Persistent reduction of retinal microvascular vessel density in patients with moderate and severe COVID-19 disease

ObjectiveThis study aims to analyse the possible recovery or worsening in retinal microvasculature after 8 months in a previously studied COVID-19 cohort.Methods and analysisA cross-sectional case–control study and a prospective longitudinal cohort study. Participants were the subjects of our previous study who re-enrolled for a new examination including a fundus photograph (retinography), an optical coherence tomography (OCT) scan and an OCT angiography. COVID-19 diagnosed patients were divided into three groups: group 1: mild disease, asymptomatic/paucisymptomatic subjects who received outpatient care; group 2: moderate disease and group 3: severe disease, both of which required hospital admission because of pneumonia. Statistical analyses were performed using SPSS software (V.23.0). Cross-sectional intergroup differences were analysed by means of analysis of variance for normally distributed variables and the Kruskal-Wallis test for non-normally distributed ones. In reference to the prospective part of the study (intragroup differences, baseline with 8-month comparison), a paired t-test was used for normally distributed data and Wilcoxon signed ranks sum for non-normally distributed data.ResultsThe fovea-centered superficial and deep vascular densities were significantly diminished in severe cases compared with mild cases (p=0.004; p=0.003, respectively, for superficial and deep) and to controls (p=0.014; p=0.010), also in moderate cases to mild group (p=0.004; p=0.003) and to controls (p=0.012; p=0.024). In the longitudinal study, no significant statistical differences were found between baseline and 8-month follow-up vessel density values.ConclusionWe demonstrated persistent reduction in the central vascular area over time in patients with moderate and severe COVID-19.

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Retinal microvascular abnormalities in patients after COVID-19 depending on disease severity

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2020-317953 ◽

2020 ◽

pp. bjophthalmol-2020-317953

Author(s):

Miguel Ángel Zapata ◽

Sandra Banderas García ◽

Adrián Sánchez ◽

Anna Falcó ◽

Susana Otero-Romero ◽

...

Keyword(s):

Respiratory Distress ◽

Severe Disease ◽

Control Group ◽

Vascular Density ◽

Mild Disease ◽

Global Pandemic ◽

Group 3 ◽

Group 2 ◽

Group Control Group ◽

Group 1

BackgroundGlobal pandemic SARS-CoV-2 causes a prothrombotic state without fully elucidated effects. This study aims to analyse and quantify the possible retinal microvascular abnormalities.Materials and methodsCase–control study. Patients between 18 and 55 years old with PCR-confirmed SARS-CoV-2 infection within the last 3 months were included. Risk stratification: group 1—mild disease (asymptomatic/paucisymptomatic); group 2—moderate disease (required hospital admission with no acute respiratory distress) and group 3—severe disease (subjects who developed an acute respiratory distress were admitted in the intensive care unit and presented interleukin 6 values above 40 pg/mL). Age-matched volunteers with negative serology tests were enrolled to control group. A colour photograph, an optical coherence tomography (OCT) and an angiography using OCT centred on the fovea were performed.ResultsControl group included 27 subjects: group 1 included 24 patients, group 2 consisted of 24 patients and 21 participants were recruited for group 3. There were no funduscopic lesions, neither in the colour images nor in the structural OCT. Fovea-centred vascular density (VD) was reduced in group 2 and group 3 compared with group 1 and control group (control group vs group 2; 16.92 vs 13.37; p=0.009) (control group vs group 3; 16.92 vs .13.63; p=0.026) (group 1 vs group 2; 17.16 vs 13.37; p=0.006) (group 1 vs group 3; 17.16 vs 13.63 p=0.017).ConclusionPatients with moderate and severe SARS-CoV-2 pneumonia had decreased central retinal VD as compared with that of asymptomatic/paucisymptomatic cases or control subjects.

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P070 TRENDS AND CHARACTERISTICS OF CLINICAL TRIALS PARTICIPATION IN THE IBD PARTNERS COHORT

Inflammatory Bowel Diseases ◽

10.1093/ibd/zaa010.027 ◽

2020 ◽

Vol 26 (Supplement_1) ◽

pp. S11-S12

Author(s):

Cole Johnson ◽

Edward Barnes ◽

Xian Zhang ◽

Millie Long

Keyword(s):

Clinical Trials ◽

Controlled Trial ◽

Severe Disease ◽

Drug Approval ◽

Cross Sectional Study ◽

Participation Rates ◽

Cross Sectional ◽

Mild Disease ◽

Randomized Controlled ◽

Study Results

Abstract Background and Aims There are currently several recruitment challenges in randomized controlled trials (RCT) for inflammatory bowel disease (IBD) which prolong the drug approval process and affect the generalizability of study results. The purpose of this study is to characterize individuals who participate in IBD RCTs and identify factors which could influence future recruitment strategies. Methods We performed a cross-sectional study within the IBD Partners cohort comparing patients with current or prior participation in an interventional randomized controlled trial (RCT) of a medical therapy for IBD to those without any RCT participation. Bivariate statistics were used to compare RCT participation by IBD subtype and by other demographic and disease characteristics, and predictive modeling was used to identify factors predictive of RCT participation. We calculated the percent of the cohort that participated an in RCT during each calendar year from 2011–2018 and Clinicaltrials.gov was accessed to determine the number of active RCTs for IBD therapies per year during that same period. Results A total of 14,747 patients with IBD were included in the analysis and 1,116 (7.6%) reported RCT participation at any time. Demographic factors predictive of RCT participation (Table 1) included following at an academic institution (OR=1.8; 95%CI: 1.51–2.04) and age 36–75 (OR=1.6; 95%CI: 1.43–1.87). Patients with Crohn’s disease (CD) were more likely to participate than those with ulcerative colitis (UC) (OR=1.5; 95%CI: 1.35–1.77). Patients with more severe disease were more likely to participate, including those with prior IBD-related hospitalization (OR=2.6; 95%CI: 2.19–2.99), IBD-related surgery (OR=2.5; 95%CI: 2.24–2.87), biologic exposure (OR=3.2; 95%CI: 2.76–3.65), and “Poor” or worse quality of life (OR=1.7; 95%CI: 1.45–1.93). Steroid-free remission was associated with lower likelihood of RCT participation (OR=0.6; 95%CI: 0.53–0.70). While the number of active RCTs for IBD more than doubled between 2011 and 2018, RCT participation rates during that same time period decreased from 1.1% to 0.7% of the cohort (Figure 1). Conclusions RCT participation rates declined within this cohort between 2011–2018. Groups underrepresented in RCTs for IBD included younger patients, patients followed in community settings, and patients with more mild disease. The non-RCT group had mean sCDAI and SCCAI scores that did not meet remission thresholds, demonstrating populations in need of alternate therapies for whom clinical trials could be an option. Given anti-TNF exposure rates in this national cohort, studies should focus on anti-TNF failure populations. Investigators should make every effort to offer RCTs to all patients and network with community providers to increase awareness of RCTs.

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Clinical Characteristics and degree of severity of COVID-19 in Hemodialysis Patients in Armed Forces Institute of Urology.

Pakistan Journal of Kidney Diseases ◽

10.53778/pjkd54169 ◽

2021 ◽

Vol 5 (4) ◽

pp. PP1-6

Author(s):

Saba Umar ◽

Sohail Sabir ◽

Khalid Raja ◽

Khurram Mansoor ◽

Tanveer Sajid ◽

...

Keyword(s):

Abdominal Pain ◽

Clinical Characteristics ◽

Severe Disease ◽

Armed Forces ◽

Hemodialysis Patients ◽

Maintenance Hemodialysis ◽

Cross Sectional ◽

Mild Disease ◽

Spread Of Infection ◽

Degree Of Severity

Introduction This study was conducted to evaluate the clinical characteristics and severity of COVID -19 in hemodialysis patients at from 1st March 2020 to 15th August 2020. Methodology It was a prospective and Cross Sectional Observational Study. We collected data prospectively that includes all patients on maintenance hemodialysis and reviewed clinical characteristics of those with laboratory-confirmed COVID-19 between March 1and August 15, 2020. Results 39 out of 268 dialysis dependent patients had COVID-19. Mean age of patients was 55.9yrs. Only 35.8% patients were symptomatic. 15 out of 39 were having mild disease,12 had moderate and 12 had severe disease. Females (54.5%) were found to be more affected than males(45.5%). Dry cough was the commonest symptom (53.8%) followed by fever (46.1%) and abdominal pain(18.1%). Patients with multiple comorbidities were found to have severe disease. Conclusion We concluded that patients receiving maintenance hemodialysis are susceptible to COVID-19 and that hemodialysis centers are high risk for spread of infection. Isolating patients with COVID-19 can help in preventing the spread of COVID-19.

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376. COVID-19 Severity in HIV+ Patients Receiving Tenofovir

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.571 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S258-S258

Author(s):

Nora Homsi ◽

Kendra Vermeulen ◽

Mitchell Snyder ◽

David J Cennimo ◽

Alexandra Sonyey

Keyword(s):

Severe Disease ◽

Cd4 Count ◽

World Health ◽

Hiv Viral Load ◽

Hiv Patients ◽

Cd4 Cell Count ◽

Mild Disease ◽

Presenting Symptoms ◽

Group 2 ◽

Health Organization

Abstract Background Early in the COVID-19 pandemic, tenofovir (TAF/TDF) was identified as a potential agent for SARS-CoV-2 due to binding to RNA-dependent RNA polymerase similarly to remdesivir. This led to the hypothesis that TAF/TDF may be lessening the severity and improving outcomes of COVID-19 infection. COVID-19 Severity COVID-19 Infection Outcomes Methods Patients were identified by searching for HIV infection and SARS-CoV2 PCR testing. Type of antiretroviral therapy (ART), CD4+ cell count, HIV viral load (VL), comorbidities, presenting symptoms, severity of COVID infection, and outcomes were analyzed. COVID disease was classified as mild, moderate, severe, or critical based on World Health Organization criteria. We primarily sought to determine the effect of TAF/TDF on the severity of COVID infection. The secondary endpoint was to determine the effect of low CD4 count and HIV VL on the severity of infection. Results 39 HIV+ patients were tested at least once for SARS-CoV2 by PCR at VA NJ Health Care System. 18 of 39 patients were PCR positive. In those, common presenting symptoms included: fever (15/18), cough (7/18), and lethargy/fatigue (6/18). 16 of the 39 HIV+ patients’ ART included TAF/TDF; 8 of 18 COVID+ and 8 of 21 COVID-. In the COVID- group, 2 patients had CD4 count < 200 cells/mm3, 3 patients had HIV VL >200, and 19 of 21 had at least 1 comorbidity. In the COVID+ group, 3 had CD4 count < 200 cells/mm3, none had detectible HIV viremia, and all but one had comorbidities. Of COVID+ infections, 7 were mild, 3 moderate, 8 severe, and 5 patients died. 4 of the 5 patients that did not survive were in non-TAF/TDF group. All 3 patients with CD4 count < 200 cells/mm3 had severe disease. 6 out of 8 patients developed mild disease in TAF/TDF group vs. 1 out of 10 patients in non-TAF/TDF group. 1 out of 8 and 7 out of 10 patients had severe or critical disease in TAF/TDF vs non-TAF/TDF groups respectively. Conclusion In this sample of 18 HIV+ patients with COVID-19 infection, patients receiving TAF/TDF were more likely to develop mild disease and have full recovery than those who were on TAF/TDF-free regimens (75% vs. 10% and 87.5% vs. 50%, respectively). Patients not on TAF/TDF-based regimens had a higher rate of developing severe and critical COVID-19 disease (40% vs. 0% and 30% vs. 12.5%, respectively). Disclosures All Authors: No reported disclosures

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Corona virus lowers hemoglobin more in severe infection than mild COVID-19 infection.

The Professional Medical Journal ◽

10.29309/tpmj/2021.28.08.6523 ◽

2021 ◽

Vol 28 (08) ◽

pp. 1211-1214

Author(s):

Zunnera Rashid Chaudhry ◽

◽

Sana Rasheed ◽

Sabeen Shakir ◽

Erum Rashid ◽

...

Keyword(s):

Severe Disease ◽

Severe Infection ◽

Health Sciences ◽

Hemoglobin Level ◽

Adult Patients ◽

Distributed Data ◽

Blood Hemoglobin ◽

Corona Virus ◽

Group I ◽

Normally Distributed

Objectives: To study the effect of corona virus on blood hemoglobin and the changes this virus causes on hemoglobin in COVID-19 infected patients. Study Design: Observational study. Settings: Rawal institute of Health Sciences and Pakistan Institute of Medical Sciences, Islamabad. Period: Feb 2021 to April 2021. Material & Methods: Total 100 adult patients were included all were suffering from corona virus infection. COVID-19 infected patients belonging to both genders with no other cause of anemia were selected and all adult patients in which anemia was due to diseases other than corona infection were excluded. The blood samples of COVID-19 infected patients was taken in 5cc syringe and was send to the laboratory of Rawal Institute Of Health Sciences Islamabad for hemoglobin estimation. Blood heamoglobin (Hb) at the time of admission was recorded. Changes in their blood Hb was noted. Statistical Analysis: Data was be entered into SPSS version 23, normality of data was checked. For non-normally distributed data kruskal wallis and Mann whitney U test was applied and for normally distributed data Anova and post hoc was used. Spearsman correlation was used to correlate non distributed data and Pearson’s correlation was used for normally distributed data. Results: 100 adult patients were divided in two groups. Group I with mild symptoms of corona virus and group II with severe symptoms of corona virus. Patients with mild corona symptoms their blood hemoglobin level was 12.2 g/dl and those with severe corona symptoms their blood hemoglobin level was 10.0 g/dl. Conclusion: It was observed that patients suffering from severe disease of corona COVID-19 had reduced hemoglobin levels than those suffering from milder form of disease, thus confirming that corona virus effects the hemoglobin level and reduces its serum value causing anemia leading to complication of disease.

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CLINICAL PROFILE OF COVID-19 PATIENTS ADMITTED IN A TERTIARY CARE COVID HOSPITAL-AN OBSERVATIONAL STUDY

10.36106/ijar/3007073 ◽

2020 ◽

pp. 15-16

Author(s):

S. Durga Prasad ◽

K.V. Seshaiah ◽

K.S.S.S.Surya Prakash ◽

N. Lavanya ◽

Ch.Akhil Reddy ◽

...

Keyword(s):

Observational Study ◽

Viral Infections ◽

Clinical Symptoms ◽

Severe Disease ◽

Tertiary Care ◽

Care Hospital ◽

Cross Sectional ◽

Multiple Systems ◽

Mild Disease ◽

System Methodology

BACKGROUND: Since the origin of Covid-19, a plethora of symptoms have been described in the past few months, which indicate involvement of multiple systems with much more impact on the respiratory system. METHODOLOGY: We retrospectively evaluated from the medical records of 100 Covid-19 patients diagnosed with RT-PCR. It was a cross-sectional observational study of Covid-19 patients admitted in our tertiary COVID care hospital, Vijayawada, Andhra Pradesh during the period of two months i.e.,01-04-2020 to 31-05-2020. RESULTS: We observed the different clinical symptoms with varying frequency in Covid-19 patients. In our study the clinical symptoms in the descending order of frequency were fever (59%), cough (48%), diarrhoea (6%), dyspnoea (4%), running nose (3%), headache (3%), chest pain (1%). These symptoms are not specific to covid-19 but similar to those found in other viral infections. CONCLUSION: Based on clinical picture, disease has been classified as mild, moderate and severe. More than 80% patients have mild disease and will recover.14% will have severe disease and 5% will progress to respiratory failure, shock and multiorgan dysfunction.1-2% are fatal.

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Compensatory contribution of retinal larger vessels to perfusion density in diabetics without retinopathy

Scientific Reports ◽

10.1038/s41598-021-02554-y ◽

2022 ◽

Vol 12 (1) ◽

Author(s):

Dulce Milagros Razo Blanco-Hernández ◽

Selma Alin Somilleda-Ventura ◽

Rebeca Chávez-Herrera ◽

María Guadalupe Colas-Calvere ◽

Virgilio Lima-Gómez

Keyword(s):

Regression Model ◽

Cross Sectional Study ◽

Quadratic Equation ◽

Vessel Density ◽

Retinal Vessels ◽

Cross Sectional ◽

Capillary Plexus ◽

Group 2 ◽

Perfusion Density ◽

Superficial Capillary Plexus

AbstractVessel and perfusion densities may decrease before diabetic retinopathy appears; it is unknown whether these changes affect the contribution of vessel density to perfusion density. This was a non-experimental, comparative, prospective, cross-sectional study in non-diabetic subjects (group 1) and diabetics without retinopathy (group 2). Vessel and perfusion densities in the superficial capillary plexus were compared between groups at the center, inner, and full regions and by field (superior, temporal, inferior, nasal) using optical coherence tomography angiography. Coefficients of determination (R2) between vessel and perfusion densities were calculated to find the contribution of larger retinal vessels to perfusion density. Percent differences were used to evaluate the contribution of these vessels to perfusion density in a regression model. There were 62 participants, 31 eyes by group; vessel and perfusion densities as well as the coefficients of determination between them were lower in group 2, especially in the nasal field (R2 0.85 vs. 0.71), which showed a higher contribution of larger retinal vessels to perfusion density. The regression model adjusted to a quadratic equation. In diabetics without retinopathy the contribution of vessel density to perfusion density may decrease; a low vessel density may increase the contribution of larger retinal vessels to perfusion density.

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Clustering of COVID-19 Symptoms Among Iranian Patients: The Role of Preexisting Comorbidity on Latent Class Membership

Asia Pacific Journal of Public Health ◽

10.1177/10105395211017755 ◽

2021 ◽

pp. 101053952110177

Author(s):

Eslam Moradi-Asl ◽

Davoud Adham ◽

Hassan Ghobadi ◽

Abbas Abbasi-Ghahramanloo

Keyword(s):

Odds Ratio ◽

Latent Class ◽

Severe Disease ◽

Cross Sectional Study ◽

Cross Sectional ◽

Mild Disease ◽

Indicator Variables ◽

Specific Subgroup ◽

Latent Subgroups ◽

Northwest Of Iran

This study aimed to identify subgroups of coronavirus disease 2019 (COVID-19) symptoms and assess the role that preexisting comorbidity on membership of specific subgroup. This cross-sectional study took place in Ardabil, northwest of Iran. All patients (16 183) who were admitted to the hospitals of Ardabil province were recruited. Six indicator variables were selected to identify latent subgroups of patients using the result of polymerase chain reaction (PCR) test as a grouping variable. Data analysis was performed using χ2, independent t test, and latent class analysis. This study found that among PCR-positive patients, there were 3 latent classes: (1) mild disease (16.1%), (2) semi-severe disease (62.5%), and (3) severe disease (21.3%). This study showed that having preexisting comorbidity increase the odds of membership in semi-severe disease (odds ratio = 2.30) and severe disease (odds ratio = 1.60) classes compared with mild disease class. Focusing on patients who experience co-occurrence of more symptoms may be helpful in control of COVID-19.

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Definition of fibromyalgia severity: findings from a cross-sectional survey of 2339 Italian patients

Rheumatology ◽

10.1093/rheumatology/keaa355 ◽

2020 ◽

Cited By ~ 1

Author(s):

Fausto Salaffi ◽

Marco Di Carlo ◽

Laura Bazzichi ◽

Fabiola Atzeni ◽

Marcello Govoni ◽

...

Keyword(s):

Disease Severity ◽

Severe Disease ◽

Fibromyalgia Impact Questionnaire ◽

Cross Sectional Survey ◽

External Criterion ◽

Cross Sectional ◽

Mild Disease ◽

Moderate Disease ◽

Definition Of ◽

Distress Scale

Abstract Objective To establish optimal cut-off values for the scores of the revised Fibromyalgia Impact Questionnaire (FIQR), the modified Fibromialgia Assessment Scale (FAS 2019mod), and the Polysymptomatic Distress Scale (PDS) in order to distinguish five levels of FM disease severity. Methods Consecutive FM patients were evaluated with the three clinimetric indices, and each patient was required to answer the anchor question: ‘In general, would you say your health is 1 = very good, 2 = good, 3 = fair, 4 = poor, or 5 = very poor?’—which represented the external criterion. Cut-off points were established through the interquartile reconciliation approach. Results The study sample consisted of 2181 women (93.2%) and 158 men (6.8%), with a mean age of 51.9 (11.5) years, and mean disease duration was 7.3 (6.9) years. The overall median FIQR, FAS 2019 mod and PDS scores (25th–75th percentiles) were respectively 61.16 (41.16–77.00), 27.00 (19.00–32.00) and 19.0 (13.00–24.00). Reconciliation of the mean 75th and 25th percentiles of adjacent categories defined the severity states for FIQR: 0–23 for remission, 24–40 for mild disease, 41–63 for moderate disease, 64–82 for severe disease and >83 for very severe disease; FAS 2019 mod: 0–12 for remission, 13–20 for mild disease, 21–28 for moderate disease, 29–33 for severe disease and >33 for very severe disease; PDS: 0–5 for remission, 6–15 for mild disease, 16–20 for moderate disease, 21–25 for severe disease and >25 for very severe disease. Conclusions Disease severity cut-offs can represent an important improvement in interpreting FM.

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Estimation of Fluoride and Sirtuin1 in Patients with Diabetic Nephropathy in Kolar District of Karnataka, India

Journal of Laboratory Physicians ◽

10.1055/s-0041-1732817 ◽

2021 ◽

Author(s):

Sai Deepika R. ◽

KN Shashidhar ◽

Raveesha A. ◽

Muninarayana C.

Keyword(s):

Diabetic Nephropathy ◽

Statistical Analysis ◽

Cross Sectional Study ◽

Cellular Damage ◽

P Value ◽

Distributed Data ◽

Cross Sectional ◽

Middle Income ◽

Normally Distributed

Abstract Objective Prevalence of type-2 diabetes mellitus (DM) and diabetic nephropathy is growing rapidly in Asian countries, affecting low- and middle-income groups. One of the epidemiological issues of Kolar district is fluorosis; advanced glycation end product, carboxymethyl lysine (CML), and a molecule of interest Sirtuin1 are employed in the present study. In the correlation of fluoride with sirtuin1and CML with sirtuin1 of cases lies the important rationale of the study to assess the extent of kidney damage. Materials and Methods This is a comparative cross-sectional study with three groups, each with 70 patients, as follows: G1, control; G2, diabetes with diabetic nephropathy; and G3, type-2 DM without any complications. Informed written consent was obtained from all study patients. All the routine investigations were performed by fully automated Vitro 5, 1 Fs, Vitros. Fasting insulin was analyzed by Vitro eCI and glycated hemoglobin was estimated by BioRad D10. Sirtuin1, CML, and fructosamine were estimated by double antibody sandwich technique. Statistical Analysis The statistical analysis was performed by SPSS 20 (IBM) software. Means of normally distributed data were compared using analysis of variance (ANOVA), and not normally distributed data were compared by Kruskal–Wallis test. A p- value of < 0.05 was considered statistically significant. Results A decrease in sirtuin1, serum, and urine fluoride of group 2 (34.74 [25.08–53.2], 0.24 [0.2–0.5], and 0.24 [0.16–0.41]) was observed compared with other groups. Increased CML and fluoride act as prooxidant, restricting the effect of sirtuin1 on cellular damage, causing further complications such as increased insulin resistance and decreased insulin sensitivity. Conclusion The alterations in serum sirtuin1 levels indicate the severity of damage due to stress during hyperglycemia and fluoride toxicity; hence, sirtuin1 can be considered as biomarker of aging. Subsequently, the correlation of CML, estimated glomerular filtration rate (eGFR), and fluoride with sirtuin1 indicates that increasing sirtuin1 may defend the forthcoming damage and could be considered in therapeutics.

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