scholarly journals Severe hypocalcaemia in a COVID-19 female patient

2021 ◽  
Vol 2021 ◽  
Author(s):  
Edmond Puca ◽  
Entela Puca ◽  
Pellumb Pipero ◽  
Holta Kraja ◽  
Najada Como
Keyword(s):  
Vitamin D ◽  
Risk Factor ◽  
Inflammatory Markers ◽  
Throat Swab ◽  
Ground Glass Opacity ◽  
High Dose ◽  
List Type ◽  
Rt Pcr ◽  
Laboratory Findings ◽  
Severe Hypocalcaemia

Summary Comorbidities are a risk factor for patients with COVID-19 and the mechanisms of disease remain unclear. The aim of this paper is to present a case report of an COVID-19 patient with severe hypocalcaemia. This is a report of an 81-year-old female, suffered from myalgia and fatigue for more than 3–4 weeks. Fever and cough appear 2 days before she presented to the emergency room. On physical examination, she was febrile with a temperature of 38.8°C, accompanied by cough, sore throat, headache, fatigue, and muscle ache. Her past medical history was remarkable with no chronic disease. She had lymphopenia. Laboratory test revealed moderate liver dysfunction, hypoalbuminemia, and severe hypocalcaemia (serum corrected calcium level: 5.7  mg/dL). Parathyroid hormone (PTH) was 107.9 pg/mL (range: 15–65) and 25(OH)2D levels was 4.5 ng/mL (range: 25–80). Chest CT scan detected peripheral ground-glass opacity. Throat swab for coronavirus by RT-PCR assay tested positive for the virus. She was treated with lopinavir/ritonavir, third generation cephalosporin, anticoagulant, daily high-dose calcium acetate, vitamin D3, fresh frozen plasma and oxygen therapy. She was discharged after two negative throat swab tests for coronavirus by conventional RT-PCR. Learning points Comorbidities are a risk factor for patients with COVID-19. Laboratory findings are unspecific in COVID-19 patients; laboratory abnormalities include lymphopenia, elevated of LDH, CPK and the inflammatory markers, such as C reactive protein, ferritinemia and the erythrocyte sedimentation rate. In addition to inflammatory markers, in COVID-19 patients it is crucial to check the level of vitamin D and calcium. There may be a correlation between vitamin D deficiency and the severity of COVID-19 disease.

scholarly journals Diagnostic performance of chest CT in differentiating COVID-19 from other causes of ground-glass opacities

2021 ◽  
Vol 52 (1) ◽  
Author(s):  
Ali H. Elmokadem ◽  
Dalia Bayoumi ◽  
Sherif A. Abo-Hedibah ◽  
Ahmed El-Morsy
Keyword(s):  
Diagnostic Performance ◽  
Pulmonary Nodules ◽  
Ground Glass Opacity ◽  
Chest Ct ◽  
Ground Glass ◽  
Rt Pcr ◽  
Laboratory Findings ◽  
Halo Sign ◽  
Traction Bronchiectasis ◽  
Chest Ct Scan

Abstract Background To evaluate the diagnostic performance of chest CT in differentiating coronavirus disease 2019 (COVID-19) and non-COVID-19 causes of ground-glass opacities (GGO). Results A total of 80 patients (49 males and 31 females, 46.48 ± 16.09 years) confirmed with COVID-19 by RT-PCR and who underwent chest CT scan within 2 weeks of symptoms, and 100 patients (55 males and 45 females, 48.94 ± 18.97 years) presented with GGO on chest CT were enrolled in the study. Three radiologists reviewed all CT chest exams after removal of all identifying data from the images. They expressed the result as positive or negative for COVID-19 and recorded the other pulmonary CT features with mention of laterality, lobar affection, and distribution pattern. The clinical data and laboratory findings were recorded. Chest CT offered diagnostic accuracy ranging from 59 to 77.2% in differentiating COVID-19- from non-COVID-19-associated GGO with sensitivity from 76.25 to 90% and specificity from 45 to 67%. The specificity was lower when differentiating COVID-19 from non-COVID-19 viral pneumonias (30.5–61.1%) and higher (53.1–70.3%) after exclusion of viral pneumonia from the non-COVID-19 group. Patients with COVID-19 were more likely to have lesions in lower lobes (p = 0.005), peripheral distribution (p < 0.001), isolated ground-glass opacity (p = 0.043), subpleural bands (p = 0.048), reverse halo sign (p = 0.005), and vascular thickening (p = 0.013) but less likely to have pulmonary nodules (p < 0.001), traction bronchiectasis (p = 0.005), pleural effusion (p < 0.001), and lymphadenopathy (p < 0.001). Conclusions Chest CT offered reasonable sensitivity when differentiating COVID-19- from non-COVID-19-associated GGO with low specificity when differentiating COVID-19 from other viral pneumonias and moderate specificity when differentiating COVID-19 from other causes of GGO.

P06 A study to assess the effectiveness of vitamin d supplementation in paediatric cystic fibrosis patients

2018 ◽  
Vol 103 (2) ◽  
pp. e1.9-e1
Author(s):  
Christiansen Nanna ◽  
Ashraf Saleha
Keyword(s):  
Cystic Fibrosis ◽  
Vitamin D ◽  
Vitamin D Deficiency ◽  
Dose Range ◽  
Vitamin D Supplementation ◽  
High Dose ◽  
List Type ◽  
Current Guideline ◽  
Paediatric Patients ◽  
Significant Difference

AimsPatients with cystic fibrosis (CF) require supplementation of fat-soluble vitamins due to the effects of the disease on the pancreas and the resulting inability of absorb fat effectively.1The study aimed to assess the effectiveness of current of vitamin D supplementation to achieve adequate serum Vitamin D (25OHD) levels in paediatric CF patients.2 Secondly, this study assessed the effectiveness of ‘Stoss’ therapy (a high dose vitamin D therapy administered every three months) as an alternative to daily vitamin D supplementation for patients with known poor compliance.3MethodsVitamin D doses and serum 25OHD levels between January and December 2016 were reviewed for paediatric CF patients at a UK centre. Data was collected for 138 paediatric patients. The ‘clinical record summary’ system was used to extract the data which included age, hospital number, weight in 2015 and 2016, 25OHD levels from 2015 and 2016, vitamin D dose before each level and pancreatic status.Data was entered onto Statistical Package for the Social Sciences (SPSS) system for analysis. A paired T-test was conducted to ascertain if there was a significant difference in weekly/kg doses between patients that were sufficient (25OHD>50 nmol/L) and insufficient (25OHD<50 nmol/L).ResultsData was collected for a total of 138 patients. The data from only 70 patients was analysed when investigating the first objective, as all other patients did not have 25OHD levels available for both 2015 and 2016. A further five patients wereexcluded and analysed seperately due to receiving Stoss therapy. The weekly Vitamin D dose range was very wide for both years with 43% (n=40) of patients requiring additional vitamin D in addition to Aquadeks (CF multivitamin preparation). There was no significant difference in Vitamin D doses between patients with sufficient and insufficient 25OHD levels. This was thecase for both 2015 (p=0.432) and 2016 (p=0.192). The daily supplementation doses were successful at maintaining vitamin D sufficiency for 83% of patients in 2015 and 93% in 2016.Out of the 5 patients who received ‘Stoss’ therapy, 3 had an increase in 25OHD levels. However, only one of the patients had a significant increase leading to sufficient 25OHD levels. In 2 cases there was actually a 60%–68% decrease in 25OHD levels, which lead to these patients developing vitamin D deficiency.ConclusionThis study was useful in determining the effectiveness of current Vitamin D dosing. The results suggest that patients having insufficient 25OHD levels may not be due to an inadequacy of doses provided in the current guideline, as there was no significant difference in dose between patients with sufficient and insufficient 25OHD levels. Given the patient group, the difference could be attributable to a lack of compliance to daily therapies in the patients with insufficient 25OHD levels or even differences in individual responses to therapy.In this sample, ‘Stoss’ therapy is not effective in maintaining sufficient 25OHD levels. Although the data for this part of the study was very limited, it identifies a need to investigate the effectiveness of ‘Stoss’ therapy further.ReferencesFerguson JH, Chang AB. Vitamin D supplementation for cystic fibrosis. Cochrane Database of Syst Rev [Internet] 2014. http://onlinelibrary.wiley.com/ & doi:10.1002/14651858.CD007298.pub3/pdf [Available: 2017April 12].Green D, Carson K, Leonard A, et al. Current treatment recommendations for correcting vitamin D deficiency in paediatric patients with cystic fibrosis is inadequate. J Pediatr2008;4:554–559.Shepherd D, Belessis Y, Katz, et al. Single high-dose oral vitamin D3 (stoss) therapy: A solution to vitamin D deficiency in children with cystic fibrosis?J Cyst Fibros2013;2:177–182.

scholarly journals Short term, high-dose vitamin D supplementation for COVID-19 disease: a randomised, placebo-controlled, study (SHADE study)

2020 ◽  
pp. postgradmedj-2020-139065 ◽  
Author(s):  
Ashu Rastogi ◽  
Anil Bhansali ◽  
Niranjan Khare ◽  
Vikas Suri ◽  
Narayana Yaddanapudi ◽  
...  
Keyword(s):  
Vitamin D ◽  
Inflammatory Markers ◽  
Intervention Group ◽  
Vitamin D Supplementation ◽  
Controlled Study ◽  
Control Group ◽  
High Dose ◽  
Baseline Serum ◽  
Cholecalciferol Supplementation ◽  
And Control

BackgroundVitamin D has an immunomodulatory role but the effect of therapeutic vitamin D supplementation in SARS-CoV-2 infection is not known.AimEffect of high dose, oral cholecalciferol supplementation on SARS-CoV-2 viral clearance.DesignRandomised, placebo-controlled.ParticipantsAsymptomatic or mildly symptomatic SARS-CoV-2 RNA positive vitamin D deficient (25(OH)D<20 ng/ml) individuals.InterventionParticipants were randomised to receive daily 60 000 IU of cholecalciferol (oral nano-liquid droplets) for 7 days with therapeutic target 25(OH)D>50 ng/ml (intervention group) or placebo (control group). Patients requiring invasive ventilation or with significant comorbidities were excluded. 25(OH)D levels were assessed at day 7, and cholecalciferol supplementation was continued for those with 25(OH)D <50 ng/ml in the intervention arm. SARS-CoV-2 RNA and inflammatory markers fibrinogen, D-dimer, procalcitonin and (CRP), ferritin were measured periodically.Outcome measureProportion of patients with SARS-CoV-2 RNA negative before day-21 and change in inflammatory markers.ResultsForty SARS-CoV-2 RNA positive individuals were randomised to intervention (n=16) or control (n=24) group. Baseline serum 25(OH)D was 8.6 (7.1 to 13.1) and 9.54 (8.1 to 12.5) ng/ml (p=0.730), in the intervention and control group, respectively. 10 out of 16 patients could achieve 25(OH)D>50 ng/ml by day-7 and another two by day-14 [day-14 25(OH)D levels 51.7 (48.9 to 59.5) ng/ml and 15.2 (12.7 to 19.5) ng/ml (p<0.001) in intervention and control group, respectively]. 10 (62.5%) participants in the intervention group and 5 (20.8%) participants in the control arm (p<0.018) became SARS-CoV-2 RNA negative. Fibrinogen levels significantly decreased with cholecalciferol supplementation (intergroup difference 0.70 ng/ml; P=0.007) unlike other inflammatory biomarkers.ConclusionGreater proportion of vitamin D-deficient individuals with SARS-CoV-2 infection turned SARS-CoV-2 RNA negative with a significant decrease in fibrinogen on high-dose cholecalciferol supplementation.Trial register numberNCT04459247.

scholarly journals Impact of daily high dose oral vitamin D therapy on the inflammatory markers in patients with COVID 19 disease

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Maheshwar Lakkireddy ◽  
Srikanth Goud Gadiga ◽  
R. D. Malathi ◽  
Madhu Latha Karra ◽  
I. S. S. V. Prasad Murthy Raju ◽  
...  
Keyword(s):  
Vitamin D ◽  
Inflammatory Markers ◽  
Standard Treatment ◽  
Statistical Significance ◽  
Hypovitaminosis D ◽  
High Dose ◽  
Treatment Protocols ◽  
Dose Oral ◽  
The Difference ◽  
The Impact

AbstractCOVID 19 is known to cause immune dysregulation and vitamin D is a known immunomodulator. This study aims to objectively investigate the impact of Pulse D therapy in reducing the inflammatory markers of COVID-19. Consented COVID-19 patients with hypovitaminosis D were evaluated for inflammatory markers (N/L ratio, CRP, LDH, IL6, Ferritin) along with vitamin D on 0th day and 9th/11th day as per their respective BMI category. Subjects were randomised into VD and NVD groups. VD group received Pulse D therapy (targeted daily supplementation of 60,000 IUs of vitamin D for 8 or 10 days depending upon their BMI) in addition to the standard treatment. NVD group received standard treatment alone. Differences in the variables between the two groups were analysed for statistical significance. Eighty seven out of one hundred and thirty subjects have completed the study (VD:44, NVD:43). Vitamin D level has increased from 16 ± 6 ng/ml to 89 ± 32 ng/ml after Pulse D therapy in VD group and highly significant (p < 0.01) reduction of all the measured inflammatory markers was noted. Reduction of markers in NVD group was insignificant (p > 0.05). The difference in the reduction of markers between the groups (NVD vs VD) was highly significant (p < 0.01). Therapeutic improvement in vitamin D to 80–100 ng/ml has significantly reduced the inflammatory markers associated with COVID-19 without any side effects. Hence, adjunctive Pulse D therapy can be added safely to the existing treatment protocols of COVID-19 for improved outcomes.

scholarly journals High-Dose Vitamin D Supplementation Improves Microcirculation and Reduces Inflammation in Diabetic Neuropathy Patients

Nutrients ◽  
2020 ◽  
Vol 12 (9) ◽  
pp. 2518 ◽  
Author(s):  
Tatiana Karonova ◽  
Anna Stepanova ◽  
Anna Bystrova ◽  
Edward B. Jude
Keyword(s):  
Vitamin D ◽  
Peripheral Neuropathy ◽  
Inflammatory Markers ◽  
Signs And Symptoms ◽  
Vitamin D Supplementation ◽  
High Dose ◽  
Treatment Groups ◽  
Cutaneous Microcirculation ◽  
Before And After ◽  
Cholecalciferol Supplementation

We assessed the effect of different doses of vitamin D supplementation on microcirculation, signs and symptoms of peripheral neuropathy and inflammatory markers in patients with type 2 diabetes (T2DM). Sixty-seven patients with T2DM and peripheral neuropathy (34 females) were randomized into two treatment groups: Cholecalciferol 5000 IU and 40,000 IU once/week orally for 24 weeks. Severity of neuropathy (NSS, NDS scores, visual analogue scale), cutaneous microcirculation (MC) parameters and inflammatory markers (ILs, CRP, TNFα) were assessed before and after treatment. Vitamin D deficiency/insufficiency was detected in 78% of the 62 completed subjects. Following treatment with cholecalciferol 40,000 IU/week, a significant decrease in neuropathy severity (NSS, p = 0.001; NDS, p = 0.001; VAS, p = 0.001) and improvement of cutaneous MC were observed (p < 0.05). Also, we found a decrease in IL-6 level (2.5 pg/mL vs. 0.6 pg/mL, p < 0.001) and an increase in IL-10 level (2.5 pg/mL vs. 4.5 pg/mL, p < 0.001) after 24 weeks of vitamin D supplementation in this group. No changes were detected in the cholecalciferol 5000 IU/week group. High-dose cholecalciferol supplementation of 40,000 IU/week for 24 weeks was associated with improvement in clinical manifestation, cutaneous microcirculation and inflammatory markers in patients with T2DM and peripheral neuropathy.

scholarly journals CT scores predict mortality in 2019-nCoV pneumonia

2020 ◽  
Author(s):  
Yun Xie ◽  
Luyu Yang ◽  
Hui Dong ◽  
Hu Peng ◽  
Yuetian Yu ◽  
...  
Keyword(s):  
Risk Factor ◽  
Multivariate Regression ◽  
Independent Risk Factor ◽  
Laboratory Data ◽  
Ground Glass Opacity ◽  
Multivariate Regression Analysis ◽  
Rt Pcr ◽  
Absolute Count ◽  
Single Center Study ◽  
Worse Prognosis

Abstract Background: While 2019-nCoV nucleic acid swab tests has high false positives rate, How to diagnose 2019-nCoV pneumonia and predict prognosis by CT is very important. Methods: In this retrospective single-center study, we consecutively included suspected 2019-nCoV pneumonia critical cases in the intensive care unit of Wuhan third hospital from January 31, 2020 to February 16, 2020. The cases were confirmed by real-time RT-PCR, and all patients were evaluated with CT, cutoff values were obtained according to the Yoden index, and were divided into high CT score group and low CT score group. Epidemiological, demographic, clinical, and laboratory data were collected. Results: The major imaging feature of 2019-nCoV pneumonia is the ground glass opacity (GGO). Multivariate regression analysis found that CT score and absolute count of lymphocytes were independent risk factor for death, and CT score predicted mortality AUC-ROC =0.7, cutoff=1.45. When the absolute count of lymphocytes decreased, the patient's CT also deteriorated. Conclusion: CT score and absolute count of lymphocytes were independent risk factor for death, and patients with high CT score may have a worse prognosis. Lower absolute count of lymphocytes may indicated the patient's CT also deteriorated.

scholarly journals Vitamin D deficiency as risk factor for severe COVID-19: a convergence of two pandemics

2020 ◽  
Author(s):  
D. De Smet ◽  
K. De Smet ◽  
P. Herroelen ◽  
S. Gryspeerdt ◽  
G.A. Martens
Keyword(s):  
Vitamin D ◽  
Risk Factor ◽  
Observational Study ◽  
Lung Disease ◽  
Vitamin D Deficiency ◽  
Reference Population ◽  
Vitamin D Supplementation ◽  
Disease Stage ◽  
List Type ◽  
Stage 1

Structured abstractImportanceVitamin D deficiency increases the incidence of respiratory virus infections. More than 1 billion people worldwide are vitamin D deficient. If vitamin D deficiency is associated to incidence or severity of SARS-CoV-2 infection, a global call could be made for vitamin D supplementation to mitigate the pandemic.Objectiveto determine if lower serum 25-hydroxyvitamin D (25(OH)D) levels are correlated to the risk for COVID-19 and its severity as measured by CTDesignsingle-center observational studySettingAZ Delta general hospitalParticipants186 consecutive patients with PCR-confirmed SARS-CoV-2 infection hospitalized for COVID-19 from March 1, 2020 to April 7, 2020Main outcome and measurescomparative analysis of 25(OH)D levels in patients hospitalized for COVID-19 at various radiological stages and a season/age/sex-matched diseased control populationResultswe report on 186 SARS-CoV-2 infected patients requiring hospitalization for severe COVID-19: 109 males (median age 68 years, IQR 53–79 years) and 77 females (median age 71 years, IQR 65–74 years). At admission patients were screened by CT to determine temporal changes of COVID-19 lung disease and classified as stage 1 (ground glass opacities), 2 (crazy paving pattern) and 3 (consolidation). At intake, 25(OH)D levels were measured and compared to a season-matched population of 2717 diseased controls, consisting of 999 males (median age 69 years, IQR 53–81 years) and 1718 females (median age 68 years, IQR 43–83 years). Male and female COVID-19 patients combined showed lower median 25(OH)D than controls (18.6 ng/mL, IQR 12.6–25.3, versus 21.5 ng/mL, IQR 13.9–30.8; P=0.0016) and a higher fraction of vitamin D deficiency (58.6% versus 45.2%, P=0.0005). A strong sexual dimorphism was found: female patients had comparable vitamin D status as control females. Male COVID-19 patients, however, showed markedly higher percentage of vitamin D deficiency than controls (67.0% versus 49.2%, P=0.0006) and this effect was more pronounced with advanced radiological stage ranging from 55.2% in stage 1 to 74% in stage 3.Conclusions and relevancevitamin D deficiency is a possible risk factor for severe SARS-CoV-2 infection in males. Vitamin D supplementation might be an inexpensive, accessible and safe mitigation for the SARS-CoV-2 pandemic.Key pointsQuestion: does vitamin D deficiency predispose to severity of SARS-CoV-2 infection?Findings: in this observational study on 186 consecutive patients hospitalized with PCR-confirmed SARS-CoV-2 infection, we find that patients with severe COVID-19 show lower median serum 25(OH)D and a higher percentage of vitamin D deficiency at intake than a season/age-matched reference population. The correlation between vitamin D deficiency and the need for hospitalization due to COVID-19 was only seen in male patients. In males but not females, the percentage of vitamin D deficient patients also increased with more advanced COVID-19 disease stage as measured by CT.Meaning: our data indicate a strong statistical correlation between the degree of vitamin D deficiency and severity of COVID-19 lung disease. With more than 1 billion people worldwide affected by vitamin D deficiency, vitamin D supplementation might be a lifesaving, inexpensive, accessible and safe component of primary prevention during the SARS-CoV-2 pandemic and beyond

scholarly journals Author Correction: Impact of daily high dose oral vitamin D therapy on the inflammatory markers in patients with COVID 19 disease

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Maheshwar Lakkireddy ◽  
Srikanth Goud Gadiga ◽  
R. D. Malathi ◽  
Madhu Latha Karra ◽  
I. S. S. V. Prasad Murthy Raju ◽  
...  
Keyword(s):  
Vitamin D ◽  
Inflammatory Markers ◽  
High Dose ◽  
Oral Vitamin ◽  
Dose Oral
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