Potential Predictors of Poor Prognosis among Severe COVID-19 Patients: A Single-Center Study

Background. Timely detection of the progression of the highly contagious coronavirus disease (COVID-19) is of utmost importance for management and intervention for patients in intensive care (ICU). Aim. This study aims to better understand this new infection and report the changes in the various laboratory tests identified in critically ill patients and associated with poor prognosis among COVID-19 patients admitted to the ICU. Methods. This was a retrospective study that included 160 confirmed SARS-CoV-2-positive patients. Results. Elevated serum ferritin, D-dimer, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and nonconjugated bilirubin levels were present in 139 (96%), 131 (96%), 107 (68%), 52 (34%), and 89 (70%) patients, respectively. Renal parameters were abnormal in a significant number of cases with elevated creatinine and blood urea nitrogen in 93 (62%) and 102 (68%) cases, respectively. Hematological profiles revealed lower red blood cell count, hemoglobin, eosinophils, basophils, monocytes, and lymphocytes in 90 (57%), 103 (65%), 89 (62%), 105 (73%), 35 (24%), and 119 (83%) cases, respectively. The neutrophil count was found to increase in 71.3% of the cases. There was significantly higher mortality (83%) among patients older than 60 years p=0.001 and in female patients (75%) p=0.012. Patients with lung diseases had a poor outcome compared to patients with other comorbidities p=0.002. There was a significant association between elevated D-dimer levels and increased mortality p=0.003. Elevated levels of AST, creatinine, blood urea nitrogen, and bilirubin were significantly associated with unfavorable outcomes. Conclusion. Different parameters can be used to predict disease prognosis, especially the risk of poor prognosis. Accurate diagnosis and monitoring of disease progression from the early stages will help in reducing mortality and unfavorable outcomes

Gastric antral vascular ectasia (GAVE) in a non-cirrhotic patients with diabetes: case report and possible pathophysiological mechanism

Gastric antral vascular ectasia (GAVE) syndrome is an uncommon but well-described cause of recurrent upper gastrointestinal bleeding or iron deficiency anaemia. Atiology is unknown but several associated diseases have been reported like connective tissue or autoimmune disorders or cirrhosis. Cases have been reported in systemic sclerosis, achlorhydia, atrophic gastritis and chronic renal failure. The most common cause is portal hypertension and portal hypertensive gastropathy. This is especially so after eradication of oesophageal varices by sclerotherapy or banding. Diabetic complications are characterised by microvascular diseases especially in the retina, glomerulus and vasa nervorum. It involves apoptosis and remodelling of endothelial cells. Hyperglycaemia is an essential cause of reactive oxygen species (ROS)-mediated oxidative stress in this complication. Angiopathy of gastric mucosa in diabetes mellitus has not been reported so far in the literature. We are presenting an interesting case of diabetes mellitus with gastric vascular ectasia without evidence of any other systemic illness

Clinical, radiological and therapeutic characteristics of patients with COVID-19 in Saudi Arabia

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a rapidly spreading global pandemic. The clinical characteristics of COVID-19 have been reported; however, there is limited research investigating the clinical characteristics of COVID-19 in the Middle East. This study aims to investigate the clinical, radiological and therapeutic characteristics of patients diagnosed with COVID19 in Saudi Arabia. METHODS: This study is a retrospective single-centre case series study. We extracted data for patients who were admitted to the Al-Noor Specialist Hospital with a PCR confirming SARS-COV-2 between 12th and 31st of March 2020. Descriptive statistics were used to describe patients’ characteristics. Continuous data were reported as mean ± SD. Chi-squared test/Fisher test were used as appropriate to compare proportions for categorical variables. RESULTS: A total of 150 patients were hospitalised for COVID-19 during the study period. The mean age was 46.1 years (SD: 15.3 years). The most common comorbidities were hypertension (28.8%, n = 42) and diabetes mellitus (26.0%, n = 38). Regarding the severity of the hospitalised patients, 105 patients (70.0%) were mild, 29 (19.3%) were moderate, and 16 patients (10.7%) were severe or required ICU care. CONCLUSION: This case series provides clinical, radiological and therapeutic characteristics of hospitalised patients with confirmed COVID-19 in Saudi Arabia