ABSTRACT
Hypoxic patients with coronavirus disease 2019 (COVID-19) are at high risk of adverse outcomes. Inhaled nitric oxide (iNO) has shown anti-viral and immunomodulatory effects in vitro. However, in vivo evidence of efficacy in hypoxic COVID-19 is sparse. This open label feasibility study was conducted at a single referral center in South India and evaluated the effectiveness of repurposed iNO in improving clinical outcomes in COVID-19 and its correlation with viral clearance. We recruited hypoxemic COVID-19 patients and allocated them into treatment (iNO) and control groups (1:1). Viral clearance on day 5 favored the treatment group (100% vs 72%, P < 0.01). The speed of viral clearance as adjudged by normalized longitudinal cycle threshold (Ct) values was positively impacted in the treatment group. The proportion of patients who attained clinical improvement, defined as a ≥2-point change on the World Health Organization ordinal scale, was higher in the iNO cohort (n = 11, 79%) as compared to the control group (n = 4, 36%) (odds ratio 6.42, 95% confidence interval 1.09-37.73, P = 0.032). The proportion of patients progressing to mechanical ventilation in the control group (4/11) was significantly higher than in the treatment group (0/14). The all-cause 28-day mortality was significantly different among the study arms, with 36% (4/11) of the patients dying in the control group while none died in the treatment group. The numbers needed to treat to prevent an additional poor outcome of death was estimated to be 2.8. Our study demonstrates the putative role of repurposed iNO in hypoxemic COVID-19 patients and calls for extended validation. Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.
ABSTRACT
Introduction: The COVID-19 pandemic is a global public health challenge that has affected more than 30 million people and taken more than 4 lakh lives in India. The first and second COVID waves have greatly impacted the lives of a vast majority and vaccination of the masses remains a struggle. Although SARS -CoV-2 infections in patients with hematological diseases are expected to have an adverse outcomes, only limited reports are available from India. Hence, our study aims to identify the outcome in terms of severity and mortality in this group and the risk factors involved in developing severe COVID-19 and death. Methodology: This is a cross sectional analytical study done in a tertiary care hospital in Southern India for a period of 11 months. All hematological patients irrespective of age, who were infected with SARS-CoV-2 during the first wave (June -December 2020) and second wave (March - June 2021) were consecutively enrolled for the study after IRB approval. The patients were then categorized as neoplastic (acute and chronic leukemia, lymphoma, myeloma, MPN and MDS ) and non-neoplastic (ITP, aplastic anemia, hemolytic anemia, MGUS and TTP ) diseases. The clinical data was collected retrospectively from the electronic medical records and by direct telephonic contact. Patients were categorized as having mild (spO2 > 94 % symptomatic /asymptomatic), moderate (spO2 90 - 94 %) and severe (spO2 < 90 %) disease based on their severity of infection, each category of patients received appropriate clinical management. Treatment details, mortality and other outcomes were recorded for 30 days. The continuous variables were represented as mean (± SD)/median (IQR) and categorical variables as frequency and percentage. The association of the outcome variable with selected variables were calculated using Chi-square tests and kaplan meier survival analysis. The data sets were analyzed (SPSS version 21) and a p value of < 0.05 was considered statistically significant. Results: The study was conducted with 70 patients (n=70). Demographic details of patients are summarized in Table 1.Seventeen (24.3%) out of 49 (70%) hospitalized patients required ICU care. There were 13 (18.6%)deaths. in the patients who survived, prolonged antigen positivity of COVID on testing after 21 days was seen in 9 patients (16.1%). In 35 patients (50%)hematological treatment was restarted with a mean delay of 9.2 +/- 10.72 days. Predictors of severity of the disease is summarized in Table 2. Age more than 50 years (P=0.002)(Figure 1a), severe COVID (P=<0.001) and D dimer value of >2 times normal (P=0.047) were associated with a 30-day mortality. Additionally, patients on active treatment for hematological disease were at greater risk of severe COVID (P=0.012). There was no significant difference in severity (P=0.197) or mortality (P=0.556)in patients with neoplastic vs. non-neoplastic disorders Conclusion: COVID-19 patients with malignant and non-malignant hematological diseases showed an increased mortality. Age > 50 years and high D dimer values (>2N) were identified as predictors of mortality. Active treatment for haematological disease predisposed to severe disease.The study needs to be validated further on a larger cohort of patients. Preventive strategies including vaccination is warranted in patients with hematological disorders. [Formula presented] Disclosures: No relevant conflicts of interest to declare.
ABSTRACT
COVID-19 pandemic has challenged the capabilities of hospital healthcare delivery systems worldwide. Among patients admitted in hospitals, sudden severity deterioration leading to out-of-ICU ward crashes are observed in many care areas. During the current pandemic, the major gap in the timely identification of COVID patient deterioration is due to the isolation precautions precluding continuous patient monitoring in wards. To address this challenge, we developed and deployed a wearable IoT integrated system called Remote Early Warning of Out-of-ICU Crashes (REWOC in short), which consists of wearable devices at the patient end and early warning score integrated dashboards for physicians and nurses to monitor patients remotely. We describe the architecture and design of REWOC as well as our deployment experience of REWOC on COVID patients in a large hospital in India. To our knowledge, this is one of the first reports of a real-world deployment using wearable devices for monitoring out-of-ICU ward crashes among COVID patients. © 2021 IEEE.
ABSTRACT
The novel pandemic, coronavirus disease 2019 (COVID-19), is a public health exigency of global concern with expanding cases worldwide. Severe acute respiratory syndrome-corona virus-2 is the virus that accounts for COVID-19. The disease manifests with a wide array of symptoms ranging from mild upper respiratory tract infection to severe pneumonia and death. The Happy hypoxemia, synonymously Silent hypoxemia, is described as a clinical entity in individuals with COVID-19, generally expressed as objective hypoxemia lacking respiratory distress symptoms. The condition is characterized by a drop in oxygen saturation and varying arterial blood gas. Intrapulmonary shunting, intravascular microthrombi, loss of lung perfusion control, and impaired diffusion capacity contributes to hypoxemic etiology in COVID-19. The ventilation-perfusion mismatch, covering from shunts to alveolar dead space ventilation, is the principal distinctive feature, suggesting numerous medical goals. © 2022. Chithira V. Nair et al. This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).