Distinctions in the DNA sequence of the genes pertaining to α and β adrenergic receptors can result in genetic polymorphisms. These variations can potentially impact response to treatment with adrenergic agonists and antagonists that likely warrant medical intervention. Pharmacogenomics is conceptualized as “the right drug to the right patient,” which implies that pharmacogenomics is entirely personalized. Given that adrenoreceptors play a fundamental role in regards to the pharmacogenetic interaction between catecholamines with α and β adrenergic receptors, it is, therefore, pivotal to highlight and further analyze variants amongst adrenergic receptors to improve the management of diseases pertaining to catecholamine dysfunction. In this review, we highlight the pharmacogenomics of adrenergic receptors and their potential clinical implications in critical care. It is evident that there are several variants associated with the adrenergic receptor alpha 1A (ADRA1A), adrenergic receptor alpha 2A (ADRA2A), adrenergic receptor beta-1 (ADRB1), adrenergic receptor beta-2 genes for α and β adrenergic receptors that were observed among different populations and ethnic groups including the Arg347Cys and Arg389Gly in ADRA1A and ADRB1, respectively. These polymorphisms have resulted in interindividual variability in drug responses for epinephrine, dexmedetomidine, and salbutamol, which concludes that pharmacogenomics of adrenergic receptors have proven immense variability in candidate genes amongst populations that lead to different drug responses.

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Introduction: Acute kidney injury (AKI) in coronavirus disease (COVID-19) is understudied, especially after the initial pandemic wave and in South East Asian Region. Materials and Methods: This was a single-center retrospective cohort of 856 hospitalized COVID-19 cases between March 26, 2021, and June 7, 2021 in India to study the spectrum of AKI in COVID-19. The primary outcome was to analyze predictors of AKI. Other secondary outcome measured was mortality in AKI. Results: The incidence of AKI was 38.1%. The incidence of hemodialysis requirement was 3.5%. The proportion of AKI I, II, and III was 80.2%, 8.2%, and 11.6%, respectively. The mortality in AKI was statistically significantly higher than in non-AKI compared to AKI. Among the laboratory markers, the highest area under the curve (AUC) in the receiver operator curve was reached for red cell distribution width [AUC = 0.77 (0.73–0.81); P < 0.01]. The predictors for AKI calculated by multivariable logistic regression model in the cohort were obesity (hazard ratio (HR) = 3.2 (1.08–9.73); P = 0.04) and baseline European Cooperative Oncology Group (ECOG ≥ 3) (HR = 3.4 (1.77–6.69); P < 0.01). Similarly, the risk factors for developing AKI III included male sex (HR = 1.33 (1.05–1.68); P = 0.02) and ECOG ≥ 3 (HR = 1.5 [1.18–1.9]; P < 0.01). Conclusion: The incidence of AKI is high in hospitalized patients in the COVID-19 second wave. The mortality associated with AKI remains high. The comorbidity burden was not linked with AKI.

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Background: With the COVID-19 pandemic having a significant negative impact on the health-care systems globally, different models of respiratory intermediate care units were shown to play a vital role in the management of COVID-19 patients, especially those with impaired oxygenation. The present study demonstrates that respiratory intermediate care units were helpful in reducing health-care cost and acting as a backup for intensive care units (ICUs) in Saudi Arabia. Design and Setting: This is a retrospective study that was carried out in King Saud University Medical City, Riyadh, Saudi Arabia, between June 15, 2020, and August 7, 2020. The study team collected information from patients' records. The data collected comprised patient's demographic information, admission site, admission criteria, and length of hospital stay. Descriptive and comparative analyses were carried out through the SPSS version 26. Results: Eighty-one patients were eligible for inclusion: 67.9% were male, 58% were above 50 years old, and similar proportions were overweight. Chronic kidney disease was the most commonly occurring comorbidity (23.5%), whereas only three patients had hypertension, and a similar number had some form of immunosuppression. In addition, 44.4% of patients were admitted through COVID wards. The mean length of hospital stay was 11 ± 5 days, with 54.3% of patients staying for more than 10 days. About 97.5% of the patients were transferred to the general medical COVID-19 ward, whereas only 2.5% were admitted to ICU. The percentage of high-flow oxygen either high-flow nasal cannula or noninvasive ventilator was 66.2 ± 15.7%. About 27.2% of the patients required oxygenation through a simple standard interface such as a mask or nasal cannula. There was no significant difference among age groups and different body mass index categories in terms of hospitalization course and oxygenation. Females used noninvasive ventilation (P = 0.008) more than males. Conclusion: Females are more prone to higher oxygenation needs compared to males with COVID-19 infections. Respiratory care units can reduce the number of females who need ICU admissions for noninvasive ventilation.

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