmia/hyposmia (P=0.015). (2) Persistence of anosmia/hyposmia and the duration of anosmia/hyposmia (P=0.012). (3) Duration of anosmia/hyposmia and the duration of COVID-19 symptoms (P=0.010). Interestingly, there was a significant association between the subjective participants' claim of anosmia/hyposmia and the score of their objective assessment (P=0.026). The current study demonstrated that post-COVID-19 participants with delayed onset of anosmia/hyposmia and/or longer duration of either anosmia/hyposmia or COVID-19 symptoms were prone to have persistent olfactory dysfunction. Further studies are necessary to uncover the underlying pathophysiology and management of this olfactory dysfunction in COVID-19 patients.

Association of subclinical left ventricular systolic dysfunction detected on 2d echocardiogram global longitudinal strain and in-hospital adverse clinical outcomes in covid 19 patients

Abstract Introduction There are no standardized recommendations regarding the cardiovascular evaluation of patients hospitalized with COVID-19. Transthoracic echocardiography remains a useful imaging modality for patients with COVID-19. Normal left ventricular ejection fraction (LVEF) may not be a reliable parameter for the sole assessment of LV systolic function in COVID-19 patients. LV-GLS can evaluate subclinical impairment of myocardium earlier and more accurately as well as myocardial dysfunction than the conventional echocardiography. Purpose To determine the association of LV-GLS on transthoracic 2D echocardiogram (TTE) with heart failure, ACS and arrhythmia, length of hospital stay among patients with COVID-19. Methods This was a retrospective, analytical, observational, cross-sectional study involving COVID-19 patients admitted at a tertiray hospital who underwent transthoracic 2D echocardiographic examination with normal left ventricular systolic function. Results We analyzed 449 COVID-19 patients, in whom 253 patients had normal LV-GLS and 196 patients had abnormal LV-GLS. The mean age in years was 64 with male dominance (55.68 % vs 44.32%). There were more males in the abnormal LV-GLS group (61.22% vs 51.38%, p=.044). In terms of COVID-19 severity, many patients had severe infection (42.09%), while the rest had mild (4.9%), moderate (21.38%) and critical (31.63%) infection. Many patients also had abnormal BMI of 25-29.9 kg/m2 (40.09%). The top two most common comorbidities were hypertension and diabetes mellitus. Majority (89.09%) never smoked while for the 49 patients who were former/current smokers, their median cigarette consumption was 20 pack years. Most of the patients were taking maintenance medications (68.6%) and had COVID-19 medications (91.76%). The prevalence of subclinical left ventricular systolic dysfunction among patients with COVID-19 was 43.7% (95% CI [39.0% to 48.4%]). There is no evidence of acute myocardial infarction (OR 1.29, 95% CI 018-9.27, p = 0.79), overt left systolic dysfunction (OR 2.60, 95% CI 0.23-28.86, p = 0.437), or longer hospital stay (average 11 days [7-19] p = 0.830) among patients with abnormal LV-GLS. However, abnormal LV-GLS is associated with incidence of arrhythmias requiring intervention (OR 2.00, 95% CI 1.14-3.51, p = 0.015). Arrhythmia was associated with age, COVID-19 severity, and LV-GLS. For every unit increase in age, the odds of arrhythmia increase by 5% (aOR 1.02-1.08, p &amp;lt; 0.001). Patients with critical COVID were about 18 times more likely to have an arrhythmia (aOR 17.94, 95% CI 5.21 -61.74, p&amp;lt;.001), while those abnormal GLS were twice as likely to have arrhythmia (aOR 2.32, 95% CI 1.22-4.40, p = 0.01). Conclusion The prevalence of subclinical left ventricular systolic dysfunction in COVID-19 patients was at 43.7% which was significantly associated with arrhythmias requiring treatment. Age, COVID severity, obesity, and abnormal GLS were associated with COVID 19 mortality.Patient characteristic with mortalityPredictors of mortality

Olfactory and gustatory dysfunction, evaluation and the impact on quality of life among COVID-19 patients: a multi-centre study

Background: Olfactory and gustatory dysfunctions are frequently reported symptoms among COVID-19 patients. However, several reports suggested that there might be significant variation in the prevalence and clinical picture of chemosensory dysfunction in COVID-19 patients among different population. Objective: To study the prevalence of chemosensory dysfunction, recovery time and its impact on quality of life (QoL) among COVID-19 patients in Saudi population. Methods: This multi-centre observational study was conducted at three COVID-19 centres in Saudi Arabia. Epidemiological and clinical data were extracted at baseline and within the 2-month post-infection. Olfactory and gustatory dysfunctions were assessed via valid taste and smell questionnaire, electronically collected via online survey. Short version of questionnaire of Olfactory disorders-negative statements (sQOD-NS) was used to assess the impact on QoL. Result: Total 1734 patients [926 males and 808 females, the mean age of patients was 37.7±11.6 years] with laboratory confirmed COVID-19 were recruited for this study. Chemosensory dysfunction was reported in 56.5% cases. olfactory and gustatory dysfunctions were significantly high in females (66.2%) and age group younger than or equal to 40 years (62.2%). Among patients with olfactory dysfunction and gustatory dysfunction, recovery rate was 757 (77.2%) and 702 (71.6%). Furthermore, the recovery time was within 8 days of onset of symptoms in 53.6% and 61.3% of olfactory dysfunction and gustatory dysfunction cases, respectively. Overall mean QoL score indicated Olfactory and gustatory dysfunction has significant impact on QoL [11.3±6.2 (P value&lt;0.001)]. female as compared to males (12.8±7). Females had significant impact on QoL (11.4±6.6) as compared to males [12.8±7 (P value&lt;0.001)]. Conclusion: Chemosensory dysfunction among Saudi population was comparable to the European data and significantly higher than Asian supporting the fact that these symptoms vary as per ethnicity. Olfactory and gustatory dysfunction significantly impaired QoL and could present as an early symptom of COVID-19. Recovery rate of these symptoms can serve as a good prognostic data for patient’s counselling. Further long-term follow-up studies would lead to better understanding of prognosis and clinical outcomes.

Thyroid dysfunctions in covid-19 patients: impact on in-hospital outcomes and long-covid symptoms

Thyroid dysfunctions in covid-19 patients: impact on in-hospital outcomes and long-covid symptoms

Recovery of Endothelium-dependent vascular relaxation impairment in convalescent COVID-19 patients: Insight from a pilot study

BackgroundEndothelial dysfunction is a key-feature in acute COVID-19. However, follow-up data regarding endothelial dysfunction and injury after COVID-19 infection are lacking. We aimed to investigate the changes in endothelium-dependent vasorelaxation at baseline and four months after hospital discharge in COVID-19 patients. MethodsTwenty COVID-19 patients were compared to 24 healthy controls. Clinical and morphological data were collected after hospital admission for SARS-CoV-2 infection and reactive hyperaemia index (RHI) measurement was performed with a delay between 24 and 48 h after hospital admission and four months after hospital discharge in the outpatient clinics. Blood tests including inflammatory markers and measurement of post-occlusive vasorelaxation by digital peripheral arterial tonometry were performed at both visits. ResultsAt baseline, COVID-19 patients exhibited reduced RHI compared to controls (p < 0.001), in line with an endothelial dysfunction. At four months follow-up, there was a 51% increase in the RHI (1.69 ± 0.32 to 2.51 ± 0.91; p < 0.01) in favor of endothelium-dependent vascular relaxation recovery. RHI changes were positively correlated with baseline C-reactive protein (r = 0.68; p = 0.02). Compared to COVID-19 patients with a decrease in RHI, COVID-19 patients with an increase in RHI beyond the day-to-day variability (i.e. >11%) had less severe systemic inflammation at baseline. ConclusionConvalescent COVID-19 patients showed a recovery of systemic artery endothelial dysfunction, in particular patients with lower inflammation at baseline. Further studies are needed to decipher the interplay between inflammation and endothelial dysfunction in COVID-19 patients.

A Retrospective Study on Smell Dysfunction in COVID-19 Patients Presenting to a Tertiary Care Teaching Hospital in Northern India

Introduction: The smell dysfunction in COVID-19 patients has remained an unexplained topic. The blood parameters’ variability in COVID-19 patients with anosmia has been studied in few literatures. The study is aimed to find the association of anosmia with the blood grouping and C-reactive protein (CRP) levels in coronavirus-infected patients. Materials and Methods: Database from Medical Records Department of a Tertiary Care Teaching Hospital in Northern India was searched from July 2020 to December 2020. Every fifth file was selected using the stratified random sampling. Laboratory-confirmed COVID-19 cases by reverse transcription-polymerase chain reaction files were included. Blood grouping and CRP levels were assessed and statistically correlated. Results: A total of 103 patients of coronavirus-associated infection with anosmia were included among which 52 (50.48%) patients were from moderate category of AIIMS-ICMR joint task Force’s clinical guidelines. A total of 44 (42.71%) patients had moderate levels of elevated CRP. The blood Group B-type was found most commonly in 35 (33.98%) patients. The correlation of severity of COVID-19 infection with CRP was found to be statistically significant (Chi-square test statistic was 31.203 and P = 0.00023) in patients presenting with smell dysfunction. Conclusion: Anosmia was found to a suggestive symptom for the early identification of coronavirus-infected cases. In this study, CRP levels showed statistically significant association with anosmia in COVID-19 patients. Predilection for specific blood groups serves as platform for further research.

Olfactory dysfunction in COVID-19 pandemic and its long-term outcome

Background: Olfactory dysfunction (OD) has commonly affected covid infected patients. This study is done to detect, analyse and study the recovery pattern of OD in laboratory confirmed COVID-19 infected patients since there is very less data available on OD recovery rate. Methods: Study design is a prospective cohort type and patients were followed up over 16 months of duration. Data was collected of COVID-19 positive patients from January 2020 to May 2021 who were hospitalized and seen after discharge in out-patient department of tertiary care Santosh medical college and hospital, Ghaziabad (Delhi NCR). In these patients, university of Pennsylvania smell identification test (UPSIT)-40 was used for assessment of OD. Results: Total number of patients enrolled in the study were 153 of which 15 were lost to follow-up. None of the patients died. Among the 138 hospitalized patients with RTPCR-confirmed COVID-19 infection [mean (SD) age, 38.91 (13.90) years; 70 males (50.7%); 68 females (49.3%)]. This is a prospective cohort study studied over 16 months. At the time of diagnosis of COVID-19, smell sensation was categorised based on UPSIT test as anosmic in 69.6% of the patients, severely amosmic in 9.4%, moderately anosmic in 12.3%, mildly anosmic in 8.7%. After a follow-up for 16 months, full recovery was observed in 125 patients (90.6%). Conclusions: Prognosis for recovery of olfaction dysfunction in COVID-19 patients was favourable. Individuals with sudden onset and gradual onset OD had higher rate of recovery over one-month follow-up period. Sudden onset OD had higher rate of recovery than gradual onset.

On the relationship between neurocognitive measures and olfactory dysfunction in COVID-19 patients with and without anosmia

One of the predominant symptoms of the COVID-19 virus is the complete (anosmia) or partial (hyposmia) loss of smell. Anosmia may be a critical neurocognitive symptom because there is an empirically demonstrated association of anosmia with neurodegenerative diseases like Parkinson's disease, Alzheimer's disease, etc. The present study assessed the neurocognitive disorder patterns in recovered COVID-19 patients who either self-reported anosmia or its absence. Of the 60 adult participants (n = 32 males, n = 28 females; Mage = 20.78 years, range = 18–31 years), 15 reported COVID-19 induced anosmia, 15 reported COVID-19 without anosmia, and 30 reported not having contracted COVID-19. The participants were first administered a 10-item smell test, and analysis of variance revealed significantly better scores for the control group than the other two groups. Further, there was no significant difference in smell scores between the patients who self-reported anosmia or denied it. This statistical pattern was consistent across all neuropsychological tests: short- and long-term verbal memory, digit span, Trail Making, and a self-report 46-item neurocognitive scale. Regardless of the self-report of anosmia or denial, all thirty COVID-19 patients scored significantly poorer than the control group on all of the tests and neurocognitive scale. In summary, the self-report of anosmia appears to be unreliable, and the COVID-19 patients who were found to be anosmic on the initial objective smell test demonstrated poorer neuropsychological performance than controls.

Sodium Status and Its Correlation with Indices of Pulmonary Dysfunction in COVID-19 Patients

Background: COVID-19-induced hyponatremia is reportedly associated with pulmonary dysfunction, but mostly among Caucasians. Hence, the current study evaluated sodium status and its correlation with indices of pulmonary dysfunctions among Nigerians of Negroid race. Methods: This was a retrospectively-designed observational study. Data, all obtained at presentation, were acquired from medical records of 480 RT-PCR-confirmed COVID-19 patients managed at a COVID-19-designated treatment facility in Port Harcourt, Southern Nigeria. Analysis of acquired data was done by COVID-19 clinical grades and sodium status using descriptive and inferential statistics. Results: At presentation, hyponatremia and hypernatremia were observed in 47.7% and 1.0% of the entire studied cohorts (n=480), respectively. Both disorders (hyponatremia/hypernatremia) were mostly observed among the moderate, severe, and critical cases. Most hyponatremic cases (n=154;67.2%) and the entire hypernatremic cases (n=5;100%) were of mild grades. Hyponatremics had higher proportions of fever, breathlessness, confusion, and a higher burden of inflammatory markers which increased with worsening hyponatremic grade. Etiologically, hyponatremia was mostly associated with the syndrome of inappropriate anti-diuretic hormone secretion (SIADH) (n=132;56.7%). Among the hyponatremics, an inverse correlation existed between sodium and respiratory rate (RR), while a correlation existed between sodium and oxygen saturation (SpO2). Compared to mild hyponatremics, the moderate/severe hyponatremics had a greater risk of having RR&gt;30 and SpO2 &lt;95%. Conclusion: Hyponatremia, mostly of mild grade, was common among the studied COVID-19 patients and was associated with indices of pulmonary dysfunctions, including disease severity, inflammatory markers, and SIADH. Hence, hyponatremia should be utilized to triage COVID-19 patients at presentation. However, further studies are recommended to verify these findings.

Pulmonary hypertension predicts higher mortality in patients admitted with severe COVID-19 infection.

Patients with underlying conditions are predicted to have worse outcomes with COVID-19. A strong association between baseline cardiovascular disease and COVID-19-related mortality has been shown by a number of studies. In the current retrospective study, we aim to identify whether patients with pulmonary hypertension have worse outcomes compared with patients without pulmonary hypertension. Data from patients of ⩾18 years of age with COVID was retrospectively collected and analyzed (n = 679). Patients who underwent transthoracic echocardiography, at the discretion of the medical team, were identified and the transthoracic echocardiography was reviewed for the presence of pulmonary hypertension. Patient health parameters and outcomes were measured and statistically analyzed. Of 679 consecutive patients identified with a diagnosis of COVID-19, 57 underwent transthoracic echocardiography, 32 of which were found to have pulmonary hypertension. Patients who underwent transthoracic echocardiography had a significantly higher intensive care unit admission rate (73.7% versus 25.4%, p < 0.001) and increased presence of acute respiratory distress syndrome (63.2% versus 21.6%, p > 0.001). These patients had longer intensive care unit length of stay, longer mechanical ventilation time, longer hospital length of stay, and a significantly higher mortality rate when compared to those not undergoing transthoracic echocardiography (59.7% versus 32.3%, p < 0.001). Among patients who underwent transthoracic echocardiography, those with pulmonary hypertension had significantly higher mortality compared to those without pulmonary hypertension (80% versus 43.8%, p < 0.01). COVID-19 in patients with pulmonary hypertension was associated with high in-hospital mortality even when adjusted for confounding factors. A number of mechanisms have been proposed for the worse outcomes in patients with pulmonary hypertension and right ventricular dysfunction, including right ventricle overload and indirect pro-inflammatory cytokine storm. Further, large-scale studies are required to evaluate the impact of right ventricular dysfunction in COVID-19 patients and to elucidate the associated mechanisms.