Non-critical Patients Research Articles

Blood flow restricted exercise – The new exercise therapy stimulating endothelial response and angiogenesis

Background and Aims: Peripheral artery disease (PAD) is a common atherosclerosis manifestation affecting over 20% of Europeans above 55 years old. Even though endovascular treatment is the common and frequently used treatment method, non-invasive treatment such as physical training remains the first option treatment for non-critical limb ischemia patients.[PM1] As in the last decade, the innovative blood flow restricted training (BFRT) was gaining popularity, our team decided to examine its influence on the endothelium for future use in PAD patients.

Deployment of telemedicine as another mitigation tool during the COVID-19 pandemic in India

Healthcare systems in resource scarce countries continue to face unprecedented challenges due to the COVID-19 pandemic, including saturation of healthcare system capacities. Data suggest that medical staff deployed for COVID-19 containment are at higher risk of exposure and thus greater susceptibility to infection, further decreasing the available workforce. Telemedicine, as an additional healthcare delivery approach, can circumvent hospital visits of non-critical COVID-19 patients and thus reduce exposure of both providers and non-COVID-19 patients. Widespread implementation of telemedicine at this watershed moment for healthcare system in India will establish a new public health delivery alternative that can cater to the COVID-19 pandemic and beyond.

Critically Ill vs. Non-Critically Ill Patients With COVID-19Pneumonia: Clinical Features, Laboratory Findings, and Prediction.

ObjectivesThe objective of this study was to investigate the clinical features and laboratory findings of patients with and without critical COVID-19 pneumonia and identify predictors for the critical form of the disease.MethodsDemographic, clinical, and laboratory data of 63 COVID-19 pneumonia patients were retrospectively reviewed. Laboratory parameters were also collected within 3–5 days, 7–9 days, and 11–14 days of hospitalization. Outcomes were followed up until March 12, 2020.ResultsTwenty-two patients developed critically ill pneumonia; one of them died. Upon admission, older patients with critical illness were more likely to report cough and dyspnoea with higher respiration rates and had a greater possibility of abnormal laboratory parameters than patients without critical illness. When compared with the non-critically ill patients, patients with serious illness had a lower discharge rate and longer hospital stays, with a trend towards higher mortality. The interleukin-6 level in patients upon hospital admission was important in predicting disease severity and was associated with the length of hospitalization.ConclusionsMany differences in clinical features and laboratory findings were observed between patients exhibiting non-critically ill and critically ill COVID-19 pneumonia. Non-critically ill COVID-19 pneumonia also needs aggressive treatments. Interleukin-6 was a superior predictor of disease severity.

Predicting the 30-day Adverse Outcomes of Non-Critical New-Onset COVID-19 Patients in Emergency Departments based on their Lung CT Scan Findings; A Pilot Study for Derivation an Emergency Scoring Tool

Introduction: Coronavirus Disease (COVID‐19) has become the most important global health issue, and chest computed tomography (CT) scan can help determine the severity of the infection. Objectives: This study aimed to provide an emergency scoring tool for predicting 30-day adverse outcomes in non-critical new-onset COVID-19 patients. Methods: This derivation study was conducted on new-onset COVID-19 patients presenting to the emergency department of an urban teaching hospital in Tehran, Iran, between 20 February and 20 March 2020. The total lobe severity score (TSS), age, history of comorbidities, and 30-day adverse outcomes (death, ICU admission or intubation) were taken into account to produce three prediction models. Results: Overall, 137 patients were included in the study. Their mean age was 59.9±16.8 years and 62% were male. The ground glass nodule, patch B/punctate ground-glass opacity, fibrous stripes, and air bronchogram sign with perihilar distribution, bilateral and ≥ 2 affected lobes were the most common findings. The mean TSS (model 1) was significantly higher in patients with an adverse outcome (9.4±3.2) compared to the discharged patients (7.2±3.3) (p<0.001, AUC: 0.703, sensitivity: 64.4% and specificity: 74.1%). The optimal cut-off point of model 2 (TSS and age) had the following parameters: AUC: 0.721, sensitivity: 71.2% and specificity: 67.2%. The optimal cut-off point of model 3 (TSS, age, comorbidities) had: AUC: 0.755, sensitivity: 79.7% and specificity: 65.5%. The discrimination achieved with model 3 based on Bonferroni’s test was significantly better than that achieved with TSS (p<0.001). Conclusion: TSS combined with age and history of at least one comorbidity had a better predictive value for adverse outcomes with a cut-off point above 8.

Venous Thromboembolism in Hospitalized Critical and Noncritical COVID-19 Patients: A Systematic Review and Meta-analysis.

Introduction Venous thromboembolism (VTE) has been observed as a frequent complication in patients with severe novel coronavirus disease 2019 (COVID-19) infection requiring hospital admission. Aim This study was aimed to evaluate the epidemiology of VTE in hospitalized intensive care unit (ICU) and non-ICU patients. Materials and Methods PubMed was searched up to November 13, 2020, and updated in December 12, 2020. We included studies that evaluated the epidemiology of VTE, including pulmonary embolism (PE) and/or deep vein thrombosis (DVT), in patients with COVID-19. Results A total of 91 studies reporting on 35,017 patients with COVID-19 was included. The overall frequency of VTE in all patients, ICU and non-ICU, was 12.8% (95% confidence interval [CI]: 11.103–14.605), 24.1% (95% CI: 20.070–28.280), and 7.7% (95% CI: 5.956–9.700), respectively. PE occurred in 8.5% (95% CI: 6.911–10.208), and proximal DVT occurred in 8.2% (95% CI: 6.675–9.874) of all hospitalized patients. The relative risk for VTE associated with ICU admission was 2.99 (95% CI: 2.301–3.887, p <0.001). DVT and PE estimated in studies that adopted some form of systematic screening were higher compared with studies with symptom-triggered screening. Analysis restricted to studies in the 5th quintile of sample size reported significantly lower VTE estimates. Conclusion This study confirmed a high risk of VTE in hospitalized COVID-19 patients, especially those admitted to the ICU. Nevertheless, sensitivity analysis suggests that previously reported frequencies of VTE in COVID-19 might have been overestimated.

The Satisfaction of the Users with the Islamic Design Quality in Instant Hospitals for Non-Critical Covid-19 Patients in Malaysia

Malaysia is currently going through its 3rd wave of Covid-19 and the cases have spiked up to nearly 4000/day. This has put an enormous pressure on the Malaysian healthcare system. Therefore, the Ministry of Health has come up with the idea of so-called “instant hospitals” to cope with the excessive number of patients, particularly non-critical Covid-19 patients. As a multi-racial country with Islam as the official religion, the Islamic Principles should be considered in the design of “instant hospitals” to promote Islamic awareness, strengthen the commitment to Islam and ultimately gain Allah’s mercy and forgiveness. The implementation of Islamic Principles in the design of these hospitals will enhance the healing process. The objective of this study is to identify the qualified personages to be selected as respondents and the criteria to implement Islamic design quality in an instant hospital or quarantine centre. This study sifts the satisfaction of the respondents on the basis of the criteria related to the implementation of Islamic design quality. This research has utilised the descriptive and survey-based method rooted in qualitative and quantitative research and supported by Media Content Analysis. From the analysis, new Islamic design criteria for hospitals has been outlined, which is consistent with the qualities in the Islamic Built Environment. The results will influence the Malaysian administrators and designers to develop a better hospital environment with the implementation of Islamic quality for the benefit of all the Malaysians.

Clinical manifestations and socio-demographic status of COVID-19 patients during the second-wave of pandemic: A Bangladeshi experience

BackgroundBangladesh is a densely populated country with a substandard healthcare system and a mediocre economic framework. Due to the enormous number of people who have been unaware until now, the development of COVID-19’s second-wave infection has become a severe threat. The present investigation aimed to characterize the clinical and socio-demographic characteristics of COVID-19 in Bangladesh. MethodsA cross-sectional analysis was carried out from all the other COVID-19 patients and confirmed by RT-PCR undergoing a specialized COVID-19 hospital. From March 1 to April 15, 2021, a total of 1326 samples were collected. Samples were only obtained from non-critical COVID-19 patients as critically ill patients required emergency intensive care medications. Then, from April 17 to May 03, 2021, SARS-CoV-2 infection and clinical assessment was performed based on interim guidelines from the WHO. The diagnosis was conducted through RT-PCR. Later, identifying the symptomatic and asymptomatic patient based on checking the Clinical Observation Form (COF). The patients filled the COF form. Finally, statistical analyses were done using the SPSS 20 statistical program. ResultsIn this investigation, a total of 326 patients were diagnosed as COVID-19 positive. Among them, approximately 19.02% (n = 62) were asymptomatic, and 80.98% (n = 264) were symptomatic. Here, the finding shows that the occurrence of this infection was varied depending on age, sex, residence, occupation, smoking habit, comorbidities, etc. However, Males (60.12%) were more affected than females (39.88%), and, surprisingly, this pandemic infected both urban and rural residents almost equally (urban = 50.92%; rural = 49.08%). Approximately 19% of the asymptomatic and 62% of symptomatic cases had at least one comorbid disorder. Interestingly, an unexpected result was exhibited in the case of smokers, where non-smokers were more affected than smokers.The study indicates community transmission of COVID 19, where people were highly infected at their occupations (35.58%), at houses (23.93%) and by traveling (12.88%). Noteworthy, according to this report, a large number (19.33%) of individuals did not know exactly how they were contaminated with SARS-CoV-2. Patients were most commonly treated by an antibiotic 95.09%, followed in second by corticosteroid 46.01%. Anti-viral drugs, remdesivir, and oxygenation are also needed for other patients. Among those, who were being treated, approximately 69.33% were isolated at home, 27.91% were being treated at dedicated COVID-19 hospitals. Finally, 96.63% were discharged without complications, and 0.03% has died. ConclusionThis investigation concludes that males became more infected than females. Interestingly, both urban and rural people became nearly equally infected. It noticed community transmission of SARS-CoV-2, where people were highly infected at their workplaces. A higher rate of silent transmission indicates that more caution is needed to identify asymptomatic patients. Most of the infected people were isolated at home whereas nearly one-fourth were treated at hospitals. Clinically, antibiotics were the most widely used treatment. However, the majority of the patients were discharged without complications. The current investigation would be helpful to understand the clinical manifestations and socio-demographic situations during the second wave of the COVID-19 pandemic in Bangladesh.

An Evolutionary Belief Rule-Based Clinical Decision Support System to Predict COVID-19 Severity under Uncertainty

Accurate and rapid identification of the severe and non-severe COVID-19 patients is necessary for reducing the risk of overloading the hospitals, effective hospital resource utilization, and minimizing the mortality rate in the pandemic. A conjunctive belief rule-based clinical decision support system is proposed in this paper to identify critical and non-critical COVID-19 patients in hospitals using only three blood test markers. The experts’ knowledge of COVID-19 is encoded in the form of belief rules in the proposed method. To fine-tune the initial belief rules provided by COVID-19 experts using the real patient’s data, a modified differential evolution algorithm that can solve the constraint optimization problem of the belief rule base is also proposed in this paper. Several experiments are performed using 485 COVID-19 patients’ data to evaluate the effectiveness of the proposed system. Experimental result shows that, after optimization, the conjunctive belief rule-based system achieved the accuracy, sensitivity, and specificity of 0.954, 0.923, and 0.959, respectively, while for disjunctive belief rule base, they are 0.927, 0.769, and 0.948. Moreover, with a 98.85% AUC value, our proposed method shows superior performance than the four traditional machine learning algorithms: LR, SVM, DT, and ANN. All these results validate the effectiveness of our proposed method. The proposed system will help the hospital authorities to identify severe and non-severe COVID-19 patients and adopt optimal treatment plans in pandemic situations.

Excess short-term mortality in noncritical patients with atrial fibrillation presenting to the emergency department.

BackgroundMortality data of non-critically ill patients presenting with symptomatic atrial fibrillation to an emergency department are scarce. We aimed to analyze the short-term mortality of these patients compared with that of the general Austrian population.Design/methodsThis study analyzed a consecutive series of non-critically ill adults presenting to the emergency department at the Medical University of Vienna between 2012 and 2016 with complaints related to atrial fibrillation. The study outcome was mortality during the observation period. Age-specific and sex-specific mortality rates per 100 person-years were calculated and compared with the mortality rates of the Austrian population during the same period.ResultsIn total, 1754 patients with atrial fibrillation (43.1% female) were included in the study. During a median follow-up of 25 months, 248 of these patients died. Observed mortality rates were 7.8 per 100 person-years for females (95% confidence interval, CI 6.6–9.5) and 5.9 per 100 person-years for males (95% CI 5.0–7.1). Age-adjusted and sex-adjusted mortality rates were 2.8 (95% CI 2.3–3.3) and 2.7 (95% CI 2.2–3.2) per 100 person-years, respectively. Mortality rates for the Austrian population were 1.1 per 100 person-years for both females and males. Corresponding standardized mortality ratios were 2.5 for females (95% CI 2.1–3.0) and 2.4 for males (95% CI 2.0–2.9).ConclusionThe short-term mortality of patients with symptomatic atrial fibrillation presenting to the emergency department was substantially higher compared with the general Austrian population.Supplementary InformationThe online version of this article (10.1007/s00508-021-01895-y) contains supplementary material, which is available to authorized users.

Persistent Symptoms in Non-critical COVID-19 Patients at Two Months Follow-Up in a District Hospital: A Descriptive Cross-sectional Study.

The corona virus disease 2019 is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 belonging to corona viruses which are enveloped positive stranded RNA viruses. Non-critical coronavirus disease 2019 patients often lack follow up visits which has led to incomplete understanding of disease process. The aim of this study was to find out the prevalence of persistent symptoms in such patients during two months follow-up to a district hospital. This descriptive cross-sectional study was conducted in a district hospital from September 2020 to February 2021 among non-critical corona virus disease 2019 patients admitted to the isolation center of Nepal. Ethical approval was taken from the ethical review board of Nepal Health Research Council (reference number: 1707). Convenience sampling was done. Data was collected using a structured questionnaire. Data analysis was done using Statistical Package for the Social Sciences version 26. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Out of 132 patients, 66 (50%) (41.5-58.5 at 95% Confidence Interval) patients had persistent symptoms at two-month follow-up. Forty-eight (36.4%) patients showed one symptom, 15 (11%) had two symptoms, and 3 (2%) had two or more symptoms. The most frequent symptom reported was fatigue in 17 (13%), cough in 15 (11%), myalgia in 9 (7%), and headache in 9 (7%). The prevalence of persistent symptoms at two months follow up in our study was lower than findings from other international studies.

Integrating electronic health data records to develop and validate a predictive model of hospital-acquired acute kidney injury in non-critically ill patients.

ABSTRACTBackgroundModels developed to predict hospital-acquired acute kidney injury (HA-AKI) in non-critically ill patients have a low sensitivity, do not include dynamic changes of risk factors and do not allow the establishment of a time relationship between exposure to risk factors and AKI. We developed and externally validated a predictive model of HA-AKI integrating electronic health databases and recording the exposure to risk factors prior to the detection of AKI.MethodsThe study set was 36 852 non-critically ill hospitalized patients admitted from January to December 2017. Using stepwise logistic analyses, including demography, chronic comorbidities and exposure to risk factors prior to AKI detection, we developed a multivariate model to predict HA-AKI. This model was then externally validated in 21 545 non-critical patients admitted to the validation centre in the period from June 2017 to December 2018.ResultsThe incidence of AKI in the study set was 3.9%. Among chronic comorbidities, the highest odds ratios (ORs) were conferred by chronic kidney disease, urologic disease and liver disease. Among acute complications, the highest ORs were associated with acute respiratory failure, anaemia, systemic inflammatory response syndrome, circulatory shock and major surgery. The model showed an area under the curve (AUC) of 0.907 [95% confidence interval (CI) 0.902–0.908), a sensitivity of 82.7 (95% CI 80.7–84.6) and a specificity of 84.2 (95% CI 83.9–84.6) to predict HA-AKI, with an adequate goodness-of-fit for all risk categories (χ2 = 6.02, P = 0.64). In the validation set, the prevalence of AKI was 3.2%. The model showed an AUC of 0.905 (95% CI 0.904–0.910), a sensitivity of 81.2 (95% CI 79.2–83.1) and a specificity of 82.5 (95% CI 82.2–83) to predict HA-AKI and had an adequate goodness-of-fit for all risk categories (χ2 = 4.2, P = 0.83). An online tool (predaki.amalfianalytics.com) is available to calculate the risk of AKI in other hospital environments.ConclusionsBy using electronic health data records, our study provides a model that can be used in clinical practice to obtain an accurate dynamic and updated assessment of the individual risk of HA-AKI during the hospital admission period in non-critically ill patients.

Predicting QT interval prolongation in patients diagnosed with the 2019 novel coronavirus infection

Introduction2019 novel coronavirus (COVID‐19) patients frequently develop QT interval prolongation that predisposes them to Torsades de Pointes and sudden cardiac death. Continuous cardiac monitoring has been recommended for any COVID‐19 patient with a Tisdale Score of seven or more. This recommendation, however, has not been validated.MethodsWe included 178 COVID‐19 patients admitted to a non‐intensive care unit setting of a tertiary academic medical center. A receiver operating characteristics curve was plotted to determine the accuracy of the Tisdale Score to predict QT interval prolongation. Multivariable analysis was performed to identify additional predictors.ResultsThe area under the curve of the Tisdale Score was 0.60 (CI 95%, 0.46–0.75). Using the cutoff of seven to stratify COVID‐19, patients had a sensitivity of 85.7% and a specificity of 7.6%. Risk factors independently associated with QT interval prolongation included a history of end‐stage renal disease (ESRD) (OR, 6.42; CI 95%, 1.28–32.13), QTc ≥450 ms on admission (OR, 5.90; CI 95%, 1.62–21.50), and serum potassium ≤3.5 mmol/L during hospitalization (OR, 4.97; CI 95%, 1.51–16.36).ConclusionThe Tisdale Score is not a useful tool to stratify hospitalized non‐critical COVID‐19 patients based on their risks of developing QT interval prolongation. Clinicians should initiate continuous cardiac monitoring for patients who present with a history of ESRD, QTc ≥450 ms on admission or serum potassium ≤3.5 mmol/L.

Electrocardiographic findings in non-critical patients with coronavirus disease-2019

Background/Aim: Cardiovascular involvement in patients with coronavirus disease 2019 (COVID-19) is closely related to the course of the disease; however, this issue has not been adequately studied in Turkey. Thus, we aimed to investigate the electrocardiography (ECG) findings in noncritical patients with COVID-19 in Turkey. Methods: This retrospective cohort study was conducted on non-critical patients with COVID-19 with no history of any cardiac disease. The laboratory parameters and ECG findings of the patients at the time of admission were analyzed. Results: In total, 100 patients with a mean age of 56.8 (16.7) years were included in the study, among which 54 were males. The rate of patients having at least one abnormal ECG finding, ST segment pathology, and elevated troponin level were 58%, 26%, and 48%, respectively. The respiratory rate and mean troponin level were higher and the mean lymphocyte count was lower in patients with ST segment pathology than in patients without. The respiratory rate, fibrinogen level, and incidence of T negativity and abnormal ECG findings were higher, and the lymphocyte count was lower in patients with elevated troponin levels than in patients with normal troponin levels (P0.03 mg/mL (P

Outcome of noncritical COVID-19 patients with early hospitalization and early antiviral treatment outside the ICU

Background/aimDespite the fact that the COVID-19 pandemic has been going on for over 5 months, there is yet to be a standard management policy for all patients including those with mild-to-moderate cases. We evaluated the role of early hospitalization in combination with early antiviral therapy with COVID-19 patients in a tertiary care university hospital. Materials and methodsThis was a prospective, observational, single-center study on probable/confirmed COVID-19 patients hospitalized in a tertiary care hospital on COVID-19 wards between March 20 and April 30, 2020. The demographic, laboratory, and clinical data were collected. ResultsWe included 174 consecutive probable/confirmed COVID-19 adult patients hospitalized in the Internal Medicine wards of the University Adult Hospital between March 20 and April 30, 2020. The median age was 45.5 (19–92) years and 91 patients (52.3%) were male. One hundred and twenty (69%) were confirmed microbiologically, 41 (23.5%) were radiologically diagnosed, and 13 (7.5%) were clinically suspected (negative microbiological and radiological findings compatible with COVID-19); 35 (20.1%) had mild, 107 (61.5%) moderate disease, and 32 (18.4%) had severe pneumonia. Out of 171 cases, 130 (74.3%) showed pneumonia; 80 were typical, and 50 showed indeterminate infiltration for COVID-19. Patients were admitted within a median of 3 days (0-14 days) after symptoms appear. The median duration of hospitalization was 4 days (0-28 days). In this case series, 13.2% patients were treated with hydroxychloroquine alone, 64.9% with hydroxychloroquine plus azithromycin, and 18.4% with regimens including favipiravir. A total of 15 patients (8.5%) were transferred to the ICU. Four patients died (2.2%).ConclusionIn our series, 174 patients were admitted to the hospital wards for COVID-19, 69% were confirmed with PCR and/or antibody test. At the time of admission, nearly one fifth of the patients had severe diseases. Of the patients, 95.4% received hydroxychloroquine alone or in combination. The overall case fatality rate was 2.2%.

Natural-Derived Polysaccharides From Plants, Mushrooms, and Seaweeds for the Treatment of Inflammatory Bowel Disease.

Inflammatory bowel disease (IBD) is a chronic inflammatory disease impairing the gastrointestinal tract, and its incidence and prevalence have been increasing over time worldwide. IBD greatly reduces peoples' quality of life and results in several life-threatening complications, including polyp, toxic colonic dilatation, intestinal perforation, gastrointestinal bleeding, and cancerization. The current therapies for IBD mainly include drugs for noncritical patients and operation for critical patients. However, continuous use of these drugs causes serious side effects and increased drug resistance, and the demand of effective and affordable drugs with minimal side effects for IBD sufferers is urgent. Natural-derived polysaccharides are becoming a research hotspot for their therapeutic effects on IBD. This study focuses on the research progress of various natural polysaccharides from plants, seaweeds, and mushrooms for the treatment of IBD during recent 20 years. Regulation of oxidative stress, inflammatory status, gut microbiota, and immune system and protection of the intestinal epithelial barrier function are the underlying mechanisms for the natural-derived polysaccharides to treat IBD. The excellent efficacy and safety of polysaccharides make them promising candidates for IBD therapy.

POS-623 COVID19 IN MAINTAINENCE HEMODIALYSIS PATIENTS - CLINICAL MANIFESTATIONS AND OUTCOMES

The unprecedented pandemic caused by Severe Acute Respiratory Syndrome Coronavirus 2, began in December 2019 in China and rapidly spread globally. ESRD patients on maintenance haemodialysis (MHD) are vulnerable to COVID19 due to various comorbidites like Diabetes Mellitus, Hypertension, Cardiovascular disease. There is limited experience about the clinical profile of hemodialysis patients with COVID19 infection.We describe our experience of 35 MHD patients who developed COVID19 at a tertiary care hospital in Kolkata, India. We also compared the clinical and laboratory parameters of critical and non-critical patients. This is a single center, observational, retrospective study, recording the demographic data, exposure history, clinical features, laboratory and radiological findings, treatment and outcome data for all patients with laboratory-confirmed COVID-19 (RT-PCR test) between15 March to 15 Sept, 2020. RT-PCR was repeated every 5 days and a patient was considered as negative for COVID-19 if RT-PCR was negative two times 24 hours apart. Patients were divided into critical (ICU admissions) and non-critical (domiciliary/ward admissions) groups. Out of 394 patients on MHD, 35(8.88%) were found to be COVID-19 positive during these 6 months. 27 (77.1%) patients were symptomatic and hospitalised; 17(48.6%) in wards and 10 (22.9%) in ICU. Rest 8 patients with mild or no symptoms received domiciliary treatment. Common underlying comorbidities were hypertension (88.6%), DM-2 (48.6%), obesity (14.3%). There was no statistical difference in the comorbidities between both groups The table shows clinical symptoms and radiological parameters. 8 (22.9%) patients were asymptomatic and detected on routine screening. Generalized fatigue and fever were the commonest symptoms. Cough, dyspnoea & pneumonia were found to be significantly higher in patients admitted to ICUs. Reason for hospitalization in 70.37 % patients was a lower respiratory tract infection . 51.85 % of the admitted patients developed pneumonia. HRCT chest showed ground glass opacities in 77.1% and consolidation in 42.9%. 50% of the patients in ICU required mechanical ventilation due to hypoxic respiratory failure. 30% required NIV support and 20 % required high flow nasal oxygen. Four patients died due to COVID pneumonia and ARDS. Median time from admission to death was 12 days. Mortality was 11.42% . 24 patients recovered and became COVID-19 negative. Mean time to virus negativity was 16.4 days. Median duration of hospitalization was 14 days (range 4 to 25 days). Laboratory parameters like CRP, LDH, D-Dimer, Serum ferritin levels in the ICU group were higher with significantly lower absolute lymphocyte count. Oxygen saturation levels were lower in the ICU group (Mean-91.8% vs 98% in the Non-ICU group) at the time of admission. Patients receiving MHD are susceptible to COVID19 and hemodialysis centers are high risk areas for cross infection during the pandemic. Increasing preventive efforts, instituting triage and screening, isolating patients of COVID19, contact tracing, and dialysing them in isolated centers would be help in prevention and disease contention.

A potential impact of SARS-CoV-2 on pituitary glands and pituitary neuroendocrine tumors

IntroductionAngiotensin-converting enzyme 2 (ACE2) is the receptor of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The effects of SARS-CoV-2 on normal pituitary glands function or pituitary neuroendocrine tumors (PitNETs) have not yet been elucidated. Thus, the present study aimed to investigate the potential risks of SARS-CoV-2 infection on the impairment of pituitary glands and the development of PitNETs.MethodsPitNETs tissues were obtained from 114 patients, and normal pituitary gland tissues were obtained from the autopsy. The mRNA levels of ACE2 and angiotensin II receptor type 1 (AGTR1) were examined by quantitative real-time PCR. Immunohistochemical staining was performed for ACE2 in 69 PitNETs and 3 normal pituitary glands. The primary tumor cells and pituitary cell lines (MMQ, GH3 and AtT-20/D16v-F2) were treated with diminazene aceturate (DIZE), an ACE2 agonist, with various dose regimens. The pituitary hormones between 43 patients with SARS-CoV-2 infection were compared with 45 healthy controls.ResultsPituitary glands and the majority of PitNET tissues showed low/negative ACE2 expression at both the mRNA and protein levels, while AGTR1 showed high expression in normal pituitary and corticotroph adenomas. ACE2 agonist increased the secretion of ACTH in AtT-20/D16v-F2 cells through downregulating AGTR1. The level of serum adrenocorticotropic hormone (ACTH) was significantly increased in COVID-19 patients compared to normal controls (p < 0.001), but was dramatically decreased in critical cases compared to non-critical patients (p = 0.003).ConclusionsThis study revealed a potential impact of SARS-CoV-2 infection on corticotroph cells and adenomas.

Combined clinical and imaging features better predict the critical outcomes of patients with SARS-COV-2.

The purpose of this study was to investigate the predictive value of combined clinical and imaging features, compared with the clinical or radiological risk factors only. Moreover, the expected results aimed to improve the identification of severe acute respiratory syndrome coronavirus-2 (SARS-COV-2) patients who may have critical outcomes.This retrospective study included laboratory-confirmed SARS-COV-2 cases between January 18, 2020, and February 16, 2020. The patients were divided into 2 groups with noncritical illness and critical illness regarding severity status within the hospitalization. Univariable and multivariable logistic regression models were used to explore the risk factors associated with clinical and radiological outcomes in patients with SARS-COV-2. The ROC curves were performed to compare the prediction performance of different factors.A total of 180 adult patients in this study included 20 critical patients and 160 noncritical patients. In univariate logistic regression analysis, 15 risk factors were significantly associated with critical outcomes. Of importance, C-reactive protein (1.051, 95% confidence interval 1.024-1.078), D-dimer (1.911, 95% CI, 1.050–3.478), and CT score (1.29, 95% CI, 1.053–1.529) on admission were independent risk factors in multivariate analysis. The combined model achieved a better performance in disease severity prediction (P = .05).CRP, D-dimer, and CT score on admission were independent risk factors for critical illness in adults with SARS-COV-2. The combined clinical and radiological model achieved better predictive performance than clinical or radiological factors alone.

The laboratory findings and different COVID-19 severities: a systematic review and meta-analysis

BackgroundAbnormal laboratory findings are common in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The aim of this systematic review was to investigate the effect of the level of some laboratory factors (C-reactive protein (CRP), creatinine, leukocyte count, hemoglobin, and platelet count) on the severity and outcome of coronavirus disease 2019 (COVID-19).MethodsWe searched PubMed, Web of Science, Scopus, and Google Scholar. We collected the articles published before May 26, 2020. We gathered the laboratory factors in groups of patients with COVID-19, and studied the relation between level of these factors with severity and outcome of the disease.ResultsMean CRP level, creatinine, hemoglobin, and the leukocytes count in the critically ill patients were significantly higher than those of the other groups (non-critical patients); mean CRP = 54.81 mg/l, mean creatinine = 86.82 μmol/l, mean hemoglobin = 144.05 g/l, and mean leukocyte count = 7.41 × 109. The lymphocyte count was higher in patients with mild/moderate disease (mean: 1.32 × 109) and in the invasive ventilation group (mean value of 0.72 × 109), but it was considerably lower than those of the other two groups. The results showed that the platelet count was higher in critically ill patients (mean value of 205.96 × 109). However, the amount was lower in the invasive ventilation group compared with the other groups (mean level = 185.67 × 109).ConclusionWith increasing disease severity, the leukocyte count and the level of CRP increase significantly and the lymphocyte count decreases. There seems to be a significant relation between platelet level, hemoglobin, and creatinine level with severity of the disease. However, more studies are required to confirm this.

Quantification of COVID-19 Opacities on Chest CT – Evaluation of a Fully Automatic AI-approach to Noninvasively Differentiate Critical Versus Noncritical Patients

ObjectivesTo evaluate the potential of a fully automatic artificial intelligence (AI)-driven computed tomography (CT) software prototype to quantify severity of COVID-19 infection on chest CT in relationship with clinical and laboratory data.MethodsWe retrospectively analyzed 50 patients with laboratory confirmed COVID-19 infection who had received chest CT between March and July 2020. Pulmonary opacifications were automatically evaluated by an AI-driven software and correlated with clinical and laboratory parameters using Spearman-Rho and linear regression analysis. We divided the patients into sub cohorts with or without necessity of intensive care unit (ICU) treatment. Sub cohort differences were evaluated employing Wilcoxon-Mann-Whitney-Test.ResultsWe included 50 CT examinations (mean age, 57.24 years), of whom 24 (48%) had an ICU stay. Extent of COVID-19 like opacities on chest CT showed correlations (all p < 0.001 if not otherwise stated) with occurrence of ICU stay (R = 0.74), length of ICU stay (R = 0.81), lethal outcome (R = 0.56) and length of hospital stay (R = 0.33, p < 0.05). The opacities extent was correlated with laboratory parameters: neutrophil count (NEU) (R = 0.60), lactate dehydrogenase (LDH) (R = 0.60), troponin (TNTHS) (R = 0.55) and c-reactive protein (CRP) (R = 0.51). Differences (p < 0.001) between ICU group and non-ICU group concerned longer length of hospital stay (24.04 vs. 10.92 days), higher opacity score (12.50 vs. 4.96) and severity of laboratory data changes such as c-reactive protein (11.64 vs. 5.07 mg/dl, p < 0.01).ConclusionsAutomatically AI-driven quantification of opacities on chest CT correlates with laboratory and clinical data in patients with confirmed COVID-19 infection and may serve as non-invasive predictive marker for clinical course of COVID-19.