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COVID 19 pandemic has put a massive strain on healthcare all over the world. Every day new data is getting released and various complications are being reported in patients of COVID 19 Pneumonia. One such complication is pneumothorax and pneumomediastinum. Both these conditions can lead to an increase in mortality and morbidity in patients with COVID 19 pneumonia. We studied 476 patients of COVID 19 pneumonia at our hospital, out of which 18 (3.78%) had developed pneumothorax and/or pneumomediastinum. While most of these patients were on some form of positive pressure ventilation (invasive/non-invasive), some of them had a HRCT Chest suggestive of either air trapping and/or cyst formation. Three patients had developed bilateral pneumothorax while on non-invasive ventilator. Nine of the 18 patients expired and nine were discharged. Through this article, we would like to emphasize that an acute deterioration in hypoxemia in a COVID-19 patient could indicate a pneumothorax. Pneumothorax as well as pulmonary thromboembolism are reported complications in COVID-19 and clinician vigilance is required during assessment of patients, as both share the common symptom of breathlessness and therefore can mimic each other.
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Objective: Mesenchymal stem cells can serve as a therapeutic option for COVID-19. Their immunomodula-tory and anti-inflammatory properties can regulate the exaggerated inflammatory response and promote recovery of lung damage. Method: Phase-1, single-centre open-label, prospective clinical trial was conducted to evaluate the safety and efficacy of intravenous administration of mesenchymal stem cells derived from umbilical cord and placenta in moderate COVID-19. The study was done in 2 stages with total 20 patients. Herein, the results of stage 1 including first 10 patients receiving 100 million cells on day 1 and 4 with a follow up of 6 months have been discussed. Results: No adverse events were recorded immediately after the administration of MSCs or on follow up. There was no deterioration observed in clinical, laboratory and radiological parameters. All symptoms of the study group resolved within 10 days. Levels of inflammatory biomarkers such as NLR, CRP, IL6, ferritin and D-dimer improved in all patients after intervention along with improved oxygenation demonstrated by improvement in the SpO2/FiO2 ratio and PaO2/FiO2 ratio. None of the patients progressed to severe stage. 9 out of 10 patients were discharged within 9 days of their admission. Improvements were noted in chest x-ray and chest CT scan scores at day 7 in most patients. No post-covid fibrosis was observed on chest CT 28 days after intervention and Chest X ray after 6 months of the intervention. Conclusion: Administration of 100 million mesenchymal stem cells in combina-tion with standard treatment was found to be safe and resulted in prevention of the cytokine storm, halting of the disease progression and acceleration of recovery in moderate COVID-19. This clinical trial has been registered with the Clinical Trial Registry-India (CTRI) as CTRI/2020/08/027043. http://www.ctri.nic.in/Clinicaltrials/pmaindet2. php?trialid=43175.
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BACKGROUND: Provision of virtual health care (VHC) home monitoring for patients who are experiencing mild to moderate COVID-19 illness is emerging as a central strategy for reducing pressure on acute health systems. Understanding the enablers and challenges in implementation and delivery of these programs is important for future implementation and re-design. The aim of this study was to explore the perspectives of staff involved with the implementation and delivery, and the experience of patients managed by, a VHC monitoring service in Melbourne, Australia during the COVID-19 pandemic. METHODS: A descriptive qualitative approach informed by naturalist inquiry was used. Staff interviews were analysed using the Consolidated Framework for Implementation Research (CFIR). Patient experience was captured using a survey and descriptive statistics were used to describe categorical responses while content analysis was used to analyse free text responses as they related to the CFIR. Finally, data from the interviews and patient experience were triangulated to see if patient experience validated data from staff interviews. RESULTS: All 15 staff were interviewed, and 271 patients were surveyed (42%). A total of four final overarching themes emerged: service implementation enablers, service delivery benefits for patients, fragmentation of care, and workforce strengths. 19 subthemes aligned with 18 CFIR constructs from staff and patient data. CONCLUSION: Rapid implementation was enabled through shared resources, dividing implementation tasks between senior personnel, engaging furloughed healthcare staff in design and delivery, and having a flexible approach that allowed for ongoing improvements. Benefits for patients included early identification of COVID-19 deterioration, as well as provision of accurate and trustworthy information to isolate safely at home. The main challenges were the multiple agencies involved in patient monitoring, which may be addressed in the future by attributing responsibility for monitoring to a single agency.
Subject(s)
COVID-19 , Australia , COVID-19/epidemiology , Delivery of Health Care , Humans , Pandemics , Patient Outcome Assessment , Qualitative ResearchABSTRACT
Background: COVID-19, an infectious disease caused by SARS-CoV-2 virus has reported to be a global pandemic. About 5% of the total develop severe ARDS. Aim: To study the clinical profile, comorbidities and outcome including mortality rate in severe Covid- 19 ARDS patients. Methodology: 40 cases of severe COVID 19 infection (P/F ratio<300) admitted in tertiary care ICU treated with standard covid protocol were included in the study. Their demography, severity of hypoxia, mode of ventilation and outcome analysed. Results: Out of the 40 patients admitted, 29 (72%) were discharged with 11 patients (38%) requiring home oxygen therapy. The most common comorbidities were diabetes mellitus (30%) and hypertension (22.5%). Mean hospital stay was 17 days, and 35 patients (87.5%) required ventilation of which 80% on NIV and 20% on Mechanical ventilation. The mortality rate was 27.5%. The P/F ratio and CRP values was statistically significant with mortality rate (p-value<0.05). Three patients (7.5%) on positive pressure ventilation developed pneumothorax. One patient (2.5%) developed pulmonary thromboembolism.14 patients (35%) were in MODS out of which 8 patients died. Conclusion: Mortality rate was less in patients with a high P/F ratio and low CRP levels at the time of admission. Severe COVID 19 patients admitted in the ICU had developed additional complications requiring interventions. Patients in MODS had high mortality rate. Most common comorbidity associated was diabetes mellitus.
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Background: Covid 19 and Tuberculosis are the infectious diseases primarily affecting the lung. Both of them present with cough, fever and difficulty in breathing but Tuberculosis has a longer incubation period and onset of disease is slower. The patients of Tuberculosis are more likely to have comorbidities (malnutrition, diabetes mellitus, Human Immunodeficiency Virus) that increases their vulnerability to covid-19. Aim: To study the clinical profile, course, management and outcome in patient presented with covid-19 and tuberculosis in covid pandemic in Mumbai. Methods: We studied the 323-patient admitted in covid Intensive Care Unit and ward who were proven covid 19 positives by Reverse Transcriptase Polymerase Chain Reaction, Cartridge Based Nucleic Acid Amplification Test or rapid antigen test. All patients were given standard medical care, ventilatory support if required as per covid19 protocol. The chest x-ray, blood investigation and sputum investigation were studied till the time of discharge or death. Results: Out of 323 patients studied 14 had Tuberculosis. Out of those 14 patients 10 patient had pulmonary tuberculosis, 3 had Tuberculous pleural effusion and one had abdominal tuberculosis. All of them had pneumonia on chest x-ray which can be attributed to covid-19 or Tuberculosis. Conclusion: In our study all 14 patients were survived and discharged. As there is high burden of tuberculosis the covid-19 only helped in exposing the tip of the iceberg of the grave problem of undiagnosed tuberculosis in community. It seems that there is just coincidental occurrence of tuberculosis and covid19 coinfection than a causal association.
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Background: COVID 19 pandemic has put a massive strain on healthcare all over the world. Various complications are being reported in patients of COVID 19 Pneumonia. One such complication is pneumothorax and pneumomediastinum. Objective: To study the incidence, clinical profile, management and outcome of patients with pneumothorax in COVID 19 pneumonia. Method: We studied 476 diagnosed patients of COVID 19 pneumonia at our hospital between May 2020 and May 2021. All patients were treated as per standard COVID 19 protocol at the time. Clinical examination and serial chest X-Ray and/or CT Chest were done to look for pneumothorax/pneumomediastinum. Results: Out of the 476 patients, 18 (3.78%) had developed pneumothorax and/or pneumomediastinum. While most of these patients were on some form of positive pressure ventilation (13 out of the 18), some of them had a HRCT Chest suggestive of either air trapping and/or cyst formation. Three patients had developed bilateral pneumothoraces while on non-invasive ventilator. Nine of the 18 patients expired and nine were discharged. Conclusion: Through this article, we would like to emphasize that an acute deterioration in hypoxemia in a COVID-19 patient could indicate a pneumothorax. Pneumothorax as well as pulmonary thromboembolism are reported complications in COVID-19 and clinician vigilance is required during assessment of patients, as both share the common symptom of breathlessness and therefore can mimic each other.
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Background: SARS-CoV-2 virus is the cause of the most recent pandemic that has affected the world since December 2019. Objective: To study the outcome of Covid patients along with the associated co-morbidities during the First and Second Covid wave in a Respiratory Covid ward (including ICU) at a tertiary care centre. Methods: We studied 214 Covid patients in the First Covid wave and 97 patients in the Second Covid wave. Patients mainly had complaints of dyspnea, fever, cough, generalized weakness as the main symptoms. All patients with and without co-morbidities with Covid-19 were given standard treatment as per protocol. Outcome (Discharge/ Death) of all the patients were studied in both the Covid waves. Results: Out of the 214 patients in the First Covid wave, 30.8% (66) patients died. Of these, 60% (40) had comorbidities. The major co-morbidities in dead patients were diabetes (33.33%) followed by hypertension (24.2%). In patients with underlying respiratory diseases, COPD (12.1%) was followed by Post Tuberculosis OAD (3%) and Tuberculosis (3%). As compared with the First Covid wave, the Second wave had a mortality of 48.5% (47). The major co-morbidities in dead patients were hypertension (38.3%) followed by diabetes (25.5%). In patients with underlying respiratory diseases, COPD (4.3%) was the most common cause of death. Conclusion: In both the Covid waves, diabetes, hypertension and COPD (underlying respiratory disease) were the leading co-morbidities associated with death.
ABSTRACT
COVID 19 pandemic has put a massive strain on healthcare all over the world. Every day new data is getting released and various complications are being reported in patients of COVID 19 Pneumonia. One such complication is pneumothorax and pneumomediastinum. Both these conditions can lead to an increase in mortality and morbidity in patients with COVID 19 pneumonia. We studied 476 patients of COVID 19 pneumonia at our hospital, out of which 18 (3.78%) had developed pneumothorax and/or pneumomediastinum. While most of these patients were on some form of positive pressure ventilation (invasive/non-invasive), some of them had a HRCT Chest suggestive of either air trapping and/or cyst formation. Three patients had developed bilateral pneumothorax while on non-invasive ventilator. Nine of the 18 patients expired and nine were discharged. Through this article, we would like to emphasize that an acute deterioration in hypoxemia in a COVID-19 patient could indicate a pneumothorax. Pneumothorax as well as pulmonary thromboembolism are reported complications in COVID-19 and clinician vigilance is required during assessment of patients, as both share the common symptom of breathlessness and therefore can mimic each other. © 2022 Journal of Association of Physicians of India. All rights reserved.
ABSTRACT
COVID 19 is one of the world’s worst hit pandemics. WHO first learned of this new virus on 31 December 2019, following a report of cluster of cases of ‘viral pneumonia’ in Wuhan, China. Covid 19 causes systemic infection but it worst hits the lungs and can cause ARDS (<5%). Bilateral lung fibrosis is a commonly observed sequela after severe Covid 19 infection. Covid 19 pneumonia also acts as a nidus for superadded bacterial and fungal infections. However we haven’t come across fibrocavitation and fungus ball as post Covid 19 sequelae. We here present a case report of a patient who was diagnosed as ARDS due to SARS CoV2, was treated as per standard Covid 19 protocols, required NIV and discharged on home oxygen. The HRCT on discharge showed bilateral fibrosis. The follow up HRCT after 45 days of discharge showed evidence of Bilateral cavities with Fungus ball. © 2021 Journal of Association of Physicians of India. All rights reserved.