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   Table of Contents - Current issue
Coverpage
August 2022
Volume 11 | Issue 4
Page Nos. 120-167

Online since Tuesday, September 6, 2022

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REVIEW ARTICLES  

Effect of magnesium on severity and mortality of COVID–19 patients: A systematic review p. 120
Razieh Avan, Afrooz Mazidimoradi, Hamid Salehiniya
DOI:10.4103/2221-6189.355308  
Unbalanced magnesium levels in the body, like other minerals, are a factor that is important in the severity and mortality of COVID-19. This study was designed to investigate the relationship between serum magnesium levels and clinical outcomes in COVID-19 patients. In this systematic review, a comprehensive search was performed in PubMed, Scopus, and Web of Science databases until September 2021 by using the keywords COVID-19, severe acute respiratory syndrome coronavirus 2, coronavirus disease, SARS- COV-infection 2, SARS-COV-2, COVID 19, and magnesium. End-Note X7 software was used to manage the studies. Articles that evaluated effect of magnesium on COVID-19 were included in the analysis. After reviewing several articles,12 studies were finally included in the ultimate analysis. The studies show that hypomagnesemia and hypermagnesemia are both factors that increase mortality in patients with COVID-19, even in one study, hypomagnesemia is the cause of doubling thedeaths in COVID-19 patients. Some studies have also found a negative correlation between magnesium deficiency and infectionseverity, while some others have reported no correlation between magnesium level and disease severity. According to the important role of magnesium in the body and its involvement in many physiological reactions, as well as differences in physical and physiological conditions of COVID-19 patients, in addition to the need for studies with larger sample sizes, monitoring and maintaining normal serum magnesium levels during the disease seems necessary as a therapeutic target, especially in patients admitted to the intensive care unit.
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Challenges of COVID–19 prevention and control: A narrative review p. 127
Abdel-Hady El-Gilany, Eman Sameh, Hala S Abou-ElWafa
DOI:10.4103/2221-6189.355309  
This narrative review aims to highlight some of the factors contributing to challenges faced by many countries in controlling the spread of COVID-19 pandemic that continues to rage around the world, especially after stoppage of official prevention and control activities. A literature search was conducted on PubMed, and Google using search terms “COVID-19”, “challenges”, “prevention”, and “control” in different combinations. COVID-19 prevention and control challenges are related to health-system, vaccines, administration, and society culture. Controlling the spread of COVID-19 necessitates cooperation between community leaders, healthcare professionals, religious leaders, and the public.
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ORIGINAL ARTICLES Top

Effect of oral premedication of midazolam, ketamine, and dexmedetomidine on pediatric sedation and ease of parental separation in anesthesia induction for elective surgery: A randomized clinical trial p. 133
Aref Zarei, Hesameddin Modir, Behnam Mahmoodiyeh, Alireza Kamali, Farzad Zamani-Barsari
DOI:10.4103/2221-6189.355310  
Objective: To compare effect of midazolam, dexmedetomidine, and ketamine as oral premedication on pediatric sedation and ease of parental separation anxiety in anesthesia induction. Methods: This multicenter, prospective, randomized, double-blind, clinical trial focused on a pediatric population aged 2-7 years (n=153) with the American Society of Anesthesiologists I-II who required elective surgery. The patients were stratified into three intervention groups: midazolam, ketamine, and dexmedetomidine. Hemodynamic parameters (blood pressure, heart rate, and oxygen saturation) every 5 min until induction of anesthesia along with non-hemodynamic factors, comprised of sedation score before the administration and at the time of being separated from the parents, as well as parental separation anxiety scale, acceptance of anesthesia induction, and side effects were recorded and compared. Results: No statistically significant difference in oxygen saturation, heart rate, blood pressure, duration of surgery, time to achieve an Aldrete score of 9-10, or sedation score was noted in the study groups. More patients in the dexmedetomidine and midazolam groups could better ease parental separation anxiety than the ketamine group (P=0.001). Moreover, fewer patients accept anesthesia induction (P=0.001) and more had side effects in the ketamine group (P=0.047). Conclusions: Our findings indicate that compared to the ketamine group, dexmedetomidine and midazolam are better in easing parental separation anxiety and accepting induction of anesthesia with fewer side effects. Dexmedetomidine and midazolam may be considered better choices. However, the final choice hinges on the patient's specific physical condition and the anesthesiologist's preference. Clinical registarion: This study is registered in the Iranian Registry Clinical Trial center with the clinical trial code of IRCT20211007052693N1.
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Different routine laboratory tests in assessment of COVID–19: A case–control study p. 140
Imene Adouani, Tassaadit Bendaoud, Hadjer Belaaliat, Wahiba Teniou, Faiza Keriou, Farida Djabi
DOI:10.4103/2221-6189.355311  
Objective: To identify helpful laboratory paprameters for the diagnosis and prognosis of COVID-19. Methods: An observational retrospective study was conducted to analyze the biological profile of COVID-19 patients hospitalized in the Unit of Pulmonology at Setif hospital between January and December 2021. Patients were divided into two groups: the infection group and the control group with patients admitted for other pathologies. The infected group was further divided according to the course of the disease into non-severe and severe subgroups. Clinical and laboratory parameters and outcomes of admitted patients were collected. Results: The infection group included 293 patients, of whom 237 were in the non-severe subgroup and 56 in the severe subgroup. The control group included 88 patients. The results showed higher white blood cells, neutrophils, blood glucose, urea, creatinine, transaminases, triglycerides, C-reactive protein, lactate dehydrogenase, and lower levels of lymphocyte, monocyte and platelet counts, serum sodium concentration, and albumin. According to ROC curves, urea, alanine aminotransferase, C-reactive protein, and albumin were effective diagnosis indices on admission while neutrophil, lymphocyte, monocyte, glycemia, aspartate aminotransferase, and lactate dehydrogenase were effective during follow-up. Conclusions: Some biological parameters such as neutrophil, lymphocyte, monocyte, glycemia, aspartate aminotransferase, and lactate dehydrogenase are useful for the diagnosis of COVID-19.
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Hematological indices as predictors of mortality in dengue shock syndrome: A retrospective study p. 150
LA Gauri, Ketan Bhatnagar, Parvez Sameja, Hardeva Ram Nehara, Kuldeep Saini, Ravi Dutt, Bhupen Bhatnagar, Mohit Singh Khokhar, Vikas Kumar, Anjali Garg
DOI:10.4103/2221-6189.355312  
Objective: To explore predictive hematological parameters on admission which are associated with mortality in NS1 positive dengue shock syndrome patients. Methods: Demographic characteristics, hematological parameters, and the outcome of NS1 positive dengue shock syndrome patients without any comorbidity and coexisting infections were collected from the Intensive Care Unit and the results were compared between the survivor and non-survivor groups. Results: The mean age was (30.77±11.48) years and 56 (56.6%) patients were males. Out of the total 99 patients, 72 (72.27%) patients were successfully discharged and 27 (27.27%) patients eventually succumbed to death. The most common hematological finding was thrombocytopenia (95.95%), followed by anemia (52.52%) and decreased mean platelet volume (37.37%). After controlling other variables, logistic regression analysis showed that absolute neutrophil count and mean platelet volume were associated with mortality. Conclusions: Total leucocyte count, absolute neutrophil count, and total platelet count are significantly higher, and mean platelet volume is significantly lower in the non-survivor group as compared to the survivor group. Absolute neutrophil count and mean platelet volume are predictors associated with mortality.
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Associated risk factors for post−COVID−19 mucormycosis at a tertiary care centre: A cross−sectional study p. 156
Praphull Deepankar, Govind Kumar, Jyoti Kr Dinkar, Rishav Mittal
DOI:10.4103/2221-6189.355326  
Objective: To explore risk factors of mucormycosis in COVID-19 recovered patients. Methods: A total of 101 patients, who were diagnosed with mucormycosis after recovery from COVID-19 and admitted to the Indira Gandhi Institute of Medical Sciences, Patna, a tertiary care hospital in India, were included in the study. The presenting clinical features and associated risk factors were assessed and analyzed subsequently. Results: Of 101, 68 (67.3%) were males, and 33 (32.7%) were females. A total of 89 (88.1%) patients were between 46 and 65 years old. The most common subtypes were rhino-ocular (61.4%), followed by paranasal sinuses (16.8%), rhino-ocular cerebral (16.8%), ocular (3.0%), and pulmonary (2.0%). Diabetes mellitus was present in 71% of cases of mucormycosis as co-morbidities. A total of 76.2% of patients were given systemic corticosteroids in oral or intravenous form during COVID-19 treatment. Severe COVID-19 was present in 45.5% of patients with mucormycosis, while the moderate infection was present in 35.6% of mucormycosis. Most patients had gap between the onset of mucormycosis and COVID-19 <15 d. Conclusions: A lethal confluence of uncontrolled diabetes mellitus, corticosteroid usage, and COVID-19 could cause a dramatic rise in mucormycosis. So, clinicians must be aware of these risk factors in patients suffering as well as recovering from COVID-19 to prevent mucormycosis.
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CASE REPORTS Top

Severe progression of autoimmune hepatitis in a young COVID-19 adult patient: A case report p. 161
Neeraj Kumar, Sushant Satyapriya, Shaik Mohammad Tahaseen, Kunal Singh, Abhyuday Kumar
DOI:10.4103/2221-6189.355327  
Rationale: The impact of COVID-19 in patients with autoimmune liver disease treated with immunosuppressive therapy has not been described so far. This case report describes the clinical course of a patient with autoimmune hepatitis (AIH) who developed COVID-19 and the features of cytokine syndrome leading to its deterioration in our intensive care unit. Patient’s Concern: A 28-year-old male presented with generalized anasarca for two weeks and chronic liver disease for 8 months. Diagnosis: AIH and Covid-19 with features of cytokine storm syndrome. Interventions: Intravenous furosemide, mannitol, syrup lactulose, steroids (prednisolone 40 mg), azathioprine 1 mg/kg body weight, rifaximin, vitamin K, and blood products. Outcomes: The patient had hepatic encephalopathy and AIH and died on the 10th day after admission despite ventilatory support, sustained low-efficiency hemodialysis, and resuscition. Lessons: The dramatic release of cytokines and the inflammatory-immune responses not only alter the pathophysiology but also affects the onset and severity of disease progression in patients with AIH.
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Delayed post−hypoxic leukoencephalopathy following barbiturate overdose: A case report p. 165
Arshi Syal, Samiksha Gupta, Monica Gupta, Gautam Jesrani, Yajur Arya
DOI:10.4103/2221-6189.355328  
Rationale: Delayed post-hypoxic leukoencephalopathy (DPHL) is usually an overlooked condition, which arises as a result of a multitude of reversible and irreversible conditions. Patient’s Concern: A 50-year-old female with a history of epilepsy, who developed DPHL 12 days after respiratory failure secondary to barbiturate toxicity. Diagnosis: DPHL on magnetic resonance imaging of the brain. Interventions: Mechanical ventilation was initiated for respiratory failure and hemodialysis for barbiturate toxicity. Outcomes: The patient developed akinetic mutism due to infirmity and had a residual disability, which led to permanent dependency. Lessons: The diagnosis of DPHL is often delayed or missed, given the rarity of this condition and its inconsistent clinical symptomatology. Diagnostic delay can be avoided by early recognition of the classical “delayed onset” symptoms.
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