The impact of asprin use on the outcome of patients admitted to the intensive care unit with COVID-19 infection (preprint)

Background Our objective in this study is to know the impact of the use of asprin in anti-aggregation dose on the evolution during hospitalization of patients admitted in intensive care unit for a severe infection by SARS-COV-2.Methods We conducted a prospective study of patients admitted to our department with severe COVID-19 infection during the period between March 2020 and March 2022, analyzing the difference between the placebo group and the aspirin group on the primary endpoint of all-cause hospital mortality and the composite secondary endpoint of use of mechanical ventilation and thromboembolic events.Results Out of 1124 patients included, 32.6% died, with a protective effect of aspirin against placebo (Hazard-ratio = 0.691, p = 0.003), for thrombo-embolic complications, 104 events were observed, with a protective effect of aspirin (Hazard-Ratio = 0.448 and p = 0.001), finally regarding mechanical ventilation, there was no remarkable benefit on our sample.Conclusion Given the divergence of results of studies published in the literature, the availability of results of large randomized controlled trials is a necessity.

Ischemic stroke revealing COVID-19 infection: Case report.

INTRODUCTION: SARS-COV-2 viral infection primarily targets the respiratory system with a clinical picture that varies from simple symptoms to respiratory distress syndrome requiring hospitalization in the intensive care unit; SARS-CoV-2 also has neuro-invasive capabilities and could spread from the respiratory system to the central nervous system. Recently, some patients with COVID-19 have been shown to have neurological symptoms such as headache, anosmia, dysgeusia, dizziness, impaired consciousness, and ischemic stroke. CASE PRESENTATION: we describe a case of ischemic stroke as the main presentation of COVID-19 in a 68 years old man with no previous history, without any associated respiratory signs; clinical examination revealed left hemiparesis with dysarthria and left facial paralysis, NIHSS score was at 11, the brain CT scan performed 1h30min later, completed by a brain MRI that came back in favor of right frontal, temporal and parietal ischemic stroke. The decision of thrombolysis was indicated in urgency, and the patient benefited from thrombolysis, which proceeded without incidents; the outcome was favorable with regression of symptoms.Ischemic stroke has been widely described among the thromboembolic complications of COVID-19, but only a few papers have reported it as a primary manifestation of COVID-19. CONCLUSION: SARS-COV 2 infection can spread from the respiratory system to the central nervous system, resulting in an inflammatory response and excessive secretion of inflammatory markers, leading to ischemic stroke.

High-flow nasal oxygen therapy decrease the risk of mortality and the use of invasive mechanical ventilation in patients with severe SARS-CoV-2 pneumonia? A retrospective and comparative study of 265 cases.

INTRODUCTION: Corona virus disease (Covid-19) affects the airways and induces pulmonary lesions, patients with this disease require oxygen therapy as the disease progresses. Several oxygenation options have been used, l'HFNO had showed beneficial effects. THE OBJECTIVE OF THIS STUDY: To evaluate the efficacy of high-flow nasal oxygen HFNO versus non-invasive ventilation in COVID-19. METHODS: This is a retrospective and comparative study conducted over a period of 10 months from March 2020 to December 2020 and involving 600 patients hospitalized in the intensive care unit of the CHU Mohammed VI of Oujda for the management of acute respiratory failure caused by COVID-19. RESULTS: Out of 600 patients with acute respiratory failure, 265 patients were included in the analyses. 162 (61.10%) patients were treated with HFNO, the intubation rate was 49.7% (80 patients out of 162) of which 63 died intubated (78.8%). Concerning the 82 non-intubated patients, only 16 died (19.8%).The total number of patients who received NIV was 71 (26.8%), 33 (46.5%) required mechanical ventilation. In-hospital mortality in patients treated with NIV was 100%.The difference in mortality outcome between the two groups was significantly (P < 0.0001) reduced in HFNO. CONCLUSIONS: Treatment with high-flow oxygen improved survival in patients with acute hypoxemic respiratory failure compared with noninvasive ventilation, although no difference was observed in intubation rate.

High-flow nasal oxygen therapy decrease the risk of mortality and the use of invasive mechanical ventilation in patients with severe SARS-CoV-2 pneumonia? A retrospective and comparative study of 265 cases

Introduction Corona virus disease (Covid-19) affects the airways and induces pulmonary lesions, patients with this disease require oxygen therapy as the disease progresses. Several oxygenation options have been used, l’HFNO had showed beneficial effects The objective of this study To evaluate the efficacy of high-flow nasal oxygen HFNO versus non-invasive ventilation in COVID-19. Methods This is a retrospective and comparative study conducted over a period of 10 months from March 2020 to December 2020 and involving 600 patients hospitalized in the intensive care unit of the CHU Mohammed VI of Oujda for the management of acute respiratory failure caused by COVID-19. Results Out of 600 patients with acute respiratory failure, 265 patients were included in the analyses. 162 (61.10%) patients were treated with HFNO, the intubation rate was 49.7% (80 patients out of 162) of which 63 died intubated (78.8%). Concerning the 82 non-intubated patients, only 16 died (19.8%). The total number of patients who received NIV was 71 (26.8%), 33 (46.5%) required mechanical ventilation. In-hospital mortality in patients treated with NIV was 100%. The difference in mortality outcome between the two groups was significantly (P < 0.0001) reduced in HFNO. Conclusions Treatment with high-flow oxygen improved survival in patients with acute hypoxemic respiratory failure compared with noninvasive ventilation, although no difference was observed in intubation rate

Lymphopenia in Covid-19: A single center retrospective study of 589 cases.

BACKGROUND: Lymphopenia is one of features that helps identify patients with severe Covid-19. This retrospectively study analyzed the association of lymphopenia with the severity of COVID-19 infection, determinate the predictive factors of lymphopenia and the significance of mortality in patient with lymphopenia. METHODS: This retrospective study included patients diagnosed with Covid-19 and admitted to intensive care unit of our university hospital center From Mars 1st 2020, to December 31st, 2020. RESULTS: In this study, 589 patients were included, a group had lymphopenia with 357 cases (60.06%) and the non-lymphopenia group with 232 cases (39.4%). The median age of our patients having lymphopenia was 65 years (56-76). Hypertension and diabetes were noted in the majority of patients with lymphopenia than in the non-lymphopenia group. Lymphopenia was strongly correlated to the inflammatory biomarkers of COVID-19 and were significant. A significant correlation was found between lymphopenia group and CT scan. Lymphopenia was observed as an indicator of prolonged duration of hospitalization but was not significant. CONCLUSION: Analytical data from this retrospective study shows the importance in the association between lymphopenia and the severity of COVID-19 infection, hence the need for dynamic monitoring of the number of lymphocytes on admission and during hospitalization of these patients.

Predictive factors of mortality related to COVID-19: A retrospective cohort study of 600 cases in the intensive care unit of the university hospital of Oujda.

INTRODUCTION: Although the corona virus is responsible in the majority of cases for mild symptoms, there are sometimes severe and even lethal forms of this disease. Our study aimed to identify clinical and para-clinical predictors of mortality related to COVID-19. MATERIALS AND METHODS: This is a single-center retrospective cohort study conducted from March 2020 to December 2020 at intensive care unit department of Mohamed VI University Hospital Oujda, Morocco including 600 patients with COVID-19. RESULTS: We included 600 patients, the mortality rate was 32.50%, the predictors of mortality identified in our study were: associated heart disease (RR: 1.826; CI: [1.081-3.084]; p:0.024), high D-dimer level at admission (RR:1.027; CI: [1.011-1.047]; p:0.001), need for mechanical ventilation (RR: 4.158; CI: [2.648-6.530]; p: <0.0001). CONCLUSION: Based on these results, we were able to identify 3 predictors of COVID 19 mortality (associated heart failure, high D-dimer level on admission, and need for mechanical ventilation). These predictors could help clinicians to identify early patients with high risk of lethality in order to reduce mortality related to corona virus.

Early initiation of awake venovenous extracorporeal membrane oxygenation (ECMO) in critical COVID-19 pneumonia: A case reports.

INTRODUCTION: Overall, patients with Sars-cov-2 disease treated with mechanical ventilation, which is not the case in our study. This report presents our first successful experience of awake ECMO application in a critical patient with hypoxemic Respiratory Failure related to COVID-19 infection in Morocco. CASE MANAGEMENT: We have reported a 52-year-old female patient who was diagnosed with COVID-19 infection and progressed to critical cases. She was a candidate for applying awake extracorporeal membrane oxygenation (ECMO) in the absence of invasive mechanical ventilation, under local anesthesia alone with good progress and ventilatory weaning. CONCLUSION: This therapeutic attitude can be beneficial for certain critical and severe cases due to COVID-19 infection. Each ECMO program should develop goals, methods, protocols, and best practices while adapting appropriately to the personnel and equipment available.