Objectives: The primary aim of the study is to evaluate the role of cardiac biomarkers like high-sensitive troponin I (hs troponin I), N terminal-pro B-type natriuretic peptide (NT-proBNP) in coronavirus disease 2019 (COVID-19) patients who were admitted to the intensive care unit (ICU) with positive test results of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by real-time reverse transcriptase-polymerase chain reaction (rRT-PCR) in Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India. This study comprises two main objectives: • To evaluate the significance of cardiac markers in COVID-19 patients by test and receiver operating characteristic (ROC) analysis in 85 patients presented with complaints of chest pain and tested positive for SARS-CoV-2 by rRT-PCR. To represent the data considered in case and control groups for hs troponin I and NT-proBNP graphically in a box plot. Box plots may also have lines extending from the boxes (whiskers) indicating variability outside the upper and lower quartiles. • To determine the percentage positivity and mortality rate of COVID-19 patients with cardiac injury in 1 month period (August 1, 2020 to August 31, 2020) data of 261 individuals. Materials and methods: In the first part of the study, a total of 125 individuals (13–95 years) were considered for this study. Among the total number of patients considered, 85 individuals considered in the case group in the age group of 13–95 years (median age 65 years) had complaints of chest pain. The case group consisted of 22 females and 63 males. Forty healthy adults without any history and clinical evidence suggestive of COVID-19 and without any comorbidities, like diabetes, hypertension, chronic lung disease, cardiac disease, cancer, and immunocompromised status, were considered as a control group for the study. The control group comprises 8 females and 32 males in the age group of 13–86 years (median age 57 years). Cardiac biomarkers (hs troponin I and NT-proBNP) of these 85 patients were used to evaluate the cardiac injury found in COVID-19 patients. Statistical analysis was carried out on the data after determining whether the data had a normal/log-normal distribution and their significance was determined by calculating the p value. The accuracy of the biomarkers (NT-proBNP and hs troponin I) was checked using ROC analysis. The percentage of patients showing abnormal cardiac markers was also calculated. In the second part of the study, we have analyzed 1-month data (August 1, 2020 to August 31, 2020) of 261 individuals to evaluate the percentage positivity and mortality rate of COVID-19 patients with a cardiac injury. Results: The data were found to have normal/log-normal distribution. We found a significant increase in mean values of both hs troponin I and NT-proBNP in COVID-19 patients with chest pain than the control group. We applied the ROC curve to discriminate case population more precisely than the control population. Receiver operating characteristic analysis for NT-proBNP and hs troponin I showed that the area under the curve (AUC) of NT-proBNP is 1.0 and the AUC of hs troponin I is 0.91. The percentage of patients tested positive for SARS-CoV-2 with cardiac injury within 1 month time period (August 1, 2020 to August 31, 2020) was found to be 10%. The percentage recovery and death among the number of patients tested positive for SARS-CoV-2 with cardiac injury was found to be 88 and 12%, respectively. Conclusion: Both the cardiac markers (NT-proBNP and hs troponin I) have an excellent accuracy in patients with COVID-19 with chest pain, suggestive of cardiac injury. Clinical significance: Understanding the cardiac biomarkers in COVID-19 patients with chest pain appears to be beneficial to triage, risk-stratify, and prognosticate patients with COVID-19 based on the evidence of cardiac injury and the presence of underlying cardiovascular disease.
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Garg M, Jain A, Goswami B, Puri M. Association of Cardiometabolic Index and Insulin Resistance with Serum Levels of Peroxisome Proliferator Activated Receptor-γ in Polycystic Ovary Syndrome. Indian J Med Biochem 2020; 24 (2):50-54.
Introduction: Polycystic ovary syndrome or PCOS is also called “Stein-Leventhal Syndrome”. It comprises of many endocrinal disturbances of female reproductive system and manifested variably to be called as a “Syndrome.” Insulin resistance is seen in 30–40% women with PCOS and is accompanied with hyperinsulinemia in about 50–70% of women. Cardiometabolic index (CMI) is a new marker for coronary artery disease and metabolic syndrome. The relationship of CMI and insulin resistance is further explored in the present study using peroxisome proliferator activated receptor-γ (PPAR-γ) serum levels. PPAR-γ or glitazone receptors are involved in improving insulin sensitization, mainly through adipocyte differentiation. Aims and objectives: To study whether there is any association of CMI and insulin resistance with PPAR-γ serum levels. Materials and methods: A hospital-based observational case–control study was conducted in 50 diagnosed cases of PCOS (15–45 years of age) as per revised Rotterdam Criteria along with 50 age-matched apparently healthy women volunteers as controls. Fasting blood samples on D2/D3 were taken to obtain serum for analysis of biochemical and glycemic parameters, including lipid profile and HOMA-IR. PPAR-γ levels were estimated using sandwich enzyme-linked immunosorbent assay. Statistical analysis using SPSS ver. 23 employing independent sample t test for intergroup comparison of means and Pearson\'s correlation coefficient for correlation analysis was done. Results and conclusion: Serum triglyceride levels were found to be significantly higher in cases (121.08 ± 57.6 mg/dL) when compared to controls (97.6 ± 44.2 mg/dL), suggesting that dyslipidemia is associated with PCOS, with hypertriglyceridemia being an important component of it. This study showed significantly lower levels of PPAR-γ in the cases when compared to controls (p value < 0.05). HOMA-IR showed a significant positive correlation with serum TG. CMI also depicted significant and positive correlations with hypertriglyceridemia, HOMA-IR, and PPAR-γ.
Shashi S Dubey,
Introduction: Body mass index (BMI) is an important tool for monitoring development in the growing age group. Thyroid hormone affects body weight through changes in basal metabolic rate (BMR). The increasing prevalence of deranged BMI in young girls’ necessities to rule out thyroid dysfunction. Aim: The study objective was to analyze the association between BMI and thyroid function in adolescent girls. Materials and methods: Seventy-five girls of 12–18 years of age group were included in this study. All participants had undergone anthropometric measurements and serum analysis for thyroid-stimulating hormone (TSH) and T4. Based on the growth and BMI chart of the Indian Association of Pediatrics (IAP), the participants were categorized into two groups. Participants with BMI within 25–75 percentiles were categorized as group I and those below 25 and above 75 percentile were categorized as group II. Results: The median values of age, weight, and TSH levels were significantly higher in group II participants when compared with group I. In group II, serum TSH and BMI depicted a highly significant positive correlation (p value = 0.001) while in group I this correlation was 0.044. Conclusion: Serum TSH was found elevated in participants with BMI derangement. The stronger correlation between TSH and BMI suggested regarding the inter-relationship between thyroid hormone and BMI and impact of each other\'s metabolism. Clinical significance: The subclinical serum TSH levels and its correlation with BMI require more detailed study to devise a causal relationship. Thyroid hormones have a role in the development and any derangement in the adolescents affects the development.
Aim: To review pathogenesis of cytokine storm in COVID-19 cases. Background: Human coronaviruses (hCoV) mainly infect upper airways and cause seasonal mild to moderate cold-like respiratory symptoms or severe pneumonia leading to fatal acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). Recent clinical investigation reveals that mild COVID-19 patients had high level of IL1B, IFN-γ, CXCL10/IP-10, and CCL2/MCP-1, while patients requiring ICU admission had higher level of GCSF, CXCL10/IP-10, CCL2/MCP-1, and CCL3/MIP-1A, indicating inflammatory cytokine release is critical in COVID-19 progression. IL-1 and IL-6 are responsible for elevation of acute-phase reactants, such as C-reactive protein, serum amyloid A, fibrinogen, hepcidin, and inhibition of albumin synthesis which all together causes a procoagulant environment. In a meta-analysis including nine studies (total 1426 patients), mean IL-6 levels were more than 3 times higher in patients with complicated COVID-19 compared to those with uncomplicated disease, and high IL-6 levels were associated with mortality risk. IL-6 is an important marker of inflammation and can guide the clinicians in recognizing patients with severe COVID-19 early in the disease course. Delay in the interferon release and presence of LPS by secondary bacterial infections increases the severity of cytokine storm. Thus, commencement of early broad-spectrum antibiotic course is advisable. Cytokine storm appears after first week of symptoms when viral load starts decreasing, and this indicates the immunopathogenesis of the ARDS. Conclusion: The aberrant release of multiple cytokines in COVID-19 produces immunopathogenic damage to tissues and organs, even while the immune response tries to overcome the evading mechanisms of virus. Delay in the interferon release and presence of lipopolysaccharide by secondary bacterial infections increase the severity of cytokine storm. IL-6 could be used as a potential marker for severity of the ARDS. However, anti-IL6 antibody Tocilizumab failed to prove effective in clinical trials. Corticosteroid therapy is being given for moderate and severe cases of ARDS, but it needs a very fine balance to outweigh immunosuppressive effects.
Aim: To review the updated literature to find out the biochemical and hematological changes that occur in the SARS CoV-2 (COVID-19) infection that is causing the ongoing global pandemic. Background: The outbreak of COVID-19 infection began in December 2019 in Wuhan, Hubei province, and within a few months, by March 2019, it had taken the shape of a pandemic. Six months down the road, knowledge about the pathogenesis of this infection has grown rapidly. Although it is predominantly a respiratory infection, COVID-19 is now known to affect almost every organ of the body. The unpredictable clinical course has been attributed to multiple biochemical and hematological changes that are caused by the COVID-19 virus. Review results: An in-depth analysis of recently published data has highlighted that various biochemical and hematological alterations can be attributed to COVID-19 infection. These include hypoalbuminemia, reduced number of lymphocytes, elevated levels of aspartate transaminase (AST), homocysteine, and biomarkers such as ferritin. Other parameters such as lactate dehydrogenase (LDH), C-reactive protein (CRP), IL-6, Procalcitonin (PCT), D-Dimer, neutrophil–lymphocyte ratio (NLR), and angiotensin II correlate with the extent of viral load and predicted the course of the disease. Conclusion: Knowledge about the alteration biochemical and hematological markers in the COVID-19 infection is helpful in the estimation of the extent of viral load and in the prediction of the clinical course of the infection. Clinical significance: Monitoring the biochemical and hematological biomarkers, especially, CRP, ferritin, LDH, D-Dimer, and NLR, is useful for triaging patients infected with COVID-19 early in the course of disease and thus may prevent disease progression by the institution of early interventions.
Coronavirus disease 2019 abbreviated as COVID-19 has emerged out to be the greatest public health problem in the world. Coronavirus disease 2019 is caused by a novel virus belonging to the coronavirus family, which causes respiratory disease. Coronavirus disease 2019 is a highly contagious disease with person-to-person transmission, and now affecting the whole world through community transmission. The disease has spread throughout the world with varied mortality rates in different countries. The disease has higher mortality rates among people with extremes of age and the presence of comorbidities. The present review attempts to provide a snapshot of the various immunological responses against this disease sometimes with disastrous consequences such as the cytokine storm.
Coronavirus disease 2019 (COVID-19) is a fast-moving pandemic affecting almost the whole of the world. The disease is rapidly rising with a sharply increasing curve. Since this is a novel virus and its properties are not well understood, investigating the pathophysiology, diagnostic values, and immune response of the body is the need of the hour today. The clinical practice needs to be put in the right direction while following the right laboratory and management strategies. Analysis by molecular diagnostic tests and immunodiagnostic tests are complementary to each other in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The role of antibody estimation in COVID-19 infection needs to be explored so that it can be used in understanding the seroprevalence, surveillance, and containment policies. Its utility in ascertaining the asymptomatic patients and susceptible individuals cannot be denied. It is yet to be confirmed that antibody response confers immunity to SARS-CoV-2. The methodology of estimation of antibodies is also an important aspect as sensitivity and specificity play an important role.
Omkar K Choudhari,
Umesh C Ojha
The pandemic of SARS-CoV-2 has affected millions of lives worldwide. Many studies have described the cytokine storm and the subsequent shock behind acute respiratory distress syndrome. Melatonin, a hormone secreted by the pineal gland has excellent anti-inflammatory and immunomodulatory functions. Its role as an adjuvant in the treatment of COVID-19 has been described by many review studies. Serotonin is the intermediate product of melatonin and deficiency of intermediate enzymes causes serotonin surge increasing capillary permeability and shock.
The novel coronavirus with its ubiquitous impact has left no sphere untouched be it be environmental, social, economic, political, or personal. With the healthcare system being worst hit, medical fraternities worldwide have joined hands to prevent its further spread and get ahead of the disease. Whether it was providing emergency care or undertaking colossal research into this unusual disease, our doctors have proved their mettle in these testing times. Obstetrics and Gynecology is one specialty that caters to providing such essential emergency services. With the declaration of the pandemic by March 2020, our facility was converted into the largest dedicated public COVID centre in Delhi and since then massive efforts have been undertaken to streamline the services to our patients both clinically and logistically. This heralded new principles and guidelines for patient management following the strict norms of physical and social distancing. Though the basic essence of care-providing was not compromised yet this transition was not smooth for both the patients and the doctors. Whereas on one hand, we were drained both physically and mentally, our patients also continued to suffer from the effects of isolation and also the disease per se. However, with rigorous training modules, evolving treatment practices, and numerous counseling sessions we gained pace with our modem apprentice. One can only hope that in times to come, we succeed in surpassing this pandemic and go back to our original routine while having learned the lessons this pandemic taught us.
SARS CoV-2 belongs to the broad family group of viruses—coronaviridae, which is responsible for the COVID-19 pandemic. This virus is extremely infectious; hence, different countries are following various measures to slow down its spread. Treatment strategies mainly revolve around symptomatic measures with few antivirals shown to have some promising results. The mainstay to cope with this pandemic remains via limiting the transmission rates.
Social distancing (SD) has been promoted by countries around the world as an effective way to stop the transmission chain. Recently, the word physical distancing is promoted in place of SD, as people are encouraged to connect with each other on a social platform. The term SD although introduced in 21st century, its implication dates back to 5th century BC. The Book of Leviticus in Bible contains the earliest reference for social distancing.