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Cardiovascular disease (CVD) is the leading cause of death in most developed countries, including the United States, with a significant economic impact. Lifestyle changes and the administration of antiplatelet medication, like aspirin, may significantly contribute to the secondary prevention of CVD in adults. For years, aspirin has been utilized for both secondary and primary cardiovascular disease prevention. Aspirin has been extensively used because of the belief that it may have a positive impact on primary prevention, despite the debate surrounding its usage. This study briefly examines usage patterns and discusses the potential variables and factors that can decrease the ability of aspirin to prevent cardiovascular disease. The present study also explore the key studies of aspirin use in the context of recent recommendations. The risk of bleeding has been observed to significantly rise, although large randomized clinical studies have demonstrated a reduction or absence of CVD events. Prevention strategies for cardiovascular disease with low-dose aspirin are no longer advised for persons at intermediate risk. To determine whether taking aspirin is worth the potential dangers, the benefits must be evaluated.Copyright © 2022 Novyi Russkii Universitet. All rights reserved.
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Objectives: Objective of the study was to examine the laboratory findings with clinical characteristics and treatments of patients who were hospitalized in a tertiary intensive care unit with the diagnosis of coronavirus disease 2019 (COVID-19) and developed pneumothorax and to determine epidemiology and risks of pneumothorax. Method(s): The study was conducted by retrospectively examining the electronic records of 681 COVID-19 patients who were followed up between 1 April 2020 and 1 January 2021 in 3 tertiary intensive care units (each was 24 beds). Patients demographic and clinical characteristics, laboratory findings, mechanical ventilator parameters and chest imaging were evaluated retrospectively. Result(s): Pneumothorax in 22 (3.2%) of 681 with COVID-19 patients was detected and acute respiratory distress syndrome (ARDS) in 481 (70.6). All the study patients met ARDS diagnostic criterias. Mortality rates were 43.4% (296/681) in all patients, 52.8% (254/481) in patients with ARDS, and 86.3% (19/22) in patients with pneumothorax. Pneumothorax occurred in the patients within a mean of 17.4+/-4.8 days. The computed tomographies of patients were observed common ground-glass opacities, heterogenic distribution with patch infiltrates, alveolar exudates, interstitial thickening in the 1st week of their symptom onset. Conclusion(s): We observed that pneumothorax significantly increased mortality in COVID-19 patients with ARDS. We believe that understanding and preventing the characteristics of pneumothorax will make an important contribution to mortality reduction.Copyright © 2022 by The Cardiovascular Thoracic Anaesthesia and Intensive Care.
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Perinatal arterial ischemic stroke (PAIS) is a rare cause of neonatal seizures, with an incidence of 1 in 2500 to 4000 live births, globally. This is a case of a neonate with PAIS due to transpla-cental passage of COVID-19 IgG antibodies from the mother. A term, male neonate, born to a primigravida with an unevent-ful antenatal history was presented on the second day of life with multiple episodes of focal clonic seizures involving the right upper and lower limbs. Magnetic resonance imaging revealed an acute infarct in the left frontal lobe, extending into the parietal region, anterior limb, and genu of internal capsule suggestive of arterial ischemic stroke. The known causes of PAIS were evaluated and ruled out. The result of reverse transcription polymerase chain reaction analysis for SARS-CoV-2 antigen was negative for both the mother and the neonate. COVID-19 IgG antibodies in the mother and neonate were elevated. Seizures were controlled with antiepileptics. The neonate had no further seizure episodes and was discharged on oral levetiracetam. The infant was developmentally and neurologically normal at 3 months of age. PAIS is a rare cause of neonatal seizures, and maternal COVID-19 infection may be associated with neonatal stroke.Copyright © 2022, Himalaya Wellness Company. All rights reserved.
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Aim: We primarily aimed in this study was to evaluate risk factors for COVID-19 infection and if any association between dialysis inadequacy in COVID-19 infection in maintenance hemodialysis (MHD) patients. Secondly aimed to describe prevalence and risk factors associated with long-lasting symptoms of non-deceased COVID-19 MHD patients before vaccination. Material(s) and Method(s): One hundred one MHD patients infected with COVID-19 and 100 MHD patients without the infection were enrolled in this retrospective cross-sectional study. Risk factors for mortality, need to intensive care unit (ICU) stay and long-lasting symptoms were analyzed. Result(s): The mean age of patients was 59.13+/-13.58 years. COVID-19 infected patients had significantly higher number of patients with DM, COPD, CHF. The need for ICU was found to be statistically significantly higher in patients with COPD and DM. In our results, the patients who had lower Kt/V at admission hospital had more than 5 fold higher rate of COVID-19 those have higher Kt/V. We analyzed risk factors for mortality at, one year included higher age, higher CRP and lower base-line Kt/V were diagnostic criteria. Older MHD patients had a high frequent of long-lasting symptoms. Low Kt/V, low hemoglobin level and high CRP level associated with a higher risk of long-lasting symptoms (p=0.00, p=0.001, p=0.02) Discussion: We conclude that DM, CHF, COPD, older age, obesity were poor prognostic factors for in infected with COVID-19. Dialysis adequacy parameters of Kt/V, serum albumin level, hemoglobin level were significantly lower in need to ICU and deceased patients.Copyright © 2023, Derman Medical Publishing. All rights reserved.
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Objective Encouraged by reports of favorable outcomes following the use of corticosteroids in patients with moderate-to-severe coronavirus 2019 (COVID-19) pneumonia, we aimed to present our experience with early short-term corticosteroid use at our center in pediatric patients with COVID-19 pneumonia. Methods One hundred and twenty-nine pediatric patients were included in the study. Patients were divided into four groups according to the type and dose of corticosteroids given: Group 1 (those receiving dexamethasone 0.15 mg/kg/d);Group 2 (those receiving methylprednisolone 1 mg/kg/d);Group 3 (those receiving methylprednisolone 2 mg/kg/d);and Group 4 (those receiving pulse methylprednisolone 10-30 mg/kg/d). Results Of 129 patients, 19 (14.7%) patients were assigned to Group 1, 30 (23.3%) patients to Group 2, 30 (23.3%) patients to Group 3, and 50 (38.8%) patients to Group 4. Thirty-two (24.8%) patients were followed in the pediatric intensive care unit (PICU), of whom 13 (10%) required mechanical ventilation, and 7 (%5.4) died. In Group 4, the hospitalization length was significantly longer than in other groups (p < 0.001, p < 0.001). No significant difference was found among the groups in terms of mortality (p = 0.15). The most common comorbidity was obesity (33%). A significant association was found between the presence of comorbidity and mortality (p < 0.001). All patients who died had an underlying disease. Cerebral palsy was the most common underlying disease among the patients who died. Worsening of lymphopenia was significant in patients with severe COVID-19 pneumonia at the time of transfer to the PICU (p = 0.011). Conclusion Although children usually have a milder course of COVID-19 than adults, underlying diseases and obesity increase the severity of disease manifestations also in children. Further studies are needed to define the exact role of corticosteroids in COVID-19 patients. © 2022. Thieme. All rights reserved.
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Introduction: In the current study we aimed to investigate the effects of Convalescent Plasma (CP) therapy on the health outcomes of patients aged 60 and older who have mild symptoms due to Covid-19 and do not need hospitalization. Materials and methods: A total of 84 patients detected to have acute respiratory syndrome coronavirus 2 by swab polymerase chain reaction who applied a single dose of 200 mL CP administered within 7 days after the onset of any Covid-19 symptoms constituted the CP group. Health outcomes including mortality within 15 days and 30 days, hospitalization into Covid-19 service or intensive care unit (ICU) within 30 days were compared with a control group of 3197 patients who did not applied CP. Results: In the CP group (48 female, 36 male) the mean age of the patients was 68.1 ± 7.1 (min= 60, max= 85). The groups were similar in terms of age and gender (p=0.454, p=0.373, respectively). The median time from onset of any Covid-19 symptoms to CP administration was 4.15 days (min=2, max=7 days). None of the CP group patient died within 15 days, while mortality within 30 days was 2.4% (2 patients, days 25 and 27). Hospitalization into Covid-19 service and ICU was 20.2% (17 patients) and 4.8% (4 patients), respectively. There was no significant differences in terms of health outcomes within groups albeit CP group has lower mortality and hospitalization rates (p=0.052, p=0.11, p=0.562, p=0.289, respectively). Conclusion: CP therapy administered in an early course remains an option for clinicians in the treatment of Covid-19 older adult patients who have mild disease on the other hand protecting them out of hospitalization.
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Since late 2021, we have observed a significant increase in the proportion of children infected with SARS-CoV-2. The course of the disease in children is usually sparsely symptomatic or asymptomatic. However, the predominance of new virus variants makes children more likely to become symptomatically ill and require hospitalisation. This paper aims to update recommendations for managing a child with COVID-19 in out- and inpatient settings. Current options for prevention and antiviral treatment are discussed, noting the limited availability of therapy for children. In most children with COVID-19, the basis for treatment remains symptomatic and supportive therapy and measures to reduce SARS-CoV-2 infection spread.
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Rationale: COVID-19 is also known as Novel coronavirus 2019 or acute respiratory syndrome caused due to coronavirus or SARS-CoV-2 is an RNA virus belongs to β- Coronaviridae family.COVID also causes severe pneumonia and acute respiratory distress syndrome (ARDS), which can result in difficulty breathing and necessitate mechanical ventilation and intensive care unit management. Patient concerns: A 47-yearmale with a history of hypertension who was presented to hospital with worsening fevers, cough, and respiratory distress. Diagnosis: CT scan of the chest showed multiple subsegmental patchy ill, defined broncho centric and sub-pleural areas of ground glass opacities with septal thickening are seen in both the lungs and test of COVID also turned positive. Interventions: He was being treated aggressively in the intensive care unit with intravenous Prednisolone, Felbinac, Piperacillin/tazobactam.He also received a loading dose of remdesivir however was unable to complete the course due to sudden droppage of SP02. Outcomes: He remained critically ill and eventually passed away. Lessons: COVID-19 has become a global pandemic and a major hit to our healthcare systems, with a rapidly rising death rate. There is currently no approved treatment regimen for COVID-19 infections. The alarming increase in cases per day keeps researchers busy to find a cure and to reduce the global mortality rate.
ABSTRACT
Favipiravir has demonstrated efficacy against the SARS-CoV-2 virus in several preliminary studies. This study aimed to evaluate the efficacy and safety of favipiravir for treatment of mild to moderate COVID-19 in outpatients and hospitalized patients. We conducted an open-label, randomized, active-controlled trial of a generic form of favipiravir in patients with COVID-19 confirmed by PCR-test. Eligible patients (18-60 years) after stratification were randomly assigned (in a 2:1 ratio) to receive either favipiravir (1800 mg BID on day 1, followed by 800 mg BID for up to 9 days), or standard of care (SOC) treatment (umifenovir + intranasal interferon alpha-2b, or hydroxychloroquine) for up to 10 days. The co-primary outcomes were the time to clinical improvement and the time to viral clearance. Among 190 patients assessed for eligibility 168 were randomized to favipiravir (n=112) or to SOC (n=56) group. The median time to clinical improvement was 6.0 days (IQR 4.0;9.3) in the favipiravir group and 10.0 (IQR 5.0;21.0) days in the SOC group;the median difference was 4 days (HR 1.63;95% CI 1.14-2.34;P=0.007). The statistically significant difference in the median time to viral clearance was observed only for hospitalized patients: 3.0 (IQR 3.0;3.0) days in the favipiravir group vs. 5.0 (IQR 4.5;5.5) days in the SOC group (HR 2.11;95% CI 1.04-4.31;P=0.038). The rate of viral elimination on Day 5 in the favipiravir group was significantly higher than in SOC group: 81.2% vs. 67.9% (RR 1.22;05% CI 1.00-1.48;P=0.022). The rate of clinical improvement on Day 7 in the favipiravir group was 1.5-fold higher than in SOC group: 52.7% vs. 35.8% (RR 1.50;95% CI 1.02-2.22;P=0.020). Favipiravir was well-tolerated and the most common adverse reactions were asymptomatic hyperuricemia, transient elevation of ALT & AST, and mild gastrointestinal disorders. Favipiravir was superior to the SOC in shortening the time to clinical improvement in patients with mild to moderate COVID-19.