Spontaneous pneumomediastinum secondary to COVID-19 in Iran: a case series study: SPM secondary to COVID-19

BACKGROUND: Pneumomediastinum is defined as open-air in the mediastinum. Spontaneous pneumomediastinum (SPM) occurs when air leaks into the surrounding vascular sheath through small alveolar ruptures. CASE REPORT: We want to introduce 4 different cases with different outcomes. The first case was a 60-year-old man with a history of psychological disorders, the second case was a 41-year-old man with a history of hypertension (HTN) and asthma, the third case was a 50-year-old heavy smoker with no history of an underlying disease, and the fourth case was a 60-year-old man with a history of schizophrenia. They suddenly developed an exacerbation of cough, dyspnea, chest pain, and a severe decrease in oxygen saturation during hospitalization. Antibiotic therapy, corticosteroids, and high-dose oxygen therapy were administered to the patients. One of these patients died. CONCLUSION: All patients can potentially be at risk for this complication and have a good prognosis if diagnosed early and treated properly overall.

Investigation of the mechanism of fangfeng tongsheng pills in the treatment COVID-19 by network pharmacology and molecular docking

Objective: To explore the active components and potential mechanism of Fangfeng Tongsheng Pills by using network pharmacology and molecular docking in the treatment of coronavirus disease 19(COVID-19). Methods The main chemical constituents and action targets of various medicines in Fangfeng Tongsheng Pills were collected via traditional Chinese medicine system pharmacology database and online analysis platform(TCMSP). The related targets of COVID-19 were collected by using GeneCards database, and the repeating parts with Fangfeng Tongsheng Pills were taken as the research targets. Cytoscape software was used to create a drug-target-disease network. The common target was imported into STRING database, and the protein-protein interaction network diagram was constructed by Cytoscape software. The GO(gene ontology) function enrichment analysis and Kyoto encyclopedia of genes and genomes(KEGG) pathway enrichment analysis were performed by DAVID to predict their mechanism. The core components of Fangfeng Tongsheng Pills were docked with the therapeutic target of COVID-19 by AutoDock software. Results A total of 224 active compounds and 696 active targets were screened from Fangfeng Tongsheng Pills, including 79 targets coincided with COVID-19, and 10 active compounds, i.e. quercetin, luteolin, kaempferol,beta-sitosterol, naringenin, etc., 23 effective targets, i.e. PTGS2, PTGS1, NOS2, F10, DPP4, etc. A total of 65 GO function enrichment analysis results and 101 KEGG pathway enrichment results were obtained, including inflammatory response, tumor necrosis factor(TNF) signaling pathway, hypoxia inducible factor-1(HIF-1) signaling pathway, vascular endothelial growth factors(VEGF) signaling pathway, toll-like receptors(TLRs) signaling pathway, phosphatidylinositol 3-kinase-protein kinase B(PI3K-Akt) signaling pathway, and mitogen-activated protein kinase(MAPK) signaling pathway. Conclusion The active components in Fangfeng Tongsheng Pills, such as beta-sitosterol, quercetin, luteolin, kaempferol and naringenin, can combine with SARS-Co V2-3CL hydrolase and ACE2, act on the key target [TNF, Caspase-3, mitogen-activated protein kinase(MAPK1), interleukin-6(IL-6), prostaglandin-endoperoxide synthase 2(PGTS2)] of TNF, HIF-1, VEGF, MAPK and toll-like receptor signaling pathway, and play the roles of anti-inflammation, immune regulation, anti-hypoxic stress and anti-virus infection, thus play a role in the treatment of COVID-19.

Features of respiratory support for patients with pneumonia in the context of the COVID-19 pandemic

Introduction: The coronavirus infection (COVID-19) pandemic is at its peak. Since the beginning of the pandemic, the understanding of nosology has been growing every day. Although large randomized trials are underway, treatment is based on supportive care. Current recommendations are based on the treatment of other viral pneumonias and sepsis. But the course of COVID-19 is very different from them. Aim - analysis of articles on respiratory support for coronavirus infection COVID-19 published in the most authoritative evidence-based sources. Search strategy: the search was carried out in the following databases - PubMed, Google Scholar, Scopus, Embase. The initial number of articles - 325 (including duplicate articles - 188), titles and s of articles - 137 were studied (including 63 articles were excluded for the following reasons - lack of a comparison group, inconsistency of goals and titles of articles). Fully studied articles - 74 (including 39 articles were excluded for the following reasons - the lack of randomization of patients, the presence of methodological errors). The number of articles included in the study is 35.

Management of arrhythmias in COVID-19

Coronavirus disease-2019 (COVID-19) disease is caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) virus infection and firstly appeared in China and then became a pandemic. The leading cause of mortality is respiratory failure in COVID-19;however, cardiovascular manifestations are frequent and also important causes of death in COVID-19. The incidence of arrhythmia is increased in patients with COVID-19 due to increased systemic inflammatory response, hypoxia, and administered drugs. All kinds of arrhythmias, including bradyarrhythmias, supraventricular and ventricular arrhythmias, may develop during COVID-19 course. QT prolongation plays a central role in COVID-19 related arrhythmias. Therefore, QT duration should be strictly followed. All the clinicians should know the management of arrhythmias that they might face with frequently during the pandemic.

Comparison of pulse oximeter with arterial blood gas analysis in determination of SpO2 in COVID 19 at a tertiary care centre in central India

BACKGROUND: Covid 19 or SARS-COV-2 has created havoc in recent years and has put the world into a standstill with a high mortality and morbidity putting a pressure on the infrastructure of health system and making it difficult to manage all patients in hospital. As the search for triage system to judge the patients who would require home isolation and self-monitoring and the patients who will require in hospital management is still going on, some minor instruments and apparatus can be of great help in self-monitoring by patients and early detection of hypoxia or deterioration of condition can prompt then to contact health professional at an early stage. One such minor pocket apparatus is pulse oximeter. But, its effectiveness of determining the oxygen saturation can be misleading in some critical patients and they may require invasive procedure like arterial blood gas estimation for triaging patients of critical care. The present study compares the efficacy of pulse oximeter versus arterial blood gas analysis in measuring the accuracy of oxygen carrying capacity in critical covid 19 cases on oxygen therapy by different means. METHODOLOGY: Patients with COVID-19 who required oxygen to maintain saturation and the intubated patients on mechanical ventilation were admitted to the COVID ICU set-up of Datta Meghe Medical College and Shalinitai Meghe Hospital and Research Centre, Wanadongri, Hingna were analysed and documentation of their vitals were done. The study was a prospective cross-sectional hospital-based study from July 2020 till Dec 2020. Total 50 patients who fulfilled the criteria were recruited for the study group. The degree of discordance between value of PaO2 with the saturation shown by pulse oximeter was recorded. RESULT: Out of total 50 patients in study, 15 patients (30%) had a SpO2 of >90% with a measured PaO2 of <60 mmHg which was discordant according to the standard curve. CONCLUSION: The discordance of oxygen measurements between arterial blood gas analysis and peripheral pulse oximeter reading is an important factor in determining the evaluation and management of the acute hypoxemic respiratory failure in patients who required mechanical ventilatory support as seen in patients with COVID-19.

Effect of favipiravir and standard COVID-19 therapy on amino transferase in a sample of Iraqi COVID-19 patients

Background: COVID-19 is a condition that can proceed in a broad spectrum from asymptomatic moderate sickness to severe lung disease. Hepatic harm in COVID-19 may arise owing to the direct cytopathic action of the virus, uncontrolled immunological response, hypoxia related to pneumonia, and the medications used in therapy. In the literature, the rate of rise in blood transaminase levels of patients hospitalized with COVID-19 was determined to be 37.5%. Also, rise in serum transaminase levels in COVID-19 patients has been shown to be related with higher mortality in the literature. Favipiravir is a ribonucleic acid (RNA)-dependent RNA polymerase (RdRP) inhibitor antiviral drug used in the treatment of coronavirus disease-2019 (COVID-19) Aims: In this study, we investigated the changes in serum transaminase levels of patients who were hospitalized with the diagnosis of COVID-19 and underwent favipiravir therapy. Materials and methods: case-control research was done. It was done in a multi-hospital of Baghdad city over the period from November 1, 2020, to August 1, 2021. All patients in this study were hospitalized patients with polymerase chain reaction identified Coronavirus illness 2019 (severe cases) according to Iraqi criteria and supervision of a professional.

Accuracy of pulse oximeter and abg analysis in measurement of oxygen saturation in COVID 19 patients in recovery Ward and in silent hypoxia- an observational study

Need: A specific and accurate thorough clinical monitoring is crucial for observing patients' recovery status and further planning of treatment/management measures in COVID 19 pandemic. Fluctuations in blood oxygen saturation are particularly important in COVID 19 patients to prevent and early detect the unforeseen situations. Silent hypoxia is one of the threatening situations in such patients. Therefore the exact calibearation and accuracy testing of the oxygen is crucial. Method:. Out of 22 patients in COVID 19 recovery ward, 7 were encountered with silent hypoxia in sample collection process. The 30 paired samples of 15 patients and 14 paired samples of 7 patients with silent hypoxia (in a pair one sample was of SpO2 by pulse oximeter and another was of SaO2 by ABG analyzer) were analyzed seperately for accuracy by Bland and Altman's equations of limits of agreement. The mean difference and standard deviations were documented and the inferences were drawn.

Clinical features of patients with Severe acute respiratory syndrome Coronavirus 2 Delta variant infection and abnormal liver function in Guangdong Province, China. (Theme Issue: New advances in the precise diagnosis and treatment of liver cancer.) [Chinese]

Objective: To investigate the clinical features of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Delta variant infection and abnormal liver function in Guangdong Province, China.

Does damage to central neurological structures explain the lack of perception of respiratory sensations observed during SARS CoV 2 infection? [French]

Introduction: Dyspnea seems to be rarely reported in pneumonitis caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), sometimes giving rise to the term "silent hypoxemia". Dyspnea, the perception of sensory information related to breathing, is associated with a negative emotional experience. It would result from the activation of structures of the limbic/paralimbic system, including the insula. The latter would be the interoceptive alarm center, linking the perception of visceral sensations (including dyspnea) to the conscious experience of emotions. The neuroinvasive potential of SARS-CoV-2 via the olfactory bulbs raises suspicion of limbic/paralimbic damage but also of the brain stem during respiratory damage from Coronavirus Disease 2019 (COVID-19). We formulate the hypothesis that an attenuation of the affective component of dyspnea during hypoxia, resulting from impairment of interoception, is the consequence of impairment of these neurological structures.

Post-COVID-19 syndrome: clinical characteristics and therapeutic options upon discharge from the ICU. (Pautas nacionales para la atenci..n de pacientes adultos con COVID-19.) [Spanish]

Considering the definitions used by the NICE guidelines in the United Kingdom, COVID-19 is in an acute phase of 4 weeks (from the onset of symptoms), a subacute phase or ongoing symptomatic COVID (ongoing symptomaticCOVID) from the 4th to the 12th week, and a phase called post-COVID (post-COVID-19 syndrome), which goes from the 12th week onwards. -sion the concept of "acute sequelae of COVID-19" (oPASC post-acute sequelae COVID), and differentiate it from "COVID-persistent" or "long-COVID", since in the first there is structural organic damage and in the second, the existence of a persistent immune-mediated-inflammatory syndrome is proposed, with fluctuation in its clinical manifestations. The NICE guidelines include the term long-COVID (COVID-persistent in the Spanish literature), referring to the fact that it is commonly used to describe the symptoms and signs that follow the acute phase, including the terms subacute and post-COVID. The definition of post-COVID-19 syndrome refers to the symptoms and signs that occur during or after the acute COVID-19 infection, that persist beyond 12 weeks from the start of the infection and that are not explained by an alternative diagnosis. The management of the tracheostomy is the same as in the "non-COVID-19" patient In the face of the diagnosis of persistent post-COVID-19 pneumonitis, in the form of organizing pneumonia or with "fibrosis-like" alterations (confirmed by high-resolution CT), evaluate the case A case to start treatment with prednisone at a dose of 0.5 mg/kg for 2 to 3 months in a descending pattern, it is not yet clear if the dose and time are optimal, nor if there is a benefit with the use of antifibrotics. With the patient in spontaneous alveolar ventilation, the objective is to achieve saturation by pulse oximetry between 94% to 98%, maintaining oxygen therapy when oximetry is less than or equal to 92% (or less than 88% in patients with chronic lung disease).

Analysis of the effectiveness of noninvasive ventilation techniques in patients with COVID-19

Health care system from the end of 2019 faced a huge challenge worldwide which was the emergence of a new species of coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Wuhan, China. Within a short time, the pathogen revealed a pandemic nature. On January 30, 2019, the World Health Organization (WHO) announced the outbreak of the COVID-19 pandemic. The greatest threat to human health and life is the damage to the lungs that accompanies a virus infection and the development of Acute Respiratory Distress Syndrome (ARDS). As the epidemic proceeded, a significant amount of the hospital bed facilities was occupied by patients requiring passive oxygen therapy and, in large part, respiratory support using high flow oxygen therapy (HFNC) and continuous positive airway pressure (CPAP) devices. A variety of techniques for applying passive oxygen therapy allow the use of different oxygen flows, with a proportional increase in FiO2 in the breathing mixture.

Pneumorrhachis associated with COVID-19: a rare observation

This paper describe a case of a 46-year-old male with a background of diabetes presented with a week's history of fever followed by breathlessness. On initial evaluation his oxygen saturation was found to be 82 % on ambient air. His chest X-ray showed bilateral peripheral heterogeneous opacities. COVID-19 PCR from nasopharyngeal swab was positive. He was started on high flow nasal cannula and was cared for in the intensive care unit (ICU) as a case of severe COVID-19 pneumonia. He received broad spectrum antibiotics, corticosteroids, low molecular weight heparin, remdesivir, convalescent plasma and off label tocilizumab. A week later, he developed worsening hypoxia, a CT Pulmonary angiogram was done to rule out possible pulmonary embolism but demonstrated extensive pneumomediastinum with surgical emphysema extending in neck, bilateral chest walls and air in the spinal canal, known as pneumorrhachis. He was managed conservatively on high flow nasal cannula and recovered after a long course of hospitalization.

Special Issue: COVID-19 part III. (Special Issue: COVID-19 part III.)

This special issue contains 22 articles that discuss COVID-19 in the Europe. The topics include profiles of current COVID-19 vaccines, hydroxychloroquine versus lopinavir/ritonavir in severe COVID-19 patients, effect of early oseltamivir on outpatients without hypoxia with suspected COVID-19, relationship between serum osteopontin levels and the severity of COVID-19 infection, methylprednisolone in adults hospitalized with COVID-19 pneumonia, personal protective equipment in the COVID-19 pandemic and the use of cooling-wear as alleviator of thermal stress, influence of age and gender on the epidemic of COVID-19;forehead temperature measurements during cold outdoor temperatures, impact of lockdown during the COVID-19 pandemic on number of patients and patterns of injuries at a level I trauma center, establishing a telerehabilitation program for patients with Duchenne muscular dystrophy in the COVID-19 pandemic, 6-month SARS-CoV-2 antibody persistency in a Tyrolian COVID-19 cohort, evaluating the longitudinal effectiveness of preventive measures against COVID-19 and seroprevalence of IgG antibodies to SARS-CoV-2 in cancer outpatients and healthcare workers, The first 8 weeks of the Austrian SARS-CoV-2 epidemic, clinical manifestations of COVID-19 in the general population, sex and age differences in COVID-19 mortality in Europe, among others.

Evaluation of the response to the prone position in patients awake with COVID-19

COVID-19 has a high mortality, as patients who progress to intubation have poor results. The prone position in awake patients can reduce discomfort and the rate of ICU stay. To evaluate the acute effects of the types of responses to the prone position in awake patients with COVID-19. Prospective single-center study with 32 patients awake with COVID-19 with supplemental oxygen. The response to the prone position was performed for 30 minutes. After the test, they were instructed to remain in PP daily, according to tolerance. The SpO2 variables, heart rate, respiratory rate, ROX index and ICU admission rate were recorded. Twenty-five patients (78.1%) responded to PP, 13 (40.6%) had a persistente response and 12 (37.5%) had a transient response. 7 patients (21.9%) did not respond. Patients with persistent and transient responses increased SpO2 (p<0.001), ROX index (p=0.001 and p<0.001, respectively) and reduced heart rate (p=0.01 and p=0.02, respectively) and respiratory (p=0.003 and p=0.001, respectively), compared to the pre. There was no difference in all variables in patients who did not respond to PP. The ICU admission rate of patients who had persistent, transient or non-responders was 30.8% (4/13), 41.7% (5/12) and 57.1% (4/7), respectively. Patients who responded to PP had reduced heart and respiratory rates, increased ROX index. There was no difference in admission rate.

Triage and management of probable COVID-19 patients in the intensive care unit during the pandemic period

Aim: Republic of Turkey Ministry of Health dedicated our hospital as a transplant center during the pandemic period. We admitted probable Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) infection (COVID-19) cases and intensive care unit (ICU) patients from other centers, while confirmed COVID-19 cases were transferred to dedicated pandemic hospitals. The aim of this study was to determine the demographic parameters, clinical courses and outcomes of probable COVID-19 patients and to compare survivors with non-survivors admitted to our ICU. Materials and Methods: After Ethics Committee approval, 93 patients admitted to our ICU between March 23 and May 13 were analyzed retrospectively.