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Background. Introduction: Only a few cases of SARS-CoV-2 pneumonia in infants have been reported, and the epidemiological, clinical presentation and the course of these patients are not yet fully understood. Clinical presentation: we report the case of a 4-month-old infant admitted to the intensive care unit for the management of a hemorrhagic syndrome which turned out to be Sars cov 2 pneumonia. Discussion: While research into the COVID-19 pandemic is still ongoing, it appears that young children are less likely to be infected with SARS-CoV-2 and their infection is less severe. Conclusion: SARS-CoV-2 pneumonia would be less frequent and less serious in infants, but this should not make us omit this diagnosis in the face of acute respiratory distress, especially if there is an underlying family cluster.
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INTRODUCTION: COVID 19 pneumonia can lead to an inappropriate inflammatory response, and can be complicated by acute respiratory distress syndrome, multivisceral failure with a high mortality rate. OBJECTIVE: To observe the effect of therapeutic plasma exchange on the excessive inflammatory response. MATERIALS AND METHODS: In this study, we included 7 confirmed cases of COVID-19 in the intensive care unit (ICU) department of the university hospital of Oujda. COVID-19 cases were confirmed by RT PCR (reverse transcription-polymerase chain) and CT (computerized tomography) imaging according to WHO guidelines. Therapeutic plasma exchange was performed decrease cytokine storm-induced ARDS (Acute respiratory distress syndrome). Inflammation marker assays were performed before and after therapeutic plasma exchange to assess its efficacy. RESULTS: Levels of inflammatory cytokines (IL-6) and acute phase response proteins, including ferritin and CRP, were elevated before therapeutic plasma exchange.After therapeutic plasma exchange, levels of acute phase reactants, inflammatory mediators, were significantly reduced (p < 0.05). CONCLUSION: Our data suggest that therapeutic plasma exchange reduces the inflammatory response in patients with severe COVID-19 not undergoing mechanical ventilation. Further studies are needed to explore the efficacy of therapeutic plasma exchange in patients with COVID-19.
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BACKGROUNDS: Corona virus disease 19 (Covid-19) affects especially the respiratory tract, and induces lung injury which may progress to the acute respiratory distress syndrome (ARDS). Various treatment options were tried all over the world, corticosteroids had showed beneficial effects.The Objective of this study, is to compare the safety and efficiency of two corticosteroids: dexamethasone and prednisolone in the treatment of Covid-19 infection. METHODS: This retrospective and comparative study included 513 patients diagnosed with Covid-19 infection and were admitted to intensive care unit of our university hospital center of MOHAMMED VI Oujda from March 1, 2020, to December 31st, 2020. RESULTS: In this study, 513 cases were included, 230 patients were received methylprednisolone, and 283 were treated with dexamethasone. The median age in methylprednisolone group was 64 years, and 63 years in the second group treated with dexamethasone. Patients treated with dexamethasone had more critically lesions compared to patients treated with methylprednisolone (67.6%), these patients had a good evolution with a significant reduction of oxygen supplementation, lower use of invasive ventilation and a significant improvement in biological parameters. The difference in outcome between the two groups in terms of mortality was significantly reduced in the second group. CONCLUSION: Both steroids are efficient in the management of mild, moderate and severe Covid-19 pneumonia with a clear superiority of dexamethasone especially in severe forms.
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BACKGROUND: COVID-19 is a new disease that appeared in December 2019. Millions of people have been infected and died from this infection. Until today, the pathophysiology and treatment of this infection remain unknown, but a lot of studies are trying to solve the mystery. The trail of inflammation remains the most convincing, especially the Interleukin 6 (IL-6) which could play an important role in a reaction cascade leading to a cytokine storm. According to studies, although few in number, the Tociluzimab (TCZ), which is an anti-IL6, could prevent or even suppress this storm, leading to a less severe clinical state of the disease and a faster recovery. This could decrease the use of oxygen, avoid the risk of intubation and mortality. PATIENTS AND METHODS: This single-center retrospective observational case review brought together 557 COVID-19 seriously ill patients (pulmonary involvement> 25% + SatO2AA <90%) admitted to the intensive care unit of our university hospital from March 1st, 2020 to February 28th, 2021. They were divided into 2 groups a Tociluzimab group (TCZ group) and a Non Tociluzimab group (NON TCZ) to facilitate the comparison. The aim of the study was to compare the length of hospital stay, the use of mechanical ventilation and the mortality in the TCZ group versus the NON TCZ group. RESULTS: The average age of our patients was 62,05 years (±13.51) and 62.61 years (±16.33) respectively in the TCZ versus NON TCZ group. 76 (76%) were men while 24 were women (24%) in the TCZ group; and there was 313 (68.49%) men and 144 (31.51%) women in the NON TCZ group. Their average BMI was 28 kg/m2 (±4.52) in the TCZ group versus 27.89 kg/m2 (±4.73) in the NON TCZ group. Among them, the TCZ group included 38 (38%) diabetic patients, 38 hypertensive (38%), 12 heart disease (12%) and 2 chronic renal failure (2%), while the NON TCZ group regrouped 35 (7.65%) diabetics, 33 (7.22%) hypertensive, 12 heart disease (2.67%), and 5 chronic renal failure (1.09%) patients. The mean time to consultation of patients was almost similar in the two groups: 8.86 (±7,28) days for TCZ and 8.83 (±7,03) days for NON TCZ group. The mean length of ICU hospital stay was 9 days (4,94) for the TCZ group and 8,75 days (4,73) for the other one. The saturation at admission was at 74.92% (10.45) for the TCZ group ranging from 40% to 92%, and at 73,56% for the NON TCZ group. Lung damage from COVID-19 was extensive in 12%, severe in 32%, and critical in 56% of TCZ group enrolled cases. Meanwhile it was extensive in 23.63%, severe in 41,35%, and critical in 35,01% of the NON TCZ group. The biological findings found average of white blood cells at 12256/12082 e/mm3, lymphocytes at 761/842 e/mm3, CRP at 181/199 mg/L, ferritin at 1747/528 µg/L, and fibrinogen at 6.92/6.27 g/L for the TCZ group versus NON TCZ group. Medical care was based on isolation, oxygenotherapy, azithromycin, vitamin C, zinc, vitamin D, salicylic acid, dexamethasone followed with methylprednisolone, and anticoagulation for all hospitalized patients. The TCZ group received at least 1 course of Tociluzimab dosed at 400 mg (2 patients received 2 doses and 1 patient received 3 doses). The indication of a Tociluzimab course in our department was based on a set of arguments: an increase in oxygen requirements, a progression of lesions on chest-computed tomography and an increase in inflammation markers including IL-6, CRP, ferritin, fibrinogen, and a decrease in the percentage of lymphocytes. The invasive mechanical ventilation was indicated for 4 (4%) patients in the TCZ group versus 192 (42,01%) in the NON TCZ. Among the 100 patients included in our cohort in the TCZ group, 40% died in intensive care unit and 60% had a favorable evolution with a decrease of the biological markers of inflammation. However, in the NON TCZ group, 197 (43,10%) passed away. CONCLUSION: The use of Tociluzimab in ICU patients with severe COVID-19 pneumonia did not contribute to a significant difference in the reduction of hospital stay. However, the invasive mechanical ventilation was less needed in patients receiving Tociluzimab than the others. Moreover, there was a mortality benefit associated with the use of Tociluzimab, but only before 10 days of hospitalization.
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INTRODUCTION: Covid-19 is a severe emerging infection with high rate of mortality. Patients with Covid-19 and Down syndrome represent a high rate of morbidity and mortality. CASE PRESENTATION: Case 1: A 27-year-old white male with Down's syndrome admitted to the ICU for Covid-19 infection with lung damage of 30-50%. The patient improved and referred to the pulmonology department.Case 2: A 49-year-old man admitted to the ICU for Covid-19 infection with a lung damage of 50%. The evolution was lethal and he passed away after 12 days of his admission. CONCLUSION: People suffering from Down syndrome should be given priority in the management of acute respiratory distress following infection with SARS COV2, or even candidates for early immunosuppressive treatment and possible vaccination once started.
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BACKGROUND: To date, more than 105,805,951 cases of COVID-19 have been diagnosed including 2,312,278 deaths. Many patients have cardiovascular risk-factors and/or co-morbidities and a lot of them developed de novo heart conditions during the active or the post-infectious phase of the infection. A number of studies tried to demonstrate an association between poor prognostic outcomes and cardiovascular comorbidities and related damages, but the quality of current evidence is still weak. PATIENTS AND METHODS: The aim of this single-center report is to describe the prevalence of cardiac injuries among our COVID-19 patients, to explore their association with survival outcomes and to demonstrate the medical care provided in our real-world setting. Our study included 610 COVID-19 patients admitted to the intensive care unit of our university hospital of whom13.77% (n = 84) presented cardiovascular injuries and which we included in this case series. RESULTS: The average age of our patients was 65 years (27-90). 60 were men (71.42%) while 24 were women (28.55%). Their average BMI was 29.7 kg/m2. Among them, 50 had a pulmonary embolism (59.52%), 12 patients had a myocardial infarction (14.28%), 10 presented pericarditis (11.9%) and 3 developed myocarditis (3.57%). There were 6 cases of ischemia (7.14%), 2 cases of stroke (2.38%), and 1 case of decompensated heart failure (1.19%). Among our patients, 46.42% had diabetes, 32.14% had a high blood pressure, 13.09% had a chronic renal failure and 14.28% had a history of ischemic heart disease. 14 patients (16.66%) had an elevated troponin with higher levels than 1000 ng/mL. The D-dimer value was high in almost all patients (80.95%). Lung damage from COVID-19 was extensive in 27.38%, severe in 32.14%, and critical in 40.47% of enrolled cases. CT chest angiography, ECG, and cardiac ultrasound were performed to the paraclinical confirmatory exploration of cardiac damages of these patients. Medical care was based on isolation, azithromycin, vitamin C, zinc, vitamin D, salicylic acid, dexamethasone followed with methylprednisolone, and anticoagulation for all hospitalized patients. Tocilizumab was indicated for 17 patients with hyperferritinemia (20.23% of patients). The initial respiratory care of our patients required oxygen therapy using nasal cannula (7.14%) high concentration masks (33.33%), high flow nasal cannula treatment (11.9%), non-invasive ventilation (NIV) (5.95%), and mechanical ventilation (41.66%). Thrombolysis was performed in three subjects with myocardial infarction and 2 underwent angioplasty with placement of an active stent at the proximal interventricular anterior artery, which all were successful. Three massive pulmonary embolisms died despite adequate treatment. Colchicine and salicylic acid were administered for pericarditis cases. Thromboprophylaxis was indicated for all patients and was reinforced if a venous thrombotic episode was confirmed. Patients with limb ischemia underwent surgical treatment. Among the 84 patients included in our cohort, 34 (40.47%) died in intensive care unit and 50 (59.52%) had a favorable evolution. CONCLUSION: Cardiovascular involvement during COVID-19 should not be neglected and are associated with severe outcomes.
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The first case of coronavirus disease 2019 (COVID-19) was declared in December in Wuhan, before becoming a global pandemic in a few weeks. Several complications of this infection have been reported. However, a spontaneous pneumomediastinum has rarely been described. We report the fourth case of this extremely rare complication in a 65-year-old male patient with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pneumonia, discovered during his therapeutic management by a CT scan control.