European Journal of Cardiovascular Medicine

A new coronavirus, called Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), emerged in late December 2019, Wuhan (Hubei, China). The disease, now known as COVID-19, has spread rampant and has given rise to a pandemic world that has precipitated draconian measures to limit its transmission. COVID-19 has demonstrated a wide spectrum of clinical manifestations, from asymptomatic or paucisymptomatic forms, to severe viral pneumonia with respiratory failure, multi-organ and systemic dysfunction, and high morbidity and mortality. The body's hyper inflammatory response has been associated, along with the possible direct effects of SARS-CoV-2 on organs throughout the body via ACE2. Disseminated intravascular coagulation is another common complication. The inflammatory response caused by COVID-19 in the lung due to the virus itself developing pneumonia, followed by cytokine storm and hemophagocytic syndrome causes a hyper coagulation state manifesting small and large vein and arterial thrombosis and likely DEC. Many hyper coagulation biomarkers such as D-dimer, elevated cytokines such as Il-6, and inflammation parameters such as C reactive protein support this clinical picture. Anticoagulant treatment with heparin and anti platelet should always be ordered.

Background: High Resolution CT has a potential role in the diagnosis, detection of complications and in predicting clinical recovery of patients or progression of coronavirus disease 2019. Degree and severity of lung involvement can be assessed by 25 point CT severity score. This quantification plays an important role to modify the treatment plan at times in critically ill patients of COVID-19. Objectives: The purpose of the present study is to characterize the typical & atypical HRCT imaging features in patients with COVID-19 infection and to additionally establish a correlation between the CT severity score & clinical lab parameters to facilitate an expeditious management protocol. Materials & Methods: A prospective observation study of 2years duration including 75 patients with RTPCR positive proven COVID-19 disease were evaluated with HRCT and the findings were systematically documented and analysed by experienced radiologists. Results: >90% participants were found to have ground glass opacities  (GGO) on Chest CT,76%hadGGOwithsmoothinterlobularseptalthickening; whereas 64% had GGO with smooth intra lobular septalthickening.54.7% (41/75) patients had severe grade of Covid Pneumonia; followed by moderate(26;34.7) and mild (8; 10.6%). There is positive correlation of Chest CT severity scores with urea, D-dimer, CRP, IL-6 , TLC and ferritin. Conclusion: Better understanding of spectrum of CT findings in COVID-19 pneumonia may help to reach accurate diagnosis in clinically and laboratory equivocal cases. It also aids in prognostication of clinically ill cases and cases with co-morbidities.

Introduction : Tuberculosis (TB) is the most prevalent infectious disease which is brought by the mycobacterium tuberculosis. In addition to the lung tissue, TB also affects the bone marrow. Significant haematological and coagulation abnormalities are associated with TB. Therefore the diagnosis, prognosis, and therapeutic response can also be indicated by these haematological and coagulation markers. These coagulation abnormalities can lead to stroke and DIC leading to increased mortality. Aims To evaluate the haematological and coagulation parameters in pulmonary tuberculosis patients. Methods and Materials: In this study a total of 50 patients with confirmed tuberculosis were chosen using purposive sampling. Four millilitres of venous blood were drawn while taking the necessary aseptic precaution. Sysmex XN 1000 6-part haematology analyser was used to perform hematologicalanalysis on two millilitres of ethylenediamine tetra acetic acid (EDTA)vacutainer tubes. Rest two millilitres of blood
in sodium citrate vacutainer tube was used to perform coagulation parameters analysis on ACL elite pro coagulation analyser for measurement of D dimer and fibrinogen. Results Hemoglobin and other blood indices were marginally lower in both sexes
compared to healthy controls. Patients with tuberculosis show significantly greater levels of white blood cells (WBC), platelets, D-dimer, and fibrinogen when compared to healthy controls. P-value < 0.05 indicated that these increases were statistically
significant.

Background: The laboratory hematological and inflammatory biochemical markers may help to predict COVID-19 prognosis. Many studies were pinpointed various prognostic markers, including D-dimer, C-reactive protein (CRP), lactate dehydrogenase (LDH), and high-sensitivity cardiac troponin, in serum of COVID-19 patients with poor outcomes. Deep analysis of abnormal levels of such factors and the interface between their functions in the organs of the body and mechanisms of viral infection can provide the basis for first-line diagnosis as an efficient screening tool to predict the severity of the disease. Thus our study was planned to evaluate the hematological and inflammatory biochemical parameters to rule out the severity of the SARS Covid-19 among the affected patients in our set up. Research Question: Is  there any difference of Hematological, biochemical and radiological abnormalities between survived and non survived patients affected with SARS - COVID 2 Pneumonia?  The setting of the study was at Department of General Medicine, Mahatma Gandhi Medical College and Research Institute, Pondicherry.  A six months observational study was conducted during the period from January, 2021 to June, 2021 on about 240 SARS Covid-19 patients admitted during the above period in the department of General Medicine by studying their socio-demographic profiles, CBP, LFT, RFT, Serum electrolytes, Serum albumin, RBS & HbA1C, D-dimer and CT- Severity score etc; .Results: Majority (74%) of the study subjects were belong to 50 years and above age group with the mean age 58.5 years      and males (64%) were more when compared to females (36%) in this study. And also it was noticed that, the ratio of male & female was same among both the survivers and non survivors groups. Significantly (P<0.05) about 52.5% of study subjects of Non survivors group fall under severe ARDS when compared to survivors group (15.3%) basing on the NLR report. Also it was observed that significantly (P>0.05) about 70.8%% of study subjects of Non survivors group fall under severe ARDS when compared to survivors group (12.1%) basing on the PF ratio. Furthur with reference to Hematological and Biochemical inflammatory parameters significant results of differences were observed among Total count, Platelet count, Ferritin, LDH, D-dimer, Serum creatinine, Liver function tests of ALP,ALT & AST and Serum electrolytes (Sodium & Potassium) etc; between both the groups of Non survivors and Survivors.

Background: The COVID-19 pandemic has posed significant challenges, particularly for individuals with underlying health conditions such as Type 2 Diabetes Mellitus (T2DM). Understanding the interplay between T2DM and COVID-19 severity is crucial, given the contradictory findings regarding diabetes as a comorbidity affecting COVID-19 outcomes. This study aims to investigate the clinical relationship between T2DM and COVID-19 to fill the knowledge gap and inform better treatment strategies. Objective: To compare the clinical outcomes, laboratory parameters, and complications of COVID-19 between patients with and without T2DM.Methods: This retrospective cohort study was conducted at SCB Medical College and Hospital, Cuttack, including 180 COVID-19 patients (90 with T2DM and 90 non- diabetic) admitted between September 2020 and September 2021. Data on demographics, clinical presentations, laboratory findings, and outcomes were collected. Statistical analyses included the Chi-Square Test for categorical data and Spearman’s Correlation Coefficient for continuous data, using SPSS software version 26. Results: The mean age was slightly higher in diabetic patients (52.2 years) compared to non-diabetic patients (49.67 years), with a male predominance in both groups. Diabetic patients exhibited more severe disease (78.9%) compared to non-diabetics (64.4%) with a significant association between diabetes and COVID-19 severity (Χ² = 7.2053, p = 0.0273). Laboratory analysis showed higher Random Blood Sugar (RBS) and C-Reactive Protein (CRP) levels in diabetics. Significant differences were observed in SGPT and inflammatory markers (LDH, D-dimer, ferritin, and procalcitonin), indicating heightened inflammatory response in diabetics. Complications such as acute kidney injury (AKI), sepsis, and multiple organ dysfunction syndrome (MODS) were more prevalent in diabetic patients, with higher mortality rates (OR=2.55, 95% CI=1.27-5.09, p=0.007). Conclusion: T2DM significantly exacerbates the severity and complications of COVID-19, highlighting the need for tailored clinical management for diabetic patients during the pandemic. Further research is required to explore underlying mechanisms and improve therapeutic strategies for this high-risk group.

Pulmonary embolism (PE) is a potentially life-threatening condition that can present with non- specific symptoms, including dyspnea and refractory hypoxemia, complicating diagnosis, especially in the absence of clinical signs of deep vein thrombosis (DVT). This study retrospectively evaluates the use of computed tomography pulmonary angiography (CTPA) in diagnosing PE in patients presenting with refractory hypoxemia and dyspnea but without clinical evidence of DVT. The relationship between D-dimer levels, DVT presence, and patient outcomes was also explored. Twenty patients admitted to a tertiary hospital between January 2022 and September 2024 were included in the study. CTPA confirmed PE in all cases, while Doppler ultrasound post-diagnosis revealed DVT in 55% of patients despite the absence of clinical symptoms. D-dimer levels varied from 700 to 2100 ng/mL, with higher levels correlating with a more significant embolic burden. ICU admission was required for 50% of patients, and 35% received thrombolysis due to massive PE or hemodynamic instability. The overall mortality rate was 35%, predominantly among patients with malignancy or those requiring thrombolysis. These findings underscore the importance of considering PE in patients with unexplained hypoxemia, regardless of the absence of DVT symptoms. CTPA remains critical for diagnosis, and D-dimer results should be interpreted cautiously, as normal or mildly elevated levels do not rule out PE. Doppler ultrasound is valuable for detecting subclinical DVT. Further studies are needed to develop non-invasive diagnostic protocols for atypical PE presentations.

Background: India has reported a recent surge in Mucormycosis cases. Mucormycosis is a rare, life-threatening fungal infection having an increased incidence during this COVID-19 pandemic, especially in the second wave in India. Number of rhino-orbito-cerebral mucormycosis cases Post COVID-19 infection increased in Ahmednagar.  Aims and Objectives: To study the early contact of mucormycosis infection after covid positive test. To study the relation of D-Dimer, C-Reactive protein, Sr. Ferritin, blood group and HbA1c to mucormycosis infection. To study the incidence of death rate in mucormycosis patient. Materials and Methods: This retrospective clinical analysis includes data collection of 30 patients from tertiary care hospital located in Ahmednagar district of Maharashtra, India from 1st May, 2021 to 31st August, 2021. All these were post COVID-19 patients presented after varying number of days postinfection and had undergone indoor treatment at various hospitals. Results: We had majority of the patients with blood group O+ 13 cases (43.33%), followed by A+ 9 cases (30%) and B+ 6 cases (20%). KOH mount showed Zygomycetes fungus in all specimens. Debridement was done in 22 patients (73.33%). There were 10 deaths in our study participants (33.33%). We observed a significant difference in Serum ferritin levels (p = 0.048) and HbA1c levels (p = 0.017) in patients who had died of Mucormycosis as compared to those who survived. Conclusion: Close correlation was observed between rhino-orbito-cerebral mucormycosis, diabetes mellitus and Serum Ferritin level in COVID-19 positive patients. Possible follow up and larger sample size will be needed to justify these results more.

Background: Sickle cell anemia (SCA) is a severe hereditary blood disorder marked by vaso-occlusive crises (VOCs), which lead to pain, acute chest syndrome, and other serious complications. These crises are often accompanied by a hypercoagulable state, evidenced by elevated D-dimer levels. Understanding the relationship between these biomarkers and clinical outcomes is critical for managing acute episodes. Aim: This study aims to investigate the correlation between chest X-ray findings and serum D-dimer levels in patients with SCA during VOCs, to better predict complications and guide treatment. Methods: We conducted a retrospective study of 100 patients with SCA admitted for VOCs at VSS Institute of Medical Sciences and Research, analyzing serum D-dimer levels and chest X-ray findings. Data were collected for patients admitted between January 1, 2024, and December 31, 2024. Statistical analysis was performed using SPSS version 23.0, focusing on correlations between D-dimer levels, chest X-ray findings, and hospital stay durations. Results: The study found that patients with abnormal chest X-rays exhibited significantly higher D-dimer levels compared to those with normal X-rays. There was a strong negative correlation between D-dimer levels and oxygen saturation (r = -0.42, p = 0.001). Patients with findings such as consolidation and pleural effusions had longer hospital stays and higher D-dimer levels, indicating more severe crises. Conclusion: Elevated D-dimer levels are correlated with severe chest X-ray findings in SCA patients during VOCs, correlating with worse clinical outcomes. Recommendations: Routine measurement of D-dimer levels in SCA patients presenting with VOCs can be beneficial in predicting the severity of pulmonary complications. Early intervention strategies based on these findings may help in reducing hospital stay lengths and improving patient outcomes.

Purpose of the Review:Venous Thromboembolism is a complication in which blood clots and blocks a vein. Most of the time either it is underdiagnosed or misdiagnosed and becomes serious because of late diagnosis. It encompasses two interrelated conditions such as deep vein thrombosis and pulmonary embolism. Deep vein thrombosis is a significant concern in hospitalized patients and contributes to long hospital stays, morbidity and mortality. The most appropriate inflammatory biomarker for diagnosis and therapeutics in venous thromboembolism remains unclear and is under exploratory condition. The role of molecular markers in the pathophysiology of venous thrombo embolism expands the knowledge of mechanistic action and therapeutic targets. Detection of biomarkers associated with VTE and recurrence of VTE has been explored but limited to few markers like D-dimer, C reactive protein, protein C & S etc. Recent findings: Present study reviewed a total of 44 differentially expressed proteins majorly lipoproteins, glycoproteins, inflammatory proteins and few cytosolic proteins, which were considered as potential biomarker for VTE manifestation. Protein-protein interaction confirmed by a Search tool (STRING) and revealed that CRP, IL6, IL8, IL17, selectin family, JAK-STAT group and tissue factor proteins including VWF proteins are significantly interconnected in disease manifestation, thrombus formation and endothelial cell activation, platelet aggregation, and coagulation.  Summary: The current review and protein protein interaction analysis bring together shreds of evidence of differential expression of protein biomarkers associated with venous-thromboembolism by their function and protein-protein interaction involved in coagulation. 

Background: Pulmonary embolism (PE) is a life-threatening condition with nonspecific clinical presentations, making early diagnosis challenging. Clinical prediction rules (CPRs), such as the Wells Score and the Revised Geneva Score, are widely used to assess pretest probability and guide diagnostic evaluation. This study aimed to evaluate and compare the diagnostic accuracy of these two CPRs in predicting confirmed cases of PE. Methods: A prospective observational study was conducted at tertiary care centers, one in Chhattisgarh and other in Maharashtra, India, over 14 months. A total of 120 adult patients presenting with symptoms suggestive of PE were included. Each patient was evaluated using both the Wells Score and Revised Geneva Score, followed by D-dimer testing and CT pulmonary angiography (CTPA) or alternative imaging, as appropriate. Diagnostic accuracy was assessed through sensitivity, specificity, predictive values, and ROC curve analysis. Results: Among 120 patients, PE was confirmed in 46 cases. The Wells Score categorized 25.8% of patients as high risk, while the Geneva Score classified 22.5% in this category. Both scores showed a clear correlation with confirmed PE: 77.4% (Wells) and 81.5% (Geneva) in high-risk groups. The Wells Score demonstrated slightly higher sensitivity (84.3%) and specificity (71.4%) compared to the Geneva Score (82.3% and 69%, respectively). ROC analysis yielded AUCs of 0.842 (Wells) and 0.821 (Geneva), both statistically significant. Conclusion: Both the Wells and Revised Geneva Scores are effective in stratifying PE risk. However, the Wells Score showed marginally better diagnostic performance and may be preferred in emergency settings when clinical judgment is feasible.

Background: The COVID-19 pandemic, caused by SARS-CoV-2, has been associated with a wide range of clinical presentations, ranging from asymptomatic cases to severe respiratory failure. Inflammatory biomarkers such as C-reactive protein (CRP), D-dimer, and Ferritin have been recognized as important indicators of disease severity and prognosis. This study is aimed to evaluate the levels of these biomarkers in COVID-19-positive patients and correlate them with demographic parameters and clinical outcomes. Methods: A Retrospective Observational Study was conducted in the Department of Pathology, Central Laboratory, RGSSH, OPEC, RIMS, Raichur, from June 2021 to May  2022. A total of 400 COVID-19-positive patients were included. Data on CRP, D-Dimer, and Ferritin levels were collected and analyzed concerning gender, age group, and clinical outcome (ICU vs. ward admission). Results: Of the 400 patients, 58.3% were male and 41.7% were female. The majority belonged to the age group of 41–60 years. Statistically significantly higher levels of CRP (p = 0.02) and D-dimer (p < 0.001) were observed in ICU patients compared to ward patients, while the difference in ferritin levels was not statistically significant (p=0.142). There was no significant association of biomarker levels with gender. However, D-dimer levels showed a significant correlation with age (p = 0.004), with the highest levels in patients above 80 years. Conclusion: Elevated CRP and D-dimer levels are significantly associated with severe COVID-19 infection and ICU admission. These biomarkers may serve as valuable tools for the early identification of high-risk patients, aiding in timely clinical decision-making. Regular monitoring of these markers is recommended to improve patient outcomes.

Background: Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, presents with a wide clinical spectrum ranging from asymptomatic illness to severe respiratory failure. Identifying reliable biomarkers to predict disease severity remains critical, especially in resource-constrained settings. Serum ferritin, an acute-phase reactant, has emerged as a potential marker reflecting systemic inflammation and disease progression. Objective: To evaluate the correlation between serum ferritin levels and disease severity in patients with COVID-19 and to assess its association with demographic factors, comorbidities, and other inflammatory markers. Methods: This hospital-based, observational, cross-sectional study was conducted over one year at a tertiary care center in Central India. Eighty RT-PCR-confirmed adult COVID-19 patients were enrolled. Serum ferritin and inflammatory markers (CRP, IL-6, D-Dimer) were measured within 24 hours of admission. Patients were categorized into mild, moderate, and severe groups based on MoHFW guidelines. Statistical analysis included ANOVA, t-tests, and Pearson correlation using SPSS software. Results: The mean age of patients was 51.2 ± 14.6 years, with 45 males and 35 females. A significant rise in serum ferritin levels was observed across increasing severity groups (mild: 210 ± 45 ng/mL; moderate: 460 ± 110 ng/mL; severe: 890 ± 185 ng/mL). Male patients showed consistently higher ferritin levels than females within each severity category. Ferritin levels correlated positively with CRP, IL-6, and D-Dimer, all of which also rose progressively with disease severity. Conclusion: Serum ferritin levels are significantly associated with disease severity and inflammatory burden in COVID-19 patients. As a readily available biomarker, ferritin can aid early risk stratification and guide clinical decision-making. However, further multicentric studies are warranted to validate these findings and explore ferritin’s mechanistic role in COVID-19 pathogenesis.