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Background: Gastrointestinal bleeding is one of the consequences of COVID-19, which is associated with increased hospitalization and patient mortality. This study was conducted to determine the prevalence of endoscopic findings and the outcome of gastrointestinal bleeding in patients with COVID-19 who were hospitalized from September to December 2019 in Al-Zahra Hospital, Isfahan. Method(s): In this cross-sectional study, out of 5800 patients who were admitted to Al-Zahra Hospital in Isfahan from September to December 2019 due to COVID-19 (according to the positive PCR test result), 87 patients who underwent endoscopy due to upper gastrointestinal bleeding by a skilled gastroenterologist, were selected and studied. Demographic characteristics, underlying diseases, use of anticoagulants, and laboratory findings were studied and evaluated and finally, the disease was evaluated and compared based on endoscopic findings. Result(s): Based on the results obtained from this research, the patients with endoscopic lesions had higher average age (P=0.041), lower blood oxygen saturation percentage (P=0.028), and higher bleeding intensity (P=0.018). The frequency of using anticoagulant drugs in the group whose endoscopy results were abnormal was higher but insignificant. Hemoglobin, platelet, lymphocyte, and CRP levels were higher in the group whose endoscopy was normal, and NLR, LDH, and D-dimer levels were higher in the group whose endoscopy was abnormal (P<0.050). Three people (11.55%) from the group with normal endoscopy and 18 people (29.5%) from the group with abnormal endoscopy died, but the frequency of death was not significantly different between the two groups (P=0.070). Conclusion(s): The findings of the present study showed that the COVID patients with upper gastrointestinal bleeding who had endoscopic lesions had significant differences in some characteristics such as age, bleeding intensity, and blood oxygen saturation percentage with patients with normal endoscopy. Also, the frequency of death in patients with endoscopic lesions was relatively higher. Therefore, COVID patients with gastrointestinal bleeding should undergo endoscopy as soon as possible and necessary measures should be taken to control and prevent gastrointestinal bleeding.Copyright © 2022 Tabesh et al. Tehran University of Medical Sciences. Published by Tehran University of Medical Sciences.
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Objective To explore the clinical effect and safety of Suhexiang Pills () in the treatment of patients with tachycardia after severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. Methods A total of 138 patients with tachycardia after SARS-CoV-2 infection admitted to eight hospitals such as 971st Hospital of the PLA Navy, Changzhou Second People's Hospital, Xuzhou First People's Hospital, Henan Provincial People's Hospital, Henan Chest Hospital from February 2023 to March 2023 were randomly divided into control group and treatment group, with 87 patients in the treatment group and 51 in the control group. Patients in the control group were po administered with betaloc, once a day, and the initial dose was 23.75 mg, adjusted in time according to the patient's heart rate. Patients in the treatment group were po administered with Suhexiang Pills, 1 pill/time, twice daily. Patients in two groups were treated for 7 d. The clinical efficacy of the two groups was observed, and the heart rate and cardiac function indexes, RR interval, blood oxygen saturation and adverse reactions were compared between the two groups before and after treatment. Results After treatment, the total effective rate of the treatment group was 98.85%, and the total effective rate of the control group was 90.20%, and the difference between the two groups was statistically significant (P < 0.05). After treatment, heart rates were significantly decreased in both groups (P < 0.05), and the heart rates of the treatment group were significantly better than those of the control group (P < 0.05) on the 7th day of treatment. After treatment, the level of left ventricular ejection fraction (LVEF) in both groups was significantly higher than that before treatment (P < 0.05), and there was statistical difference between the treatment group and the control group (P < 0.05). The levels of left ventricular end diastolic dimension (LVEDD) and left ventricular end-systolic diameter (LVESD) in the treatment group significantly decreased than that before treatment (P < 0.05), and there was no statistical difference compared with the control group (P > 0.05). After treatment, the maximum RR interval in both groups reached the normal range on the third day, and the treatment group was significantly better than the control group (P < 0.05). Blood oxygen saturation of the treatment group was significantly increased on the 7th day of treatment compared with before treatment (P < 0.05), but there was no statistical significance between the two groups (P > 0.05). There was no significant difference in the total incidence of adverse events between the two groups (P > 0.05). Conclusion Suhexiang Pills decrease heart rates in patients with tachycardia after SARS-CoV-2 infection, which was equivalent to the effect of western medicine, and can protect heart, improve heart function to a certain extent.Copyright © 2023 Editorial Office of Chinese Traditional and Herbal Drugs. All rights reserved.
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Chapter 1: COVID-19 pathogenesis poses paradoxes difficult to explain with traditional physiology. For instance, since type II pneumocytes are considered the primary cellular target of SARS-CoV-2;as these produce pulmonary surfactant (PS), the possibility that insufficient PS plays a role in COVID-19 pathogenesis has been raised. However, the opposite of predicted high alveolar surface tension is found in many early COVID-19 patients: paradoxically normal lung volumes and high compliance occur, with profound hypoxemia. That 'COVID anomaly' was quickly rationalised by invoking traditional vascular mechanisms-mainly because of surprisingly preserved alveolar surface in early hypoxemic cases. However, that quick rejection of alveolar damage only occurred because the actual mechanism of gas exchange has long been presumed to be non-problematic, due to diffusion through the alveolar surface. On the contrary, we provide physical chemical evidence that gas exchange occurs by an process of expansion and contraction of the three-dimensional structures of PS and its associated proteins. This view explains anomalous observations from the level of cryo-TEM to whole individuals. It encompasses results from premature infants to the deepest diving seals. Once understood, the COVID anomaly dissolves and is straightforwardly explained as covert viral damage to the 3D structure of PS, with direct treatment implications. As a natural experiment, the SARS-CoV-2 virus itself has helped us to simplify and clarify not only the nature of dyspnea and its relationship to pulmonary compliance, but also the fine detail of the PS including such features as water channels which had heretofore been entirely unexpected.Copyright ©
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Clinical parameters characterizing the efficacy and safety of favipiravir were examined in a multicenter, non-interventional (before-and-after study design) trial in 264 patients with mild COVID-19. It is shown that on the background of 14-day therapy with favipiravir body temperature normalized, blood oxygen saturation improved, and the frequency of tachycardia detection reduced by 16% (p < 0.0001). A statistically significant decrease by 91,3% (p 0.0001) in the frequency of SARS-nCoV-2 RNA detection in the nasopharyngeal mucosa discharge was revealed. A decrease in the concentration of ferritin (by 69% compared to initial values), blood glucose (by 21%), creatinine (by 10%), C-reactive protein (by 36%) (p 0.0001), and D-dimer by 61% (p = 0.016) was noted. The results of the SF-36 health survey questionnaire revealed a significant (p 0.05) improvement in the quality of life in terms of physical functioning (by 35%), and role functioning associated with physical and emotional state by 107% and 160%, respectively. Analysis of the COV19-QoL questionnaire revealed a decrease by 24% in negative perception of the disease (p < 0,01). Among the identified adverse events, elevated level of ALT (in 39.47% of patients), hyperuricemia (in 28.95% of patients), and elevated AST (in 23.68% of patients) prevailed. All the adverse events occurred with mild or moderate severity. There were no lethal outcomes in the studied sample of patients. The analysis showed a satisfactory level of the tolerability of the treatment.Copyright © 2023 Izdatel'stvo Meditsina. All rights reserved.
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Background: Evidence of COVID-19 respiratory sequels is restricted and predisposing factors are not well studied more than two years passing pandemic. This study followed COVID-19 patients 12 weeks after discharge from hospital for respiratory sequels. Material(s) and Method(s): This was a prospective study on discharged COVID-19 patients in 2021, in Jahrom, Iran. Exposure was COVID-19 clinical features at hospitalization, including symptoms and physical examination and laboratory findings, and primary endpoint was 12-week lung sequel, being evaluated by a chest CT scan. Demographics and previous medical history were considered covariates. SPO2and CRP 6-week changes were followed as an early tool for prediction of 12-week lung sequel. Result(s): Totally, 383 participants (17 had sequels) with mean age of 57.43 18.03 years old (50.13% male) completed 12-week study follow-ups. Ninety-one (23.8%) subjects had an ICU admission history. SPO2% in 6th week was statistically significantly associated with a higher rate of 12-week sequelae (p<0.001). Also, patients having CT scan scores between 40% to 50% (p=0.012) and higher than 50% (p=0.040) had higher chance of experiencing lung sequelae than patients with CT scan score of below 40%, as well as having ICU admission history and lower SPO2% at 6th week of discharge. There was a statistically significant increasing trend of SPO2% (P<0.001) and a statistically significant decreasing trend of CRP levels (P<0.001), overall. SPO2% increase after 6 weeks was lower in participants with lung sequels than fully improved ones (P=0.002) and as well as total 12-week change in SPO2% (P=0.001). CRP changes in none of evaluated periods were different among study groups (P>0.05). Conclusion(s): Our results were in favor of closely following SPO2levels after patient discharge, while CRP assessment seems not helpful based on our results [GMJ.2023;12:e2695].Copyright © 2023 Shiraz University of Medical Sciences. All rights reserved.
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Background: Left ventricular assist devices (LVAD) recipients are particularly vulnerable to cardiac- and non-cardiac related complications. COVID- 19 pandemic disorganized virtually all aspects of life, affecting the health care systems and impeded its availability. Yet, patients with advanced heart failure (HF) implanted with LVADs had to cope with restricted access to specialized HF centers and as well as COVID-19 infection. The course of COVID-19 in LVAD population is largely unknown. Aim(s): We sought to verify whether there are any differences in COVID- 19 course in LVAD recipients implanted before and during COVID-19 pandemic. Method(s): Between October 2015 and December 2019 (pre-COVID-19 era=group 1) 71 patients and since January 2020 to December 2021 (COVID-19 era=group 2) 31 patients were implanted with LVAD in a tertiary center in Poland. Of note, at the beginning of COVID-19 era (since 1st/Jan/2020) there were alive 39 (55%) previously implanted LVAD patients. The censor date for this analysis was 31st December 2021. Result(s): COVID-19 occurred in a similar percentage in both groups (group 1 - 39% vs. group 2 - 32%;p=0,4;however, more patients from group 1 required hospitalization [12 (80%) vs. 6 (60%);p<0.05] (Table 1). Blood oxygen saturation (SpO2) and mean arterial pressure (MAP) were lower in the group 1 in comparison to group 2 (86.5 vs. 95% and 69 vs. 79 mmHg;respectively, both p<0.05);however, respiratory and heart rates were similar. There were significant differences of white blood count (WBC) and their subpopulations between both groups. As for inflammatory markers, both procalcytonine and interleukin 6 (IL-6) were significantly higher in the group 1 (3.6 vs. 06 ng/ml and 112.5 vs. 87 pg/ml;respectively;both p<0.05);however CRP levels were similar. All patients from group 1 required oxygen therapy [12 (100%) vs. 4 (66.7%);p<0.05]. Intravenous inotropes were also more commonly used in patients from group 1 [10 (83%) vs. 2 (33%);p<0.05];however, other standard COIVD-19 therapies were similarly utilized in both groups. Two (5.1%) patients from group 1 and 1 (3.2%) patient from group 2 (p=0.29) died due to COVID-19. There were also no differences between non-COVID-19 related deaths between the groups (p=0,63). The vaccination rate against COVID-19 was similar in both groups - 65.7%. Conclusion(s): COVID-19 infections were common in LVAD recipients. Although clinical and laboratory profiles of LVAD recipients implanted before COVID-19 pandemic were worse in comparison to those who were implanted more recently, the actual survival rates were found to be similar. Surprisingly, only two-thirds of LVAD patients decided to undertake vaccine against COVID-19. These initial and single-center observations need to be interpreted with caution until more thorough analyses on more LVAD patients will be released.
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Results from RECOVERY trial showed effect of 6 mg of dexamethasone, despite it we observed high mortality. We therefore used higher than recommended doses of steroids in severe and rapidly progressive COVID patients in January 2021. In this study we retrospectively evaluated effect of total dose of given systemic steroids on mortality in 92 consecutively admitted patients in January 2021 for COVID pneumonia to Pulmonary Dept. of University Hospital. Average age was 70,6+/-12,8, 44 (47%) females, 48 (53%) males, average BMI 29,6+/-2,4, clinical frailty score 3,7+/-2,1, Charleson Comorbidity Index 4,0+/-3,3, average blood oxygen saturation od admittance was 88,0%+/-7,1, average breath rate 20,1+/-11, CRP 123,3+/-62,7 mg/L, average length of stay was 19,0+/-13,0. Totally 40 (43,5%) required an ICU care during the stay in the hospital. Mortality was 17,3% (16 of 93 patients died).). Length of the stay correlated to severity of the COVID according to WHO classification (p<0.001, R= 0.50). During the stay in the hospital 21 patients were dependent on HFNO (22,8%), 8 patients required NIV support (8,7%) and 8 (8,7%) patients were intubated. Systemic steroids were given to 85 patients (92,4%) patients. Average daily dose of steroids was 22,4 mg of dexamethasone (DX) (95%CI 16.2-28.6), mean total dose of DX per whole hospital stay was 212.5 mg (95%CI 152.4-272.1). Length of the stay who died was significantly longer (23.5 vs 15.1 days, p=0.01). We used significantly higher total dose of steroids in patients who later died on COVID (p<0.001). Average dose of total steroids given during hospital stay was 377 mg of dexamethasone (95%CI, 252-501) in those who died, and 172mg (95%CI, 106- 238). We did not observe clinical impact of high dose steroids on mortality of COVID pneumonia patients.
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Background/Aim. For the first time, we evaluated and presented the socio-demographic characteristics, clinical manifestations and laboratory findings of hospitalized coronavirus disease 2019 (COVID-19) patients from Canton Sarajevo, Bosnia and Herzegovina. Methods. This retrospective, single-centre study included 159 RT-PCR verified COVID-19 patients (92 mild/moderate;67 severe/critical) consecutively hospitalized at the General Hospital "Prim. dr Abdulah Nakaš" in Sarajevo, Bosnia and Herzegovina. Socio-demographic, clinical, and laboratory data on admission were retrospectively obtained from each patient's electronic medical record and patient files by two experienced physicians. Results. 43.4% of the patients belonged to the age range of 46-65 years;71.1% were men, and 68.6% had comorbidities;hypertension was the most prevalent comorbidity (100%), followed by diabetes (91.7%) and ischemic heart disease (35.8%). The leading clinical symptoms were fever (87.44%), tiredness (77.8%), and body/muscle aches (70.3%). There was significant reduction of blood oxygen saturation (p = 0.005), and significant elevation of D-dimer (p = 0.003), CRP (p = 0.044), and fasting plasma glucose (p = 0.047) in the severe/critical patients group compared to mild/moderate group. Conclusion. Older age, the male gender, confirmed comorbidities, decreased blood oxygen saturation, increased levels of CRP, D-dimer, and fasting plasma glucose, together with symptoms of chest pain/shortness of breath and/or diarrhea occurred more frequently in severe/critical than mild/moderate COVID-19 patients.
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Background & Aim: The wide gap in severe Covid-19 management is increasingly addressed by mesenchymal cell (MSC) therapies, despite studies that failed to show significant efficacy in ARDS. To improve the therapeutic utility of MSCs in ARDS, Bonus BioGroup developed MesenCure: An allogeneic adipose-derived MSC product professionalized by a combination of culture conditions enhancing the cells’ potency and stability, producing unique transcriptomic, proteomic, and morphological signatures. Up to 100k fresh MesenCure doses with a shelf life sufficient for global supply can be produced from a single donor under 20 PDLs, further preventing potency loss due to cryopreservation and culture aging. Based on preclinical data presented during ISCT2021, demonstrating MesenCure’s advantages over non-professionalized MSCs, and its safety in a Phase I study, Bonus BioGroup initiated a multi-center Phase II trial in severe Covid-19 patients that was recently concluded. Methods, Results & Conclusion: The Phase II trial included 50 severe Covid-19 patients suffering from diffuse pneumonia and oxygen desaturation treated with up to 3 MesenCure doses (1.5x106 cells/kg on days 1, 3, and 5), on top of the Standard of Care (SoC), and 150 similar severe control patients treated by the SoC only and stratified according to gender, age, and comorbidities. A substantial 68% reduction in the mortality rate of the test patients was measured (Fig. 1A, p<0.05), along with a 57% drop in their risk of intubation relative to the control (Fig. 2A, p<0.05). Over 50% of the patients treated with MesenCure were released from the hospital within two days after treatment, and a 38% reduction was measured in the hospital length of stay (LoS) of patients having LoS>7 days (Fig. 1C, p<0.01). Starting from a similar baseline as the control, the median CRP and CK levels of the test patients, after MesenCure treatment, ended 52% (p<0.0001) and 33% (p<0.01) lower than their respective control levels. As shown in Fig. 2 [Figure Presented] Fig. 1 ( 25). (A) Mortality rates among test and control patients at Visit 8 (one month after the first MesenCure dose or the equivalent time points for the control). (B) Test and control patients’ risk of deteriorating to mechanical ventilation. (C) Average hospital length of stay (LoS) of patients having LoS > 7 days. Two-sided p values were calculated using the Fisher Exact test (A and B) or t-test (C). [Figure Presented Fig. 2 ( 25). (A) CRP and (B) CK levels measured at Visit 6, the earliest of two weeks after the first MesenCure dose (Visit 2) or upon hospital release, or the equivalent time points for the control. The test and control groups started from similar median CRP and CK levels. (C) Changes in control and test patients’ LDH levels from Visit 1 (screening) to Visit 6. (D) Area of test patients’ diffuse pneumonia during Visits 1, 6, and 8 (one month after Visit 2). (E) Blood oxygen saturation measured during test patients visits 1, 2-4 (upon or before receiving the first to third MesenCure dose), Visit 5 (the earliest of one week after Visit 2 or upon hospital release), and Visit 6. (F) Test patients’ blood lymphocytes levels (absolute) across Visits 1 and 6. Charts are presented as box-and-whiskers (according to the Tukey method). p values were calculated using the Mann-Whitney test (A, B, and C), Dunn’s multiple comparisons (D and E), or the Wilcoxon test (F). the more profound improvements in inflammatory and tissue damage markers observed in test patients were accompanied by a rapid recovery in pneumonia, respiratory functions, and lymphopenia, emphasizing MesenCure’s powerful effect. In conclusion, we show that MesenCure saves patients’ lives and accelerates their healing, possibly reducing the risk of long-term damages while freeing ICU beds allowing better care for other patients, and reducing the burden associated with hospitalization and additional long-term healthcare costs.
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CASE: Patient is a 67-year-old white male who is from Ohio who has a past medical history significant for diabetes mellitus type 2, essential hypertension and hyperlipidemia. He presented to the emergency department with complaints of generalized weakness and shortness of breath. He was vaccinated against COVID about 3-4 months ago. Dyspnea has been progressive over several days. Initial laboratory values and vital signs in the emergency department were pertinent for a heart rate 92/min, blood oxygen saturation of 93% on 5 L nasal cannula, ESR 40, CRP 22.9, D-dimer 21.1, positive for COVID-19 on PCR. Chest x-ray showed developing multifocal infiltrates consistent with COVID-19 pneumonia. Patient was started on dexamethasone, remdesivir, ceftriaxone, azithromycin and was placed on low molecular weight heparin for DVT prophylaxis regimen during the first few hours of admission. We continued standard therapies but the patient's oxygen requirements increased. During this hospitalization patient became acutely unresponsive and was noticed that he was not moving his right side. A stroke work-up was undertaken MRI brain/head without contrast showed large left MCA territory infarction, no acute hemorrhage has been identified, loss of flow void within the left intracranial ICA, suggesting obstruction versus high-grade stenosis. Echo showed normal LV systolic function. MRA of the head and neck showed occluded left ICA and left MCA. Unfortunately due to the size of the infarction the patient was not a candidate for full dose anticoagulation.Eventually patient was not following commands, remained unresponsive and had persistent dysphagia for which he had PEG tube placement. Family has been updated on his clinical status and overall prognosis is poor. IMPACT/DISCUSSION: The incidence of stroke has been reported in 5.7% of patients with severe COVID-19 and in 0.8% of patients with nonsevere infection.The frequency of stroke detected in hospitalized COVID-19 patients was 1.1% associated with older age and stroke risk factors.Early-onset cerebrovascular disease is more common in COVID- 19 patients with underlying cerebrovascular risk factors including older age (>65 years).The significant increase in D- dimer levels like our patient suggests that COVID-19 can induce an inflammatory response and trigger a hypercoagulable state causing an acute ischemic stroke .The hypercoagulable state in patients with COVID-19 supports the formation of small and/or large blood clots in many organs such as the brain, which have the potential to cause cerebrovascular disease.Increased D-dimer levels confirm the theories of endothelial activation and hypercoagulability. CONCLUSION: Our case report highlights the fact that COVID-19 is a risk factor for acute ischemic stroke along with other underlying cerebrovascular risk factors such as diabetes, hypertension and hyperlipidemia like in our patient. We should be aware of these neurological symptoms and act promptly in the evaluation of stroke in COVID-19 patients.
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Aim: To investigate the correlation between capillary blood oxygen saturation and Computerized tomography (CT) severity index in patients with Covid-19 pneumonia. Study design: A cross sectional study design Setting & duration: Ibne-sina hospital Multan Medical & Dental College Multan, from 1stJune 2020 to 1stJune 2021 Methods: A cross-sectional analytical study was conducted at the COVID-19 ward of Ibne-sina hospital Multan Medical & Dental College Multan for 1 year. At the time of admission, all capillary oxygen saturation of all the included patients was measured. Pulmonary CT scans were then performed on these patients and CT severity index was calculated. SPSS was used for data analysis. Results: A total of 170 Covid-19 infected patients were included in the study. At the time of admission, the mean oxygen saturation was found to be 88.9%±6.53%. Whereas, the mean severity index was 15.01±7.79. 22 patients had hypoxia when presented in hospital and a significantly high iCT severity index was found in these patients (p=0.001). Chronic obstructive pulmonary disease (COPD), hypertension, and diabetes were significantly related to reduced blood oxygen saturation (p<0.05). A significant inverse correlation was found between capillary oxygen saturation and CT severity index (r= -0.41, p< 0.01). Conclusions: The study revealed a significant inverse correlation between capillary oxygen saturation and CT severity index. Moreover, it was found that underlying commodities (i.e., past medical history) can also affect the CT severity index.
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Objective: COVID-19 exerts deleterious cardiopulmonary effects, leading to a worse prognosis in the most affected. This study aimed to analyze the trajectories of key vitals amongst hospitalized COVID-19 patients using a chest-patch wearable medical-grade monitor providing continuous remote patient monitoring of numerous vital signs. Design and method: This retrospective multicenter observational cohort study was conducted in five COVID-19 isolation units. 492 COVID-19 patients were included in the final analysis. Physiological parameters were measured every 15 minutes. Results: More than 3 million measurements were collected including heart rate, systolic and diastolic blood pressure, cardiac output, cardiac index, systemic vascular resistance, respiratory rate, blood oxygen saturation, and body temperature. Cardiovascular deterioration appeared early after admission and in parallel with changes in the respiratory parameters, showing a significant difference in trajectories within sub-populations at high risk. Conclusions: Early detection of cardiovascular deterioration of COVID-19 patients is achievable when using frequent remote patient monitoring.
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Analysis of cytokine profile markers in conjunction with the clinical manifestations of coronavirus disease 2019 (COVID-19) can provide valuable information about the pathogenetic manifestations of the disease, and therefore, in the future, determine drugs that affect the cytokine storm and have an anti-inflammatory effect. Aim. To identify correlations between the parameters of the developed cytokine profile and the clinical course in hospitalized patients with COVID-19 of different severity. Material and methods. The study included 70 hospitalized patients with a confirmed diagnosis of COVID-19, with a mean age of 58 [50;69] years, including 40 men (57%) and 30 women (43%). The average lung involvement according to computed tomography (CT) at admission was CT-2 [1;3]. Peripheral venous blood was taken at admission, which averaged 7 [6;8] days from the symptom onset. Standard biochemical parameters were studied, as well as 47 cytokines and chemokines using the Multiplex system (Merck KGaA, Darmstadt, Germany). Results. Correlations was found between the lung involvement degree and the level of IL-8 (r=0,31, p<0,05), IL-15 (r=0,35, p<0,05), IL-18 (r=0,31, p<0,05), MCP-1 (r=0,36, p<0,05), MIG (r=0,50, p<0,05), TNF-α (r=0,41, p<0,05). An inverse correlation was also found in the level of blood oxygen saturation with the same indicators as follows: IL-8 (r=-0,27, p<0,05), IL-15 (r=-0,34, p<0,05), IL-18 (r=-0,31, p<0,05), MCP-1 (r=-0,40, p<0,05), MIG (r=-0,56, p<0,05), TNF-α (r=-0,45, p<0,05). IL-6 levels were significantly elevated in patients with severe COVID-19 (CT3, CT4), while no increase in IL-6 was observed in patients with moderate disease (CT1, CT2). It is noteworthy that in patients with diabetes, the highest values of IL-12, IL-9 were recorded. Conclusion. Hyperinflammatory syndrome in severe COVID-19 is manifested by high levels of IL-6, MIG, MDC, MCP-1, M-CSF, TNF-α, β, IL-8, IL-18, IL-15. With the CT-1 and CT-2, an increase in only the level of IL-18, IL-8 is noted. The identified patterns prove and make it possible to explain a number of systemic inflammatory changes that occur with COVID-19.
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Objective: To determine the degree of knowledge in the usage of pulse oximeter as a home assessment tool among the community in Malaysia. Methods: A cross-sectional survey was conducted in November 2021. The questionnaire assessed the knowledge in using pulse oximeters, user experience and opinions in using pulse oximeter as a home assessment tool during the pandemic. Results: A total of 504 respondents were included in the study, and the mean score in knowledge related to application of pulse oximetry was 73.00%, while the mean score in knowledge related to factors affecting pulse oximetry readings was only 38.51%. A total of 90.5% of the respondents recognised normal pulse rate and 88.5% knew the blood oxygen saturation levels of a healthy adult, while 69.4% recognised the definition of silent hypoxia. In addition, the majority of the respondents agreed that factors such as poor blood circulation (71.2%), excessive movements (69.8%), and hand position (60.7%) affected oximetry readings. However, 61.7%, 81.7%, 77.2% and 76.8% of the respondents could not identify nail polish, skin colour, skin thickness and tattoos as factors that may affect oximetry readings respectively. Conclusions: The respondents showed a satisfactory level of knowledge related to application of pulse oximetry, but a poor level of knowledge related to factors affecting pulse oximetry readings among the community in Malaysia. Continuous efforts in educating the community on the correct use of pulse oximeters are crucial for appropriate home assessment and avoiding unnecessary stress.
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Background-Aim: While a frontal dysfunction is reported in post- SARS-CoV-2 with neurological symptoms (neuro-SARS-CoV-2), it is unclear whether this brain vulnerability is long lasting or reversible. The present study evaluated brain dysfunctions-as measured by FDG-PET-in neuro-SARS-CoV-2 over time to provide a better understanding of physiopathology underlying central nervous system involvement. Methods: 26 patients with neuro-SARS-CoV-2 were included. Seven patients were in the acute, the others in the sub-acute and chronic phase, namely, four at 1-month, four at 2-months, four at 3-months, four at 5 months and four at 7-9-months after onset. Patients underwent FDG-PET exams, clinical and cognitive evaluations. One patient was evaluated longitudinally, during the acute phase, and at a 5-months follow-up. Brain metabolism was analysed at the singlesubject and group levels by a comparisons with healthy controls. Correlations between severity/extent of hypometabolism and clinical variables of interest (global cognitive cognition, blood oxygen level saturation, and inflammatory status -C-reactive protein measurements) were also assessed. Results: Patients with acute neuro-SARS-CoV-2 showed the most severe and diffuse cortical hypometabolism, affecting almost all cortical areas. 2-months after the acute infection, a significant decrease in hypometabolism extension emerged, affecting mainly the frontal and temporal cortex. At 5-months after the acute phase, a recovery of cortical hypometabolism was evident, with limited residual clusters in frontal regions. At 7-9-months, no regions with brain hypometabolism were present. The only patient evaluated longitudinally showed a significant brain metabolic improvement from the acute phase (with diffuse cortical hypometabolism) to a 5-months follow-up (brain hypometabolism limited to frontal areas). Of note, the extent and severity of hypometabolism were associated with severe global cognitive dysfunctions, low blood oxygen level saturation, and high inflammatory status in all patients. Conclusions: These findings suggest that cortical functional impairment observed in patients with neuro-SARS-CoV-2 infection is likely to be transient and almost reversible, possibly due to synergistic effects of systemic virus-mediated inflammation sustained by systemic cytokine release and transient hypoxia inducing reversible neural dysfunction and local microglial activation.
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The health care burden and risks to health care workers imposed by novel coronavirus disease 2019 (COVID-19) mandated the need for a simple, noninvasive, objective, and parsimonious risk stratification system predicting the level of care, need for definitive airway, and titration of the ongoing patient care. Shock index (SI = heart rate/systolic blood pressure) has been evaluated in emergency triage, sepsis, and trauma settings including different age group of patients. The ever accumulating girth of evidences demonstrated a superior predictive value of SI over other hemodynamic parameters. Inclusion of respiratory and/or neurological parameters and adjustment of the cutoffs appropriate to patient age increase the predictability in the trauma and sepsis scenario. Being reproducible, dynamic, and simple, SI can be a valuable patient risk stratification tool in this ongoing era of COVID-19 pandemic.
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The Coronavirus Disease 2019 (COVID-19) pandemic has displayed heterogeneity in disease manifestations and complications. This case report illustrates a rare issue : the spontaneous pneumomediastinum. A 73-year-old male presented with chills, and respiratory symptoms. A reverse transcriptase polymerase chain reaction (RT-PCR) test- confirmed COVID19. At admission, the patient was in severe respiratory distress. C reactive protein was 54 mg/l (normal: 0-5 mg/l), , troponin were negative, brain natriuretic peptid 55 pg/ml (normal range <100 pg/ml) and D-dimer 700 mcg/l (normal: 0-500 mcg/l). Arterial blood gases showed pH 7.49 (normal: 7.35-7.45), PCO2 33,8 mmHg (normal: 34-46 mmHg) and PO2 56 mmHg (normal: 80-97 mmHg) with 16 liter per minute of oxygen. Computed tomography of the chest (CT chest) showed diffuse groundglass opacities (60-70%) without pulmonary embolism. Diagnosis of acute respiratory distress syndrome (ARDS) was made. Low flow oxygen was provided (Oxygen saturation target ≥ 94%), intermediate dose of low molecular weight heparin and 8mg of dexamethason were administarted daily. On day 10, worsening hemodynamics and blood oxygen levels was noted. CT chest showed moderate bilateral pneumomediastinum, without pneumothorax, persistent groundglass opacities (75%) with early fibrosis elements. The patient recovered with no pulmonary sequelae. This case report encourages health workers to get used with infrequent clinical and radiological manifestations of COVID-19 that is still surprising the world.
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Objective: In this example, the patient accidentally fell from 8 meters high, causing trauma to the patient’s chest with tracheal laceration and ‘white lung’ in both lungs. The patient lost respiratory function and was using a breathing machine with 100% pure oxygen while still maintaining 80% oxygen saturation. Routine tracheal intubation under general anaesthesia could potentially cause patient death during the operation. The objective was to assess the use of extracorporeal membrane oxygenation (ECMO) in surgery to repair the patient’s tracheal laceration. Methods: The thoracic surgery department applied hybrid surgery combined with ECMO to rescue the patient. With the support of ECMO, the patient’s intraoperative vital signs were stable, blood oxygen saturation was 100% and the surgery for repairing the laceration with fibreoptic bronchoscopy was successfully completed. Results: The patient recovered and was discharged from hospital. Conclusion: ECMO has successfully treated many critically ill COVID-19 patients during the pandemic, but this is the first time in China that ECMO has been applied to patients suffering from multiple critical injuries such as chest trauma and tracheal laceration.
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Background: Early prediction of the outcome situation of COVID-19 patients can decrease mortality risk by assuring efficient resource allocation and treatment planning. This study introduces a very accurate and fast system for the prediction of COVID-19 outcomes using demographic, vital signs, and laboratory blood test data. Methods: In this analytic study, which is done from May 2020 to June 2021 in Tehran, 41 features of 244 COVID-19 patients were recorded on the first day of admission to the Masih Daneshvari Hospital. These features were categorized into eight different groups, demographic and patient history features, vital signs, and six different groups of laboratory blood tests including complete blood count (CBC), coagulation, kidney, liver, blood gas, and general. In this study, first, the significance of each of the extracted features and then the eight groups of features for prediction of mortality outcomes were considered, separately. Finally, the best combination of different groups of features was assessed. The statistical methods including the area under the receiver operating characteristic curve (AUC-ROC) based on binary Logistic Regression classification algorithm were used for evaluation. Results: The results revealed that red cell distribution width (RDW), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and mean corpuscular volume (MCV) in CBC features have the highest AUC with values of 85.29, 80.96, 79.94 and 79.70, respectively. Then, blood oxygen saturation level (SPO2) in vital features has a higher AUC with a value of 79.28. Moreover, combinations of features in the CBC group have the highest AUC with a value of 95.57. Then, coagulation and vital signs groups have the highest AUC with values of 85.20 and 83.84, respectively. Finally, triple combinations of features in CBC, vital signs, and coagulation groups have the highest AUC with the value of 96.54. Conclusion: Our proposed system can be used as an assistant acceptable tool for triage of COVID-19 patients to determine which patient will have a higher risk for hospitalization and intensive care in medical environments.
ABSTRACT
A 45 old female patient came to the cardiac imaging unit of Ain Shams Specialized hospital complaining of exertional dyspnea on mild effort of one week duration. she has no past medical history of importance except for Covid 19 infection 3 months before (may 2021). She had fever and respiratory manifestations with + ve PCR for Covid 19. Her chest CT has a picture typical for Covid. Her blood oxygen concentration was above 95% and she was sent for home isolation and received the Egyptian ministry of health protocol for moderate cases. All the manifestations disappeared except for exertional dyspnea on moderate effort that progressed to dyspnea on mild effort one week before. she sought medical advice and underwent chest X ray that revealed increased cardiac shadow and was sent for echocardiographic evaluation. She had a large circular pericardial effusion measuring 10 mm anteriorly and laterally , 20 mm posteriorly causing early diastolic or late systolic of collapse of RA and the free wall and apex of the RV. After the imaging she was hospitalised for pericardiocentesis, 1000 cc of serosanguinous us exudate fluid was withdrawn and was discharged 48 hours later on Colchicine and Ibuprofen.