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1.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-321178

ABSTRACT

This is a case of an elderly female with comorbidities and a history of cardiac transplant 13 years back, presented with diarrhea and diagnosed with COVID-19. She was hospitalized and found to have a cardiac injury and urinary tract infection, treated with antibiotics, antivirals, immunosuppressives, and required non-invasive ventilatory support.

2.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-321177

ABSTRACT

Tension pneumomediastinum (TPM) is a rare but potentially fatal clinical entity. This leads to leakage of air into the mediastinal cavity and increased pressure on thoracic vessels, respiratory tract, and the heart. We report a series of five cases of COVID-19 complicating into acute respiratory distress syndrome and developing TPM.

3.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-305274

ABSTRACT

Background: Immunomodulatory property of intravenous immunoglobulin (IVIG) has been used to counteract severe systemic inflammation in coronavirus disease 2019 (COVID-19). However, its use in acute respiratory distress syndrome (ARDS) due to COVID-19 pneumonia is not well established. Methods: : In this retrospective study, we analyzed electronic health records of COVID-19 patients admitted to intensive care units (ICUs) at Hazm Mebaireek General Hospital, Qatar, between March 7, 2020, and September 9, 2020. Patients receiving invasive mechanical ventilation for moderate-to-severe ARDS were divided into two groups based on whether they received IVIG therapy. The primary outcome was all-cause ICU mortality. Secondary outcomes studied were ventilator-free days and ICU-free days at day-28 and incidence of acute kidney injury (AKI). Propensity score matching was used to adjust for confounders, and the primary outcome was compared using competing-risks survival analysis. Results: : Among 590 patients included in the study, 400 received routine care, and 190 received IVIG therapy in addition to routine care. One hundred eighteen pairs were created after propensity score matching with no statistically significant differences between the groups. Overall ICU mortality in the study population was 27.1%, and in the matched cohort, it was 25.8%. Mortality was higher among IVIG-treated patients (36.4% vs. 15.3%;sHR 3.5;95% CI 1.98- 6.19;P<0.001). Ventilator-free days and ICU-free days at day-28 were lower (P<0.001 for both), and the incidence of AKI was significantly higher (85.6% vs. 67.8%;P=0.001) in the IVIG group. Conclusion: IVIG therapy in mechanically ventilated patients with COVID-19 related moderate-to-severe ARDS was associated with higher ICU mortality. A randomized controlled study is required to confirm this observation further.

4.
Ann Med ; 54(1): 310-313, 2022 12.
Article in English | MEDLINE | ID: covidwho-1642146

ABSTRACT

INTRODUCTION: COVID-19 patients presenting with ocular manifestations are from 0.8% to 32% of patients seen in the ED. The available literature is scarce regarding COVID-19 patients presenting with ocular manifestations from the Middle Eastern region. PURPOSE: This study aims to report the incidence of ocular signs and symptoms in COVID-19 patients and find any correlation between the occurrence of ocular manifestations and patients' comorbidities. METHODS: All patients having the primary diagnosis of COVID-19 infection and concurrent ocular manifestations on admission to our tertiary COVID-19 health care centre were included in the study. The patient's demographic data, comorbidities, and type of ocular manifestations were recorded from the patients' health records retrospectively. RESULTS: In our study, 39 (7.8%) patients presented with ocular manifestations. The majority of COVID-19 patients were male, and 200 (20%) patients had a history of other comorbidities. The majority of our patients had hyperaemia (13 [33.3%]), followed by eye pain (9 [23.1%]), epiphora (8 [20.5%]), burning sensation (4 [10.3%]), and photophobia (2 [5.1%]) patients. There was no statistically significant difference in the occurrence of ocular manifestations and patients' gender or comorbidities (p > .05). CONCLUSION: The occurrence of ocular manifestations was lower compared to the present literature. There was no significant association between the occurrence of ocular manifestations and the patient's gender or comorbidities.


Subject(s)
COVID-19 , Comorbidity , Female , Humans , Male , Retrospective Studies , SARS-CoV-2 , Tertiary Care Centers
5.
Clin Case Rep ; 9(7): e04513, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1525422

ABSTRACT

Most of the post-renal transplant patients are taking immunosuppressive medications, including calcineurin inhibitors, anti-proliferative agents, and steroids. This case series highlights the clinical characteristics and outcomes of eight post-renal transplant patients with severe COVID-19 infection admitted to the intensive care unit.

6.
BMC Pulm Med ; 21(1): 354, 2021 Nov 08.
Article in English | MEDLINE | ID: covidwho-1505545

ABSTRACT

BACKGROUND: Intravenous immunoglobulin (IVIG) has been used as an immunomodulatory therapy to counteract severe systemic inflammation in coronavirus disease 2019 (COVID-19). But its use in COVID-19 related acute respiratory distress syndrome (ARDS) is not well established. METHODS: We conducted a retrospective analysis of electronic health records of COVID-19 patients admitted to intensive care units (ICUs) at Hazm Mebaireek General Hospital, Qatar, between March 7, 2020 and September 9, 2020. Patients receiving invasive mechanical ventilation for moderate-to-severe ARDS were divided into two groups based on whether they received IVIG therapy or not. The primary outcome was all-cause ICU mortality. Secondary outcomes studied were ventilator-free days and ICU-free days at day-28, and incidence of acute kidney injury (AKI). Propensity score matching was used to adjust for confounders, and the primary outcome was compared using competing-risks survival analysis. RESULTS: Among 590 patients included in the study, 400 received routine care, and 190 received IVIG therapy in addition to routine care. One hundred eighteen pairs were created after propensity score matching with no statistically significant differences between the groups. Overall ICU mortality in the study population was 27.1%, and in the matched cohort, it was 25.8%. Mortality was higher among IVIG-treated patients (36.4% vs. 15.3%; sHR 3.5; 95% CI 1.98-6.19; P < 0.001). Ventilator-free days and ICU-free days at day-28 were lower (P < 0.001 for both), and incidence of AKI was significantly higher (85.6% vs. 67.8%; P = 0.001) in the IVIG group. CONCLUSION: IVIG therapy in mechanically ventilated patients with COVID-19 related moderate-to-severe ARDS was associated with higher ICU mortality. A randomized clinical trial is needed to confirm this observation further.


Subject(s)
COVID-19/drug therapy , Immunoglobulins, Intravenous/therapeutic use , Immunologic Factors/therapeutic use , Respiratory Distress Syndrome/drug therapy , Administration, Intravenous , Adult , Aged , COVID-19/complications , COVID-19/mortality , Female , Humans , Male , Middle Aged , Propensity Score , Respiratory Distress Syndrome/mortality , Respiratory Distress Syndrome/virology , Retrospective Studies , Severity of Illness Index , Survival Analysis , Treatment Outcome
7.
Qatar Med J ; 2021(3): 55, 2021.
Article in English | MEDLINE | ID: covidwho-1497704

ABSTRACT

Tension pneumomediastinum (TPM) is a rare but potentially fatal clinical entity. TPM leads to the leakage of air into the mediastinal cavity and increased pressure in thoracic vessels, respiratory tract, and the heart. Herein, this report presents a series of five cases of coronavirus disease-2019 (COVID-19) that caused acute respiratory distress syndrome (ARDS) and TPM. All patients were male who had severe ARDS with a secondary lung infection that required invasive ventilation and had moderate positive-end expiratory pressure. All patients required vasopressors to maintain hemodynamics, and two patients needed decompression with chest drains. One patient received extracorporeal membrane oxygenation therapy. Three patients had cardiac arrest, and two patients died; thus, the mortality rate was 40%. Patients with COVID-19 pneumonia with ARDS required invasive ventilation and prone positioning. Secondary lung infection can cause TPM, and TPM may cause cardiac arrest. Management should be prompt recognition and decompression with the insertion of drains, and conservative treatment is required in stable cases. Protocols for the management of pneumomediastinum and TPM may enable early detection, earlier management, and prevention of TPM.

8.
Health Sci Rep ; 4(3): e339, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1332972

ABSTRACT

INTRODUCTION: COVID-19 can occasionally complicate into spontaneous pneumothorax (SP) and/or spontaneous pneumomediastinum (SM). This study aims at exploring the occurrence of SP and or SM, risk factors, and outcomes in COVID-19 patients. MATERIALS AND METHODS: All patients with COVID-19, which complicated into SP and/or SM at Hamad Medical Corporation (the principal public healthcare provider in Qatar) from March to September 2020, were retrospectively enrolled. The clinical diagnosis was confirmed by CXR and CT. Between-group comparisons were performed by using Chi-square and t-test. Differences were considered statistically significant at P ≤ .05. RESULTS: A total of 1100 patients were admitted, and 43 patients developed SP, SP + SM, or SM. Most patients were males (42/97.9%), and the most common comorbidity was diabetes mellitus (13/30.2%). All patients had acute respiratory distress syndrome (ARDS), and most patients had low lung compliance at the time of developing SP or SM. Twenty-two of the patients developed SP (51.2%), 11 patients had both SP and SM (25.6%), and 10 patients had SM only (23.3%). There was no significant difference in the development of SP or SM and patients' gender or blood group or whether patients were on invasive or noninvasive ventilation or even the mortality (P > .05). Lung compliance was significantly (P < .05) lower in patients complicated with SP and or SM. Patients with SP required significantly higher (P < .001) chest drain insertion. CONCLUSION: Patients with severe COVID-19 pneumonia can complicate into SP and SM. These complications are more common in male diabetic patients. Patients with ARDS and having low lung compliance are at a higher risk of developing SP, SP + SM, or SM.

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