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Background: REGEN-COV is a combination of 2 monoclonal antibodies (casirivimab and imdevimab) that bind to two different sites on the receptor binding domain of the SARS-CoV-2 spike protein, and thus stops the progression of disease. We aim to evaluate the safety and efficacy of REGEN COV in patients presenting with Mild to moderate Covid 19 disease. Methodology: This is a retrospective observational study done in a tertiary hospital in South India. Patients admitted with RTPCR confirmed SARS COV 2 infection and within 10 days of symptoms onset were included in the trial. All patients received 1,200 mg each of casirivimab and imdevimab as a single intravenous infusion. All the patients were followed up for a period of 30 days with weekly telephonic consultation. Results: Between June 1 , 2021 and October 15 ,2021 , 30 patients got enrolled into the study and the mean age of patients was 60 years. The median duration from symptom onset to Regen Cov treatment was 5 days. Only 2 (10%) patients had adverse events and 83% of patients (25/30) had no symptoms after Regen Cov administration and 86% of patients (26/30) had no progression of clinical symptoms for up to 30 days after discharge. Conclusion: The monoclonal antibody combination of casirivimab and imdevimab (REGEN-COV) successfully prevented the progression of disease in 86% of patients presented with mild to moderate COVID 19 disease. Our study also underlined the safety of Regen Cov treatment with no major adverse event occurred in any of the patients.
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Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-also known as 2019 novel coronavirus or COVID-19-first emerged on December 31, 2019 in China, and has since rapidly spread to become a world-wide pandemic. Orthopaedic trauma services, have maintained a significant portion of their previous volume throughout the pandemic, specifically, hip fractures in the elderly population.Intertrochanteric fracture is one of the most common injuries among the elderly and is associated with a high mortality rate within 30 days after the injury event.Treatment of Intertrochanteric fractures during the coronavirus disease 2019 (COVID-19) pandemic has posed unique challenges for the management of COVID-19infected patients and the maintenance of standards of care. PFNA2 provide stability, compression as well as rotational control of the fracture and allows early post operative mobilization, weight bearing and thereby early fracture union. This study aims to assess the functional outcome of intertrochanteric fracture treated by PFNA2 in COVID-19-positive patients. Objectives: To evaluate the functional outcome of intertrochanteric fracture treated by PFNA2 in COVID-19-positive patients: a retrospective study Methodology: This was a retrospective study of 30 patients,18 females and 12 males ≥55 years of age with intertrochanteric fracture and COVID-19 who underwent operative management with PFNA2. Clinical characteristics and early postoperative outcomes were reported. Results: A total of 30 patients, 21 patients (70%) had fever, cough, and fatigue at the time of presentation. 9 patients (30%) had sore throat and dyspnea, headache and dizziness (23%) (7 patients), abdominal pain and vomiting (16%) (5 patient), chest pain and nasal congestion (10%) (3 patient).18 patients (60%) had comorbidities. Postoperatively all 30 patients (100%) required non-invasive mechanical ventilation. All patients (100%) were given antibiotic therapy,18 patients underwent anti thromboembolic prophylaxis. 20 patients were treated with corticosteroids. Blood transfusion was done in 14 patients. Average HARRIS HIP SCORE was 83.6 at the end of six months graded as good outcome. The length of hospital stay in our study was 10 days (7-14 days). The complications in our study included bed sores, superficial and (which settled subsequently with Intravenous antibiotics and debridement respectively). Conclusions: Our study shows that intertrochanteric fracture patients who present with a mild to moderate COVID-19 symptoms who underwent Intertrochanteric fracture surgeries with PFNA2 had a good functional outcome with few post op complications.
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Background: Orthopaedic trauma surgery focused mainly on femoral fragility fractures in the elderly, since the “lockdown” began on March 23, 2020 in our country. Proximal femur fractures carry a high mortality rate due the age and complications. Thus, orthopaedic surgeons face the daily dilemma of performing life-saving surgery on patients who, have severe respiratory compromise, have a higher risk of peri-operative death. The optimal surgical treatment of displaced femoral neck fractures is still debated. Hemiarthroplasty4 contributes to early ambulation and good functional recovery. Determining mortality and risk factors for adverse outcomes for patients with COVID-19 and a concurrent hip fracture is of great importance, as it can improve clinical pathways, perioperative management, and resource allocation. Methods: This was a retrospective study of 10 patients ≥60 years of age with a neck of femur fracture and COVID-19 who underwent hip hemiarthroplasty. Clinical characteristics and early postoperative outcomes were reported. Results: Seven out of the 10 COVID-positive hip fracture patients in our series were asymptomatic on admission with no clinical signs or symptoms of COVID-19 infection. One of the patient had cough and other 2 patients presented with hypoxia. 7 patients was given supplemental oxygen postoperatively which includes the patient presented with hypoxia. 7 patients required post op blood transfusion.None of the patients were put on mechanical ventilation. There was no case of surgical site infection.Average harris hip score was 80 with good outcome. The average length of inpatient stay was 15 days. Conclusions: Our study shows that neck of femur fracture patients who present with asymptomatic or mild COVID-19 who underwent hip hemiarthroplasty had a good functional outcome with few post op complications.
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BACKGROUND: There is limited data on frontline health-care workers and risk of COVID-19 from the developing nations. It is imperative to identify those at higher risk to prevent further transmission. We assessed the relationship between exposure risk and COVID-19 among front-line health-care workers who were primary contacts of a COVID-19 patient. METHODS: A retrospective cohort study was conducted among front-line health-care workers in a tertiary care hospital who were exposed to a COVID-19 patient. Information on demographic factors, medical history, exposure related factors and subsequently COVID-19 lab reports were collected. An exposure risk assessment designed collating various exposure related factors categorized the participants into those with high and low risk. We used logistic regression to estimate the odds ratio of our primary outcome, a positive COVID-19 test when the independent variables were exposure risk, age, gender and occupation. RESULTS: Among1858 frontline workers who were primary contacts of a COVID-19 patient at the hospital, 106 (5.7%) incident reports of a positive COVID-19 test were recorded. None of the exposure related factors had any significant association with a positive COVID-19 test. However, high exposure risk category was significantly associated with COVID-19 positive test at the end of quarantine. CONCLUSION: COVID-19 was more frequent among front-line health-care workers who belonged to high exposure category. Education at different levels of service delivery at hospitals is required for best practice in order to prevent COVID-19 among health care providers. There is need to develop additional strategies to ensure that the information is translated in to practice.
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Background: Early reports of acute kidney injury (AKI) associated with COVID-19 have claimed high incidence of proteinuria. If so, it may suggest an AKI pathogenesis not solely related to ischemic acute tubular injury (ATI). We hypothesized that those claims result from observation bias. Therefore, we sought to investigate the rate of De novo proteinuria in AKI associated with COVID-19 (CoV-AKI) compared to that of AKI in the pre-COVID-19 era (non-CoV-AKI). Methods: Hospitalized patients with CoV-AKI entered the cohort (n=161). As a control non-CoV-AKI group (n=186), we accessed a database of patients with AKI who underwent urinary sediment microscopy due to suspicion of an intrinsic cause of AKI (Sedi-AKI cohort, 2017-2019). We examined the incidence of proteinuria of any degree (1+ dipstick), significant [urine protein-to-creatinine ratio (UPCR) ≥ 0.5-3.0 g/g or 2+ dipstick] or overt [UPCR ≥ 3.0 g/g + 3+ dipstick]. Results: Median age were similar: 65 (34-95) and 60 (20-88) years for CoV-AKI and non-CoV-AKI, respectively. Women were 62% and 63% (p=0.86). Black race was more common in CoV-AKI (75% vs. 35%;p=<0.0001). ATI (ischemic and/or toxic) was the presumed cause of AKI in 75% and 71% of CoV-AKI and non-CoV-AKI, respectively. Incidence of any, significant or overt proteinuria were 123/148 (83%) vs. 127/184 (69%) (p=0.003), 98/148 (66%) vs. 81/184 (44%) (p=0.0001) and 14/148 (10%) vs. 23/184 (13%) (p=0.39), for CoV-AKI and non-CoV-AKI, respectively. Among those with significant proteinuria, no difference in median UPCR was found [0.69 vs. 0.69 g/g (p=0.23)]. Using baseline UPCR when available, rates of De novo significant and overt proteinuria were similar [57/124 (46%) vs 57/123 (46%) (p=1.00) and 6/124 (5%) vs 7/123 (7%) (p=0.75)]. Among overt cases who underwent kidney biopsy, collapsing glomerulopathy was found in 3/4 (75%) in the CoV-AKI group compared to 0/11 (0%) in the control (p=0.002). Conclusions: The incidence rate of new onset proteinuria was not found to be increased in CoV-AKI and is consistent with that of other forms of ATI. An observed overall greater incidence in significant proteinuria in CoV-AKI may be driven by preexisting proteinuria. While the rate of overt proteinuria is not greater in CoV-AKI, the primary cause of De novo glomerular disease may vary.
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Background: There have been anecdotal accounts of an unusual incidence of persistent hyperkalemia (hyperK) and hyperphosphatemia (hyperP) in patients with COVID-19 and acute kidney injury (AKI) (CoV-AKI) despite renal replacement therapy (RRT). However, an observation bias could not be discarded. Thus, we examined the rate and severity of hyperK and hyperP in patients with CoV-AKI actively treated with RRT. Methods: Among 161 patients with CoV-AKI, we selected those who underwent RRT by sustained low efficiency dialysis (SLED) for ≥2 days (n=64). A database of patients with AKI on SLED who underwent urinary sediment microscopy (Sedi-AKI cohort, 2017-2019, n=60) served as control (non-CoV-AKI). We examined the rate of hyperK [serum potassium (sK) ≥ 5.5 mEq/L], severe hyperK [sK ≥ 6.5 mEq/L], hyperP [serum phosphate (sP) ≥ 4.5 mg/dL], moderate hyperP [sP ≥ 7.0-10.0 mg/dL] and severe hyperP [sP >;10.0 mg/dL] as % SLED-days with an event. Results: Median age were similar: 60 (39-84) and 58 (22-88) years for CoV-AKI and non-CoV-AKI, respectively. Black race (77% vs. 30%;p<0.0001) and male sex (78% vs. 61%;p=0.04) were more common in CoV-AKI. Ischemic ATI was the presumed cause of AKI in 85% and 82% of the CoV-AKI and non-CoV-AKI, respectively. Along the duration of SLED, the incidence of hyperK was greater in CoV-AKI [mean 19 ± 2% vs. 14 ± 3% SLED-days, p=0.002]. The proportion of patients with ≥1 event of severe hyperK was greater in CoV-AKI [33% vs. 7%, p=0.0004]. The incidence of hyperP were similar between groups [mean 56 ± 4% vs. 53 ± 5% SLED-days, p=0.49]. However, the proportion of patients with ≥1 event of moderate and severe hyperP were greater in CoV-AKI [86% vs. 60% (p=0.001) and 50% vs. 18%, (p=0.0002)]. In CoV-AKI, sK and sP correlated with lactate dehydrogenase (LDH) [R=0.305 (p=0.044) and R=0.307 (p=0.043), respectively] but not with creatine kinase;and hyperP events correlated with shorter SLED runs (hours/run) (R=-0.268, p=0.055). Conclusions: HyperK and hyperP refractory to RRT (by SLED) were more frequent in CoV-AKI compared to other forms of AKI in the pre-COVID-19 era. Because of the correlation of sK and sP with higher LDH and shorter SLED runs, intracellular ion release from cell injury due to cytokine 'storm' and RRT interruptions may play a role.
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Background: Acute kidney injury (AKI) is a complication of COVID-19 that is not fully understood. Microscopic examination of the urinary sediment (MicrExUrSed) is a valuable diagnostic tool in AKI. Thus far, there has been scarcity of data about MicrExUrSed in COVID-19-associated AKI (CoV-AKI). We hypothesized that MicrExUrSed provides diagnostic clues in CoV-AKI. Methods: We conducted a prospective observational study in patients seen for inpatient nephrology consultation with KDIGO AKI stage ≥ 1 and COVID-19 over a 1-month period. Urine specimens were collected with personal protective equipment to perform MicrExUrSed. Slides were assessed for presence of white blood cells (WBC) [≥ 2+ dipstick, ≥ 6 per low power field (LPF)], red blood cells (RBC) (≥ 2+ dipstick, ≥ 8 per LPF), acanthocytes, granular casts (GC), renal tubular epithelial cell casts (RTECC) and waxy casts (WxC). Slides were assigned to a category of acute tubular injury (ATI) based on either a Perazella cast score ≥ 2 or a Chawla cast score ≥ 3. Results: Among 161 cases of AKI, MicrExUrSed was performed in 20 (12.4%). Anuria and contact precautions were barriers to obtain specimens. GC were found in 17 (85%) of which 16 (80%) had 'muddy' brown GC (MBGC). A median 5 MBGC per LPF (1-20) were found in a median 40% (10-95%) of LPFs. WxC were found in 10 (50%) cases with a median 2 (1-5) per LPF, all of whom had MBGC also present. RTECC were found in 3 (15%) cases with a median 1 (1-4) per LPF. Altogether, ATI score was assigned to 17 (85%) patients, of which 12 (60%) had AKI either after a hemodynamic/ischemic insult (9) or after a toxic insult (3) (rhabdomyolysis, vancomycin, contrast) and 3 (15%) had biopsy-proven ATI along with collapsing glomerulopathy;for a total of 15 (75%) patients with either clinical or histological evidence on ATI matching the MicrExUrSed findings. Ten (50%) and 5 (25%) had WBCs and RBCs, respectively. Acanthocytes were found in 1 (5%) patient with presumptive proliferative endocapillary glomerulonephritis. Conclusions: MicrExUrSed in most patients with CoV-AKI showed overt evidence of ATI with an abundance of MBGC and WxC, including in cases of coexisting glomerulopathy. Pyuria was observed in half. The diagnostic utility of MicrExUrSed in CoV-AKI was comparable to that demonstrated in other forms of AKI.