IntroductionSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) started as a pathology chiefly affecting the lower respiratory tract. It was first encountered in Wuhan, China. As an infection with an unknown etiology, it was extensively studied in order to establish its profile with respect to the probable manifestations and required medical management. The hematological profile of a patient typically affected with coronavirus disease 2019 (COVID-19) showed lymphopenia with an altered neutrophil-lymphocyte ratio, raised inflammatory markers like D-dimer, interleukin 6 (IL-6), C-reactive protein (CRP), lactate dehydrogenase, and serum ferritin. The prognostic significance of these markers has been studied in this cross-sectional study. Patients and methodsData were collected from consecutive subjects admitted in the intensive care unit of Acharya Vinobha Bhave Rural Hospital, Sawangi Meghe, Wardha, who were aged more than 16 years and were later confirmed to be positive for COVID-19 through throat/nasal swab (rapid antigen test/reverse transcription-polymerase chain reaction (RT-PCR)). Written informed consent (by signature or thumbprint) was obtained from all participants. Statistical analysis was done by using descriptive and inferential statistics with the help of the chi-square test and z-test for the difference between two means. The software used in the analysis was SPSS 27.0 (IBM Corp., Armonk, NY) and GraphPad Prism 7.0 (GraphPad Software, San Diego, CA). P<0.05 was considered as the level of significance. ResultsA total of 200 patients were studied. Fifty-nine point five percent (59.5%) of those who succumbed were over 50 years of age and a significant number (23.5 %) had comorbidities like diabetes mellitus, hypertension, and chronic kidney disease. There was a significant positive correlation between the mortality rate and mean platelet volume (P=0.001), neutrophil-lymphocyte ratio (P=0.001), raised D-dimer (P=0.006), serum ferritin (P=0.0001), lactate dehydrogenase (P=0.0001), and C-reactive protein (P=0.0001). ConclusionThe analysis of the data collected highlights the correlation between the studied hematological manifestations of COVID 19 and their association with the severity of the disease.
SARS-CoV2 started as pneumonia of unknown aetiology in Wuhan, China. Considered a respiratory pathogen primarily initially, COVID 19 is now identified as a systemic infection with significant effects on the hematopoietic system. Lymphopenia, peak platelet/ lymphocyte ratio and neutrophil/lymphocyte ratio are some of the parameters that could be considered as prognostic markers of the disease. Disseminated intravascular coagulation, along with elevated D-dimer levels, are commonly encountered and are usually associated with a worsening clinical picture. IL-6, C reactive protein and Lactate Dehydrogenase with high serum prolactin and serum ferritin levels project a dismal outcome. Venous thromboembolism occurs in both ambulatory and bedridden patients making thromboprophylaxis with LMWH popular. To correlate haematological parameters like lymphopenia, deranged coagulation profile and elevated d- dimer levels with the outcome (recovery or death) of the patients infected with SARS-CoV-2. In this prospective cross-sectional study, data will be gathered from patients found to be positive for COVID 19 with the duration of the study being four months. Lymphopenia, elevated D-dimer levels and deranged coagulation profile are expected in patients with COVID-19. Haematological parameter like lymphopenia raised D-dimer levels, and deranged coagulation profile are associated with poor prognosis in COVID 19.
Background: Anaphylaxis is a medical emergency and requires immediate medical attention. Kounis syndrome is myocardial infarction or injury occurring in the setting of anaphylaxis and can also be due to the effects of epinephrine. Adrenaline is a common drug in the management of anaphylaxis but the electrocardiographic consequences of its administration post an attack are seldomly seen. Vasospasm is generally the cause for myocardial injury in an acute setting following the administration of epinephrine. Case Presentation: A 21-year- old female developed sudden onset breathlessness and giddiness post vaccination with the oxford –AstraZeneca COVID -19 vaccine. She was administered 0.5 ml adrenaline (1:1000) intramuscularly on the lateral aspect of the left thigh, following which she complained of chest tightness and palpitations. This was accompanied by hypotension and global ST segment depression on her Electrocardiogram. The second electrocardiogram, done after 30 minutes showed a relative resolution in ST segment depressions with sinus rhythm in the one done at 16:00 hours. Creatine Kinase- MB and Troponin I were within normal limits and the patient experienced symptomatic improvement with normalization of blood pressure post fluid challenge. Conclusion: This case report highlights the case of a young female with no comorbidities who developed transient myocardial ischemia after administration of intramuscular adrenalin in therapeutic dose in view of an anaphylactic reaction. The probable action is alpha mediated coronary vasospasm. The potential adverse effects in an acute setting are hence outlined in this case report without discouraging its use given the potential benefits outweigh the risks.
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