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1.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-322457

ABSTRACT

Background: Arterial and venous thrombosis are reported to be common in critically ill COVID-19 patients.Method and Results: This is a national multicenter retrospective observational study involving all consecutive adult COVID-19 patients who required intensive care units (ICU) admission between 23 January 2020 and 30 April 2020 in Singapore. 111 patients were included and the venous and arterial thrombotic rates in ICU were 1.8% (n=2) and 9.9% (n=11), respectively. Major bleeding rate was 14.8% (n=16). Conclusions: Critically ill COVID-19 patients in Singapore have lower venous thromboembolism but higher arterial thrombosis rates and bleeding manifestations than other reported cohorts.

4.
J Thromb Thrombolysis ; 53(3): 646-662, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1439746

ABSTRACT

Severe COVID-19 patients demonstrate hypercoagulability, necessitating thromboprophylaxis. However, less is known about the haemostatic profile in mild COVID-19 patients. We performed an age and gender-matched prospective study of 10 severe and 10 mild COVID-19 patients. Comprehensive coagulation profiling together with Thromboelastography and Clot Waveform Analysis were performed. FBC, PT, APTT, D-dimer, fibrinogen and CWA were repeated every 3 days for both groups and repeat TEG was performed for severe patients up till 15 days. On recruitment, severe patients had markers reflecting hypercoagulability including raised median D-dimer 1.0 µg/mL (IQR 0.6, 1.4) (p = 0.0004), fibrinogen 5.6 g/L (IQR 4.9, 6.6) (p = 0.002), Factor VIII 206% (IQR 171, 203) and vWF levels 265.5% (IQR 206, 321). Mild patients had normal values of PT, aPTT, fibrinogen and D-dimer, and slightly elevated median Factor VIII and von Willebrand factor (vWF) levels. Repeated 3-day assessments for both groups showed declining trends in D-dimer and Fibrinogen. CWA of severe COVID-19 group demonstrated hypercoagulability with an elevated median values of aPTT delta change 78.8% (IQR 69.8, 85.2) (p = 0.001), aPTT clot velocity (min1) 7.8%/s (IQR 6.7, 8.3) (p = 0.001), PT delta change 22.4% (IQR 19.4, 29.5) (p = 0.004), PT min1 7.1%/s (IQR 6.3, 9.0) (p = 0.02), PT clot acceleration (min 2) 3.6%/s2 (IQR 3.2, 4.5) (p = 0.02) and PT clot deceleration (max2) 2.9%/s2 (IQR 2.5, 3.5) (p = 0.02). TEG of severe patients reflected hypercoagulability with significant increases in the median values of CFF MA 34.6 mm (IQR 27.4,38.6) (p = 0.003), CRT Angle 78.9° (IQR 78.3, 80.0) (p = 0.0006), CRT A10 67.6 mm (IQR 65.8, 69.6) (p = 0.007) and CFF A10 32.0 mm (IQR 26.8, 34.0) (p = 0.003). Mild COVID-19 patients had absent hypercoagulability in both CWA and TEG. 2 severe patients developed thromboembolic events while none occurred in the mild COVID-19 group. Mild COVID-19 patients show absent parameters of hypercoagulability in global haemostatic tests while those with severe COVID-19 demonstrated parameters associated with hypercoagulability on the global haemostatic tests together with raised D-Dimer, fibrinogen, Factor VIII and vWF levels.


Subject(s)
COVID-19 , Hemostatics , Thrombophilia , Thrombosis , Venous Thromboembolism , Anticoagulants/therapeutic use , COVID-19/complications , Factor VIII , Fibrinogen/analysis , Humans , Prospective Studies , Thrombelastography , Thrombophilia/diagnosis , Thrombophilia/etiology , Thrombosis/drug therapy , Venous Thromboembolism/drug therapy , von Willebrand Factor
5.
Blood ; 136(Supplement 1):37-38, 2020.
Article in English | PMC | ID: covidwho-1338985

ABSTRACT

ObjectiveArterial and venous thrombosis are reported to be common in critically ill COVID-19 patients.This study aims to describe the thrombotic and bleeding rates in COVID-19 patients admitted to intensive care units (ICU) in Singapore.DesignRetrospective observational study involving all consecutive adult COVID-19 patients who required ICU admission between 23 January 2020 and 30 April 2020.SettingNational multicenter study involving all eight public hospitals in Singapore.Patients111 consecutive COVID-19 patients who required ICU admission were included.Measurements and Main ResultsPrimary outcome was any venous or arterial thrombotic events occurred in ICU. Other measures included (1) the overall, venous and arterial thrombotic events throughout the hospitalisation, (2) major and minor bleeding events. The overall thrombotic rate in ICU was 11.7% (n=13), with 1.8% (n=2) venous and 9.9% (n=11) arterial events. The overall thrombotic rates throughout hospitalisation, censored at 30 April 2020, increased to 18.0% (n=20) with 6.3% (n=7) venous and 11.7% (n=13) arterial events. Major and minor bleeding rates were 14.8% (n=16) and 3.7% (n=4), respectively. Two-third of the patients received pharmacological thromboprophylaxis in ICU.ConclusionsCritically ill COVID-19 patients in Singapore have lower VTE but higher arterial thrombosis rates with higher bleeding manifestations than other reported cohorts. Standard thromboprophylaxis may be sufficient to prevent thrombotic complications in patients with similar demographics.

6.
Smart Healthcare System Design ; n/a(n/a):301-311, 2021.
Article in English | Wiley | ID: covidwho-1272154

ABSTRACT

Summary COVID-19 has already affected the world with this deadly virus, resulting in over 3.5 lakh deaths. The behavior of this virus is extraordinarily peculiar and mutates frequently. So, the scientific community faces the problems to analyze and forecast the virus's growth and transmission capability. The combined effort of powerful Artificial intelligence and Image processing techniques to predict the initial pattern of COVID-19 disease identifies the most affected areas in each country through social networking information and predicts drug-protein interactions for making new drugs vaccines. However, AI-empowered X-Ray and computed tomography image acquisition and segmentation techniques help us identify and diagnose the COVID-19 affected patients with minimal contact. In this chapter, our primary motivation is to sum up the essential roles of some AI-driven techniques (Machine learning, Deep learning, etc.) and AI-empowered imaging techniques to analyze, predict, and diagnose against COVID-19 disease. An essential set of open challenges and future research issues on AI-empowered procedures for handling COVID-19 are also discussed in this chapter. Summary This paper mainly deals with the design of Machine Learning model for the analysis of transmission dynamics of Covid 19. The entire globe is affected because of Corona virus. Ventilator dependent, Severe Acute respiratory and quarantine care ICU patients frequently face difficulties for their most basic human interactions, namely communication due to either respiratory illness, language problem or intubated. ICU patients have serious implications with respect to physical and psychological due to non communication problems. Researchers have developed different types of services like Speech language Pathologist so that Augmentative and alternative communication assistance can be given to all health professionals and caretakers. A probabilistic model is designed to analyse the new cases and death cases. Using machine learning approach Regression model is designed and future predications are displayed. The adequacy of the model is discussed along with the residuals of new cased and death cases. PCF and APCAF are obtained. This paper mainly deals with a probabilistic model to analyse and predict the new cases and deaths of covid 19. A new transformation of analyzing stationarity is carried out and based on this forecasting is executed. Summary This research express an impression of automated decision-making techniques that have been suggested for scrutiny of data from IoT based healthcare systems. IoT data analytics plays a vital role in this modern era since data from connected devices reveal meaningful results with better insights for the future. The chapter involves the design of a decision-making system that collects data from IoT based healthcare systems, preprocess and analyzes data, and generates detailed information reports for better diagnosis. Data preprocessing methods such as data cleaning, munging, normalization, reduction, and removing noisy data are applied. The blend of IoT data with analytics technique results to be beneficial in healthcare systems. The collected IoT information like pulse rate, temperature, oxygen level and heart rate from connected devices can be used to analyze the need and severity in the preliminary stage itself using appropriate machine learning techniques. Multi Criteria Decision Making (MCDM) techniques such as SMART, WPM, and TOPSIS are also applied for conclusion production procedure to generate detailed informative diagnostic reports. Being healthcare data, the overall objective is to aid business organizations with better decision making processes through data analytics thereby deploying the right IoT strategy. The result of the next-generation expert systems can utilize the results for further analysis in diagnosis and treatment. Summary The proposed work deals with the design and development of touch and native voice-assisted prototype to enable the intuitive communication & interaction between health professionals and patients who are affected with Severe Acute Respiratory Infection (SARI), Ventilator-dependent and admitted in Quarantine care. It also ensures the development of the multilingual capability to communicate effectively in most speaking ten Indian languages, so that the patients will be relieved from pains etc., as their queries are being addressed by health professionals. In this prototype, touch based gesture patterns can be effectively used as an interactive module and helps the doctors to monitor and answer to the queries of ICU patients regularly by updating it to the caretakers such that the patients are at ease to express their emotions or pains. The proposed prototype will be made available and accessible in an open software repository. As per the existing methods patients express their needs through non-verbal communication methods and they could be missed out or misinterpreted resulting in symptoms that are poorly understood and the clinicians overestimate their ability to understand their communication feelings. These situations are eradicated by employing the use of ?Touch Voice of SARI? Application. Hence this can be considered as an assistive communication tool which replaces the nonverbal communication to a meaningful communication for ventilator patients and healthcare professionals.

9.
Thromb J ; 19(1): 14, 2021 Mar 08.
Article in English | MEDLINE | ID: covidwho-1123658

ABSTRACT

BACKGROUND: Arterial and venous thrombosis are reported to be common in critically ill COVID-19 patients. METHOD AND RESULTS: This is a national multicenter retrospective observational study involving all consecutive adult COVID-19 patients who required intensive care units (ICU) admission between 23 January 2020 and 30 April 2020 in Singapore. One hundred eleven patients were included and the venous and arterial thrombotic rates in ICU were 1.8% (n = 2) and 9.9% (n = 11), respectively. Major bleeding rate was 14.8% (n = 16). CONCLUSIONS: Critically ill COVID-19 patients in Singapore have lower venous thromboembolism but higher arterial thrombosis rates and bleeding manifestations than other reported cohorts.

11.
J Thromb Thrombolysis ; 51(3): 663-674, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-886991

ABSTRACT

Patients with COVID-19 are known to be at risk of developing both venous, arterial and microvascular thrombosis, due to an excessive immuno-thrombogenic response to the SARS-CoV-2 infection. Overlapping syndromes of COVID-19 associated coagulopathy with consumptive coagulopathy and microangiopathy can be seen in critically ill patients as well. Blood was collected from 12 Intensive Care Unit (ICU) patients with severe COVID-19 who were on either mechanical ventilation or on high flow oxygen with a PaO2/FiO2 ratio of <300 mmHg. Laboratory tests were performed for parameters of haemostasis, clot waveform analysis and anti-phospholipid antibodies. CWA parameters were raised with elevated aPTT median Min1 (clot velocity) 9.3%/s (IQR 7.1-9.9%/s), elevated PT median Min1 10.3%/s (IQR 7.1-11.1%/s), elevated aPTT median Min2 (clot acceleration) 1.5%/s2 (IQR 1.0-1.6%/s2), elevated PT median Min2 5.2%/s2 (3.6-5.7%/s2), elevated aPTT median Max2 (clot deceleration) 1.3%/s2 (IQR 0.8-1.4%/s2) elevated PT median Max2 3.8%/s2 (IQR 2.6-4.2%/s2), increased aPTT median Delta change (decreased light transmission due to increased clot formation) 87.8% (IQR 70.2-91.8%) and PT median Delta change 33.0%. This together with raised median Factor VIII levels of 262.5%, hyperfibrinogenemia (median fibrinogen levels 7.5 g/L), increased median von Willebrand factor antigen levels 320% and elevated median D-dimer levels 1.7 µg/dl support the diagnosis of COVID-19 associated coagulopathy. A lupus anticoagulant was present in 50% of patients. Our laboratory findings further support the view that severe SARS-CoV-2 infection is associated with a state of hypercoagulability.


Subject(s)
Blood Coagulation , COVID-19/blood , Thrombophilia/virology , Adult , Blood Coagulation Tests , COVID-19/complications , COVID-19/physiopathology , Critical Illness , Female , Humans , Lupus Coagulation Inhibitor/blood , Male , Middle Aged , Retrospective Studies , Thrombophilia/blood
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