Predictive Risk Assessment of D-Dimers and Troponin Levels of Thrombotic Events among COVID-19 Patients in a Community-Based Hospital, New York City |Chapter 9 | Medicine and Medical Research: New Perspectives Vol. 5

 

The coronavirus disease 2019 (COVID-19) continues to pose an unprecedented challenge for the entire world and the healthcare system. The role of D-dimer and troponin-I as markers of thrombosis or procoagulant state in COVID-19 infection has been under investigation since the inception of this disease. Different theories have been proposed elucidating the pathophysiological mechanisms attributing to high mortality and morbidity in COVID-19 infection. Out of them, thrombosis and procoagulant state have managed to earn the maximum limelight. The main objective of our study was to assess the risk and occurrence of thrombotic events (both venous and arterial) among hospitalized patients including the intensive care unit (ICU) and non-ICU admissions with confirmed COVID-19 infection. An observational study was conducted based on data from randomly selected 349 hospitalized patients with COVID-19 infection in a community-based hospital in New York City during the first wave of the COVID-19 viral surge in March 2020. Diagnoses were made during the inpatient clinical care, as screening for thrombotic events is not a standard method. The statistical analysis involved non-normally distributed continuous variables that were described as the median and interquartile range (IQR) while mean and standard deviation were used to describe normally distributed continuous variables. The primary outcome in our study was defined as the thrombotic events that included myocardial infarction (MI), deep venous thrombosis (DVT), cerebrovascular accidents (CVA), and pulmonary embolism (PE). The study correlated the association of thrombotic events with the level of biomarkers of interest: D-dimer >1000 ng/ml, troponin-I >1 ng/ml, or both. The association of D-dimers and troponin-I with thrombotic events was measured using both univariate and multivariate Cox proportional hazard (PH) regression analysis. Out of a total of 349 patients, 78 patients (22.35%) were found to have elevated biomarkers (D-dimer >1000 ng/ml and/or troponin-I >1 ng/ml) and were categorized as a high-risk group. Eighty-nine patients developed thrombotic complications (evidence of more than one thrombotic event was found in several patients). Two-hundred seventy-one (77.65%) patients had no documentation of thrombosis. The in-patient mortality rate among patients in our study group, with a high risk of thrombotic events was 44.87% (35/78) as compared to 38.80% (104/271) in patients without any thrombotic events. The incidence of thrombotic events included myocardial infarction (MI; N=45; 12.8%), cerebrovascular accidents (CVA; N=16; 4.5%), deep venous thrombosis (DVT; N=16; 4.5%), and pulmonary embolism (PE; N=9; 2.57%). The lack of prior immunity to COVID-19 has resulted in large numbers of infected patients across the globe and uncertainty regarding the management of the complications that arise in the course of this viral illness. Although D-dimer, sepsis, and microvascular thrombosis are associated with mortality, current data are inconclusive for the use of therapeutic doses of anticoagulation for these findings. With the resurgence of the COVID-19 wave, it is imperative to focus on optimal diagnostic and prophylactic strategies to prevent thromboembolic events and potentially improve survival in COVID-19 patients.

 

Author (s) Details

Ruchi Yadav
Hematology/Oncology, Brookdale University Hospital and Medical Center, Brooklyn, USA.

 

Beka Aroshidze
Hematology/Oncology, Brookdale University Hospital and Medical Center, Brooklyn, USA.

 

Vivek Yadav
Pulmonary and Critical Care, State University of New York Downstate Health Sciences University, New York, USA.

 

Umar Zahid
Nephrology, Brookdale University Hospital and Medical Center, Brooklyn, USA.

 

Apoorva Jayarangaiah
Internal Medicine, New York City (NYC) Health and Hospitals/Jacobi Medical Center, Bronx, USA.

 

Anjula Gandhi
Internal Medicine, Brookdale University Hospital and Medical Center, Brooklyn, USA.

 

Vladimir Gotlieb
Hematology/Oncology, Brookdale University Hospital and Medical Center, Brooklyn, USA.

 

 

Please see the book here:- https://doi.org/10.9734/bpi/mmrnp/v5/1997

Determining the Homocysteine and D-Dimer Levels and Multilayer Computed Tomography for Diagnosis of Pulmonary Artery Thromboembolism | Chapter 15 | Advancement and New Understanding in Medical Science Vol. 6

The aim of our investigation was to assess the importance of measuring D-dimer and homocysteine levels, along with the use of multilayer computer tomography (CT), in the diagnosis of patients with suspected PATE. According to reports, D-dimer is crucial in the diagnosis of pulmonary embolism. Furthermore, homocysteine has been shown to be a risk factor for thrombosis, vascular disease, and atherosclerosis. The purpose of this chapter is to assess the diagnostic utility of multi-detector computed tomography (CT) in conjunction with D-dimer and homocysteine levels in cases of suspected pulmonary embolism. We examined 54 patients from 18 to 76 years of age, who were suffering from conditions and complaints that are typical of PATE, such as chest pain, haemoptysis, dyspnoea, tachycardia, arterial hypotension and signs of vein thrombosis in the inferior limbs.  In these patients, PATE was found in different localizations with varying rates of severity. D-dimer levels were measured in patients with suspected PATE using enzyme-linked immunosorbent assays. Homocysteine levels were determined by an enzymatic method. Pulmoangiography is the method of choice in pulmonary embolism diagnostics. All patients were examined to evaluate the presence of pulmonary embolism by multi-detector CT angiopulmonography. Changes in homocysteine levels can be considered a separate independent factor for PATE diagnostics. The correlation between multi-detector CT angiopulmonography, elevated D-dimer levels, and concomitant hyperhomocysteinemia can be used not only for diagnostics but also for the assessment of the effectiveness of PATE treatment. Multi-detector CT angiopulmonography, D-dimer levels and related hyperhomocysteinemia can serve as significant laboratory markers in the diagnosis and treatment efficacy of PATE. The changes in homocysteine levels can be considered as a separate independent factor for PATE diagnostics. The interdependence between D-dimer and concomitant hyperhomocysteinemia can be used not only for diagnostics but also for the assessment of the effectiveness of PATE treatment. It can be concluded that multilayer CT pulmoangiography is a non-invasive highly informative method, providing a very low level of complications, and is thus indicated for acute PATE diagnostics, and for control of the disease dynamics after anticoagulation treatment.

Author(s) Details:

Fridon Todua,
Todua Clinic, 0112 Tbilisi, Georgia.

Manana Akhvlediani,
Todua Clinic, 0112 Tbilisi, Georgia.

Elena Vorobiova,
Todua Clinic, 0112 Tbilisi, Georgia.

Giorgi Tsivtsivadze,
Todua Clinic, 0112 Tbilisi, Georgia.

Anna Baramidze,
Todua Clinic, 0112 Tbilisi, Georgia.

Please see the link here: https://stm.bookpi.org/ANUMS-V6/article/view/13395

Circulating Biomarkers in Arterial Aneurysms | Chapter 1 | Current Progress in Medicine and Medical Research Vol. 9

Arterial aneurysms are a weighty medical condition associated with extreme morbidity and death. The degenerative disease process, generally driven by atherosclerosis and age-connected changes in blood vessel structure, leads to the local dilation of channels. This chapter focuses on the role of flowing biomarkers in predicting and directing arterial aneurysms, with a particular importance on peripheral and intestinal aortic aneurysms in the Indian population. The objective is to recognize specific biomarkers that can be used to anticipate aneurysm rupture by analysing blood samples from victims. Matrix metalloproteinase-9 (MMP-9), plasma fibrinogen, D-dimer, interleukin-6 (IL-6), and C-reactive protein (CRP) are checked as potential biomarkers. The findings from our study take care of contribute to the development of enhanced diagnostic finishes and treatment strategies for arterial aneurysms, eventually enhancing patient consequences and reducing the burden of this condition on community health.

Author(s) Details:

Rohit Kumar Singh,
Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University Varanasi, Uttar Pradesh, India.

Mohd Zeeshan Hakim,
Department of CTVS, KGMU, Lucknow, Uttar Pradesh, India.

Ajay K. Khanna,
Department of General Surgery, Institute of Medical Sciences, Banaras Hindu University Varanasi, Uttar Pradesh, India.

Please see the link here: https://stm.bookpi.org/CPMMR-V9/article/view/11685

Acute Ischemic Stroke in Covid 19 | Chapter 9 | Current Innovations in Disease and Health Research Vol. 2

 Corona bug disease (Covid 19) is an catching disease caused by Sars-cov2 bug. It mostly influences the respiratory system, developing in fever, hacking, and shortness of respite. However, the central nervous system can also experience.  Some COVID-19 patients have exhibited extensive neurological proofs including stroke. Several methods related to immune-arbitrated thrombosis and the effect of SARS-CoV-2 in intelligence tissue may influence the pathogenesis of ischemic stroke in patients accompanying COVID-19. Recent studies suggest that the internalization of SARS-CoV-2 is mediated for one binding of the spike glycoprotein of the bug to the angiotensin-converting catalyst 2 (ACE2) on cellular membranes. ACE2 is expressed in various tissues including body part alveolar cells, gastrointestinal tissue, and intellect. The aim of this case report search out provide understandings into the clinical manifestations and pathophysiological machines of stroke in COVID-19 patients. SARS-CoV-2 can unhappy-regulate ACE2 and, in turn, overactivate the classic renin-angiotensin system (RAS) arbor and decrease the activation of the alternative RAS road in the brain. The consequent inequality in vasodilation, neuroinflammation, oxidative stress, and thrombotic response concede possibility contribute to the pathophysiology of stroke during SARS-CoV-2 contamination. The neuropilin (NRP-1) which is a co-receptor for the vascular endothelial progress factor (VEGF), integrins, and plexins, is complicated in the pathogenesis of Acute Ischemic Stroke. When examining a patient who has affecting animate nerve organs manifestations, clinicians must use a exact approach. To lessen post-covid neurological sequelae, the affecting animate nerve organs disease of COVID 19 must be pronounced and treated early.

Author(s) Details:

T. R. Mamatha,
Department of General Medicine, ESIMC PGIMSR, Rajajinagar, Bengaluru, Karnataka – 560 010, India.

Please see the link here: https://stm.bookpi.org/CIDHR-V2/article/view/11197

Biochemical Changes as Early Markers of Adverse Neuro-developmental Outcome in Multisystem Inflammatory Syndrome-Neonate | Chapter 15 | New Advances in Medicine and Medical Science Vol. 5

 This study was understood to identify the biochemical gravestones during neonatal period that correlate accompanying neurodevelopmental outcome, so that even when hide and early imaging gives no clues, clinicians maybe on guard about later onset of delays. The multisystem angering syndrome-Newborn (MISC-N) occurs in male babies innate to Covid positive founders and is a sign that the mother has Covid-19, making pregnant mothers and newborns particularly naive to it. Sixteen newborns born to Covid positive founders were enrolled prospectively in this place study after earning informed consent at 40 weeks of gestational age. Newborns with MIS-N accompanying proven agent for negating the effect of an infection or poison titers and newborns with positive Covid experiment for the mother at transfer were included in the study. Demographic description, treatment details and biochemical limits were analyzed accompanying neurodevelopmental follow-up. 25% mothers taken 2 doses of Covid vaccine; 50% had oligohydromnios and 75% taken antenatal steroids.87.5% were preterm of which 62.5% required surfactant accompanying ventilator support and 75% necessary ionotropic support. Significant association was erect between the antibody level and D-dimer admit the ferritin and LDH levels of the baby (p < 0.05); gestational age with LDH and D-dimer levels (p < 0.05) and Covid often causing illness level of the baby vs the duration of ventilator necessity (P-value-0.0009). Babies innate to Covid positive founders should be included in the extreme-risk newborn type and should be strictly listened and followed up for early labeling of neurodevelopmental and neurobehavioral problems and early stimulation and attack. D-dimer values of babies were absolutely associated with two together maternal antibody and D-dimer levels. Neurodevelopmental effect done at 6 months of rectified gestational age showed 37.5% were normal, 37.5% hypertonic and 25% hypotonic. HINE score was beneath 60 in 62.5%. Development assessment utilizing Bayley-III showed a delay in the engine domain (62.5%), cognitive rule (56.25%) and language rule (62.5%). Hence, it should be born in mind that neurodevelopmental questions occur in babies innate to Covid positive mothers and endure be stratified as “extreme risk”. Anticipatory guidance bear be given to prospective inventors for preterm care. Covid antibody titre and D-dimer levels can help to predict the NICU stay, ventilator necessity and the adverse neuro-enlightening outcomes in these babies.

Author(s) Details:

Devika Sanil Kumar,
Department of Research and Development, Saveetha Medical College and Hospital, Chennai, India.

Lal Devayani Vasudevan Nair,
Department of Pediatrics, Saveetha Medical College and Hospital, Chennai, India.

Perumalsathya Sankaranarayanan,
Department of Pediatrics, Saveetha Medical College and Hospital, Chennai, India.

Harshitha Shanmuganathan,
Department of Pediatrics, Saveetha Medical College and Hospital, Chennai, India.

Santosh Kamalakannan,
Department of Neonatology, Saveetha Medical College and Hospital, Chennai, India.

Please see the link here: https://stm.bookpi.org/NAMMS-V5/article/view/10875