Immune thrombocytopenia, often known as immune thrombocytopenic purpura (ITP), has emerged as an important complication of COVID-19. A systematic review was done to analyze the clinical profile and outcomes in a total of 45 cases of new-onset ITP in COVID-19 patients described in literature until date. A comprehensive approach is essential for diagnosing COVID-19associated ITP after excluding several concomitant factors that can cause thrombocytopenia in COVID-19. Majority of ITP cases (71%) were found to be elderly (> 50 years) and 75% cases had moderate-to-severe COVID-19. Three patients (7%) were in the pediatric age group. Reports of ITP in asymptomatic COVID-19 patients (7%) underscore the need for COVID-19 testing in newly diagnosed patients with ITP irrespective of COVID-19 symptoms amid this pandemic. ITP onset occurred in 20% cases 3 weeks after onset of COVID-19 symptoms, with many reports after clinical recovery. SARS-CoV-2-mediated immune thrombocytopenia can be attributed to the underlying immune dysregulation, susceptibility mutations in SOCS 1, and other mechanisms, including molecular mimicry, cryptic antigen expression, and epitope spreading. No bleeding manifestations were reported in 31% cases at diagnosis. Severe life-threatening bleeding was uncommon. One case of mortality was attributed to intracranial hemorrhage. Secondary Evans syndrome was diagnosed in one case. Good initial response to short course of glucocorticoids and intravenous immunoglobulin has been found with the exception of delayed lag response in one case. Thrombopoietin receptor agonist usage as a second-line agent has been noted in few cases for short duration with no adverse events. In the relatively short follow-up period, four relapses of ITP were found.

Background and aim To conduct a systematic literature review and analyze the demographic/biochemical parameters and clinical outcomes of COVID-19 patients with diabetic ketoacidosis (DKA) and combined DKA/HHS (hyperglycemic hyperosmolar syndrome). Methods PubMed, Scopus, Embase, and Google Scholar databases were systematically searched till August 3, 2020 to identify studies reporting COVID-19 patients with DKA and combined DKA/HHS. A total of 19 articles reporting 110 patients met the eligibility criteria. Results Of the 110 patients, 91 (83%) patients had isolated DKA while 19 (17%) had DKA/HHS. The majority of the patients were male (63%) and belonged to black ethnicity (36%). The median age at presentation ranged from 45.5 to 59.0 years. Most of the patients (77%) had pre-existing type 2 diabetes mellitus. Only 10% of the patients had newly diagnosed diabetes mellitus. The median blood glucose at presentation ranged from 486.0 to 568.5 mg/dl, being higher in patients with DKA/HHS compared to isolated DKA. The volume of fluid replaced in the first 24 h was higher in patients with DKA/HHS in contrast to patients with DKA alone. The in-hospital mortality rate was 45%, with higher mortality in the DKA/HHS group than in the isolated DKA group (67% vs. 29%). pH was lower in patients who had died compared to those who were discharged. Conclusion DKA in COVID-19 patients portends a poor prognosis with a mortality rate approaching 50%. Differentiating isolated DKA from combined DKA/HHS is essential as the latter represents nearly one-fifth of the DKA cases and tends to have higher mortality than DKA alone.

PurposeObservations studies have shown that prior use of statins is associated with a reduced risk of adverse clinical outcomes in patients with COVID-19. However, the available data are limited, inconsistent and conflicting. Besides, no randomised controlled trial exists in this regard. Hence, the present meta-analysis was conducted to provide an updated summary and collate the effect of statin use on clinical outcomes in COVID-19 using unadjusted and adjusted risk estimates.MethodsPubMed, Scopus and Web of Science databases were systematically searched using appropriate keywords till December 18 2020, to identify observational studies reporting clinical outcomes in COVID-19 patients using statins versus those not using statins. Prior and in-hospital use of statins were considered. Study quality was assessed using the Newcastle-Ottawa Scale. Unadjusted and adjusted pooled odds ratio (OR) with 95% CIs were calculated.ResultsWe included 14 observational studies pooling data retrieved from 19 988 patients with COVID-19. All the studies were of high/moderate quality. Pooled analysis of unadjusted data showed that statin use was not associated with improved clinical outcomes (OR 1.02; 95% CI 0.69 to 1.50, p=0.94, I2=94%, random-effects model). However, on pooling adjusted risk estimates, the use of statin was found to significantly reduce the risk of adverse outcomes (OR 0.51; 95% CI 0.41 to 0.63, p<0.0005, I2=0%, fixed-effects model).ConclusionsStatin use is associated with improved clinical outcomes in patients with COVID-19. Individuals with multiple comorbidities on statin therapy should be encouraged to continue the drug amid the ongoing pandemic.

Similar to the SARS-CoV experience, 1 a possible link between ABO blood groups with COVID-19 susceptibility and severity has been shown in multiple observational studies. [2][3][4] Gérard et al 5 have further noted that people with B and/or O blood groups were less represented among COVID-19 patients, thereby highlighting the possible beneficial role of anti-A antibodies in COVID-19 susceptibility. In fact, it was known that anti-A antibodies can block the adhesion of SARS-CoV S-protein to ACE2 expressing cell lines. 6 Given the genomic similarity between SARS-CoV-2 and SARS-CoV, it might be prudent to hypothesise a protective role of anti-A antibodies against COVID-19 severity as well. However, existing clinical evidence in this regard is controversial. Hoiland et al 7 had reported that critically ill COVID-19 patients with blood groups A and AB (lacking anti-A antibodies) were more likely to require mechanical ventilation and prolonged intensive care compared with patients with B/O (with anti-A antibodies). However, a genomewide association study of severe COVID-19 patients showed that those with blood group A had a higher risk of severe disease, while blood group O had a protective effect. 8 Other studies found no association between ABO blood groups and COVID-19 severity/ mortality. [9][10][11][12] We aimed to summarise the available literature and provide a pooled analysis of the effect of A/AB (without anti-A antibodies) on clinical outcomes in COVID-19 patients compared with B/O (with anti-A antibodies) blood groups.This meta-analysis was conducted and reported according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement.

has emerged as a pandemic, claiming over 350,000 lives worldwide. Disease mortality has been mostly attributed to viral pneumonia, complicated by acute respiratory distress syndrome (ARDS) and/or sepsis. A cytokine storm like picture in peripheral blood, as evident by significantly higher plasma levels of interleukin (IL)-2, IL-7, tumor necrosis factor-α (TNF-α), granulocyte colonystimulating factor (GCSF), monocyte chemoattractant protein-1 (MCP-1), inducible protein 10 (IP 10) and macrophage inflammatory protein 1-α (MIP-1α), has been shown in severe COVID-19 illness [1]. Albeit uncommon, but biochemical findings like C-reactive protein, D-dimer, liver enzymes and ferritin in high concentration along with increase in IL-6, IL-10 and interferon (IFN)-γ are being reported in critically ill children with COVID-19 [2]. This points towards a coexistence of possible secondary hemophagocytic

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Acute lymphoblastic leukemia (ALL) diagnosed during pregnancy is rare and causes ethical and therapeutic challenges. We performed a retrospective search of ALL patients (n = 202) treated at our institution from 2015 to 2020 and found five patients diagnosed during pregnancy. In this report, we discuss the individual patients in detail and the challenges faced during their treatment. The use of established lymphoblastic leukemia treatment protocols and the modifications made therein to prevent untoward chemotherapy-related toxicities to the fetus are discussed in this study. We report the second use of rasburicase during pregnancy in literature with favorable maternal and fetal outcomes. We also present an extensive literature review of 41 cases of ALL in pregnancy previously reported. It is important to note that there is a dearth of guidelines for the treatment of these complex situations, and although certain general principles can be established, an individualized approach is needed in most cases of leukemia diagnosed during pregnancy.