C-Reactive Protein (CRP): A poor prognostic biomarker in COVID-19.

Introduction: The COVID-19 pandemic continues to be rampant with considerable morbidity and mortality worldwide since its emergence in December 2019. Several studies have focused on identifying different predictive factors of poor prognosis, including biological markers, such as C Reactive Protein among others. The objective of our work was to determine whether the CRP levels on admission to the intensive care unit are predictive of an unfavorable evolution of patients with COVID-19 through the experience of the Anesthesia and Intensive Care Unit of the University Hospital of Oujda and to compare our results with those reported in the literature. Methods: We conducted a retrospective, monocentric, descriptive and analytical study in the Department of Anesthesia and Intensive Care of the Mohammed VI University Hospital of Oujda, Morocco, between March 2020 and October 2021, including all critically ill patients admitted to the department during this period and meeting the inclusion criteria. The baseline admission CRP value was arbitrarily set at 100mg/d, thus conditioning the division of our patients into two groups (group 1: CRP < 100mg/L, group 2: CRP ≥ 100mg/L). Results: Among our 1035 included patients, 291 patients with had a CRP<100mlg/L (group 1) and 744 presented a CRP level equal or superior to 100mg/L (group 2). Lung parenchymal involvement was more severe or even critical (CT involvement > 75%) in group 2 (60.8%) compared to group 1 (39.2%). In group 2, 79.8% of patients were mechanically ventilated, compared to 20.2% of patients in group 1. Finally, the mortality rate in patients with a CRP ≥ 100mg/l was 77.4%, compared with 22.6% for patients with a CRP < 100mg/l. These findings are all statistically highly significant (p<0.001). Conclusion: Given the high contagiousness of the virus and the emergence of several variants, the management of the COVID-19 pandemic has focused more on prevention through vaccination against the virus, but also on an early identification of patients likely to evolve unfavorably for a personalized management.

C-Reactive Protein (CRP): A poor prognostic biomarker in COVID-19

Introduction The COVID-19 pandemic continues to be rampant with considerable morbidity and mortality worldwide since its emergence in December 2019. Several studies have focused on identifying different predictive factors of poor prognosis, including biological markers, such as C Reactive Protein among others. The objective of our work was to determine whether the CRP levels on admission to the intensive care unit are predictive of an unfavorable evolution of patients with COVID-19 through the experience of the Anesthesia and Intensive Care Unit of the University Hospital of Oujda and to compare our results with those reported in the literature. Methods We conducted a retrospective, monocentric, descriptive and analytical study in the Department of Anesthesia and Intensive Care of the Mohammed VI University Hospital of Oujda, Morocco, between March 2020 and October 2021, including all critically ill patients admitted to the department during this period and meeting the inclusion criteria. The baseline admission CRP value was arbitrarily set at 100mg/d, thus conditioning the division of our patients into two groups (group 1: CRP < 100mg/L, group 2: CRP ≥ 100mg/L). Results Among our 1035 included patients, 291 patients with had a CRP<100mlg/L (group 1) and 744 presented a CRP level equal or superior to 100mg/L (group 2). Lung parenchymal involvement was more severe or even critical (CT involvement > 75%) in group 2 (60.8%) compared to group 1 (39.2%). In group 2, 79.8% of patients were mechanically ventilated, compared to 20.2% of patients in group 1. Finally, the mortality rate in patients with a CRP ≥ 100mg/l was 77.4%, compared with 22.6% for patients with a CRP < 100mg/l. These findings are all statistically highly significant (p<0.001) Conclusion Given the high contagiousness of the virus and the emergence of several variants, the management of the COVID-19 pandemic has focused more on prevention through vaccination against the virus, but also on an early identification of patients likely to evolve unfavorably for a personalized management.

Management of post cardiac transplantation immunosuppression and COVID-19: A case report.

BACKGROUND: There is very limited experience in management of heart transplant (HT) recipients and their immunosuppressive drug therapies while confronted with a SARS-CoV-2 infection. CASE DETAILS: We report the case of a 60-year-old male, heart transplant recipient patient, admitted in our ICU for severe COVID-19. His immunosuppressors were discontinued. He presented an ARDS, a multiple organ failure and a refractory septic shock that eventually resulted in his death. DISCUSSION: Multiple studies reported a lower incidence of SARS-Cov-2 infection in HT recipients compared to the general population, probably due to their prior knowledge and use of protective and barrier measures; but when infected they tend to have poorer outcomes and higher fatality; on account of their pre-existing comorbidities and immunodeficiency. Therefore, the management of the immunosuppressive therapy raises a challenge, in the absence of trials. Physicians rely on experts' recommendations, to maintain the immunosuppressors in case of mild COVID-19, lower to the bare minimum or even discontinue them in case of critical COVID-19 or systemic complications. CONCLUSION: COVID-19 infection is associated with poor outcomes and high mortality in HT recipients, and their immunosuppressive therapy management still raises questions and challenges in the absence of trial-validated data.

Prone position during ECMO in patients with COVID-19 in Morocco: Case series.

INTRODUCTION: The main manifestation of COVID-19 pneumonia is acute respiratory distress syndrome (ARDS), which in some cases can be more severe, requiring Veno-venous extracorporeal membrane oxygenation (VV-ECMO) to ensure hemostasis. Despite support from Veno-venous extracorporeal membrane oxygenation, some patients may remain hypoxemic. One possible therapeutic procedure for these patients is the application of the prone position (PP). OBJECTIVE: The aim of this study was to investigate the effect of VV-ECMO on arterial oxygenation and compliance of the respiratory system in mechanically ventilated patients with refractory hypoxemia. The secondary objective was to evaluate the safety and feasibility of prone position for ECMO. METHODS: We retrospectively reviewed the electronic records of all 23 COVID-19 patients on ECMO who were placed for the first time in prone position with an average duration of 16 h. Patient characteristics, pre-ECMO characteristics, changes in ventilator/ECMO settings and blood gas analysis before and after PP. RESULTS: A total of 23 position changes to prone position were performed. Oxygenation and respiratory compliance improved 16 h after adoption of prone position without any accidents during PP. CONCLUSIONS: The use of prone position during Veno-venous extracorporeal membrane oxygenation demonstrated an improvement in oxygenation as well as lung compliance. It is a safe and reliable technique.

Acute limb ischemia in patients with COVID-19 pneumonia.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic developing since the late 2019 and early 2020 has caused thousands of deaths and has had an enormous impact on our health systems and economies. Thrombotic complications associated with coronavirus disease 2019 (COVID-19) have been described. Acute limb ischemia is associated with complications related to cytokine storm syndrome and acute respiratory distress syndrome. that can result in significant morbidity and mortality. However, limited published data is available regarding thrombosis in coronavirus disease 2019 (COVID-19). Here we are presenting 2 cases of COVID-19 infection complicated by arterial thrombosis in the form of acute limb ischemia.

Spontaneous Pneumomediastinum Associated with COVID-19 Pneumonia.

The first case of coronavirus disease 2019 (COVID-19) was declared in December in Wuhan, before becoming a global pandemic in a few weeks. Several complications of this infection have been reported. However, a spontaneous pneumomediastinum has rarely been described. We report the fourth case of this extremely rare complication in a 65-year-old male patient with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pneumonia, discovered during his therapeutic management by a CT scan control.