Objective To determine the incidence of and risk-factors for development of acute kidney injury (AKI) and investigate the association between AKI and mortality in patients hospitalized with Covid-19. Patients and Methods This retrospective case series includes the first 370 patients consecutively hospitalized with confirmed Covid-19 illness between March 10, 2020 and May 13, 2020, at a 242-bed teaching hospital. To determine independent association between demographic factors, comorbidities and AKI incidence, multivariable-logistic regression models were used to estimate odds ratios adjusted for clinical covariates. Results Median age of patients was 71 (59–82) years and 44.3% were female. Patients with AKI were significantly older with a higher comorbidity-burden and mortality-rate (58.1% vs 19.6%, p<.001) when compared to those without AKI. Increasing age, chronic kidney disease, hyperlipidemia and being of African-American descent showed higher odds of AKI. Patients with AKI had significantly higher odds of mortality when compared to patients without AKI, and this effect was proportional to the stage of AKI. Increasing age and acute respiratory distress syndrome also revealed higher adjusted odds of mortality. Conclusion AKI is a common complication among hospitalized Covid-19 patients. We found significantly higher odds of AKI with increasing age, among hyperlipidemics and patients with chronic kidney disease and among African-Americans. We demonstrate an independent association between AKI and mortality with increasingly higher odds of mortality from progressively worsening renal failure in hospitalized Covid-19 patients.

SettingOur study was conducted at a tertiary care center for respiratory illnesses (Viswanathan Chest Hospital, Vallabhbhai Patel Chest Institute (VPCI), University of Delhi, Delhi, India). Patients were enrolled in the study from the outpatient clinic.ObjectiveTo assess the effects of pulmonary rehabilitation (PR) in patients with chronic lung impairment from previously treated tuberculosis (CLIPTB), on exercise capacity (six-minute walk distance), pulmonary function tests, quality of life and markers of systemic inflammation.DesignProspective cohort study including 29 patients who had finished anti-tubercular therapy and currently had symptoms of dyspnea with or without cough secondary to CLIPTB.ResultSignificant improvement in six-minute walk distance (488 meters at baseline vs 526 meters post PR intervention, p-value 0.033) and chronic respiratory questionnaire score (17.21 at baseline vs 18.96 post PR intervention, p-value 0.025) with pulmonary rehabilitation was noted. Pulmonary function tests, inflammatory markers and mid-thigh muscle mass trended towards improvement with pulmonary rehabilitation but were not statistically significant.ConclusionOur study shows that pulmonary rehabilitation is an effective intervention in post-tuberculosis patients and should be recommended.

Invasive pulmonary aspergillosis (IPA) is a severe fungal infection with a high mortality rate. The incidence of IPA is on the rise due to an increase in the number of patients undergoing transplants and receiving chemotherapy and immunosuppressive therapy. Diagnosis is challenging due to the non-specific nature of symptoms. Voriconazole is the mainstay of therapy. We present a case of an elderly woman presenting with acute bronchitis and asthma exacerbation, who succumbed to overwhelming IPA. It is uncommon for IPA to develop in patients on short-term steroid therapy for asthma exacerbation. The possibility of aspergillosis in immunocompetent patients should be considered in those on systemic steroids and deteriorating pulmonary functions.