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Objectives: Reporting a case of a COVID-19 vaccinated patient admitted to our intensive care unit with severe acute respiratory failure due to SARSCoV2 - Omicron variant, rapidly deteriorating requiring intubation, prone ventilation, and ECMO support. Method(s): A 62 years old Caucasian male was admitted in ICU for rapidly deranging respiratory failure and fever which occurred over the previous 24h. The patient received two doses of SARS-CoV2 vaccine (Oxford, AstraZeneca), the last one over five months before onset of symptoms. The patient was admitted to the intensive care unit (ICU) with tachypnea, low peripheral saturation (80%), elevated serum creatinine (2.4 mg/dl), and mild obesity (BMI 34,6). Pressure support ventilation trial (2 hours) failed carryng out to orotracheal intubation and protective ventilation. Worsening of respiratory exchanges (5 th day from the admission) required a rescue prone ventilation cycle, in the meantime an indication was given to the placement of veno-venous ECMO. The cannulation site was femoro-femoral and the configuration used was Vivc25- Va21, according to the current ELSO nomenclature;ECMO flow was progressively increased until a peripheral saturation of 95% was obtained. Result(s): The patient passed out after 2 month of extracorporeal support with no sign of recovery of pulmonary and renal function. Conclusion(s): Unlike evidences showing a lower symptomatic engagement of the Omicron variant SARSCoV2 positive patients, we have witnessed a rapid and massive pulmonary involvement. The short time that passed from the onset of symptoms and the rapid decay of respiratory function required rapid escalation of the intensity of care up to extracorporeal support. The patient showed previous pathologies that can lead to suspicion of a loss of immune coverage given by the vaccine, in addition to the long time elapsed since the last dose. (Figure Presented).
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The clinical evaluation of the patient with COVID-19 allows better care, application of safety criteria and preventive measures. The disease progresses from mild to severe and critical. In this work, is evaluated in patients with COVID-19 clinical format to identify moderate to severe stages of the disease. Following a cohort of male and female patients over 18 years of age admitted to the Infectology Service of the General Hospital of Mexico. Each patient is studied using the"COVID-19 Infectology"clinical format and in the first 24 hours of admission, a real-time RT-PCR molecular test is performed for SARS-CoV-2 infection. 65 patients classified as severe COVID-19 were studied, the RT-PCR was positive in 60 patients and negative in 5, clinical data did not differ from the positive ones and the 5 negative were considered false negative cases of the molecular test. There were no differences between positives and negatives with Fisher's test, and no difference in age, comorbidities, or prognostic evaluation with Student's t test. The conclusion is that the clinical format"COVID-19 Infectology"allows to recognize the cases and identify those that are in a severe evolution.Copyright /© 2021 Sociedad Medica del Hospital General de Mexico. Published by Permanyer.
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Background: The purpose was to determine the frequency and duration of vital sign deviations in acutely admitted patients in general wards with confirmed COVID-19 infection using continuous wireless vital sign monitoring. Material(s) and Method(s): Patients were equipped with two wireless sensors live-transmitting respiratory rate (RR), heart rate (HR) and peripheral oxygen saturation (SpO2). Frequency and duration of vital sign deviations were compared with manual point measurements performed by clinical staff according to the national Early Warning Score (EWS), assuming linear relationship between EWS point measurements. Result(s): Continuous monitoring detected episodes of SpO2 < 92% for more than 60 consecutive min in 92% of patients versus 42% of patients detected by EWS (p < 0.0001). Events of desaturation with SpO2 < 88% for more than 10 min was registered in 87% with continuous monitoring versus 27% with EWS (p < 0.0001). Desaturation with SpO2 < 80% for more than 1 min was detected in 76% with continuous monitoring versus 6% with EWS (p < 0.0001). 70% of patients had episodes of tachypnea with RR >24 breaths per minute >5 min detected with continuous monitoring versus 36% assessed by EWS (p = 0.0001). Episodes of HR >111 for >60 min was recorded in 51% versus 24% (p = 0.0002). Conclusion(s): Moderate and severe episodes of desaturation, tachypnea, and tachycardia during hospital admission in patients with COVID-19 infection are common and most often not detected by routine manual measurements.
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Backgrounds: The clinical and socioeconomic effects of COVID-19 are still being felt through-out the world. The disease affects people of all age groups, but it is known to have a milder clinical course in children including neonates. There is paucity of data from Sub-Saharan Africa on neonatal COVID-19 infection, and no such case has been reported in the literature in Ghana. Case presentation: This study presented a case report of a neonate who was found to be positive for COVID-19 infection after presenting symptoms such as respiratory distress, rhinorrhoea, and cough. This neonate was managed with in-hospital standard protocol for sepsis with a focus on pneumonia. Conclusion(s): The national guidelines on COVID-19 management were used for the neonate who was recovered and discharged.Copyright © 2021, TMU Press.
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Although case reports have been made regarding adverse transfusion reactions, few have been made regarding blood transfusions leading to cardiac arrest. Today, we present a case of a COVID-19 positive Bahraini male, triple vaccinated, transfused with packed red blood cell (pRBC) after finding out he has low haemoglobin levels (64 g/dl) after routine laboratory investigations. During the blood transfusion, he developed hypertension, tachycardia and tachypnoea. The patient went into cardiac arrest within a few minutes of this presentation. Return of spontaneous circulation was achieved, and the patient was managed as transfusion-associated circulatory overload (TACO) with a good overall outcome.Copyright © 2023, Bahrain Medical Bulletin. All rights reserved.
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Introduction: Orogastric tube insertion is a routine procedure in medical care. However, misplacement of the tube can cause a variety of complications, which can be life threatening in some instances. Case Description/Methods: 71-year-old male presented with dyspnea, fever, chills, cough, and myalgia for 2 weeks. He had tachycardia, tachypnea, and was hypoxic to 66% in room air. He was found to have acute hypoxic respiratory failure secondary to COVID-19 Pneumonia and was admitted to ICU. But, he continued to be hypoxic and was started on BiPAP. He eventually became altered, and was intubated. Post intubation orogastric tube (OGT) placement was unsuccessful on the first attempt due to resistance. On the second attempt, the nurse was able to advance partially (Figure). But, a chest XR showed OGT in the mediastinum, and OGT was removed. CT of neck and chest revealed pneumomediastinum with possible mid-thoracic esophageal perforation. The patient was started on broad-spectrum antibiotics and thoracic surgery was consulted. Given his mechanical ventilation requirement, surgery deemed him unfit to tolerate thoracotomy and the endoscopic procedure was not available in the hospital. So, recommendation was to manage conservatively. His hospital course was complicated by hypotension requiring vasopressors and metabolic acidosis in setting of acute renal failure requiring CRRT. Code status was changed by the family to Do Not Resuscitate due to his deteriorating condition. Eventually, he had a PEA arrest and was expired. Discussion(s): OGT intubation is performed at hospitals for feeding, medication administration or gastric decompression. Although it is considered a safe procedure, complications can arise due to OGT misplacement or trauma caused by the OGT itself or the intubation process. OGT misplacement is typically endotracheal or intracranial. Misplacement within the upper GI lumen is usually detected by a kink in the oropharynx or esophagus. The subsequent complications are identified by the structure that is perforated (e.g., mediastinitis or pneumothorax). Regardless of whether counteraction is perceived, the physician must be careful not to apply excessive force. The location of the OGT tip should be determined by a chest radiograph;visualization of the tip below the diaphragm verifies appropriate placement. Complications of OGT insertion are uncommon;however, the consequences are potentially serious, and the anatomy of the upper GI tract should be understood by all who are involved in the care.
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Respiratory viral infections are important cause of morbidity and mortality in early life. The relative influence of host and viral factors possibly contribute to the disease pathogenesis. Predisposing conditions like prematurity, Low birth weight and congenital heart diseases etc. have been incriminated in the disease progression. The development of cough, wheezing, and tachypnea, usually peaking on days 4 to 5, go parallel with host cytokine responses and viral load. Various host cytokines, chemokines and molecules involved in the immune response against RSV infection might be responsible for the outcome of the disease process. Nasopharyngeal aspirates (NPAs) from children (n = 349) between 2013-2017 were subjected for IL-17A, IFN-gamma, TNF-alpha, IL-10, IL-6 levels by CBA and MMP-9 and TIMP-1 levels by ELISA. The viral load in RSV positive samples and cytokine levels were correlated with the WHO criteria for acute lower respiratory tract illness (ALRTI). RSV viral load, Pro-inflammatory cytokine (TNF-alpha) levels in severe ALRTI patients were significantly higher than the ALRTI patients [p<0.001]. Whereas Th17 cytokine (IL-17) was found to be significantly higher (p<0.05) in ALRTI patients than severe patients. MMP-9 is secreted in higher levels in severe ALRTI patients (n = 77) in comparison to Acute LRTI patients (n = 35) with an increase of thirty seven fold (p<0.001). Thus, the study highlights the role of TNF -alpha, IL-17 and Th2 cytokine biasness in the pathogenesis of RSV disease with the possible contribution of higher MMP-9/TIMP-1 ratio as a bad prognostic marker towards disease severity. To study the gene expression of autophagy and mTOR signalling pathways in RSV infected children with ALRTI. Nasopharyngeal aspirate (NPA) samples (n = 145) from children suffering from ALRTI were subjected for detection of RSV (Oct 2019 to March 2020). Semi-quantitative gene expression analysis for 5 representative genes each of mTOR signalling and autophagy pathway were performed in respiratory tract epithelial cells using 25 RSV positive cases and 10 healthy controls subjects. Autophagy gene expression analysis revealed significant upregulation in NPC1 and ATG3 autophagy genes. mTOR, AKT1 and TSC1 genes of mTOR pathway were significantly down-regulated in RSV positive patients except RICTOR gene which was significantly upregulated. Thus, survival of RSV within autophagosome might have been facilitated by upregulation of autophagy and downregulation of mTOR signalling genes. To assess the impact of SARS-CoV2 pandemic on RSV, samples were collected from children with ALRTIs admitted to emergency, PICU and indoor admissions during pre-pandemic period (October 2019 to February 2020;n = 166) and during COVID-19 Pandemic (July 2021 to July 2022;n = 189, SARS-CoV2 negative). These NP swabs were analyzed for pdm InfA H1N1, InfA H3N2, Inf B, RSV, hMPV, hBoV, hRV, PIV-2 and PIV-3 by PCR. Higher proportion of children with ALRTIs have had virus/es isolated during pre-pandemic period than during pandemic period (p<0.001). During pre-pandemic period, significantly higher proportion of children had RSV positivity (p<0.001);and significantly lower positivity for hRV (p<0.05), hMPV (p<0.05), and hBoV (p <= 0.005). The occurrence of COVID-19 pandemic has significantly impacted the frequency and pattern of detection of RSV among hospitalized children with LRTIs. RSV Fusion protein plays a critical role in the entry of the virus into the host cell by initiating the fusion of host and viral membranes. It happens to be a target of neutralizing antibodies paving the way as a vaccine candidate. Hence effort was made to introduce point mutation in hRSV fusion protein which can confer stability in its prefusion form. In-silico a stable structure of RSV fusion protein was generated making it a potential vaccine candidate. The timely diagnosis of RSV infection in this population is important for initiating therapy and instituting appropriate infection prevention measures. Serological testing is not widely used for the diagnosis of RSV. C ll Cultures including shell vial culture were used for RSV diagnosis. However, culture approaches lack sensitivity, often quite significantly, compared to nucleic acid amplification assays for the diagnosis of RSV infections. Molecular multiplex assays now offer increased sensitivity for a more accurate diagnosis. However issues with the use of these types of commercial panel assays include the requirement for substantial training, quality systems, and infrastructure to maintain and run these assays and many a times identification of viruses where the true pathogenic potential of those multiple viruses are debatable. Studies are available with laboratory- developed nucleic acid amplification test systems for the detection of RSVA and RSVB in clinical specimens either by PCRbased technologies or RT-LAMP. Gene targets of laboratory-developed molecular assays point towards M gene and the N gene in RSVA and -B with the benefits of flexibility to modify assays when targets are under evolutionary pressure to change, as well as a perceived initial low cost to carry out testing.
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Background: Data regarding the features and outcomes of hospitalized COVID-19 patients in Africa are increasingly available. Objective(s): To describe socio-demographic, clinical and laboratory characteristics and outcomes of COVID-19 patients. Method(s): A cross-sectional study of 86 adult patients hospitalized with COVID-19 between March and November 2020. Characteristics were described in survivors and non-survivors. Result(s): Mean age was 60.9+/-16.1 years, 53(61.6%) were male. Co-morbidities were found in 77(89.5%) patients. On severity, 6(7%) were mild, 23(26.7%) moderate, 51(59.3%) severe and 6(7%) critical. Oxygen saturation and respiratory rate were 71+/-22% and 38+/-11/minute in non-survivors and 90+/-7% and 31+/-7/minute in survivors respectively (p<0.001, p<0.001)). Overall mortality was 47.7% with no death among patients with mild disease and deaths in all patients with critical disease. Duration of hospitalization was 2.0(1.0-4.5) days in those who died and 12(7.0-15.0) days in those who survived (p<0.001). Of the 42 patients that received dexamethasone, 11(26.2%) died, while 31(73.8%) survived (p=<0.001). Conclusion(s): Most of the patients had co-morbidities and there was high mortality in patients with severe and critical COVID-19. Mean oxygen saturation was low and respiratory rate high overall. Factors associated with mortality included: Significantly greater hypoxia and tachypnea, less dexamethasone use and shorter hospitalization.Copyright © 2023 Adekanmbi O et al. Licensee African Health Sciences.
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Almost eight million people were affected by the novel coronavirus (COVID-19) disease outbreak until now. The understanding of the disease has not fully emerged, but recent studies showed that thromboembolic events are frequently seen in this unique patient group as a contributor to mortality. A 65-year-old female was admitted to the emergency department (ED) with shortness of breath and fever for three days. Physical examination was notable with tachypnea and right lower extremity edema. The bedside ultrasound evaluation showed right-sided non-compressible common femoral vein with thrombus, and her laboratory was remarkable with a high D-dimer value (39.4 mug/dl). Finally, the patient was sent to the radiology unit for pulmonary computed tomography angiography, revealing filling defects at the pulmonary arteries and parenchymal findings that are consistent with COVID-19 pneumonia and pulmonary embolism (PE). Here, we presented a case of venous thromboembolism without any risk factor but COVID-19 pneumonia. To the best of our knowledge, this is one of the first cases reported in the literature diagnosed as COVID-19 pneumonia simultaneously with PE and deep vein thrombosis in the ED. Eventually, physicians should be vigilant about the occult pathologies associated with the novel coronavirus infection.Copyright © 2023, Kuwait Medical Association. All rights reserved.
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Case report We present a rare case of a right-sided diaphragmatic herniation of the ascending colon, in a 76-year-old asthmatic patient with a non-congenital diaphragmatic hernia, no history of trauma, surgery, or radiation. The patient presented at the emergency room with dyspnea, non-productive cough, wheezing, tachypnea, tight chest, respiratory failure. This patient has a 40-year history of severe persistent extrinsic asthma, treated with high doses of inhaled corticosteroids and LABA. Before the pandemic, this patient was hospitalized 3-4 times a year for her asthma attacks, but in the last 2 years, due to Covid-19, the patient was not hospitalized, resulting in uncontrolled asthma with daily symptoms. During the hospitalization, chest radiography was performed where the hernia was suspected and confirmed by a CT Scan. Despite the diagnosis of diaphragmatic herniation, she was clinically better with the proper asthma treatment and after consulting with her family she refused the intervention to correct the hernia. She has had two vaginal deliveries, no malignancies, no trauma, no intervention in her life. In this case, the only possible cause for the herniation of the colon is persistent cough combined with advanced age, chronic steroid use, and obstructive lung disease. Non-traumatic, right-sided diaphragmatic hernia of the colon in adults is very rare. Persistent cough with other predisposing conditions of this patient is the cause of this herniation. The chest X-ray and CT were essential for making the diagnosis. Rare hernias like this should be kept in mind when coming to a diagnosis.
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Objective: Novel coronavirus has raised substantial concern for patients with chronic lung diseases. The aim of this study was to evaluate the clinical characteristics and outcome of COVID-19 in children with persistent tachypnea of infancy (PTI). Method(s): Children who were previously diagnosed with PTI and admitted for regular follow-up visits were assessed. Data on the history of having SARS-CoV-2 infection was collected. Result(s): Between January 1, 2021, and February 28, 2022, 62 patients with PTI (median age 3.7 years) were evaluated. Thirty-eight patients (61.3%) were diagnosed with COVID-19. Fourteen (36.8%) of them had a positive SARS-CoV-2 PCR test, and 24 (63.2%) were diagnosed by a positive serology test for specific antibodies connected with a history of close contact. Sixteen patients (42.1%) were asymptomatic, and 22 (57.9%) symptomatic. The most common symptoms were rhinorrhea or nasal congestion (77.3%), cough (72.7%), and sore throat (45.5%). According to NIH guidelines, 16 (42.1%) patients were classified as having mild disease, and in 3 (7.9%) children who had dyspnea, the moderate disease was recognized. Three children (7.9%) with increased dyspnea and oxygen demand required admission to the hospital. Follow-up performed in a median time of 6 months revealed that nearly all PTI patients after COVID-19 returned to their baseline status (78.9%);4 children (10.5%) suffered from exacerbating symptoms of the chILD for one month. Surprisingly two (5.3%) children became completely asymptomatic after COVID-19. Conclusion(s): SARS-CoV-2 infection in children with PTI is usually associated with a mild illness with a low risk of hospitalization.
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The average recovery time of patients with SARS COV 2 infection was very variable in many studies. Few studies focused on risk factors predicting the hospitalization time of patients with COVID 19. Aim(s): Evaluate the risk factors for a long hospitalization time of patients with SARS COV2 infection. Method(s): A retrospective study included 238 patients who was hospitalized with confirmed COVID-19 pneumonia. We defined two groups: G1:short term group < 14 days: 172 patients (72,3%) G2: long term group >14 days: 66 patients (27,7%). Result(s): The median hospitalization time was 10 days. No predominance of sex was noted in both groups (p=0,8). The average age was similar in G1 and G2 (60 years;p=0,1). Diabetes and renal failure was more frequent in G2 (G1: 30% vs G2: 44,4% and G1:5,6% vs 12%;p=0,03 and p=0,046 respectively). Hypertension and cardiac failure were similar in both groups (35% and 3%;p=0,8 and p=0,7 respectively). Patients in G2 had significantly more frequent dyspnea and tachycardia (G1:78% vs G2:92% and G1: 30% vs G2:44,4%;p=0,043 and p=0,02 respectively). Fever and polypnea were similar in both groups (61% ;p=0,8 and 75% ;p=0,7respectively). Hyperleukocytosis and eosinophilia were significantly higher in G2 (42% vs 24% ;p=0,006 and 14% vs 6% ;p=0,04 respectively). Sever radiological damage (>50% of damage) was similar in both groups (38%-40%;p=0,9). Patients admitted in reanimation had more long-term hospitalization (G1 : 3% vs G2:10%;p=0,04). Conclusion(s): The result of our study shows that diabetes, renal failure, dyspnea, tachycardia, eosinophilia, hyperleukocytosis, and admission in reanimation were risk factors of long-term hospitalization.
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NLR is an inflammatory marker suggested to be able to predict the COVID-19 severity. Aim(s): to determine the diagnostic and prognostic role of NLR level in COVID-19-associated pneumonia pts. Material(s) and Method(s): we studied 105 hospitalized pts (age-58,4 +/- 1,4 yrs, male-62 (59%)) with severe, moderate and critical Covid-19 confirmed by RNA detection of the 2019-nCoV. Measurements included medical history, clinical status, CBC with NLR calculating. Pts were divided into three groups according to disease severity (1- Group-37 critical pts (male-21 (56,7%)), 2-Group-44 severe (male-25 (26,8%)), 3-Group-24 moderate male-11 (45,8%). Result(s): research has shown that the lowest NLR level was in moderate pts - 3,5 (2,3;4,2), the highest level was observed in critical pts-8,5 (6,2;10,1) (p=0,001) (figure 1). Despite appropriate treatment, 26 examined pts showed pathological process progression (decreased SpO2, increased dyspnea and tachypnea). Cut off point of NLR level due to ROC analysis was 5,6 (figure 2). Conclusion(s): NLR is a marker of COVID-19 severity. NLR level >=5,6 can be a predictor of COVID-19-associated pneumonia progression.
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Neuroendocrine cell hyperplasia of infancy (NEHI) is a rare interstitial lung disease in children. The clinical features of the disease are characterized by tachypnea, moist rales/crepitus, retraction of compliant chest areas and delayed weight gain. The disease is diagnosed using the NEHI clinical scale coupled with the computed tomography of the chest organs. The clinical manifestations of NEHI regress as the child grows, but may persist up to the age of 10 y/o. The purpose of the research was to characterize the course of NEHI including the features of COVID-19 and the impact of passive smoking in children below the age of 8 y/o. Material(s) and Method(s): a single-center longitudinal study with follow-up observation of 29 patients with NEHI in January 2012 - December 2022 aged 8 months to 8 years old, 21 of which had COVID-19. Result(s): 20 of 29 patients with a known follow-up have undergone the long-term oxygen therapy (LTOT) at home lasting from 2 weeks up to 5.5 years (Me 1 year and 2 months;IQR 6 months - 4.5 years). Bronchial asthma was diagnosed in 2. 8 (28%) were diagnosed with atopic dermatitis, 6 (21%) with mental retardation, 3 (10%) with acute urticaria, and 2 (7%) with allergic rhinitis. Gastroesophageal reflux disease (GERD) was diagnosed in 7, all requiring LTOT. The frequency of episodes of respiratory infection was maximum in the first 2 years of life, amounting to 16 episodes per 2 years (Me 7;IQR 4 to 10), and the maximum frequency of hospitalizations during this age period was 5 (Me 2;IQR 1 to 2). Children-passive smokers were diagnosed with malnutrition more often (75%, p=0.449) and required LTOT more often (75%, p=0.694), were more often hospitalized (42%, p=0.422). Despite the possible need for LTOT patients with NEHI had COVID-19 in the form of nasopharyngitis in the majority of cases (89%). Only 8 out of 14 patients had symptoms of NEHI after 5 years of age, and only 1 out of 5 after 7 years. Malnutrition (body mass index for the age<-2) in the first year of life was diagnosed in 13 (45%) children. Malnutrition persisted in 9 out of 24 (37%) by the second year of life, in 5 out of 19 (26%) by the third year, and in 2 out of 14 (14%) by the fourth year of life. Not a single child died. Conclusion(s): the course of NEHI is characterized by the absence of lethal outcomes, frequent respiratory infections that led to hospitalizations in the first 2 years of life, mild course of COVID-19, regression of clinical symptoms and malnutrition as the child grows, comorbidity with atopic diseases and GERD. The priority should be given to the prevention of passive smoking in children with NEHI.Copyright © 2023, Pediatria Ltd. All rights reserved.
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Introduction: Extrapulmonary manifestations of COVID-19 must not be neglected during the pandemic. Subacute thyroiditis is one of the possible complications people encounter during post-COVID-19 days. Thyroid scintigraphy and radioiodine uptake test help discriminate hyperthyroidism from destructive thyrotoxicosis. Finding a more precise way to diagnose subacute thyroiditis can help in the early detection and treatment of thyroid-related disorders. Method(s): In this cross-sectional study, we evaluated 69 cases of COVID-19. Patients were divided into moderate and severe groups based on their clinical conditions. A thyroid scintigraphy scan was performed on the discharge day. Imaging was done 15-20 minutes after intravenous administration of 3-5 mCi of [99mTc]TcO4-. Scan findings were compared between moderate and severe groups and other participants' demographic and clinical features. Result(s): In 69 patients, according to thyroid scintigraphy, 25 (36%) cases were reported as thyroiditis, and the rest were normal. There was no significant difference between the normal and subacute thyroiditis groups based on age, gender, past medical history, the severity of COVID-19, laboratory values and clinical signs and symptoms. Patients with subacute thyroiditis experienced palpitation and sore throat significantly higher than the normal group (P=0.002 and P=0.009, respectively). Conclusion(s): We conclude that patients admitted due to acute COVID-19 infection experiencing palpitation and sore throat can develop subacute thyroiditis more than others. Whereas the severity of the disease and laboratory testing were not diagnostic in subacute thyroiditis, thyroid scintigraphy may help in early detection.Copyright © 2023 The Authors.
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OBJECTIVE: New-onset or persistent symptoms beyond after 4 weeks from COVID-19 are termed "long-COVID." Whether the initial severity of COVID-19 has a bearing on the clinicoradiological manifestations of long COVID is an area of interest. MATERIAL AND METHODS: We did an observational analysis of the long-COVID patients after categorizing them based on their course of COVID-19 illness into mild, moderate, and severe groups. The clinical and radiological profile was compared across these groups. RESULT(S): Out of 150 long-COVID patients recruited in the study, about 79% (118), 14% (22), and 7% (10) had a history of mild, moderate, and severe COVID-19, respectively. Fatigue (P = .001), breathlessness (P = .001), tachycardia (P = .002), tachypnea (P < .001), raised blood pressure (P < .001), crepitations (P = .04), hypoxia at rest (P < .001), significant desaturation in 6-minute walk test (P = .27), type 1 respiratory failure (P = .001), and type 2 respiratory failure (P = .001) were found to be significantly higher in the long-COVID patients with a history of severe COVID-19. These patients also had the highest prevalence of abnormal chest X-ray (60%) and honeycombing in computed tomography scan thorax (25%, P = .027). CONCLUSION(S): The course of long COVID bears a relationship with initial COVID-19 severity. Patients with severe COVID-19 are prone to develop more serious long-COVID manifestations.Copyright © Author(s).
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Aim: In severe COVID-19 infection, most organs are affected, including the thyroid gland. A decrease in thyroid functions can be seen in relation to the severity of the disease. We aimed to retrospectively analyze the relationship between thyroid function tests and mortality in patients admitted to the intensive care unit (ICU) with severe COVID-19 pneumonia. Material(s) and Method(s): The study was performed retrospectively on 46 adult patients admitted to the intensive care unit with severe COVID-19 pneumonia. Demographic, clinical, laboratory data were recorded. Patients were grouped into two according to mortality. Laboratory data were compared between groups. Additionally, the correlation of free triiodothyronine (fT3), free thyroxine (fT4), and thyrotropin (TSH) with infection parameters was investigated. Result(s): At the time of ICU admission, fT3 levels below the normal range were present in 91.3%, fT4 levels were below normal in 39.13%, and TSH levels were below normal in 52.17% of the study patients. There was a positive correlation between fT4 and CRP (r=0.315, p<0.05), while there were no significant correlations between other parameters. TSH, fT3, or fT4 did not differ between patients with and without mortality. Partial arterial oxygen pressure/fraction of inspired oxygen was lower in patients with mortality (p=0.015). Discussion(s): Low thyroid hormone levels and TSH are common occurrences in patients admitted to the ICU with severe COVID-19 pneumonia. No relationship could be shown between low thyroid function test levels and mortality in patients with severe COVID-19 pneumonia.Copyright © 2022, Derman Medical Publishing. All rights reserved.
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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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Introduction: To describe the incidence and outcomes of SARS-CoV-2 infection, to evaluate its impact (mortality), and the factors associated with infection and mortality in dialysis patients in Argentina. Method(s): All prevalent dialysis patients were included from the period from April 2020 to February 2022. The positive COVID diagnosis was always made with swab and PCR. Signs and symptoms at disease onset were included, as well as the evolution of the patient that included the requirement of hospitalization, hospitalization in a care unit (ICU) and the need for invasive respiratory assistance. Continuous variables are expressed as mean +/- standard deviation or median and range, whether or not they are parametric, continuous variables are expressed as frequency and prevalence. According to the pandemic in the general population, 3 periods were considered: period 1 (Jan2020-Feb2021), period 2 (Mar2021-Nov2021), period 3 (Dec2021-Feb2022). Univariate analysis was performed for infection and mortality as dependent variables, using the T Test, Wilcoxon or Chi2 as appropriate. Multivariate analysis was performed for the dependent variable mortality. A p<0.05 was considered significant. The analysis was performed with the software MedCalc 20113. Result(s): 27,548 cases were recorded (12,221, 10,241, and 5,086 in periods 1, 2, and 3, respectively). The median age was 60.8 years (52% > 60 years) and 58% were male. The most frequent antecedents were community transmission and close contact with a suspected or confirmed case. The most frequent symptoms were malaise (16%), headaches (13%), odynophagia (10%) and myalgia (11%). The most frequent clinical signs were: cough (28%9, Tdegree >= 38degreeC (20%), dyspnoea (12%) and tachypnoea (6%). Mean time between the onset of symptoms and the PCR result of 3.8 days. Of the positive cases, 31% required hospitalization, and of these 26% were in the ICU. Of those admitted to the ICU, 50% required MV. Overall mortality was 23.4%. Mortality was higher during the first period and consequently reduced during 2nd and 3rd period (27, 2%;19, 8%;2, 9% respectively).The most frequent CKD aetiologies were DBT, unknown and nephroangiosclerosis. Most of the patients had less than 3 years on dialysis, but the highest mortality was seen in the group with more than 3 years of dialysis. COVID-19 cases were more prevalent in HD patients compared to PD patients, however the type of modality did not show differences in terms of mortality. Table 1 shows those variables associated with mortality. [Formula presented] Conclusion(s): Throughout the three periods of the COVID pandemic, a decrease in hospitalization and mortality was observed. These variables as well as the infection rate were higher than in the general population. Vaccination, a priority in this population, was associated with lower mortality. Joint actions between Public Health entities and Scientific Societies in pandemic situations ensure an adequate diagnosis of the situation and the bases for timely actions. No conflict of interestCopyright © 2023
ABSTRACT
Introduction: The coronavirus disease 2019 (COVID-19) has rapidly spread globally and infected millions, with increasing infection rates and mortality. In our institution, there have been several cases of COVID-19 patients who, in the initial laboratory exam at the ED (Emergency Department), turned out to be dysnatremic. On admission, most patients with normal serum Na+ developed dysnatremia during their ICU (Intensive Care Unit) stay. This study aimed to determine the relationship between serum Na+ levels on presentation and any point during hospitalization with morbidity and mortality in critically ill COVID-19 subjects. Method(s): This retrospective cohort study included 261 patients aged 18 years and above diagnosed with COVID-19 infection confirmed by positive real-time RT PCR test, who were admitted from January 2020 to December 2021 in the critical care units of a tertiary care hospital. The outcomes were evaluated after 8 weeks of hospitalization as to AKI (Acute Kidney Injury), length of hospital stay, length of ICU stay, need for ventilator support, vasopressor support, COVID recovery, and mortality. Subjects' serum Na+ levels were obtained on admission, day 3, day 7, day 14, and the last serum Na+ before death or discharge. Result(s): Among the 261 COVID-19 cases analyzed, the number of patients with either hyponatremia or hypernatremia on presentation and anytime during hospitalization was 67.05%. The predominant disorder was hyponatremia, seen in 51.34% of patients (95% CI 45.10% to 57.55%). Hypernatremia was seen in 36 patients, or 13.79%. The most common etiology of both disorders was hypovolemia, mostly from poor oral intake, followed by insensible losses from fever and tachypnea, and GI losses. Mortality rates were higher in hypovolemic patients compared to euvolemic patients (86.21% vs. 42.86% in hypernatremic patients;62.77% vs. 53.85% in hyponatremic patients). Patients with dysnatremia had a significantly higher proportion of AKI (80% vs. 31.4%, p < 0.001), a longer length of ICU stay (19 vs. 12 days, p < 0.001), a higher proportion that required ventilator support (80% vs. 28%, p < 0.001) or vasopressor support (73.71% vs. 20.93%, p < 0.001), and death (64% vs. 2.33%, p < 0.001) after 8 weeks of hospitalization. In a subgroup analysis of hypernatremic and hyponatremic patients, it appeared that hypernatremia had worse outcomes in terms of AKI (94.44% vs. 75.37%), length of ICU stay (IQR 16-35 vs. 14-25), need for ventilator support (91.67% vs. 77.61%), vasopressor support (86.11% vs. 70.9%), and death (77.78% vs. 60.45%). [Formula presented] Conclusion(s): Dysnatremia at any time point during the ICU stay is related to excess mortality. Hypernatremia was a significant risk factor for mortality, especially for the subgroup of hypovolemic patients. Dysnatremia was found to be more frequent on the day of presentation in the ED, making it a potential risk stratification tool for determining COVID-19 severity and poor outcomes. Clinicians managing COVID-19 patients should know that dysnatremia anytime during hospitalization confers a higher risk for death than those presenting with normal Na+ levels, and early nephrology referral may provide benefit. No conflict of interestCopyright © 2023