ABSTRACT
Introduction: Due to the presence of ACE 2 receptors in the diaphragm, its involvement is likely among patients with Covid 19. This study aimed to describe the presence of diaphragm dysfunction among patients who have recovered from Covid 19. Method(s): The thickness fraction (TF) of the diaphragm was assessed via ultrasonography in supine or semirecumbent posture in the right hemidiaphragm in the zone of apposition. A TF of less than 20% was classified as diaphragm dysfunction. Result(s): A total of 50 (males 34) with a mean age of 49.36 years and recovered from acute Covid were enrolled in the study. Among these 50 participants, 11, 12, and 27 had recovered from mild, moderate, severe Covid, respectively. Overall, 37(74%) subjects were hospitalized, 13 (26%) cases were home quarantined;30 (60%) subjects required oxygen during the course of illness. The average weeks from the onset of symptoms to enrolment was 7.1 weeks. Among the study participants, 9 (18%) subjects (8 males and 1 female) had diaphragm dysfunction (thickness fraction less than 20%). Among subjects who were managed at the hospital (n=37), diaphragm dysfunction was observed in 8 (21.6%). Of patients who had diaphragm dysfunction, 3 out of 9 had mild disease, whereas 6 of 9 (66.6%) subjects had severe illness. sub7 out of 9 (77.7%) subjects were hospitalized and 6 required oxygen during the illness. Conclusion. A significant percentage of COVID-19 survivors had diaphragm dysfunction which may also attribute to the persistent shortness of breath. There is an urgent need for large-scale (nationwide) assessment of diaphragm function among the survivors.
ABSTRACT
Introduction: The persistence of symptoms beyond 4 weeks of SARS-CoV-2 infection is referred to as long COVID. There is lack of data about the clinical determinants and natural history of this condition. Aims & objectives: We aimed to determine the risk factors, symptomatology, spirometric abnormalities and evolution of long COVID over a 1-year period. Method(s): We enrolled adult patients at 1-4 months after diagnosis of COVID-19. The demographics, COVID-19 history, clinical symptoms and spirometric results were recorded. Follow-up assessments were done in-person or telephonically at 4-8 months and 8-12 months, respectively. Result(s): We enrolled 128 patients (69% male) with median (IQR) age of 49 (37-56) years. Among these, 99 (77%) needed hospitalization, and 47 (37%) received oxygen for COVID-19. At the 1st assessment at median (IQR) of 64.5 (39.5-90) days after COVID-19 onset, 86 (67%) patients had symptoms, most commonly dyspnea (34%), fatigue (19%) and cough (19%). Reduced FVC (<80% of predicted) was found in 61% subjects. On multivariate analysis, the predictors of symptomatic long COVID were female gender (OR, 4.1;95% CI: 1.5-11;p=0.006) and dyspnea during acute COVID-19 (OR, 3.6;95% CI:1.1-11.3;p=0.03). The predictors of reduced FVC were dyspnea (OR, 4.4;95% CI: 1.6-12;p=0.004) and oxygen therapy (OR, 5.6;95% CI: 1.5-21;p=0.01) during acute COVID-19. The proportion of symptomatic patients reduced between 1st and 2nd assessment (67% vs 37%, p<0.001) and then plateaued at 3rd assessment (42%). Conclusion(s): Persistent symptoms are common over a 1-year follow-up among survivors of COVID-19. Female gender and dyspnea during acute COVID-19 may predict development of long COVID.
ABSTRACT
Coronavirus disease-2019 (COVID-19) may lead to hypoxemia, requiring intensive care in many patients. Awake prone positioning (PP) is reported to improve oxygenation and is a relatively safe modality. We performed a systematic review of the literature to evaluate the available evidence and performed meta-analysis of the effect of awake PP in non-intubated patients on improvement in oxygenation and reducing the need for intubation. We searched the PubMed and EMBASE databases to identify studies using awake PP as a therapeutic strategy in the management of COVID-19. Studies were included if they reported respiratory outcomes and included five or more subjects. The quality of individual studies was assessed by the Qualsyst tool. A meta-analysis was performed to estimate the proportion of patients requiring intubation. The degree of improvement in oxygenation parameters (PaO2: FiO2 or PaO2 or SpO2) was also calculated. Sixteen studies (seven prospective trials, three before-after studies, six retrospective series) were selected for review. The pooled proportion of patients who required mechanical ventilation was 0.25 (95% confidence interval (CI) 0.16-0.34). There was a significant improvement in PaO2: FiO2 ratio, PaO2, and SpO2 during awake PP. To conclude, there is limited evidence to support the efficacy of awake PP for the management of hypoxemia in COVID-19. Further RCTs are required to study the impact of awake PP on key parameters like avoidance of mechanical ventilation, length of stay, and mortality.
ABSTRACT
OBJECTIVES: The incidence of emerging coronavirus disease 2019 (COVID-19) disease is variable across the different parts of the world. Apart from travel patterns, other factors determining this difference may include host immune response. The aim of this study was to assess the effect of tuberculosis (TB) endemicity and Bacille Calmette-Guerin (BCG) coverage on COVID-19. STUDY DESIGN: This was a cross-sectional study. METHODS: We reviewed available data regarding TB incidence, BCG coverage (as per the World Health Organization), and COVID-19 incidence of 174 countries. We divided the countries into four cohorts depending on annual TB incidence and BCG coverage. RESULTS: Countries with high TB incidence had lower COVID-19 than countries with low TB incidence. Similarly, countries with high BCG coverage had lower incidence of COVID-19, suggesting some protective mechanisms in TB-endemic areas. However, the ecological differences and different testing strategies between countries could not be accounted for in this analysis. CONCLUSION: Higher TB incidence and BCG coverage were found to be associated with lesser incidence of COVID-19. This outcome paves the way for further research into pathogenesis and immune response in COVID-19.