Dr. Santhosh

Severe Acute Respiratory Syndrome Coronavirus -2 (SARS-CoV-2), primarily acts on lungs. Most of these patients present with typical respiratory symptoms and signs. SARS-CoV-2, mainly detected by nasopharyngeal/oropharyngeal swab(s) of suspected subjects. The present study aimed at evaluating and discussing the alterations in biochemical and hematological parameters in COVID-19 patients in a tertiary care hospital. This observational study was conducted in a Tertiary care hospital, Coastal Karnataka, India. In this study, 124 COVID-19 patients were involved. Co-morbidities, such as hypertension was observed in 98 (79%), diabetes in 91 (73.3%), cardiovascular disease in 20 (16.1%), chronic kidney disease in 4 (3.2%) and liver disease in 2 (1.6%) cases. Hypertension and diabetes were more common. Symptoms such as fever was found in 109 cases (87.9%), dry cough in 102 (82.2%), fatigue in 89 (71.7%), chest tightness in 79 (63.7%), myalgia in 67 (54%) and mild shortness of breath in 46 (37%) cases. In this study, hemoglobin (9.4±1.7 %) and platelets (240.1±89.7) were decreased and erythrocyte sedimentation rate (ESR) (50.7±15.7) significantly increased in severe cases. Mean values of random blood sugar (RBS) was 245.6 ± 126.9 mg/dl, HbA1c 7.9±2.8%, serum urea 82.8±25.2 mg/dl, Creatinine 3.2±1.5 mg/dl, Uric acid 6.8±1.5 mg/dl), Total Bilirubin 1.2±0.6 mg/dl, Alkaline Phosphatase 135.4±38.9 IU/L, C-Reactive protein (CRP) 84.8±7.7 mg/L, lactate dehydrogenase (LDH) 644.6±175.1 U/L, Ferritin 828.3±195.4 µg/L, D-Dimer [2680.9 (1899.0-5475.7 ng/ml)] were elevated in severe cases than mild group. In contrast, serum total proteins (6.3±0.7g%) and globulin (2.8±0.5 g%) levels were significantly decreased in severe cases than mild/moderate cases. Study may conclude that presence of co-morbidities, abnormalities in biochemical and hematological parameters, should be regularly monitored, especially in severe / critical COVID-19 patients.

Background: COVID-19 is a rapidly spreading communicable disease worldwide. It varies widely in its spectrum of manifestations, from being mild self-limiting disease, to fulminant disease, often leading to complications and death. Diabetes is an important co-morbidity linked to severity of infection by SARSCoV- 2, which predisposes them to severe pneumonia. Poor glycaemic control is associated with worse outcomes. The disease burden of COVID-19 is continuously increasing, and with a high prevalence of diabetes, it is all the more important to understand the vital aspects of COVID-19 infection in diabetic population. Hence, we try to provide close insights into its pathophysiology, clinical characteristics, recommendations on management and prevention and possible avenues for improving disease outcomes. Methods: PubMed database and Google Scholar were searched using the key terms ‘COVID-19’, ‘SARS CoV- 2’, ‘Corona’ and ‘diabetes’. Full texts of the retrieved articles were accessed and referred. Three main mechanisms which influence COVID-19 disease manifestation in diabetics include: (a) Entry of virus via ACE-2 receptors (b) Action through Dipeptidyl-peptidase-4, and (c) Elevation of glucose concentration in airways by elevated blood glucose.ACE-2 is expressed in alveolar epithelial cells, heart, renal-tubular and intestinal epithelia and pancreas. S-Glycoprotein on the surface of SARS-CoV-2 binds to this ACE-2 and undergoes a conformational change. This allows its’ proteolytic digestion by host cell proteases TMPRSS2 and Furin, leading to internalization of virus. Viral entry into cells triggers an inflammatory response by T-helper-cells and at times, a ‘cytokine storm’, resulting in organ damage. Apart from diminishing neutrophil chemotaxis and reducing phagocytosis, by which diabetes predisposes individuals to infections, there are several specific factors with respect to SARS-CoV2: (i) Increased ACE-2 expression (ii) Raised Furin (iii) Diminished T-cell functioning, and (iv) Increased IL-6 levels. Movement restrictions, increased stress due to social isolation and lack of physical activity further complicates the issue. It is therefore, much essential to raise awareness among front-line workers. Finally, the current situation emphasizes the need for more clinical investigation and define best practices for optimum outcomes. Bangladesh Journal of Medical Science Vol. 21(1) 2022 Page : 19-23

Introduction: Being a mirror image of metabolic syndrome, Gestational Diabetes Mellitus (GDM) is associated with significant maternal and fetal morbidity. Increased blood lactate concentration and alterations of substrate utilization are partly involved in development of insulin resistance in GDM. Fetuses born to such mothers have shown low umbilical vein oxygen saturation and low oxygen content and increased lactate concentrations. These changes may certainly reflect enhanced fetal metabolism as a result of hyperglycaemia and hyperinsulinemia and therefore, these fetuses deserve intense surveillance at term and during delivery. Ideally, HbA1c should be maintained below 5% during their first trimesters and below 6% during third trimester. We planned to investigate GDM women for their HbA1c levels too. Aim: To know if there is any alteration in blood lactate and/or HbA1c levels and to know if there is any correlation between these two parameters in GDM pregnancies, in comparison with the previous studies which measured lactate in cord blood and placental vessels of GDM women. Materials and Methods: It was a hospital based prospective study on 40 women with gestational diabetes and 40 agematched normal pregnant women. We analysed the biochemical and metabolic mileau in these women by estimating venous blood lactate and HbA1c levels. We paid special attention to follow them up regarding maternal complications if any and perinatal outcomes. The independent samples t-test and Pearson’s correlation test were applied. Results GDM mothers showed significantly higher lactate and HbA1c levels than normal pregnant women, both with p<0.001. Blood pressure and fetal birth weight were also significantly higher in GDM group than Normal Pregnant (NP) group, both with p-values of <0.001. Further, this increased lactate levels showed significant positive correlation with HbA1c, blood pressure and fetal birth weight. Conclusion Maternal blood lactate and HbA1c levels have a significant role to play in determining the metabolic mileau of both mother and fetus and thus, their obstetric and general health outcomes.