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1.
J Med Virol ; 93(3): 1678-1686, 2021 03.
Article in English | MEDLINE | ID: covidwho-1196494

ABSTRACT

BACKGROUND: The role of convalescent plasma therapy for patients with coronavirus disease 2019 (COVID-19) is unclear. METHODS: We retrospectively compared outcomes in a cohort of critical COVID-19 patients who received standard care (SC Group) and those who, in addition, received convalescent plasma (CP Group). RESULTS: In total, 40 patients were included in each group. The median patient age was 53.5 years (interquartile range [IQR] 42-60.5), and the majority of patients required invasive ventilation (69, 86.2%). Plasma was harvested from donors after a median of 37 days (IQR 31-46) from the first positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) result and 26 days (IQR 21-32) after documented viral clearance; it was administered after a median of 10 days (IQR 9-10) from the onset of symptoms and 2.5 days (IQR 2-4) from admission to intensive care unit. The primary endpoint of improvement in respiratory support status within 28 days was achieved in 26 patients (65%) in the SC Group and 31 patients (77.5%) in the CP Group (p = .32). The 28-day all-cause mortality (12.5% vs. 2.5%; p = .22) and viral clearance (65% vs. 55%; p = .49) were not significantly different between the two groups. Convalescent plasma was not significantly associated with the primary endpoint (adjusted hazard ratio 0.87; 95% confidence interval 0.51-1.49; p = .62). Adverse events were balanced between the two study groups. CONCLUSION: In severe COVID-19, convalescent plasma therapy was not associated with clinical benefits. Randomized trials are required to confirm our findings.


Subject(s)
COVID-19/therapy , Plasma/immunology , Adult , COVID-19/immunology , Female , Humans , Immunization, Passive/methods , Male , Middle Aged , Retrospective Studies , SARS-CoV-2/immunology , Severity of Illness Index , Treatment Outcome
2.
Am J Trop Med Hyg ; 104(1): 63-65, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1067875

ABSTRACT

Clinical manifestations and complications of SARS-CoV-2 are still emerging and variant. Gastrointestinal (GI) manifestations and complications are hugely under-recognized. The presence of angiotensin converting enzyme-2 receptors in the intestinal enterocytes, the receptors primarily involved in the pathogenesis of COVID-19 pneumonia, maybe the key factor contributing to the pathogenesis of GI manifestations. Ischemic colitis, although the most common ischemic pathology of the GI tract, is relatively rare, occurring as a result of colonic hypoperfusion. The innumerable causes of colonic ischemia are categorized into occlusive and nonocclusive pathologies. Here, we have discussed a case of severe COVID-19 pneumonia, developing ischemic colitis, as a rare GI complication. The cause of ischemia in COVID-19 pneumonia is multifactorial, including hypercoagulable state, coagulopathy leading to thromboembolic complications, and use of vasopressors in severely ill patients with hemodynamic compromise.


Subject(s)
COVID-19/complications , Colitis, Ischemic/etiology , SARS-CoV-2 , Aged , COVID-19/therapy , Colitis, Ischemic/therapy , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/therapy , Humans , Male
3.
Clin Case Rep ; 9(3): 1397-1401, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1025073

ABSTRACT

Our work highlights patients at risk of prolonged viral shedding in COVID-19 and its implications for isolation strategies and explores possible solution by PCR-CT value testing (cycle threshold value). We also review the impact of HIV on COVID-19.

4.
Br J Radiol ; 94(1117): 20200812, 2021 Jan 01.
Article in English | MEDLINE | ID: covidwho-970894

ABSTRACT

An outbreak of corona virus disease 2019 (COVID-19) began in China in December 2019, and rapidly spread to become a worldwide pandemic. Neurological complications encountered in hospitalized patients include acute arterial ischemic cerebrovascular stroke, cerebral venous thrombosis, critical illness-associated cerebral microbleeds, hypertensive hemorrhagic posterior reversible encephalopathy, meningoencephalitis/flare up of infections, flare up of multiple sclerosis, acute disseminated encephalomyelitis, cerebral hemodynamic/hypoxic changes such as watershed ischemic changes and hypoxic ischemic encephalopathy, and spine manifestations of Guillain Barre syndrome and viral myelitis. The purpose of our study is to illustrate the different neuroimaging features in critically ill hospitalized COVID-19 positive patients in the State of Qatar.


Subject(s)
COVID-19/complications , Nervous System Diseases/diagnostic imaging , Nervous System Diseases/etiology , Neuroimaging , Adult , Aged , Female , Humans , Male , Middle Aged
5.
Am J Trop Med Hyg ; 103(4): 1600-1603, 2020 10.
Article in English | MEDLINE | ID: covidwho-740526

ABSTRACT

The COVID-19 pandemic has recently spread worldwide, presenting primarily in the form of pneumonia or other respiratory disease. In addition, gastrointestinal manifestations have increasingly been reported as one of the extrapulmonary features of the virus. We report two cases of SARS-CoV-2 infection complicated by paralytic ileus. The first patient was a 33-year-old man who was hospitalized with severe COVID-19 pneumonia requiring ventilator support and intensive care. He developed large bowel dilatation and perforation of the mid-transverse colon, and underwent laparotomy and colonic resection. Histopathology of the resected bowel specimen showed acute inflammation, necrosis, and hemorrhage, supporting a role for COVID-19-induced micro-thrombosis leading to perforation. The second patient was a 33-year-old man who had severe COVID-19 pneumonia, renal failure, and acute pancreatitis. His hospital course was complicated with paralytic ileus, and he improved with conservative management. Both cases were observed to have elevated liver transaminases, which is consistent with other studies. Several authors have postulated that the angiotensin-converting enzyme 2 receptors, the host receptors for COVID-19, that are present on enterocytes in both the small and large bowel might mediate viral entry and resultant inflammation. This is a potential mechanism of paralytic ileus in cases of severe COVID-19 infection. Recognizing paralytic ileus as a possible complication necessitates timely diagnosis and management.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/virology , Intestinal Perforation/virology , Intestinal Pseudo-Obstruction/virology , Pancreatitis/virology , Pneumonia, Viral/virology , Renal Insufficiency/virology , Adult , Biomarkers/metabolism , COVID-19 , Coronavirus Infections/diagnostic imaging , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Humans , Intestinal Perforation/diagnostic imaging , Intestinal Perforation/physiopathology , Intestinal Perforation/therapy , Intestinal Pseudo-Obstruction/diagnostic imaging , Intestinal Pseudo-Obstruction/physiopathology , Intestinal Pseudo-Obstruction/therapy , Liver/enzymology , Liver/pathology , Liver/virology , Male , Pancreatitis/diagnostic imaging , Pancreatitis/physiopathology , Pancreatitis/therapy , Pandemics , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , Positive-Pressure Respiration/methods , Renal Dialysis , Renal Insufficiency/diagnostic imaging , Renal Insufficiency/physiopathology , Renal Insufficiency/therapy , SARS-CoV-2 , Tomography, X-Ray Computed , Transaminases/metabolism
6.
Neuroradiol J ; 33(5): 374-376, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-696870

ABSTRACT

We are reporting the imaging findings of the rare entity of critical illness-associated cerebral microbleeds in a COVID-19-positive 66-year-old woman with hypoxic respiratory failure, who was eventually intubated and ventilated. Multiple scattered cerebral microhaemorrhages diffusely distributed in the juxtacortical white matter and internal capsule region, sparing the deep and periventricular white matter, basal ganglia, thalami and cortex were seen, which is a unique imaging finding in critically ill patients with respiratory failure and hypoxemia requiring mechanical ventilation. The mechanism underlying these microhaemorrhages relates to the endpoint of critical illness, rather than a specific underlying disease.


Subject(s)
Brain Edema/diagnostic imaging , Cerebral Hemorrhage/diagnostic imaging , Coronavirus Infections/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , White Matter/diagnostic imaging , Aged , Betacoronavirus , Brain Edema/complications , COVID-19 , Cerebral Hemorrhage/complications , Coronavirus Infections/complications , Coronavirus Infections/therapy , Critical Illness , Female , Humans , Hypoxia/etiology , Hypoxia/therapy , Magnetic Resonance Angiography , Magnetic Resonance Imaging , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/therapy , Respiration, Artificial , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy , SARS-CoV-2 , Tomography, X-Ray Computed
7.
J Med Virol ; 92(10): 2042-2049, 2020 10.
Article in English | MEDLINE | ID: covidwho-306523

ABSTRACT

Tocilizumab, an interleukin-6 inhibitor, may ameliorate the inflammatory manifestations associated with severe coronavirus disease 2019 (COVID-19) and thus improve clinical outcomes. This was a retrospective review of patients with laboratory-confirmed severe COVID-19 who received tocilizumab and completed 14 days of follow up. Twenty-five patients were included, median age was 58 years (interquartile range, 50-63) and the majority were males (92%). Co-morbidities included diabetes mellitus (48%), chronic kidney disease (16%), and cardiovascular disease (12%). Fever (92%), cough (84%), and dyspnea (72%) were the commonest presenting symptoms. All patients received at least two concomitant investigational antiviral agents. Median oral temperature was on day 1, 3, and 7 was 38.0°C, 37.3°C (P = .043), and 37.0°C (P = .064), respectively. Corresponding median C-reactive protein was 193 and 7.9 mg/L (P < .0001) and <6 mg/L (P = .0001). Radiological improvement was noted in 44% of patients by day 7% and 68% by day 14. Nine patients (36%) were discharged alive from intensive care unit and three (12%) died. The proportion of patients on invasive ventilation declined from (84%) at the time of tocilizumab initiation to 60% on day 7 (P = .031) and 28% on day 14 (P = .001). The majority (92%) of patients experienced at least one adverse event. However, it is not possible to ascertain which adverse events were directly related to tocilizumab therapy. In patients with severe COVID-19, tocilizumab was associated with dramatic decline in inflammatory markers, radiological improvement and reduced ventilatory support requirements. Given the study's limitations, the results require assessment in adequately powered randomized controlled trials.


Subject(s)
Antibodies, Monoclonal, Humanized/therapeutic use , COVID-19/drug therapy , Antiviral Agents/therapeutic use , C-Reactive Protein/analysis , Female , Humans , Male , Middle Aged , Qatar , Respiration, Artificial , Retrospective Studies
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