Objectives The coronavirus disease 2019 (COVID-19) has become a worst pandemic. The clinical characteristics vary from asymptomatic to fatal. This study aims to examine the association between body mass index (BMI) levels and the severity of COVID-19. Methods and study design A cohort study included 147 adult patients with confirmed COVID-19 were categorized into 4 groups by BMI levels on admission: <18.5 (underweight), 18.5–22.9 (normal weight), 23.0–24.9 (overweight), and ≥25.0 kg/m2 (obese). Rates of pneumonia, severe pneumonia, acute kidney injury (AKI), and ICU stay during hospitalization across BMI group was determined. Logistic regression analysis was used to determine the association between BMI and severe pneumonia. Results Of the totals, patients having a BMI <18.5, 18.5–22.9, 23.0–24.9, and ≥25.0 kg/m2 were 12.9%, 38.1%, 17.7%, and 31.3%, respectively. The rates of pneumonia and severe pneumonia tended to be higher in patients with higher BMI, whereas the rates of AKI and ICU stay were higher in patients with BMI <18.5 kg/m2 and ≥ 25 kg/m2, when compared to patients with normal BMI. After controlling for age, sex, diabetes, hypertension and dyslipidemia in the logistic regression analysis, having a BMI ≥25.0 kg/m2 was associated with higher risk of severe pneumonia (OR 4.73; 95% CI, 1.50–14.94; p = 0.003) compared to having a BMI 18.5–22.9 kg/m2. During admission, elevated hemoglobin and alanine aminotransferase levels on day 7 and 14 of illness were associated with higher BMI levels. In contrast, rising of serum creatinine levels was observed in underweight patients on days 12 and 14 of illness. Conclusions Obesity in patients with COVID-19 was associated with severe pneumonia and adverse outcomes such as AKI, transaminitis and ICU stay. Underweight patients should be closely monitored for AKI. Further studies in body composition are warranted to explore the links between adiposity and COVID-19 pathogenesis.

Objectives To study abnormality of spirometry, six-minute walk distance, and chest radiograph among patients recovered from Coronavirus Disease 2019 (COVID-19). Methods and study design A prospective cohort study was conducted in 87 COVID-19 confirmed cases who recovered and discharged from a medical school hospital in Thailand. At the follow-up visit on day 60 after onset of symptoms, patients underwent an evaluation by spirometry (FVC, FEV1, FEV1/FVC, FEF25-75, and PEF), a six-minute-walk test (6MWT), and a chest radiograph. Results There were 35 men and 52 women, with a mean age of 39.6±11.8 years and the mean body mass index (BMI) was 23.8±4.3 kg/m2. Of all, 45 cases had mild symptoms; 35 had non-severe pneumonia, and 7 had severe pneumonia. Abnormality in spirometry was observed in 15 cases (17.2%), with 8% of restrictive defect and 9.2% of obstructive defect. Among the patients with an abnormal spirometry, the majority of the cases were in the severe pneumonia group (71.4%), compared with 15.6% in the non-severe pneumonia group, and 10.2% in the mild symptom group (p = 0.001). The mean six-minute-walk distance (6MWD) in the mild symptom and non-severe pneumonia groups was 538±56.8 and 527.5±53.5 meters, respectively. Although the severe pneumonia group tended to have a shorter mean 6-min walking distance, but this was not statistically significant (p = 0.118). Twelve patients (13.8%) had abnormal chest radiographs that showed residual fibrosis. This abnormality was more common in the severe pneumonia group (85.7%) and in others (7.5%) (p<0.001). Conclusions Abnormal spirometry was noted in 17.2% of COVID-19 survivors with both restrictive and obstructive defects. Severe COVID-19 pneumonia patients had higher prevalence rates of abnormal spirometry and residual fibrosis on the chest radiographs when compared to patients in the mild symptom and non-severe pneumonia groups.

Introduction: Peri-procedural i.v. fluid administration is important for the prevention of contrast-induced acute kidney injury (CI-AKI). However, standardized fluid management protocols may not be suitable for all patients. We therefore wished to determine whether an individualized fluid administration protocol guided by measuring extracellular water (ECW) using bioimpedance analysis (BIA) would be safe and would reduce the incidence CI-AKI compared to a standardized fluid administration prescription. Methods: In this pilot, randomized, parallel-group, single-blind, controlled trial, we compared the effect of BIA-guided isotonic bicarbonate administration according to the ratio of ECW to total body water (ECW/ TBW) to our standard isotonic bicarbonate protocol in regard to the safety and efficacy of preventing CI-AKI in chronic kidney disease patients undergoing elective cardiac angiography. Our primary outcome was the incidence of CI-AKI, which was defined as a $0.3 mg/dl or 150% increase in serum creatinine concentration within 48 to 72 hours after cardiac angiography. Results: We studied 61 patients, 30 in the bioimpedance group and 31 in the control group. Age was similar (72.5 AE 7 vs. 71.4 AE 7.9 years), as were body mass index (25.5 vs. 25.8 kg/m 2) and baseline serum creatinine (1.3 AE 0.3 vs. 1.4 AE 0.4 mg/dl). The peri-procedural fluid volume administered was significantly greater in the BIA-guided hydration group (899.0 AE 252.7 ml vs. 594.4 AE 125.9 ml, P < .01). The incidence of CI-AKI was 3.3% in BIA-guided hydration group and 6.5% in the control group (relative risk ¼ 0.52, 95% confidence interval ¼ 0.05À5.40, P ¼ 1.00). Adverse events reported were comparable between groups (6.7% vs. 6.5%, P ¼ 1.00). Conclusions: The overall incidence of CI-AKI after cardiac angiography in our patients with mild-tomoderate renal insufficiency was lower than anticipated. Isotonic bicarbonate administration guided by bioimpedance measurements was safe, and probably led to a lower incidence of CI-AKI, although this not reach statistical significance.

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Essentials • We present the first reported case of left ventricular thrombus in coronavirus disease 2019 (COVID-19). • Three consecutive cases of pulmonary embolism in Thai patients with COVID-19 are also demonstrated. • d-dimer is a strong marker to predict thrombosis. • Thromboprophylaxis is essential in Asian patients hospitalized with COVID-19.

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Objective: To determine the association between AGE accumulation detected by skin-autofluorescence (SAF) and hospitalization among ESKD patients.Materials and Methods: 196 ESKD patients from two hemodialysis (HD) units in Bangkok were enrolled in this retrospective study from November 2015 to March 2016. Before HD treatment, AGEs were measured with the SAF device on the area with intact skin on the volar surface of the non-fistula arm. The study concluded in December 2020, and the number of and causes of hospitalization were reviewed. A logistic regression model was used to determine the association between SAF level and patient hospitalization.Results: Of the 196 patients enrolled in the study, SAF was measured in 165 patients with a mean (SD) age of 69.2 (13.0) years. Most of the participants were non-smokers who had hypertension and diabetes and were on high-flux dialyzers. The average weekly spKt/V was 2.1, and the mean (SD) SAF was 3.05 (0.81) AU. The group with high SAF consisted of older patients and had a higher proportion of diabetics and smokers, but this was not statistically significant when compared to the low SAF group. In the multivariable analysis model, SAF greater or equal to 3.05 AU (OR = 2.28; 95% CI, 1.05–4.94; P < 0.05) and increased age (OR = 1.05; 95% CI, 1.01–1.09; P < 0.05) were associated with an increased risk of hospitalization.Conclusion: Higher values of age and SAF were independently associated with increased risk of hospitalization among ESKD patients.

Background: Lanthanum carbonate is a phosphate binder in the form of a chewable tablet, which is commonly prescribed in chronic kidney disease patients. We reported an unusual radio-opaque foreign body which was accidentally found in a chest X-ray of an elderly female patient and later identified as an intact lanthanum carbonate tablet.Case Presentation: A 60-year-old woman with end stage renal disease, receiving lanthanum carbonate was found having a coin-shaped, homogeneous radiopaque foreign body in the position of esophagus of her chest X-ray. Due to awareness of mimicking other conditions (e.g. button battery or coin ingestion), urgent endoscopy was performed. An intact lanthanum carbonate tablet was found in the upper stomach and was removed successfully.Conclusion: Physicians should be aware of unchewed lanthanum carbonate tablets when a metallic-like object is detected on chest radiograph of a lanthanum carbonate user. Also, prescription of chewing medication should be cautioned particularly in an elderly female patient.