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1.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-309520

ABSTRACT

Dysregulation of inflammation is hypothesized to play a crucial role for inducing the severe complications of Covid-19, with IL-1/IL-6 pathway being central in these events. Eight patients with severe Covid-19 pneumonia treated with the interleukin-1 receptor antagonist anakinra are reported;seven patients hospitalized in intensive care units (ICUs) in Greece and one non-ICU patient in the Netherlands. Patients scored positive for the hemophagocytosis score and they were diagnosed with secondary hemophagocytic lymphohistocytosis (sHLH). At the end-of-treatment with anakinra, ICU patients had less demands on vasopressors;they also had lower C-reactive protein, procalcitonin, troponin I, D-dimers, and ferritin - the hallmark marker of sHLH. All patients improved their respiratory function. Only two patients died. These data argue that the administration of anakinra may be a viable treatment in severe Covid-19 with sHLH, supporting for larger clinical studies to validate this concept.

2.
J Crit Care Med (Targu Mures) ; 7(1): 14-20, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1115377

ABSTRACT

INTRODUCTION: Healthcare professionals who are directly involved in the diagnosis, treatment, and general care of patients with SARS-CoV-2 are at risk of developing adverse psychological reactions. A cross-sectional study of healthcare professionals aimed to determine the impact of the SARS-CoV-2 pandemic on the mental health of healthcare professionals in two of the largest referral hospitals in Athens, Greece. METHODS: The study was conducted in the two largest SARS-CoV-2 referral hospitals in Athens, Greece. An assessment and the interrelationship of post-traumatic stress disorder, using the Impact of Event Scale-Revised [IES-R]) and burnout, using the Maslach Burnout Inventory [MBI]) was carried out. RESULTS: A total of 162 subjects were enrolled in the study. Fifty-six (35%) had an IES-R score > 33, suggesting post-traumatic stress disorder. Forty-nine (30%) had an MBI score > 27. Seventy-five (46%) had a personal accomplishment score of < 33 and 46 (28%) had a depersonalization score >10. Stepwise backward logistic regression revealed that the only independent variable that was retained regarding the presence of post-traumatic stress disorder was the emotional exhaustion score of the MBI (at a cut-off of 24 in this scale, the 95% CI of the odds ratio for the presence of post-traumatic stress disorder was 1.077-1.173). CONCLUSIONS: In this sample of first-line Greek healthcare professionals against SARS-CoV-2, most of them were proven to be quite resilient to this challenge. One-third of them had post-traumatic stress disorder, which depended on their degree of emotional exhaustion. Healthcare professionals, as represented by this study, performed their duties without feeling helpless and developing adverse psychological reactions.

4.
Am J Case Rep ; 21: e926915, 2020 Sep 23.
Article in English | MEDLINE | ID: covidwho-789900

ABSTRACT

BACKGROUND Recent studies demonstrated evidence of coagulation dysfunction in hospitalized patients with severe coronavirus disease 2019 (COVID-19) due to excessive inflammation, hypoxia, platelet activation, endothelial dysfunction, and stasis. Effective anticoagulation therapy may play a dominant role in the management of severe COVID-19 cases. CASE REPORT A 73-year-old man with a 6-day history of fever up to 38.5°C, dyspnea, cough, and fatigue was diagnosed with COVID-19. He had a past medical history significant for hypertension and coronary artery bypass grafting. Two days after hospital admission, the patient developed acute respiratory failure, requiring intubation, mechanical ventilation, and transfer to the intensive care unit (ICU). He received treatment including antibiotics, hydroxychloroquine, tocilizumab, vasopressors, prone positioning, and anticoagulation with enoxaparin at a prophylactic dose. After a 15-day ICU stay, the patient was hemodynamically stable but still hypoxemic; a transthoracic echocardiogram at that time, followed by a transesophageal echocardiogram for better evaluation, revealed the presence of a right atrium thrombus without signs of acute right ventricular dilatation and impaired systolic function. Since the patient was hemodynamically stable, we decided to treat him with conventional anticoagulation under close monitoring for signs of hemodynamic deterioration; thus, the prophylactic dose of enoxaparin was replaced by therapeutic dosing, which was a key component of the patient's successful outcome. Over the next few days he showed significant clinical improvement. The follow-up transesophageal echocardiogram 3 weeks after effective therapeutic anticoagulation revealed no signs of right heart thrombus. CONCLUSIONS The presented COVID-19 case, one of the first reported cases with evidence of right heart thrombus by transesophageal echocardiography, highlights the central role of diagnostic imaging strategies and the importance of adequate anticoagulation therapy in the management of severe COVID-19 cases in the ICU.


Subject(s)
Coronavirus Infections/complications , Echocardiography, Transesophageal/methods , Heart Atria/diagnostic imaging , Heart Diseases/therapy , Pneumonia, Viral/complications , Severe Acute Respiratory Syndrome/complications , Thrombosis/therapy , Aged , COVID-19 , Combined Modality Therapy , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Cough/diagnosis , Cough/etiology , Critical Care/methods , Disease Progression , Emergency Service, Hospital , Fever/diagnosis , Fever/etiology , Follow-Up Studies , Greece , Heart Atria/pathology , Heart Diseases/diagnostic imaging , Heart Diseases/etiology , Humans , Intensive Care Units , Length of Stay , Male , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Severe Acute Respiratory Syndrome/diagnosis , Severe Acute Respiratory Syndrome/therapy , Severity of Illness Index , Thrombosis/diagnostic imaging , Thrombosis/etiology , Treatment Outcome
5.
Cell Host Microbe ; 28(1): 117-123.e1, 2020 07 08.
Article in English | MEDLINE | ID: covidwho-260325

ABSTRACT

Dysregulation of inflammation is hypothesized to play a crucial role in the severe complications of COVID-19, with the IL-1/IL-6 pathway being central. Here, we report on the treatment of eight severe COVID-19 pneumonia patients-seven hospitalized in intensive care units (ICUs) in Greece and one non-ICU patient in the Netherlands-with the interleukin-1 receptor antagonist Anakinra. All patients scored positive for the hemophagocytosis score (HScore) and were diagnosed with secondary hemophagocytic lymphohistocytosis (sHLH) characterized by pancytopenia, hyper-coagulation, acute kidney injury, and hepatobiliary dysfunction. At the end of treatment, ICU patients had less need for vasopressors, significantly improved respiratory function, and lower HScore. Although three patients died, the mortality was lower than historical series of patients with sHLH in sepsis. These data suggest that administration of Anakinra may be beneficial for treating severe COVID-19 patients with sHLH as determined by the HScore, and they support the need for larger clinical studies to validate this concept.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Coronavirus Infections/drug therapy , Interleukin 1 Receptor Antagonist Protein/therapeutic use , Lymphohistiocytosis, Hemophagocytic/drug therapy , Pneumonia, Viral/complications , Pneumonia, Viral/drug therapy , Aged , Aged, 80 and over , COVID-19 , Comorbidity , Female , Humans , Lymphohistiocytosis, Hemophagocytic/etiology , Male , Middle Aged , Off-Label Use , Oxygen/blood , Pandemics , Respiratory Insufficiency/prevention & control , SARS-CoV-2
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