Clinical profile of hospitalised moderate category COVID-19 patients: Short study from a Tertiary Care Centre in Delhi

Background

The clinical profile of hospitalized moderate-category COVID-19 patients has been understudied globally and in India.

Aim

The present study was conducted to study the clinical profile and assess the proportions of patients who progressed to severe disease and its predictors among moderate COVID-19 patients.

Materials and Methods

In this single-center observational study, 100 moderate-category COVID-19 patients as per Ministry of Health and Family Welfare (MoHFW) criteria of age ≥18 years of either sex, excluding pregnant females from February to November 2021, were studied by analyzing their clinical profiles and assessing Quick Sequential Organ Failure Assessment (qSOFA), National Early Warning Score 2 (NEWS-2), and chest computed-tomography severity score (CTSS) to predict progression to severe disease. Severe disease was defined as per MoHFW criteria.

Results

Out of 100 moderate-category COVID-19 patients, progression to severe disease was seen in 11 patients (11%), among which eight patients had expired, three patients were discharged, and the rest of the 89 patients (89%) who did not progress to severe disease were discharged. A higher age (62.2± 19.5 vs 54.8 ± 14.6 years), along with multivariate analysis revealing male sex (1.25 times), chronic kidney disease (2.86 times), leukocytosis (6.10 times), thrombocytopenia (1.04 times), anemia (9.3 times), a higher qSOFA score (3.6 times), and a higher NEWS-2 score on admission (1.56 times) had higher odds of progression to severe disease. A significant correlation (P < .05) of qSOFA score with serum LDH, ferritin, and hs-CRP levels; CT severity score with the serum ferritin, IL-6, and LDH levels; and NEWS-2 with serum LDH, hs-CRP, and ferritin levels were found. Moreover, the NEWS-2 score was found slightly better than qSOFA on receiver operating characteristic (ROC) curve analysis, with an area under the curve of 85.8% and 83.2%, respectively, predicting progression to severe disease.

Conclusion

Our study revealed male gender, chronic kidney disease, leukocytosis, anemia, thrombocytopenia, a higher qSOFA and NEWS-2 score on admission, and further, NEWS-2 score better than qSOFA on ROC curve analysis, with an area under the curve of 85.8% and 83.2%, respectively, in predicting severe disease among hospitalized moderate COVID-19 patients.

Tubercular Empyema Thoracic: An Acute Presentation with COVID-19 Co-infection

COVID-19 (Coronavirus Disease 2019) pandemic is caused by a novel Coronavirus, SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2, which has received worldwide attention and most COVID-19 patients have respiratory symptoms and develop a mild disease. In addition, co-infection of SARS-CoV-2 with other respiratory infections of bacterial, other viral and fungal origin needs to be validated. The clinical features, course and treatment of TB patients with COVID-19 are unclear and understudied. There is paucity of literature on this co-infection. Here, authors present a case report of a young diabetic Asian male patient who presented to the emergency department as COVID-19 positive with acute exacerbation of symptoms, who later developed respiratory distress and was eventually found to have a lung abscess with subsequent tubercular empyema thoracic on contrary to a severe COVID-19 pneumonia or a fungal infection, as thought of. Contrast Enhanced Computed Tomography (CECT) chest along with Cartridge-Based Nuclei Acid Amplification Test (CBNAAT) of pleural fluid pus confirmed the tubercular lesion timely to aid the diagnosis and further course of management.

A Curious Case of Acute Pancreatitis in Pregnancy

Hypercalcaemia is rare in pregnancy and is under diagnosed owing to its non-specific presentation which is frequently attributed to the pregnancy itself. Severe hypercalcaemia presents a therapeutic challenge, especially during pregnancy. The present case of a 26-year-old primigravida who presented with acute pancreatitis is described here. The pancreatitis was found to be secondary to parathyroid adenoma- induced hypercalcaemia. After initial conservative medical management with subcutaneous and intranasal calcitonin, she underwent a small-incision adenoma excision. This unusual cause and presentation of hypercalcaemia and its management is reviewed thereof.

Postprandial lipaemia in patients with impaired fasting glucose, impaired glucose tolerance and diabetes mellitus

AIMS

To compare the postprandial lipid responses in subjects with prediabetes (IFG and IGT), newly detected diabetes mellitus (NDDM) and normal glucose tolerance (NGT).

METHODS

Postprandial lipid responses to a standard oral fat challenge was studied in forty-four subjects who were divided after an OGTT into NGT, pure impaired fasting glucose (PIFG), pure impaired glucose tolerance (PIGT) and NDDM.

RESULTS

There was a significantly higher postprandial triglyceride (PPTg) response with a higher PPTg area under curve (p=0.004) and peak PPTg levels (p=0.003) in patients with NDDM but not with either PIFG (p>0.05) or PIGT (p>0.05) when compared with NGT. Overall, PPTg responses correlated significantly with fasting plasma glucose (p=0.001) and 2h plasma glucose (p=0.001) but not with age, sex, body mass index, waist, or insulin resistance.

CONCLUSION

Subjects with newly detected diabetes mellitus displayed postprandial hypertriglyceridemia after a standard oral fat meal challenge while no such abnormality could be demonstrated in subjects with IFG or IGT. This defect is probably related to glycemic status and insulin resistance.

T lymphocyte subset profile and serum alpha-1-antitrypsin in pathogenesis of chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is an inflammatory disorder characterized by the presence of non-fully reversible airflow limitation. The study was undertaken to investigate the involvement of alpha-1-antitrypsin (alpha(1)AT) and T lymphocyte subsets in the pathogenesis of COPD. Blood samples of 50 subjects, including 25 healthy volunteers and 25 patients with COPD, were analysed. Serum trypsin inhibitory capacity (STIC) was determined by enzymatic assay. CD4(+) and CD8(+) T lymphocytes were enumerated in heparinized blood using a fluorescence activated cell sorter counter. The STIC in COPD patients was found to be decreased significantly than in controls (P < 0.01). In COPD patients with lower expression levels of alpha(1)AT, a highly significant decrease in the number of CD4(+) T lymphocytes (P < 0.0009) and CD4/CD8 ratio was observed compared with control subjects (P < 0.008). The mean +/- standard error of CD8(+) lymphocytes was found to be little different (only marginally decreased) in COPD patients compared to healthy controls; however, an alteration in the individual count of CD8(+) lymphocytes cells was observed in COPD patients. Using linear regression analysis, a negative correlation was observed between STIC and CD4(+) lymphocytes and CD8(+) lymphocytes (r = -0.40, P < 0.04; r = -0.42, P < 0.03, respectively) in COPD patients. An alteration in alpha(1)AT and T lymphocyte subsets in COPD patients suggested that interplay of these factors may be responsible for the progression of COPD.

Association of the PIM3 allele of the alpha-1-antitrypsin gene with chronic obstructive pulmonary disease

OBJECTIVE

The study investigated the association of genetic polymorphism of the alpha1AT gene with COPD.

DESIGN AND METHODS

The mutations and polymorphism of alpha1AT gene were investigated by DNA sequence analysis using polymerase chain reaction.

RESULTS

The frequency of the PIM3 allele in COPD patients was found to be significantly higher than the controls (P < 0.0001). Five SNPs, including a novel SNP (24_25insA), were observed near the junction of exon-intron I. The occurrence of these SNPs didn't show any association with COPD. However, the PIM3 allele of the alpha1AT gene was found to be associated with COPD.

CONCLUSION

The PIM3 allele of the alpha1AT gene is found to have an association with the pathogenesis of COPD in the Indian population.

Metrondazole-induced neurotoxicity

A 50 year old male with history of prolonged intake of metronidazole for treatment of liver abscess developed acute ataxia, disorientation, distal symmetrical sensory and proximal motor neuropathy. Patients being treated with metronidazole particularly those on high doses for prolonged period should be monitored for neurotoxicity.

Emergency treatment with ketoconazole in disseminated intravascular coagulation due to metastatic prostatic carcinoma

We report the use of ketoconazole to control disseminated intravascular coagulation due to prostatic carcinoma. Clinical improvement in the condition of the patient was noted in 48 hours and coagulation profile became normal in 10 days.

Ocular manifestations of rheumatoid arthritis

One hundred and seven patients of definite rheumatoid arthritis were screened for the presence of ocular manifestations of which 21 (19.63%) were observed to have ocular changes. Of these keratoconjunctivitis sicca in 19 (17.7%) patients and episcleritis in one (0.93%) were attributable to rheumatoid arthritis. Bilateral retinal haemorrhage in one patient was due to grade 3 hypertensive retinopathy. Absence of posterior subcapsular cataract in 106 (99.06%) patients who did not receive corticosteroids supports the hypothesis that steroids are the aetiologic agents and not rheumatoid arthritis.

Trigeminal and peripheral neuropathy in a patient with systemic sclerosis and silicosis

The unusual occurrence of cranial (trigeminal) and peripheral neuropathy in a case of progressive systemic sclerosis (PSS) is described. The possible association of PSS with silicosis is also discussed.