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1.
Indian J Crit Care Med ; 26(3): 376-380, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1742856

ABSTRACT

Coronavirus disease-2019 (COVID-19) pandemic is raging all over the world. As we are delving more into management of COVID-19, certain new challenges are emerging. One of these is emergence or reactivation of viral infections belonging to Herpesviridae family, especially cytomegalovirus (CMV). Although we have come across the threat of fungal and resistant bacterial infections, experience regarding reactivation or coinfection with concomitant viral infections like CMV during the COVID pandemic is still limited. Whether CMV is a bystander or pathogen is difficult to say categorically and needs further research. In this case series, we intend to describe three patients of COVID-19 with CMV coinfections. To our knowledge, this is the first case series from India. How to cite this article: Siddiqui SS, Chatterjee S, Yadav A, Rai N, Agrawal A, Gurjar M, et al. Cytomegalovirus Coinfection in Critically Ill Patients with Novel Coronavirus-2019 Disease: Pathogens or Spectators? Indian J Crit Care Med 2022;26(3):376-380.

2.
Critical care explorations ; 4(3), 2022.
Article in English | EuropePMC | ID: covidwho-1728475

ABSTRACT

Hypoalbuminemia has been associated with poor outcome in critically ill population including sepsis and COVID-19. The observational study by Su et al showed a favorable albumin kinetics, with an initial downwards trend followed by recovery back to the predicted albumin levels, in survivors of COVID-19 and sepsis-induced acute respiratory distress syndrome (ARDS). However, nonsurvivors in COVID-19 group did not have an upwards recovery slope, while those in sepsis group did not follow any sort of albumin kinetics. Thus, authors concluded that the pattern of albumin kinetics may be predictive of outcome in COVID-19 and sepsis-induced ARDS. Here, we would like to highlight a few more points in this letter.

3.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-311691

ABSTRACT

Background: Mental health disturbances have been well documented due to COVID-19 pandemic. There was surge in literature about use of various Mind Body Therapies during pandemic to curb these disturbances. But none have been studied to prospectively during COVID-19 pandemic. Hence, present study was planned to evaluate the efficacy of Yoganidra in frontline Health care workers (HCW) during pandemic using online and digital tools. Methods This open label randomized trial consisting of 2 arms (Yoganidra and Supine Relaxation technique [SRT]) was conducted at Level- III COVID care centre involving dedicated frontline HCWs. Online YouTube digital platform was used deliver the respective intervention to study participants. Daily reminders were sent using digital social media. Each intervention lasted for 30min a day. Participants completing > 9 days of practice were included for analysis. Primary outcome was changes in scores of Physical Health Quality (PHQ)-9, Generalized Anxiety Score (GAD)-7, Insomnia Severity Index (ISI) scale. Secondary outcomes were rate of recruitment, days of intervention practice, satisfaction of digital contents. Statistical analysis was carried out using SPSS v.23. Results Of 139 HCWs contacted, 79 HCWs (40 in SRT and 39 in Yoganidra) consented and were recruited into study. After withdrawal and incomplete practice days, 32 in SRT group and 30 in Yoganidra group were included for final analysis. Demographics and pre-intervention scores of PHQ-9, GAD-7, ISI were comparable at baseline. After completion of study, there were significant reduction in scores of PHQ-9, GAD-7 and ISI in Yoganidra 0.002 vs 0.064, < 0.001 vs 0.123, < 0.001 vs 0.828 respectively and effect size was 0.041, 0.013 and 0.024 respectively compared to SRT group. Recruitment rate was 56.8%, 78% of participants completed > 9 days of practice and 100% satisfaction among participants. Conclusion Yoganidra significantly reduces depression, anxiety and insomnia scores among frontline COVID HCWs compared to SRT using virtual session platform. It is also feasible to conduct the virtual sessions of Yoga Nidra using digital platform. Trial Registration: Clinical Trials Registry of India REF/CTRI/2020/07/026609, (ctri.nic.in/clinicaltrials/login.php, number REF/CTRI/2020/07/026609)

5.
Indian J Crit Care Med ; 25(11): 1280-1285, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1526937

ABSTRACT

INTRODUCTION: There is strong evidence for the use of corticosteroid in the management of severe coronavirus disease-2019 (COVID-19). However, there is still uncertainty about the timing of corticosteroids. We undertook a modified Delphi study to develop expert consensus statements on the early identification of a subset of patients from non-severe COVID-19 who may benefit from using corticosteroids. METHODS: A modified Delphi was conducted with two anonymous surveys between April 30, 2021, and May 3, 2021. An expert panel of 35 experts was selected and invited to participate through e-mail. The consensus was defined as >70% votes in multiple-choice questions (MCQ) on Likert-scale type statements, while strong consensus as >90% votes in MCQ or >50% votes for "very important" on Likert-scale questions in the final round. RESULTS: Twenty experts completed two rounds of the survey. There was strong consensus for the increased work of breathing (95%), a positive six-minute walk test (90%), thorax computed tomography severity score of >14/25 (85%), new-onset organ dysfunction (using clinical or biochemical criteria) (80%), and C-reactive protein >5 times the upper limit of normal (70%) as the criteria for patients' selection. The experts recommended using oral or intravenous (IV) low-dose corticosteroids (the equivalent of 6 mg/day dexamethasone) for 5-10 days and monitoring of oxygen saturation, body temperature, clinical scoring system, blood sugar, and inflammatory markers for any "red-flag" signs. CONCLUSION: The experts recommended against indiscriminate use of corticosteroids in mild to moderate COVID-19 without the signs of clinical worsening. Oral or IV low-dose corticosteroids (the equivalent of 6 mg/day dexamethasone) for 5-10 days are recommended for patients with features of disease progression based on clinical, biochemical, or radiological criteria after 5 days from symptom onset under close monitoring. HOW TO CITE THIS ARTICLE: How to cite this article: Nasa P, Chaudhry D, Govil D, Daga MK, Jain R, Chhallani AA, et al. Expert Consensus Statements on the Use of Corticosteroids in Non-severe COVID-19. Indian J Crit Care Med 2021;25(11):1280-1285.

6.
Front Med (Lausanne) ; 8: 735860, 2021.
Article in English | MEDLINE | ID: covidwho-1518494

ABSTRACT

Background: Data regarding delivery of evidence-based care to critically ill patients in Intensive Care Units (ICU) during the COVID-19 pandemic is crucial but lacking. This study aimed to evaluate the implementation rate of the ABCDEF bundle, which is a collection of six evidence-based ICU care initiatives which are strongly recommended to be incorporated into clinical practice, and ICU diaries for patients with and without COVID-19 infections in ICUs, and to analyze the impact of COVID-19 on implementation of each element of the bundle and independent associated factors. Methods: A world-wide 1-day point prevalence study investigated the delivery of the ABCDEF bundle and ICU diary to patients without or with COVID-19 infections on 27 January 2021 via an online questionnaire. Multivariable logistic regression analysis with adjustment for patient demographics evaluated the impact of COVID-19 and identified factors in ICU administrative structures and policies independently associated with delivery. Results: From 54 countries and 135 ICUs, 1,229 patients were eligible, and 607 (49%) had COVID-19 infections. Implementation rates were: entire bundle (without COVID-19: 0% and with COVID-19: 1%), Element A (regular pain assessment: 64 and 55%), Element B (both spontaneous awakening and breathing trials: 17 and 10%), Element C (regular sedation assessment: 45 and 61%), Element D (regular delirium assessment: 39 and 35%), Element E (exercise: 22 and 25%), Element F (family engagement/empowerment: 16 and 30%), and ICU diary (17 and 21%). The presence of COVID-19 was not associated with failure to implement individual elements. Independently associated factors for each element in common between the two groups included presence of a specific written protocol, application of a target/goal, and tele-ICU management. A lower income status country and a 3:1 nurse-patient ratio were significantly associated with non-implementation of elements A, C, and D, while a lower income status country was also associated with implementation of element F. Conclusions: Regardless of COVID-19 infection status, implementation rates for the ABCDEF bundle, for each element individually and an ICU diary were extremely low for patients without and with COVID-19 infections during the pandemic. Strategies to facilitate implementation of and adherence to the complete ABCDEF bundle should be optimized and addressed based on unit-specific barriers and facilitators.

7.
Disaster Med Public Health Prep ; : 1-4, 2020 Oct 22.
Article in English | MEDLINE | ID: covidwho-983140

ABSTRACT

During the current coronavirus disease (COVID-19) pandemic, it is estimated that tens of thousands of health care workers have been infected. The doffing of personal protective equipment (PPE) has been identified an important place and procedure that might influence the self-contamination of health care workers. More recent evidence suggests that, in addition to existing infection control standards, there is an urgent need for the incorporation of various recent information and advancements pertaining to structure and process to reduce the self-contamination of health care workers during the doffing of PPE.

8.
Expert Rev Med Devices ; 17(12): 1265-1276, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-933795

ABSTRACT

Introduction: The current pandemic of novel Corona Virus Disease 2019 (COVID-19) has created a significant shortage of personal protective equipment (PPE) in many countries of the world, stressing medical services during this crisis. Along with addressing problems of demand and supply mismatch, there also a need to ensure the procurement of high-quality PPEs that provides both safety and comfort to users. The purpose of this article is to review existing standards and recommendations on the technical aspects of PPE. Areas covered: For this review, MEDLINE, Google Scholar, and Research Gate were searched. Studies reporting technical aspects of the components of PPE including mask and respirator, gown, and coverall, gloves, goggles, face shields, or visors, and boots, are included in this review. Expert opinion: The design and materials of PPE needs further research, which might have minimal carriage of infective biological load like the use of antimicrobial repellent finishes along with adequate tensile strength and breathability through the fabric. Respirators should have the least resistance while providing maximum protection; goggles should not have fogging. Also, there is a need of formulating universal technical specifications for medically used PPE and ensuring easy availability of the testing facilities.


Subject(s)
COVID-19 , Personal Protective Equipment , Humans , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Pandemics/prevention & control , Personal Protective Equipment/standards , Personal Protective Equipment/supply & distribution , SARS-CoV-2
9.
Crit Care ; 24(1): 194, 2020 05 06.
Article in English | MEDLINE | ID: covidwho-186516

ABSTRACT

The aim of this review is to describe variation in standards and guidelines on 'heating, ventilation and air-conditioning (HVAC)' system maintenance in the intensive care units, across the world, which is required to maintain good 'indoor air quality' as an important non-pharmacological strategy in preventing hospital-acquired infections. An online search and review of standards and guidelines published by various societies including American Institute of Architects (AIA), American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE), Centers for Disease Control and Prevention (CDC), Department of Health Estates and Facilities Division, Health Technical Memorandum 2025 (HTM) and Healthcare Infection Control Practices Advisory Committee (HICPAC) along with various national expert committee consensus statements, regional and hospital-based protocols available in a public domain were retrieved. Selected publications and textbooks describing HVAC structural aspects were also reviewed, and we described the basic structural details of HVAC system as well as variations in the practised standards of HVAC system in the ICU, worldwide. In summary, there is a need of universal standards for HVAC system with a specific mention on the type of ICU, which should be incorporated into existing infection control practice guidelines.


Subject(s)
Air Conditioning/methods , Heating/methods , Ventilation/methods , Air Conditioning/trends , Air Pollution, Indoor/analysis , Heating/trends , Humans , Infection Control/instrumentation , Infection Control/methods , Infection Control/trends , Intensive Care Units/organization & administration , Particulate Matter/adverse effects
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