Tracheostomy care and outcomes during the COVID-19 pandemic- an observational cohort perspective from Cardiff

Introduction: Prior to the COVID-19 pandemic an estimated 5000 surgical and 12000 percutaneous tracheostomies were completed in the UK each year.1 A UK study looking at COVID-19 tracheostomy outcomes found 1605 tracheostomy cases from 126 hospital, median time from intubation to tracheostomy was 15 days while 285 (18%) patients died following the procedure.2 COVID-19 patients also typically spend longer in critical care with prolonged time receiving organ support when compared to patients diagnosed with other viral pneumonias.3 Incidence of laryngeal pathologies are also higher in COVID-19 patients post tracheostomy.4 Objectives: The aim of this observational study was to review the outcomes of patients post tracheostomy insertion during the COVID-19 pandemic compared to non-COVID patients. Method(s): A service evaluation was completed including all patients requiring a tracheostomy since the beginning of the COVID-19 pandemic in March 2020 within University Hospital Wales, Cardiff. Data was captured from local tracheostomy databases. Patients were grouped into either COVID or non-COVID based on their clinical history. The key outcomes evaluated were number of tracheostomies, average time to cuff deflation and decannulation, critical care and hospital length of stay, occurrence of adverse events and time from critical care admission to tracheostomy insertion. Data was evaluated using descriptive statistics using Microsoft ExcelTM. Result(s): During the review period 58 patients with COVID-19 and 158 without required a tracheostomy. In the COVID-19 group cuff deflation occurred at a median of 10 days post insertion compared to 7 days. Decannulation occurred at a median of 16 days in patients with COVID-19 compared to 18 days. The rate of decannulation was also higher in the COVID-19 group at 74.1% compared to 67.1%. Critical care length of stay was 37 days in the COVID-19 compared to 25 days. Time from intubation to tracheostomy was comparable between groups at a median of 16 days for our COVID-19 cohort compared to 15 days. The incidence of clinical incidents was higher in the non-COVID-19 group at 10.1% compared to 5.2%. Conclusion(s): This internal service evaluation has shown that COVID-19 patients typically spend longer in critical care but their time to decannulation was shorter and their rate of decannulation was higher in our cohort then in the comparison group. This could be due to the tertiary neuroscience and major trauma specialities within our Health Board. Both with groups of patients that, due to the nature of their injuries may require prolonged periods of tracheostomy insertion even after critical care discharge.

Acute aortic thrombosis in a patient with SARS-CoV-2 coronavirus disease (COVID-19).

One of the rare and life-threatening conditions is acute aortic thrombosis. We have described a case of thrombosis of the aorta and iliac arteries in a patient against the background of viral pneumonia COVID-19, with newly diagnosed diabetes mellitus and arterial hypertension.Copyright © 2021 The authors. All right reserved.

The Association of COVID-19 Severity with Laboratory Parameters, Radiologic Findings, Maternal and Neonatal Outcomes in Pregnant Women: A Multicenter Study in Indonesia

Objectives: Severe acute respiratory syndrome-coronavirus 2/COVID-19 infection is still a global concern, with pregnant women are considered as vulnerable population. Until now, the characteristics of pregnant women in Indonesia who are infected with COVID-19, as well as pregnancy and neonatal outcomes, are still unknown. This study aims to obtain national data, which are expected to be useful for the prevention and management of COVID-19 in pregnant women in Indonesia. Method(s): There were 1,427 patients recruited in this retrospective multicenter study. This study involved 11 hospitals in 10 provinces in Indonesia and was carried out using secondary patient data from April 2020 to July 2021. COVID-19 severity was differentiated into asymptomatic-to-mild symptoms and moderate-to-severe symptoms. The collected data include maternal characteristics, laboratory examinations, imaging, pregnancy outcomes, and neonatal outcomes. Result(s): Leukocyte, platelets, basophil, neutrophils segment, lymphocytes, monocytes, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, alanine aminotransferase (ALT), aspartate aminotransferase (AST), C-reactive protein (CRP), urea, and creatinine were found to be significantly associated with severity differences (p < 0.05). Moderate-severe symptoms of COVID-19 also shown to have suggestive pneumonia findings on chest X-ray findings. Patients with asymptomatic-to-mild symptoms had significantly (p < 0.001) higher recovery rate, shorter hospital stay, less intensive care unit (ICU) admission, and had more vaginal delivery. Neonates from mother with mild symptoms also had significantly (p < 0.001) higher survival rate, higher birth weight, and higher APGAR score. Conclusion(s): Several laboratory and radiology components, as well as maternal and neonatal outcomes are related to the severity of COVID-19 in pregnant women in Indonesia.Copyright © The Author(s). 2023.

Comparison of PCR-negative patients with CT findings and PCR-positive COVID-19 patients

Aim: The gold standard diagnostic method for the diagnosis of COVID-19 is based on the demonstration of viral RNA in samples taken from the upper respiratory tract in reverse transcriptase-polymerase chain reaction (RT-PCR). However, in emergencies, the World Health Organization (WHO) also recommends to use computed tomography (CT) in order to reduce the loss of time and to provide rapid diagnosis, treatment and isolation of suspicious cases. In our study, we aimed to compare the laboratory values of patients with PCR negative CT findings and PCR positive patients. Material(s) and Method(s): The medical records of 1280 COVID-19 patients registered at our Family Medicine Center were reviewed retrospectively. Result(s): In our study, it was found that 66,70 % of PCR-negative patients with CT findings were aged 60 years and older, and 50.70% of PCR-positive COVID-19 patients were between the ages of 40-59 years;61.30% of the patients with CT findings and 48% of the PCR-positive patients were male;73% of PCR-positive patients had lung involvement. When CRP, fibrinogen and D-dimer values were examined, it was found that in PCR-negative COVID-19 patients with CT findings these values were statistically significantly higher. Discussion(s): Although the definitive diagnosis of the disease is made using a PCR test, it should not be overlooked that the patients may remain PCR negative, and it should not be forgotten that thoracic tomography findings are a good diagnostic method for this group.Copyright © 2022, Derman Medical Publishing. All rights reserved.

Late complications of the new coronavirus infection: a clinical case.

According to the literature, exudative pleurisy and pericarditis are considered rare complications of the new coronavirus infection. This estimation can be explained by the fact that statistical studies cover mainly the hospital treatment of this disease. The true frequency of these complications and their consequences are not fully understood. Aim. The study of late complications of the new coronavirus infection in the form of pleurisy and pericarditis. Conclusion. In our case, a 62-year-old patient with the new coronavirus infection confirmed by polymerase chain reaction, severe bilateral polysegmental viral pneumonia, CT3, 60% on day 43 after the onset of clinical symptoms, was found to have manifestations of pleurisy and pericarditis during outpatient treatment. Cardiac MRI is the most informative method for detecting small pericardial and pleural effusions. The diagnostic capabilities of this method are superior to ultrasounography of the heart and pleural cavities and computed tomography of the lungs. Administration of colchicine 1.0 g per day for 1 month allowed not only to the elimination of pericarditis and pleurisy, but also the reduction of pressure in the right ventricle, probably by reducing the damage to the pulmonary parenchyma.Copyright © Chepurnenko S.A. et al., 2023.

Clinical profile and outcomes of COVID-19 infection during the first wave in children with hematological illnesses and cancer: An observational study from a tertiary care center in North India

Background: Patients with cancer are at a higher risk of getting infected with the severe acute respiratory syndrome coronavirus 2 owing to their immunocompromised state. Providing care to these patients amidst the first wave of the coronavirus disease-2019 (COVID-19) pandemic was extremely challenging. Objective(s): This study was aimed at evaluating the clinical profile and disease-related outcomes of pediatric patients with hematological illnesses and cancer. Material(s) and Method(s): This retrospective study was conducted at a tertiary care center in North India during the first wave of the pandemic from March 2020 to December 2020. Children aged up to 18 years, who were treated for a hematological illness or malignancy or underwent hematopoietic stem cell transplantation (HSCT) and tested positive for COVID-19 regardless of symptoms were included in the study. Baseline demographic data related to the age, diagnosis, treatment status, and chemotherapy protocol used were collected. Outcomes including the cure rates, comorbidities, and sequelae were recorded. Result(s): A total of 650 tests for COVID-19 were performed for 181 children;22 patients were found to be COVID-19 positive. The most common diagnosis was acute leukemia (63.6%). None of the patients developed COVID-19 pneumonia. The majority of patients had asymptomatic infection and were managed at home. Among those with a symptomatic infection, the most common symptoms were fever and cough. A total of 3 (13.6%) patients needed oxygen therapy, one developed multisystem inflammatory syndrome of children leading to cardiogenic shock. Three patients required intensive care or respiratory support;all the patients had favorable clinical outcomes. The median time from the onset of COVID-19 to a negative result on the reverse transcription-polymerase chain reaction test was 21.3 days. Cancer treatment was modified in 15 patients (68.2%). Conclusion(s): Our results suggest that children with hemato-oncological illnesses rarely experience severe COVID-19 disease. The impact of the first wave of COVID-19 primarily manifested as disruptions in the logistic planning and administration of essential treatment to these children rather than COVID-19 sequelae.Copyright © 2021 Cancer Research, Statistics, and Treatment Published by Wolters Kluwer - Medknow.

Relationship Between Pulmonary Vascular Dilatation and Clinical Symptoms on Chest Computed Tomography in Patients with Confirmed COVID-19

BACKGROUND: Chest computed tomography (CT) is important in establishing a diagnosis, including detecting pulmonary vascular dilatation as a radiological feature of COVID-19, and consequently in providing comprehensive treatment. AIM: This study aimed to analyze the relationship between pulmonary vascular dilatation and clinical symptoms on chest CT in patients with confirmed COVID-19. PATIENTS AND METHODS: This retrospective and cross-sectional study was conducted at the Radiology Department of Dr. Wahidin Sudirohusodo Hospital and Hasanuddin University Hospital, Makassar, Indonesia, from July to September 2021 in a total of 231 patients with confirmed COVID-19. The Chi-squared correlation test was used to analyze the data, with p < 0.05 considered significant. RESULT(S): Pulmonary vascular dilatation was observed in 31 (37.8%) of the 82 patients with confirmed COVID-19 with mild-to-moderate clinical symptoms and in 51 (69.8%) of the 73 patients with confirmed COVID-19 with severe-to-critical clinical symptoms. The incidence of pulmonary vascular dilatation increased in the patients with confirmed COVID-19 with severe-to-critical clinical symptoms. The chief complaints of most patients were cough, shortness of breath, and fever. In the patients with mild-to-moderate clinical symptoms, the most common chief complaint was cough (n = 53;64.63%), while in those with severe-to-critical clinical symptoms, the most common chief complaint was shortness of breath (n = 60;82.19%). CONCLUSION(S): Based on chest CT findings, pulmonary vascular dilatation is related to clinical symptoms in patients with confirmed COVID-19.Copyright © 2023 Sri Asriyani, Nikmatia Latief, Andi Alfian Zainuddin, Muzakkir Amir, Bachtiar Murtala, Hendra Toreh.

Pulmonary infections in cancer patients

Lymphangitis carcinomatosa refers to pulmonary interstitial involvement by cancer and is a dreaded clinical finding in oncology because it is a late manifestation indicative of metastatic malignancy, from either a lung or a nonlung primary cancer, and is associated with poor prognosis. Its presentation is nonspecific, often with subacute dyspnoea and a nonproductive cough in a person with a known history of malignancy, but in some cases is the first manifestation of cancer. CT imaging can be suggestive, typically demonstrating thickening of the peribronchovascular interstitium, interlobular septa and fissures. However, a biopsy may be required to confirm the pathological diagnosis as these changes can also be due to concurrent disease such as heart failure, ILD, infection, radiation pneumonitis and drug reactions. Diagnosis allows symptomatic treatment, with personalised treatment directed towards the primary cancer most likely to provide a meaningful benefit. Future research should focus on prospective clinical trials to identify new interventions to improve both diagnosis and treatment of lymphangitis carcinomatosa.Copyright © ERS 2021.

Myocardial injury in coronavirus infection combined with lung, skin and kidney lesions: Clinical case and literature review

The most common clinical manifestation of new coronavirus infection is bilateral pneumonia. At the same time, COVID-19 has a wide range of cardiovascular complications, with the development of acute heart failure, arrhythmias, acute coronary syndrome, and myocarditis. Myocardial injury is relatively common in COVID-19, accounting 7-23 % of cases. The presented clinical case describes a 56-year-old patient with a confirmed coronavirus infection. The peculiarity of this clinical case is that it is the first report on COVID-19 with systemic manifestations: lungs, heart, kidneys and skin lesions. It should be noted that despite viral pneumonia typical for COVID-19, clinical picture and severity of the patient's condition were determined by the developed myocardial injury. The presented clinical case is specific due to skin lesions.Copyright © 2021, Krasnoyarsk State Medical University. All rights reserved.

Acute urticaria with Angioedema in a patient with COVID-19 pneumonia: Favipiravir side effect or a rare cutaneous manifestation

Introduction: Coronavirus disease 2019 (COVID-19) has caused thousands of deaths since it was declared as a pandemic. Recently it continues to be one of the most followed topics in the world in terms of its course and treatment. Favipiravir is a broad-spectrum anti-viral agent that has been shown to be effective against various Coronaviruses in vitro. However, as with any drug use, side effects may develop with the use of favipravir treatment. Case Report: We reported a 55-year-old female patient with acute urticarial with angioedema whom had COVID-19 pneumonia. She had no history of allergy, atopy, previous similar episodes or family history of hereditary angioedema. There is no drug or food consumption that may be suspicious in terms of allergy described by the patient other than favipravir. Conclusion(s): As far as we know, it is the first case reported from our country. Since there is no specific examination for differential diagnosis, we cannot distinguish as a rare side effect due to favipiravir treatment or COVID-19 cutaneous manifestation. As a result, studies involving more cases of COVID-19 skin findings are needed.© Copyright 2020 by Emergency Physicians Association of Turkey.

Antibiotic Stewardship Strategies to Limit Inappropriate Antibiotic Use and Reduce Multi-Drug Resistant Pathogens during Covid-19 Pandemic

Antibiotics have been extensively used in COVID-19 patients without a clear indication. COVID-19 pneumonia is associated with a mortality up to 20% varying by country with the number of global deaths over 5 million. Antibiotics have been extensively used in COVID-19 patients in intensive care units (ICUs) without a clear indication. According to a previous study, the frequency of bacterial pneumonia in COVID-19 patients was 6.9%, while >70% of patients received antibiotics. This is likely due to the clinical findings of COVID-19 pneumonia overlapping with those of bacterial pneumonia and the lack of reliable indicators of bacterial infection. Strategies that distinguish bacterial from viral pneumonia are desirable. In this session, I will discuss the impact of inappropriate antibiotic use during pandemic as well as the strategy to limit inappropriate antibiotic use as well as multi-drug resistant pathogen during COVID-19 pandemic among COVID-19 and non-COVID-19 populations.Copyright © 2023

Mitral valve thromboendocarditis in a patient with a novel coronavirus disease COVID-19

Since the beginning of the novel coronavirus disease pandemic, which has claimed millions of lives around the world, vaccines and effective therapeutic strategies have been developed, but along with this, approaches to the diagnosis and treatment of well-known diseases have changed, these metamorphoses also affected cardiovascular diseases. So, a flurry of publications is devoted to the development of myocarditis and myocardial damage within the framework of novel coronavirus infectious disease, however, there are practically no data on the concomitant course of COVID-19 and infective endocarditis or thromboendocarditis. In our case, we demonstrate the combined course of novel coronavirus infectious disease, viral pneumonia and infectious thromboendocarditis in a patient with pre-existing corrected valvular heart disease. Of particular interest are the pathogenetic links, the nature of the clinical course and prognosis in the combination of these nosologies.Copyright © 2022 Creative Cardiology. All rights reserved.

Acute Fibrinous Organizing Pneumonia in a COVID-19 Patient: A Case Report

Background: Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has varied clinical and radiographic manifestations. Severe initial viral infection, cytokine release, opportunistic infection and post-viral inflammation may all contribute to progressive symptoms and severe lung injury. Acute fibrinous and organizing pneumonitis (AFOP), a rare pattern of acute lung injury characterized by intra-alveolar fibrin ball, has so far been reported associated with infections, connective tissue diseases, drugs and toxins, hematologic malignancy, altered immune status and inhalation injury. Case Report: The authors report a case of 26-year-old man with severe COVID-19 pneumonia that clinical and radiographic imaging worsened after episode of cytokine storm. The diagnosis of AFOP was confirmed by transbronchial biopsy, and the patient was successfully treated with high-dose corticosteroids. Conclusion(s): AFOP can be found in severe COVID-19 patients especially when clinical deterioration occurs later in disease course. Clinical suspicion is needed for prompt diagnosis and treatment. High-dose corticosteroid is an effective medication.Copyright © 2023 JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND.

Respiratory support for adult patients with COVID-19

The COVID-19 pandemic is creating unique strains on the healthcare system. While only a small percentage of patients require mechanical ventilation and ICU care, the enormous size of the populations affected means that these critical resources may become limited. A number of non-invasive options exist to avert mechanical ventilation and ICU admission. This is a clinical review of these options and their applicability in adult COVID-19 patients. Summary recommendations include: (1) Avoid nebulized therapies. Consider metered dose inhaler alternatives. (2) Provide supplemental oxygen following usual treatment principles for hypoxic respiratory failure. Maintain awareness of the aerosol-generating potential of all devices, including nasal cannulas, simple face masks, and venturi masks. Use non-rebreather masks when possible. Be attentive to aerosol generation and the use of personal protective equipment. (3) High flow nasal oxygen is preferred for patients with higher oxygen support requirements. Non-invasive positive pressure ventilation may be associated with higher risk of nosocomial transmission. If used, measures special precautions should be used reduce aerosol formation. (4) Early intubation/mechanical ventilation may be prudent for patients deemed likely to progress to critical illness, multi-organ failure, or acute respiratory distress syndrome (ARDS).Copyright © 2020 The Authors. JACEP Open published by Wiley Periodicals LLC on behalf of the American College of Emergency Physicians.

Late complications of the new coronavirus infection: a clinical case.

According to the literature, exudative pleurisy and pericarditis are considered rare complications of the new coronavirus infection. This estimation can be explained by the fact that statistical studies cover mainly the hospital treatment of this disease. The true frequency of these complications and their consequences are not fully understood. Aim. The study of late complications of the new coronavirus infection in the form of pleurisy and pericarditis. Conclusion. In our case, a 62-year-old patient with the new coronavirus infection confirmed by polymerase chain reaction, severe bilateral polysegmental viral pneumonia, CT3, 60% on day 43 after the onset of clinical symptoms, was found to have manifestations of pleurisy and pericarditis during outpatient treatment. Cardiac MRI is the most informative method for detecting small pericardial and pleural effusions. The diagnostic capabilities of this method are superior to ultrasounography of the heart and pleural cavities and computed tomography of the lungs. Administration of colchicine 1.0 g per day for 1 month allowed not only to the elimination of pericarditis and pleurisy, but also the reduction of pressure in the right ventricle, probably by reducing the damage to the pulmonary parenchyma.Copyright © Chepurnenko S.A. et al., 2023.

Comparison of Chest CT Findings between COVID-19 Pneumonia and Influenza Pneumonia

Introduction: With increasing global concerns about the prevalence of COVID-19, chest imaging findings are essential for effective diseases diagnosis and treatment. There is a need to distinguish between imaging features of COVID-19 pneumonia and other viral pneumonia like Influenza.For this purpose, a study was performed on a comparison of chest CT findings between COVID-19 pneumonia and Influenza pneumonia. Method(s): Fifty patients with respiratory symptoms and positive real-time PCR (RT-PCR) of nasopharyngeal swab for Influenza and fifty patients with respiratory symptoms and positive real-time PCR (RT-PCR) of nasopharyngeal swabfor COVID-19 from March to May 2020 were enrolled in the study. In the patient's checklist, information such as demographic characteristics (age, sex), laboratory findings including (CRP, ESR, WBC), and clinical signs (fever, cough, fatigue, dyspnea) were also recorded. Result(s): Gastrointestinal symptoms, anorexia, high CRP, ground-glass opacityare more common in patients with COVID-19 pneumonia than in patients with influenza pneumonia and this difference was statistically significant (P <0.05). But, fever is more common in influenza patients than in Covid-19 patients and this difference is statistically significant (P=0.029). The location of CT scan findings in COVID-19 patients was dominant in peripheral (54 %), while the location of CT scan findings in patients with Influenza was dominant in central (32 %), which is statistically significant (P <0.05). Conclusion(s): According to the results of the study, lung CTscan findings along with some clinical and laboratory findings can help differentiate COVID-19 pneumonia from influenza pneumonia, which is very important in faster diagnosis and timely treatment of both diseases.Copyright © 2023 The Russian Archives of Internal Medicine. All rights reserved.

[The status of ENT health care workers at the forefront of fighting against COVID-19 in Wuhan and some response options].

It is a critical period of fighting against new coronavirus（SARS-CoV-2） disease now，since its outbreak on December 2019 in Wuhan.Even though the front line staffs are thought heroes，the ENT doctors and nurses are also indispensable power in defending the disease.The number of outpatients of ENT is huge.The early stage of SARS-CoV-2 pneumonia（COVID-19） may present pharyngalgia or cough without fever.Thus，the ENT doctors have high risks of being consulted by early stage COVID-19 patients.This paper means to talk about the contributions of ENT doctors and nurses in defending against SARS-CoV-2 virus，as well as the mental status of them.

Diagnostic Performance of Human Readers and Artificial Intelligence Model in Classification Task of Computed Tomography Images of Different Types of Viral Pneumonia

Purposes: Artificial Intelligence (AI) models are constantly developing to help clinicians in challenging tasks such as classification of images in radiological practice. The aim of this work was to compare the diagnostic performance of an AI classifier model developed in our hospital with the results obtained from the radiologists reading the CT images in discriminating different types of viral pneumonia. Material(s) and Method(s): Chest CT images of 1028 patients with positive swab for SARS-CoV-2 (n=646) and other respiratory viruses (n=382) were segmented automatically for lung extraction and Radiomic Features (RF) of first (n=18) and second (n=120) order were extracted using PyRadiomics tools. RF, together with patient age and sex, were used to develop a Multi-Layer Perceptron classifier to discriminate images of patients with COVID-19 and non-COVID-19 viral pneumonia. The model was trained with 808 CT images performing a LASSO regression (Least Absolute Shrinkage and Selection Operator), a hyper-parameter tuning and a final 4-fold cross validation. The remaining 220 CT images (n=151 COVID-19, n=69 non-COVID-19) were used as independent validation (IV) dataset. Four readers (three radiologists with >10 years of experience and one radiology resident with 3 years of experience) were recruited to blindly evaluate the IV dataset using the 5-points scale CO-RADS score. CT images with CO-RADS >=3 were considered "COVID-19". The same images were classified as "COVID-19" or "non-COVID-19" by applying the AI model with a threshold on the predicted values of 0.5. Diagnostic accuracy, specificity, sensibility and F1 score were calculated for human readers and AI model. Result(s): The AI model was trained using 24 relevant features while the Area under ROC curve values after 4-fold cross validation and its application to the IV dataset were, respectively, 0.89 and 0.85. Interreader agreement in assigning CO-RADS class, analyzed with Fleiss' kappa with ordinal weighting, was good (k=0.68;IC95% 0.63-0.72) and diagnostic performance were then averaged among readers. Diagnostic accuracy, specificity, sensibility and F1 score resulted 78.6%, 78.3%, 78.8% and 78.5% for AI model and 77.7%, 65.6%, 83.3% and 72.0% for human readers. The difference between specificity and sensitivity observed in human readers could be related to the higher rate of false positive due to the higher incidence of COVID-19 patients in comparison with other types of viral pneumonitis during the last 2 years. Conclusion(s): A model based on RF and artificial intelligence provides comparable results with human readers in terms of diagnostic performance in a classification task.Copyright © 2023 Southern Society for Clinical Investigation.

Cerebellar syndrome as a complication of COVID-19 disease

COVID-19 disease is caused by the new coronavirus SARS-CoV-2. The disease first appeared in China in 2019 and quickly spread throughout the world. It primarily affects the respiratory tract, manifested by fever, cough and the devel-opment of dyspnoea, but the symptoms and complications can affect any organ system. Neurological symptoms include headaches, muscle and joint pain, taste and smell disorders. Complications include inflammatory diseases of the central nervous system, ataxia, peripheral nerve and muscle diseases, worsening of extra-pyramidal diseases, and neuropsychiatric disorders. This paper presents a case report of a 62-year-old man with cere bellar syndrome, ataxia, intentional tremor and hypermetria when dealing with COVID-19 disease.Copyright © 2021 Neuroendocrinology Letters.

Management of patients with primary immunodeficiency and COVID-19: The experience of a single reference center in Moscow, Russia

Case report: At present, the course of COVID-19 in patients with various PID remains a question of a major research interest. CVID and XLA are two major types of PID, prevalent in adult patients. We present a cohort observational study of patients with COVID-19 and PID admitted to our reference center. Case 1: 37 y.o., male, with CVID and agammaglobulinemia, developed COVID-19 symptoms since October 6, 2021. PCR test positive on October 7, 2021. On 7th day of the disease CT Scan revealed lung involvement -Pattern 1. Laboratory test: CRP 65g/L(10N), LDH-239U/ L, Lymph.1x109/L. At admission, virus-neutralizing Abs (nMAbs) were initiated. The temperature stayed subfebrile. On Oct. 18, the negative progression with the incidence of new foci on CT scan, accompanied by the decrease of Lymph. 0.9 x 109/L. IL-6R blockers were initiated. Despite the administration of nAbs in the early stages of the disease (Day 7), the patient experienced SARS-CoV- 2 breakthrough, which resulted in both clinical and laboratory parameters deterioration. Thus, patients with PID might be recommended a much earlier administration of nMAbs. Case 2: 36 y.o. male, with a agammaglobulinemia has experienced several COVID-19 episodes: Episode 1 (Dec. 2020) PCR (+), the patient had no lung lesion;2 (Jan 2021) PCR (-), CT scan showed ground-glass opacities and the crazy-paving pattern;3 (Feb 2021) PCR (positive), CT scan showed ground-glass opacities and the crazy-paving pattern, Chest CT revealed Pattern 2, tocilizumab and remdesivir were administrated;4 (Feb-Mar 2021) PCR (-), Chest CT showed viral pneumonia with variable findings (treatment against pneumocystis pneumonia);5 (Mar 2021) PCR (+), CT showed Pattern 2, Double force of a specific etiotropic treatment included remdesivir and COVID-globulin as iv infusion of to "accumulate" IgG antibodies against SARS-CoV- 2 and interrupt the virus persistence was successful and the elimination was finally reached. Conclusion(s): 25 patients with PID and COVID-19 were observed, 16% of them experienced several COVID-19 episodes.Depending on the PID type, several scenarios of COVID-19 in this cohort are being discussed:.