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2.
Front Med (Lausanne) ; 9: 956409, 2022.
Article in English | MEDLINE | ID: covidwho-1933715
3.
Lancet Infect Dis ; 2022 Apr 04.
Article in English | MEDLINE | ID: covidwho-1773856

ABSTRACT

COVID-19-associated pulmonary mucormycosis (CAPM) remains an underdiagnosed entity. Using a modified Delphi method, we have formulated a consensus statement for the diagnosis and management of CAPM. We selected 26 experts from various disciplines who are involved in managing CAPM. Three rounds of the Delphi process were held to reach consensus (≥70% agreement or disagreement) or dissensus. A consensus was achieved for 84 of the 89 statements. Pulmonary mucormycosis occurring within 3 months of COVID-19 diagnosis was labelled CAPM and classified further as proven, probable, and possible. We recommend flexible bronchoscopy to enable early diagnosis. The experts proposed definitions to categorise dual infections with aspergillosis and mucormycosis in patients with COVID-19. We recommend liposomal amphotericin B (5 mg/kg per day) and early surgery as central to the management of mucormycosis in patients with COVID-19. We recommend response assessment at 4-6 weeks using clinical and imaging parameters. Posaconazole or isavuconazole was recommended as maintenance therapy following initial response, but no consensus was reached for the duration of treatment. In patients with stable or progressive disease, the experts recommended salvage therapy with posaconazole or isavuconazole. CAPM is a rare but under-reported complication of COVID-19. Although we have proposed recommendations for defining, diagnosing, and managing CAPM, more extensive research is required.

4.
Lung India ; 39(2): 139-144, 2022.
Article in English | MEDLINE | ID: covidwho-1726385

ABSTRACT

Background: Lower respiratory tract (LRT) sampling through bronchoscopy has been done sparingly in COVID-19 acute respiratory distress syndrome (ARDS) due to the high aerosol risk for the health-care workers (HCWs). Valuable information can be gained by a detailed evaluation of bronchoscopic LRT samples. Methods: LRT samples were obtained by bedside bronchoscopy severe COVID-19 ARDS patients on mechanical ventilation. Microbiological, cellular, and cytological studies including LRT COVID-19 reverse transcription-polymerase chain reaction were analyzed. Results: A total of 100 samples were collected from 63 patients, 53 were males (84%). Forty-three patients (68%) had at least 1 comorbidity. 55% of cases had a secondary bacterial infection, commonly with multidrug-resistant organisms (94.5%). The most common organisms were Klebsiella pneumoniae and Acinetobacter baumannii in 56.3% and 14.5% of cases, respectively. Fungal superinfection was observed in 9 patients (14.3%). Bronchoscopy helped confirm COVID-19 diagnosis in 1 patient and helped rule out COVID-19 in 3 patients. The median bronchoalveolar lavage fluid (BALF) white blood cell (WBC) count was 953 (inter quartile range; 400-2717), with mean neutrophil count 85.2% (±13.9) and mean lymphocyte count 14.8% (±13.9). Repeat sampling done in some patients showed a progressive increase in the total WBC count in BALF, an increase in neutrophil percentage, and a higher chance of isolating an organism on the culture. Rate of superinfection increased with a longer duration of illness. Bronchoscopic LRT sampling contributed significantly to modifying antibiotic coverage and discontinuing steroids in 37% of cases. Conclusions: Our study provides a detailed analysis of bronchoscopic LRT sampling in critically ill COVID-19 patients, augmenting disease understanding and contributing to clinical management.

5.
Lung India ; 39(2): 187-190, 2022.
Article in English | MEDLINE | ID: covidwho-1726382

ABSTRACT

The explosive rise in angioinvasive mucormycosis (MM) in India and other parts of the world has been described as the "epidemic following the COVID-19 pandemic," with the majority being rhino-orbital-cerebral MM. We report a case series of five COVID-19-associated pulmonary MM (CAPM) with an aggressive clinical course. Clinical and radiological clues were limited, and the initial suspicion of CAPM was the morphological appearance on bronchoscopy, which led to the diagnosis. Histopathology was consistently positive in all cases, while other microbiological and molecular tests had varying sensitivity. Most patients had a fulminant and fatal course. Also noted was dual fungal infection in 3/5 cases with coexisting multidrug resistant bacterial infection in all cases. CAPM is the hidden part of the COVID-MM epidemic and warrants a high degree of suspicion with early diagnosis and treatment.

7.
Int J Infect Dis ; 106: 71-77, 2021 May.
Article in English | MEDLINE | ID: covidwho-1279592

ABSTRACT

OBJECTIVES: Remdesivir is the current recommended anti-viral treatment in moderate-to-severe COVID-19. However, data on impact of timing of therapy, efficacy, and safety are limited. We evaluated the impact of timing of remdesivir initiation (symptom onset to remdesivir treatment [SORT] interval) on in-hospital all-cause mortality in patients with moderate-to-severe COVID-19. METHODS: This retrospective study was conducted between June 25 and October 3, 2020, at a tertiary care dedicated COVID center in India. Patients with moderate-to-severe COVID-19 (moderate: SpO2 <94%; severe: SpO2 <90%) were included. The main outcome was impact of SORT interval on in-hospital all-cause mortality. Subgroups were formed and analyzed based on SORT interval. RESULTS: Of 350 patients treated with remdesivir, 346 were included in the final analysis. Overall, 76 (22.0%) patients died (moderate: 3 [2.8%], severe: 73 [30.8%]). All-cause mortality was significantly lower in patients with SORT interval ≤9 days (n = 260) vs SORT interval >9 days (n = 86; 18.1% vs 33.7%; p = 0.004). The odds of death were significantly lower in patients with SORT interval ≤9 days vs >9 days (odds ratio = 0.43; 95% CI, 0.25-0.75; p = 0.003). CONCLUSION: Remdesivir initiation ≤9 days from symptom onset was associated with mortality benefit, defining a treatment window and reinforcing the need for appropriately-timed remdesivir in moderate-to-severe COVID-19.


Subject(s)
Adenosine Monophosphate/analogs & derivatives , Alanine/analogs & derivatives , COVID-19/drug therapy , COVID-19/mortality , Adenosine Monophosphate/therapeutic use , Alanine/therapeutic use , Antiviral Agents/therapeutic use , Hospital Mortality , Humans , Male , Middle Aged , Odds Ratio , Retrospective Studies , Treatment Outcome
8.
Lung India ; 38(Supplement): S105-S115, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1123963

ABSTRACT

During the times of the ongoing COVID pandemic, aerosol-generating procedures such as bronchoscopy have the potential of transmission of severe acute respiratory syndrome coronavirus 2 to the healthcare workers. The decision to perform bronchoscopy during the COVID pandemic should be taken judiciously. Over the years, the indications for bronchoscopy in the clinical practice have expanded. Experts at the Indian Association for Bronchology perceived the need to develop a concise statement that would assist a bronchoscopist in performing bronchoscopy during the COVID pandemic safely. The current Indian Association for Bronchology Consensus Statement provides specific guidelines including triaging, indications, bronchoscopy area, use of personal protective equipment, patient preparation, sedation and anesthesia, patient monitoring, bronchoscopy technique, sample collection and handling, bronchoscope disinfection, and environmental disinfection concerning the coronavirus disease-2019 situation. The suggestions provided herewith should be adopted in addition to the national bronchoscopy guidelines that were published recently. This statement summarizes the essential aspects to be considered for the performance of bronchoscopy in COVID pandemic, to ensure safety for both for patients and healthcare personnel.

9.
Contemp Clin Trials ; 103: 106330, 2021 04.
Article in English | MEDLINE | ID: covidwho-1101134

ABSTRACT

BACKGROUND AND AIMS: Retrospective studies have shown that angiotensin-converting-enzyme (ACE) inhibitors are associated with a reduced risk of complications and mortality in persons with novel coronavirus disease 2019 (COVID-19). Thus, we aimed to examine the efficacy of ramipril, an ACE-inhibitor, in preventing ICU admission, mechanical ventilation and/or mortality while also minimizing the risk of transmission and use of personal protective equipment (PPE). METHODS: RAMIC is a multicenter, randomized, double-blind, allocation-concealed, placebo-controlled trial comparing the efficacy of treatment with ramipril 2.5 mg orally daily compared to placebo for 14 days. The study population includes adult patients with COVID-19 who were admitted to a hospital or assessed in an emergency department or ambulatory clinic. Key exclusion criteria include ICU admission or need for mechanical ventilation at screening, use of an ACE inhibitor or angiotensin-receptor-II blocker within 7 days, glomerular filtration rate < 40 mL/min or a systolic blood pressure (BP) < 100 mmHg or diastolic BP < 65 mmHg. Patients are randomized 2:1 to receive ramipril (2.5 mg) or placebo daily. Informed consent and study visits occur virtually to minimize the risk of SARS-CoV-2 transmission and preserve PPE. The primary composite endpoint of ICU admission, invasive mechanical ventilation and death are adjudicated virtually. CONCLUSIONS: RAMIC is designed to assess the efficacy of treatment with ramipril for 14 days to decrease ICU admission, mechanical ventilator use and mortality in patients with COVID-19 and leverages virtual study visits and endpoint adjudication to mitigate risk of infection and to preserve PPE (ClinicalTrials.gov, NCT04366050).


Subject(s)
COVID-19 , Ramipril , Adult , Angiotensin-Converting Enzyme Inhibitors/administration & dosage , Angiotensin-Converting Enzyme Inhibitors/adverse effects , Biomarkers/analysis , COVID-19/complications , COVID-19/mortality , COVID-19/therapy , COVID-19/transmission , Critical Care/statistics & numerical data , Disease Transmission, Infectious/prevention & control , Double-Blind Method , Female , Humans , Male , Mortality , Ramipril/administration & dosage , Ramipril/adverse effects , Randomized Controlled Trials as Topic , Respiration, Artificial/statistics & numerical data , SARS-CoV-2 , Treatment Outcome
11.
Nat Rev Nephrol ; 16(12): 747-764, 2020 12.
Article in English | MEDLINE | ID: covidwho-872710

ABSTRACT

Kidney involvement in patients with coronavirus disease 2019 (COVID-19) is common, and can range from the presence of proteinuria and haematuria to acute kidney injury (AKI) requiring renal replacement therapy (RRT; also known as kidney replacement therapy). COVID-19-associated AKI (COVID-19 AKI) is associated with high mortality and serves as an independent risk factor for all-cause in-hospital death in patients with COVID-19. The pathophysiology and mechanisms of AKI in patients with COVID-19 have not been fully elucidated and seem to be multifactorial, in keeping with the pathophysiology of AKI in other patients who are critically ill. Little is known about the prevention and management of COVID-19 AKI. The emergence of regional 'surges' in COVID-19 cases can limit hospital resources, including dialysis availability and supplies; thus, careful daily assessment of available resources is needed. In this Consensus Statement, the Acute Disease Quality Initiative provides recommendations for the diagnosis, prevention and management of COVID-19 AKI based on current literature. We also make recommendations for areas of future research, which are aimed at improving understanding of the underlying processes and improving outcomes for patients with COVID-19 AKI.


Subject(s)
Acute Kidney Injury/therapy , Acute Kidney Injury/virology , COVID-19/complications , COVID-19/therapy , Renal Replacement Therapy/methods , Acute Kidney Injury/diagnosis , Acute Kidney Injury/pathology , Anticoagulants/therapeutic use , Consensus , Humans , Risk Factors , SARS-CoV-2
12.
Am J Physiol Renal Physiol ; 319(5): F792-F795, 2020 11 01.
Article in English | MEDLINE | ID: covidwho-791655

ABSTRACT

Coronavirus disease 2019 (COVID-19) poses an unprecedented challenge to world health systems, substantially increasing hospitalization and mortality rates in all affected countries. Being primarily a respiratory disease, COVID-19 is mainly associated with pneumonia or minor upper respiratory tract symptoms; however, different organs can sustain considerable (if not terminal) damage because of coronavirus. Acute kidney injury is the most common complication of COVID-19-related pneumonia, and more than 20% of patients requiring ventilatory support develop renal failure. Additionally, chronic kidney disease is a major risk factor for COVID-19 severity and mortality. All these data demonstrate the relevance of renal function assessment in patients with COVID-19 and the need of early kidney-directed diagnostic and therapeutic approaches. However, the sole assessment of renal function could be not entirely indicative of kidney tissue status. In this viewpoint, we discuss the clinical significance and potential relevance of renal functional reserve evaluation in patients with COVID-19.


Subject(s)
Acute Kidney Injury/etiology , Betacoronavirus , Coronavirus Infections/complications , Kidney/pathology , Pneumonia, Viral/complications , COVID-19 , Humans , Kidney Diseases/etiology , Kidney Function Tests , Pandemics , SARS-CoV-2
13.
Lung India ; 37(3): 282-283, 2020.
Article in English | MEDLINE | ID: covidwho-456782
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