The lack of feasible therapies and comorbidities aggravate the COVID-19 case-fatality rate (CFR). However, reports examining CFR associations with diabetes, concomitant cardiovascular diseases, chronic kidney disease, and chronic liver disease (CLD) are limited. More studies assessing hydroxychloroquine (Hcq) and antivirals are needed. Purpose: To examine associations of COVID-19 CFR in comorbid patient groups each with single comorbidities and after treatment with Hcq, favipiravir, and dexamethasone (Dex), either alone or in combination versus standard care. Methods: Using statistical analysis, we descriptively determined these associations among 750 COVID-19 patient groups during the last quarter of 2021. Results: A diabetes comorbidity (40%, n=299) showed twice the fatality (CFR 14%) of the others (CFR 7%; P=0.001). Hypertension (Htn) was the second-commonest comorbidity (29.5%, n=221), with similar CFR to diabetes (15% and 7% for Htn and non-Htn, respectively), but with higher significance (P=0.0006167). Although only 4% (n=30) heart failure (HF) was reported, the CFR (40%) was much higher than in those without it (8%). A similar rate (4%) for chronic kidney disease was reported, with CFRs of 33% and 9% among those with and without it, respectively (P=0.00048). Ischemic heart disease was 11% (n=74), followed by chronic liver disease (0.4%) and history of smoking (1%); however, these were not significant due to the sample sizes. Treatment indicated standard care and Hcq alone or in combination were superior (CFR of 4% and 0.5%, respectively) compared to favipiravir (25%) or Dex (38.5%) independently or in combination (35.4%). Furthermore, Hcq performed well (CFR 9%) when combined with Dex (9%; P=4.28-26 ). Conclusion:The dominance of diabetes and other comorbidities with significant association with CFR implied existence of a common virulence mechanism. The superiority of low-dose Hcq and standard care over antivirals warrants further studies.

Coinfections and comorbidities add additional layers of difficulties into the challenges of COVID-19 patient management strategies. However, studies examining these clinical conditions are limited. We have independently investigated the significance of associations of specific bacterial species and different comorbidities in the outcome and case fatality rates among 129 hospitalized comorbid COVID-19 patients. For the first time, to best of our knowledge, we report on the predominance of Klebsiella pneumoniae and Acinetobacter baumannii in COVID-19 non-survival diabetic patients The two species were significantly associated to COVID-19 case fatality rates (p-value = 0.02186). Coinfection rates of Klebsiella pneumoniae and Acinetobacter baumannii in non-survivors were 93% and 73%, respectively. Based on standard definitions for antimicrobial resistance, Klebsiella pneumoniae and Acinetobacter baumannii were classified as multidrug resistant and extremely drug resistant, respectively. All patients died at ICU with similar clinical characterisitics. Of the 28 major coinfections, 24 (85.7%) were in non-survivor diabetic patients, implying aggravating and worsening the course of COVID-19. The rates of other comorbidities varied: asthma (47%), hypertension (79.4%), ischemic heart disease (71%), chronic kidney disease (35%), and chronic liver disease (32%); however, the rates were higher in K. pneumoniae and were all concomitantly associated to diabetes. Other bacterial species and comorbidities did not have significant correlation to the outcomes. These findings have highly significant clinical implications in the treatment strategies of COVID-19 patients. Future vertical genomic studies would reveal more insights into the molecular and immunological mechanisms of these frequent bacterial species. Future large cohort multicenter studies would reveal more insights into the mechanisms of infection in COVID-19.

Background: Many modifiable risk factors have been linked to the etiology of the increased renal disease worldwide. The objective of this study was to assess the consequences of arbitrary herbal and analgesics on renal function in a series of Saudi patients. Methodology: This study investigated 2944 Saudi volunteers who have joined during a cross-sectional survey conducted in Hai'l region. Renal function status was established corresponding to Glomerular infiltrating Rate (GFR) estimation using creatinine level, age, and sex. GFR was categorized into: Stage III CKD (GFR = <60 -30 mL/min). Stage IV (GFR = <30 -15 mL/min). Stage V (GFR = <15 mL/min). Results: Around 14.4% of participants claimed using non-steroidal anti-inflammatory drugs (NSAIDs). Of the 391 analgesics users, about 12.8% were found with impaired renal function. The risk of analgesics uses in deteriorating renal function, the relative risk (RR) and the 95% confidence interval (95%CI), RR (95%CI) = 1.7926 (1.3313 to 2.4137), P = 0.0001. Out of the 426/2714(15.7%) herbal users, 45/426(10.6%) were found with impaired renal function. The risk of herbal uses in deteriorating renal function, the RR (95%CI) = 1.3659 (1.0366 to 1.7999), P = 0.0268. Conclusion: Significant Reverse associations between arbitrary herbal use as well as, frequent NSAIDs renal function. The frequent use of Arbitrary herbal and NSAIDs is common among the Saudi Community, particularly among women.

Background: The side effects of hormonal contraceptives (HCs) vary greatly between women, and different HCs cause distinct side effects. This study aimed to assess the rife of self-confessed disorders associated with hormonal contraceptives. Methodology: The study enrolled 200 ladies of reproductive age. One hundred women were HCs users (ascertained as cases) and 100 women non-contraceptives users (ascertained as a control group). Results: Irregular menstrual cycles were observed in 29% of the cases and 28% of the controls. In 21% of cases, the duration of menstruation recycling was unpredictable, compared to 26% in controls. Hormonal abnormalities were more common among controls than among cases. The hormonal associated problems in controls were: OR (95%CI) = 2.5550(1.1753 to 5.5545), P-value = 0.0179. The risk of recurrent infection among control group was OR (95%CI) = 1.5952 (0.8984 to 2.8326), P = 0.1109. Conclusion: The current study revealed no statistically significant differences in hormonal contraceptive-related illnesses between HCs users and non-users.

Placental insufficiency is the failure of the placenta to supply nutrients to the fetus and remove toxic wastes; it is a common cause of intra uterine growth restriction (IUGR), fetal distress peri and postnatal mortality. Specifically gestational diabetes and hypertension during pregnancy alters placental architecture which contributes to insufficiency of the placenta. Placenta is the most accurate record of infant’s prenatal experiences. Clinical condition such as hypertension and diabetes that complicate pregnancy leads to significant structural changes in placenta, these histological changes and  morphological alterations in placenta lead to insufficiency, resulting in IUGR and fetal distress. In the present study morphology of placentas collected from diabetic and hypertensive pregnancy will be observed, the histo-pathological findings will be recorded and correlated to birth weight, APGAR scores and congenital anomalies of babies and will be compared to the findings in normal placentas also. This study will be beneficial for obstetrician and pediatrician in gathering knowledge about patho genesis of placental insufficiency; it will add to the knowledge on placental morphology and will high light the abnormalities in placental  anatomy.