Pulmonary artery stent thrombosis and symptomatic pulmonary hypertension following COVID-19 infection in Alagille patient:A case report

BACKGROUND Alagille syndrome is a multisystem disease that results in various vascular anomalies,commonly involving the cardiac and pulmonary systems.To the best of our knowledge,there is no literature regarding the cardiovascular outcomes of these patients in association with coronavirus disease 2019(COVID-19).CASE SUMMARY A 34-year-old woman with a history of Alagille syndrome who underwent successful atrial septal defect with partial anomalous pulmonary veins and patent ductus arteriosus repair,as well as left pulmonary artery catheterization and stenting in childhood due to pulmonary stenosis.The patient was without any respiratory symptoms and was a dancer prior to contracting COVID-19.Several weeks after her COVID-19 infection,she developed left pulmonary artery stent thrombosis and subsequent symptomatic pulmonary hypertension.A treatment strategy of anticoagulation alongside pharmacological agents for pulmonary hypertension for 3 months followed by balloon pulmonary artery angioplasty to reopen the stenosis was unsuccessful.CONCLUSION In the era of COVID-19,patients with pulmonary vascular malformations and endovascular stents are at an increased risk for chronic thromboembolic disease.Patients may benefit from prophylactic antiplatelet or anticoagulation therapy.Stent thrombosis is a devastating phenomenon and should be treated urgently and aggressively with balloon pulmonary angioplasty,and/or a thrombolytic agent.

COVID-19 infection and inactivated vaccination:Impacts on clinical and immunological profiles in Chinese children with type 1 diabetes

BACKGROUND The coronavirus disease 2019(COVID-19)pandemic has been linked to an increased incidence of diabetes and diabetic ketoacidosis(DKA).However,the relationship between COVID-19 infection and progression to type 1 diabetes(T1D)in children has not been well defined.AIM To evaluate the influence of COVID-19 infection and inactivated vaccine adminis-tration on the progression of T1D among Chinese children.METHODS A total of 197 newly diagnosed patients with T1D were retrospectively enrolled from Children's Hospital of Fudan University between September 2020 and December 2023.The patients were divided into three groups based on their history of COVID-19 infection and vaccination:the infection group,the vacci-nation-only group,and the non-infection/non-vaccination group.Comprehensive clinical assessments and detailed immunological evaluations were performed to delineate the characteristics and immune responses of these groups.RESULTS The incidence of DKA was significantly higher in the COVID-19 infection group(70.2%)compared to the non-infection/non-vaccination group(62.5%)and vac-scination-only group(45.6%;P=0.015).Prior COVID-19 infection was correlated with increased DKA risk(OR:1.981,95%CI:1.026-3.825,P=0.042),while vacci-nation was associated with a reduced risk(OR:0.558,95%CI:0.312-0.998,P=0.049).COVID-19 infection mildly altered immune profiles,with modest dif-ferences in autoantibody positivity,lymphocyte distribution,and immunoglobulin levels.Notably,HLA-DR3 po-sitive children with a history of COVID-19 infection had an earlier T1D onset and lower fasting C-peptide levels than the HLA-DR3 negative children with a history of infection(both P<0.05).CONCLUSION COVID-19 infection predisposes children to severe T1D,characterized by enhanced DKA risk.Inactivated vaccination significantly lowers DKA incidence at T1D onset.These findings are valuable for guiding future vaccination and T1D risk surveillance strategies in epidemic scenarios in the general pediatric population.

Comprehensive analysis of the potential pathogenesis of COVID-19 infection and liver cancer

BACKGROUND A growing number of clinical examples suggest that coronavirus disease 2019(COVID-19)appears to have an impact on the treatment of patients with liver cancer compared to the normal population,and the prevalence of COVID-19 is significantly higher in patients with liver cancer.However,this mechanism of action has not been clarified.Gene sets for COVID-19(GSE180226)and liver cancer(GSE87630)were obtained from the Gene Expression Omnibus database.After identifying the common differentially expressed genes(DEGs)of COVID-19 and liver cancer,functional enrichment analysis,protein-protein interaction network construction and scree-ning and analysis of hub genes were performed.Subsequently,the validation of the differential expression of hub genes in the disease was performed and the regulatory network of transcription factors and hub genes was constructed.RESULTS Of 518 common DEGs were obtained by screening for functional analysis.Fifteen hub genes including aurora kinase B,cyclin B2,cell division cycle 20,cell division cycle associated 8,nucleolar and spindle associated protein 1,etc.,were further identified from DEGs using the“cytoHubba”plugin.Functional enrichment analysis of hub genes showed that these hub genes are associated with P53 signalling pathway regulation,cell cycle and other functions,and they may serve as potential molecular markers for COVID-19 and liver cancer.Finally,we selected 10 of the hub genes for in vitro expression validation in liver cancer cells.CONCLUSION Our study reveals a common pathogenesis of liver cancer and COVID-19.These common pathways and key genes may provide new ideas for further mechanistic studies.

Miller fisher syndrome with positive anti-GQ1b/GT1a antibodies associated with COVID-19 infection:A case report

BACKGROUND Miller fisher syndrome(MFS)is a variant of Guillain-Barrésyndrome,an acute immune-mediated peripheral neuropathy that is often secondary to viral infections.Anti-ganglioside antibodies play crucial roles in the development of MFS.The positive rate of ganglioside antibodies is exceptionally high in MFS patients,particularly for anti-GQ1b antibodies.However,the presence of other ganglioside antibodies does not exclude MFS.CASE SUMMARY We present a 56-year-old female patient who suddenly developed right blepharoptosis and progressively worsening vision in both eyes.There were flu symptoms prior to onset,and a coronavirus disease 2019 test was positive.On physical examination,the patient exhibited bilateral extraocular muscle paralysis,weakened reflexes in both limbs,and impaired coordination.The cerebrospinal fluid examination results showed no obvious abnormalities.Bilateral peroneal nerve F-waves were not extracted.Serum anti-GD1b IgG and anti-GT1a IgG antibodies were positive.The patient received intravenous methylprednisolone(1000 mg/day),with the dosage gradually decreased.Additionally,intravenous high-dose immunoglobulin treatment was administered for 5 days(0.4 g/kg/day)from day 2 to day 6 of hospitalization.The patient’s symptoms improved after treatment with immunoglobulins and hormones.CONCLUSION Positive ganglioside antibodies may be used as supporting evidence for the diagnosis;however,the diagnosis of MFS is more reliant on clinical symptoms.

Massive bleeding in small intestinal mucosa-associated lymphoid tissue lymphoma associated with COVID-19 infection:a case report

The increased risk of mucosa-associated lymphoid tissue(MALT)lymphoma is closely associated with chronic antigenic stimulation,with infection being the most common cause of recurrence.Lesions are usually associated with the gastrointestinal tract,and the involvement of small intestinal is rare.Recent studies have established a close relationship between novel coronavirus 2019(COVID-19)and the occurrence and progression of various diseases.This article presents a rare case of a small intestinal MALT lymphoma.The patient was initially admitted with COVID-19 pneumonia and subsequently developed gastrointestinal bleeding during hospitalization.Medical and endoscopic treatments were ineffective,and an emergency exploratory laparotomy was performed.The affected segment of the small intestine was excised,and a pathological biopsy confirmed the diagnosis of MALT lymphoma.This case underscores the significance of raising clinical awareness of this condition among health care professionals.

Outcome of COVID-19 infection in patients on antihypertensives:A cross-sectional study

BACKGROUND Patients with coronavirus disease 2019(COVID-19)infection frequently have hypertension as a co-morbidity,which is linked to adverse outcomes.Antihypertensives may affect the outcome of COVID-19 infection.AIM To assess the effects of antihypertensive agents on the outcomes of COVID-19 infection.METHODS A total of 260 patients were included,and their demographic data and clinical profile were documented.The patients were categorized into nonhypertensive,angiotensin-converting enzyme inhibitor/angiotensin receptor blocker(ACEI/ARB),calcium channel blocker(CCB),a combination of ACEI/ARB and CCB,and beta-blocker groups.Biochemical,hematological,and inflammatory markers were measured.The severity of infection,intensive care unit(ICU)intervention,and outcome were recorded.RESULTS The mean age of patients was approximately 60-years-old in all groups,except the nonhypertensive group.Men were predominant in all groups.Fever was the most common presenting symptom.Acute respiratory distress syndrome was the most common complication,and was mostly found in the CCB group.Critical cases,ICU intervention,and mortality were also higher in the CCB group.Multivariable logistic regression analysis revealed that age,duration of antihypertensive therapy,erythrocyte sedimentation rate,high-sensitivity C-reactive protein,and interleukin 6 were significantly associated with mortality.The duration of antihypertensive therapy exhibited a sensitivity of 70.8%and specificity of 55.7%,with a cut-off value of 4.5 years and an area under the curve of 0.670(0.574-0.767;95%confidence interval)for COVID-19 outcome.CONCLUSION The type of antihypertensive medication has no impact on the clinical sequence or mortality of patients with COVID-19 infection.However,the duration of antihypertensive therapy is associated with poor outcomes.

Acute macular neuroretinopathy following COVID-19 infection:Three case reports

BACKGROUND During the Coronavirus disease 2019(COVID-19)pandemic,a notable increase in acute macular neuroretinopathy(AMN)cases was observed.This study aimed to investigate the potential association between AMN and COVID-19 by examining 3 cases in China.CASE SUMMARY The first case involved a 30-year-old man who presented with progressive vision loss following a COVID-19 infection.Optical coherence tomography(OCT)and near-infrared imaging identified hallmark AMN lesions,hyperreflective disruptions within the outer plexiform layer,and hyporeflective anomalies in the ellipsoid zone,leading to an AMN diagnosis.Despite partial visual recovery,OCT angiography(OCTA)revealed persistent microvascular changes,specifically a decreased vascular density in the deep capillary plexus.The second case was a 24-year-old woman who experienced blurred vision and exhibited bilateral cottonwool spots on fundus examination post-COVID-19.Imaging confirmed the presence of AMN along with paracentral acute middle maculopathy(PAMM).Follow-up OCTA found a progressive reduction in vascular density,indicating ongoing microvascular compromise.The third case was a 28-year-old woman who reported sensations of occlusion in her right eye following a COVID-19 infection.Imaging confirmed both AMN and PAMM,revealing similar decreases of microvascular density on OCTA despite a significant improvement in visual acuity.We noted that all 3 patients had received the COVID-19 vaccine prior to the appearance of symptoms.CONCLUSION The findings highlight the diagnostic utility of advanced ocular imaging in detecting AMN in COVID-19 patients and the importance of comprehensive eye examinations.

Kikuchi-Fujimoto Disease: A Case of Lymphadenitis Following COVID-19 Infection

Introduction: Kikuchi-Fujimoto disease (KFD), also known as histiocytic necrotizing lymphadenitis, is a rare disease of uncertain origin proposed to be secondary to viral or autoimmune causes. It presents as unilateral cervical lymphadenopathy and fever, typically resolving within a few months, however, it mimics malignant lymphoma, leading to extensive work-up fearing malignancy. Case History: A 33-year-old female with a history of Sjögren’s syndrome, rheumatoid arthritis (not on immunosuppressive therapy) and recent COVID-19 infection two months ago presented with episodes of flu-like symptoms;fever (101˚F), chills, and myalgias for two months. Upon evaluation, she had leukopenia (WBC 1.8 k/uL), neutropenia (1.0 k/uL), elevated CRP (134 mg/L), and CT neck demonstrated multiple enlarged cervical lymph nodes with necrosis. The patient was started on Cefdinir and doxycycline for a possible atypical infection given neutropenic fevers and the patient continued to have fevers. A biopsy showed focal necrosis with no evidence of malignancy, suggesting KFD that was likely triggered by a recent COVID infection. She was treated with Prednisone and naproxen, which led to an improvement in symptoms and recovery of her pancytopenia. Discussion: This case is unique since the patient’s recent infection with COVID-19 may have triggered the clinical manifestations of KFD. There have been a few case reports of children who were diagnosed with KFD after a COVID-19 infection and adults diagnosed with KFD following COVID vaccinations;however, this is the first case report involving a young adult in her thirties who was diagnosed with KFD two months after COVID-19.

Bilateral pericapsular end nerve blocks for steroid-induced avascular necrosis following COVID-19 infection requiring bilateral total hip replacement

BACKGROUND Osteonecrosis or avascular necrosis(AVN)of the hip was one of the dreaded complications of coronavirus disease 2019(COVID-19),which emerged in patients who received steroid therapy.Corticosteroids have been a mainstay in the treatment protocol of COVID-19 patients.Popular corticosteroid drugs used in patients suffering from COVID-19 were intravenous(IV)or oral dexamethasone,methylprednisolone or hydrocortisone.The use of such high doses of corticost-eroids has shown very positive results and has been lifesaving in many cases.Still,long-term consequences were drug-induced diabetes,osteoporosis,Cushing syndrome,muscle wasting,peripheral fat mobilization,AVN,hirsutism,sleep disturbances and poor wound healing.A significant number of young patients were admitted for bilateral total hip replacements(THR)secondary to AVN following steroid use for COVID-19 treatment.AIM To assess the efficacy of bilateral pericapsular end nerve group(PENG)blocks in patients posted for bilateral THR post-steroid therapy after COVID-19 infection and assess the time taken to first ambulate after surgery.METHODS This prospective observational study was conducted between January 2023 and August 2023 at Care Hospitals,Hyderabad,India.Twenty young patients 30-35 years of age who underwent bilateral THR were studied after due consent over 8 months.All the patients received spinal anaesthesia for surgery and bilateral PENG blocks for postoperative analgesia.RESULTS The duration of surgery was 2.5 h on average.Seventeen out of twenty patients(85%)had a Visual Analog Score(VAS)of less than 2 and did not require any supplementation.One patient was removed from the study,as he required re-exploration.The remaining two patients had a VAS of more than 8 and received IV morphine post-operatively as a rescue analgesic drug.Fifteen out of seventeen patients(88.2%)could be mobilized 12 h after the procedure.CONCLUSION Osteonecrosis or AVN of the hip was one of the dreaded complications of COVID-19,which surfaced in patients who received steroid therapy requiring surgical intervention.Bilateral PENG block is an effective technique to provide post-operative analgesia resulting in early mobilization and enhanced recovery after surgery.

Level of Acceptance of COVID-19 Vaccine and Its Determinants among High Risk Groups for Severe COVID-19 Infection Living in Mogadishu Somalia

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, which is widely referred to as “COVID-19”, has been infecting more than 5.5 million over 144 countries. A vaccine is considered to be the most awaiting intervention and hundreds of global R&D institutions engaged in unprecedented speed to develop the vaccine. The availability of COVID-19 vaccines may not translate into its uptake. Although governments will provide the vaccines, their uptake is voluntary. Objective: This study was carried out to evaluate the level of acceptance of COVID-19 vaccine and it’s determinants among high risk groups for severe COVID-19 infection living in Mogadishu Somalia. Methods: The study was cross-sectional, descriptive analysis conducted to obtain reliable information about the acceptance of COVID-19 vaccine and it is determinants among high-risk groups living in Mogadishu, Somalia. The calculated sample size was 404 using Cochran’s formula = Z2p(1 − p)/d2 and addition of 5% non-respondent rate. According to PESS population estimate in 2020, there are 17 districts. We grouped them into 2 strata and through simple random sampling one district was selected from each strata. After randomly selecting the two districts, three sub districts were randomly selected from each and then every second house (1, 3, 5) in the main roads will be selected. If target population were not found in the second selected house, the next house will be taken until sample size is obtained. Results: 59.4% of respondents were willing to accept and take vaccination while 40.6% of them were not accepting the vaccination. Being afraid of the side effect was the most common reason for not accepting the vaccine Conclusion: More than one third of respondents (40.6%) were not willing to accept the vaccination, knowledge towards COVID-19 was strongly associated with acceptance level of COVID-19 vaccine. Recommendation: Multi-sector organized awareness campaigns involving FMH as well as local authorities and civil society to enhance level of knowledge of community towards COVID-19.

Automatic Detection of COVID-19 Infection Using Chest X-Ray Images Through Transfer Learning

The new coronavirus(COVID-19),declared by the World Health Organization as a pandemic,has infected more than 1 million people and killed more than 50 thousand.An infection caused by COVID-19 can develop into pneumonia,which can be detected by a chest X-ray exam and should be treated appropriately.In this work,we propose an automatic detection method for COVID-19 infection based on chest X-ray images.The datasets constructed for this study are composed of194 X-ray images of patients diagnosed with coronavirus and 194 X-ray images of healthy patients.Since few images of patients with COVID-19 are publicly available,we apply the concept of transfer learning for this task.We use different architectures of convolutional neural networks(CNNs)trained on Image Net,and adapt them to behave as feature extractors for the X-ray images.Then,the CNNs are combined with consolidated machine learning methods,such as k-Nearest Neighbor,Bayes,Random Forest,multilayer perceptron(MLP),and support vector machine(SVM).The results show that,for one of the datasets,the extractor-classifier pair with the best performance is the Mobile Net architecture with the SVM classifier using a linear kernel,which achieves an accuracy and an F1-score of 98.5%.For the other dataset,the best pair is Dense Net201 with MLP,achieving an accuracy and an F1-score of 95.6%.Thus,the proposed approach demonstrates efficiency in detecting COVID-19 in X-ray images.

COVID-19 infection and liver injury:Clinical features,biomarkers,potential mechanisms,treatment,and management challenges

It is hypothesized that liver impairment caused by coronavirus disease 2019(COVID-19)infection might play a central role in severe clinical presentations.Liver injury is closely associated with severe disease and,even with antiviral drugs,have a poor prognosis in COVID-19 patients.In addition to the common hepatobiliary disorders caused by COVID-19,patients with pre-existing liver diseases demand special considerations during the current pandemic.Thus,it is vital that upon clinical presentation,patients with concurrent pre-existing liver disease associated with metabolic dysfunction and COVID-19 be managed properly to prevent liver failure.Careful monitoring and early detection of liver damage through biomarkers after hospitalization for COVID-19 is underscored in all cases,particularly in those with pre-existing metabolic liver injury.The purpose of this study was to determine most recent evidence regarding causality,potential risk factors,and challenges,therapeutic options,and management of COVID-19 infection in vulnerable patients with pre-existing liver injury.This review aims to highlight the current frontier of COVID-19 infection and liver injury and the direction of liver injury in these patients.

COVID-19 infection with keratitis as the first clinical manifestation

·AIM:To report a case which keratitis is the first clinical manifestation of COVID-19 that occurred 3 d earlier than the common COVID-19 symptoms.·METHODS:Regular slit lamp examination,corneal scraping test,and chest computed tomography(CT)were performed for patients with COVID-19 infection.The ophthalmologic treatment included ganciclovir eye drop(50 mglmL,6 times/d).The treatment for diarrhea included Guifu Lizhong pills(TID).The antiviral therapy consisted of oseltamivir(75 mg capsule Q12 H);therapy preventing bacterial infection consisted of azithromycin(250 mg tablet QD)and moxifloxacin(0.4 g tablet Q12 H);and therapy for cough relief and fever prevention consisted of Chinese herbal decoction.·RESULTS:A 35-year-old male suddenly suffered pain,photophobia,and tears in his right eye for one day without systemic COVID-19 symptoms.Patient was diagnosed with keratitis,which was seemingly different from common keratitis.Ganciclovir eye drop was initiated.The corneal scraping test for COVID-19 was positive.The chest CT images were abnormal confirming the diagnosis of COVID-19 infection.The antiviral and antibacterial therapies were initiated.Chinese herbal therapy was used for cough relief and fever prevention.After roughly two weeks,patient recovered from COVID-19.·CONCLUSION:A new type of keratitis,atypical keratitis,is a clinical manifestation of COVID-19,and this clinical manifestation could appear 3 d earlier than fever and cough.The earlier a COVID-19 clinical manifestation is identified,the earlier can a patient be directed to stay at home,and significantly fewer people would be infected.

Mesenchymal stromal cell secretome in liver failure:Perspectives on COVID-19 infection treatment

Due to their immunomodulatory potential and release of trophic factors that promote healing,mesenchymal stromal cells(MSCs)are considered important players in tissue homeostasis and regeneration.MSCs have been widely used in clinical trials to treat multiple conditions associated with inflammation and tissue damage.Recent evidence suggests that most of the MSC therapeutic effects are derived from their secretome,including the extracellular vesicles,representing a promising approach in regenerative medicine application to treat organ failure as a result of inflammation/fibrosis.The recent outbreak of respiratory syndrome coronavirus,caused by the newly identified agent severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),has forced scientists worldwide to use all available instruments to fight the infection,including the inflammatory cascade caused by this pandemic disease.The use of MSCs is a valid approach to combat organ inflammation in different compartments.In addition to the lungs,which are considered the main inflammatory target for this virus,other organs are compromised by the infection.In particular,the liver is involved in the inflammatory response to SARS-CoV-2 infection,which causes organ failure,leading to death in coronavirus disease 2019(COVID-19)patients.We herein summarize the current implications derived from the use of MSCs and their soluble derivatives in COVID-19 treatment,and emphasize the potential of MSCbased therapy in this clinical setting.

Review on acute pancreatitis attributed to COVID-19 infection

The coronavirus disease 2019(COVID-19)is known to cause gastrointestinal symptoms.Recent studies have revealed COVID-19-attributed acute pancreatitis(AP).However,clinical characteristics of COVID-19-attributed AP remain unclear.We performed a narrative review to elucidate relation between COVID-19 and AP using the PubMed database.Some basic and pathological reports revealed expression of angiotensin-converting enzyme 2 and transmembrane protease serine 2,key proteins that aid in the entry of severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)into the pancreas.The experimental and pathological evaluation suggested that SARS-CoV-2 infects human endocrine and exocrine pancreas cells,and thus,SARS-CoV-2 may have a direct involvement in pancreatic disorders.Additionally,systemic inflammation,especially in children,may cause AP.Levels of immune mediators associated with AP,including interleukin(IL)-1β,IL-10,interferon-γ,monocyte chemotactic protein 1,and tumor necrosis factor-αare higher in the plasma of patients with COVID-19,that suggests an indirect involvement of the pancreas.In real-world settings,some clinical features of AP complicate COVID-19,such as a high complication rate of pancreatic necrosis,severe AP,and high mortality.However,clinical features of COVID-19-attributed AP remain uncertain due to insufficient research on etiologies of AP.Therefore,high-quality clinical studies and case reports that specify methods for differential diagnoses of other etiologies of AP are needed.

Mortality rate of COVID-19 infection in end stage kidney disease patients on maintenance hemodialysis:A systematic review and meta-analysis

BACKGROUND Coronavirus disease 2019(COVID-19)has been the most talked-about disease of the past few years.Patients with significant comorbidities have been at particular risk of adverse outcomes.This study looked at the outcomes and risk factors for adverse outcomes among patients on chronic hemodialysis for end-stage renal disease,a group of patients known to be particularly susceptible to infectious complications.AIM To assess outcomes and risk factors for adverse outcomes of COVID-19 infection among patients on chronic hemodialysis.METHODS We searched PubMed/MEDLINE,EMBASE,Reference Citation Analysis(https://www.referencecitationanalysis.com/)and Web of Science databases for relevant terms and imported the results into the Covidence platform.From there,studies were assessed in two stages for relevance and quality,and data from studies that satisfied all the requirements were extracted into a spreadsheet.The data was then analyzed descriptively and statistically.RESULTS Of the 920 studies identified through the initial database search,only 17 were included in the final analysis.The studies included in the analysis were mostly carried out during the first wave.We found that COVID-19 incidence among patients on hemodialysis was significant,over 10%in some studies.Those who developed COVID-19 infection were most likely going to be hospitalized,and over 1 in 5 died from the infection.Intensive care unit admission rate was lower than the infection lethality rate.Biochemical abnormalities and dyspnea were generally reported to be associated with adverse outcomes.CONCLUSION This systematic review confirms that patients on chronic hemodialysis are very high-risk individuals for COVID-19 infections,and a significant proportion was infected during the first wave.Their prognosis is overall much worse than in the general population,and every effort needs to be made to decrease their exposure.

Liver function in COVID-19 infection

Coronavirus disease 2019(COVID-19)disease affects multiple organs,including anomalies in liver function.In this review we summarize the knowledge about liver injury found during severe acute respiratory syndrome coronavirus 2(SARSCoV-2)infection with special attention paid to possible mechanisms of liver damage and abnormalities in liver function tests allowing for the evaluation of the severity of liver disease.Abnormalities in liver function observed in COVID-19 disease are associated with the age and sex of patients,severity of liver injury,presence of comorbidity and pre-treatment.The method of antiviral treatment can also impact on liver function,which manifests as increasing values in liver function tests.Therefore,analysis of variations in liver function tests is necessary in evaluating the progression of liver injury to severe disease.

Relationship between Radiological Lung Findings and Laboratory Ferritin and D-Dimer Levels in Patients with COVID-19 Infection

Introduction: Pulmonary symptoms of COVID-19 infection range from asymptomatic infection to severe pneumonia. Pathogenesis and severity of symptoms were found to be related to the body’s immune response. Objectives: Ferritin and D-Dimer in COVID-19 confirmed cases can predict lung injury and possible poor patient prognosis. Materials and Methods: Patients who had been admitted to Dr. Sulaiman Alhabib-Arryan Hospital with positive COVID-19 polymerase chain reaction (PCR) tests between March 2020 and December 2021 were studied for blood ferritin and D-Dimer levels in relation to pulmonary radiological findings. Results: A total of 494 cases are included in this study. Male patients represent 74.1% of the cases, and the mean age is 51.68 ± 13.37 years. Increased age, ferritin, D-Dimer levels, and respiratory symptoms are factors that showed a statistically significant association with positive computed tomography (CT) findings. Receiver operator characteristic curve (ROC) showed that ferritin has a higher capability than D-Dimer to detect CT findings and that both are equal in predicting possible patient mortality. Suggested cutoff values for Ferritin > 336 ng/mL, with 78.21% sensitivity and 86.42% specificity and for D-Dimer > 0.55 mg/L FEU, with sensitivity of 74.82% and specificity of 75.31%. For mortality, the suggested cutoff point for ferritin is >864.6 ng/mL, which gives a sensitivity of 80.26 and a specificity of 64.83%. The suggested cutoff point for D-Dimer is >1.46 mg/L FEU, which gives a sensitivity of 65.79% and a specificity of 78.23%. Conclusion: Laboratory markers such as Ferritin and D-Dimer can be an accurate predictor of lung injury in COVID-19 patients and their increased values can predict the poor patient prognosis and possible mortality if aggressive hospital care is not provided.

Gastrointestinal and hepatic manifestations of COVID-19 infection:Lessons for practitioners

Originating from Wuhan in China,coronavirus disease 2019(COVID-19)spread globally within months and was declared a pandemic by World Health Organization in March 2020,making it one of the biggest healthcare calamities of our time.As more data on COVID-19 infection became available,what was initially thought to be a simple respiratory illness was found to be more complex.Many extra-pulmonary manifestations are now frequently reported for COVID-19 in available literature,most commonly gastrointestinal and hepatopancreatobiliary manifestations.Due to early scarcity of data,extra pulmonary manifestations were initially overlooked and may have contributed to nosocomial spread of the infection.Practitioners,especially gastroenterologists,who frequently encounter patients with these symptoms,need to be aware of them.This can not only help minimize the nosocomial spread,ensure safety of provider but also help conserve already stretched-thin healthcare resources.A tremendous amount of COVID-19 related literature is getting added to the growing pool every day,making it difficult for providers to follow.The aim of our review is to summarize the available evidence for gastrointestinal and hepatopancreatobiliary manifestations of COVID-19.We here briefly discussed the possible pathophysiologic mechanism for these manifestations and summarized the recommendations put forward by multiple gastrointestinal societies regarding safe and effective clinical practice during the ongoing pandemic.

Review of the Prognosis Factors of COVID-19 Infection

An epidemic of Coronavirus disease 2019 (COVID-19) outbroke in December 2019 in China, Wuhan, which is becoming a Public Health Emergency of International Concern. As this entity has become one of the worst infectious disease outbreaks of recent times, with mortality estimates in general population ranging from 1.4% to 8%, it is crucial to better understand the prognostic factors which can be associated to the outcome of this disease. However, as the pandemic is still unfortunately under progression, there are limited data with regard to the prognostic factors. Hence, this review seeks to gather and provide the existing data of the literature of all the prognosis factors of COVID-19 infection such as older age, obesity, comorbidities, lymphocytopenia, d-dimers elevation, thrombocytopenia, elevated levels of high-sensitivity cardiac troponin, C-reactive protein elevation and imaging features of COVID-19.