Introduction: Coronavirus disease 2019 (COVID-19) cases are increasing rapidly worldwide. Similar to Middle East respiratory syndrome where cardiovascular diseases were present in nearly 30% of cases, the increased presence of cardiovascular comorbidities remains true for COVID-19 as well. The mechanism of this association remains unclear at this time. Therefore, we reviewed the available literature and tried to find the probable association between cardiovascular disease with disease severity and mortality in COVID-19 patients. Methods: We searched Medline (via PubMed) and Cochrane Central Register of Controlled Trials for articles published until Sept 5, 2020. Nineteen articles were included involving 6,872 COVID-19 patients. Results: The random-effect meta-analysis showed that cardiovascular disease was significantly associated with severity and mortality for COVID-19: odds ratio (OR) 2.89, 95% confidence interval (CI) 1.98–4.21 for severity and OR 3.00, 95% CI 1.67–5.39 for mortality, respectively. Risk of COVID-19 severity was higher in patients having diabetes, hypertension, chronic obstructive pulmonary disease, malignancy, cerebrovascular disease and chronic kidney disease. Similarly, patients with diabetes, hypertension, chronic liver disease, cerebrovascular disease and chronic kidney disease were at higher risk of mortality. Conclusion: Our findings showed that cardiovascular disease has a negative effect on health status of COVID-19 patients. However, large prevalence studies demonstrating the consequences of comorbid cardiovascular disease are urgently needed to understand the extent of these concerning comorbidities. Keywords: Cardiovascular disease, COVID-19, SARS-CoV-2

Objectives:Cross sectional studies have reported a tremendous amount of stress in caregivers of patients with Alzheimer's disease (AD) and Mild Cognitive Impairment (MCI). The present study aimed at evaluating the perceived stress in caregivers of patients with AD and MCI compared to controls.Materials and Methods:Caregivers of patients diagnosed with Alzheimer's disease/Mild Cognitive Impairment were recruited at the Memory Clinic of Neurology Department of a Tertiary Care Hospital in Northern India. The controls included caregivers of patients with chronic medical and psychiatric disorders. Caregivers were interviewed using Perceived Stress Scale (PSS) and the patients were assessed using The Blessed Activity of Daily Living (ADL), Mini Mental State Examination (MMSE) and Clinical Dementia Rating scale. The perceived stress of caregivers was compared amongst both groups and correlated with the severity of illness and activities of daily living of the patients.Results:Caregivers of a total of 31 patients of AD/MCI (Males = 24, Females = 7), and 30 controls (Males = 18, Females = 12) were interviewed. PSS Score was 23.29 ± 7.17 in cases and 7.5 ± 3.12 in controls. ADL Score was 7.97±5.53 in cases and 0.00 in controls. There was a significant difference between the PSS and ADL scores between those with AD and controls (P < 0.0001). Caregivers of patients with MCI had lower PSS scores compared to AD caregivers but significantly higher scores compared to caregivers of other chronic disorders. Similarly, correlation between Perceived Stress and ADL was significant (P < 0.001).Conclusions:Present study shows that caregivers of patients with AD/MCI have a high perceived stress compared to caregivers of patients with other chronic illness.

Purpose Coronavirus disease‐2019 (COVID‐19) may predispose to venous thromboembolism (VTE) and arterial thromboembolism because of excessive inflammation, hypoxia, immobilisation and diffuse intravascular coagulation. The understanding of the association might be helpful in early vigilant monitoring and better management of COVID‐19 patients at high risk. Thus, in this meta‐analysis, we aim to assess the association of VTE with the severity of COVID‐19 disease. Methods A literature search was conducted on PubMed and Cochrane Central Register of Controlled Trials using the keywords “COVID‐19 and thromboembolism” and “COVID‐19 and embolism,” till 20 February 2021. Thirteen studies including 6648 COVID‐19 patients were incorporated in this systematic review and exploratory meta‐analysis. Results The analysis revealed nearly three times more risk than intensive care unit (ICU) care in patients with VTE compared to non‐VTE patients (RR: 2.78; 95% CI: 1.75‐4.39; P < .001; I 2 : 65.1%). Patients with pulmonary embolism and deep vein thrombosis are at increased risk of being admitted to ICU (RR: 2.21; 95% CI: 1.86‐2.61; P < .001; I 2 : 41.2%) and (RR: 2.69; 95% CI: 2.37‐3.06; P < .001; I 2 : 0.0%), respectively. The quality assessment indicated that the included studies were of fair quality. Conclusions Our findings suggest that VTE either deep vein thrombosis or pulmonary embolism may have a negative effect on the health status of COVID‐19 patients. This study highlights the need to consider measures for reducing thromboembolism risk amongst COVID‐19 patients.

Objectives: Extensive evidence links low vitamin D status and comorbidities with coronavirus disease 2019 (COVID-19) outcomes, but the results of published studies are contradictory. Therefore, we investigated the association of lower levels of vitamin D and comorbidities with the risk of COVID-19 infection.Methods: We searched MEDLINE (via PubMed), Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov for articles published until August 20, 2021. Sixteen eligible studies were identified (386 631 patients, of whom 181 114 were male). We included observational cohort and case-control studies that evaluated serum levels of vitamin D in COVID-19-positive and COVID-19-negative patients. Mean differences (MDs) with 95% confidence intervals (CIs) were calculated.Results: Significantly lower vitamin D levels were found in COVID-19-positive patients (MD, -1.70; 95% CI, -2.74 to -0.66; <i>p</i>=0.001), but with variation by study design (case-control: -4.04; 95% CI, -5.98 to -2.10; <i>p</i><0.001; cohort: -0.39; 95% CI, -1.62 to 0.84; <i>p</i>=0.538). This relationship was more prominent in female patients (MD, -2.18; 95% CI, -4.08 to -0.28; <i>p</i>=0.024) than in male patients (MD, -1.74; 95% CI, -3.79 to 0.31; <i>p</i>=0.096). Male patients showed higher odds of having low vitamin D levels (odds ratio [OR], 2.09; 95% CI, 1.38 to 3.17; <i>p</i><0.001) than female patients (OR, 1.17; 95% CI, 0.74 to 1.86; <i>p</i>=0.477). Comorbidities showed inconsistent, but generally non-significant, associations with COVID-19 infection.Conclusions: Low serum vitamin-D levels were significantly associated with the risk of COVID-19 infection. This relationship was stronger in female than in male COVID-19 patients. Limited evidence was found for the relationships between comorbidities and COVID-19 infection, warranting large population-based studies to clarify these associations.

Behavioral and Psychological Symptoms of Dementia (BPSD) are common in dementias but is a relatively new entity described in patients with Mild Cognitive Impairment (MCI). The International Psychogeriatric Association Consensus Group defines BPSD as “symptoms of disturbed perception, thought content, mood or behavior” (Coen et al., 1997). The present study was aimed at assessing the frequency of the same in patients with MCI.

The world is in the midst of the COVID-19 pandemic. In addition to quarantine, public health interventions which can reduce the risk of infection and death are urgently required. This article discusses the roles of vitamin D in reducing the risk of COVID-19, and how vitamin D supplementation may be a useful risk reduction measure. Vitamin D can reduce the risk of infections through a variety of mechanisms: induction of cathelicidins and defensins that can lower the rate of viral replication and decrease the concentrations of pro-inflammatory cytokines, which are responsible for induction of inflammation, injuring lining of lungs and contributing to developing pneumonia. Evidence supporting the role of vitamin D in reducing the incidence of COVID-19 includes a) winter outbreak; b) a timeframe when concentrations of 25-hydroxyvitamin D (25(OH)D) are lowest; c) a small number of cases in the southern hemisphere toward the end of summer; d) a vitamin D deficiency found to lead to acute respiratory distress syndrome (ARDS); e) and a rise in case-fatality rates with increasing age and comorbid chronic diseases, both of which are associated with lower concentrations of 25(OH)D. It is recommended that people at risk of COVID-19 consider taking 10,000 IU/d of vitamin D3 for a few weeks to rapidly increase 25(OH)D concentrations, followed by 5,000 IU/d to reduce the risk of infection. Higher doses of vitamin D3 may be useful for treating people who are infected with COVID-19. To test these guidelines, randomized controlled trials and comprehensive population studies should be performed.

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Objectives: Changes in serum cortisol levels have been reported in Alzheimer's disease (AD) and Mild Cognitive Impairment (MCI). Atrophy of Medial Temporal Lobes (MTLs) is common in both conditions. Glucocorticoids are known to be neurotoxic and have been believed to cause damage to memory mechanisms in the brains; whether the same is applicable to AD/MCI is not known. Also, they have long been hypothesized to cause atrophy of MTLs but the proof of the same is lacking. The present study was performed to delineate correlations between serum Cortisol levels, Depression in Dementia and Medial Temporal Lobe Atrophy in patients with AD/MCI. Methods: We randomly recruited 28 patients out of a total of 65 presenting with subjective memory complaints to the Department of Neurology, at a tertiary care institute during the study period (July 2014-2015). Morning serum Cortisol levels (8 AM) were analyzed in all patients (n=28) who met the diagnostic criteria for diagnosis of probable AD e.g. National Institute of Neurological and Communicative Disorders and Stroke, Alzheimer's disease related Disease Association criteria (NINCDS-ARDA) and Clinical Dementia Rating (CDR) for AD and MCI respectively. The Cornell Scale for Depression in Dementia (CSDD) was used to evaluate Depression. Visual Rating of Medial Temporal Lobe Atrophy (MTLA) was done using the Scheltens Visual Rating Scale. An association between the Depression and MTLA was evaluated using Pearson correlation coefficient. Results: A total of 28 Patients (M: F=24:4, AD=13, MCI=15) were recruited for the present study. The mean age was 73.39 ±7.6 years and mean duration of illness was 3.4±3 years. Mean Mini Mental State Examination (MMSE) score was 21.7±7.4. A total of 4 patients (14%) had a high basal serum cortisol. Only one case out of these 4 had MCI and the rest had AD. There was a statistically significant correlation between serum Cortisol levels and MTLA (Pearson Correlation Coefficient=0.39, p<0.05). Similarly, a statistically significant correlation was found between serum Cortisol levels and CSDD scores (Pearson Correlation Coefficient=0.49, p<0.05). Likewise, there was a statistically significant negative correlation between MMSE and CSDD (Pearson Correlation Coefficient=-0.48, p<0.001). Conclusion : Statistically significant correlation between Serum Cortisol and MTA Scores as assessed by Scheltens Visual Rating Scores was found (Pearson Correlation Coefficient=0.39, p<0.05; 95% confidence interval=0.02 to 0.66). Similarly, a significantly correlation was present between serum cortisol and CSDD Scores (Pearson Correlation Coefficient=0.49, p<0.05; 95% confidence interval=0.144 to 0.729). This suggests that glucorticoids and depression and MTA in AD/MCI are interrelated and points towards the possible role that increase in endogenous glucocorticoids may play in pathophysiology of AD/MCI.