The beneficial role of N-acetylcysteine as an adjunctive drug in treatment of COVID-19 patients in a tertiary care hospital in India: an observational study

Background: N-acetyl cysteine, a mucolytic agent, demonstrates free radical scavenging and anti-inflammatory properties, and prevents endothelial dysfunction by inhibition of NF-KB and formation of no adducts. This has a potential role to tackle cytokine storms, endothelial dysfunction and prothrombotic state observed in COVID-19 manifestations like ARDS and Multi organ dysfunction.Methods: Institution based descriptive cross sectional study, 164 patients from laboratory confirmed RT PCR positive COVID-19 patients, in the study period from 27th May 2020 to 10th August 2020, were assessed, in medical college Kolkata, a dedicated COVID-19 care facility.Results: It was observed that moderate-severe patients who received N-acetyl cysteine along with standard therapy had average hospital stay duration of 12 days, higher rate of discharge, average duration of oxygen therapy of 8 days, less number of deaths and reduced transfer to critical care facilities.Conclusions: N-acetyl cysteine can be considered as an adjunctive therapy with standard protocol driven care, due to its beneficial anti-inflammatory and free radical scavenging properties.

Pressure bandage over venous conduit harvesting site causing compartment syndrome in a patient with intra-aortic balloon pump: An unusual cause.

Intra Aortic Balloon Pump (IABP) is conventionally used to support coronary perfusion and weaning from cardiopulmonary bypass. IABP in situ has its own share of complications. We present a case where a patient on IABP support who had reduced peripheral pulsations of the ipsilateral limb and was initially misdiagnosed as IABP catheter associated thromboembolism. A negative embolectomy ruled out the same. Further looking for the cause of reduction of ipsilateral pulses it was found that the tight compressive bandage at saphenous vein conduit harvesting site had led to development of compartment syndrome (CS).

Pulmonary artery catheter insertion in a patient of dextrocardia with anomalous venous connections.

In a young adult patient having situs solitus with dextrocardia the attempted pulmonary artery catheter placement for emergency mitral valve replacement required an unduly long length (50cm) of catheter insertion to get into right ventricle and then into pulmonary artery. Although catheter coiling was suspected initially, chest x-ray taken after successfully placement revealed an uncommon congenital anomalous venous connection i.e. right internal jugular opening into left sided superior vena cava then into inferior vena cava after running all along the left border of the heart. With the result, it required to pass 50cm of PA catheter to get into right ventricle in our patient. This emphasizes the need to look for abnormal venous connections during echocardiography and x-ray screening in congenital heart disease. Fluoroscopy is recommended when an unusual length of pulmonary artery catheter insertion is required to enter the pulmonary artery.