<b><i>Background:</i></b> Most COVID-19 studies conclude old age and coexisting illnesses as mortality determinants owing to different populations or methodologies, or omitting factors affecting outcomes. <b><i>Methods:</i></b> We analyzed COVID-19 patients’ data (<i>N</i> = 391) of Dubai Hospital between January 1, 2020 and June 30, 2020. <b><i>Results:</i></b> Only 19 patients (4.8%) were UAE nationals, while 372 (95.2%) were expatriates. Median age was 48 (interquartile range, 40–56) years; 22% were &#x3c;40 years, and only 16.6% were female. Cough was the most common symptom (78.7%), fever was 77.4%, and gastrointestinal symptoms were least common (13.8%). Approximately 95% had elevated C-reactive protein (CRP) and D-dimers (79%), lymphocytopenia 47.3%, and thrombocytopenia 13.8%. Mortality was 30% for the total sample and 50% in ICU patients. ICU patients were older than non-ICU (age; 49.6 ± 10.9 vs. 46.7 ± 12.7 years, <i>p</i> = 0.04). Eighty-five percent of ICU patients required invasive mechanical ventilation, 78% vasopressors, 88% sedation, 84% muscle paralysis, while none require any of these in the medical group. Survivors had fewer patients with sedatives (<i>p</i> = 0.01). The median length of stay in the hospital was 19 days, ICU stays 14 days, and ventilator 11 days. The Mann-Whitney test showed that survivors spent more days in the ICU (median [IQR] 18 [6.5–29.5] vs. 11 [4–18], <i>p</i> value 0.003) and the hospital (32 [14.5–49.5] vs. 14 [7–21], <i>p</i> value 0.001) than nonsurvivors. Ferritin and D-dimers were higher in nonsurvivors, but CRP was lower in nonsurvivors (ferritin (ng/mL) median (IQR) 1,434 (661.5–2206.5) versus 1,362 (630–2,094), <i>p</i> value = 0.017, CRP (mg/L) 118.7 (53.4–184) versus 134.9 (66.5–203.2), <i>p</i> value 0.001 and D-dimer (µg/mL) 1.54 (0–3.13) versus 1.09 (0–2.51), <i>p</i> value = 0.001). Multiple logistic regression analysis determined age, fever on admission, use of oxygen, mechanical ventilation, and steroids as predictors of survival. <b><i>Conclusions:</i></b> COVID-19 patients were young males with pre-existing conditions. Ferritin, CRP, and D-dimers were higher in nonsurvivors. Treatment with chloroquine, antivirals, and anticoagulation was not different between survivors and nonsurvivors. Steroid use was a survival predictor.

The renin angiotensin aldosterone system (RAAS) inhibitors represent an invaluable class of drugs in the management of various stages of the cardiovascular disease continuum. Both angiotensin converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) have unique pharmacodynamics properties. These enable them to block the RAAS system at multiple levels. The ARBs inhibit RAAS in a mechanistically distinct fashion when compared to the ACEIs. Whereas ACEIs decrease the synthesis of angiotensin II, ARBs selectively and competitively bind to the AT1 receptors hence preventing there activation by angiotensin II. The differential effects of these two groups of drugs, resulted in them playing different roles in primary and secondary cardiovascular protection. It is suggested that ACEIs tend to be more "cardioprotective" whereas ARBs may be more "cerebral-protective". In this review article, we will attempt to enhance understanding of the role of RAAS blockers in cardiovascular disease continuum and help make the most appropriate selection of ACEIs and ARBs according to their attributes and the needs of the clinical situation. We will initially described the role of RAAS activation in the pathophysiology of common cardiovascular disease processes. This will be followed by a review of the major clinical trials of different ACEIs and ARBs in the primary prevention and secondary prevention of cardiovascular diseases.In conclusion, the effects of ACEIs across a wide spectrum of cardiovascular diseases remain indisputable. However, ARBs showed a superior effect to ACEIs with regard to stroke, but their efficacy in certain major clinical end points seems limited.

BackgroundThe coronavirus disease (COVID-19) virus has caused millions of deaths. It is difficult to differentiate between pure viral COVID-19 pneumonia and secondary infection. Clinicians often use procalcitonin (PCT) to decide on empiric antibiotic therapy. MethodologyWe performed a retrospective study of patients admitted with COVID-19 between January 1st, 2020, and June 30th, 2020. Patient demographics, clinical findings, and laboratory findings with a focus on PCT levels were recorded. Coinfection was considered if clinicians ordered a septic workup (urine, blood, and respiratory cultures) or if the physicians started or escalated antimicrobial therapy. PCT levels on the day of culture and daily for the next three days were recorded. Significant PCT change was defined as a decrease in PCT levels of >50% from the initial elevated PCT level. ResultsIn total, 143 (59.8%) patients had one secondary infection. These included pulmonary infections (118, 49.4%), blood infections (99, 41.4%), and urine infections (64, 26.8%). Many patients had more than one documented positive culture: respiratory system and blood together in 80 (33.4%) patients, sputum and urine in 55 (23.1%) patients, and urine and blood in 46 (19.2%) patients. Out of the 143 patients with a positive culture, PCT was abnormal on the day of positive culture in 93 (65.5%), while PCT was abnormal in 64 out of 96 on the day of negative culture (66.7%) (p = 0.89). Individual analysis for PCT levels of respiratory cultures showed out of 118 positive sputum cultures, 86 (72%) had abnormal PCT on the day of culture. PCT in positive versus negative cultures was not significantly different, with median PCT (interquartile range, IQR) of 1.66 (6.61) versus 1.03 (2.23) (p = 0.172). For blood cultures, out of 99 positive blood cultures, 73 (73%) had abnormal PCT levels on the day of the culture. PCT in positive versus negative cultures was significantly elevated, with a median of 1.61 (5.97) vs. 0.65 (1.77) (p < 0.001). For urine, out of 64 positive cultures, 41 (64.1%) had abnormal PCT levels on the day of the culture. PCT in positive versus negative cultures was not significantly different, with a median of 0.71 (2.92) vs. 0.93 (4.71) (p = 0.551). To observe the change in PCT after culture, PCT values for the next three days after culture were analyzed. We found that patients with positive cultures had higher PCT levels than those with negative cultures. There was no significant improvement over the following three days. Patients with abnormal PCT on the day of the suspected infection had a longer length of stay in the hospital, with a median (IQR) of 23.9 days (3.16) vs. 16.9 days (2.18) (p = 0.021). ConclusionsSecondary coinfections in patients with COVID-19 infections are not associated with PCT elevation on the day of suspected secondary infection. However, most patients with bacteremia had a significant elevation of PCT on the day of bacteremia before collection and reporting of positive culture. Patients with abnormal PCT levels on the day of suspected i...

Geriatric population is a special subset of adult population with different needs as there are physiological changes that occur with aging, that lead to a decline in patient's overall performance functional disabilities and, cognitive impairment,We reviewed the various anti diabetic regimes in Emirati geriatric patients with type 2 diabetes following outpatient medical clinics. In a view to find optimum anti-diabetic regime which is more suitable and acceptable to the patients with minimum side effects. We believe that patients following in government hospitals would be a true representation of whole subset of Emirati geriatric population and hence any results obtained could be a reflection of entire Emirati geriatric population. Medical records of 350 Emirati type 2 diabetic patients age above 65 were reviewed. HBAIC at the clinic visit was noted and they were retrospectively followed up as to see which anti diabetic regime these patients were on for the preceding 3 months. Patients were divided accordingly into 4 groups namely. a) Those on oral hypoglycemic, b) oral hypoglycemic plus basal insulin, c) premix insulin and d) basal insulin bolus. Mean HBAIC was compared amongst the various age groups. Conclusion350 patients were following medical clinics, 16 patients were excluded. Out of the remaining 334 patients 224 were females and 110 were males. Patients were divided into 2 groups according to age. Patients less than 70 years of age were 121 (36.2%) and patients greater than 70 years of age were 213 (63.8%).Patients in both these age groups had uncontrolled blood sugars. HBAIC 8.1% vs. HBAIC 7.76% in patients less than 70 year's vs. patients greater than 70 years age). In higher age groups HBAIC was better controlled as compared to lesser age groups reflecting better care of elderly in the Emirati society.Most patients were on oral hypoglycemic as compared to insulin (60.5% vs. 21.6%). Both males and females were better controlled on oral medication as compared to insulin (HBAIC 7.58% males and HBAIC 7.69% in females on oral medications). Sulfonyl urea and metformin being the most popular oral medications used. Only 21.6% were on insulin reflecting increase needle phobia in the elderly age groups.

Crimean-Congo haemorrhagic fever (CCHF) is a viral zoonosis transmitted to humans and animals (which act as a reservoir) through the bite of a ‘Hyalomma’ tick. CCHF virus belongs to the genus Nairovirus. Humans are infected when they come in direct contact with the blood or secretions of infected livestock or other infected humans. This disease initially presents with non-specific febrile symptoms common to many viral illnesses and later progresses to disseminated intravascular coagulation (DIC) with haemorrhagic manifestations.We present the case of a middle-aged man with CCHF. He presented to the hospital with DIC and acute compartment syndrome in the right forearm, requiring urgent orthopaedic intervention. The diagnosis was delayed because there was no clear history of contact. The patient was started taking ribavirin on the fifth day of hospital admission. He recovered fully.