ABSTRACT
Background: The clinical characteristics of the novel coronavirus disease (COVID-19) were diverse and unspecific. Here, we identified the associated factors with surviving of COVID-19 ICU patients based on the clinical characteristics of patients admitted to one of the Corona Centre Hospitals of Iran. Material(s) and Method(s): This cohort study was performed retrospectively from February to June 2020 on 133 COVID-19 patients admitted to 4 intensive care units of Masih Daneshvari Hospital in Tehran, Iran. Demographic, medical, clinical manifestation at admission, laboratory parameters and outcome data were obtained from medical records. Also the SOFA and APACHE II scores were calculated. All data were analyzed using SPSS (version 23, IBM Corp.) software. Result(s): The median (IQR) age of the patients was 62.0 (54.0-72.0) years in total. RT-PCR of throat swab SARS-CoV-2 in 80 patients (60.2%) was positive. Total mortality rate was 57.9 percent (77 patients). Dyspnea, hypertension and chronic pulmonary diseases were significantly common in non-survivors than survivors (p<0.05). Both SOFA and APACHE II scores were significantly higher in the non-survivors (p<0.05). Also other significant differences were observed in other parameters of the study. Conclusion(s): The mortality rate of COVID-19 patients admitted to ICU is generally high. Dyspnea as initial presentation and comorbidity, especially hypertension and pulmonary diseases, may be associated with higher risk of severe disease and consequent mortality rate. Also, higher SOFA and APACHE II scores could indicate higher mortality in patients admitted to ICU. Copyright © 2020 NRITLD, National Research Institute of Tuberculosis and Lung Disease, Iran.
ABSTRACT
Background: Making decisions and planning about tracheostomy is not clear yet. Objectives: This study aimed to report intensive care unit (ICU) admission, intubation, and tracheostomy rates among patients in different settings and compare the outcomes of surgical and Percutaneous dilational tracheostomy (PDT) techniques between COVID-19 and non-COVID patients.
ABSTRACT
Background and Aim: The COVID-19 disease is an emerging infectious disease that appeared in December 2019 in Wuhan, China. An uncontrolled systemic inflammatory response is one of the primary mechanisms causing death in this disease. In this study, the expression levels of some inflammatory cytokines, vitamin D, and some hematological and biochemical parameters were compared in patients with severe COVID-19 and mild types. Materials and Methods: In this cross-sectional study, 60 blood samples were taken from 30 severe coronavirus patients and 30 mild coronavirus patients. The expression levels of cytokines such as IL (interleukin)-6, interferon (IFN)-α, IL-12, transforming growth factor (TGF) β, IL-8 and tumor necrosis factor (TNF)-α were evaluated using Real-time PCR. A T-test was used for Statistical Analysis. Results: IL-6, IFN-α, IL-12, TGF-β, IL-8, and TNF-α cytokines in the peripheral blood of severe patients, were positive in 28/30 (93.33%), 27/30 (90%), 24/30 (80%), 25/30 (83.33%), 26/30 (86.66%), and 27/30 (90%) respectively. The positive rate of these cytokines in the mild patients were 20/30 (66.67%), 21/30 (70%), 18/30 (60%), 17/30 (56.67%), 19/30 (63.33%), 18/30 (60%), respectively. There was a statistically significant difference between these two groups in terms of cytokines biomarkers. A significant difference was found between both groups in terms of the serum level of lactate dehydrogenase (LDH), the mean number of lymphocytes and neutrophils as well as the mean percentage of neutrophils/ lymphocytes ratio (NLR). Conclusion: The expression of cytokine genes and their release into the peripheral blood was increased in both severe and mild patients with COVID-19. However, they were more intense in patients with severe symptoms than those with mild symptoms and can cause inflammatory and even destructive reactions. Vitamin D deficiency plays no role in causing severe COVID-19 in patients without risk factors. Severe COVID-19 is characterized by elevated serum levels of LDH and NLR≥3.45. © 2022. This is an original open-access article distributed under the terms of the Creative Commons Attribution-noncommercial 4.0 International License which permits copy and redistribution of the material just in noncommercial usages with proper citation.
ABSTRACT
The severity of COVID-19 disease and its mortality may be due to a localized vascular problem owing to the activation of bradykinin B1 receptors on endothelial cells in the lungs that occur following inflammation. Bromelain acts as an anti-inflammatory factor and can lower the level of bradykinin in the serum and tissues. Patients with the novel coronavirus (COVID-19) referred to Masih Daneshvari Hospital in Tehran were included in the study after providing full explanations and obtaining written consent. The 40 patients with mild to moderate symptoms were randomly divided into the control group (No: 20) and sample (No: 20). In the sample group, a dose of 200 mg bromelain was given to patients every 8 hours. In the control group, placebo capsules were administered exactly at the above intervals. Clinical and paraclinical factors (including SaO2, RR body temperature, MAP, HR, CRP, ESR, AST, ALT, Bil, BUN, Cr, WBC, Lymph, LDH, Plt were evaluated on a regular basis for up to five days. The results were evaluated using t-test and SPSS21 software. After treatment, the sample (Bromelain) group indicated significant improvement in SaO2, RR, HR, AST, ALT, BUN, ESR, LDH, and WBC and Lymphocyte count (P<0.05). Other factors did not have a significant difference with the control group. Bromelain causes improvement in some clinical symptoms such as respiratory parameters and para clinical items of mild to moderate hospitalized COVID-19 patients, so it can be a promising treatment. Furthered evaluation of larger groups is recommended.
ABSTRACT
BACKGROUND: A big difficulty in today's world, the Coronavirus has affected all industries and man's life. The disease is caused by a type of the Coronavirus known as COVID-19. A living activated complex, the body is capable of offering various reactions from the defense system against the virus. It should be noted that the most important reaction of the body to the virus involves an activation of the cytotoxic T-shaped cells, which can destroy infected cells as a result of their activity. A more accurate recognition of the cytokine storm mechanism in this disease can greatly contribute to its treatment. In the present study, we investigated the use of IL-10, IL-6, IL-2, and TNF-alpha cytokines in patients with severe conditions at the Intensive Care Unit, and compared that to the real-time PCR method used to relieve the disease in patients. METHODS: We analyzed 30 blood samples from patients with severe conditions and 30 from cured ones using relative real-time RT-PCR, the results of which were subject to statistical analysis using SPSS 20. Moreover, groups of the same age were compared using the t-test. RESULTS: The results showed that age in groups with severe symptoms that were hospitalized in the ICU and people recovering from the disease did not have a significant effect. There was an increase in the expression of IL-10, IL-6, IL-2, and TNF-alpha cytokine genes in the peripheral blood of patients admitted to the ICU compared with those with recovered disease, and there was a significant difference (P value <0.001). CONCLUSIONS: The numerical value of fold change for the cytokine genes of IL-10, IL-6, IL-2, and TNF-alpha in patients admitted to the ICU, compared to recovered patients are 1.28, 1.12, 1.30, 1.22 respectively.
ABSTRACT
Background: A heterogeneous pattern was detected in COVID-19 severe acute respiratory distress syndrome (ARDS) patients. The aim of this study was to define special features and individualized treatment modalities for this fatal infectious disease. Methods: Thirty-six patients diagnosed as COVID-19 severe ARDS were chosen. Lung mechanics (compliance), the extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI), and serum concentrations of immunology markers (interleukin [IL]-1β, IL-6, IL-8, ferritin, and C-reactive protein) were measured. Accordingly, individualized treatment consisting of Actemra, hemoperfusion (HP), continuous renal replacement therapy (CRRT), and extracorporeal membrane oxygenation (ECMO) was implemented for each patient. Results: Patients were categorized according to the lung compliance: 18 in 'L type' with compliance >40 cc/cmH2O and 18 in 'H type' with compliance ≤40 cc/cmH2O. In 16 patients, standard mechanical ventilation management and antiviral therapy were unsuccessful;therefore, hemodynamic and immunity responses were evaluated. Results of transpulmonary thermodilution in L-type patients surprisingly showed EVLWI = 8.8 ± 1.3 (6.9-9.7) and PVPI = 2.4 ± 0.1 (2.2-2.6). In the H-type patients, five cases showed EVLWI = 8.7 ± 0.8 (7.5-9.8) and PVPI = 2.6 ± 0.3 (2.1-2.8) which were subclassified as 'Ha type' and five cases with EVLWI = 17.5 ± 1.9 (15.7-20.6) and PVPI = 3.9 ± 0.4 (3.5-4.5) were named 'Hb type'. By measuring immunologic markers, these two groups were subdivided into high and low marker groups. Individualized treatment resulted in 2 survivals with Actemra, 1 with HP, 2 with HP + CRRT, and 1 with ECMO. Conclusion: According to the heterogeneity of COVID-19 severe ARDS presentation, which is due to various immunologic and hemodynamic responses, a systematic approach is an important and relatively successful strategy in choosing the appropriate treatment modality. © 2020 Medknow.