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Background: Today, various drugs have been investigated as the primary or complementary treatment for coronavirus disease 2019 (COVID-19). N-acetylcysteine (NAC) has been used as a mucolytic in pulmonary diseases. This drug apparently contributes to the retrieval of the intracellular antioxidant system. Objective(s): This study aimed to determine the efficacy of NAC in severe COVID-19 patients admitted to the intensive care unit (ICU). Method(s): This single-blinded randomized controlled phase III clinical trial included 40 patients with confirmed COVID-19 (based on polymerase chain reaction) admitted to the Shahid Mohammadi Hospital's ICU, Bandar Abbas, Iran, in 2020. All cases had severe COVID-19. They were allocated randomly to two equal groups. Patients in the control group received standard drug therapy based on the treatment protocol of the national COVID-19 committee, while those in the NAC group received a single dose of intravenous NAC (300 mg/kg) upon admission to the ICU in addition to standard drug treatment. Clinical status and laboratory tests were done on admission to the ICU and then 14 days later or at discharge without knowing the patient grouping. Result(s): The two groups were comparable regarding age, gender, and other baseline laboratory and clinical parameters. At the final evaluation, respiratory rate (21.25 +/- 4.67 vs. 27.37 +/- 6.99 /min) and D-dimer (186.37 +/- 410.23 vs. 1339.04 +/- 2183.87 ng/mL) were significantly lower in the NAC group (P = 0.004 and P = 0.030, respectively). Also, a lower percentage of patients in the NAC group had lactate dehydrogenase (LDH) <= 245 U/L (0% vs. 25%, P = 0.047). Although the length of ward and ICU stay was shorter in the NAC group than in controls, the difference was statistically insignificant (P = 0.598 and P = 0.629, respectively). Mortality, on the other hand, was 75% in the control group and 50% in the NAC group, with no statistically significant difference (P = 0.102). Concerning the change in the study parameters, only the decrease in diastolic blood pressure (DBP) was significantly higher with NAC (P = 0.042). The intubation and mechanical ventilation rates were higher, while oxygen with mask and nasal oxygen rates were lower with NAC, but the difference was statistically insignificant. Conclusion(s): Based on the current research, NAC is related to a significant decrease in RR, D-dimer, and DBP in severe COVID-19. Also, LDH was significantly lower in the NAC group than in the controls. More research with larger sample sizes is needed to validate the current study results.Copyright © 2023, Author(s).
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Aim: Troponin I is an important prognostic marker in critically ill patients with COVID-19, similar to cytokines and other inflammatory mediators. The aim of this study was to evaluate the predictive value of troponin I levels for mortality in geriatric patients transferred to the intensive care unit for COVID-19 pneumonia according to age group. Material(s) and Method(s): Seventy-four patients with COVID-19 pneumonia were grouped according to age (Group 1:65-74 years, Group 2: 75-84 years, and Group 3: >= 85 years) and retrospectively analyzed. Demographics, clinical findings, laboratory results upon admission to the intensive care unit, and outcomes were compared among the groups. Predictive value of troponin I levels upon admission to intensive care unit (Troponin Iicu), difference in troponin levels between general wards and intensive care unit (Troponin Idiff), C-reactive protein, ferritin, lactate dehydrogenase, neutrophil-to-lymphocyte ratio, procalcitonin, and D-dimer levels for mortality were also investigated. Result(s): The mortality rate was 74.3% for the patients overall, and increased, albeit insignificantly, with increasing age. Neither Troponin Iicu nor Troponin Idiff was predictive for mortality for any of the age groups or for the patients overall. Ferritin, lactate dehydrogenase, neutrophil-to-lymphocyte ratio, and C-reactive protein levels were predictive for mortality for patients overall (p= 0.016, p= 0.001, p= 0.013, and p < 0.001, respectively). Discussion(s): For geriatric patients, troponin I levels at the time of the first admission to the ICU are not sufficient to predict mortality alone and should be evaluated together with other parameters.Copyright © 2022, Derman Medical Publishing. All rights reserved.
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Covid19 is still one of the major public health problems of all countries nowadays. The most common cardiac manifestations reported till now are acute coronary syndrome, myocarditis, and arrhythmia. The prevalence of COVID-19 induced arrhythmias is different in recent reports and varies from benign sinus tachycardia to more ominous cases of severe bradycardia or even malignant ventricular arrhythmias. Here in, we describe a case of complete heart block in severe covid-19 pneumonia and review all recent relevant case reports published to date in order to understand the probable mechanisms and contributing factors of this rare complication of the disease.Copyright © 2022, Isfahan University of Medical Sciences(IUMS). All rights reserved.
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INTRODUCTION: The first data for COVID-19 in pregnancy showed mild-to-moderate forms of the disease while the current data speak of severe forms in these subjects. Here, we present a case of a severe form of COVID-19 in a gemelar pregnant woman complicated with pneumomediastinum and pneumothorax, during her hospital stay, in a late stage of disease. CASE PRESENTATION: A 38-year-old multiparous woman was referred to university hospital at 25 weeks of gemelar pregnancy. On admission, the patient presented with signs of moderate respiratory insufficiency, which after 12 h progressed further to severe ARDS. She tested positive for SARS-CoV-2 on quantitative real-time polymerase chain reaction. Under these conditions, it was decided that the patient undergoes a cesarean section for termination of pregnancy. Remdesivir 200 mg/day and tocilizumab 8 mg/kg were administered, based on national guidelines. The patient’s fever subsided, but her SpO2 remained at 94%, even with a 15 L/min oxygen mask. After 12 days, the patient complains of a severe back pain and her respiratory condition rapidly worsened and reduced saturations up to 80% being under O2 therapy with facial mask with 15 l/min. Chest CT findings confirmed pneumomediastinum and pneumothorax, which deteriorated the patient’s status. Thereafter, tube thoracostomy was performed. There was a clinical and ABG analysis parameter’s improvement. The patient was discharged 34 days after cesarean delivery with a proper general health. CONCLUSION: Our case highlights even more convincingly the fact that, in pregnancy, can be severe to life-threating forms of COVID-19. Pneumothorax and pneumomediastinum are complications that can be encountered even in the late stages of severe forms cases with COVID-19 in pregnancy. Early diagnosis of these complications is essential in adequate management and treatment to avoid fatal outcome.
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SESSION TITLE: Respiratory Care: Oxygen, Rehabilitation, and Inhalers SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: INTRODUCTION: Oxygen is life saving if administered properly. Low and middle income countries recently faced a acute oxygen shortage during covid surge. We aim to study the oxygen requirement and its administration in patients with acute respiratory failure requiring oxygen therapy. AIMS AND OBJECTIVES: 1. To study the oxygen requirement and its utilization in patients with acute respiratory failure 2. To study the effectiveness of oxygen saving protocols and its impact on healthcare delivery METHODS: Sample size: 50 patients with acute respiratory failure INCLUSION CRITERIA: 1. Patients aged 20 years and above 2. Patients with acute respiratory failure 3. Patients requiring oxygen EXCLUSION CRITERIA: 1.Patients unable to consent 2.Patients requiring NIV 3.Patients with poisoning METHODOLOGY: We developed a protocol according to which ROX index of each patient was calculated and suitable interface like nasal prongs, face mask, NRB mask etc were used. Oxygenation was delivered with the target oxygen saturation of 92% and above. Also the oxygen delivery system was checked for potential leakage. RESULTS: 1. 80% of the oxygen delivery lines had a minute leakage and were a source of oxygen wastage 2. 92% patients just removed the oxygen mask for drinking water, eating, etc without turning off the valve 3. Night nursing staff was a bit careless and never cared to check for oxygen leakage from mask in night shifts. It accounted for approximately 24% of total leakage per patient 4. 56% of patients were not aware of proper usage of nasal prongs 5. Unavailability of liquid oxygen storage facilities in hospitals was a cause of delayed supply of oxygen during the crises CONCLUSIONS: Liquid medical oxygen is a life saving in patients of acute respiratory failure. However proper supply, storage facilities and usage protocols have to be followed rigorously to avoid acute shortages. CLINICAL IMPLICATIONS: Oxygen if used properly is a live saving measure in patients of respiratory failure. DISCLOSURES: No relevant relationships by Sarang Patil
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Background: The COVID-19 pandemic has heightened awareness surrounding the danger of aerosolizing procedures which may lead to viral transmission. Most viruses are spread via droplets which are predominantly 5-10 microns (mm) in size and can remain suspended in the environment for extended periods of time. While personal protective equipment may reduce some risk, this prolonged suspension of infectious droplets may still lead to transmission. Furthermore, there is little data describing the risk of aerosolization during upper endoscopic procedures. We sought to characterize particle aerosolization between patients undergoing upper endoscopy with and without an endoscopic patient facemask. Methods: Adult patients scheduled for elective upper endoscopic procedures under monitored anesthesia care at a tertiary care center between August and October 2021 were prospectively enrolled. Patients were randomized to either receive an endoscopic facemask designed with fenestrated openings for endoscope insertion (Procedural Oxygen Mask, Simi Valley, CA) or undergo endoscopy with no mask using nasal cannula oxygen support. Exclusion criteria included requiring endotracheal intubation or medically needing an endoscopic facemask for oxygen delivery. Particle aerosols were measured using a commercially available particle detector (Met One GT-526S, Grants Pass, OR) which measured particles of six different sizes (<0.3mm, 0.3-0.5mm, 0.5-0.7mm, 0.7-1mm, 1-5mm and 5- 10mm). The device was placed at 1 foot from the subject's mouth and equidistant between the endoscopist and the anesthesia staff. Measurements were taken every 5 seconds for analysis. A linear mixed effects model was used to analyze the difference in particle aerosolization between groups. Results: Out of 57 patients who were randomized, 27 underwent endoscopy with a facemask and 30 underwent endoscopy with no mask. There were no significant differences in age, gender, body mass index, Mallampati score, patient positioning, or American Society of Anesthesiology (ASA) score between the 2 groups. Analysis of 27,724 measurements showed no difference in particle aerosolization of any size particle between the 2 study arms. The predictive model demonstrated a trend of decreasing particles during endoscopy which then increased by the end for all six particle sizes for both groups. Conclusions: Use of a widely available endoscopic patient facemask did not prevent particle aerosolization during upper endoscopic procedures. Interestingly, there was an initial decrease in particle counts during the procedures followed by a subsquent increase which may reflect heightened aerosolization with insertion and removal of the endoscope. Further study is warranted to determine if additional interventions may be useful for preventing particle aerosolization during endoscopy and improving safety for all health care staff. (Table Presented) (Figure Presented)
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BACKGROUND AND AIMS: We aimed to analyze the outcomes of HD patients with COVID-19 hospitalized in the Moscow region, Russia, and to compare it with those in the general population. METHOD: Data were obtained retrospectively from the Moscow region COVID-19 register database, which comprises all hospitalizations with suspected or confirmed COVID-19 between February 2020 and November 2021. A total of 384 327 patients were included;1 435 of them were ESRD patients. RESULTS: Among ESRD patients there were 1386 HD patients and 49 kidney graft recipients. Thus, during the specified period, 48.5% of all prevalent HD patients of the Moscow region and only 7.8% of the graft recipients required hospitalization. Due to a few number of hospital admissions among kidney recipients they were excluded from the further analyses. We observed typical 4 waves of hospital admissions in the general population, but not in HD patients. In these patients, we noted a peak in December 2020 with a subsequent decrease in February, 2021;then the number of hospitalizations remained stable. The proportion of HD patients was approximately 0.5% of all patients with COVID-19 admitted to hospital. Almost all HD patients with COVID-19 were hospitalized regardless of disease severity. The mean age of hospitalized HD patients was significantly more than that in the general population: 68.95 ± 13.69 years versus 59.18 ± 17.11 years, P < 0.001. Of note, the mean age of HD patients in Russia is 56.3 ± 11.7 years. The proportion of men among hospitalized HD patients with COVID-19 reached 50.4% versus 43.5% in the general population. HD was associated with a significant increase in the risk of critical but stable and extremely critical (+ worsened: terminal and clinical death) condition at admission (Figure 1A): RR = 3.36 [95% confidence interval (95% CI) 3.12-3.59], P < 0.001 and RR = 4.83 (95% CI 3.93-5.92), P < 0.001, respectively. HD patients were significantly more likely to need for any kind of respiratory support (oxygen mask and mechanical ventilation (MV)) or MV alone (Figure 1B): RR = 1.72 (95% CI 1.63-1.81), P < 0.001 and RR = 4.67 (95% CI 4.18-5.21), P < 0.001, respectively. HD was associated with a significant increase in the risk of death (Figure 1C): RR = 3.48 (95% CI 3.24-3.72), P < 0.001. HD significantly increased the risk of death in patients without oxygen support and in patients with need for an oxygen mask (Figure 2A): RR = 3.56 (95% CI 2.97-4.25), P < 0.001 and RR = 2.47 (95% CI 2.18-2.78), P < 0.001, respectively. For patients requiring MV, mortality was >95% in both cohorts: RR = 0.999 (95% CI 0.955-1.01), P = 0.309. Deceased patients were older than survivors both in HD patients [73 (IQR 65-82) versus 69 (IQR 59-78) years;P < 0.001] and in the general population [72 (IQR 63- 82) versus 60 (IQR 48-69) years;P < 0.001], however, the difference between medians was significantly greater in the general population: 13 (95% CI 12-14) versus 5 (95% CI 3-6) years. Heart and lung diseases increased the risk of death. In the general population concomitant heart diseases worsened the prognosis to a greater extent compared with lung diseases: RR = 2.69 (95% CI 2.64-2.74), P < 0.001 and RR = 1.3 (95% CI 1.26-1.35), P < 0.001, respectively. In HD patients pre-existing lung diseases had a greater impact on the risk of death than heart diseases: RR = 2.02 (95% CI 1.71-2.41), P < 0.001 and RR = 3.05 (95% CI 2.73-3.41), P < 0.001, respectively. In the multivariate model, significant predictors of death in HD patients were need for MV (OR = 9.81, 95% CI 8.48-17.8;P < 0.001) and lung diseases (OR = 2.92, 95% CI 1.92-5.42;P < 0.001], but not heart diseases, age and gender. CONCLUSION: HD patients with COVID-19 have a significantly worse prognosis compared with the general population. The main risk factors for death are need for respiratory support and pre-existing lung diseases.
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Introduction: The outbreak of the novel coronavirus disease (COVID-19), a highly contagious and deadly infection. Aim: To evaluate the epidemiological pattern and spectrum of the covid ocular morbidity and appraise the typical presentation of ocular manifestations in hospitalized covid patients. Methods: A prospective, cross-sectional study was conducted on individuals, who were hospitalized for COVID treatment between May 2021 and June 2021. The Data on patient history, physical exam, thorough ocular examination, laboratory results, and hospital disposition were collected and analyzed. Results: A total of 658 patients were included. Ocular signs and symptoms were noted in 162 (24.62%) patients. 51.6% patients wereof >50 years of age and 54.1% were males. 71.6% of them belonged to urban community.75.3% patients developed ocular discomfort with in acute (<1 week) period of covid infection. The most common ocular abnormality was watering with conjunctival irritation, followed by conjunctival injection and lid swelling. Among the 162 patients, 30 (79.0%) developed ocular involvement prior to day 30 of onset of their COVID symptoms. 56.7% patients relieved from ocular discomfort after treatment. 5.7% patients reported deterioration of visual acuity. 65.8% patients reported ocular discomfort associated with regular oxygen mask wearing. Most significant ocular morbidity was black discoloration of lids and peri ocular skin, lid swelling, and redness and purulent discharge of conjunctivitis needed emergency ophthalmic reference. Conclusion: spectrum of covid sore eyes extends from ocular irritation to mucormycosis and other long-term complications.
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BACKGROUND: During pandemic situations, many guidelines recommend that surgical masks be worn by both healthcare professionals and infected patients in healthcare settings. The purpose of this study was to clarify the levels and changes of oxygen concentration over time while oxygen was administered over a surgical mask. METHODS: Patients scheduled to undergo general anesthesia (n = 99) were enrolled in this study. First, patients were administered oxygen at 6 L/min via an oxygen mask over a surgical mask for 5 min. The patients removed the surgical mask and then took a 3-min break; thereafter, the same amount of oxygen was administered for another 5 min via the oxygen mask. We measured the fraction of inspired oxygen (FiO2), the end-tidal CO2 (EtCO2), and respiratory frequency every minute for 5 min, both while administering oxygen with and without a surgical mask. The FiO2 was measured at the beginning of inspiration and the EtCO2 was measured at the end of expiration. RESULTS: The FiO2 at 5 min was significantly lower when breathing with a surgical mask than that without it (mean difference: 0.08 [95% CI: 0.067-0.10]; p < 0.001). In contrast, the EtCO2 at 5 min was significantly higher when breathing with a surgical mask than that without it (mean difference: 11.9 mmHg [95% CI: 10.9-12.9]; p < 0.001). CONCLUSION: The FiO2 was lower when oxygen was administered over surgical masks than when patients did not wear surgical masks. Oxygen flow may need to be adjusted in moderately ill patients requiring oxygen administration.
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Masks , Oxygen , Delivery of Health Care , Humans , Pandemics , RespirationABSTRACT
INTRODUCTION: Caring for patients with acute hypoxic respiratory failure from COVID-19 has been quite difficult for healthcare workers for a variety of reasons. For the last several months patients have been encouraged or required to wear surgical masks due to evolving best practice but concern among healthcare providers remains elevated to this day, specifically regarding how much protection a surgical mask actually offers when the patient is on supplemental oxygen. We performed high-fidelity analysis using laseraugmented detection of exhalations to quantify mitigation of aerosols and droplets by surgical masks worn by patients over the oxygen delivery device. Due to the inherent significant population variability suffering from COVID-19, the already burdensome requirements on an increasingly fatigued staff, difficulty in repeatability, and the sometimes marked differences in patient rooms, we chose a manikin respiration system to allow us to visualize and quantify the direction and density of exhalations on supplemental oxygen under reproducible conditions. METHODS: The “healthy” manikin had a set respiratory rate and tidal volume of 12 breaths per minute and 500 mL, while the “COVID” manikin was set at 20bpm and 350 mL. The exhalations were visualized using an aerosol fog composed of approximately 1-5 micron water-based droplets. (Image 1). RESULTS: We found that while wearing nasal cannula without a mask, exhalations have concentrated linear momentum for >0.5m from mouth and may be directly in the direction of a healthcare worker. The addition of a simple surgical mask decreased the concentrated linear momentum by half (0.26m) and redirected the exhalated gas laterally and inferiorly. There were similar findings while wearing simple oxygen facemask with and without surgical mask. CONCLUSIONS: Wearing a surgical mask significantly reduces momentum of the initial exhalation and redirects the exhalation puffs away from providers. We demonstrate this simple strategy provides additional protection for healthcare providers and first responders treating patients with COVID-19 and other contagious disease spread through infectious aerosols and droplets.