Hemorrhage, Disseminated Intravascular Coagulopathy, and Thrombosis Complications Among Critically Ill Patients with COVID-19: An International COVID-19 Critical Care Consortium Study.

OBJECTIVES: To determine the prevalence and outcomes associated with hemorrhage, disseminated intravascular coagulopathy, and thrombosis (HECTOR) complications in ICU patients with COVID-19. DESIGN: Prospective, observational study. SETTING: Two hundred twenty-nine ICUs across 32 countries. PATIENTS: Adult patients (≥ 16 yr) admitted to participating ICUs for severe COVID-19 from January 1, 2020, to December 31, 2021. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: HECTOR complications occurred in 1,732 of 11,969 study eligible patients (14%). Acute thrombosis occurred in 1,249 patients (10%), including 712 (57%) with pulmonary embolism, 413 (33%) with myocardial ischemia, 93 (7.4%) with deep vein thrombosis, and 49 (3.9%) with ischemic strokes. Hemorrhagic complications were reported in 579 patients (4.8%), including 276 (48%) with gastrointestinal hemorrhage, 83 (14%) with hemorrhagic stroke, 77 (13%) with pulmonary hemorrhage, and 68 (12%) with hemorrhage associated with extracorporeal membrane oxygenation (ECMO) cannula site. Disseminated intravascular coagulation occurred in 11 patients (0.09%). Univariate analysis showed that diabetes, cardiac and kidney diseases, and ECMO use were risk factors for HECTOR. Among survivors, ICU stay was longer (median days 19 vs 12; p < 0.001) for patients with versus without HECTOR, but the hazard of ICU mortality was similar (hazard ratio [HR] 1.01; 95% CI 0.92-1.12; p = 0.784) overall, although this hazard was identified when non-ECMO patients were considered (HR 1.13; 95% CI 1.02-1.25; p = 0.015). Hemorrhagic complications were associated with an increased hazard of ICU mortality compared to patients without HECTOR complications (HR 1.26; 95% CI 1.09-1.45; p = 0.002), whereas thrombosis complications were associated with reduced hazard (HR 0.88; 95% CI 0.79-0.99, p = 0.03). CONCLUSIONS: HECTOR events are frequent complications of severe COVID-19 in ICU patients. Patients receiving ECMO are at particular risk of hemorrhagic complications. Hemorrhagic, but not thrombotic complications, are associated with increased ICU mortality.

Hypercoagulability, endotheliopathy, and inflammation approximating 1 year after recovery: Assessing the long-term outcomes in COVID-19 patients.

Sustained hypercoagulability and endotheliopathy are present in convalescent COVID-19 patients for up to 4 months from recovery. The hemostatic, endothelial, and inflammatory profiles of 39 recovered COVID-19 patients were evaluated up to 16 months after recovery from COVID-19. These values were compared with a control group of healthy volunteers (n = 124). 39 patients (71.8% males, median age 43 years) were reviewed at a mean of 12.7 ± 3.6 months following recovery. One patient without cardiovascular risk factors had post COVID-19 acute ischaemic limb. Elevated D-dimer and Factor VIII levels above normal ranges were noted in 17.9% (7/39) and 48.7% (19/39) of patients respectively, with a higher median D-dimer 0.34 FEU µg/mL (IQR 0.28, 0.46) (p < .001) and Factor VIII 150% (IQR 171, 203) (p = .004), versus controls. Thrombin generation (Thromboscreen) showed a higher median endogenous thrombin potential (ETP) of 1352 nM*min (IQR 1152, 1490) (p = .002) and a higher median peak height of 221.4 nM (IQR 170.2, 280.4) (p = 0.01) and delayed lag time 2.4 min (1.42-2.97) (p = 0.0002) versus controls. Raised vWF:Ag and ICAM-1 levels were observed in 17.9% (7/39) and 7.7% (3/39) of patients respectively, with a higher median VWF:Ag 117% (IQR 86, 154) (p = 0.02) and ICAM-1 54.1 ng/mL (IQR 43.8, 64.1) (p = .004) than controls. IL-6 was noted to be raised in 35.9% (14/39) of patients, with a higher median IL-6 of 1.5 pg/mL (IQR 0.6, 3.0) (p = 0.004) versus controls. Subgroup analysis stratifying patients by COVID-19 severity and COVID-19 vaccination preceding SARS-CoV-2 infection did not show statistically significant differences. Hypercoagulability, endothelial dysfunction, and inflammation are still detectable in some patients approximately 1 year after recovery from COVID-19.

Global haemostatic tests demonstrate the absence of parameters of hypercoagulability in non-hypoxic mild COVID-19 patients: a prospective matched study.

Severe COVID-19 patients demonstrate hypercoagulability, necessitating thromboprophylaxis. However, less is known about the haemostatic profile in mild COVID-19 patients. We performed an age and gender-matched prospective study of 10 severe and 10 mild COVID-19 patients. Comprehensive coagulation profiling together with Thromboelastography and Clot Waveform Analysis were performed. FBC, PT, APTT, D-dimer, fibrinogen and CWA were repeated every 3 days for both groups and repeat TEG was performed for severe patients up till 15 days. On recruitment, severe patients had markers reflecting hypercoagulability including raised median D-dimer 1.0 µg/mL (IQR 0.6, 1.4) (p = 0.0004), fibrinogen 5.6 g/L (IQR 4.9, 6.6) (p = 0.002), Factor VIII 206% (IQR 171, 203) and vWF levels 265.5% (IQR 206, 321). Mild patients had normal values of PT, aPTT, fibrinogen and D-dimer, and slightly elevated median Factor VIII and von Willebrand factor (vWF) levels. Repeated 3-day assessments for both groups showed declining trends in D-dimer and Fibrinogen. CWA of severe COVID-19 group demonstrated hypercoagulability with an elevated median values of aPTT delta change 78.8% (IQR 69.8, 85.2) (p = 0.001), aPTT clot velocity (min1) 7.8%/s (IQR 6.7, 8.3) (p = 0.001), PT delta change 22.4% (IQR 19.4, 29.5) (p = 0.004), PT min1 7.1%/s (IQR 6.3, 9.0) (p = 0.02), PT clot acceleration (min 2) 3.6%/s2 (IQR 3.2, 4.5) (p = 0.02) and PT clot deceleration (max2) 2.9%/s2 (IQR 2.5, 3.5) (p = 0.02). TEG of severe patients reflected hypercoagulability with significant increases in the median values of CFF MA 34.6 mm (IQR 27.4,38.6) (p = 0.003), CRT Angle 78.9° (IQR 78.3, 80.0) (p = 0.0006), CRT A10 67.6 mm (IQR 65.8, 69.6) (p = 0.007) and CFF A10 32.0 mm (IQR 26.8, 34.0) (p = 0.003). Mild COVID-19 patients had absent hypercoagulability in both CWA and TEG. 2 severe patients developed thromboembolic events while none occurred in the mild COVID-19 group. Mild COVID-19 patients show absent parameters of hypercoagulability in global haemostatic tests while those with severe COVID-19 demonstrated parameters associated with hypercoagulability on the global haemostatic tests together with raised D-Dimer, fibrinogen, Factor VIII and vWF levels.

The Implementation of AI and AI-Empowered Imaging System to Fight Against COVID-19—A Review Implementation of Machine Learning Techniques for the Analysis of Transmission Dynamics of COVID-19 Data-Driven Decision Making in IoT Healthcare Systems—COVID-19: A Case Study Touch and Voice-Assisted Multilingual Communication Prototype for ICU Patients Specific to COVID’19 Cerebral Venous Thrombosis post BNT162b2 mRNA SARS-CoV-2 vaccination: A Black Swan Event

Summary COVID-19 has already affected the world with this deadly virus, resulting in over 3.5 lakh deaths. The behavior of this virus is extraordinarily peculiar and mutates frequently. So, the scientific community faces the problems to analyze and forecast the virus's growth and transmission capability. The combined effort of powerful Artificial intelligence and Image processing techniques to predict the initial pattern of COVID-19 disease identifies the most affected areas in each country through social networking information and predicts drug-protein interactions for making new drugs vaccines. However, AI-empowered X-Ray and computed tomography image acquisition and segmentation techniques help us identify and diagnose the COVID-19 affected patients with minimal contact. In this chapter, our primary motivation is to sum up the essential roles of some AI-driven techniques (Machine learning, Deep learning, etc.) and AI-empowered imaging techniques to analyze, predict, and diagnose against COVID-19 disease. An essential set of open challenges and future research issues on AI-empowered procedures for handling COVID-19 are also discussed in this chapter. Summary This paper mainly deals with the design of Machine Learning model for the analysis of transmission dynamics of Covid 19. The entire globe is affected because of Corona virus. Ventilator dependent, Severe Acute respiratory and quarantine care ICU patients frequently face difficulties for their most basic human interactions, namely communication due to either respiratory illness, language problem or intubated. ICU patients have serious implications with respect to physical and psychological due to non communication problems. Researchers have developed different types of services like Speech language Pathologist so that Augmentative and alternative communication assistance can be given to all health professionals and caretakers. A probabilistic model is designed to analyse the new cases and death cases. Using machine learning approach Regression model is designed and future predications are displayed. The adequacy of the model is discussed along with the residuals of new cased and death cases. PCF and APCAF are obtained. This paper mainly deals with a probabilistic model to analyse and predict the new cases and deaths of covid 19. A new transformation of analyzing stationarity is carried out and based on this forecasting is executed. Summary This research express an impression of automated decision-making techniques that have been suggested for scrutiny of data from IoT based healthcare systems. IoT data analytics plays a vital role in this modern era since data from connected devices reveal meaningful results with better insights for the future. The chapter involves the design of a decision-making system that collects data from IoT based healthcare systems, preprocess and analyzes data, and generates detailed information reports for better diagnosis. Data preprocessing methods such as data cleaning, munging, normalization, reduction, and removing noisy data are applied. The blend of IoT data with analytics technique results to be beneficial in healthcare systems. The collected IoT information like pulse rate, temperature, oxygen level and heart rate from connected devices can be used to analyze the need and severity in the preliminary stage itself using appropriate machine learning techniques. Multi Criteria Decision Making (MCDM) techniques such as SMART, WPM, and TOPSIS are also applied for conclusion production procedure to generate detailed informative diagnostic reports. Being healthcare data, the overall objective is to aid business organizations with better decision making processes through data analytics thereby deploying the right IoT strategy. The result of the next-generation expert systems can utilize the results for further analysis in diagnosis and treatment. Summary The proposed work deals with the design and development of touch and native voice-assisted prototype to enable the intuitive communication & interaction between health professionals and patients who are affected with Severe Acute Respiratory Infection (SARI), Ventilator-dependent and admitted in Quarantine care. It also ensures the development of the multilingual capability to communicate effectively in most speaking ten Indian languages, so that the patients will be relieved from pains etc., as their queries are being addressed by health professionals. In this prototype, touch based gesture patterns can be effectively used as an interactive module and helps the doctors to monitor and answer to the queries of ICU patients regularly by updating it to the caretakers such that the patients are at ease to express their emotions or pains. The proposed prototype will be made available and accessible in an open software repository. As per the existing methods patients express their needs through non-verbal communication methods and they could be missed out or misinterpreted resulting in symptoms that are poorly understood and the clinicians overestimate their ability to understand their communication feelings. These situations are eradicated by employing the use of ?Touch Voice of SARI? Application. Hence this can be considered as an assistive communication tool which replaces the nonverbal communication to a meaningful communication for ventilator patients and healthcare professionals.

Tuberculous pericarditis with tamponade diagnosed concomitantly with COVID-19: a case report.

BACKGROUND: Tuberculous pericarditis is a rare manifestation of tuberculosis infection. COVID-19 pandemic poses a challenge in detecting uncommon diseases. CASE SUMMARY: A 47-year-old man was admitted with symptoms of COVID-19 infection. Rapid progression of cardiomegaly on radiograph with clinical deterioration were suggestive of pericardial tamponade. Urgent pericardiocentesis revealed haemoserous fluid, elevated adenosine deaminase, and positive tuberculous (TB) polymerase chain reaction (PCR). He was started on anti-TB therapy and Remdesivir with marked improvement of symptoms. Repeat echocardiogram and CT thorax showed resolution of pericardial fluid, and the patient remained well on discharge. DISCUSSION: This case highlights the difficulty in detecting a concomitant rare but important disease. The development of massive pericardial tamponade acutely is not pathognomonic for COVID-19, and a careful diagnostic process involving multi-modality imaging occurred to arrive at a diagnosis of tuberculosis.

COVID-19 associated coagulopathy in critically ill patients: A hypercoagulable state demonstrated by parameters of haemostasis and clot waveform analysis.

Patients with COVID-19 are known to be at risk of developing both venous, arterial and microvascular thrombosis, due to an excessive immuno-thrombogenic response to the SARS-CoV-2 infection. Overlapping syndromes of COVID-19 associated coagulopathy with consumptive coagulopathy and microangiopathy can be seen in critically ill patients as well. Blood was collected from 12 Intensive Care Unit (ICU) patients with severe COVID-19 who were on either mechanical ventilation or on high flow oxygen with a PaO2/FiO2 ratio of <300 mmHg. Laboratory tests were performed for parameters of haemostasis, clot waveform analysis and anti-phospholipid antibodies. CWA parameters were raised with elevated aPTT median Min1 (clot velocity) 9.3%/s (IQR 7.1-9.9%/s), elevated PT median Min1 10.3%/s (IQR 7.1-11.1%/s), elevated aPTT median Min2 (clot acceleration) 1.5%/s2 (IQR 1.0-1.6%/s2), elevated PT median Min2 5.2%/s2 (3.6-5.7%/s2), elevated aPTT median Max2 (clot deceleration) 1.3%/s2 (IQR 0.8-1.4%/s2) elevated PT median Max2 3.8%/s2 (IQR 2.6-4.2%/s2), increased aPTT median Delta change (decreased light transmission due to increased clot formation) 87.8% (IQR 70.2-91.8%) and PT median Delta change 33.0%. This together with raised median Factor VIII levels of 262.5%, hyperfibrinogenemia (median fibrinogen levels 7.5 g/L), increased median von Willebrand factor antigen levels 320% and elevated median D-dimer levels 1.7 µg/dl support the diagnosis of COVID-19 associated coagulopathy. A lupus anticoagulant was present in 50% of patients. Our laboratory findings further support the view that severe SARS-CoV-2 infection is associated with a state of hypercoagulability.

Tuberculous Pericarditis with tamponade in COVID-19: A case report (preprint)

IntroductionTuberculous pericarditis is a rare manifestation of tuberculosis infection. COVID-19 pandemic poses a challenge in detecting uncommon disease. Pericardial effusion with tamponade has been described with COVID-19 but the association with tuberculosis is not yet known. Case presentationA 47-year-old man was admitted with symptoms of COVID-19 infection. Rapid progression of cardiomegaly on radiograph with clinical deterioration were suggestive of pericardial tamponade. Urgent pericardiocentesis revealed hemoserous fluid, elevated adenosine deaminase and positive TB PCR. He was started on steroid, anti-tuberculous therapy and Remdesivir with marked improvement of symptoms. Repeat echocardiogram and CT Thorax showed resolution of pericardial fluid and patient was discharged well. ConclusionsThis case highlights the difficulty in detecting a concomitant rare but important disease. The development of massive pericardial tamponade acutely is not pathognomonic for COVID-19, and a careful diagnostic process involving multi-modality imaging, occurred to arrive at a diagnosis of tuberculosis.