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Background: The clinical course of coronavirus disease-2019 (COVID-19) varies from those who are asymptomatic, experience mild symptoms such as fever, cough, and dyspnea, to more severe outcomes including acute respiratory distress, pneumonia, renal failure, and death. Early reports suggested severe outcomes in patients with primary immunodeficiency (PID), particularly those with type 1 interferon signalling defects. This prompted a rigid approach to social distancing to protect this patient population, particularly children. To date, real-world data describing the course and outcome of COVID-19 in paediatric PID patients remains scarce. Method(s): In this retrospective case series, we describe the clinical course of 36 paediatric patients with underlying primary immunodeficiency (PID) followed by SickKids Hospital (Toronto, Canada) who were symptomatic and tested positive for SARS-CoV-2 infection between October 2020 to November 2022. Result(s): Our cohort consisted of patients with combined immunodeficiency (66.7%), antibody deficiency (22.2%), neutrophil dysfunction (8.3%), and immune dysregulation (2.8%). The median age was 7.5 years (range: 8 months - 17 years), with 21 male and 15 female patients. Three (8.3%) patients were post-hematopoietic stem cell transplant (HSCT) and 12 (33%) patients were on immunoglobulin replacement. Nine (25%) patients had underlying lung problems including bronchiectasis (1), interstitial lung disease on home oxygen therapy (1), and underlying asthma (7). Most patients had mild clinical course and were managed at home. The most common symptoms were fever (80%), cough (75%) and other upper respiratory tract symptoms (72%). Nineteen (52.7%) patients experienced other symptoms which included headache, lethargy, or gastrointestinal upset. At the time of the infection, 13 patients (36.1%) had received 2 doses of a SARS-CoV-2 vaccine, 5 patients (13.9%) had received 1 dose, and 18 (50%) were not vaccinated. None of the patients received antiviral or monoclonal antibody as prophylaxis or treatment. Only 1 patient required hospital admission out of precaution given the close proximity to HSCT. All patients recovered without complications. Conclusion(s): The paediatric patients with PID followed by our centre experienced mild to moderate COVID-19 symptoms and recovered fully without complications. These findings support the return of much needed social interactions among children, which were impacted severely during the COVID-19 pandemic.Copyright © 2023 Elsevier Inc.
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Introduction: The purpose of this study was to evaluate the functional status and ongoing respiratory symptoms of patients who have been discharged home, who were admitted to the intensive care unit (ICU) with severe COVID-19 disease. Long term complications post critical illness, such as post intensive care syndrome (PICS), are well-recognised [1], however, little data exists specific to COVID-19 ICU survivors. Method(s): Local ethics committee approval was secured. Participants were recruited using the electronic intensive care chart database. All patients, from March 2020 to November 2021, who survived Covid-19 were included. Researchers conducted phone interviews with participants and completed three questionnaires;Katz Index of Independent Living Questionnaire, Karnofsky Performance Status Scale and the American Thoracic Society (ATS) Respiratory Disease Questionnaire. Data was input and analysed using excel and stored on a password encrypted computer. Result(s): Database search revealed 61 patients available, 33 of 61 patients were included. 20 (61%) were male, 13 (39%) were female. Mean age was 58, with a range of 25-81. Mean length of ICU stay was 15 days, with a range of 1-74 days. 15 (45%) patients were intubated. Most common Katz score (range 1-6) was the highest score of 6 in 23 (70%) patients. Most common Karnofsky score (range 10-100) was 60 in 11 (33%) patients, with 31 (94%) scoring < 100. The most frequent ATS shortness of breath (SOB) grade (range 0-4) was 3 in 10 (9%) patients, with 23 (70%) patients scoring > 0. 14 (42%) patients had an ongoing cough, 11 (33%) patients had a wheeze and 0 (0%) patients were on home oxygen therapy. Conclusion(s): This study highlights in the majority of patients who survived severe Covid-19 disease to discharge home, there were serious ongoing limitations to their functional status and exercise tolerance, however, they remained independent of basic activities of daily living.
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Introduction and aim: COVID19 pandemic caused by SARS-CoV-2 is associated with high morbidity and mortality rate worldwide,producing inflammation that can lead to persistent parenchymal lesions. The aim was to analyse the medium-long term evolution of patients with severe COVID19. Method(s): Follow-up of a cohort of 97 COVID19 patients admitted to intensive care unit from March 2020 to June 2021,requiring invasive/non-invasive mechanical ventilation (IMV/NIMV) and/or high-flow nasal cannula (HFNC). They were clinically evaluated in the Interstitial Diseases consult at 4-6 weeks after discharge with spirometry (SP),CO diffusion capacity (DLCO) and thoracic ultrasound (TU);those suggestive of mild interstitial changes (IC) were evaluated at 3 months and moderate-severe ones at 6 months with HRCT,SP and DLCO. Result(s): Mean age was 61+/-15 years (61% male) and hospital stay was 26+/-17 days.93% used HFNC,57% NIMV and 31% IMV. At 4-6 week after discharge assessment showed 45% dyspnea and 33% crackles. SP was normal in 63%,with mild DLCO disorders in 36% and 77% pathological TU. The most frequent abnormality on HRCT was ground glass. After clinical-functional and ultrasound-radiological evaluation at 4-6 weeks after COVID19,37% of cases were discharged,another 2% at 3 months,22% at 6 months and 7% at 12 months. The remaining 32% are still being followed up for persistent IC(6 receiving home oxygen therapy,6 treated with steroids and 4 with antifibrotic). Conclusion(s): Most patients with severe COVID19 infection have after discharge IC with mild clinical-functional impact at 4-6 weeks,although one third have persistent changes after 12 months. Medium to long-term follow-up of postCOVID19 patients is necessary to identify those with permanent abnormalities.
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Bakground COVID-19 patients mostly experience a favorable evolution of the disease. However patients without acute respiratory distress syndrome (ARDS) but in need of long term oxygen therapy have received much less attention. Aim(s): To determine the predictive factors of home therapy oxygen after hospital discharge for COVID19 pneumonia. Method(s): We conducted a retrospective study including with laboratory-confirmed COVID-19 infection hospitalized in the pulmonology department of the military hospital of Tunisia. We divided our patients into two groups : the first group (16 patients, 7%) requiring long term oxygen therapy (G1), the second group discharged without oxygen (G2). Result(s): A total of 245 patients were enrolled in the study. The median age was 61 years old. The majority of the population were male (77%). Home therapy oxygen needs were not correlated with the scanner degree impairment upon admission as well as the duration and posology of corticotherapy during hospitalization. It was significatively associated with an increased hospital stay (r=0,314;p=<0,001). Predictive home oxygen therapy factors were patients with extensive fibrotic-like changes on lung CT scan upon admission (r=0.223;p=0.04), heightened procalcitonin (PCT) level (p=0.009). No correlation was found with, intensive care transfer or other biomarkers levels. Independent predictive factors of long term oxygen therapy prescription were increased hospital stay (ORa = 1.092 [1.026-1.164], p = 0.006) and pulmonary fibrosis on lung CT scan upon admission (ORa = 17.405 [2.353-128.721], p = 0.005). Conclusion(s): Increased hospital stay and extensive fibrotic-like on lung CT scan initial should be used to identify patients in need for adjunctive therapy.
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Tunisia, like many countries, was confronted to the unprecedented COVID-19 pandemic. Home oxygen therapy, classically proposed for chronic respiratory insufficiency, was a real solution to high pressure on health system. to evaluate feasability and safety of home oxygen therapy after discharge from intensive care unit (ICU) in severely ill COVID-19 patients. we conducted a prospective, observational, single- center study between October 2020 and December 2021. We included patients, with confirmed SARS-CoV-2 pneumonia, requiring home oxygen therapy after their discharge from intensive care unit of Zaghouan's Hospital (Tunisia). Home oxygen therapy is offered to eligible patients after clinical improvement and still requiring nasal oxygen therapy less than 6 L/min. After their consent, patients and their caregivers were instructed on using concentrator and monitoring pulse oxygen saturation. A daily telephone follow-up was fulfilled. Twenty patients were enrolled. Median age was 54.5 [28-68] years, 60% pas de pourcentage si nb inf a30 were male. At least one comorbidity was observed in 11/20 patients. Hypertension (7/20), COPD (4/20) and diabetes mellitus (3/20) were the most common associated risk factors. Among the cohort and during their hospital stay all patient were under mechanical ventilation. Median length of ICU stay was 14 [2-33] days. Median rate of oxygen flow, at the moment of hospital discharge, was 2.9 [2-5] L/min. Oxygen therapy was required for a median of 26 days [6-90]. No deaths or urgent unplanned hospitalization were reported during the follow-up period. Early discharge of oxygen-requiring COVID-19 patients after an ICU stay was safe and effective.
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Introduction: After COVID-19 infection, symptoms last for weeks or months. In this study, it was aimed to examine the relationship between functional status and fatigue and the associated factors in patients with COVID-19. Method(s): Patients with COVID-19 infection who applied to 13 centers were included into the study according to the inclusion criteria. Age, gender, height, body weight, body mass index (BMI), marital status, smoking status and amount, presence, duration of chronic disease, Charlson comorbidity index, regular exercise habit, time of diagnosis with COVID-19, presence of hospitalization,length of hospital stay, intubation status, home oxygen therapy need, participation in PR program, presence of dyspnea, cough, sputum, mMRC score, post-COVID functional status scale, fatigue severity scale, EQ-5D-5L Questionnaire scores were recorded. Result(s): Of the 1095 patients, 603 (55%) were male and 492 (45%) were female. Their mean age was 50+/-14 years. The most common chronic lung disease was COPD (11%), while 266 patients (29%) had non-pulmonary systemic disease. The median time of COVID-19 diagonosis was 5 months ago with 47% hospitalization rate. The median value of post-COVID functional status scale was 1 (0:4), and fatigue severity scale score was 4.4 (1:7). There was a significant correlation between post-COVID functional status and fatigue severity scale (r=0.43, p <0.01). Conclusion(s): Functional status and fatigue were found to be related primarily to quality of life and then patients' age, BMI, presence of chronic and systemic lung disease, regular exercise habits before COVID-19, hospitalization and its duration, home oxygen therapy and symptoms.
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Since the introduction of the first home oxygen systems, evidence has been generated about their benefits;however, controversies persist in their prescription in respiratory and non-respiratory diseases (Albert, R.K. et al. N Engl J Med 2016;375: 1617-27). The access to home oxygen systems has always been limited in the Dominican Republic;the COVID-19 pandemic has increased the need to reduce hospital stays, avoid readmissions, treat patients at home due to the lack of beds, risk of infection, or fear of isolated admission;generating an unprecedented rise in prescriptions, and an oxygen crisis in some countries (Usher AD. Lancet 2021;397: 868869). In order to optimize the available resources, we thought about the possibility of rationalize the use of home oxygen systems. From April 2020 to December 2021, we followed up 327 patients diagnosed with COVID-19 under home oxygen treatment;every two weeks we perform a phone call to assess the need to continue the oxygen therapy according to the oxygen saturation, and clinical evolution. The data results shows that 80% needed oxygen therapy less than 30 days and 93.2% of the patients less than 90 days, which corresponds to provisional use, and allowed us to provided the oxygen therapy to all those patients with only 20 oxygen concentrators. Provisional prescriptions of home oxygen therapy is an area of controversy due to lack of evidence on their benefits;however, it has played an important role due to the changing needs during the COVID-19 pandemic. As long as the prescription is reviewed by a pulmonologist to optimize resources, it becomes a useful tool as we have been able to observe.
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Introduction: Some patients affected by COVID-19 remain hospitalized due exclusively to persistent hypoxemia. The indication of long-term home oxygen therapy (LTOT) has become a strategy adopted to reduce the length of hospital stay. The influence of the degree of severity of disease involvement on the effectiveness of the strategy is unknown. Objective(s): To evaluate the clinical characteristics of patients with LTOT indication according to the type of hospitalization in COVID-19 patients. Method(s): An exploratory cross-sectional study of associated factors in stable discharged COVID-19 patients using LTOT were consecutively included. Result(s): Between April and December 2021, a total of 62 patients with LTOT indication were evaluated 15 days after hospital discharge. Of these, 32 of them required intensive care unit (ICU) at some point during their hospitalization. When we compared the ICU and ward care groups, we observed differences in age (55.84 +/-13.5 vs 68.42 +/- 14.8, p=0.001) and time of hospitalization (31.63 +/- 21.8 v 17.65 +/-9, p=0.002). However, we did not identify statistical differences between groups on gender and degree of pulmonary involvement on tomography during hospitalization. After 15 days of discharge, there was no statistically significant difference between the two groups in terms of the number of patients who needed to maintain LTOT for more period (8 vs 11). Conclusion(s): Regardless of the severity of hospitalization, most patients did not need to maintain LTOT for more than 15 days. LTOT proved to be a temporary and effective strategy to shorten the length of stay in both groups in stable COVID-19 patients.
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OBJECTIVE: We evaluated the accuracy of a neural network to classify and predict the possibility of home oxygen therapy at the time of discharge from hospital based on patient information post-coronavirus disease (COVID-19) at admission. METHODS: Patients who survived acute treatment with COVID-19 and were admitted to the Amagasaki Medical Co-operative Hospital during August 2020-December 2021 were included. However, only rehabilitation patients (n = 88) who were discharged after a rehabilitation period of at least 2 weeks and not via home or institution were included. The neural network model implemented in R for Windows (4.1.2) was trained using data on patient age, gender, and number of days between a positive polymerase chain reaction test and hospitalization, length of hospital stay, oxygen flow rate required at hospitalization, and ability to perform activities of daily living. The number of training trials was 100. We used the area under the curve (AUC), accuracy, sensitivity, and specificity as evaluation indicators for the classification model. RESULTS: The model of states at rest had as AUC of 0.82, sensitivity of 75.0%, specificity of 88.9%, and model accuracy of 86.4%. The model of states on exertion had an ACU of 0.82, sensitivity of 83.3%, specificity of 81.3%, and model accuracy of 81.8%. CONCLUSION: The accuracy of this study's neural network model is comparable to that of previous studies recommended by Japanese Guidelines for the Physical Therapy and is expected to be used in clinical practice. In future, it could be used as a more accurate clinical support tool by increasing the sample size and applying cross-validation.
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STUDY OBJECTIVE: During the COVID-19 pandemic, prescribing supplemental oxygen was a common reason for hospitalization of patients. We evaluated outcomes of COVID-19 patients discharged from the Emergency Department (ED) with home oxygen as part of a program to decrease hospital admissions. METHODS: We retrospectively observed COVID-19 patients with an ED visit resulting in direct discharge or observation from April 2020 to January 2022 at 14 hospitals in a single healthcare system. The cohort included those discharged with new oxygen supplementation, a pulse oximeter, and return instructions. Our primary outcome was subsequent hospitalization or death outside the hospital within 30 days of ED or observation discharge. RESULTS: Among 28,960 patients visiting the ED for COVID-19, providers admitted 11,508 (39.7%) to the hospital, placed 907 (3.1%) in observation status, and discharged 16,545 (57.1%) to home. A total of 614 COVID-19 patients (535 discharge to home and 97 observation unit) went home on new oxygen therapy. We observed the primary outcome in 151 (24.6%, CI 21.3-28.1%) patients. There were 148 (24.1%) patients subsequently hospitalized and 3 (0.5%) patients who died outside the hospital. The subsequent hospitalized mortality rate was 29.7% with 44 of the 148 patients admitted to the hospital dying. Mortality all cause at 30 days in the entire cohort was 7.7%. CONCLUSIONS: Most patients discharged to home with new oxygen for COVID-19 safely avoid later hospitalization and few patients die within 30 days. This suggests the feasibility of the approach and offers support for ongoing research and implementation efforts.
Subject(s)
COVID-19 , Humans , COVID-19/epidemiology , COVID-19/therapy , Retrospective Studies , Pandemics , Hospitalization , Patient Discharge , Emergency Service, Hospital , Oxygen Inhalation Therapy , Oxygen/therapeutic useABSTRACT
SESSION TITLE: Management of COVID-19-Induced Complications SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: Up to 17% of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been shown to develop pancreatic lesions (1). We present 2 cases of coronavirus disease 2019 (COVID-19) patients that presented with pancreatic lesions. CASE PRESENTATION: Case1 A 47-year-old lady with a history of type 2 diabetes mellitus present to the emergency department (ED) with complaints of flu-like symptoms for ten days. She tested positive for COVID-19 by rapid PCR. Computed tomography (CT) scan without contrast on admission shows an incidental finding of a pancreatic mass (see Figure 1). Abdominal CT with contrast shows a large, multiloculated cystic mass in the pancreatic tail (see Figure 2). Laboratory examination depicted lipase: 27 U/L, CA19-9: 72 U/mL, CEA: 6.5 ng/mL, CA125: 24 U/mL, erythrocyte sedimentation rate (ESR):2 mm/h, Total Bilirubin: 0.6 mg/dl, Direct Bilirubin: 0.1 mg/dl. Following treatment, the patient recovered fully and is discharged from the hospital 10 days later with home oxygen therapy. Case2 An 81-year old Caucasian lady presented to the outpatient clinic with complaints of fecal incontinence. She tested positive for COVID-19, four months before her visit. CT scan of the abdomen with oral contrast revealed multiple hypodense masses on the pancreas measuring 0.3cm in diameter (see Figure 3). Laboratory tests reveal CA19-9: 57 U/mL, CA125: 8 U/mL, CEA: 1.9 ng/mL, erythrocyte sedimentation rate (ESR):11 mm/h, C-reactive protein: 0.7 mg/L, Total Bilirubin: 1.5 mg/dl, Direct Bilirubin: 1.3 mg/dl. Following outpatient treatment and follow-up, the patient's symptoms were relieved. DISCUSSION: Pancreatic lesions in COVID-19 patients can be caused directly by the cytopathic effects of the viral infection, or indirectly by systemic responses to inflammation or respiratory failure. Several studies have shown that ACE2 is the functional receptor used by SARS-CoV-2 to gain access to target cells (2) and ACE-2 receptors are expressed in significant amounts in the pancreas (3). In the first case, an incidental finding of a multi-cystic pancreatic mass on admission was reported. There was no pancreatic ductal dilation on the CT scan, which may indicate a direct injury caused by cytopathic effects of the virus rather than inflammation resulting in exocrine secretions forming cysts. In the second case, multiple masses on the pancreas were found after recovering from COVID-19. These lesions could be remnants of a previous pancreatic injury during the acute phase of the infection. CONCLUSIONS: COVID-19 infection may trigger pancreatic injury in some patients. Reference #1: Yong, Shin Jie. Long COVID or post-COVID-19 syndrome: putative pathophysiology, risk factors, and treatments. Infectious diseases. 2021 Oct;53(10): 737–754. Reference #2: Ma C, Cong Y, Zhang H. COVID-19, and the Digestive System. Vol. 115, American Journal of Gastroenterology. Wolters Kluwer Health;2020. p. 1003–6. Reference #3: Liu F, Long X, Zhang B, Zhang W, Chen X, Zhang Z. ACE2 Expression in Pancreatic Damage After SAERS-CoV-2 Infection. Gastroenterology. 2020 Aug 1;18(9): 2128 – 2130.e2. DISCLOSURES: No relevant relationships by Ailine Canete Cruz No relevant relationships by Claudia Ramirez No relevant relationships by Joseph Varon No relevant relationships by Mohamed Ziad
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Introduction: Patients on maintenance hemodialysis are at higher risk for severe COVID-19. Various inflammatory markers have been used to assess the severity of COVID 19 in general population. However, whether the same markers are useful among hemodialysis patients is yet to be ascertained. Hence this study was conducted. Methods: This is an observational, retrospective and prospective study. All patients who were on maintenance hemodialysis, affected with COVID-19 infection and requiring hospitalization, between March 2020 to June 2021 were included. Clinical profile, biochemical parameters and inflammatory markers at admission, during the hospital stay and at the time of final outcome were noted. Patient’s clinical condition was scored as per WHO clinical progression scale (WHOCPS), and were classified as “non-severe” (0-5), and “severe” (6-10). The medications received by them in the hospital was noted. Patient’s discharge status was categorized into stable discharge, discharged with home oxygen therapy or death. Results: 140 patients were included in the study. Diabetic nephropathy was the major cause for ESRD (fig1). Most patients had co-morbidities as shown in fig2. 17% of the patients had a previous kidney transplant. 25.7 % required supplemental oxygen at presentation. 15% required ICU care and 12.9% required mechanical ventilation eventually. The % of lymphocytes, IL6, Albumin and LDH correlated with severity of the disease. These values were observed during the hospital stay, and were higher in patients who required ICU care and mechanical ventilation (table 1). % of lymphocytes, CRP, IL6, albumin and LDH were found to be higher at the time of admission in patients who required ICU care and Mechanical ventilation. Between Days 2-5, total WBC counts, %lymphocytes correlated with complications and mortality (Table 2). Rising CRP, LDH, Ferritin and total WBC counts were associated with longer ICU stay. CRP, LDH and Ferritin levels were higher in those who had higher WHOCP score, thus correlating poor outcomes (table 3). Ferritin and albumin showed a significant difference between severe and non-severe cases at discharge. ROC curve at admission (fig 5) showed that LDH had better AUC than IL 6. During days 2-5, the % of lymphocytes had better AUC than Total counts (Fig 6). At discharge, serum albumin was found to be the best predictor of the outcome (fig 7) 90% of the patients who required oxygen support/ ICU care/ mechanical ventilation received corticosteroids and remdesvir. Prophylactic anticoagulants were used in 101 patients. Tocilizumab(n=3) and Tofacitinib (n=1)were used in those patients who had severe COVID-19 illness, with very high inflammatory markers. 80% recovered, 17.1% expired and 2.9% required home oxygen therapy at discharge. 27 % of patients developed complications (secondary bacterial infections, mucormycosis, deep vein thrombosis, stroke, and myocardial infarction). Conclusions: LDH on day of admission, % of lymphocytes on days 2-5, and serum albumin on day of discharge were the best predictors of outcomes among CKD patients on hemodialysis having COVID-19. Use of these biomarkers will definitely be more helpful for optimum usage of drugs, and will help us risk stratification of hemodialysis patients. No conflict of interest
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COVID-19 can lead to persistent hypoxia due to persistent inflammatory responses to SARS-CoV- 2 in the respiratory system. Post-COVID syndrome, may involve multiple organ systems leading to physical and medical sequelae following COVID-19, including chronic hypoxemia. Long-term oxygen therapy (LTOT) is an established treatment for patients with chronic hypoxemia, generally used in chronic airway diseases. Aims and objectives 1.To evaluate COVID-19 patients advised LTOT in post-COVID period 2. To determine if the need for oxygen support continues 3. To ascertain as to if these post covid patients actually need oxygen concentratorsMethodology500 post COVID-19 patients on oxygen therapy at home were questioned about LTOT at follow-up visit. Patients' demographics, admission symptoms, laboratory and radiological findings were recorded retrospectively from hospital database. Inclusion criteria1.patients aged 30 yrs and above2.Post covid patients patients with ARDS3.Patients consenting for the study Exclusion criteria Patients with active tuberculosis Patients with recent history of myocardial infarction in last 3 monthsResults1.There were 300 men (60%) and 200 women (40%) 2.The mean age of 68.6±12.6. 3.Average visit time for evaluation was 3.03±1.43 months. 4.18% of the patients died during the post-COVID process, which was related with high age (p=0.003), usage of mechanical ventilation (p=0.019) 5.The need for oxygen support continued in 32.9% of the patients. 6.Admission to intensive care unit and having a high serum D-dimer level (> 1000μg/L) were significant risk factors for the ongoing need of home oxygen support (p= 0.026 and 0.010, respectively). 7.The oxygen saturation level at hospital admission was found to be significantly lower in patients who continued to require oxygen therapy (p<0.001).Conclusion1.Most COVID-19 patients do not need LTOT in the post-COVID period meaning that the clinicians should be more selective when planning home oxygen therapy. Chest physiotheray and breathing exercises in post hospitalisation and pulmonary rehabilitation helped to exclude the need for LTOT in follow-up visits 2.Oxygen cylinders can be a more affordable option for most out covid patients discharged on LTOT. Oxygen concentrators should only be prescribed if home oxygen requirement persist on followup visits.
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Introduction: First synthesized in 1869, Hydroxyurea is known for its efficacy in treating myeloproliferative disorders, cervical cancer, and sickle cell disease. Usually well-tolerated, Hydroxyurea has numerous documented adverse effects, including bone marrow suppression, fevers, gastrointestinal upset, anorexia, and maculopapular rash. In addition, one rare side effect is interstitial pneumonitis, a potentially devastating complication if overlooked. We present one such case of Hydroxyurea-induced interstitial pneumonitis. Case Description: A 65-year-old man with a six-month diagnosis of Chronic Granulocytic Leukemia (CGL) on Hydroxyurea developed acute hypoxemic respiratory failure saturating 80% on room air with HR 102, RR 24, and increasing oxygen requirements (10 Lpm) after being admitted with complaints of worsening dyspnea, fatigue, and productive cough with yellow/green sputum. Physical examination was notable for cachexia, ill appearance, generalized weakness, hoarse voice, tachycardia, tachypnea, diffusely diminished breath sounds, and scattered rales on auscultation of lung fields. Initial imaging was notable for bilateral airspace disease and pulmonary opacities on chest radiography and bilateral pneumonia (concerning for COVID-19 pneumonia), mediastinal adenopathy, and splenomegaly on chest computed tomography. Initial laboratory results were notable for leukocytosis 62.5 th/uL, lactic acidosis 2.5 mmol/L, procalcitonin level 4.95 ng/mL, and negative COVID-19 PCR test. Prompt initiation of Vancomycin/Cefepime therapy ensued upon collection of blood cultures in light of possible sepsis. Flagyl, Valacyclovir, and Posaconazole were added to antimicrobial coverage, along with steroid therapy, due to minimal clinical improvement. Tachycardia with significant oxygen requirements alternating between BiPAP and heated high flow nasal cannula with FiO2 ranging from 70-85% persisted. Daily imaging also showed worsening airspace disease. Negative viral, bacterial, and fungal cultures led to subsequent discontinuation of Hydroxyurea therapy due to suspicion of medicationinduced pneumonitis. Three days after cessation of Hydroxyurea, the patient's oxygen requirements began to decrease and imaging revealed interval resolution of pneumonitic changes in the absence of antimicrobial therapy. The patient was later transitioned to Ruxolitinib for his underlying CGL prior to his discharge home without the need for home oxygen therapy. Discussion: Thought to be caused by hypersensitivity pneumonitis, pulmonary toxicity from Hydroxyurea can easily be misdiagnosed. Unfortunately, while much is known about the pancytopenic, gastrointestinal, and cutaneous side effects of Hydroxyurea, few cases in the literature highlight the potentially fatal interstitial pneumopathy caused by Hydroxyurea, first reported in 1999. Thus, this case serves as an additional contribution to the minutiae of literature detailing Hydroxyurea's adverse pulmonary side effect profile. (Figure Presented).
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AIM: Procedures normally performed in the hospital setting are increasingly delivered as part of hospital at home (HAH) programmes. The aim of this study is to describe the procedures and diseases treated during the first 2 years of a new paediatric HAH programme. METHODS: This is a retrospective, observational study conducted in the HAH programme of Niño Jesús Children's Hospital (Spain). We included demographic data, diagnosis and procedures delivered to patients admitted to the HAH programme from November 2018 to November 2020. RESULTS: There were 935 admissions of 833 patients. The median age was 5 years (interquartile range 2.3-9.5). Seventy-five percent of patients were previously healthy. The most frequent illnesses were acute infections (37%) (e.g. complicated appendicitis and ENT, genitourinary, skin and soft tissue infections) and acute respiratory diseases (17.3%) (e.g. asthma, bronchiolitis and pneumonia). Thirty-six percent of admissions underwent nocturnal polysomnography. The median length of stay was 4 days (SD 4.9 days). Eight percent of the episodes studied required care in the emergency department due to condition worsening (55.3%) and problems with devices (36.1%). Hospital readmission was required in 5.6% of cases, 42.4% of which later resumed care in the HAH. The estimated daily cost of HAH is 330.65 euros, while the hospital per-day costs of polysomnography, asthma and endovenous therapy are 1899.24, 1402.5, and 976.26 euros. Ninety percent of families reported a high level of satisfaction. CONCLUSIONS: Paediatric HAH programmes are a feasible, cost-effective alternative to hospital care. Further studies should compare the evolution of patients treated in the traditional hospital setting and those in HAH.
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Asthma , Home Care Services , Acute Disease , Child , Child, Preschool , Follow-Up Studies , Hospitals , HumansABSTRACT
BACKGROUND AND AIMS: Haemodialysis (HD) patients are at increased risk for adverse short-term consequences of COVID-19. In this study, we investigated the characteristics of chronic HD patients in the post-COVID-19 period and compared them with the control group. METHOD: We conducted a national multicentre observational study involving adult chronic HD patients recovering from COVID-19. The control HD group was selected from patients with similar characteristics who did not have COVID-19 in the same center. SARS-CoV-2 RT-PCR negative patients and patients in the active period of COVID-19 were not included. RESULTS: A total of 1223 patients (635 COVID-19 groups, 588 control groups) were included in the study from the data collected from 47 centres between 21 April 2021 and 11 June 2021. The patients' baseline demographics, comorbidities, medications, HD characteristics and basic laboratory tests were quite similar between the groups (Table 1). 28th-day mortality and between 28th day and 90th day mortality were higher in the COVID-19 group than in the control group [19 (3.0%) patients and 0 (0%) patients;15 (2.4%) patients and 4 (0.7%) patients, respectively]. Presence of respiratory symptoms, rehospitalization, need for home oxygen therapy, lower respiratory tract infection and A-V fistula thrombosis were significantly higher in the COVID-19 group in the first 28 days of illness and between 28 and 90 days. Mortality was significantly associated with preexisting COVID-19, age, current smoking, use of tunneled HD catheter, persistence of respiratory symptoms, rehospitalization, need for home oxygen support, presence of lower respiratory tract infection within 28 days and persistence of respiratory symptoms. CONCLUSION: In the post-COVID-19 period, mortality, rehospitalization, respiratory problems and vascular access problems are higher in maintenance HD patients who have had COVID-19 compared to control HD patients. (Table Presented).
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Background: COVID-19, an infectious disease caused by SARS-CoV-2 virus has reported to be a global pandemic. About 5% of the total develop severe ARDS. Aim: To study the clinical profile, comorbidities and outcome including mortality rate in severe Covid- 19 ARDS patients. Methodology: 40 cases of severe COVID 19 infection (P/F ratio<300) admitted in tertiary care ICU treated with standard covid protocol were included in the study. Their demography, severity of hypoxia, mode of ventilation and outcome analysed. Results: Out of the 40 patients admitted, 29 (72%) were discharged with 11 patients (38%) requiring home oxygen therapy. The most common comorbidities were diabetes mellitus (30%) and hypertension (22.5%). Mean hospital stay was 17 days, and 35 patients (87.5%) required ventilation of which 80% on NIV and 20% on Mechanical ventilation. The mortality rate was 27.5%. The P/F ratio and CRP values was statistically significant with mortality rate (p-value<0.05). Three patients (7.5%) on positive pressure ventilation developed pneumothorax. One patient (2.5%) developed pulmonary thromboembolism.14 patients (35%) were in MODS out of which 8 patients died. Conclusion: Mortality rate was less in patients with a high P/F ratio and low CRP levels at the time of admission. Severe COVID 19 patients admitted in the ICU had developed additional complications requiring interventions. Patients in MODS had high mortality rate. Most common comorbidity associated was diabetes mellitus.
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Platypnea-Orthodeoxia syndrome (POS) is a rare condition in which dyspnoea and arterial oxygen desaturation are present in the upright position, while in the supine position, they are alleviated. It is observed in the presence of an anatomical (intra-or extracardiac) communication between the right and left heart causing a right-to-left shunt. POS is most frequently caused by a patent foramen ovale (PFO) and usually, the clinical assessment and a transthoracic echocardiograms with bubble study are enough to reach the diagnosis. The only possible treatment of POS is the percutaneous closure of the defect. We describe two cases of POS due to a PFO which manifested itself years after an episode of acute pulmonary embolism (PE), a finding never reported to date in the literature. Few cases describe the relationship between PE and POS, but these conditions may be more closely related than we currently think.