ABSTRACT
Introduction: Amyotrophic lateral sclerosis (ALS) is marked by a gradual decline in functional capacity and increased morbidity from respiratory infections due to progressive loss of muscle strength. The regular monitoring by a multidisciplinary team, adjustments in ventilatory parameters, and maintenance of NIV are essential for disease management. This study aimed to monitor functional progression of patients with ALS during COVID-19 pandemic using telemedicine. Method(s): This is longitudinal case series with patients with ALS. Five assessments were performed, being two occurred in-person and three were performed remotely during the COVID-19 pandemic. First assessments included pulmonary function, respiratory muscle strength, functionality (ALSFRS-R), rate of disease progression, and disease staging. The further assessments included a clinical evaluation form, use and parameters of NIV. Result(s): We followed 11 patients for 30 months. Most patients had spinal onset ALS (72.7%), were male (72.7%), had a median age of 51 years. Total ALSFRS-R (P < 0.01) and motor domain (P < 0.01) scores reduced during the pandemic. However, total and domain scores were not different between patients with spinal and bulbar onset. According to ALSFRS-R, 90.9% of patients presented a slow disease progression. Most patients used NIV at night and during a half-day shift. Conclusion(s): The telemedicine facilitates monitoring clinical and seems to influence functional progression of patients with ALS during COVID-19 pandemic. Patients with ALS have a slow rate of disease progression and a functional decrease during 14 months follow-up period.
ABSTRACT
About a third of COVID-19 patients experience ongoing symptoms that have been referred to as long-COVID. In cooperation with Rehabilitation Medicine and Psychology departments, we developed a protocol for evaluation and further referral of the long-COVID patients that sought our Emerging Infectious Diseases (EID) consultation. The aim was to characterize the symptoms according to their frequency and to develop a screening tool that allows referral to intervention programs. Long-COVID was defined as persistent or new-onset symptoms 12 or more weeks after initial infection. In our EID consultation all patients answered a questionnaire regarding the evolution and impact on daily activities of the persistent symptoms, using a 6-point Likert scale. Participants (n=42) had a mean age of 44.8 years (IQR 18.8) and 76% were female. Ninety-five percent of the patients had a mild to moderate course of acute infection. Fatigue (78.6%), physical capacity impairment (74%), brain fog (62%), anxiety and sleep disorders (52% each) were the most frequently reported symptoms. Regarding the impact of persistent symptoms, 50% of the patients with anxiety disorders, 69% of the ones reporting brain fog and 71% of those with physical capacity impairment reported being moderately or more affected on their daily activities by that symptom. When asked "Did you recover your previous health status?" all patients answered no. As the number of new infections continues to rise worldwide, long-COVID will be a challenging burden to healthcare systems and societies. Establishing a follow-up protocol and a reliable screening tool will allow us to reach a wider population and also promote a better and patient-centered use of medical resources.
ABSTRACT
Background: Leukotriene receptor antagonists might have a role in viral infections, either by improving lung injury and inflammation, or by acting on 3CL proteinase of the HCoV-19. Thus, we hypothesised that montelukast may be an adjuvant drug in HCoV-19 infection treatment. This study aims to evaluate the efficacy and safety of montelukast in the adjuvant treatment of COVID-19 pneumonia. Method: We are conducting a randomized, controlled, parallel, open-label trial involving hospitalized adult patients with confirmed COVID-19. Patients were randomly assigned in a 1:1 ratio to receive either montelukast 10 mg, once a day for 14 days, in addition to standard of care (SoC), or SoC alone. SoC follows the best practice for treating these patients, according to updated recommendations. The primary outcome is time to recovery. Participants are assessed using diary cards to capture data on treatment-related improvements in an 8-point ordinal scale (COVID-19 scale). Secondary endpoints include changes in NEWS (National Early Warning Score), respiratory and inflammatory parameters. Mann-Whitney U test for continuous variables and Ficher's exact test for categorical variables were used to compare differences between groups. This phase IV clinical trial takes place at the University Hospital of São João, Porto. EudraCT number: 2020-001747-21. Results: Eighteen patients (11 males, mean age 60 years, age range 42-89, table 1) enrolled and completed the trial. The trial is still open for the recruitment of participants. The participants from the active group spent less time hospitalized than control group [median (P25-75): 3.0 (3-6) vs 7.5 (4.75-17.75) days, p = 0.03]. The number of days to achieve 7 (not hospitalized, limitation on activities) or 8 points (not hospitalized, no limitations) in the COVID-19 scale was also statistically significant. The number of patients in need of supplemental high flux oxygen and the NEWS score followed the same trend (table 1). Conclusion: In conclusion, early efficacy results from this ongoing clinical trial suggest montelukast may have a role in treating COVID-19 patients as an adjuvant treatment by diminishing hospitalization days until discharge. Data were presented as median (25th percentile-75th percentile) unless otherwise states. Bpm: beats per minute;cpm: cycles per minute;NEWS: National Early Warning Score);SoC: standard of care. NEWS is based on 7 clinical parameters (respiration rate, oxygen saturation, any supplemental oxygen, temperature, systolic blood pressure, heart rate, level of consciousness), and is being used as an efficacy measure. Higher points represent higher risk of poor outcomes. COVID-19 scale is as follows: (1) Death;(2) Hospitalized, on invasive mechanical ventilation or extracorporeal membrane oxygenation (ECMO);(3) Hospitalized, on non-invasive ventilation or high flow oxygen devices;(4) Hospitalized, requiring supplemental oxygen;(5) Hospitalized, not requiring supplemental oxygen-requiring ongoing medical care (COVID-19 related or otherwise);(6) Hospitalized, not requiring supplemental oxygen-no longer requires ongoing medical care;(7) Not hospitalized, limitation on activities and/or requiring home oxygen;(8) Not hospitalized, no limitations on activities. (Figure Presented).
ABSTRACT
Objective: We aimed to describe the characteristics and outcomes of patients with coronavirus disease 2019 (COVID-19) admitted to an intensive care unit (ICU) in Portugal. Design: This is an observational retrospective study. Demographic and clinical data were col-lected. Respiratory failure treated with invasive mechanical ventilation (IMV) and death during ICU stay were the main outcomes evaluated. Setting: This study was conducted in the Infectious Diseases ICU of Centro Hospitalar e Uni-versitário de São João, in Porto, Portugal, be-tween March 11 and August 17, 2020. Patients and participants: All consecutive patients with confirmed Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infec-tion, admitted to the ICU during the study peri-od were enrolled, and 62 patients were included. Measurements and results: The median age was 71 years (IQR, 54-78) and 39 (62.9%) were male. Thirty-four (54.8%) patients received. IMV in contrast to 28 (45.2%) who were not intubated and the median lowest PaO2/FiO2 was 86 (IQR, 70-113) in IMV and 150 (94-257) in non-IMV patients. Several patients with severe hypoxemic COVID-19 were treated without IMV, especially with high flow nasal cannu-la (HFNC). Overall mortality was 21.8% and older age, male sex, active cancer, lower lym-phocyte count, higher aspartate aminotransfer-ase (AST) level, and higher creatinine level at admission, hematologic dysfunction, and renal dysfunction during ICU stay were all associated with fatal outcome. Mortality was lower than observed in other series of critically ill patients, although comparisons are limited by different ICU admission criteria, management practices, and duration of follow-up. Conclusions: This study provides data regard-ing the characteristics and outcomes of COVID-19 critically ill patients that can be used to op-timize ICU preparedness in the future. © 2021, The Indonesian Foundation of Critical Care Medicine. All rights reserved.