RETRACTED ARTICLE: Evaluation of ferritin level in COVID-19 patients and its inflammatory response

Pathological Effects of SARS-CoV-2 Associated with Hematological Abnormalities

The SARS coronavirus 2 (SARS-CoV-2) is the causative agent of the 2019 coronavirus disease (COVID-19) pandemic that has claimed the lives of 6.9 million people and infected over 765 million. It has become a major worldwide health problem and is also known to cause abnormalities in various systems, including the hematologic system. COVID-19 infection primarily affects the lower respiratory tract and can lead to a cascade of events, including a cytokine storm, intravascular thrombosis, and subsequent complications such as arterial and venous thromboses. COVID-19 can cause thrombocytopenia, lymphopenia, and neutrophilia, which are associated with worse outcomes. Prophylactic anticoagulation is essential to prevent complications and death rates associated with the virus's effect on the coagulation system. It is crucial to recognize these complications early and promptly start therapeutic anticoagulation to improve patient outcomes. While rare, COVID-19-induced disseminated intravascular coagulation (DIC) exhibits some similarities to DIC induced by sepsis. Lactate dehydrogenase (LDH), D-dimer, ferritin, and C-reactive protein (CRP) biomarkers often increase in serious COVID-19 cases and poor prognosis. Understanding the pathophysiology of the disease and identifying risk factors for adverse outcomes is critical for effective management of COVID-19.

SARS-CoV-2 infection and multi-organ system damage: A review

The SARS-CoV-2 infection causes COVID-19, which has affected approximately six hundred million people globally as of August 2022. Organs and cells harboring angiotensin-converting enzyme 2 (ACE2) surface receptors are the primary targets of the virus. However, once it enters the body through the respiratory system, the virus can spread hematogenously to infect other body organs. Therefore, COVID-19 affects many organs, causing severe and long-term complications, even after the disease has ended, thus worsening the quality of life. Although it is known that the respiratory system is most affected by the SARS-CoV-2 infection, many organs/systems are affected in the short and long term. Since the COVID-19 disease simultaneously affects many organs, redesigning diagnostic and therapy policies to fit the damaged organs is strongly recommended. Even though the pathophysiology of many problems the infection causes is unknown, the frequency of COVID-19 cases rises with age and the existence of preexisting symptoms. This study aims to update our knowledge of SARS-CoV-2 infection and multi-organ dysfunction interaction based on clinical and theoretical evidence. For this purpose, the study comprehensively elucidates the most recent studies on the effects of SARS-CoV-2 infection on multiple organs and systems, including respiratory, cardiovascular, gastrointestinal, renal, nervous, endocrine, reproductive, immune, and parts of the integumentary system. Understanding the range of atypical COVID-19 symptoms could improve disease surveillance, limit transmission, and avoid additional multi-organ-system problems.

Assessment of inflammatory markers and their association with disease mortality in severe COVID-19 patients of tertiary care hospital in South India

Background

COVID-19 infection involves a complex interplay of the immunological and inflammatory responses. Low blood-oxygen levels have been a hallmark in COVID-19 patients. The lung tissue damage infiltered by the viral-mediated inflammation decreases oxygen saturation to cause silent hypoxia and cell death. This study aimed to evaluate the association of inflammatory biomarkers with oxygen saturation (SpO₂) and mortality in severe COVID-19 patients.

Methods

A total of 190 severe COVID-19 patients were included in this study after confirmed by the RT-PCR assay. The laboratory tests were performed for biochemical assessment. Serum levels of C-reactive protein (CRP), lactate dehydrogenase (LDH), and ferritin were determined and compared between survivors and nonsurvivors using independent sample t-test. The correlation of these inflammatory markers was studied using Spearman’s correlation, and their association with mortality was studied using logistic regression.

Results

All the COVID-19 patients were severe with SpO₂< 90% and respiratory rate > 30/min. While the serum levels of CRP, LDH, ferritin, aspartate transaminase (AST), urea, and random blood sugar (RBS) were elevated, hemoglobin (Hb) and SpO₂ levels were reduced in COVID-19 patients. LDH and ferritin levels were significantly higher in nonsurvivors compared to survivors with p values of 0.001 and 0.022 respectively. Spearman’s correlation showed a significant correlation of the inflammatory markers with SpO₂, serum electrolytes (potassium, chloride), liver enzymes (AST and alanine transaminase (ALT)), and markers of kidney damage (urea, creatinine).

Conclusion

Inflammatory markers could effectively discriminate the risk of mortality in severe COVID-19 patients. As CRP, LDH, and ferritin levels determine the tissue oxygen availability, they seem to be valuable biomarkers in the prognosis of COVID-19.

Iron metabolism: pathways and proteins in homeostasis

Iron is essential to human survival. The biological role and trafficking of this trace essential inorganic element which is also a potential toxin is constantly being researched and unfolded. Vital for oxygen transport, DNA synthesis, electron transport, neurotransmitter biosynthesis and present in numerous other heme and non-heme enzymes the physiological roles are immense. Understanding the molecules and pathways that regulate this essential element at systemic and cellular levels are of importance in improving therapeutic strategies for iron related disorders. This review highlights the progress in understanding the metabolism and trafficking of iron along with the pathophysiology of iron related disorders.

COVID-19 Pregnancies with Heart Disease: Challenges of Delivery

This case series of four cases of pregnancy with rheumatic heart disease with COVD-19 disease reports on the management of delivery and complications of heart disease with COVID-19, high-lighting the presentation, severity, delivery concerns, and clinical management with the maternal and fetal outcomes. Of the four full-term deliveries, one delivered normally, one instrumental delivery and two by cesarean section. All four required oxygen support post-delivery, 2/4 (50%) were transferred for intensive care unit (ICU) care, 1/4 (25%) required mechanical ventilation, 1/4 (25%) had postpartum hemorrhage, 1/4 (25%) had COVID related sepsis and received convalescent plasma therapy, and 2/4 (50%) received antiviral remdesivir. The most severe disease (COVID sepsis and ICU stay) was seen in patient of heart disease with COVID with preclampsia. All neonates tested SARS-CoV-2 negative, with one early neonatal death. All four mothers were discharged in stable condition of COVID and heart status. COVID-19 in cardiac disease pregnancies has increased rates of complications, oxygen, and ICU requirements than other pregnancies with COVID, requiring multidisciplinary team for intensive monitoring of intrapartum and postpartum period.