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Dear Editor, We would like to thank Dr Kounis and his colleagues for taking interest in our paper and providing their valuable opinion.[1] In his letter, Dr Kounis highlights the possible use of corticosteroids in mild COVID-19. Google Scholar Crossref Search ADS PubMed WorldCat 6 Sarda R, Swain S, Ray A, Wig N. COVID-19 associated mucormycosis and evolving evidence. [Extracted from the article]

'Medical consent; striking the right balance between shared decision-making and shared responsibility': A win-win scenario if done well Agarwal and colleagues illustrate in their letter[1] how balancing shared responsibility and shared decision-making can help achieve positive clinical outcomes as well as reduce the risk of litigation, which was the focus of our paper.[2] Their case of a young girl fighting metastatic bone cancer and severe coronavirus disease 2019 (COVID-19) infection on an intensive care unit (ICU) highlights the clear benefit of ensuring that treatment decisions are not made in isolation. The approach taken by Agarwal and the ICU team, nonetheless, ensured that everyone was aware of the options and on board with the treatment offered. [Extracted from the article]

Objectives This study aims to describe the demographic and clinical profile and ascertain the determinants of outcome among hospitalized coronavirus disease 2019 (COVID-19) adult patients enrolled in the National Clinical Registry for COVID-19 (NCRC). Methods NCRC is an on-going data collection platform operational in 42 hospitals across India. Data of hospitalized COVID-19 patients enrolled in NCRC between 1st September 2020 to 26th October 2021 were examined. Results Analysis of 29 509 hospitalized, adult COVID-19 patients [mean (SD) age: 51.1 (16.2) year; male: 18 752 (63.6%)] showed that 15 678 (53.1%) had at least one comorbidity. Among 25 715 (87.1%) symptomatic patients, fever was the commonest symptom (72.3%) followed by shortness of breath (48.9%) and dry cough (45.5%). In-hospital mortality was 14.5% (n  = 3957). Adjusted odds of dying were significantly higher in age group ≥60 years, males, with diabetes, chronic kidney diseases, chronic liver disease, malignancy and tuberculosis, presenting with dyspnoea and neurological symptoms. WHO ordinal scale 4 or above at admission carried the highest odds of dying [5.6 (95% CI: 4.6–7.0)]. Patients receiving one [OR: 0.5 (95% CI: 0.4–0.7)] or two doses of anti-SARS CoV-2 vaccine [OR: 0.4 (95% CI: 0.3–0.7)] were protected from in-hospital mortality. Conclusions WHO ordinal scale at admission is the most important independent predictor for in-hospital death in COVID-19 patients. Anti-SARS-CoV2 vaccination provides significant protection against mortality. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused significant economic and health damage worldwide. Rapid vaccination is one of the key strategies to curb severe illness and death due to SARS-CoV-2 infection. Hundreds of millions of people worldwide have received various COVID-19 vaccines, including mRNA vaccines, inactivated vaccines and adenovirus-vectored vaccines, but the side effects and efficacy of most vaccines have not been extensively studied. Recently, there have been increasing reports of immunoglobulin A nephropathy (IgAN) after COVID-19 vaccination, however, whether their relationship is causal or coincidental remains to be verified. Here, we summarize the latest clinical evidence of IgAN diagnosed by renal biopsy associated with the COVID-19 vaccine published by 10 July 2022 with the largest sample size, and propose a hypothesis for the pathogenesis between them. At the same time, the new opportunity presented by COVID-19 vaccine allows us to explore the mechanism of IgAN recurrence for the first time. Indeed, we recognize that large-scale COVID-19 vaccination has enormous benefits in preventing COVID-19 morbidity and mortality. The purpose of this review is to help guide the clinical assessment and management of IgA nephropathy post-COVID-19 vaccination and to enrich the 'multi-hit' theory of IgA nephropathy. [ABSTRACT FROM AUTHOR]

Background Coronavirus disease 2019 (Covid-19) pandemic is representing a massive burden to the community with the new virus. There is few data regarding Covid-19 in liver transplant patients. Concerns were raised regarding the course of the disease in transplanted patients due to immunosuppression and risk of hepatic injuries. Aim To describe the outcomes of Covid-19 infection in recipients of living-donor liver transplantation (LDLT). Methods Retrospective analysis of 41 recipients of LDLT diagnosed with Covid-19 by real-time PCR or CT chest criteria of Covid-19 between April 2020 and April 2021. This Cohort was derived from Ain Shams Center for Organ Transplantation database, Ain Shams Specialized Hospital, Cairo, Egypt, which is considered one of the largest centers of LDLT in the Middle East. Patients were classified to mild, moderate, severe and critics according to clinical classification released by the National Health Commission of China. Results A total of 41 patients and 2 patients with reinfection were included in this cohort with mean age 54 years with 74% male and 26% female. The body mass index ranged from 19.3 to 37. About 30% were described as a mild case, 46.5% were moderate, 14% were severe and 9% were critical cases. Two cases developed infection twice. Total of 20 patients (46.5%) were managed in home isolation setting, 17 patients (39.5%) needed admission to ward, 4 patients (9%) in intermediate care unit and 2 patients (4%) admitted to intensive care unit. About 60% of cases were on room air, only 3 patients needed invasive methods, 2 patients needed face mask and 1 case needed invasive CPAP. In total, 41 patients recovered (95%) and 2 patients (5%) died; 1 was Covid related and the other one was non-Covid related. Female gender, higher BMI and hypertension were associated with severe course of the disease. Conclusion In the setting of LDLT, the possibilities of catching Covid-19 infection are high due to chronic immunosuppression use. Yet, the outcome of infection in term of morbidity and the needs for hospital admission or intensive care is generally matched to general population. [ABSTRACT FROM AUTHOR]

Background Interleukin-6 inhibitors showed promising results in observational trials of patients with coronavirus disease 2019 (COVID-19). Aim To evaluate whether interleukin-6 inhibitor tocilizumab (TCZ) reduces mortality among hospitalized COVID-19 patients. Design A systematic review and meta-analysis. Methods Systematic review and meta-analysis of randomized controlled trials (RCTs) comparing TCZ vs. placebo/control, for treatment of adults with COVID-19. Primary outcome was 28–30 days all-cause mortality. Search was conducted up to 1 April 2021. Two independent reviewers screened citations, extracted data and assessed risk of bias. Relative risk (RR) with 95% confidence intervals (CI) were pooled. We performed subgroup analysis for patients with critical illness and sensitivity analyses. Results Eight RCTs were included, assessing 6481 patients with mostly severe non-critical COVID-19 infection. TCZ was associated with a reduction in all-cause 28–30-day mortality compared to placebo/control (RR = 0.89, 95% CI 0.82–0.96). Among the subgroup of critically ill patients no reduced mortality was demonstrated (RR = 0.94, 95% CI 0.74–1.19). No mortality benefit with TCZ was demonstrated in trials that used steroids for >80% of patients. TCZ was associated with significantly reduced risk for mechanical ventilation (MV); for combined endpoint of death or MV and for intensive care unit (ICU) admission. No significant difference in adverse events was demonstrated. Risk of serious superinfection was significantly lower with TCZ (RR = 0.57, 95% CI 0.35–0.93). Conclusion The treatment with TCZ reduces 28–30 days all-cause mortality, ICU admission, superinfections, MV and the combined endpoint of death or MV. Among critically ill patients, and when steroids were used for most patients, no mortality benefit was demonstrated. Additional research should further define sub-groups that would benefit most and preferred timing of administration of TCZ in severe COVID-19. [ABSTRACT FROM AUTHOR]

COVID-19 is deadly to older adults, with research showing that being older and having underlying chronic diseases are significant risk factors for COVID-19 related deaths. However, though similarities exist between both nursing home residents and older community-dwelling people, nursing home residents are substantially more vulnerable to COVID-19. A closer review of both demographic groups provides clarity concerning the difference within the context of COVID-19. Therefore, to address the research gap, drawing insights from Maslow's hierarchy of needs model, this article aims to examine similarities and differences in COVID-19 risk factors experienced by nursing home residents and community-dwelling older people. [ABSTRACT FROM AUTHOR]

Background Given the limited and diverse nature of published literature related to COVID-19 in pediatrics, it is imperative to provide evidence-based summary of disease characteristics for guiding policy decisions. We aim to provide comprehensive overview of epidemiological, clinical and biomarker profile of COVID-19 infection in pediatric population. Methods For this umbrella review, published systematic reviews from PubMed and pre-print databases were screened. Literature search was conducted from December 2019 to April 2021. Details of clinical, radiological and laboratory features were collected from each review. Qualitative observations were synthesized and pooled prevalence of mortality and asymptomatic cases were assessed using meta-analysis. Results Evidence synthesis of 38 systematic reviews included total 1145 studies and 334 398 children and adolescents. Review revealed that COVID-19 is relatively milder with better prognosis in pediatrics. However, patients with comorbidity are at higher risk. Meta-analysis of reviews showed that 21.17% (95% CI: 17.818–24.729) of the patients were asymptomatic and mortality rate was 0.12% (95% CI: 0.0356–0.246). Though there was no publication bias, significant heterogeneity was observed. Fever (48–64%) and cough (35–55.9%) were common symptoms, affecting almost every alternate patient. Ground-glass opacities (prevalence range: 27.4–61.5%) was most frequent radiographic observation. Rise in C-reactive protein, lactate dehydrogenase and D-dimer ranged from 14% to 54%, 12.2–50% and 0.3–67%, respectively. Some of the included reviews (44.7%-AMSTAR; 13.2%-GRADE) were of lower quality. Conclusion Current umbrella review provides most updated information regarding characteristics of COVID-19 infection in pediatrics and can be used to guide policy decision regarding vaccination prioritization, early screening and identification of at-risk population. [ABSTRACT FROM AUTHOR]

Dear Editor, We read with great interest the article by Shah I et al i . entitled 'Does vitamin D supplementation reduce coronavirus disease-19 (COVID-19) severity: a systematic review'.[1] The authors aimed to evaluate the effect of vitamin D supplementation on morbidity and mortality in hospitalized COVID-19 patients. A statistical commentary on 'Does vitamin D supplementation reduce COVID-19 severity? REFERENCES 1 Shah K, Varna VP, Sharma U, Mavalankar D. Does vitamin D supplementation reduce COVID-19 severity?. [Extracted from the article]

In this issue of the Journal, we continue this initiative with reports of further central nervous system (CNS) complications post-COVID-19 vaccinations and in particular optic neuritis. The reversible tinnitus and cochleopathy followed first-dose AstraZeneca COVID-19 vaccination. [Extracted from the article]

I would like to comment on those suggestions During the UK-India Telemedicine Project, junior doctors managed the patinets in some satellite Covid-19 centres as their workforce capacity was stretched to the limit by an influx of many patients. These junior doctors presented cases (by maintaining patient confidentiality) to a panel of UK Consultants in a virtual ward round. All the UK clinicians involved in this project are full-time National Health Service (NHS) doctors and they contributed to this project in their free time. [Extracted from the article]