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Objective: To investigate the association between acute kidney injury (AKI) with patient outcome, among patients with COVID-19 and compare its outcome with patients who did not develop AKI. Study Design: Comparative cross sectional study. Place and Duration of Study: COVID-19 Intensive Treatment Unit, Combined Military Hospital, Lahore Pakistan, from Apr to Jul 2020. Methodology: We retrospectively reviewed the medical records of individuals with severe pneumonia caused by SARS-CoV-2 and having acute kidney infections hospitalized at Combined Military Hospital, Lahore. Patients were divided into two groups, Group-A (patients who developed acute kidney injury during their stay) and Group-B (patients who did not develop acute kidney injury). The outcome was compared in both groups. Results: Of the 350 patients studied, 83 developed acute kidney injury (23.7%). Of the 350 patients with AKI, 59(71.08 %) were males, and 24(28.9%) were females, with a mean age of 68.3 years. Among acute kidney injury, urea (p=0.001), sodium (p=0.01) and potassium (p=0.001) were significantly different as compared to non-AKI patients. Independent predictors of severe AKI were chronic kidney disease and higher serum potassium at admission. Conclusion: Acute kidney injury and renal replacement therapy are common in critically ill patients presenting with COVID19. It is associated with increased severity of illness on admission to ICU, increased mortality and prolonged ICU and hospital length of stay.

The receptor for advanced glycation-end products (RAGE) is a multiligand receptor with a role in inflammatory and pulmonary pathologies. Hyperactivation of RAGE by its ligands has been reported to sustain inflammation and oxidative stress in common comorbidities of severe COVID-19. RAGE is essential to the deleterious effects of the renin–angiotensin system (RAS), which participates in infection and multiorgan injury in COVID-19 patients. Thus, RAGE might be a major player in severe COVID-19, and appears to be a useful therapeutic molecular target in infections by SARS-CoV-2. The role of RAGE gene polymorphisms in predisposing patients to severe COVID-19 is discussed. 

In March 2020, at the beginning of the COVID-19 pandemic, state-funded community mental health service programs (CMHSP) in Michigan, organized into 10 regions known as a “Prepaid Inpatient Health Plan” (PIHP), grappled with the task of developing a modified plan of operations, while complying with mitigation and social distancing guidelines. With the premise that psychiatric care is essential healthcare, a panel of physician and non-physician leaders representing Region 5, met and developed recommendations, and feedback iteratively, using an adaptive modified Delphi methodology. This facilitated the development of a service and patient prioritization document to triage and to deliver behavioral health services in 21 counties which comprised Region 5 PIHP. Our procedures were organized around the principles of mitigation and contingency management, like physical health service delivery paradigms. The purpose of this manuscript is to share region 5 PIHP’s response; a process which has allowed continuity of care during these unprecedented times.

PurposeCOVID-19 infection has manifested as a major threat to both patients and healthcare providers around the world. Radiation oncology institutions (ROI) deliver a major component of cancer treatment, with protocols that might span over several weeks, with the result of increasing susceptibility to COVID-19 infection and presenting with a more severe clinical course when compared with the general population. The aim of this manuscript is to investigate the impact of ROI protocols and performance on daily practice in the high-risk cancer patients during this pandemic.MethodsWe addressed the incidence of positive COVID-19 cases in both patients and health care workers (HCW), in addition to the protective measures adopted in ROIs in Germany, Austria and Switzerland using a specific questionnaire.ResultsThe results of the questionnaire showed that a noteworthy number of ROIs were able to complete treatment in SARS-CoV‑2 positive cancer patients, with only a short interruption. The ROIs reported a significant decrease in patient volume that was not impacted by the circumambient disease incidence, the type of ROI or the occurrence of positive cases. Of the ROIs 16.5% also reported infected HCWs. About half of the ROIs (50.5%) adopted a screening program for patients whereas only 23.3% also screened their HCWs. The range of protective measures included the creation of working groups, instituting home office work and protection with face masks.Regarding the therapeutic options offered, curative procedures were performed with either unchanged or moderately decreased schedules, whereas palliative or benign radiotherapy procedures were more often shortened. Most ROIs postponed or cancelled radiation treatment for benign indications (88.1%). The occurrence of SARS-CoV‑2 infections did not affect the treatment options for curative procedures. Non-university-based ROIs seemed to be more willing to change their treatment options for curative and palliative cases than university-based ROIs.ConclusionMost ROIs reported a deep impact of SARS-CoV‑2 infections on their work routine. Modification and prioritization of treatment regimens and the application of protective measures preserved a well-functioning radiation oncology service and patient care.

Although there is strong evidence that SARS-CoV-2 infection is associated with adverse outcomes in certain ethnic groups, the association of disease severity and risk factors such as comorbidities and biomarkers with racial disparities remains undefined. This retrospective study between March 2020 and February 2021 explores COVID-19 risk factors as predictors for patients’ disease progression through country comparison. Disease severity predictors in Germany and Japan were cardiovascular-associated comorbidities, dementia, and age. We adjusted age, sex, body mass index, and history of cardiovascular disease comorbidity in the country cohorts using a propensity score matching (PSM) technique to reduce the influence of differences in sample size and the surprisingly young, lean Japanese cohort. Analysis of the 170 PSM pairs confirmed that 65.29% of German and 85.29% of Japanese patients were in the uncomplicated phase. More German than Japanese patients were admitted in the complicated and critical phase. Ethnic differences were identified in patients without cardiovascular comorbidities. Japanese patients in the uncomplicated phase presented a suppressed inflammatory response and coagulopathy with hypocoagulation. In contrast, German patients exhibited a hyperactive inflammatory response and coagulopathy with hypercoagulation. These differences were less pronounced in patients in the complicated phase or with cardiovascular diseases. Coagulation/fibrinolysis-associated biomarkers rather than inflammatory-related biomarkers predicted disease severity in patients with cardiovascular comorbidities: platelet counts were associated with severe illness in German patients. In contrast, high D-dimer and fibrinogen levels predicted disease severity in Japanese patients. Our comparative study indicates that ethnicity influences COVID-19-associated biomarker expression linked to the inflammatory and coagulation (thrombo-inflammatory) response. Future studies will be necessary to determine whether these differences contributed to the less severe disease progression observed in Japanese COVID-19 patients compared with those in Germany.

Coronavirus disease 2019 (COVID-19) vaccines effectively protect against severe disease and death. However, the impact of the vaccine used, viral variants, and host factors on disease severity remain poorly understood. This work aimed to compare COVID-19 clinical presentations and outcomes in vaccinated and unvaccinated patients in Mexico City. From March to September 2021, clinical, demographic characteristics, and viral variants were obtained from 1014 individuals with a documented SARS-CoV-2 infection. We compared unvaccinated, partially vaccinated, and fully vaccinated patients, stratifying by age groups. We also fitted multivariate statistical models to evaluate the impact of vaccination status, SARS-CoV-2 lineages, vaccine types, and clinical parameters. Most hospitalized patients were unvaccinated. In patients over 61 years old, mortality was significantly higher in unvaccinated compared to fully vaccinated individuals. In patients aged 31 to 60 years, vaccinated patients were more likely to be outpatients (46%) than unvaccinated individuals (6.1%). We found immune disease and age above 61 years old to be risk factors, while full vaccination was found to be the most protective factor against in-hospital death. This study suggests that vaccination is essential to reduce mortality in a comorbid population such as that of Mexico.

Introduction: COVID-19, although primarily a respiratory illness, has been linked to complications in multiple organ systems, including the liver. Proposed mechanisms for liver injury include direct viral cytopathic effects, systemic inflammation, hypoxia, and drug-induced liver injury (DILI). Moreover, post-COVID cholangiopathy is an emerging entity with features that may overlap with autoimmune phenomena. Case Presentation: A 60-year-old male patient with multiple comorbidities presented with fever, chills, and cough for 1 day. In the emergency department, he tested positive for COVID-19 by PCR and his chest X-ray revealed features suggestive of pulmonary edema. The patient was intubated and admitted to the Medical Intensive Care Unit (MICU) for management of COVID-19 pneumonia with pulmonary edema. During hospitalization, he developed cardiac complications that required targeted management. Approximately 1 week after admission, his liver enzymes began to rise. Although drug-DILI was initially suspected and hepatotoxic medications were discontinued with the initiation of ursodeoxycholic acid (UDCA), the liver function tests (LFTs) remained elevated. Subsequent magnetic resonance cholangiopancreatography revealed periportal inflammation with intrahepatic biliary dilatation and stricturing, findings consistent with COVID-19 induced cholangiopathy. The UDCA dosage was doubled, resulting in gradual biochemical improvement; however, the patient ultimately discharged against medical advice. Conclusion: COVID-19-induced cholangiopathy is a rare but serious liver complication. Effective management requires a multidisciplinary team. Ongoing research is needed to better understand long-term liver effects and improve care strategies.

Background: Although COVID-19 has spread in Côte d’Ivoire, there is no report that summarizes the comorbidities of COVID-19 death cases.Objective: To verify the types and prevalence of commodities associated with recorded COVID-19 deaths compared with the general adult population in Côte d’Ivoire. Methods: Data on the comorbidities of COVID-19 deaths and the country’s disease structure were collected from official government reports and WHO’s reports.Results: Among 67 patients studied, the biggest age group was 60- 69 years old with 23 people (34%). Fifty-four patients (81%) had non-communicable diseases (NCDs) as comorbidities. The prevalence ratio between COVID-19 deaths and general adult population was 8.96 [95% Confidence Interval: 6.86-11.68] for diabetes, 1.74 [1.27-2.37] for hypertension, and 2.16 [1.32-3.51] for obesity.Conclusions: To reduce the risk of death from COVID-19 in Côte d’Ivoire, focused infection prevention measures for elderly and diabetic patients are needed.

Introduction: Despite global improvements in perioperative care, surgical site infections (SSIs) continue to pose a significant burden, and data from Albania remain limited. This study aimed to determine the incidence of SSIs following abdominal surgery in an Albanian tertiary hospital and identify associated risk factors, microbiological profiles, and antimicrobial resistance patterns. Methodology: A prospective observational study was conducted at the University Hospital Centre “Mother Theresa” in Tirana. A univariate and multivariate logistic regression adjusted for confounders was performed to identify factors associated with the development of SSIs. Results: 1179 patients were enrolled in the study, with a mean age of 57.80 ± 16.16 years (range, 19-92 years), and 51.23% were male. 64 patients (5.43%) developed surgical site infections following abdominal surgery. The most frequently isolated microorganisms from infected surgical wounds were Escherichia coli and Enterococcus faecalis, identified in 39.0% and 22.0% of cases, respectively. The rate of SSIs was higher in patients undergoing lower gastrointestinal surgery compared to those having upper gastrointestinal procedures. As risk factors for developing SSIs in univariate regression analysis, age ≥ 50 years (OR: 2.69, 95% CI: 1.25–5.78), comorbidities (OR: 2.71, 95% CI: 1.53–4.83), and type 2 diabetes mellitus (OR: 2.98, 95% CI: 1.59-5.56) were identified. Conclusions: Although the rate of SSIs after abdominal surgery has decreased, it remains a significant concern in Albania. Age, comorbidities, and lower gastrointestinal surgery are important risk factors. The findings emphasise the need for improved infection control and antimicrobial stewardship to reduce postoperative complications.

The next most commonly affected age group was 61-80 years (28%). [...]around three-fourths of our patients were in the 41-80 years bracket [Table 2]. [8] The next most commonly affected age group was 61-80 years (28%). [...]around three-fourths of our patients were in the 41-80 years bracket indicating that people who usually move out of their homes in search of their daily bread are more likely to get the infection. COVID 19 has been known to attack people irrespective of their health status. [...]it comes as no surprise that almost a third of our patients were normal, healthy people. L Ratio crosses 12 with an abrupt jump in the mortality percentage thereafter. [...]patients presenting with N: