Association Of Pre-Infection Vitamin D Status With COVID-19 Severity

Madam, Vitamin D is a fat-soluble vitamin, well known for regulating serum calcium and phosphate levels by stimulating intestinal absorption, renal reabsorption of calcium in the distal convoluted tubule and bone calcium mobilization. As an important modulator of innate immunity, reduced vitamin D levels have been linked to the development of different autoimmune disorders and increased susceptibility to infectious diseases(1). Vitamin D pivotal role in inhibiting cytokine storm and inflammation reactions(1). It is reported that the active form of vitamin D enhances the antimicrobial effect of macrophages and monocytes(1). It is also involved in the stimulation and production of lymphocyte function and it also supports the differentiation and function of natural killer cells (1). Since December 2019, COVID-19 caused by SARS-CoV-2 has spread all over the globe causing unparalleled health, social and economic crises. Initially, an association of vitamin D status with SARS-CoV-2 infection was observed which has sparked debate over the advantages of vitamin D in preventing and treating this disease. A greater risk of COVID-19 was substantially related with low serum 25-(OH) Vitamin D levels. It also suggests that the patients with Vitamin D deficiency had poorer outcomes leading to comparatively longer stays in the Intensive Care Unit (ICU), and had a higher fatality rate. (2). There is much debate about whether infections caused the low D3 levels or whether a deficiency adversely affects the immune system. Recently, Amiel et al. discussed that among hospitalized COVID-19 patients, pre-infection vitamin D insufficiency was linked to increased disease severity and mortality in hospitalized COVID-19 patients.(3). This study presents convincing evidence that low D3 levels are a predictor rather than a side effect of infection (3). The study by Lorenz et. al. suggested that 50ng/mL of 25-(OH)D3 might potentially result in a mortality rate close to zero(4). According to a systematic review and meta-analysis of the incidence of vitamin D deficiency among South Asian adults, about seven out of ten individuals in this region are vitamin D deficient.(5). Owing to the study Amiel et al. we suggest it would be reasonable to encourage daily sun exposure and fortification of food items with vitamin D. ---Continue

Insertable cardiac monitoring devices versus external cardiac monitoring for detecting atrial fibrillation and preventing the recurrence of stroke: A systematic review and meta-analysis

BACKGROUND

Atrial Fibrillation (AF) is a major risk factor for stroke, which is the second leading cause of death worldwide. It remains uncertain whether insertable cardiac monitors (ICMs) enhance the ability to recognize AF over external cardiac monitoring in patients who have experienced a stroke.

AIM

We conducted a systematic review and meta-analysis to determine whether ICM devices are more effective than external cardiac monitoring for the detection of AF in stroke patients.

METHODS

We included studies that reported an AF detection rate in stroke patients with a follow-up of at least 12 months. We analyzed the data of 1233 patients from 3 randomized control trials (RCTs).

RESULTS

When compared to external cardiac monitoring, ICM devices (Medtronic Reveal LINQ and Reveal XT) showed a significantly higher detection rate of AF (RR = 5.04, 95% CI = 2.93-8.68; p < 0.05; ARR = 10.47%, NNT = 10). The ICM arm had significantly higher usage of oral anticoagulants (OAC) as compared to the control arm. (RR = 2.76, 95% CI = 1.89-4.02, p < 0.05). Additionally, ICM usage was associated with a higher incidence of mild to moderate adverse events (RR = 10.52, 95% CI =1.35-82.14; p = 0.02) and a higher number of severe adverse events as compared to the control arm (RR = 7.61, 95% CI = 1.36-42.51; p = 0.02).

CONCLUSION

ICM devices are associated with better detection rates of AF and higher usage of OAC as compared to external cardiac monitoring in post-stroke patients. However, ICM insertion is associated with a higher incidence of mild/moderate and severe adverse effects.