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1.
Lung India ; 39(SUPPL 1):S157, 2022.
Article in English | EMBASE | ID: covidwho-1857209

ABSTRACT

Background: A patient presenting with cavitatory lung lesions offers a variety of differential diagnosis to the treating chest physician. It varies from acute and chronic infections, systemic illnesses and malignancy.[1] Arriving at a proper diagnosis and proceeding to next step of management is very challenging. Case Study: Case 1: 27 male, day 10 of COVID-19 infection, presented with hemoptysis. HRCT Thorax showed bilateral cavitatory lung lesions. Serum Aspergillus IgM and sputum Galactomannan positive. He was started on Injectable liposomal Amphotericin-B. Patient improved. Case 2: 48 male, post COVID, presented with breathlessness and headache. He was diagnosed with Right maxillary mucormycosis. HRCT Thorax showed right lung cavitatory lesion. Started on Injectable liposomal Amphotericin-B. The patient underwent Right side Bilobectomy as there was no improvement. Antifungal medications continued and patient improved. Case 3: 42 year old male, post COVID, presented with headache and fever and diagnosed as left maxillary mucormycosis. Chest X-ray showed right side cavitatory lung lesion. Started on liposomal Amphotericin-B and Posaconazole. Patient was inoperable as he developed bilateral pneumothorax, for which left sided ICD inserted. Patient improved with antifungal therapy. Discussion: Case 2 required surgical intervention, while case 1 and case 3 improved with medical management. A multidisciplinary team was involved in the management. Early diagnosis is the cornerstone for management. Conclusion: Each patient of post COVID cavitatory lung lesion should be assessed properly and to be treated by individualised approach rather than a generalised approach. Newer antifungals and combination antifungals should be further explored along with surgical management.

3.
Stroke ; 52(SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1234426

ABSTRACT

Introduction: Stroke nurse is functioning as a vital member of the stroke team. She/he provides care to the stroke patients in acute as well as post-acute periods. She/he coordinates among other team members to facilitate the stroke care continuum. Post-stroke care is always a challenge for health care professional as well as caregivers. During current pandemic conditions, it is essential to provide quality care at their home. Purpose: To develop a mobile application to provide home based care for prevention and management of post stroke complications among survivors. Methods: Survey was carried out among 170 bedridden stroke survivors and their caregivers to assess problems faced like aspiration pneumonia, bedsore, urinary tract infection, deep vein thrombosis, frozen shoulder, contractures, and caregiver burden. On the basis of findings 'Stroke home care' a bilingual (in Hindi and English) mobile application was developed which contains step by step nursing-care-procedural videos to prevent bedsore, bedsore dressing, positioning change, Ryle's tube feeding, Foley's catheter care, active and passive range of motion exercises, hand washing with soap-water as well with sanitizer, psychological support to patients. Results: Through this intervention, caregivers of bedridden stroke patients get trained for care procedures so that they can provide best possible nursing care to their patients at home and can prevent post stroke complications and ultimately enhances quality of life of survivors and reduce caregivers' burden. Conclusion: 'Stroke Home Care' is a novel intervention developed by a stroke nurse which has been developed and tested not just for its feasibility and acceptability but also proven for its clinical applicability through PROBE designed study. This web based intervention can provide rehabilitation services to bedridden stroke survivors at their home in this pandemic.(Figure Presented).

4.
PubMed; 2020.
Preprint in English | PubMed | ID: ppcovidwho-8105

ABSTRACT

Background Multiple Biomarkers have recently been shown to be elevated in COVID-19, a respiratory infection with multi-organ dysfunction;however, information regarding the prognostic value of cardiac biomarkers as it relates to disease severity and cardiac injury are inconsistent. Research Question The goal of this meta-analysis was to summarize the evidence regarding the prognostic relevance of cardiac biomarkers from data available in published reports. Study Design and Methods PubMed was searched from inception through April 2020 for studies comparing median values of cardiac biomarkers in critically ill versus non-critically ill COVID-19 patients, or patients who died versus those who survived. The weighted mean differences (WMD) and 95% confidence interval (CI) between the groups were calculated for each study and combined using a random effects meta-analysis model. The odds ratio (OR) for mortality based on cardiac injury was combined from studies reporting it. Results Troponin levels were significantly higher in COVID-19 patients who died or were critically ill versus those who were alive or not critically ill (WMD 0.58, 95% CI 0.42-0.71, p<0.001). Cardiac injury was independently associated with significantly increased odds of mortality (OR 6.641, 95% CI 1.26 - 35.1, p=0.03). No difference in BNP was seen between the two groups. A significant difference in levels of D-dimer was seen in those who died or were critically ill. CK levels were only significantly higher in those who died versus those who were alive (WMD 0.47 95% CI 0.09-0.84, p=0.014). Interpretation Cardiac biomarkers add prognostic value to the determination of the severity of COVID-19 and can predict mortality.

5.
Journal of the Indian Medical Association ; 118(9):70-76, 2020.
Article in English | EMBASE | ID: covidwho-875422

ABSTRACT

The COVID-19 pandemic continues to have a serious impact on the lives of millions of people worldwide. Empirical therapy is being used to reduce morbidity and mortality of COVID-19 patients. Favipiravir, which is an oral broad-spectrum anti-viral agent with proven efficacy against various RNA viruses, acceptable tolerability profile and favorable benefit-risk ratio in short term use, has got an emergency use authorization in many countries including India for the treatment of mild to moderate cases of COVID-19. It has demonstrated promising results in terms of rapid viral clearance, quick symptom control, and pulmonary radiographic improvement. Due to reasons such as lockdown, isolation, diagnostic delays, fear of quarantine or getting tested, cost, etc., the golden time period (first 24-48 hrs) is lost in COVID-19 patients which is crucial for initiating antiviral therapy. Therefore, the panel members of ‘Academy of Advanced Medical Education’ propose that favipiravir can be recommended in confirmed, early probable and possible cases of mild and moderate severity as an empirical therapy during current pandemic. It is important to counsel the patients and explain to them about the limited clinical evidences with favipiravir, therefore, a signed consent form from patient must be kept before initiating treatment. Well-designed double-blind controlled trials are urgently required to understand this further.

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