LATENT CLASS ANALYSIS: AN INNOVATIVE APPROACH FOR IDENTIFICATION OF CLINICAL AND LABORATORY MARKERS OF DISEASE SEVERITY AMONG COVID-19 PATIENTS ADMITTED TO THE INTENSIVE CARE UNIT

Evidence about the phenotypic profile of COVID-19 ICU patients in sub- Saharan Africa remains insufficient. Our study aimed to identify clinical and laboratory phenotype distribution patterns and their usefulness as prognostic markers in COVID-19 patients admitted to the intensive care unit (ICU) in South Africa. We used a latent class analysis (LCA) model in a prospective cohort study of clinical and laboratory data collected from 343 COVID-19 patients between 27 March 2020 and 10 February 2021. A sub-analysis was performed to determine sub-phenotypes associated with clinical outcomes among COVID-19 patients and their impact on survival. Data from 343 COVID-19 patients were analysed. Two distinct phenotypes 1 and 2, comprising 68.46 % and 31.54% patients respectively, were identified. The phenotype 2 patients were characterized by increased coagulopathy markers (D-dimer, median value 1.73 ng/L vs 0.94 ng/L, p <0.001), end-organ dysfunction (creatinine, median 79 umol/L vs 69.5 umol/L, p <0.003), under-perfusion marker (lactate, median value 1.60 mmol/L, vs 1.20 mmol/L, p <0.001), abnormal cardiac function markers (median N‐terminal pro‐brain natriuretic peptide (NT-proBNP) 314 pg/ml vs 63.5 pg/ml, p <0.001 and median high‐sensitivity cardiac troponin (Hs-TropT) 39 ng/l vs 12 ng/ l, p<0.001) and acute inflammatory syndrome (median neutrophil-to-lymphocyte ratio 15.08 vs value 8.68, p <0.001 and monocyte, median value 0.68 × 109/L vs 0.45 × 109/L, p <0.001). Females in class 2 had lower mean haemoglobin levels than females in class 1 (11.88g/dL vs 12.67g/dL, p = 0.014). In a sub-analysis, mortality and survival were characterized in two sub-phenotypes with increased acute inflammatory syndrome, under-perfusion, end-organ dysfunction, and cardiac function markers in sub-phenotype 2. The identification of COVID-19 phenotypes and sub-phenotypes among ICU patients could be used as prognostic markers in day-to-day management of patients. Future studies are required in sub-Sahara Africa to elucidate pathophysiological mechanisms underlying these phenotypes. [ FROM AUTHOR] Copyright of International Journal of Infectious Diseases is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Thrombocytopenia And Estimated Mortality Probability In Relation To SOFA, APACHE II And News-2 Scoring Systems In Hospitalized Patients With COVID-19

Introduction: It has been shown that thrombocytopenia, like coagulation disorders, are common complications of COVID-19, increasing the risk of thrombosis and bleeding, producing in patients symptoms such as hematomas, petechiae, equimosis and bleeding from natural cavities, which are usually related to the severity of thrombocytopenia. For this reason, the present research aimed to establish the relationship between thrombocytopenia and the probability of mortality with the SOFA, APACHE II and NEWS-2 scoring systems in patients with COVID-19 admitted to the Ambato General Hospital during the period June 2021-November 2021. Materials and Methods : For the development of the research, there was a sample of 216 hospitalized patients who met the inclusion criteria, where 156 patients were in the clinical unit and 60 patients in the intensive care unit. Ifit was a descriptive, retrospective and crosssectional study, in which data from hospitalized patients were collected through the internal results reporting system DATALAB, and the AS-400 medical system for the review of patients' medical records, in addition to finding the relationship that existed between the study variables, the statistical program SPSS 25 was used. Results and Conclusions : The results indicate that, in terms of the risk factors of the patients, it was found that 64.81% were male, 54.6% over 50 years, 43.1% of hospitalized patients did not present or did not know their pathological history. When analyzing the analytical data of thrombocytopenia it was found that 14.8% of pacientis the presented during hospitalization, finally when analyzing the relationship between thrombocytopenia and the scoring systems SOFA, APACHE II and NEWS-2, Chi-square values of 1.329;3.327;2.406 respectively were obtained, indicating that no This is a correlation between the variables. It was concluded that there is no statistically significant relationship between thrombocytopenia and scoring systems. Further analyses with a larger population and that they have all theparameters necessary for the calculation of scoring systems are recommended. [ FROM AUTHOR] Copyright of Journal of Pharmaceutical Negative Results is the property of ResearchTrentz and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Health Care Monitoring Application using IoT Devices

Nowadays, health monitoring is crucial, especially monitoring the temperature and heartbeat of the patient in Covid / non-Covid situations. Continued monitoring of the patient is not a possible and tedious job. IoT plays a critical role in Hospitals where patients are in Intensive Care Units (ICU), and patients are treated at home (isolation points). The devices receive data continuously and monitor by the doctors remotely. This paper presents temperature and heartbeat monitoring using Internet Of Things (IoT) devices with an algorithm to capture data from devices and sends it to computer devices at a reasonable cost. Proof Of Concept has been created with the help of an Arduino board, Pulse Sensor, Temperature Sensor, Breadboard, ESP8266 Wi-Fi module, and Liquid Crystal Display (LCD). The IoT devices capture data from different devices (patient health data) in real time. The Health Care Monitoring (HCM) Application builds using microservices architecture, runs on top of the Thingspeak data, and sends notifications to the doctors if there is an emergency. The doctors can act according to rather than monitor continuously. This model eliminates manual intervention for taking the reading from time to time. © 2022 IEEE.

Coagulation Disorder's in SARS-CoV-2 Patients

Context: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease of 2019 (COVID-19). Pulmonary manifestations have been identified as the common symptom, and patients present a wide range of hematologic changes depending on the flow of the diseases. The interpretation and treatment of hematological complications in COVID-19 patients are very challenging. There are limited guidelines thus far due to the novelty of the disease. Evidence Acquisition: This review summarizes the hematological findings (platelet and coagulation/fibrinolytic) in COVID-19 patients and discusses possible mechanisms for their changes. Results: The results showed that the common findings were thrombocytopenia, elevated D-dimer levels, and prolonged prothrombin time (PT) and partial thromboplastin time (PTT) in severe patients. Conclusions: Attention to hematological changes may be helpful biomarkers in diagnosing and determining patients needing intensive care, as well as monitoring the treatment process and treatment effects on COVID-19 patients. [ FROM AUTHOR]

Timing to perform bed-side surgical tracheostomy in COVID-19 patients in intensive care unit

Background: Tracheostomy is an important surgical procedure in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (COVID-19) pandemic, particularly those patients undergoing prolonged tracheal intubation. The timing and indications for tracheostomy in COVID-19 patients with ventilators are still controversial. Methods: We prospectively studied the best timing for performing surgical tracheostomy in COVID-19 patients (n = 22) from April 2020 to May 2021 in the COVID-19 ICU attached to our COVID-19 hospital. The tracheotomised patients were followed up and the number and timing of the death were documented. Results: There were 14 males (male:female = 1.75:1). The mean duration of endotracheal intubation to tracheostomy was 14.4 days (range 10-22 days). The mean time for tracheostomy was 18.45 min (range 12-25 min). Five patients (22.7%) died after tracheostomy. The median time between tracheostomy and death was 4 days. Conclusions: Surgical tracheostomy has to be performed in a proper time with safe manner for benefit of the patients with COVID-19 and the health care professionals managing the patient. [ FROM AUTHOR] Copyright of Journal of Clinical & Scientific Research is the property of Sri Venkateswara Institute of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Neurological Manifestations in Critically Ill COVID-19 Patients

Patients with COVID-19 frequently experience neurological symptoms. Headaches and dizziness are common but non-specific symptoms. Both peripheral and central nervous systems can be impacted in severe stages. We focused on the neurological manifestations of COVID-19 patients in critical care. A cohort study evaluated the acute neurological manifestations in 204 patients admitted to intensive care units (ICU) tertiary Imam Khomeini hospital complex, Tehran, Iran. Patients with positive COVID-19 tests and severe clinical symptoms in both sexes, older than 16 years, were included in the study. Two groups of patients with positive or negative neurologic complications were compared by chi-square or Fisher exact test for categorical variables. The differences in continuous variables between the two groups were investigated using an independent sample t-test. The Kolmogorov-Simonov test was used to verify the normality assumption. A P less than 0.05 was considered statistically significant. The study included 204 individuals (130 males and 74 females) out of 270 ICU patients. Ninety (44.1%) patients were discharged, while 114 (55.9%) died. Overall, 17 (8.3%) patients had neurological complications, while 187 (91%) did not (P=0.005). The two groups did not have significantly different mean age (P=0.325) and sex (P=.793). The ventilation support was significantly different in the two groups (P=0.002). The death group had a higher incidence of loss of consciousness (P=0.003). COVID-19 causes neurological symptoms, especially during the inflammatory phase, and clinicians should be alert for neurological issues. [ FROM AUTHOR] Copyright of Acta Medica Iranica is the property of Tehran University of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

A novel survival algorithm in COVID-19 intensive care patients: the classification and regression tree (CRT) method

AJOL : Background/aim: The present study aimed to create a decision tree for the identification of clinical, laboratory and radio- logical data of individuals with COVID-19 diagnosis or suspicion of Covid-19 in the Intensive Care Units of a Training and Research Hospital of the Ministry of Health on the European side of the city of Istanbul. Materials and methods: The present study, which had a retrospective and sectional design, covered all the 97 patients treated with Covid-19 diagnosis or suspicion of COVID-19 in the intensive care unit between 12 March and 30 April 2020. In all cases who had symptoms admitted to the COVID-19 clinic, nasal swab samples were taken and thoracic CT was per- formed when considered necessary by the physician, radiological findings were interpreted, clinical and laboratory data were included to create the decision tree. Results: A total of 61 (21 women, 40 men) of the cases included in the study died, and 36 were discharged with a cure from the intensive care process. By using the decision tree algorithm created in this study, dead cases will be predicted at a rate of 95%, and those who survive will be predicted at a rate of 81%. The overall accuracy rate of the model was found at 90%. Conclusions: There were no differences in terms of gender between dead and live patients. Those who died were older, had lower MON, MPV, and had higher D-Dimer values than those who survived

Relationship between Inflammatory Parameter and Mortality in Intensive Care Patients with COVID-19

We aimed to examine the relationship between hypoxemia, inflammatory parameters, cytokine storm and mortality in the COVID-19 Intensive Care Unit. COVID-19 patients followed in intensive care unit between 21 March and 1 June 2020 were retrospectively an alyzed. Inflammatory parameters (CRP, ferritin, D Dimer, leukocyte and lymphocyte, LDH...) were measured in blood samples taken simultaneously. The relationship of these parameters with mortality was evaluated. Of the 30 patients, 11 (36.7%) were female, 19 (63.3%) were male. When living (Group 1) and dead (Group 2) patient groups were compared, a statistically significant difference was found between the groups in terms of mean age (p = 0.013). It was observed that PaO2 / FiO2 ratios were lower in Group 2 in all measurements starting from the day of hospitalization in intensive care. While there was no difference between CRP and procalcitonin values in the first week, the 12th and last day measurements were found to be statistically significantly higher in Group 2 (respectively p2 = 0.050, p2 = 0.016;p2 = 0.050, p2 <0.001). When the patients with severe pneumonia treated in the intensive care unit with the diagnosis of COVID-19 were examined, it was observed that the patients who died were more hypoxic at the intensive care entrance and on the 3rd day compared to the survivors, the level of hypoxemia did not affect the cytokine storm, and there was no difference in mortality between those who experienced cytokine storm and those who did not. [ FROM AUTHOR] Copyright of Eastern Journal of Medicine is the property of Yuzuncu Yil University, Faculty of Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

MENTAL HEALTH OUTCOMES FOLLOWING INTENSIVE CARE ADMISSION FOR COVID-19

B Introduction: b The long-term mental health impact of severe COVID-19 is unknown. B Methods: b This is a prospective cohort study of adult patients admitted to the intensive care unit (ICU) due to COVID-19 at two academic medical centers in Los Angeles and discharged between March 1, 2020 and December 31, 2020. [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

DISCHARGE DISPOSITION OF COVID-19 PATIENTS ADMITTED TO THE INTENSIVE CARE UNIT

A significant number of ICU patients and non-ICU patients (over 25%) required SNF placement. Patients admitted to the ICU with COVID-19 early during the pandemic had significantly higher APACHE II scores and body weight compared to non-ICU patients. [Extracted from the article] Copyright of Critical Care Medicine is the property of Lippincott Williams & Wilkins and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Unusual presentation of acid base abnormalities in critically ill COVID-19 patients: A retrospective observational study in a tertiary care centre, Telangana

Introduction: Since the novel corona virus disease 2019 (COVID-19) was declared a pandemic, the impact globally has been unparalleled. The World Health Organization (WHO) has notified about the novel coronavirus (COVID-19) as pandemic and have been identified as the causative agent for pneumonia and ARDS shortly thereafter. As the severity of COVID-19 progresses, many patients require intensive care unit (ICU) admission requiring frequent arterial blood gas (ABG) analysis which led to discovery of unusual acid base abnormalities in the patients. Arterial blood gas analysis is an important routine investigation to monitor the acid base balance of the patients, effectiveness of gas Exchange. Disorders of acid base balance can complicate many diseases and occasionally the abnormality may be so severe that it can be life threatening. The present study was carried out to assess acid-base patterns in COVID-19 ICU patients and to find their outcomes. Objective: To find out profile and pattern of Arterial Blood Gas anomalies (ABG) in intensive care (COVID-19) patients. Materials and methods: A single-center retrospective, observational study in a dedicated COVID-19 intensive care unit from the period of 8 months. A total of 32 Reverse Transcription Polymerase Chain Reaction (RT PCR) positive cases;that needed ICU admission were included in this study done at Malla Reddy Institute of Medical Sciences, Hyderabad, India. Data of Arterial Blood Gas (ABG) performed on day of admission was noted and they were followed up until they remained in ICU. Results: The age group affected with COVID-19 in this study was 26-75 years. Out of the patients admitted 21 were male (M) and 11 were female (F). Average duration of hospital stay for patients included in study was 22.31 + 9.68. Out of 32 patients, there were 81.25% (n=26) survivors and (n=6) (18.75%) were non-survivors. In this study population majority of patients had (n=7) (21.88%) metabolic alkalosis, while 5 patients (15.63%) had Normal ABG. Metabolic acidosis was seen in 4 patients (12.50%), and respiratory acidosis was seen in 4 patients (12.50%) each. Conclusion: Majority of patients admitted with COVID-19 experienced pH changes with a wide range of acid--base abnormalities, with metabolic alkalosis being the most prevalent. The observed occurrence of metabolic alkalosis on admission in a large number of COVID-19 patients is an undocumented finding that necessitates a multicenter investigation to uncover the disease's pathogenesis, including the importance of other acid-base imbalances that have been discovered in the present study. [ FROM AUTHOR] Copyright of International Archives of Integrated Medicine is the property of International Archives of Integrated Medicine and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)