Introduction Background Burden of COVID 19 Need of the study Rationale of the study Review of literature Epidemiology Hypothesis Aim and objective Material and Method Criteria Study design Outcome Result Analysis Discussion Coronavirus are a large family of viruses that causes illness ranging from the common cold to more serve disease such as middle east respiratory syndrome(MERS-COV) and sever acute respiratory syndrome (SARS-COV). A novel corona virus (nCOV) is a new strain that has not been previously identified in humans. SARS-CoV-2 belongs to the Single Standing RNA Viruses class of coronaviruses, but the infection had been rapidly spreading around the world and World Health Organization (WHO) declared a pandemic .

1. 1
Investigation of Long term Hazards and Multi organ Impact of SARS COV-2 in
Post Covid Patients
R. C. Patel Institute of Pharmaceutical Education and Research

2. 2
Investigation of Long term Hazards and Multi organ Impact of SARS COV-2 in
Post Covid Patients
Presented by :
Jagruti .N. Marathe
Clinical Department
M.Pharm IVth Sem
Guided by:
Mrs. Hemakshi. E. Chaudhari
Assistant Professor
Department of Clinical Pharmacy
R. C. Patel Institute of Pharmaceutical Education and Research
HOD: Dr Savita Patil

3. Content
3
 Introduction
 Background
 Burden of COVID 19
 Need of the study
 Rationale of the study
 Review of literature
 Epidemiology
 Hypothesis
 Aim and objective
 Material and Method
 Criteria
 Study design
 Outcome
 Result
 Analysis
 Discussion

4. Introduction
 Coronavirus are a large family of viruses that causes illness ranging from the common cold to
more serve disease such as middle east respiratory syndrome(MERS-COV) and sever acute
respiratory syndrome (SARS-COV).
 A novel corona virus (nCOV) is a new strain that has not been previously identified in
humans.
 SARS-CoV-2 belongs to the Single Standing RNA Viruses class of coronaviruses, but the
infection had been rapidly spreading around the world and World Health Organization (WHO)
declared a pandemic .
4

5. Background
￮ According to A recent report of in Indian Express 20 March2021
showed that about 80 percent of the participants had major
complaints of fatigue (similar to post-SARS fatigue) and the rest, a
small percentage had critical manifestations such as lung fibrosis,
kidney failure, myocarditis and stroke.
￮ Therefore, further investigations are needed to detect the exact
mechanisms of pathogenesis.
￮ Hence this study aims to add onto the ever-emerging landscape of
medical knowledge on COVID-19, encapsulating its multiorgan
impact in post Covid patients. 5

6. Burden of Covid-19
 The coronavirus (COVID-19) is spreading rapidly across the country but testing regime of India
is far from the global standards.
 It is important to identify the states where testing needs expansion and the magnitudes of active
COVID cases are higher focusing on current health infrastructure to meet the pandemic.
 The data on COVID-19 was extracted from the Application Programming Interface.
 Test positive rate, test per confirmed case, recovery rate, case fatality rate, and percent
distribution of active cases were computed.
6

7. 7

8. 8

9. 9
https://www.worldometers.info/coronavirus/?fbclid=IwAR3
5ZFiRZJ8tyBCwazX2N
-k7yJjZOLDQiZSA_MsJAfdK74s8f2a_Dgx4iVk

10. Need of the study
 COVID-19 patients can suffer long-term multi organ effects. The findings of this study show
the importance of implementing structured follow-up care for patients suffered from COVID-
19 infection.
10

11. 11
11
Endocrine
complication
Renal
complication
Lung
complication
Cardiac
complication
The pulmonary pathobiology of Covid-19 from that of equally severe influenza virus
infection.
cardiac cases showed higher rates of organ failure and mortality than non-cardiac
cases. Hence need more supervision
patients with AKI during severe SARS-CoV-2 infection is higher death rate reported
COVID-19 patients with CKD presented high incidence of neutrophilia, poor prognosis and in-
hospital death
ICU cases showed higher rates of organ failure and mortality than non-ICU cases.
Hence need more supervision
Review of literature

12. 12

13. Hypothesis
13
Long term lung disturbances occurs in post covid patients due to SARS CoV 2 infection

14. 14

15. Timeline
15
SEP
AUG
JUL
JUN
MAY
APR
MAR
FEB
Dec-
JAN
NOv
OCT
SEP
Collection of data Review writting
Ethical committee
approval
Research work
Thesis writting
Thesis printing
Making plain for
research work
Progress Seminar Thesis correction
submission

16. 16

17. Aim:
Investigation of Long term Hazards and Multi organ Impact of SARS COV-2 in Post Covid Patients
Objectives
This study will help to…
Conduct the longitudinal study to assess the health status of the COVID-19 recovered patient
Generate the validated data on Possible influence of COVID-19 to cause multiorgan damage
Conduct Follow-up survey of COVID-19 recovered patients will be helpful to evaluate any
changes in the other organs in human systems
Conduct Follow-up study will be useful to design a possible vaccine for this dreadful infection.
Report Recommendation for COVID-19 recovered patients
17

18. 18
Criteria Particulars
Research Method Experimental method
Study Site Indira Gandhi Memorial Hospital, Shirpur, Dist.-Dhule, Maharashtra
Study Type Case Control, Observational, Non Interventional, Comparative Study
Study Subjects Post Covid and Normal Patients
Sample Size 200
Sample Volume 2 ml(blood sample)
Duration of study 1 year
Study Parameters Demographic Parameters, Anthropometric
Parameters, Socioeconomic Parameters
Name, Age, Weight, Height, Sex, Gender,
Occupation, Past Medical History
Lung Function FVC , FEV, FEV/FVC, PEF, FEF25-75
Liver Function LDH-p
Cardiac Function CK-MB
Kidney Function CRE
Inflammation CRP

19. 19
Instrument Required:
Lung Function Test: Software based Ultrasonic Flow Meter (Easy on
Spirometer)
Hematological parameters : Hematological Autoanalyzer
Other parameters : Microplate reader, Microplate

20. 20
￮ INCLUSION CRITERIA
 Post covid 19 patients .
 Normal patients .
 Patients with associated disease like , Heart disease, Kidney
disease , Lung disease , Endocrine disease . .
￮ EXCLUSION CRITERIA
 Small children
 Pregnant women
 Old people(more than 70)
 Patients associated with untreatable disease like cancer,
HIV

21. 21
Normal of Population Post COVID -19popolation
Socioeconomic
Demographic
Anthropometric Anthropometric
Demographic
Socioeconomic
Collection of Blood
Lung function test
P
A
R
A
M
E
T
E
R
P
A
R
A
M
E
T
E
R
Collection of Blood
Lung function test
Study design and out come

22. 22
Normal polulation
CRE
LDH-P
CK-MB
CRP
Lung function test
Post Covid-19 polulation
CRE
LDH-P
CK-MB
CRP
Lung function test
Vs

23. 23

24. 24
Paramet
er
Low Mid High
CRE
LDH-P
CK-MB
CRP
24

25. 25
N
o
r
m
a
l
P
o
p
u
l
a
t
i
o
n
P
o
s
t
-
C
o
v
i
d
-
1
9
p
o
p
u
l
a
t
i
o
n
0
10
20
30
40
CK-MB
Normal Population
Post-Covid-19 population
Graph:2 table Analyzed of (CK-MB) Column A
(Normal Population)vs Column B (Post-Covid-19
Population) unpaired t-test Value=<0.0001 significant,
t=4.845 df=214, Mean of column A=18.69 and mean of
column B=26.76, difference between means(B-
A)±SEM8.068±0.0220095%confidence interval 0.2645 to
0.3512 R squared(eta squared) 0.4779
CK-MB in the Control Group and Post-Covid-19 Patients The CK-MB biomarker patients with post
COVID-19 in elements of direct infection of myocardial injury, specific binding to functional receptors
and cardiomyocytes, and immune-mediated myocardial injury in post-Conid-19 patients.. During
hospitalisation, laboratory myocardial damage markers should be monitored more closely in post-
COVID-19 patients

26. 26
LDH-P
Norm
al Population
Post Covid
19 population
0
100
200
300
400
LDH-P
Graph:3 table Analyzed of LDH-P) Column A (Normal
Population)vs Column B (Post-Covid-19 Population)
unpaired t-test Value=<0.0001 significant, t=9.366
df=214, Mean of column A=174.8and mean of column
B=236.7, difference between means(B-
A)±SEM61.96±6.615 95%confidence interval 48.92 to
75.00 R squared(eta squared) 0.2908,
F, DFn, Dfd=4.750,101,110
LDH-P in Normal Population and Post-Covid-19 patients. In the case of post-Conid-19 patients, the
LDH-P biomarker patients with post COVID-19 in aspects of Lactate dehydrogenase (LDH) is one such
biomarker of interest, especially since elevated LDH levels have been associated with worse outcomes
in patients with other viral infections in the past

27. 27
Norm
al Polulation
Post-Covid
Population
0.0
0.5
1.0
1.5
2.0
CRE
Graph:4 table Analyzed of (CRE) Column A (Normal
Population)vs Column B (Post-Covid-19 Population)
unpaired t-test Value=<0.0001 significant, t=13.50
df=214, Mean of column A=0.8011and mean of column
B=1.367, difference between means(B-
A)±SEM0.5662±0.04195 95%confidence interval 0.4835
to 0.6488 R squared(eta squared) 0.4598,
F, DFn, Dfd=6.750,101,110
CRE in Normal Population and Post-Covid-19 patients. In the case of post-Conid-19 patients, the CRE
biomarker increases it shows patients with post COVID-19 high risk of renal disorder.

28. 28
N
orm
al
P
ost C
O
VID
-19
0
1
2
3
4
FVC
Normal
Post COVID-19 Graph:5 table Analyzed of (FVC) Column A (Normal
Population)vs Column B (Post-Covid-19 Population) unpaired t-
test Value=<0.0001 significant, t=8.833 df=214, Mean of
column A=2.147and mean of column B=2.843, difference
between means(B-A)±SEM0.6960±0.07880 95%confidence
interval 0.5407 to 0.8513 R squared(eta squared) 0.2672,
F, DFn, Dfd=1.055,101,110

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N
o
r
m
a
l
P
o
s
t
C
O
V
I
D
-
1
9
0
1
2
3
FEV1
Graph:7 table Analyzed of FEV1 Column A (Normal Population)vs
Column B (Post-Covid-19 Population) unpaired t-test Value=<0.0001
significant, t=12.47 df=214, Mean of column A=1.754 and mean of
column B=2.251, difference between means(B-A)±SEM0.469±0.03986
95%confidence interval 0.4183 to 0.5735 R squared(eta squared)
0.4207,
F, DFn, Dfd=1.111,101,110

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N
orm
al P
opulation
P
ost-C
ovid-19
population
0.0
0.5
1.0
1.5
FEV1/FVC
Normal Population
Post-Covid-19 population Graph:6 table Analyzed of FEV1/FVC Column A (Normal
Population)vs Column B (Post-Covid-19 Population) unpaired t-
test Value=<0.0001 significant, t=2.159 df=214, Mean of
column A=0.8427and mean of column B=0.9073, difference
between means(B-A)±SEM0.6463±0.02994 95%confidence
interval 0.005612 to 0.1236 R squared(eta squared) 0.02131,
F, DFn, Dfd=7.671,101,110
FEV1/FVC suggests that the lungs are the organ most affected by COVID-193 with different
pathophysiological events that include diffuse alveolar epithelium destruction, hyaline membrane
formation, capillary damage and bleeding, alveolar septal fibrous proliferation, and pulmonary
consolidation. Post-infection COVID-19 patients showed impaired lung function; the most important of the
pulmonary function tests affected was the diffusion capacity

31. 31
N
o
r
m
a
l
p
o
p
o
l
a
t
i
o
n
P
o
s
t
C
O
V
I
D
-
1
9
0
5
10
15
FEF25-75[l/s]
Normal popolation
Post COVID-19
Graph: table Analyzed of FEF25-75(L/s) Column A
(Normal Population)vs Column B (Post-Covid-19
Population) unpaired t-test Value=<0.0001 significant,
t=22.46 df=214, Mean of column A=6.383 and mean of
column B=10.50, difference between means(B-
A)±SEM04.113±0.1831 95%confidence interval 3.752 to
4.474 R squared(eta squared) 0.7022,
F, DFn, Dfd=1.003,101,110

32. 32
N
orm
al P
opulation
P
ost-C
ovid-19
population
0
1
2
3
4
5
PEF[L/s]
Normal Population
Post-Covid-19 population Graph:7 table Analyzed of (PEF) Column A (Normal
Population) vs Column B (Post-Covid-19 Population)
unpaired t-test Value=<0.0001 significant, t=3.911 df=214,
Mean of column A=3.745and mean of column B=3.225,
difference between means(B-A)±SEM-
0.5203±0.133095%confidence interval -0.07825 to -0.2580
R squared(eta squared) 0.06670,
F, DFn, Dfd=1.376,101,110
The suggested pathogenic mechanism proposes that COVID-19 causes first damage, similar to SARS, as a
result of a microvascular injury with initial interstitial thickening and clean lungs on radiological tests, as
well as significant hypoxaemia.

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N
o
r
m
a
l
p
o
p
o
l
a
t
i
o
n
P
o
s
t
C
O
V
I
D
-
1
9
0
1
2
3
4
5
FET
Normal popolation
Post COVID-19
Graph:7 table Analyzed of (PEF) Column A (Normal
Population) vs Column B (Post-Covid-19 Population)
unpaired t-test Value=<0.0001 significant, t=8.833
df=214, Mean of column A=2.147and mean of column
B=2.843, difference between means(B-A)±SEM-
0.6960±0.07880%confidence interval -0.5407 to -0.8513
R squared(eta squared) 0.2672,
F, DFn, Dfd=1.055,104,110

34. Analysis
34

35. Discussion
35
23 high quality retrospective studies systematically evaluated the risk of severe
disease, ICU admission, or death associated with COVID-19-related cardiac injury
performance. Their findings are as follows:
(1) COVID-19 patients with elevated TnF alpha levels are at significantly higher risk
of developing severe disease, requiring ICU admission, or death;
(2) elevated CK, CK-MB, LDH, and IL-6 levels and emerging arrhythmia are
associated with the development of severe disease or requirement for ICU admission;
and mortality rates are significantly higher among patients with elevated LDH and IL-
6 levels.

36. 36
Post-infection COVID-19 patients showed altered respiratory function. The most important of the PFTs
affected was the diffusion capacity in close to 40% of patients. The results of PFTs must be analysed with
caution and considering the respiratory comorbidities and the possible impairment generated by smoking and
air pollution. Well-designed studies conducted in post-COVID-19 infection patients, taking into consideration
the infection severity and based on the pulmonary function guidelines are required.
Future research should be focused on the characterisation of short and long-term respiratory function sequelae
to optimise the decision-making in clinical practice. The data collected to date in this systematic review could
be a useful starting point for further studies. of 69%. The incidence of LDH was associated with presence of
diabetes, this phenomenon might be due to reduced glycogen synthesis, change in glucose

37. 37
These mechanisms because elevated lactate in patients with insulin resistance compared with those without.
LDH has been found to affect the prognosis of various diseases, including cancers.32 LDH elevation in
patients with COVID-19 indicates lung and tissue injuries.19 COVID-19 may lead to inadequate tissue
perfusion and multiple organ failure due to various mechanisms, including thrombosis, which lead to LDH
elevation. Thus, high LDH serves as a biomarker of the disease extent
. But in present study we have actually performed these all parameters in post covid patients and tried to find
the impact of SAARS Cov 2 on different organs. This study has generated the data on organ function due to
Covid 19.
The care should be taken at lea t for 1 year after covid 19 to prevent relaps of this infection further.

38. Outcome
 This study has generated the systematic data on……….
 Comparison of lung pattern alteration between post COVID 19 patients and normal patients
 Level of CRP, LDH, Creatinine Kinase, Creatinine, and Complete Blood Count in Post-Covid
Patients.
 Long term hazards of Sars Cov-2 in Post-covid patients
 Impact of Saars-Cov2 on Lung, Heart, Liver Blood and Kidney.
 Levels of FVC FEV PEF FEF in post covid patients compared with normal
38

39. 39
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10.1016/S0140-6736(20)30743-1

40. 40
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