Evaluation of Lactate Dehydrogenase (LDH) in predicting the severity of lung involvement and pneumomediastinum in hospitalized COVID-19 Evaluación de la lactato deshidrogenasa (LDH) para predecir la gravedad de la afectación pulmonary neumomediastino en COVID-19 hospitalizado

Background: COVID-19 is a health crisis that triggered the need to find a rapid and sensitive tool to screen populations with a high risk of complications. Lactate Dehydrogenase (LDH) is an enzyme found in almost all body cells, particularly pneumocytes, and appears to be associated with worst outcome. Pneumomediastinum (PM), which results from ruptured alveoli, can occur in non-ventilated patients. Acute pneumocytes injury induces the release of serum LDH. Objective: This study evaluates the role of baseline serum LDH levels in predicting COVID-19 lung necrosis. Methods: This retrospective study was conducted among 524 COVID-19 patients admitted to Hôtel-Dieu de France university hospital, Lebanon, between March 2020 and March 2021. Baseline serum LDH was retrieved from patients’ medical records. Radiological severity outcomes were assessed at admission and during follow-up by non-contrast computed tomography (NCCT) of the chest. Results: The mean age of participants was 63 ± 16 years, with 359 males (68.5%) and median (IQR) LDH levels upon admission of 328 (248-430). LDH was correlated with lobar involvement at both admission and NCCT follow-up (Spearman’s rho 0.527 and 0.264, respectively) and the development of a PM (p = 0.035) in 3% of the patients. Using ROC analysis, a baseline LDH value higher than 395 U/L was associated with the presence of a PM on admission and follow up chest CT, with a sensitivity of 75% and a specificity of 60.1%. Conclusion: Baseline LDH levels could serve as a tool for early diagnosis of severe pulmonary injury with poor radiological outcomes in hospitalized COVID-19 patients.

Evaluation of Lactate Dehydrogenase (LDH) in predicting the severity of lung involvement and pneumomediastinum in hospitalized COVID-19

Background: COVID-19 is a health crisis that triggered the need to find a rapid and sensitive tool to screen populations with a high risk of complications. Lactate Dehydrogenase (LDH) is an enzyme found in almost all body cells, particularly pneumocytes, and appears to be associated with worst outcome. Pneumomediastinum (PM), which results from ruptured alveoli, can occur in non-ventilated patients. Acute pneumocytes injury induces the release of serum LDH. Objective: This study evaluates the role of baseline serum LDH levels in predicting COVID-19 lung necrosis. Methods: This retrospective study was conducted among 524 COVID-19 patients admitted to Hôtel-Dieu de France university hospital, Lebanon, between March 2020 and March 2021. Baseline serum LDH was retrieved from patients’ medical records. Radiological severity outcomes were assessed at admission and during follow-up by non-contrast computed tomography (NCCT) of the chest. Results: The mean age of participants was 63 ±16 years, with 359 males (68.5%) and median (IQR) LDH levels upon admission of 328 (248-430). LDH was correlated with lobar involvement at both admission and NCCT follow-up (Spearman’s rho 0.527 and 0.264, respectively) and the development of a PM (p=0.035) in 3% of the patients. Using ROC analysis, a baseline LDH value higher than 395 U/L was associated with the presence of a PM on admission and follow up chest CT, with a sensitivity of 75% and a specificity of 60.1%. Conclusion: Baseline LDH levels could serve as a tool for early diagnosis of severe pulmonary injury with poor radiological outcomes in hospitalized COVID-19 patients. o Fundamento: El COVID-19 es una crisis sanitaria que desencadenó la necesidad de encontrar una herramienta rápida y sensible para el cribado de poblaciones con alto riesgo de complicaciones. La lactato deshidrogenasa (LDH) es una enzima que se encuentra en casi todas las células del cuerpo, particularmente en los neumocitos, y parece estar asociada con el peor resultado. El neumomediastino (PM), que resulta de la ruptura de los alvéolos, puede ocurrir en pacientes no ventilados. La lesión aguda de neumocitos induce la liberación de LDH sérica. Objetivo: Este estudio evalúa el papel de los niveles séricos basales de LDH en la predicción de la necrosis pulmonar por COVID-19. Métodos: Este estudio retrospectivo se realizó entre 524 pacientes con COVID-19 ingresados en el hospital universitario Hôtel-Dieu de France, Líbano, entre marzo de 2020 y marzo de 2021. La LDH sérica basal se recuperó de los registros médicos de los pacientes. Los resultados de gravedad radiológica se evaluaron al ingreso y durante el seguimiento mediante tomografía computarizada (TCNC) sin contraste del tórax. Resultados: La edad media de los participantes fue de 63 ±16 años, con 359 varones (68,5%) y mediana (IQR) niveles de LDH al ingreso de 328 (248-430). La LDH se correlacionó con la afectación lobar tanto al ingreso como al seguimiento de la NCCT (rho de Spearman 0,527 y 0,264, respectivamente) y el desarrollo de un PM (p=0,035) en el 3% de los pacientes. Mediante el análisis ROC, se asoció un valor basal de LDH superior a 395 U/L con la presencia de un PM al ingreso y seguimiento de la TC de tórax, con una sensibilidad del 75% y una especificidad del 60,1%. Conclusión: Los niveles basales de LDH podrían servir como una herramienta para el diagnóstico precoz de lesión pulmonar grave con malos resultados radiológicos en pacientes hospitalizados con COVID-19.

INHALED EPOPROSTENOL WITH HIGH-FLOW NASAL CANNULA IN COVID ARDS

We aimed to assess the clinical and physiological outcomes of administering Inhaled Epoprostenol (iEpo) to patients with Acute Hypoxemic Respiratory Failure (AHRF) due to COVID-19 requiring High Flow Nasal Cannula (HFNC). B Methods: b We present a case series of 16 patients with AHRF due to COVID-19 who were administered iEpo for refractory hypoxemia requiring 100% FiO2 on HFNC. B Introduction: b Inhaled pulmonary vasodilators have been used as a rescue therapy for refractory hypoxemia in mechanically ventilated patients with Acute Respiratory Distress Syndrome (ARDS), but have not shown a difference in mortality outcomes. [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Impact of Timing of Tocilizumab Use in Hospitalized Patients With SARS-CoV-2 Infection.

BACKGROUND: SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) continues to be a global challenge due to the lack of definitive treatment strategies. We sought to determine the efficacy of early administration of anti-interleukin 6 therapy in reducing hospital mortality and progression to mechanical ventilation. METHODS: This was a retrospective chart review of 11,512 patients infected with SARS-CoV-2 who were admitted to a New York health system from March to May 2020. Tocilizumab was administered to subjects at the nasal cannula level of oxygen support to maintain an oxygen saturation of >88%. The Charlson comorbidity index was used as an objective assessment of the burden of comorbidities to predict 10-year mortality. The primary outcome of interest was hospital mortality. Secondary outcomes were progression to mechanical ventilation; the prevalence of venous thromboembolism and renal failure; and the change in C-reactive protein, D-dimer, and ferritin levels after tocilizumab administration. Propensity score matching by using a 1:2 protocol was used to match the tocilizumab and non-tocilizumab groups to minimize selection bias. The groups were matched on baseline demographic characteristics, including age, sex, and body mass index; Charlson comorbidity index score; laboratory markers, including ferritin, D-dimer, lactate dehydrogenase, and C-reactive protein values; and the maximum oxygen requirement at the time of tocilizumab administration. Mortality outcomes were evaluated based on the level of oxygen requirement and the day of hospitalization at the time of tocilizumab administration. RESULTS: The overall hospital mortality was significantly reduced in the tocilizumab group when tocilizumab was administered at the nasal cannula level (10.4% vs 22.0%; P = .002). In subjects who received tocilizumab at the nasal cannula level, the progression to mechanical ventilation was reduced versus subjects who were initially on higher levels of oxygen support (6.3% vs 18.7%; P < .001). There was no improvement in mortality when tocilizumab was given at the time of requiring non-rebreather, high-flow nasal cannula, noninvasive ventilator, or invasive ventilator. CONCLUSIONS: Early use of anti-interleukin 6 therapy may be associated with improved hospital mortality and reduction in progression to more severe coronavirus disease 2019.

Utilization of Airway Pressure Release Ventilation as a Rescue Strategy in COVID-19 Patients: A Retrospective Analysis.

BACKGROUND: Airway Pressure Release Ventilation (APRV) is a pressure controlled intermittent mandatory mode of ventilation characterized by prolonged inspiratory time and high mean airway pressure. Several studies have demonstrated that APRV can improve oxygenation and lung recruitment in patients with Acute Respiratory Distress Syndrome (ARDS). Although most patients with COVID-19 meet the Berlin criteria for ARDS, hypoxic respiratory failure due to COVID-19 may differ from traditional ARDS as patients often present with severe, refractory hypoxemia and significant variation in respiratory system compliance. To date, no studies investigating APRV in this patient population have been published. The aim of this study was to evaluate the effectiveness of APRV as a rescue mode of ventilation in critically ill patients diagnosed with COVID-19 and refractory hypoxemia. METHODS: We conducted a retrospective analysis of patients admitted with COVID-19 requiring invasive mechanical ventilation who were treated with a trial of APRV for refractory hypoxemia. PaO2/FIO2 (P/F ratio), ventilatory ratio and ventilation outputs before and during APRV were compared. RESULTS: APRV significantly improved the P/F ratio and decreased FIO2 requirements. PaCO2 and ventilatory ratio were also improved. There was an increase in tidal volume per predicted body weight during APRV and a decrease in total minute ventilation. On multivariate analysis, higher inspiratory to expiratory ratio (I: E) and airway pressure were associated with greater improvement in P/F ratio. CONCLUSIONS: APRV may improve oxygenation, alveolar ventilation and CO2 clearance in patients with COVID-19 and refractory hypoxemia. These effects are more pronounced with higher airway pressure and inspiratory time.

General attitudes toward and awareness of vaccines among students at a university in Northern Cyprus.

Misinformation and movements against vaccines put public health at risk. This study investigated vaccine awareness and opinions on the anti-vaccination movement among students at three faculties of Eastern Mediterranean University. Data were collected by questionnaire. Exposure to anti-vaccination propaganda increased proportionally with the size of the cities where participants were born. In total, 88.6% of the participants declared that they planned to vaccinate their children, while those who did not cited various reasons including the belief that vaccines do not work, that vaccines are harmful, and that it is better to be infected naturally. 60.6% of participants reported that they would get vaccinated against SARS-CoV-2 if there was an effective vaccine. Meanwhile, 24.5% of participants were not sure whether would get vaccinated even if it were possible, 11.4% of participants stated that they would not vaccinate their children for a variety of reasons. These results are important, especially in the context of a pandemic, because students will become leaders in education, business, and media, and thus shape the thoughts and opinions of future generations. The anti-vaccination movement is building momentum, and is especially influential in big cities; therefore, it is vital to change our approach to informing students about vaccination.

Asthma in COVID-19: An extra chain fitting around the neck? (preprint)

Introduction The novel coronavirus disease 2019 (COVID-19) has rapidly spread across the globe, overwhelming healthcare systems and depleting resources. The infection has a wide spectrum of presentations, and pre-existing comorbidities have been found to have a dramatic effect on the disease course and prognosis. We sought to analyze the effect of asthma on the disease progression and outcomes of COVID-19 patients. Methods We conducted a multi-center retrospective study of positively confirmed COVID-19 patients from multiple hospitals in Louisiana. Demographics, medical history, comorbidities, clinical presentation, daily laboratory values, complications, and outcomes data were collected and analyzed. The primary outcome of interest was in-hospital mortality. Secondary outcomes were Intensive Care Unit (ICU) admission, risk of intubation, duration of mechanical ventilation, and length of hospital stay. Results A total of 502 COVID-19 patients (72 asthma and 430 non-asthma cohorts) were included in the study. The frequency of asthma in hospitalized cohorts was 14.3%, higher than the national prevalence of asthma (7.7%). Univariate analysis revealed that asthma patients were more likely to be obese (75% vs 54.2%, p=0.001), with higher frequency of intubation (40.3% vs 27.8%, p = 0.036), and required longer duration of hospitalization (15.1{+/-}12.5 vs 11.5{+/-}10.6, p=0.015). After adjustment, multivariable analysis showed that asthmatic patients were not associated with higher risk of ICU admission (OR=1.81, 95%CI=0.98-3.09, p=0.06), endotracheal intubation (OR=1.77, 95%CI=0.99-3.04, p=0.06) or complications (OR=1.37, 95%CI=0.82-2.31, p=0.23). Asthmatic patients were not associated with higher odds of prolonged hospital length of stay (OR=1.48, 95%CI=0.82-2.66, p=0.20) or with the duration of ICU stay (OR=0.76, 95%CI=0.28-2.02, p=0.58). Kaplan-Meier curve showed no significant difference in overall survival of the two groups (p=0.65). Conclusion Despite the increased prevalence of hospitalization in asthmatic COVID-19 patients compared to the general population, after adjustment for other variables, it was neither associated with increased severity nor worse outcomes.