School based interventions are required to reduce the morbidity associated with non-communicable diseases.

Background and Aim There is a paucity of data on the clinical presentations and outcomes of Corona Virus Disease-19 (COVID-19) in patients with underlying liver disease. We aimed to summarize the presentations and outcomes of COVID-19-positive patients and compare with historical controls. Methods Patients with known chronic liver disease who presented with superimposed COVID-19 (n = 28) between 22 April 2020 and 22 June 2020 were studied. Seventy-eight cirrhotic patients without COVID-19 were included as historical controls for comparison. Results A total of 28 COVID-19 patients (two without cirrhosis, one with compensated cirrhosis, sixteen with acute decompensation [AD], and nine with acute-on-chronic liver failure [ACLF]) were included. The etiology of cirrhosis was alcohol (n = 9), non-alcoholic fatty liver disease (n = 2), viral (n = 5), autoimmune hepatitis (n = 4), and cryptogenic cirrhosis (n = 6). The clinical presentations included complications of cirrhosis in 12 (46.2%), respiratory symptoms in 3 (11.5%), and combined complications of cirrhosis and respiratory symptoms in 11 (42.3%) patients. The median hospital stay was 8 (7-12) days. The mortality rate in COVID-19 patients was 42.3% (11/26), as compared with 23.1% (18/78) in the historical controls (p = 0.077). All COVID-19 patients with ACLF (9/9) died compared with 53.3% (16/30) in ACLF of historical controls (p = 0.015). Mortality rate was higher in COVID-19 patients with compensated cirrhosis and AD as compared with historical controls 2/17 (11.8%) vs. 2/48 (4.2%), though not statistically significant (p = 0.278). Requirement of mechanical ventilation independently predicted mortality (hazard ratio 13.68). Both non-cirrhotic patients presented with respiratory symptoms and recovered uneventfully. Conclusion COVID-19 is associated with poor outcomes in patients with cirrhosis, with worst survival rates in ACLF. Mechanical ventilation is associated with a poor outcome.

The burden and impact of secondary superadded infections in critically ill coronavirus disease 2019 (COVID‐19) patients is widely acknowledged. However, there is a dearth of information regarding the impact of COVID‐19 in patients with tuberculosis, HIV, chronic hepatitis, and other concurrent infections. This review was conducted to evaluate the consequence of severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) infection in patients with concurrent co‐infections based on the publications reported to date. An extensive comprehensive screening was conducted using electronic databases up to 3rd September 2020 after obtaining registration with PROSPERO (CRD420202064800). The observational studies or interventional studies in English, evaluating the impact of SARS‐CoV‐2 in patients with concurrent infections are included for the meta‐analyses. Our search retrieved 20 studies, with a total of 205,702 patients. Patients with tuberculosis (RR = 2.10; 95% CI, 1.75–2.51; I2 = 0%), influenza (RR = 2.04; 95% CI, 0.15–28.25, I2 = 99%) have an increased risk of mortality during a co‐infection with SARS‐CoV‐2. No significant impact is found in people living with HIV (RR = 0.99; 95% CI, 0.82–1.19; I2 = 30%), Chronic hepatitis (RR = 1.15; 95% CI, 0.73–1.81; I2 = 10%). Several countries (Brazil, Paraguay, Argentina, Peru, Colombia, and Singapore) are on the verge of a dengue co epidemic (cumulative 878,496 and 5,028,380 cases of dengue and COVID‐19 respectively). The impact of COVID‐19 in patients of concurrent infections with either tuberculosis or influenza is detrimental. The clinical outcomes of COVID‐19 in HIV or chronic hepatitis patients are comparable to COVID‐19 patients without these concurrent infections.

Prognostic predictors are of paramount interest for prompt intervention and optimal utilization of the healthcare system in the ongoing context of the COVID‐19 pandemic. The platelet‐to‐lymphocyte count ratio (PLR), has emerged as a potential tool for risk stratification of critically ill patients with sepsis. The current systematic review explores the utility of PLR as a prognostic predictor of COVID‐19 patients. We screened the electronic databases until May 15, 2021 after enrolling in PROSPERO (CRD42021220269). Studies evaluating the association between PLR on admission and outcomes in terms of mortality and severity among COVID‐19 patients were included. We retrieved 32 studies, with a total of 2768 and 3262 COVID‐19 patients for mortality and disease severity outcomes. Deceased and critically ill patients had higher PLR levels on admission in comparison to survivors and non‐severe patients (mean differences [MD] = 66.10; 95% confidence interval [CI]: 47.75–84.44; p < 0.00001 and MD = 86.74; 95% CI: 67.7–105.7; p < 0.00001, respectively). A higher level of PLR on admission in COVID‐19 patients is associated with increased morbidity and mortality. However, the evidence is of low quality and further studies regarding the cut‐off value of PLR are the need of the hour.