Angiocatheter Decompression on a Covid-19 Patient with severe Pneumonia, Pneumothorax, and Subcutaneous Emphysema.

BACKGROUND: A novel coronavirus, currently known as Severe Acute Respiratory Syndrome Coronavirus 2, causes Coronavirus disease 2019 (Covid-19). Its most significant complication is a kind of pneumonia known as of 2019 New Coronavirus-Infected Pneumonia (NCIP). Covid-19 pneumonia can have unusual complications that affect both lungs in a widespread manner. Acute lung damage and Acute Respiratory Distress Syndrome (ARDS) are typical in severe Covid-19 cases. Several potential risk factors cause the pneumonia associated with this disease, such as age over 65, diabetes, hypertension, chronic obstructive pulmonary disease, immunosuppression, and pregnancy. Furthermore, various laboratory markers like high levels of C-reactive protein (CRP), D-dimers, ferritin, interleukin-6 (IL-6), and LDH, as well as a low lymphocyte and thrombocyte count, have been linked to increased disease severity and a poor prognosis. METHODS: In this study, we present a case of a 45-year-old patient with a rare evolution of the disease, who made a full recovery against all odds. We highlight the atypical presentation of Covid-19 in this patient, who developed some unusual complications, such as pneumonia, pneumothorax, pneumomediastinum, and subcutaneous emphysema. RESULTS: There is a scarcity of information on patient-related variables linked to pneumothorax in severely sick Covid-19 patients. This study adds to the existing research, reinforcing that spontaneous pneumothorax can be caused by the infection itself, in addition to ventilator-induced trauma in mechanically ventilated patients. CONCLUSIONS: We conclude that patients with Covid-19 pneumonia may develop a more robust and systemic illness characterized by acute lung injury, acute respiratory distress syndrome (ARDS), shock, coagulopathy, and nu¬merous organ dysfunctions, all of which are linked with a high risk of death.

COVID-19 Independent Risk Factors for Unfavorable Disease Progression: A Cross-Sectional Study from Romania

Purpose: Since the initial documentation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in late December 2019, the coronavirus disease 2019 (COVID-19) pandemic has become a leading cause of morbidity and mortality worldwide. Under these circumstances, the present study aimed to analyze the characteristics of hospitalized cases, according to the progression and severity of the disease, to reveal the main independent risk factors for death by COVID-19 in the western Romanian population. Patients and Methods: This retrospective study included 936 patients admitted to Victor Babes Clinical Hospital of Infectious Diseases Timisoara, with COVID-19 between 1 February 2020 and 31 January 2021. The patients were divided into three subsamples based on disease severity: subsample I (n = 344), comprising patients with mild forms of the disease;subsample II (n = 475) comprising patients with moderate disease;and subsample III (n = 117) for patients with severe disease. Biochemical analysis and assessment of disease severity were performed on all patients. Results: The mean age was 48.76 years (two months to 94 years). The median values for age, number of hospitalization days, and disease duration days before hospital admission varied with high statistical significance between the three subsamples (p < 0.001). A statistically significant difference was also observed regarding body mass index (BMI), with higher values in subsample III (p < 0.001). The in-hospital fatality rate was zero in subsample I, 3.58% in subsample II, and 71.79% in subsample III (p < 0.001). Of the deceased patients, 69.31% were over the age of 65 years, 29.70% were aged 36–64 years, and 0.99% were aged 19–35 years. Cumulated comorbidities were recorded in 92.08% of the deceased patients. Conclusion: Older age, the number of disease duration days before hospital admission, BMI, and renal pathology are independent risk factors for mortality in COVID-19 and can help clinicians to identify patients with poor prognosis and who are at high risk for mortality at an early stage.

Deficiency of Vitamin D, a Major Risk Factor for SARS-CoV-2 Severity.

BACKGROUND: The SARS-CoV-2 outbreak started in March 2020 with more than 120,552,261 cases at present and having caused over 2,667,248 deaths worldwide at the time this paper was written. The clinical signs of SARS-CoV-2 infection are especially evident in the respiratory and cardiovascular systems. Patients can be asymptomatic or present mild respiratory symptoms to severe acute lung injury leading to multiorgan failure and death. The study aims to assess the levels of serum 25-hydroxyvitamin D (25-(OH)-D) in 20 hospitalized patients infected with SARS-CoV-2 and 20 deceased people and to analyze the influence of vitamin D status on the severity of their disease. METHODS: The present study was conducted on 40 patients who tested positive for SARS-CoV-2 infection. They were divided into two groups: 20 patients admitted to the "Victor Babes" Hospital of Infectious Diseases and 20 postmortem cases autopsied at the Institute of Legal Medicine Timisoara, Romania. During the autopsy, blood and bronchial fluid samples were collected for the laboratory. Automate Viral RNA extraction was performed on the Maxwell 48 RSC Extraction System (Promega, USA) using the Maxwell RSC Viral Total Nucleic Acid Purification kit (Promega, USA). After RNA extraction, the samples were amplified on a 7500 real-time PCR (Applied Biosystems, USA) using the genesig® Real-Time PCR Assay 2G (Primer Design, UK). RESULTS: The living and deceased patients selected for the research presented decreased vitamin D levels, which are associated with increased levels of D-dimers, C reactive protein (CRP), and interleukin-6 (IL-6). These patients had a severe form of the SARS-CoV-2 disease, which led to death. CONCLUSIONS: We conclude that deficiency of vitamin D in patients infected with SARS-CoV-2 presents a major risk factor related to the evolution and severity of the disease.