nafiseh alizadeh

Despite the increasing vaccination coverage, COVID-19 is still a concern. With the limited health care capacity, early risk stratification is crucial to identify patients who should be prioritized for optimal man- agement. The present study investigates whether on-admission lactate dehydrogenase to albumin ratio (LAR) can be used to predict COVID-19 outcomes.

This retrospective cross-sectional study evaluated hos- pitalized COVID-19 patients in an academic referral center in Iran from May 2020 to October 2020. The area under the receiver operating characteristic (ROC) curve (AUC) was used to evaluate the value of LAR in the pre- diction of mortality. The Yuden index was used to find the optimal cut-off of LAR to distinguish severity. Patients were classified into three groups (LAR tertiles), first: LAR<101.46, second: 101.46 ≤ LAR< 148.78, and third group: LAR ≥ 148.78. Logistic regression analysis was used to identify the association between tertiles of LAR, as well as the relationship between each one-unit increase in LAR with mortality and ICU admission in three models, based on potential confounding variables.

A total of 477 patients were included. Among all patients, 100 patients (21%) died, and 121 patients (25.4%) were admitted to intensive care unit (ICU). In the third group, the risk of mortality and ICU admission increased 7.78 times (OR=7.78, CI: 3.95-15.26; p <0.0001) and 4.49 times (OR=4.49, CI: 2.01-9.04; p <0.0001), respectively, compared to the first group. The AUC of LAR for prediction of mortality was 0.768 (95% CI 0.69- 0.81). LAR ≥ 136, with the sensitivity and specificity of 72% (95%CI: 62.1-80.5) and 70% (95%CI: 64.9-74.4), respectively, was the optimal cut-off value for predicting mortality.

High LAR was associated with higher odds of COVID-19 mortality, ICU admission, and length of hospitalization. On-admission LAR levels might help health care workers identify critical patients early on.

Based upon WHO (World Health Organization) Coronavirus Dashboard more than 5 million deaths worldwide have been attributed to the COVID-19 (Coronavirus Disease 2019) caused by the SARS-Cov-2 virus (Severe Acute Respiratory Syndrome Coronavirus) till November 2021. The annual flu vaccination has raised many questions about the vaccine's effects on Covid-19 outcomes. Several possible mechanisms including cross-reactivity and cross-protection have been reported to be responsible for the potential protective effect of the flu vaccine on the COVID-19 infection. This study was performed to evaluate the possible effect of the influenza vaccine on the disease severity, the mortality rate, and the length of hospitalization in COVID-19 patients. 

The data of 1300 patients were recorded from May 2020 to October 2020. Patients with a previous history of COVID-19, patients under 18 years old, and patients who did not have accurate information about their influenza vaccination history were excluded. 498 hospitalized unvaccinated COVID-19 patients with typical clinical manifestations and a positive PCR (Polymerase Chain Reaction) test for COVID-19 were included in this observational, cross-sectional study. The participants were divided into two groups (vaccinated and unvaccinated) based on the history of influenza vaccination at the time of admission.

The length of hospital stay was lower in the vaccinated compared to the unvaccinated group (p < 0.05). However, there was no significant difference between the mortality rate, the need for ICU (Intensive Care Unit) admission, and the severity of the disease between the two groups (p> 0.05).

Since the patients studied in this article did not receive any of the Covid-19 vaccines; Therefore, the effect of influenza vaccination on the clinical course of Covid-19 can be evaluated using the results of this study. A longer length of hospital stay was observed in the unvaccinated patients in our study, which may suggest the possible protective effect of the influenza vaccine against COVID-19.

Aluminum phosphide (AlP) has remained a chemical cause of completed suicides in some developing countries. ALP toxicity can cause multi-system damage. As far as we know, this is the first case of ALP-induced Thrombotic Thrombocytopenic Purpura (TTP) and its successful management. A 34-year-old man, who had attempted suicide with ALP was admitted to our hospital. On the 3rd day of admission, the patient developed hematuria, hemolysis, and thrombocytopenia. Based upon available evidence, TTP was diagnosed. Following a complete patient evaluation, ALP was recognized as the probable cause of TTP. Following the treatment using prednisolone and therapeutic plasma exchange, the patient substantially improved. Finally, he was discharged on the 22nd day. Toxin-induced intravascular hemolysis should be considered for patients presenting with ALP toxicity. As reported in this patient, TTP is another manageable consequence of ALP poisoning.

Intracerebral hemorrhage (ICH) is one of the most debilitating kinds of stroke. Recent evidence shows that the proper initiation of neuroprotective agents might save at risk neurons and improve the outcome.

The focus of this study is to evaluate the neuroprotective effect of melatonin on patients with hemorrhagic stroke.

Forty adult patients with confirmed nontraumatic ICH, who were admitted to the ICU within 24 hours of the stroke onset were enrolled in this study. Subjects in the melatonin group received 30 mg of melatonin every night for 5 consecutive nights. In order to evaluate the intensity of the neuronal injury, S100B was assessed once on day 1 and, day 5 post ICU admission. Additionally, the length of ICU stay, mortality, and the duration of mechanical ventilation were also recorded.

Forty patients completed the study. In both groups the plasma concentrations of S100B decreased after 5 days compared with their baseline values. However, this reduction was more significant in the melatonin compared to the control group (P-value < 0.05). The duration of mechanical ventilation and length of ICU stay was shorter in the melatonin group, and this difference was statistically significant for the length of ICU stay (P-value < 0.05), and marginally significant for the duration of mechanical ventilation (P-value = 0.065). The in-ICU mortality rate of the melatonin group was 15%, almost half of that of the control group (30%). However, this difference was not statistically significant.

In conclusion, melatonin can be considered as a harmless and effective nueroprotective agent with some unique features which has made it an appropriate adjunctive medicine for critically ill intubated patients.

There is few data regarding the correlation between serum Vitamin D level and unfavorable intensive care unit (ICU) outcome in postsurgical patients. In this study, correlation between serum 25(OH)D level and length of ICU stay and in‑hospital mortality has been evaluated in critically ill surgical patients.

Serum 25(OH)D has been evaluated in 70 surgical, critically ill patients. Demographic, laboratory, and clinical data of the patients were collected. Correlation between serum 25(OH) D level and duration of ICU stay and hospital mortality was evaluated using two‑factor analysis of covariance. Multivariable Cox‑regression analysis was used for adjusting the effect of season of blood sampling and type of surgery on the main variables. For all the analyses, P values less than or equal to 0.05 were considered as statistically significant.

Serum 25(OH)D deficiency was identified in 52 (74.3%) of the patients. Patients with serum Vitamin D levels < 30 ng/ml had longer length of ICU stay than those with serum Vitamin D levels ≥ 30 ng/ml (7.8 ± 5.1 vs. 4.05 ± 2.12 days, P = 0.003). Although hospital mortality was more common in Vitamin D deficient patients than sufficient ones (25% in deficient group versus 22.2% in sufficient group), there was no significant difference regarding hospital mortality rate between the groups.

Statistically significant association was found between low 25(OH)D level and increased length of ICU stay in critically ill surgical patients. It could be explained by favorable effects of Vitamin D on immune system functions, reducing tissue dysfunction, and risk of organ failure and overall complications. However, there was no correlation between serum Vitamin D level and patients’ in‑hospital mortality. Further, well‑designed prospective clinical studies with adequate sample size are needed to evaluate correlation between serum Vitamin D level and mortality in critically ill patients.