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Background: Cystic fibrosis (CF) is a chronic, multi-system disease that can greatly affect quality of life, so it is important for people with CF to be closely evaluated. Routine care includes measurement of basic vital signs, which allows providers to assess respiratory, cardiovascular, and nutritional status, all of which are aspects people with CF at high risk of decompensation because of the disease's pathophysiology [1]. Providing patients with home devices can improve access to vital sign monitoring, which in turn can expand the scope of telehealth and bring attention to daily changes in a patient's overall health [2]. We predict that providing patients with medical devices to monitor vitals will benefit their overall health and wellbeing. Method(s): Medical device kits were offered to patients coming for their routine in-person visits at VCU Health Mayland Medical Center. Each kit contained a tape measure, pulse oximeter, thermometer, blood pressure apparatus, and weight scale. Before receiving the kit, patients who agreed to participate in the study filled out a pre-distribution survey that was modeled after the Centers for Disease Control and Prevention Health- Related Quality of Life-14. If patients did not know how to use a device, health care staff instructed them on its use. Twoweeks after they received the kit, patients were emailed a post-distribution survey that assessed the usefulness of each medical device. Result(s): Seventeen of 18 patients (94.4%) agreed to participate in the study. From the pre-distribution survey, 11.8% of patients frequently monitored their vitals;94.1% of those believed that using the devices would help improve the maintenance of their health, and 82.3% were aware of normal values for blood pressure, pulse, oxygen level, and body temperature and how to measure height and weight. All six of the 17 (35.3%) patients who responded to the post-distribution survey stated that the devices had worked as intended and that they did not find the devices too time consuming. Of the five devices that patients received, most patients found the pulse oximeter and blood pressure apparatus to be useful (100%), followed by the weight machine (75%), thermometer (50%), and tape measure (0%). Conclusion(s): Although most patients agreed that monitoring their vital signs at home would help maintain or enhance their health (94.1%), before this study, only two (11.8%) indicated that they regularly self-measured their vital signs. Overall, patients received being provided home devices was overall positively, with the pulse oximeter and blood pressure apparatus being the most popular. Reasons included ease of access and ability to self-triage and determine the urgency of seeing a health care provider if feeling unwell. The results of this study highlight not only patient desires to be more involved with their health, but also the importance of continuing to find ways to optimize remote monitoring during this COVID era.Copyright © 2022, European Cystic Fibrosis Society. All rights reserved
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Arterial blood oxygen saturation measured by pulse oximetry (SpO2) may be differentially less accurate for people with darker skin pigmentation, which could potentially affect COVID-19 treatment course. We analyzed pulse oximeter accuracy and association with COVID-19 treatment outcomes using electronic health record (EHR) data from Sutter Health, a large, mixed-payer, integrated healthcare delivery system in northern California, United States (US). We analyzed two cohorts: (1) 43,753 concurrent arterial blood gas (ABG) oxygen saturation (SaO2)/SpO2 measurement pairs taken January 2020-February 2021 for Non-Hispanic white (NHW) or Non-Hispanic Black/African American (NHB) adults, and (2) 8,735 adults who went to the emergency department (ED) with COVID-19 July 2020-February 2021. Pulse oximetry systematically overestimated blood oxygenation by 1% more in NHB individuals than in NHW individuals. For people with COVID-19, this was associated with lower admission probability (-3.1 percentage-points), dexamethasone treatment (-3.1 percentage-points), and supplemental oxygen treatment (-4.5 percentage-points), as well as increased time-to-treatment: +37.2 minutes before dexamethasone initiation and +278.5 minutes before initiation of supplemental oxygen. These results call for additional investigation of pulse oximeters, and suggest that current guidelines for development, testing, and calibration of these devices should be revisited, investigated, and revised.
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BACKGROUND: The SARS-CoV-2 virus has impacted life in many ways, one change being the use of face masks. Their effect on MRI-based measurements of cerebral oxygen levels with quantitative susceptibility mapping (QSM) and cerebral blood flow (CBF) is not known. PURPOSE: This study investigated whether wearing a face mask leads to changes in CBF and cerebral venous oxygen saturation measured with MRI. STUDY TYPE: Repeated-measures cohort study. POPULATION: A total of 16 healthy volunteers (eight male, eight female; 22-36 years) were recruited for the 3-ply study. Ten of the 16 participants (five male, five female; 23-36 years) took part in the KN95 study. FIELD STRENGTH/SEQUENCE: A 3 T, single-delay 3D gradient-and spin-echo pseudo-continuous arterial spin labeling (pCASL) scan for CBF quantification, and gradient-echo for QSM and oxygenation quantification. ASSESSMENT: Gray matter CBF and magnetic susceptibility were assessed by masking the pCASL CBF map and the QSM map to the T1 -weighted gray matter tissue segmentation. Venous oxygenation was determined from venous segmentation of QSM maximum intensity projections. STATISTICAL TESTS: Paired Student's t-tests and Cohen's d effect sizes were used to compare the face mask and no face mask scans for gray matter CBF, gray matter magnetic susceptibility, and cerebral venous oxygen saturation. Standard t-tests were used to assess whether the order of scanning with and without a mask had any impact. A statistical cut off of P < 0.05 was used. RESULTS: The 3-ply masks increased gray matter CBF from an average of 43.99 mL/(100 g*min) to 46.81 mL/(100 g*min). There were no significant changes in gray matter magnetic susceptibility (P = 0.07), or cerebral venous oxygen saturation (P = 0.36) for the 3-ply data set. The KN95 masks data set showed no statistically significant changes in gray matter CBF (P = 0.52) and magnetic susceptibility (P = 0.97), or cerebral venous oxygen saturation (P = 0.93). DATA CONCLUSION: The changes in blood flow and oxygenation due to face masks are small. Only CBF increased significantly due to wearing a 3-ply mask. EVIDENCE LEVEL: 2 TECHNICAL EFFICACY: Stage 3.
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How an infection propagates inside the lung is not well understood. Capturing its dynamics might help to understand how pathologies such as COVID19 can lead to rapid airways inflammation and respiratory failure. We hypothesized that respiratory failure might result from the interaction between the propagation of the infection from airway to airway (inner contagiousness) and the pathogen virulence. We develop a mathematical model of the infection and inflammation of the proximal lung (511 susceptible airways) by a generic pathogen that propagates from neighbor to neighbor between the airways. The degree of respiratory failure is evaluated by computing the mean number of infected airways (NI) and the mean drop in oxygen transfer to blood (DOx), assuming no compensation from patient ventilation. We simulated 840 idealized patients, covering 3 different degrees of virulence (Cured (C), Aseptic (A) and Septic (S) outcomes) and 14 degrees of contagiousness (1<=c<=14, arbitrary units). When virulence increases, the pathogens remain longer in the airways, increasing the propagation probability: NI(C)=51, DOx(C)=8.9%;NI(A)=410, DOx(A)=47.2%;NI(S)=511, DOx(S)=55.5%. For low contagiousness, c=1, NI(C)=1.6, DOx(C)=2.2%;NI(A)=132, DOx(A)=25.8%. However, NI(S)=511 and DOx(S)=52.2%. High contagiousness, c=14, leads to a large propagation whatever the virulence (NI(S/A)=511 and DOx(S/A)=57.5%;NI(C)=428 and DOx(C)=38.6%). Medium virulence and contagiousness also lead to a large propagation: for c=7, NI(A)=508, DOx=52.5%. Residence time of pathogens and inner contagiousness are interacting factors that might bring high NI and DOx. This interaction might be a core determinant of potential respiratory failure.
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Aim: to evaluate the efficacy and safety of convalescent plasma therapy for patients with severe SARS-CoV-2 infection. Material(s) and Method(s): the study included 64 patients with laboratory-confirmed severe new coronavirus infection. The control group consisted of 58 patients who, in addition to standard therapy, received a transfusion of plasma from donors who had recovered from COVID-19. The effectiveness of immune plasma was assessed by the duration of fever, the level of oxygen (SpO2%) in dynamics, the detection of SARSCoV-2 RNA in nasopharyngeal and oropharyngeal swabs using PCR method in dynamics, as well as by the dynamics of blood tests results. Adverse events (any medically adverse events that occurred after immune plasma transfusion) were recorded as safety criteria. Result(s): patients who received convalescent plasma, showed a significantly shorter period of SARS-CoV-2 replication compared with the control group. The use of immune plasma did not have a statistically significant effect on the duration of the fever, as well as the dynamics of blood oxygenation. Also, there were no significant differences compared with the control group when assessing blood tests parameters. Conclusion(s): The use of COVID-19 convalescent plasma to treat severe COVID-19 did not show significant clinical effect but reduced the period of viral replication. It also showed no unexpected or serious adverse events.Copyright © 2022 Interregional public organization Association of infectious disease specialists of Saint-Petersburg and Leningrad region (IPO AIDSSPbR). All rights reserved.
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Aim: to evaluate the efficacy and safety of convalescent plasma therapy for patients with severe SARS-CoV-2 infection. Material(s) and Method(s): the study included 64 patients with laboratory-confirmed severe new coronavirus infection. The control group consisted of 58 patients who, in addition to standard therapy, received a transfusion of plasma from donors who had recovered from COVID-19. The effectiveness of immune plasma was assessed by the duration of fever, the level of oxygen (SpO2%) in dynamics, the detection of SARSCoV-2 RNA in nasopharyngeal and oropharyngeal swabs using PCR method in dynamics, as well as by the dynamics of blood tests results. Adverse events (any medically adverse events that occurred after immune plasma transfusion) were recorded as safety criteria. Result(s): patients who received convalescent plasma, showed a significantly shorter period of SARS-CoV-2 replication compared with the control group. The use of immune plasma did not have a statistically significant effect on the duration of the fever, as well as the dynamics of blood oxygenation. Also, there were no significant differences compared with the control group when assessing blood tests parameters. Conclusion(s): The use of COVID-19 convalescent plasma to treat severe COVID-19 did not show significant clinical effect but reduced the period of viral replication. It also showed no unexpected or serious adverse events.Copyright © 2022 Interregional public organization Association of infectious disease specialists of Saint-Petersburg and Leningrad region (IPO AIDSSPbR). All rights reserved.
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Background: Neutrophil serine proteases (NSPs) are involved in the pathogenesis of COVID19 and are increased in severe and fatal infection. We investigated whether treatment with Brensocatib, an inhibitor of dipeptidyl peptidase-1, an enzyme responsible for the activation of NSPs, would improve outcomes in hospitalized patients with COVID19. Method(s): In a randomized, double-blind, placebo-controlled trial, 406 hospitalized patients with COVID19 with at least one risk factor for severe disease were randomized 1:1 to once-daily Brensocatib 25mg (n=192) or placebo (n=214) for 28 days. Primary outcome was the 7-point World Health Organisation Clinical Status scale at day 29. Secondary outcomes included time to clinical improvement, national early warning score, new oxygen and ventilation use, neutrophil elastase activity in blood and mortality. Finding(s): Brensocatib treatment was associated with worse clinical status at day 29 (adjusted odds ratio 0 72, 95%CI 0 57-0 92) compared to placebo. The adjusted hazard ratio (aHR) for time to clinical improvement was 0 87 (95%CI 0 76-1 00) and time to hospital discharge was 0 98 (95%CI 0 84-1 13). During the 28-day follow-up period, 23 (11%) and 29 (15%) patients died in the placebo and Brensocatib treated groups respectively). Oxygen and new ventilation use were greater in the Brensocatib treated patients. Neutrophil elastase activity in blood was significantly reduced in the Brensocatib group from baseline to day 29. Prespecified subgroup analyses of the primary outcome supported the primary results.
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Aim: to build, a predictive model for severe COVID-19 prediction in young adults using deep learning methods. Material(s) and Method(s): data from 906 medical records of patients aged. 18 to 44 years with laboratory-confirmed SARS- CoV-2 infection during 2020-2021 period, was analyzed. Evaluation of laboratory and. instrumental data was carried out using the Mann-Whitney U-test. The level of statistical significance was p<0,05. The neural network was trained, using the Pytorch. framework. Result(s): in patients with mild to moderate SARS-CoV-2 infection, peripheral oxygen saturation, erythrocytes, hemoglobin, total protein, albumin, hematocrit, serum, iron, transferrin, and. absolute peripheral blood, eosinophil and. lymphocyte counts were significantly higher than in patients with severe SOVID-19 (p< 0,001). The values of the absolute number of neutrophils, ESR, glucose, ALT, AST, CPK, urea, LDH, ferritin, CRP, fibrinogen, D-dimer, respiration rate, heart rate, blood, pressure in the group of patients with mild and. moderate severity were statistically significantly lower than in the group of severe patients (p < 0.001). Eleven indicators were identified as predictors of severe COVID-19 (peripheral oxygen level, peripheral blood erythrocyte count, hemoglobin level, absolute eosinophil count, absolute lymphocyte count, absolute neutrophil count, LDH, ferritin, C-reactive protein, D-dimer levels) and. their threshold, values. A model intended, to predict COVID-19 severity in young adults was built. Conclusion. The values of laboratory and instrumental indicators obtained in patients with SARS-CoV-2 infection upon admission significantly differ. Among them, eleven indicators were significantly associated with the development of a severe COVID-19. A predictive model based, on artificial intelligence method, with high, accuracy predicts the likelihood, of severe SARS-CoV-2 course development in young adults.Copyright © 2022 Interregional public organization Association of infectious disease specialists of Saint-Petersburg and Leningrad region (IPO AIDSSPbR). All rights reserved.
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Background: Forcrd oscillation technique (FOT) is a non-invasive method for investigation of lung mechanics without active participation of the patient. The objectives of the study were to find out whether FOT method could be used for monitoring of covid-19 pneumonia (CVP) course and how FOT indices correlate with other, commonly used indicators of disease severity. Method(s): During the hospital stay and 3 months after the discharge from hospital repeated measurements of lung mechanics were performed with portable device Tremoflo-100 (Thorasys, Canada). Result(s): Most relevant differences between disease stages reflected the lung reactance indices - Fres and AX. Indices characterizing the airflow resistance didn't reach the significance level. Correlation analysis also was performed between FOT indices and CT score, body mass index (BMI), patients age, blood CRP and ferritin levels, duration of hospital stay and patients oxygen demand (FiO2). Significant correlations View inline were found only between the last two. The highest significance showed Fres % pred and AX % pred. Fres correlated to FiO2 with R=0,498 and p-0,0000004, but AX% with r=0,502 Conclusion(s): The study has shown that FOT method reflects the changes in lung mechanics occurring during acute phase and recovery period from covid-19 pneumonia. FOT indices correlate with patients oxygen demand and hospital stay-time.
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Aim: During the first episodes of COVID-19 pandemic mostly affected population is elderly, but data about possible effects of the geriatric syndromes on clinical course and mortality are still conflicting. Method(s): Between April-June 2020 patients aged over 60 years, newly diagnosed as COVID-19 with a positive PCR test and need for hospitalization (ward or ICU) were prospectively enrolled to study. Demographics, whole blood analysis and laboratory results at the admission, computerized tomography findings, stage of the disease, need of oxygen, mechanical ventilation and intensive care unit were recorded. All patients were evaluated with a survey for sarcopenia, frailty and insufficient nutrutional status. Result(s): 65 patients were enrolled to study %41 (n:27) were females and the mean age was 69+/-8,4. Demographics were similiar in both gender, mean hospital stay was 9,2+/-4,3days. Respectively number of patients with frail, prefrail, risk of sarkopenia and insufficient nutrition were 6(%9,2), 16(%24,6), 7 (%10,8), 5 (%7,7). Advance age (>70 years) was a risk factor frailty (p>0,001). Risk factors for mortality advanced age (p<0.041), frail-prefrail (p<0,0042) chronic renal failure(p<0.001), arrhythmia (p<0.045), need of ICU (p<0.001), need of noninvasive mechanical ventilator (NIMV) (p<0.001) and intubation (p<0.002) Conclusion(s): Advanced age is highly correlated with frailty. Sarkopenia and insufficient nutritional status were also commonly with frailty. Comorbidities, need of ICU, NIMV and intubation were risk factors for mortality and common in prefrail patients. Not only frail but prefrail COVID-19 patients should follow up closely during hospitalization.
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Introduction: Coronavirus disease-2019 (COVID-19) has become a life-threatening healthcare crisis all over the world. Numerous biomarkers are currently under investigation to predict severity in this disease. Objective : This study aims to determine the possible association between increased lactate dehydrogenase (LDH) values odds of disease severity in COVID-19 patients. Method(s): We conducted a descriptive study including 356 patients who were admitted to our pulmonology department, from September 2020 to December 2021, for COVID-19 pneumonia confirmed by RT-PCR. We assembled sociodemographic information, clinical data, baseline inflammatory markers including blood LDH levels and follow-up oxygen saturation levels from medical records. Result(s): The sample included 204 male (57,3%) and 152 female (42,7%) with a mean age of 63,51 +/- 13,80 years. At admission, 51,9% of patients had initial oxygen requirements higher than 6 liters per minute. According to the clinical and biological severity, COVID-19 pneumonia was classified into 3 forms: mild form (9,5%), moderate form (29,1%), and severe form (61,6%). A total of 124 (64%) patients presented with elevated LDH values. A high level of blood LDH was positively associated with an important extent of lung abnormalities at CT scan (p=0.008), cardiovascular complications (p=0.041), and initial oxygen requirements higher than 6 liters per minute (p=0,034). Remarkably, elevated LDH values were found to be associated with the administration of antibiotics (p=0.014 ) and with death (p=0,049). Conclusion(s): Elevated LDH values were high in patients with severe COVID-19 pneumonia. LDH should be considered as a useful biomarker to predict severity in COVID-19.
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Effectiveness of the inclusion of reamberin in the complex rehabilitation of patients suffering of pneumonia caused by SARS-CoV-2 was evaluated at the outpatient stage. The data of 162 patients who received the rehabilitation treatment including, in addition to pharmacological benefits, exercise therapy and vacuum labile massage, were analyzed. In addition, patients of the main group (n = 82) received reamberin (1.5%, intravenously in a volume of 500 mL) for 10 days. The biochemical parameters of blood were studied in dynamics, and the blood oxygenation was monitored by the Stange and Genchi tests and the pulse oximetry. The quality of life was assessed in terms of the SF-36 questionnaire. The inclusion of reamberin in the complex rehabilitation contributed to improvement of the main biochemical parameters of blood (the levels of aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyl transpeptidase decreased 1.2, 1.7, and 1.9 times, respectively, p0.5) and caused a more pronounced increase in the external respiration function (on the average by 8.4 sec according to the Stange test and by 9.1 sec according to the Genchi test), which was accompanied by positive trends in the quality of life indicators (according to the SF-36 questionnaire) in terms of physical functioning (by 5.1 points) and general health status (by 3.76 points. The obtained clinical and laboratory data, together with good tolerance of the drug, allow us to recommend the inclusion of reamberin in rehabilitation regimens for patients with pneumonia caused by SARS-CoV-2. Copyright © 2022 Izdatel'stvo Meditsina. All rights reserved.
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Background: Reusable humidifiers are often colonised by microbes, the aerosols generated from which are hypothesised to transmit respiratory infections-jeopardising patient safety. Material(s) and Method(s): In this time-bound cross-sectional study, 10 ml of water was collected in sterile containers from humidifiers installed in selected wards/critical care units/intensive care units and from the source used to refill these humidifiers. These samples were subjected to KOH and gram staining followed by inoculation on blood, MacConkey and Sabouraud dextrose agar and brain heart infusion broth in the aerobic environment at 37degreeC. Observations were recorded as per standard guidelines and compared against blood and respiratory cultures of patients. Result(s): Despite an average of 8.23 days of exposure to oxygen humidified by contaminated water, n = 28 (of n = 39) blood samples reported no growth (NG) and n = 12 reported nonpathogenic organisms (NPO). Among n = 18 available respiratory samples, n = 1 reported Escherichia coli, which was not cultured from the same humidifier indicative of some other source. n = 1 reported NG, n = 6 reported NPO and n = 10 reported normal throat flora. No fungal elements were reported from any humidifier, source, or patient samples. The source-humidifier pathogen pair did not match for any humidifier. Conclusion(s): Sterile patient cultures, despite prolonged exposure to oxygen humidified with contaminated water, indicate that humidifier contaminants did not infect patients. The disparity between the source or patient cultures and humidifier contaminants may be attributed to compromised universal precautions due to the exhaustion of health-care professionals during COVID-19. Furthermore, the type of water used to refill (Distilled/RO/Tap water) had no effect on the microbial contamination of humidifiers. Copyright © 2022 Journal of Patient Safety & Infection Control Published by Wolters Kluwer - Medknow.
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Background: This study presents the data of ESRD patients on maintenance haemodialysis (MHD) with COVID-19 disease from Sri Padmavathi Medical College (SPMC) Hospital, SVIMS University, Andhra Pradesh, India which had been ordained as the State COVID Hospital in March 2020. Method(s): We collected the data from March 2020 to December 2021 of ESRD patients on MHD in a retrospective observational study and identified the risk factors for mortality. Result(s): At SPMC Hospital, the total number of COVID-19 disease patients managed was 15,719. The number of deaths reported was 2,878 (18.3%). We idenfited a total of 714 ESRD patients who required MHD during this period. We analyzed data for 595 patients (83.3%). The rest of patient files could not be traced owing to mismatch in the medical record numbers and patient names. The number of ESRD patients on MHD with COVID-19 disease who died were 203 out of 595 (34.1%). We identified age, SpO2 at admission, number of dialysis sessions, total leucocyte count, neutrophils, lymphocytes, blood urea, serum glutamic-oxaloacetic transaminase (SGOT), serum glutamic-pyruvic transaminase (SGPT), C-reactive protein (CRP), serum ferritin, serum lactate dehydrogenase (LDH), male, diabetes mellitus, oxygen requirement at admission, non invasive ventilation (NIV) at admission and NIV in hospital as significant risk factors for mortality (P<0.001). On multivariate analysis age, NIV during hospital stay and serum LDH returned significant. Conclusion(s): The mortality rate in ESRD patients on MHD with COVID-19 disease at our institution was not divergent from the published studies;however, we identified several different risk factors.
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BACKGROUND: Training is an essential aspect of providing high-quality treatment and ensuring patient safety in any medical practice. Because extracorporeal membrane oxygenation (ECMO) is a complicated operation with various elements, variables, and irregular situations, doctors must be experienced and knowledgeable about all conventional protocols and emergency procedures. The conventional simulation approach has a number of limitations. The approach is intrinsically costly since it relies on disposable medical equipment (i.e., oxygenators, heat exchangers, and pumps) that must be replaced regularly due to the damage caused by the liquid used to simulate blood. The oxygenator, which oxygenates the blood through a tailored membrane in ECMO, acts as a replacement for the patient's natural lung. For the context of simulation-based training (SBT) oxygenators are often expensive and cannot be recycled owing to contamination issues. METHODS: Consequently, it is advised that the training process include a simulated version of oxygenators to optimize reusability and decrease training expenses. Toward this goal, this article demonstrates a mock oxygenator for ECMO SBT, designed to precisely replicate the real machine structure and operation. RESULTS: The initial model was reproduced using 3D modeling and printing. Additionally, the mock oxygenator could mimic frequent events such as pump noise and clotting. Furthermore, the oxygenator is integrated with the modular ECMO simulator using cloud-based communication technology that goes in hand with the internet of things technology to provide remote control via an instructor tablet application. CONCLUSIONS: The final 3D modeled oxygenator body was tested and integrated with the other simulation modules at Hamad Medical Corporation with several participants to evaluate the effectiveness of the training session.
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Extracorporeal Membrane Oxygenation , Simulation Training , Humans , Extracorporeal Membrane Oxygenation/methods , Oxygenators , Lung , Computer Simulation , Oxygenators, MembraneABSTRACT
Aim of the study. To examine the effect of prone positioning on hemodynamics in patients with COVID-19. Materials and methods. The study enrolled 84 patients of both sexes with community-acquired multiseg-mental viral and bacterial pneumonia associated with COVID-19, who were divided into groups according to the type of respiratory support. The tests were performed using the integrated hardware and software system for noninvasive central hemodynamic assessment by volumetric compression oscillometry. Results. We found that the pulse blood pressure velocity decreased from 281 [242.0;314.0] to 252 [209;304] mm Hg/s in patients with severe COVID-19 on oxygen support (p=0.005);volume ejection rate decreased from 251 [200;294] to 226 [186;260] ml/s (P=0.03);actual/estimated normalized vascular resistance ratio dropped from 0.549 [0.400;0.700] to 0.450 [0.300;0.600] (P=0.002), while the arterial wall compliance increased from 1.37 [1.28;1.67] to 1.45[1.10;1.60] ml/mm Hg (P=0.009). Prone positioning of patients on noninvasive lung ventilation associated with a reduction of linear blood flow rate from 40.0 [34.0;42.0] to 42.5 [42.5;47.25] cm/s (P=0.04) and arterial wall compliance from 1.4 [1.24;1.50] to 1.32 [1.14;1.49] ml/mm Hg (P=0.03). Prone positioning of patients on invasive lung ventilation did not result in significant hemodynamic changes. Conclusion. The greatest hemodynamic changes during prone positioning were found in patients on oxygen respiratory support, whereas the least significant alterations were seen in patients on invasive ventilatory support. Copyright © 2021, V.A. Negovsky Research Institute of General Reanimatology. All rights reserved.
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Background and Aim: The Coronavirus disease 2019/COVID-19/exerts an unprecedented global impact on public health and health care delivery. The aim of this study was to evaluate the knowledge on SARS-CoV-2, epidemiology, clinical presentation including cardiovascular and immunological status in postCovid children. Method(s): A group of 70 children/previously healthy or with no pre-existing heart disease/from Sarajevo with positive postcovid history, formed this study. Patients were evaluated at the Polyclinic Eurofarm in Sarajevo, from October 2020 till April 2021. Following history and epidemiological data, a detailed cardio-vascular examination has been performed including oxygen satu-ration, pulse, blood pressure, electrocardiogram/ECG/, values of polymerase chain reaction (PCR), serological tests for corona, lab-oratory blood tests and echocardiography. Result(s): The group consisted of 70 children/40 boys/: infants: 10, 1-5 years: 20;6-10:12;11-15:21;16-18 years: 7;forming five groups. Symptoms differ depending on age group, younger chil-dren had no or mild symptoms in comparison to the older group of children. The values of immunoglobulin G were significantly higher in the older group of children with (p lt;0.05;p = 0.043) indicating that the immune system with age is more responsive to the virus. PCR test was negative in 9/70 children. The majority of children/64.3 %/were asymptomatic. Two boys aged 14 years, had palpitation on exertion, shortness of breath, ECG changes, lower oxygen saturation/91% and 94%/, elevated creatinine phosphokinase miofibrilae/CPKMB/: 38 and 45, in one patient the diameter of left coronary artery/LCA/was enlarged up do 3.8mm, no aneurysm, no skin changes, with normal ejection frac-tion of left ventricle. They were on short period/10-15days/of treatment with nonsteroids including low doses of Aspirin, vita-mins/C and D/, rest and no sport activities. After treatment and a regime of no activities, they were fully recovered, free of symptoms, with normal oxygen saturation, normal values of CPKMB, diameter of LCA was within a normal range according to age and body weight of the patient. Conclusion(s): Practitioners should consider the possibility of COVID-19 in children with atypical symptomatology and posi-tive or suspicious epidemiological survey, paying special attention to coronary and immunological status.
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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
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SESSION TITLE: COVID-Related Critical Care Cases SESSION TYPE: Case Reports PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm INTRODUCTION: Thrombotic thrombocytopenic purpura (TTP) is a rare medical emergency with mortality rates reported to be as high as 90% if untreated. We report a case of severe TTP in an immunocompetent patient diagnosed with COVID 19 infection. CASE PRESENTATION: A 34-year-old morbidly obese female not vaccinated for COVID presented to PCP 2 weeks prior with complaints of fatigue. CBC showed Hb 12.2, platelet count 108 (baseline > 200), and covid resulted positive. The patient was reluctant for further workup at the time. After 2 weeks she felt short of breath prompting ICU admission for high flow oxygen with blood work showing hemoglobin of 8.8, platelet count of 11, Reticulocyte count 3.9%, LDH 763, fibrinogen 639, schistocytes on peripheral smear, MCV < 90, INR<1.5, Creatinine 1 giving her a PLASMIC Score of 7. For concerns of TTP, she was urgently started on plasmapheresis, prednisone 1 mg/kg, and remdesivir for COVID. ADAMTS13 was sent prior to the initiation of plasmapheresis resulted at 5% indicating severe deficiency and a high risk of relapse. She underwent 3 cycles of plasma exchange and was also started on Caplacizumab. Rituximab was not started in the setting of active COVID infection and negative COVID IgG. Repeat ADAMTS13 level at 2-week interval increased to 43%. The patient was discharged on steroids and completed 1 month of Caplacizumab. On outpatient follow up the patient was asymptomatic but repeat ADAMTS13 declined to 16%. COVID IgG now resulted positive, and she was started on Rituximab. Ultimately patient was treated with 4 months of steroids and 4 doses of weekly Rituximab with the final two ADAMTS 13 levels normalized above 100. DISCUSSION: TTP is caused by decreased activity of the plasma metalloproteinase ADAMTS 13, the key enzyme involved in the cleavage of ultra-large von Willebrand Factor (vWF) multimers into smaller less procoagulant multimers. It is reported that COVID-19 infection is associated with almost a five-fold increase in vWF levels which the body's ADAMTS-13 enzyme activity cannot adequately regulate, resulting in an excess of unchecked ultra-large vWF, diffuse microthrombi, and systemic ischemia. The presentation of this disease is often characterized by the pentad of fever, thrombocytopenia, hemolytic anemia, renal dysfunction, and neurologic dysfunction. However, the full pentad is often not present in many patients Plasma exchange and immunosuppression are the mainstays of treatment for TTP. A high index of suspicion is required for a timely diagnosis. Early diagnosis is crucial as without treatment TTP is associated with a high mortality rate. CONCLUSIONS: Health care providers should be aware of this life-threatening complication of COVID-19 so that prompt and appropriate interventions can be undertaken if it is suspected or confirmed. Rituximab should be delayed until the acute COVID-19 infection has cleared, and neutralizing antibodies have been produced. Reference #1: Hindilerden F, Yonal-Hindilerden I, Akar E, Kart-Yasar K. Covid-19 associated autoimmune thrombotic thrombocytopenic purpura: Report of a case. Thromb Res. 2020;195:136-138. doi:10.1016/j.thromres.2020.07.005 DISCLOSURES: No relevant relationships by Hanish Jain No relevant relationships by Dragos Manta No relevant relationships by Parth Sampat No relevant relationships by Garima Singh No relevant relationships by Simant Thapa