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1.
International Journal of Occupational Safety and Health ; 13(1):78-86, 2023.
Article in English | Scopus | ID: covidwho-2215134

ABSTRACT

Introduction: Global pandemic of COVID-19 resulted in a nationwide lockdown which affected the migrants in terms of healthcare service accessibility. This led to an increase in the prevalence of various morbidity. Objective of this study was to assess the morbidity profile of camp attendees in Bangalore urban conducted during the lockdown period of the COVID-19 pandemic. Methods: During the pandemic lockdown, health camps were conducted in selected urban under-privileged areas of Bangalore city targeting the migrant workers and these records were reviewed and relevant data were analyzed. Variables included age, gender, residential address, occupation and morbidity. Results: Among the 484 participants who had attended the medical camp, the youngest patient was 1 year old and the oldest was 75 years with a median age of 27 years (IQR: 20 – 35). The majority of the camp attendees were males (78%) and migrants (77%). Common morbidities noted were hypertension (5%) followed by musculoskeletal pain (4%). The other illnesses were anemia (3%), gastritis (2.5%), pre-diabetes (1.7%) and combined diabetes and hypertension (1.5%). There was no significant relationship between migrant status and the presence of any morbidity. Conclusion: Hypertension and musculoskeletal pain are the most common morbidity among the camp attendees. © 2023 The authors.

2.
BMJ Open ; 13(1):e066626, 2023.
Article in English | PubMed | ID: covidwho-2193797

ABSTRACT

OBJECTIVES: To reliably quantify the radiographic severity of COVID-19 pneumonia with the Radiographic Assessment of Lung Edema (RALE) score on clinical chest X-rays among inpatients and examine the prognostic value of baseline RALE scores on COVID-19 clinical outcomes. SETTING: Hospitalised patients with COVID-19 in dedicated wards and intensive care units from two different hospital systems. PARTICIPANTS: 425 patients with COVID-19 in a discovery data set and 415 patients in a validation data set. PRIMARY AND SECONDARY OUTCOMES: We measured inter-rater reliability for RALE score annotations by different reviewers and examined for associations of consensus RALE scores with the level of respiratory support, demographics, physiologic variables, applied therapies, plasma host-response biomarkers, SARS-CoV-2 RNA load and clinical outcomes. RESULTS: Inter-rater agreement for RALE scores improved from fair to excellent following reviewer training and feedback (intraclass correlation coefficient of 0.85 vs 0.93, respectively). In the discovery cohort, the required level of respiratory support at the time of CXR acquisition (supplemental oxygen or non-invasive ventilation (n=178);invasive-mechanical ventilation (n=234), extracorporeal membrane oxygenation (n=13)) was significantly associated with RALE scores (median (IQR): 20.0 (14.1-26.7), 26.0 (20.5-34.0) and 44.5 (34.5-48.0), respectively, p<0.0001). Among invasively ventilated patients, RALE scores were significantly associated with worse respiratory mechanics (plateau and driving pressure) and gas exchange metrics (PaO2/FiO2 and ventilatory ratio), as well as higher plasma levels of IL-6, soluble receptor of advanced glycation end-products and soluble tumour necrosis factor receptor 1 (p<0.05). RALE scores were independently associated with 90-day survival in a multivariate Cox proportional hazards model (adjusted HR 1.04 (1.02-1.07), p=0.002). We replicated the significant associations of RALE scores with baseline disease severity and mortality in the independent validation data set. CONCLUSIONS: With a reproducible method to measure radiographic severity in COVID-19, we found significant associations with clinical and physiologic severity, host inflammation and clinical outcomes. The incorporation of radiographic severity assessments in clinical decision-making may provide important guidance for prognostication and treatment allocation in COVID-19.

3.
Chest ; 162(4):A1866, 2022.
Article in English | EMBASE | ID: covidwho-2060877

ABSTRACT

SESSION TITLE: Drug-Induced and Associated Critical Care Cases Posters 1 SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Interstitial pneumonitis (ILD) is inflammation of lung interstitium leading to scarring and pulmonary fibrosis. Various etiologies include idiopathic, connective tissue disorders, sarcoidosis and drug induced1. Many chemotherapy agents have been implicated in drug related ILD such as bleomycin, taxanes. However, newer chemotherapeutic drugs such as molecular agents such as anti-VEGF, anti-EGFR (panitumumab) could be causative of drug induced ILD. CASE PRESENTATION: A 75-year-old female with stage IV sigmoid colon cancer treated with surgery, adjuvant FOLFOX chemotherapy and Panitumumab. She presented to the emergency department with shortness of breath and hypoxia after known COVID-19 exposure. Initial imaging with chest radiography showed bilateral ground glass opacities. A chest CT pulmonary embolism protocol was negative for pulmonary embolism but showed bilateral ground glass opacities (GGOs) and some interstitial thickening (L>R) not typical of COVID-19 infection. She was treated with remdesivir and dexamethasone, however her oxygen requirements continued to rapidly escalate. A repeat CT chest without contrast showed bilateral asymmetric interstitial thickening and GGOs. Given persistence of CT chest abnormalities, workup for interstitial lung disease was initiated. The results include ANA titer 1:80, otherwise negative ANCA profile, rheumatoid factor, anti-CCP, Scl-70, Sjogren antibodies. Given clinical history and imaging findings, diagnosis of ILD was suspected, and she was started on solumedrol 1 mg/kg. Her oxygen requirements decreased significantly over the next 2 days, and she was discharged home on oral steroid taper and pneumocystis pneumonia prophylaxis. DISCUSSION: Panitumumab is a fully humanized monoclonal antibody against EGFR. Approved by the US Food and Drug Administration in 2006 for advanced or recurrent colorectal cancer exhibiting wild-type KRAS mutation.2 ILD is rarely reported with panitumumab monotherapy, but higher incidence when used as a combination treatment such as with FOLFOX or FOLFIRI. A Japanese post-marketing surveillance study from 2010-2015 showed an ILD incidence of 1.3% but mortality rates of 51.3%.2 EGFR is expressed on basal cells and non-cilia cells of the bronchioles and type II cells of the alveolus. EGFR mediated mechanisms are important in tissue repair.3 Therefore inhibition of this pathway has been postulated to play a role in development of ILD. Another mechanism was decreased surfactant production by type II cells in pre-clinical study.4,5 ILD secondary to Panitumumab can occur at any point during therapy and up to 1 year after administration of drug.6 The role of infectious processes, in this case, COVID-19 pneumonia, could synergistically worsen ILD presentation. CONCLUSIONS: Although the incidence of ILD is low, the mortality rate is high, therefore early recognition and treatment is associated with improved clinical outcomes. Reference #1: Mudawi D, Heyes K, Hastings R, Rivera-Ortega P, Chaudhuri N. An update on interstitial lung disease. Br J Hosp Med (Lond). Jul 2 2021;82(7):1-14. Reference #2: Osawa M, Kudoh S, Sakai F, et al. Clinical features and risk factors of panitumumab-induced interstitial lung disease: a postmarketing all-case surveillance study. Int J Clin Oncol. Dec 2015;20(6):1063-1071. Reference #3: The FASEB Journal - 2000 - Puddicombe - Involvement of the epidermal growth factor receptor in epithelial repair in asthma.pdf. DISCLOSURES: No relevant relationships by Navitha Ramesh No relevant relationships by Uba Udeh

4.
Chest ; 162(4):A1814, 2022.
Article in English | EMBASE | ID: covidwho-2060869

ABSTRACT

SESSION TITLE: Outcomes Across COVID-19 SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Spontaneous pneumothorax, pneumomediastinum and subcutaneous emphysema are reported as rare complications of COVID-19 pneumonia in various observational studies. The purpose of this study is to investigate the incidence of these complications and their outcome in hospitalized patients with COVID-19 pneumonia, at our inner-city hospital system in Central Pennsylvania. METHODS: We performed a retrospective chart review of the patients admitted with COVID-19 pneumonia from March 2020 to March 2021 in 3 different hospitals located in central Pennsylvania. Data on their demographics, pre-existing comorbidities, inpatient location, radiologic findings, timeline of events, mode of oxygenation and ventilation, hematology, chemistry profile and inflammatory markers were obtained. Patients with known inciting events for barotrauma, other than COVID-19 pneumonia were excluded from our analysis. RESULTS: The mean age of patient cohort was 66 years (SD 14.07). Almost fifty two percent were obese with BMI more than 30 kg/m2 and 69.5% were male. Only 11.4% of the study population had history of COPD and majority (63.6%) did not have history of smoking. Out of 31,260 inpatients, only 44 (0.0014 %) patients spontaneously developed thoracic free air. Among them, 33 (75%) had pneumothorax, and 22 (50%) needed chest tube for the management. 18 (40.9%) had pneumomediastinum, and 20 (45.5%) had subcutaneous emphysema. These are not exclusive findings and some patients had free air in more than one location. Thirty (68.2%) patients were admitted to ICU (Intensive Care Unit), 20 (45.5%) patients needed invasive ventilation and 26 (61.4%) had in-hospital mortality. Mortality in ICU was significantly high (86.67%) compared to non-ICU patients (7.14%). The average duration of hospitalization was 28.18 days (SD 25.46). CONCLUSIONS: Incidence of spontaneous thoracic free air complication in COVID –19 pneumonia is a rare phenomenon. In our patient cohort, occurrence of these events was seen irrespective of type of oxygen delivery and ventilation. However, patients having these complications had a high rate of ICU admission. Mortality is significantly high especially in patients admitted to ICU. CLINICAL IMPLICATIONS: Spontaneous thoracic free air complication in COVID-19 pneumonia is rare but can be a marker of poor prognosis. Vaccination status of study population was unknown, therefore the role of vaccination to prevent these complications and their outcome needs to be explored. DISCLOSURES: No relevant relationships by Yi-Ju Chen No relevant relationships by Anatoliy Korzhuk No relevant relationships by Rajan Pathak No relevant relationships by Navitha Ramesh No relevant relationships by Michaela Sangillo

5.
Chest ; 162(4):A1508, 2022.
Article in English | EMBASE | ID: covidwho-2060836

ABSTRACT

SESSION TITLE: Acute COVID-19 and Beyond: from Hospital to Homebound SESSION TYPE: Original Investigations PRESENTED ON: 10/18/22 2:45 pm - 3:45 pm PURPOSE: Coronavirus-19 (COVID-19) infection associated hypercoagulability places patients at a risk of developing of pulmonary embolism (PE) [1]. This study aims to determine the utility of traditional risk stratification tools in this patient population. METHODS: This is a retrospective analysis of non-pregnant patients, >=18 years admitted to UPMC Community Osteopathic and UPMC West Shore Hospitals with acute PE between September 2019 and June 2021. We used Student’s t-test to analyze group differences, Welch-Satterthwaite t-test for the unequal continuous data, and chi-square test to analyze group differences for the categorical variables. RESULTS: A total of 309 patients were included (52 patients diagnosed with COVID-19, and 115 patients tested negative. 142 patients were not tested and hence not included in the analysis. The mean age was 61.7 years in COVID-19 patients and 63.8 years in non-COVID-19 patients. There was no difference in the severity of PE when classified as massive (1.92% vs 3.48%, p=1.0000), sub-massive (17.31% vs 29.57%, p=0.0934), non-massive (88.77% vs 66.96%, p=0.0678). No difference was seen in shock index (0.5-0.7: 73.08% vs 66.09%;>0.8: 26.92% vs 33.91%, (p=0.3688)). PESI score was also similar with PESI Class I 25% vs 21.74%, Class II 21.15% vs 17.39%, Class III 21.15% vs 26.96%, class IV 19.23% vs 13.04%, Class V 13.36% vs 20.87% (p=0.5757). Simplified PESI identifying PE risk was similar in groups with high risk in 56.86% vs 66.09%, and low risk in 43.14% vs 33.91% (p=0.1734). No difference was seen in the outcomes of COVID-19 vs non-COVID-19 patients including the length of hospital stay (<1 day: 21.15% vs 12.17%, p=0.1230;>=6 days 21.15% vs 32.17%, p=0.1451) and ICU admission (11.54% vs 20%, p=0.1813). There was no difference in the occurrence of right heart strain (21.15% vs 32.17%, p=0.1451), saddle PE (5.77% vs 6.09%, p=1), and intubation (0% vs 1.74%, p=1.0000). Mortality rate was similar (5.77% vs 0.87%, p=0.0900). Readmission rate at 30 days was higher in non-COVID-19 patients at 30 days (9.62% vs 24.35%, p=0.0268) with no difference at 3 months (5.77% vs 6.09%, p=1.0000). Differences in laboratory findings in COVID-19 vs non-COVID-19 patients included BNP>100 (20% vs 38.46%, p=0.0276) and elevated troponin level > 0.03 (26% vs 42.86%, p=0.0408) which were more frequently observed in COVID-19. CONCLUSIONS: Our study is limited in the sense that it is retrospective in nature, and we assessed the patient population admitted to 2 of our hospitals. Despite the lab studies discrepancies in troponin and BNP levels, PE in COVID-19 patients was not associated with fatal or near fatal outcomes as compared to non-COVID-19 patients. CLINICAL IMPLICATIONS: Scoring metrics including Shock Index and PESI along with sPESI scoring systems, if utilized, can help with management and decrease length of stay among COVID-19 and non-COVID-19 patients with pulmonary embolism. DISCLOSURES: No relevant relationships by Ahmed Aladham No relevant relationships by Konstantin Golubykh No relevant relationships by Iuliia Kovalenko No relevant relationships by Kriti Lnu No relevant relationships by Navitha Ramesh No relevant relationships by Yijin Wert

6.
Chest ; 162(4):A1432, 2022.
Article in English | EMBASE | ID: covidwho-2060816

ABSTRACT

SESSION TITLE: Problems in the Pleura Case Posters 1 SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Severe COVID 19 has now been known to cause devastating damage to the lungs. The manifestations include severe pneumonia, acute respiratory distress syndrome, spontaneous pneumothorax, etc. As we were learning about the pathogenesis of the infection, we were also learning rapidly about the therapeutics targeted against it. A report a case of severe COVID 19 ARDS in a non-vaccinated young male, who later developed empyema during his hospital course. CASE PRESENTATION: A 29-year-old male with no past medical history presented to the emergency department complaining of chest pain and shortness of breath. He was not vaccinated against COVID-19. He was discharged from the hospital on 2 liters of supplemental oxygen two days ago after undergoing treatment for COVID-19 pneumonia with dexamethasone and remdesivir. Physical examination revealed bilateral diminished lung sounds on auscultation. His blood pressure was 112/75 mm Hg, heart rate (HR) 120 per minute, respiratory rate 25 per minute, the temperature of 38.5 Celsius and he was saturating 91% on 15 L of oxygen via a non-rebreather mask. Initial CT scan revealed bilateral ground-glass opacities (figure 1.). Due to high oxygen requirements and CRP of 10.5 MG/DL, the patient was started on Sarilumab. Given his escalating oxygen requirements and worsening respiratory distress, he was intubated and transferred to the intensive care unit. Despite intermittent prone positioning, he became progressively hypoxemic and eventually required Veno-venous Extracorporeal Membrane Oxygenation (VV-ECMO). One week later he developed intermittent fever spikes up to 39.5 C with HR of 120 per minute and leukocytosis of 40.8 K/µL. Bedside point of care ultrasound revealed new bilateral complex pleural effusions. Chest CT-scan showed moderate bilateral pleural effusions with new cystic changes and worsening consolidations (figure 2). Pleural fluid analysis showed lactate dehydrogenase of 2798, pH of 7.11, and cell count of 100 with 98% neutrophils. Despite aggressive therapy with chest tube placements and broad-spectrum antibiotics his condition continued to worsen over the next month with the development of hydropneumothoraxes and traction bronchiectasis (figure 3). Given the clinical deterioration despite aggressive care, his family decided to pursue a comfort-oriented treatment approach and he eventually passed away. DISCUSSION: COVID-19 related pleural effusion is a reported complication of COVID-19 pneumonia in up to 2-11% of the cases [1]. Most cases are associated with comorbid conditions, such as heart failure, superimposed bacterial infections, and pulmonary embolism [2]. CONCLUSIONS: Our case indicates that bacterial empyema may complicate COVID-19 pneumonia later in the disease course even in young immune-competent patients, it is unclear if empyema is directly related to the disease process itself r the therapeutic used to treat the COVID 19 infection. Reference #1: Chong WH, Saha BK, Conuel E, Chopra A. The incidence of pleural effusion in COVID-19 pneumonia: State-of-the-art review. Heart Lung. 2021;50(4):481-490. doi:10.1016/j.hrtlng.2021.02.015 Reference #2: Zhang L, Kong X, Li X, et al. CT imaging features of 34 patients infected with COVID-19. Clin Imaging. 2020;68:226-231. doi:10.1016/j.clinimag.2020.05.016 DISCLOSURES: No relevant relationships by Rimsha Ali No relevant relationships by Konstantin Golubykh No relevant relationships by Iuliia Kovalenko No relevant relationships by Maidah Malik No relevant relationships by Taaha Mirza No relevant relationships by Navitha Ramesh

7.
Indian Journal of Animal Sciences ; 92(2):166-173, 2022.
Article in English | EMBASE | ID: covidwho-1913183

ABSTRACT

Antimicrobial resistance (AMR) is a silent pandemic faced parallel to COVID-19 pandemic, owing to indiscriminate usage of antimicrobial agents by large mass of people as part of self-medication and unsupervised therapy protocols. This similar kind of situation does exist in livestock and poultry farming sector, which has led to AMR issues like Methicillin-resistant Staphylococcus aureus (MRSA) mastitis. AMR is really an alarming issue which needs to be addressed or else in near future it would be difficult to treat or control infections in both humans and animals. Reduction in indiscriminate antimicrobial usage and AMR issues in animal husbandry sector requires intervention in animal husbandry practices. In order to device such intervention practices, first we need to document the field level antibiotic usage and knowledge level on AMR. But unfortunately, data on AMR issues at field level were deficit and poorly documented in India. Hence this cross-sectional study was carried out to explore the knowledge and usage pattern of antibiotics among livestock and poultry farmers of Telangana state of India through direct interview method. Cent per cent of the farmers responded that antibiotics were used mainly for therapeutic purpose followed by prophylactic (32%), metaphylactic purpose (44.5%) and as growth promoters (8.33%). Farmers (78%) responded that they purchase the antimicrobial agents over-the-counter. Oxytetracyclines and Enrofloxacin were the two major antibiotics used abundantly by the livestock farmers. Large proportions of famers (80%) were neither following full dosage regime of antimicrobial used nor the withdrawal period, while antimicrobial usage on their animals owing to lack of awareness and knowledge regarding the AMR. Significant differences were found amongst the livestock and poultry farmers with respect to their knowledge level on antimicrobial usage and AMR in animals.

8.
American Journal of Respiratory and Critical Care Medicine ; 205:2, 2022.
Article in English | English Web of Science | ID: covidwho-1879917
9.
American Journal of Respiratory and Critical Care Medicine ; 205:1, 2022.
Article in English | English Web of Science | ID: covidwho-1879916
10.
Chest ; 160(4):A481, 2021.
Article in English | EMBASE | ID: covidwho-1458130

ABSTRACT

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Spontaneous pneumothorax, pneumomediastinum, and subcutaneous emphysema have been described as rare life-threatening complications of COVID-19. Reports of pneumoperitoneum or pneumoretroperitoneum are extremely rare. We present a patient with COVID-19 pneumonia who developed spontaneous pneumomediastinum and subcutaneous emphysema with subsequent progression to pneumoretroperitoneum, without evidence of pneumothorax. CASE PRESENTATION: A 61 year old man with HIV and Addison's disease presented to the emergency department with worsening dyspnea, cough, and diarrhea. On admission, his oxygen saturation was 80% on room air, and he had diffuse bilateral lung rhonchi. Nasopharyngeal swab was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Chest x-ray showed bilateral interstitial opacities. He was treated with dexamethasone, remdesivir, enoxaparin and supplemental oxygen. On hospital day three, he developed worsening hypoxia with pO2 of 41mmHg on 15L non-rebreather oxygen. He was transferred to the intensive care unit (ICU) and placed on non-invasive positive pressure ventilation but was quickly weaned to high-flow oxygen. On hospital day 17, he developed worsening hypoxia and reported neck swelling and tenderness. Computed tomography (CT) of the neck and chest confirmed extensive subcutaneous emphysema and pneumomediastinum and diffuse granular lung opacities without any normally aerated lung parenchyma, without evidence of pneumothorax. He was placed on mechanical ventilation after failing non-invasive positive pressure ventilation. Despite supportive care and lung protective ventilation, he remained hypoxic with worsening subcutaneous emphysema. CT of the chest, abdomen and pelvis showed development of pneumoperitoneum and pneumoretroperitoneum. Due to the patient's refractory hypoxia with progression to multi-system organ failure, his family opted for compassionate extubation and he expired on hospital day 34. DISCUSSION: Common causes of pneumoretroperitoneum include perforated viscous or iatrogenic introduction of air. As this patient had neither surgical procedures or evidence of perforation, his pneumoretroperitoneum was likely due to prolonged positive end expiratory pressure (PEEP) in setting of acute respiratory distress syndrome due to COVID-19. Mechanical ventilation likely acted as a shearing force intensifying air leak into the mediastinum which tracked inferiorly into the retroperitoneum. CONCLUSIONS: In conclusion, pneumomediastinum is a possible complication of COVID-19 pneumonia that can progress to pneumoretroperitoneum despite lung protective ventilation causing acute decompensation that can worsen patient prognosis. REFERENCE #1: Salehi, S., Abedi, A., Balakrishnan, S., & Gholamrezanezhad, A. (2020). Coronavirus Disease 2019 (COVID-19): A Systematic Review of Imaging Findings in 919 Patients. AJR. American journal of roentgenology, 215(1), 87–93. https://doi.org/10.2214/AJR.20.23034Zhou, C., Gao, C., Xie, Y., & Xu, M. (2020). COVID-19 with spontaneous pneumomediastinum. The Lancet. Infectious diseases, 20(4), 510. https://doi.org/10.1016/S1473-3099(20)30156-0 REFERENCE #2: Ahmed, A., Mohamed, M., & Ahmed, K. (2021). Severe COVID-19 Pneumonia Complicated by Pneumothorax, Pneumomediastinum, and Pneumoperitoneum. The American journal of tropical medicine and hygiene, tpmd210092. Advance online publication. https://doi.org/10.4269/ajtmh.21-0092Hillman K. M. (1983). Pneumoretroperitoneum. Anaesthesia, 38(2), 136–139. https://doi.org/10.1111/j.1365-2044.1983.tb13932. REFERENCE #3: Okamoto, A., Nakao, A., Matsuda, K., Yamada, T., Osako, T., Sakata, H., Yamaguchi, Y., Terashima, M., Iwano, J., & Kotani, J. (2014). Non-surgical pneumoperitoneum associated with mechanical ventilation. Acute medicine & surgery, 1(4), 254–255. https://doi.org/10.1002/ams2.52 DISCLOSURES: No relevant relationships by Christopher Ignatz, source=Web Response No relevant relationships by Bao Nhi Nguyen, source=Web Res onse No relevant relationships by Navitha Ramesh, source=Web Response

11.
Chest ; 160(4):A451, 2021.
Article in English | EMBASE | ID: covidwho-1457528

ABSTRACT

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Anaerobes generally constitute a major component of the gut microbiome. They play a significant role in the pathogenesis of infections following disruption of mucosal integrity. Anaerobic organisms are usually difficult to grow and identify and hence may often be overlooked. We present a patient with severe COVID-19 pneumonia who developed de-novo Prevotella bivia bacteremia, following tocilizumab. CASE PRESENTATION: A 38 year old Caucasian male with morbid obesity and no other past medical history presented to the emergency department with complaints of cough, fever, chills and poor appetite for the past 10 days. Upon arrival, he was profoundly hypoxic with Spo2 70% on ambient air. He tested positive for COVID-19. On physical examination, his BMI was 62 kg/m2, he was febrile, in moderate respiratory distress, cardiopulmonary examination revealed coarse bilateral breath sounds. His physical examination was otherwise unremarkable. His chest radiograph demonstrated hazy opacification in both mid lungs and left lung base suggestive of multifocal pneumonia. CT chest did not reveal evidence of pulmonary embolism. Lower extremity ultrasound was however negative for a DVT. Laboratory findings was significant for elevated C-reactive protein 12.4 mg/dl. Patient was placed on heated high flow nasal cannula and received dexamethasone and tocilizumab. His respiratory status continued to worsen and he was subsequently intubated. Lower respiratory culture was positive for MSSA and patient was started cefepime and vancomycin was added as he clinically continued to decompensate. Within the next week, blood culture was positive for Prevotella bivia and his antibiotic regimen was changed to pipericillin-tazobactam. Repeat blood culture continued to be positive and this time, for Enterococcus faecalis. The antibiotic regimen was further changed to meropenem. Interestingly, on his physical examination, there was no abnormalities on his abdomen or pelvic area. CT abdomen pelvis did not shows any acute abnormalities. Following meropenem initiation, his subsequent blood cultures have been negative for any growth. Patient remains intubated with a guarded prognosis. DISCUSSION: Prevotella bivia is one of several species of bacteria in the genus Prevotella. It is an anaerobic gram negative organism that is found in the oral, vaginal, and gut microbiome. Some of the infections caused by this organism include aspiration pneumonia, lung abscess, otitis media, and sinusitis. Various species of Prevotella have been isolated from abscesses and burns close of the mouth, bite, paronychia, urinary tract infection, brain abscess, osteomyelitis, and bacteremia when there is an associated respiratory tract infections. Prevotella bivia bacteremia is highly uncommon. CONCLUSIONS: As we continue to learn more about COVID-19 infection and its treatment modalities, we may come across such unusual scenarios. REFERENCE #1: 27.Curtis JR, Perez-Gutthann S, Suissa S, et al. Tocilizumab in rheumatoid arthritis: a case study of safety evaluations of a large postmarketing data set from multiple data sources. Semin Arthritis Rheum 2015;44:381. REFERENCE #2: Yanagisawa M, Kuriyama T, Williams DW, Nakagawa K, Karasawa T. Proteinase activity of prevotella species associated with oral purulent infection. Curr Microbiol. 2006;14(5):375–378. doi: 10.1007/s00284-005-0261-1 REFERENCE #3: Metronidazole Resistance in Prevotella spp. and Description of a New nim Gene in Prevotella baroniaeC. Alauzet, F. Mory, C. Teyssier, H. Hallage, J. P. Carlier, G. Grollier, A. Lozniewski DISCLOSURES: No relevant relationships by Alfred Aiyanyor, source=Web Response No relevant relationships by Navitha Ramesh, source=Web Response No relevant relationships by Q. Kamran Uddin, source=Web Response

12.
Indian J Crit Care Med ; 25(3): 317-321, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1140755

ABSTRACT

Background: Coronavirus disease (COVID-19) is an infectious disease caused by SARS-CoV-2, clinically presenting with common symptoms of fever, dry cough, and breathlessness within 14 days of exposure. Its severity ranges from mild to severe, latter manifesting into severe acute respiratory syndrome. As a part of multidisciplinary team, physiotherapy along with medical management was administered to patients with COVID-19 in an acute care setup. This retrospective study aims to explore various patient characteristics and will aid in identifying the impairments associated with the disease, giving a direction to the physiotherapy community in planning future management strategy to improve quality of life. Patients and methods: The present study is a unicentric study wherein prospective analysis of retrospective data of patients referred for physiotherapy from May 13 to July 31, 2020, was performed. (i) Characteristics of patients, (ii) associated comorbidities, (iii) hospital course since the time of admission to discharge, (iv) mode of oxygen delivery, (v) pre- and post-physiotherapy treatment values of oxygen saturation and heart rate, and (vi) physiotherapy treatment were recorded. The archived data were analyzed using the commercially available SPSS software version 24. Wilcoxon's matched pair test was used to compare pre- and post-treatment oxygen saturation and heart rate, and McNemar's test was used to compare mode of oxygen delivery and pre- and post-physiotherapy treatment. Results: Descriptive analysis of data showed a better outcome in terms of grade of dyspnea and rate of discharge on day 14 of physiotherapy treatment. Hence, a comparative analysis of day 1 and day 14 was performed for mode of oxygen delivery, oxygen saturation, and heart rate. A statistically significant improvement was observed in the heart rate (p = 0.001) and oxygen delivery (p = 0.000). However, no significant difference in the level of oxygen saturation was found (p = 0.6433). Conclusion: Physiotherapy treatment in conjunction with medical treatment can be effectively administered in patients with COVID-19 in acute care setup taking into consideration the health status and the hemodynamic stability of the patients. It emphasizes the role of physiotherapy in the alleviation of symptoms, facilitating early weaning and recovery enabling early discharge from the hospital. How to cite this article: Verma CV, Arora RD, Mistry HM, Kubal SV, Kolwankar NS, Patil PC, et al. Changes in Mode of Oxygen Delivery and Physiological Parameters with Physiotherapy in COVID-19 Patients: A Retrospective Study. Indian J Crit Care Med 2021;25(3):317-321.

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