Objectives: This study aimed to compare the severity of COVID-19, inflammatory parameters and clinical outcomes among patients with normal and subnormal levels of Vitamin D. Methodology: This is a retrospective cohort study of 135 patients admitted in a tertiary hospital for COVID-19. Patients were grouped according to their Vitamin D level. Primary outcome measure was the composite of all-cause mortality and morbidity. Other outcome measures determined were the comparison among the groups on the severity of COVID-19 infection, changes in inflammatory parameters, length of hospital stay and duration of respiratory support. Results: There was a significant trend of higher ICU admission (p=0.024), mortality (p=0.006) and poor clinical outcome (p=0.009) among the Vitamin D deficient group. No significant difference was found for most of the inflammatory parameters, duration of hospital stay and respiratory support. Overall, patients with deficient, but not insufficient Vitamin D level had 6 times higher odds of composite poor outcome than those with normal Vitamin D (crude OR=5.18, p=0.003; adjusted OR=6.3, p=0.043). Conclusion The inverse relationship between Vitamin D level and poor composite outcome observed in our study suggests that low Vitamin D may be a risk factor for poor prognosis among patients admitted for COVID-19.
Vitamin D ; Vitamin D Deficiency ; COVID-19

Background/Aims: Nonalcoholic fatty liver disease (NAFLD) is closely associated with diabetes. The cumulative impact of both diseases synergistically increases risk of adverse events. However, present population analysis is predominantly conducted with reference to non-NAFLD individuals and has not yet examined the impact of prediabetes. Hence, we sought to conduct a retrospective analysis on the impact of diabetic status in NAFLD patients, referencing non-diabetic NAFLD individuals. Methods: Data from the National Health and Nutrition Examination Survey 1999–2018 was used. Hepatic steatosis was defined with United States Fatty Liver Index (US-FLI) and FLI at a cut-off of 30 and 60 respectively, in absence of substantial alcohol use. A multivariate generalized linear model was used for risk ratios of binary outcomes while survival analysis was conducted with Cox regression and Fine Gray model for competing risk. Results: Of 32,234 patients, 28.92% were identified to have NAFLD. 36.04%, 38.32% and 25.63% were non-diabetic, prediabetic and diabetic respectively. Diabetic NAFLD significantly increased risk of cardiovascular disease (CVD), stroke, chronic kidney disease, all-cause and CVD mortality compared to non-diabetic NAFLD. However, prediabetic NAFLD only significantly increased the risk of CVD and did not result in a higher risk of mortality. Conclusions Given the increased risk of adverse outcomes, this study highlights the importance of regular diabetes screening in NAFLD and adoption of prompt lifestyle modifications to reduce disease progression. Facing high cardiovascular burden, prediabetic and diabetic NAFLD individuals can benefit from early cardiovascular referrals to reduce risk of CVD events and mortality.

Introduction: The unprecedented COVID-19 pandemic has led to unavoidable new norms, including increasing demands for online learning. In view of the potential constraints to virtually learn anatomy among medical students, this study was conducted to identify the level of exposure towards online anatomy learning as well as the perceived constraints among medical students in a public university in Malaysia. Methods: A cross sectional study utilizing online survey was conducted during the movement control order (MCO) enforcement in Malaysia between March and October 2020 among all consented medical students at a public university in the Klang Valley area. The data was collected using a validated self-administered questionnaire which was distributed using Google Form application. Results: A total of 281 medical students consented and completed the online survey, with 94.3% students had low level of exposure towards online anatomy learning. Year of study and accessibility towards computing facilities and internet connection were significantly associated with online anatomy learning, with the non-clinical students are 19.9 (aOR= 19.888, B=2.990, 95%CI: 2.484-159.220) times more likely to have higher exposure towards online anatomy learning respectively. Conclusion: A very high proportion of medical students having low exposure towards online anatomy learning was observed in this study, which was predicted among the clinical students. Strengthening the utilization of online learning should be seriously considered in parallel with the new norms and the many uncertainties with COVID-19 pandemic, to ensure continuity of effective and quality learning.