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Dear Readers,Welcome to the latest issue of The Magazine
WHO declared COVID-19 as pandemic on March 12th, 2020. The contagion has taken the world by storm leading to high mortality. Given the infectiousness of the disease and the rate at which the infection is spreading, the medical facilities need to be geared up to support best medical outcome for disease.
WHO has been recommending that social distancing is not sufficient for containing the contagion however, extensive testing too is the most important aspect of managing the pandemic. However, the specific testing for the infection is very important alongwith the monitoring of clinical markers so that medical intervention can be worked out.
Many automations do not offers all the necessary testings on single platform. However, Snibe has come up with COVID -19 antibody testing alongwith other important clinical markers like CRP, PCT, IL-6 etc.
The COVID-19 IgG/IgM tests on Maglumi series have been approved by CDSCO and can be of great significance for contact tracing and surveillance studies as indicated by ICMR. The tests are also being considered to be done in conjunction with RTPCR to check the false negative that could be given by RT PCR.
The PCT or Procalcitonin level for the patients are normal but many a times COVID-19 patients present sepsis or septic shock indicating bacterial co-infection or sepsis indicated in community acquired pneumonia due to viral infection.
Although CRP does not normally elevate significantly in mild viral respiratory infections, ,a similar significant increase of CRP has also been reported in COVID-19 patients. One possible explanation for this phenomenon is the overproduction of inflammatory cytokines that take part in the defense against the pathogen, but also cause more severe symptoms and damage in lung alveoli and stimulate CRP production. Therefore, CRP testing may be useful in the initial evaluation of coronavirus patients.
Critically important studies emerging from China suggest that for many patients who die of Covid-19, it may be their own immune system, rather than the virus itself, that deals the fatal blow. The hyper immune response from the patients leads to damage of healthy lung tissues which can cause acute respiratory distress and multi organ failure. This is called a cytokine storm. Untreated, cytokine storm syndrome is usually fatal.
Cytokine Storm Syndrome (CSS) is very common with COVID-19 due to overreaction which can be detected by high levels of Ferritin found in the patients. Ferritin tests can be used as first screening tests for the patients with possibility of Cytokine Storm Syndrome and having high fevers. The increased ferritin might indicate severe secondary bacterial infection in COVID-19, and might be utilized as a marker of poor prognosis.
Some recent articles highlight the Importance of IL-6 measurement in the follow-up of patient infected by COVID-19. The marker can be monitored to make the best outcome for CSS.
Recent studies showed a high rate of renal abnormalities in corona-positive patients wherein the COVID-19 patients presented elevated levels of albumin in urine (=proteinuria), a symptom of kidney damage.
Many studies have shown that a raised serum beta 2- microglobulin concentration can be induced by several forms of virus infection. The marker can thus be helpful to diagnose the viral infection and differentiate from the bacterial infection.
In a recent study, 90% of in patients with Pneumonia had increased coagulation activity, marked by increased d-dimer concentrations. It has been found that when d-dimer is greater than 1 μg/mL, it is associated with fatal outcome of COVID-19. High levels of d-dimer have a reported association with 28-day mortality in patients with infection or sepsis identified in the emergency department.
Coronary heart disease has also been found to be associated with acute cardiac events and poor outcomes in influenza and other respiratory viral infections. In a recent study, increased high-sensitive cardiac troponin I during hospitalisation was found in more than half of those who died.
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