SARS-Coronavirus Disease-19 and Comorbidities: A Systematic Review

Introduction: Coronavirus-19 (COVID-19) pandemic is evolving rapidly worldwide. It has led to a worldwide research to identify the people who are at more risk for developing the infection, increasing severity and mortality. Aim: The aim of this systematic review was to evaluate the risk of some of the common and major comorbidities on the outcome of the disease. Materials and Methods: A literature search was conducted using EMBASE, PUBMED, Web of science, SCOPUS and Cochrane database. Medical Subject Headings (MeSH) used were “COVID-19” or “SARS CoV 2” or “Coronavirus disease 19” and “Comorbidities” or “Risk factors”. Individual risk factors were also used as keywords such as “Diabetes”, Hypertension”, “Obesity”, “Chronic kidney disease”, “Elderly”, “Cardiovascular disease”, “Lung disorders” and “Malignancy”. Two researchers conducted the search independently. Results: After extensive search, 57 articles were shortlisted for complete review. It was found that patients with comorbidities had more severe disease than those without comorbidities. Patients with more number of comorbidities had more severe disease than patients with single comorbidity. Initial reports suggested that elderly were at more risk than the younger population. The most common comorbidity was hypertension followed by diabetes and obesity. Conclusion: A meticulous triage of patients should be carried out after acquiring proper medical history because this will help to identify patients who are at an increased risk of poor outcome of the infection. Also, they should be given more aggressive treatment upon diagnosis of infection

Sodium glucose cotransporter 2 (SGLT2) inhibitors and CKD: Are you a #flozinator?

Sodium/glucose cotransporter 2 (SGLT2) inhibitors have rapidly emerged as a novel therapy to reduce the rate of progression of chronic kidney disease (CKD). With humble beginnings in the 19th century for treating malaria, this class of drugs initially developed for the treatment of diabetes has now revolutionized the management of heart failure and CKD. SGLT2 inhibitors trigger glucosuria, thus modestly improving glycemic control. In addition, they have pleiotropic effects, such as reducing intraglomerular pressure and improving tubuloglomerular feedback, which lead to their beneficial effects on CKD progression. Recent data from randomized controlled trials have demonstrated the efficacy of this class of drugs in CKD. We briefly review the evidence from major trials on SGLT2 inhibitors in CKD, discuss the mechanisms of action and provide an overview of the safe and successful prescription of these medications

Transplant Renal Artery Stenosis with Varied Clinical Presentations

Renal vascular complications constitute a clinically significant cause of morbidity following renal transplantation. Transplant renal artery stenosis (TRAS) is a well-recognized complication accounting for ~75% of posttransplant vascular complications. Early recognition and prompt correction of TRAS can prevent adverse outcomes, including graft loss. This series is a summary of four renal transplant recipients who developed TRAS at varied time periods and with varied clinical presentations. A 23-year-old male who presented after 1½ months of renal transplantation with accelerated hypertension was diagnosed with TRAS and was treated successfully with percutaneous transluminal angioplasty with stenting. A 26-year-old male with acute allograft dysfunction after 1 month of transplantation without worsening hypertension was diagnosed with TRAS, which was treated successfully with angioplasty and stenting. A 49-year-old male who presented to the emergency with pulmonary edema secondary to accelerated hypertension (Pickering syndrome) after 2 months of transplantation was diagnosed to have TRAS, which was treated successfully with angioplasty with stenting. A 44-year-old male with an incidentally detected TRAS-like clinical picture secondary to kinking in the transplant renal artery in the immediate posttransplant period was successfully treated with re-exploration and repair. All the patients were screened with Doppler ultrasonogram and computed tomogram-angiography supported the diagnosis in three of the cases. None of the cases developed procedure-related complications including contrast-associated nephropathy. All the patients on follow-up after 6 months of the intervention are normotensive with normal renal function. A high index of suspicion is required in the early identification of TRAS, which is a reversible cause of hypertension and graft dysfunction. The risk of contrast-associated nephropathy cannot hinder or delay the diagnosis especially, in emerging transplant centers. The endovascular procedures used today for the treatment of TRAS are safe with high technical success rates

Demographic data of thyroiditis from a south Indian city

Background: Thyroiditis involves thyroid gland inflammation due to a wide variety of causes. The common varieties are subacute, silent and postpartum thyroiditis. Aims and Objectives: To retrospectively collect demographic data of thyroiditis from Bangalore over the past 5 years. Materials and Methods: Data were collected from three major nuclear medicine centers in Bangalore of the patients who came for technetium (Tc) 99m pertechnetate scan of the thyroid. The diagnosis was based on the Tc 99 scan evidence of thyroiditis in these patients and biochemical evidence of thyrotoxicosis. Results: The total number of cases recorded were 2513. The females were more commonly affected compared with males with sex distribution of 1698 females and 815 females (2:1). The mean age of females was 32.5 ± 11.3 years whereas the mean age of males was 37.2 ± 12.4 years. The highest numbers of cases were recorded in the months of June and August. Conclusions: The females developed thyroiditis frequently and at an earlier age when compared with males. This data could give us an insight into the demographic pattern of thyroiditis in our country and may help in planning future preventive strategies