Journal of Ideas in Health
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Pancytopenia in pregnant patients with COVID-19 infection and vitamin B12 deficiency: a case report study
Get PDFBackground: Folate and vitamin B 12 deficiency can lead to pancytopenia in pregnancy. Some cases of pancytopenia due to COVID-19 infection have also been reported. The two cases that we present are related to the coincidence of pregnancy and deficiency of folic acid and vitamin B12 with COVID-19 infection.
Case presentation: A 26-year- woman G3P1L1A1 and 21-year-woman G2P1L1 presented with pancytopenia and mild COVID-19 infection. The antenatal period was uneventful, and both cases also had folate and vitamin B12 deficiency. They received blood products, folic acid, and vitamin B12 supplementation. COVID- 19 infection was managed well with analgesic and vital monitoring. Postpartum hemorrhage occurred in the second case, which was well managed with uterotonics. All laboratory parameters came out to be normal after three months of supplementation of folic acid and vitamin B12.
Conclusion: Pancytopenia in pregnancy due to folate and vitamin B12 deficiency and COVID- 19 infection can be easily managed with timely intensive targeted therapy, but we should be extra vigilant while handling such complicated cases, keeping in mind all possible differential diagnoses for pancytopenia
Laboratory manifestations of COVID-19 associated with hemostatic abnormalities
Get PDFHemostatic abnormalities had been reported in COVID-19 patients, which may include disseminated intravascular coagulation (DIC), hypercoagulability, and alterations in platelets parameters. Articles that investigate the alterations of hemostatic abnormalities during the COVID-19 disease (2020-2021) and their predictive value of disease outcome have been thoroughly reviewed. Among the reviewed articles, thrombocytopenia is observed in 5.0-41.7% of COVID-19 patients, which is related to disease severity. Moreover, other platelets parameters, including Platelets/lymphocytes ratio (PLR), Mean platelets volume (MPV), and aggregation, may also be affected. On the other hand, findings of coagulation tests such as D dimer; fibrinogen, Antithrombin (AT), and Fibrin degradation products (FDP) are significantly elevated in COVID-19 patients, while in a single study, most of the patients had positive Lupus anticoagulants (LA) and normal protein C (PC). In the same perspective, these alterations showed significant correlations with disease severity. Overall, hemostatic laboratory markers are significant predictors of COVID-19 disease outcome as indicated by the increased risk of venous and arterial thrombotic events, especially in ICU patients.
 
Nutraceutical management of male infertility-towards new generation therapeutics
Get PDFInfertility is one of the most significant public health-related concerns globally. Both male and female factors can cause it. Male factors include poor sperm quality, idiopathic oligospermia, asthenozoospermia, and isolated asthenozoospermia. Many substances, collectively known as nutraceuticals, have been studied for their capacity to enhance hormonal state and sperm parameters through different mechanisms. Nutraceuticals are components in dietary supplements prescribed to prevent or treat a wide range of diseases. This article aims to highlight certain nutrients that can help improve male fertility based on recent advancements in the management of male infertility
Evaluation of chest computed tomography features in COVID-19: a single-center retrospective study
Get PDFBackground: Even though Real-Time Polymerase Chain Reaction (RT-PCR) is a gold standard for confirming COVID-19, it continues to be plagued by a lack of RT-PCR kits and the potential of false-negative results. Hence, during the second wave of COVID-19 in India, Computed Tomography (CT) scan is an emerging diagnostic tool in evaluating the severity of illness in COVID-19 pneumonia. The present study endeavored to assess chest CT features of COVID-19 pneumonia in Indian population.
Methods: This was a single-center, retrospective, observational study conducted in 300 consecutive adults RT-PCR confirmed COVID-19 patients from 1, Jan 2021 to 31, March 2021 at a private radio diagnostic center. Data regarding baseline demographics, clinical and laboratory characteristics, extent, pattern, and type of abnormal CT findings were noted.
Results: The study population (204 males and 108 females) had mean age of 43.18 ± 8.27 years. Our study\u27s most common clinical presentation was cough (48.1%) and fever (47.1%), respectively. Lung parenchymal abnormalities were found in 294 (94.2%) patients. Abnormal CT findings revealed the involvement of bilateral (45.6%) and multilobar (42.9%) with a predominant peripheral (92.3%) and posterior (80.8%) distribution. According to the type of opacity, Ground Glass Opacity (GGO) was the dominant abnormality found in 270 (91.8%) patients, in which pure GGO (36.7%), GGO with crazy paving pattern (39.8%), and GGO mixed with consolidation (52.0 %) were noted. Peri-lesional or intralesional segmental or subsegmental pulmonary vessel enlargement was found in 192 (65.3 %) patients.
Conclusion: During the second wave of COVID-19, a chest CT scan is a modality of choice in diagnosing COVID-19 pneumonia and related lung parenchymal changes
Sex differences on the contextual factors and physical activity levels among the Nigerian people during the COVID-19
Get PDFBackground: In the context of flattening the curve of the spread of coronavirus in Nigeria, some factors were considered. This study aimed to investigate the relationship between some of the considered factors and physical activity and investigate sex differences on physical activity during the coronavirus pandemic in Nigeria.
Methods: The study was cross-sectional using an online survey and recruited participants from Nigeria\u27s southwest geopolitical zone through the snowball sampling technique. Descriptive statistics (such as percentages), correlation analyses, and t-test of independent measures were used to analyze the data collected. The data collection was conducted from April to June 2020.
Results: The participants\u27 age ranges from 18 to 73years, with a mean age of 42.9 years, a median of 43years, and a standard deviation of 5.41. The result showed a significant difference between males and females (x ̅= 1001.21; SD=1371.83) on moderate physical activity during the pandemic in Nigeria. However, there was no significant relationship between contextual factors; perception of the spread [r (467) =0.028; P>0.05], fear of contracting COVID-19 [r (467) =0.041; P>0.05], stay at home measures [r (467) =-0.030; P>0.05], sensitizing others about COVID-19 [r (467) =-0.044; P>0.05], compliance with safety rules and regulations [r (467) =0.052; P>0.05] and overall physical activity.
Conclusion: The study concluded that the relationship between contextual variables and physical activity among Nigerian people during the COVID-19 pandemic is not significant. Secondly, males and females are not different on vigorous and walking physical activity levels
Knowledge, attitude, and practice regarding COVID-19 pandemic among medical students of Ernakulam, India
Get PDFBackground: COVID – 19 infection is a serious pandemic the world is now facing. This study aimed to assess the knowledge, attitude, and practice regarding COVID-19 infection among medical students at a private medical college in central Kerala.
Methods: A cross-sectional web-based study was conducted during April-May 2020 in a private medical college in Ernakulam District using the Universal sampling technique. The study tool was a semi-structured validated questionnaire containing sociodemographic details and questions on knowledge, attitude, and practice (KAP) regarding COVID-19 infection. Data were analyzed using SPSS version 20 software.
Results: A total of 288 students were included in the study, with a mean age of 21±1.4. The male-to-female ratio was 2.75:1. Medical students showed adequate knowledge (81.6%), attitude (91.3%), and practice (84.7%) towards the COVID-19 pandemic, respectively. The main symptoms of COVID-19 infection were known to at least 83% of the participants. The majority (85.4%) were aware that there is no specific treatment for COVID-19 infection and 90% were aware of the main modes of the disease transmission. The majority (99%) of the medical students believed that COVID-19 infection could be prevented through social distancing, wearing masks, and the practice of self-hygiene. About 75.6% believed that government measures for prevention are adequate. Steam inhalation, saline gargling, and consumption of vitamin C-rich foodstuffs were the main specific measures adopted. Older age and female gender were found to be associated with better knowledge.
Conclusion: Adequate KAP levels among medical students in this study are attributable to the current lockdown and the strict government measures to contain the infection
Renin-angiotensin-aldosterone system inhibitors – a realm of confusion in COVID-19
Get PDFCurrently, there is a persisting dispute regarding the renin-angiotensin-aldosterone-system (RAAS) inhibitors\u27 safety of use in COVID-19 pandemics. On one side, RAAS inhibitors appear to determine an overexpression of ACE2, the receptor of SARS-CoV-2. Therefore, they could increase the risk of SARS-CoV-2 infection and its degree of severity. On the other side, the discontinuation of RAAS leads to cardiovascular decompensation and has been discouraged by the major medical societies. Also, large-cohort studies report beneficial or at least neutral effects for the RAAS inhibitors in COVID-19 patients. Worldwide, millions of patients receive RAAS inhibitors for the treatment of hypertension and other important comorbidities. In this context, knowledge of the exact effect of these medications becomes of crucial significance. This paper aims to fill in a gap in the current knowledge and presents a putative mechanism by which RAAS inhibitor administration\u27s beneficial results can be explained better. RAAS inhibitors can be beneficial, as they counteract the excessive detrimental activation of the classical angiotensin-converting enzyme (ACE) axis, decreasing the angiotensin II levels. The angiotensin receptor blockers (ARBs) increase the angiotensin II levels, while the angiotensin-converting enzyme inhibitors (ACEI) increase the angiotensin I levels; these substrates will compete with the SARS-CoV-2 for the ACE2 binding, decreasing the viral infectivity. In addition, following the RAAS inhibitors treatment, the up-regulated ACE2 will cleave these substrates (angiotensin I and II), particularly to angiotensin 1-7 that possesses vasodilator, protective effects
On revisiting vital signs IoT sensors for COVID-19 and long COVID-19 monitoring: a condensed updated review and future directions
Get PDFBackground: Although the world has been facing the COVID-19 pandemic for over a year, we understand that there are still some challenges in using Internet of Things (IoT) devices as allies in this fight. Among the main difficulties, we can mention the selection of appropriate devices and the correct measurement and subsequent analysis of previously obtained vital signs.
Methods: In this context, we present a condensed compilation of IoT devices to monitor the vital signs often used to monitor COVID-19. We focus on easy-to-use devices currently available on the market to the general user. Also, the presented analysis is helpful for long COVID-19 monitoring, which is particularly useful to governments and hospitals to analyze eventual sequels on those citizens who tested positive beforehand.
Results: The review resulted in 148 heterogeneous devices offering different capabilities. Our first contribution resides in detailing several aspects of each IoT device, indicating which are the most suitable for particular use-case situations. Moreover, our article introduces some challenges and insights into assembling a smart city composed of IoT devices.
Conclusion: Here, technological trends such as Serverless computing, homomorphic cryptography, Federated Learning, Elixir programming language, Web Assembly, and vertical elasticity are discussed towards enabling vital sign-driven data capturing and processing. Although there are several IoT devices for health monitoring, there is still work to standardize data formats and APIs for data extraction
Predictive accuracy of blood inflammatory markers on COVID-19 mortality
Get PDFBackground: The impact of COVID-19 may be more severe in developing countries. Our study aims to analyze the accuracy of several inflammatory biomarkers in predicting COVID-19 mortality, providing information about the most suitable markers for developing countries.
Methods: A retrospective cohort study was conducted at Dr. Soetomo General Hospital, Indonesia, from March to June 2020. White Blood Cells (WBC) count, Neutrophil-Lymphocyte Ratio (NLR), Procalcitonin (PCT), D-Dimer, and C-Reactive Protein (CRP) have been collected from the electronic medical records. We performed survival analysis to provide the hazard ratio and Receiver Operating Characteristic (ROC) curve analysis to test for accuracy for each parameter.
Results: A total of 423 patients who met the criteria for participating had a median age of 54 (IQR 45-61) years. Patients in the death group are characterized by older age and shorter length of hospitalization. The WBC, NLR, PCT, D-Dimer, and CRP are found significantly higher in the death group (P=0.000). The WBC, NLR, PCT, D-Dimer, and CRP have an Area Under the Curve (AUC) of 0.709, 0.773, 0.738, 0.721, and 0.769, respectively moderate accuracy in predicting COVID-19 patient mortality. We found that NLR is significantly more accurate than the age parameter (Z=3.527; P=0.000) but has equal accuracy with other laboratory parameters.
Conclusions: Since NLR obtained the highest accuracy, we still recommend routine complete blood count tests as prognostic biomarkers with the highest feasibility to be performed in developing countries
Patient satisfaction in outpatient medical care: the case of Iraq
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Background: Healthcare providers are increasingly interested in patient satisfaction as an indicator to assess the quality of health services. This study investigates the level of satisfaction among Iraqi patients attending the outpatient (OP) clinic.
Methods: This was a cross-sectional study conducted from October to December 2019 among outpatient attendees in two busiest centers in Iraq. A convenience sample of 235 (response rate of 88.0%) completed the self-administered short-form patient satisfaction questionnaire (PSQ-18). The independent variables included socio-demographic, economic, and self-perceived health status. Data were analyzed in SPSS, where descriptive analysis (mean ± standard deviation) and univariate (independent sample t-test, ANOVA test) and multivariate linear regression “Enter technique” was done at 0.05 level of significance and 95% confidence interval.
Results: The mean age of respondents was 39.3 (±14.8). The sample was mostly women (55.3%), and 37.4% in the age group of 30-49 years. More than half of participants residing in the urban regions (54.5%) from families of monthly household income less than 500,000 Iraq Dinars (USD 400). However, the majority (70.6%) have the first visit to the OP clinic, and 53.6% self-perceived health as good or very good. Results of multiple linear regression showed that patients residents in rural regions (B= 5.4 , P <0.001), married (B= 4.8, P <0.001), unemployed (B= 4.7, P <0.001) and low educated (B= 1.5, P <0.051) exhibited higher service satisfaction score compared to urban residents, single, employed and high educated participants respectively. However, patients aged fifty years and more (B= -2.1, P <0.001) and those with poor health (B=-2.5, P <0.001) exhibited lower service satisfaction scores compared to young age patients and the healthy participants, respectively.
Conclusion: The high demand for the use of health resources in metropolitan cities by the rural population indicates inequality in the distribution of health services and an increase in the rural-to-urban displacement