Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 235
Filter
1.
Era's Journal of Medical Research ; 8(2):199-203, 2021.
Article in English | ProQuest Central | ID: covidwho-1964970

ABSTRACT

India is trying to maintain stability in the current circumstances;another immediate threat has developed in the shape of coronavirus diseaseassociated mucormycosis. Mucormycosis is uncommon but lethal disease, caused by a group of molds known as mucormycetes. If not treated properly, an infection might be fatal. The most ordinary risk factor is diabetes mellitus, followed by hematological malignancies. Patients with postpulmonary tuberculosis and persistent renal diseases are further probable to extend mucormycosis in India. Trauma increases the risk of cutaneous mucormycosis. Despite a rise in illness awareness among treating physicians, disease-related morbidity and mortality remain high, as patients seek medical attention late in the disease process and medication is expensive. Despite the fact that it has been present since the beginning of the pandemic, the cause of this fungal infection remains unknown. In this review we aimed to summarize about mucormycosis and its epidemiology, pathogen, and treatment options in context to COVID-19.

2.
Indian Journal of Dermatology ; 67(2):206, 2022.
Article in English | ProQuest Central | ID: covidwho-1964247

ABSTRACT

Background: Mucormycosis is an angioinvasive mucorales fungal infection. Cutaneous type formed 10.5% of cases in India in precovid-19 era. Glucocorticoid-induced immunosuppression and hyperglycemia, reusable oxygen humidifiers in COVID-19 therapy, and preexisting uncontrolled diabetes mellitus contribute to post-COVID-19 mucormycosis. However, for post-COVID-19 cutaneous mucormycosis, sufficient data is not available. Aim: To study factors related to post-COVID-19 cutaneous mucormycosis. Methodology: Clinical and investigation details of six patients admitted in tertiary center with post-COVID-19 cutaneous mucormycosis. Results: Among six patients, three were males and three females;all in 45–60 years age group from districts under tertiary center. Site of eschar was face (four) and lips (two). All six were positive for COVID-19 10–12 days prior to admission for mucormycosis. All had intravenous steroids and supportive humidified oxygen therapy for minimum 1 week under COVID-19 treatment. They presented to emergency with ophthalmic/ENT complaints;subsequently, they developed cutaneous manifestations within 2–3 days. All six had diabetes mellitus, with above 400 mg/dL sugar levels at admission. Conclusion: This study's findings correlated with various studies across the country and elsewhere. Preexisting diabetes mellitus and steroid therapy for COVID-19 increase the risk of mucormycosis. Caution for early diagnosis, maintaining blood glucose levels, and judicious use of steroids for treatment of COVID-19 are indicated.

3.
Era's Journal of Medical Research ; 8(2):204-208, 2021.
Article in English | ProQuest Central | ID: covidwho-1955361

ABSTRACT

Many complications and symptoms were documented on COVID-19 patients in the second-phase of the COVID-19 outbreak in India. Patients with COVID-19 are already of increased risk of pulmonary embolism (PE), acute cardiac injury (ACI), arrhythmias, and a variety of additional consequences such as altered mental status and proptosis. Mucormycosis, a fungal infection produced by a type of moulds known as mucormycetes, was discovered in a COVID-19 patient. It is a very rare and serious fungal infection (Black Fungus). Mucormycosis, one of the most rapidly spreading infections in COVID-19 patients, has been recorded in 11,717 cases in India. Molds dwell in the environment and primarily affect people who have a weak immune system. Inhaling pathogenic organisms from the air usually causes it to harm the sinuses and lungs. COVID-19 individuals have immunosuppressive with significant drop in CD4+T and CD8+T cells, in addition to alveoli damage and severe pulmonary inflammation. As a result, severely ill-patients, particularly those sent in the intensive-care-unit (ICU) and requiring mechanical ventilation, or those with extended hospital stays 40 to 50 days were more susceptible to mucormycosis. Further, it is crucial to find out that COVID-19 patients especially the ones who are severely ill resulting in weaker immune system can further develop a fungal infection during the middle and or latter stages of COVID-19.

4.
Era's Journal of Medical Research ; 8(2):190-193, 2021.
Article in English | ProQuest Central | ID: covidwho-1955360

ABSTRACT

Serum cortisol concentration indicates the severity of the underlying condition. More severe disease results in increased cortisol concentrations in the blood, increasing the probability of a catastrophic outcome. A high level of serum cortisol is found in patients with community-acquired pneumonia, and these patients are more likely to develop major complications and death. Corticosteroids are endogenous hormones that are produced by the hypothalamus pituitary adrenal pathway, which is involved for stress response. Considering, known risk factors of endocrine disturbance, there has been minimal discussion on measuring the serum cortisol concentration in COVID-19 patients. SARS-CoV-2 mediated pathogenetic pathways, may also affect endogenous steroid synthesis, particularly cortisol. For the purpose of improving survival rate in severe COVID-19 individuals, we discuss briefly about the current and new findings in the support of measuring the serum cortisol levels in severe COVID-19 individuals and facilitate better treatment management in this article.

5.
Journal of Clinical & Scientific Research ; 11(3):162-166, 2022.
Article in English | Academic Search Complete | ID: covidwho-1954337

ABSTRACT

Background: Rhino-orbital-cerebral mucormycosis (ROCM) has increasingly been reported in patients with severe acute respiratory syndrome coronavirus disease-2019 (COVID-19) from India. Methods: A retrospective study was done to analyse the demographic and clinical characteristics, treatment received for COVID-19 during the hospital stay, perioperative outcomes in ROCM patients posted for surgical debridement under general anaesthesia from May 2021 to July 2021 at our tertiary care teaching hospital in Tirupati, southern India. Results: Overall, 350 patients with ROCM and COVID-19 had undergone surgical debridement under general anaesthesia Mucormycosis was predominantly seen in males (65.7%). Majority of the cases (40%) were in the age group between 41-50 years. Common comorbidities were: pre-existing diabetes mellitus (DM) (70%), hypertension (32%), new-onset DM/hyperglycaemia (22%) and cardiac disease (8%). The most common sites involved in mucormycosis were the nose and paranasal sinuses (100%) followed by rhino-orbital (63.1%). A history of hospital admission for COVID-19 management was evident in 89.7%;40.7% of the patients had received oxygen therapy during their hospital stay. The use of corticosteroids for the treatment of COVID-19 was noted in 73.2%. The types of surgical procedures done were: functional endoscopic sinus surgery (FESS) (98.5%) and neurosurgery procedures (3.4%). Revision surgery was performed in 18.5% of the cases. Perioperative complications observed were anticipated difficult intubation during pre-operative airway assessment 35.7%, intraoperative hypertension 8.5%. A patient had developed intraoperative cardiac arrest, post-operative-delayed recovery and needed ventilator requirement. Outcomes of ROCM patients associated with COVID-19 were: discharged 91.7%, death 8.3%. Conclusions: Diabetes mellitus, rampant use of corticosteroids in the treatment of COVID-19 appear to have contributed to the development of ROCM. Early diagnosis, a thorough pre-operative evaluation, surgical debridement are likely to result in better prognosis in COVID-19 patients with ROCM. [ FROM AUTHOR] Copyright of Journal of Clinical & Scientific Research is the property of Sri Venkateswara Institute of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

6.
Med J Armed Forces India ; 2022 Jul 19.
Article in English | MEDLINE | ID: covidwho-1936998

ABSTRACT

Background: Corticosteroids have attracted attention as a treatment option for severe Coronavirus disease (COVID-19). However, published data on steroid therapy is debatable, and real-world data is lacking. This study evaluated the effect of treatment regimens, especially Pulse steroid therapy (Injection Methyl Prednisolone 250 mg iv once a day for three days) in severe-COVID-19 pneumonia at an Indian tertiary care hospital. Methods: This observational cross-sectional study included severe COVID-19 pneumonia patients aged >18 years, requiring assisted ventilation. As part of the hospital protocol, patients received either pulse steroid therapy, remdesivir or tocilizumab in addition to the recommended steroid doses i.e., injection of dexamethasone 6 mg iv once a day. The association of factors and treatment regimens to patient outcomes was evaluated. Results: Data of eighty-three patients were assessed, majority being above 60 years (n = 30, 36.14%) and males (n = 45/83, 54.21%). The commonest comorbidities were hypertension (n = 26), diabetes (n = 23) and obesity (n = 19), fifty-five patients (66.26%) reported at least one comorbidity. Sixty-one patients (73.49%) had received pulse steroid regimen, forty-eight patients (57.83%) were administered remdesivir-based regimen while twelve patients (14.46%) had received tocilizumab treatment. 54.1% patients managed with pulse steroid regimens were discharged after treatment, statistically similar to remdesivir-managed subgroup (62.5%, p > 0.05). On sub-group analysis, pulse steroids showed better outcomes in young males with no comorbidities. No comorbidity had significant relationship with patient outcomes (p > 0.05). Conclusion: Pulse steroid therapy is an effective therapy in management of patients with severe COVID-19 pneumonia in a real-world setting, with better outcomes in young males without comorbidities. Pulse steroids can be considered a viable option for severe-COVID-19 pneumonia management.

7.
Journal of Family Medicine and Primary Care ; 11(6):2802-2810, 2022.
Article in English | CAB Abstracts | ID: covidwho-1934394

ABSTRACT

Introduction: Acute surge in coronavirus disease-2019 (COVID)-associated mucormycosis (CAM) cases was reported during mid-May 2021, which was later declared an epidemic in various states of India including Bihar.

8.
Curr Med Res Opin ; : 1-12, 2022 Jul 24.
Article in English | MEDLINE | ID: covidwho-1927159

ABSTRACT

OBJECTIVES: With no clear end for the outbreak, identifying the drugs that are effective in COVID-19's management is of utmost importance to reduce the impact on the general population and the healthcare systems. METHODS: This is a systematic review and a meta-analysis evaluating the evidence from clinical trials on the effect of colchicine and corticosteroids against COVID-19. In this review, we have systematically searched five databases [(PubMed, Embase, clinicaltrials.gov, ICTRP, CINAHL (EBSCO)]. Cochrane's data extraction sheet was used to collect the required information, and RevMan-5.4.1 was used to conduct the meta-analysis and to assess the risk of bias. The review was registered in Prospero (CRD42022299718). RESULTS: The total number of included studies was 17, with 18,956 participants; the majority were male 12,001. Out of which, 8772 participants were on colchicine, 569 took methylprednisolone, and 64 patients received prednisolone. The meta-analysis has shown that colchicine had no significant effect on reducing the mortality rate among COVID-19 patients [OR 0.98(95% CI 0.90-1.08), p = .70), I2:1%)], corticosteroids have significantly reduced the mortality rates [OR 0.55 (95% CI 0.33-0.91), p = .02, I2:40]. Colchicine did not reduce the incidence of ICU admissions [OR 0.74 (95% CI 0.39-1.40), p = .35, I2:0%], while steroidal drugs significantly reduced the ICU admissions [OR 0.42 (95% CI 0.23-0.78), p = .005, I2:0%]. Unlike steroidal drugs [OR 0.53 (95% CI 0.30-0.95), p = .03, I2:61%], colchicine failed to reduce the need for mechanical ventilation [OR 0.73 (95% CI 0.48-1.10), p = .13, I2:76%]. Steroidal drugs significantly reduced the duration of hospitalization among COVID-19 patients [OR -0.50 (95% CI -0.79-0.21), p = .0007, I2:36%]. CONCLUSIONS: The use of colchicine did not significantly reduce the mortality rate, ICU admissions, and mechanical ventilation among COVID-19 patients. Conversely, corticosteroids significantly reduced the mortality rate, ICU admissions, mechanical ventilation, and hospitalization duration among COVID-19 patients.

9.
J Pers Med ; 12(7)2022 Jul 10.
Article in English | MEDLINE | ID: covidwho-1928600

ABSTRACT

COVID-19 has been responsible for widespread morbidity and mortality worldwide. Invasive mucormycosis has death rates scaling 80%. India, one of the countries hit worst by the pandemic, is also a hotbed with the highest death rates for mucormycosis. Cancer, a ubiquitously present menace, also contributes to higher case fatality rates. All three entities studied here are individual, massive healthcare threats. The danger of one disease predisposing to the other, the poor performance status of patients with all three diseases, the impact of therapeutics for one disease on the pathology and therapy of the others all warrant physicians having a better understanding of the interplay. This is imperative so as to effectively establish control over the individual patient and population health. It is important to understand the interactions to effectively manage all three entities together to reduce overall morbidity. In this review article, we search for an inter-relationship between the COVID-19 pandemic, emerging mucormycosis, and the global giant, cancer.

10.
Diabetes ; 71, 2022.
Article in English | ProQuest Central | ID: covidwho-1923975

ABSTRACT

Blood glucose elevates at initial high-dose steroid (HDS) administration and is prolonged by persistent amplification of glucagon-induced glycogenesis. Insulin (INS) administration at initial dose of HDS will avoid this. However, INS administration criteria regarding BS elevation are not defined. HDS were given based on COVID-treatment guidelines. HDS administration circumstances in clinical settings may clarify these criteria. The necessity of INS therapy at initial HDS administration is studied. COVID-inpatients receiving HDS, regarding a COVID-period in Japan comprising 5 waves, were sub-grouped into those requiring INS therapy and those not, and analyzed with respect to age, BMI, fasting blood glucose (FBS) , A1c, C-peptide (CPR) index, CPR/glucagon (GCG) . INS was administered, target BS level 200 mg/dL or less at 14:00, depending on BS level after HDS administration. From 396 patients, 257 received HDS as follows, 1of the 154 patients in Wave 1-3 (69.5 ± 16.7 years, BMI 23.9 ± 4.8%, A1c 6.3 ± 1.1%) , 79 of the 83 patients in Wave 4 (64.5 ± 14.6 years, BMI 24.9 ± 4.78, A1c 6.6 ± 1.1%) , and 73 of the 117 patients in Wave 5 (54.4 ± 15.2 years, BMI 25.2 ± 5.1, A1c 6.2 ± 0.8%) . Of the 257 patients above, 145 were treated with INS. In all Waves, only FBS and A1c differed significantly between INS-treated and non-INS-treated patients. ROC analysis in Wave 1-3, Wave 4 and Wave 5 showed cut-off values of A1c (sensitivity/specificity) and FBS (sensitivity/specificity) measuring 6.1% (0.85/0.62) and 121.5 mg/dL (1.00/ 0.62) , 6.5% (0.44/0.83) and133.5 mg/dL (0.40/0.93) , and 6.4% (0.49/1.0) and 112.5 mg/dL (0.81/0.85) , respectively. In patients with FBS levels of 112.5 mg/dL or higher or A1c levels of 6.3% or higher, the use of INS from the initial HDS administration reduced prolongation of hyperglycemia. Variables BMI, CPR, and GCG secretion cannot determine the need for INS therapy. It is important to use FBS and A1c levels, according to conventional practice, to ascertain if INS administration is necessary.

11.
Canadian Journal of Chemistry ; 100(7):459-474, 2022.
Article in English | ProQuest Central | ID: covidwho-1909823

ABSTRACT

For COVID-19 survivors, defeating the virus is just the beginning of a long road to recovery. The inducibility and catastrophic effects of the virus are distributed across multiple organs. The induction of cytokine storms in COVID-19 patients is due to the interaction of the SARS-CoV-2 virus and the host receptor, leading to various immunopathological consequences that may eventually lead to death. So far, COVID-19 has affected tons of people across the world, but there is still no effective treatment. Patients facing complications of COVID-19 after recovery have shown extensive clinical symptoms similar to that of patients recovering from previously circulating coronaviruses. Previous knowledge and literature have opened up ways to treat this disease and manage post-COVID-19 complications, which pose a severe challenge to the health system globally and may exacerbate the fragmentation of diseases. The use of steroids as a treatment has resulted in various health problems and side-effects in COVID-19 patients. This review discusses various post-COVID-19 complications observed and adjunctive therapies used along with common COVID-19 treatment and spotlights their side effects and consequences. This review provides the latest literature on COVID-19, which emphasizes the subsequent complications in various organs, side effects of drugs, and alternative regimens used to treat COVID-19.Alternate :Pour les survivants de la COVID-19, vaincre le virus n’est que le début d’un long chemin vers la guérison. L’inductibilité virale et les effets catastrophiques qui en découlent sont disséminés dans plusieurs organes. L’induction de tempêtes de cytokines chez les patients atteints de COVID-19 est due à l’interaction entre le virus SRAS-CoV-2 et le récepteur de l’hôte, entraînant diverses conséquences immunopathologiques, susceptibles de mener ultimement à la mort. Jusqu’à présent, le virus a frappé des millions de personnes partout dans le monde, mais il n’existe toujours pas de traitement efficace. Les patients qui présentent des complications de la COVID-19 après leur convalescence ont manifesté de nombreux symptômes cliniques semblables à ceux provoqués par d’autres coronavirus ayant circulé auparavant. Les connaissances antérieures et la littérature ont ouvert une fenêtre sur des moyens de traiter la COVID-19 et de prendre en charge les complications qui surviennent après l’infection, lesquelles posent un grave problème pour le système de santé mondial et ont le potentiel de multiplier les déclinaisons de la maladie. L’utilisation de stéroïdes comme traitement a révélé divers problèmes de santé et effets secondaires chez les patients atteints de la COVID-19. Cette revue de littérature dresse un portrait détaillé des diverses complications post-COVID-19 observées et des traitements adjuvants utilisés en association avec les médicaments couramment employés pour traiter la COVID-19, et met en évidence leurs effets secondaires et leurs conséquences. L’article offre une synthèse de la plus récente littérature sur la COVID-19, qui se concentre sur les complications subséquentes touchant divers organes, les effets secondaires des médicaments et les autres traitements qui ont été utilisés contre cette maladie. [Traduit par la Rédaction]

12.
Cureus ; 14(6): e26200, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1912130

ABSTRACT

E-vape and e-cigarettes-associated lung injury (EVALI) is a diagnostic dilemma and even more obscure during the coronavirus disease 2019 (COVID-19) pandemic. A rise was seen in EVALI cases at the beginning of the COVID-19 pandemic. Still, the non-specific presentation, or the overlapping symptoms of COVID-19 and EVALI, can negate the possible diagnosis of EVALI because of a clinician's predisposition toward infectious etiologies, and it becomes even more challenging during a viral pandemic. The patient's social history remains the key distinctive point in diagnosing EVALI. Systemic steroids are generally used along with supportive care to treat patients with EVALI. This case report demonstrates the dilemma in diagnosing EVALI in a 19-year-old female during the COVID-19 pandemic.

13.
Pharmacy (Basel) ; 10(4)2022 Jun 24.
Article in English | MEDLINE | ID: covidwho-1911509

ABSTRACT

Different pharmacotherapeutics have been introduced, and then stopped or continued, for the treatment of SARS-CoV-2. We evaluated the risks associated with mortality from SARS-CoV-2 infection. METHODS: Data was concurrently or retrospectively captured on COVID-19 hospitalized patients from 6 regional hospitals within the health system. Demographic details, the source of SARS-CoV-2 infection, concomitant disease status, as well as the therapeutic agents used for treating SARS-CoV-2 (e.g., antimicrobials, dexamethasone, convalescent plasma, tocilizumab, and remdesivir) were recorded. Discrete and continuous variables were analyzed using SPSS (ver. 27). Logistic regression identified variables significantly correlated with mortality. RESULTS: 471 patients (admitted from 1 March 2020 through 15 July 2020) were reviewed. Mean (±SD) age and body weight (kg) were 62.5 ± 17.7 years and 86.3 ± 27.1 kg, respectively. Patients were Caucasian (50%), Hispanic (34%), African-American (10%), or Asian (5%). Females accounted for 52% of patients. Therapeutic modalities used for COVID-19 illness included remdesivir (16%), dexamethasone (35%), convalescent plasma (17.8%), and tocilizumab (5.8%). The majority of patients returned home (62%) or were transferred to a skilled nursing facility (23%). The overall mortality from SARS-CoV-2 was 14%. Logistic regression identified variables significantly correlated with mortality. Intubation, receipt of dexamethasone, African-American or Asian ethnicity, and being a patient from a nursing home were significantly associated with mortality (x2 = 86.36 (13) p < 0.0005). CONCLUSIONS: SARS-CoV-2 infected hospitalized patients had significant mortality risk if they were intubated, received dexamethasone, were of African-American or Asian ethnicity, or occupied a nursing home bed prior to hospital admission.

14.
Medsurg Nursing ; 31(3):188-192, 2022.
Article in English | ProQuest Central | ID: covidwho-1904806

ABSTRACT

Remdesivir Remdesivir (Veklury®), formerly GS-5734, is a monophosphate prodrug with broad-spectrum antiviral activity;its active metabolite binds to the viral RNA-dependent RNA polymerase and inhibits viral replication through premature termination of RNA transcription (Spinner et al., 2020). The Randomized Evaluation of COVID-19 Therapy clinical trial (RECOVERY Collaborative Group, 2021) found hospitalized patients with COVID 19 who were mechanically ventilated or required supplemental oxygen had lower 28day mortality using 6 mg dexamethasone once daily for up to 10 days rather than the standard care alone. [...]dexamethasone may not be used as monotherapy in patients with viral infection because it may inhibit the protective function of T cells and block B cells from making antibodies, potentially leading to increased plasma viral load and delayed viral clearance (Theoharides & Conti, 2020). A randomized controlled trial of hospitalized patients with COVID-19 pneumonia found the use of tofacitinib resulted in lower risk of death or respiratory failure through day 28 than placebo group (Guimaräes et al., 2021).

15.
Journal of Medical Virology ; 94(4):1255-1747, 2022.
Article in English | GIM | ID: covidwho-1904355

ABSTRACT

This special issue consists of 64 papers on various aspects of COVID-19 research, including outbreaks and spread, evolution of new variants, detection and diagnosis, pathology, disease manifestations, and current treatment interventions (such as antivirals, steroids and vaccines).

16.
Curr Pharm Des ; 2022 06 14.
Article in English | MEDLINE | ID: covidwho-1902781

ABSTRACT

OBJECTIVE: Autoimmune systemic diseases (ASD) represent a predisposing condition to COVID-19. Our prospective, observational multicenter telephone survey study aimed to investigate the prevalence, prognostic factors, and outcomes of COVID-19 in Italian ASD patients. METHOD: The study included 3,918 ASD pts (815 M, 3103 F; mean age 59±12SD years) consecutively recruited between March 2020 and May 2021 at the 36 referral centers of COVID-19 & ASD Italian Study Group. The possible development of COVID-19 was recorded by means of a telephone survey using a standardized symptom assessment questionnaire. RESULTS: ASD patients showed a significantly higher prevalence of COVID-19 (8.37% vs 6.49%; p<0.0001) but a death rate statistically comparable to the Italian general population (3.65% vs 2.95%). Among the 328 ASD patients developing COVID-19, 17% needed hospitalization, while mild-moderate manifestations were observed in 83% of cases. Moreover, 12/57 hospitalized patients died due to severe interstitial pneumonia and/or cardiovascular events; systemic sclerosis (SSc) patients showed a significantly higher COVID-19-related death rate compared to the general population (6.29% vs 2.95%; p=0.018). Major adverse prognostic factors to develop COVID-19 were: older age, male gender, SSc, pre-existing ASD-related interstitial lung involvement, and long-term steroid treatment. Of note, patients treated with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) showed a significantly lower prevalence of COVID-19 compared to those without (3.58% vs 46.99%; p=0.000), as well as the SSc patients treated with low dose aspirin (with 5.57% vs without 27.84%; p=0.000). CONCLUSION: During the first three pandemic waves, ASD patients showed a death rate comparable to the general population despite the significantly higher prevalence of COVID-19. A significantly increased COVID-19-related mortality was recorded in only SSc patients' subgroup, possibly favored by preexisting lung fibrosis. Moreover, ongoing long-term treatment with csDMARDs in ASD might usefully contribute to the generally positive outcomes of this frail patients' population.

17.
Age and Ageing ; 51, 2022.
Article in English | ProQuest Central | ID: covidwho-1901103

ABSTRACT

Introduction An 88-year-old previously independent lady presented with progressive proximal weakness of all limbs and multiple falls for 10 months. Her swallowing got difficult lately. She lost weight gradually in that duration but denied any other symptoms suggestive of malignancy. PMH—Hypothyroid, Mild cognitive impairment Drg History—Atorvastatin for years. Stopped in this admission. On examination, she showed signs of proximal muscle weakness and areflexia in both upper and lower limbs without muscle tenderness. She had no facial nor eye muscle weakness. Sensory functions were intact. There were no rashes. Investigations CK 2000 TSH 24 Inflammatory markers, white cell counts—non-significant Vitamin D—18 CT-Chest Abdomen Pelvis, CT-colonography—No evidence of malignancy Paraneoplastic antibodies—Negative Anti-OJ and anti-Ro52 Antibodies—positive ENA profile—negative Anti-RNP—equivocal HMG-CoA reductase antibodies (HMCR)—Positive. Progress Prednisolone was commenced and gradually increased to 60 mg once a day but there is no significant improvement clinically though creatinine kinase level had improved. She was unfortunately infected with COVID-19 infection in the stay which delayed the plan for muscle biopsy and EMG. It affected the plan for Intravenous Immunoglobulins and was later decided to be non-beneficial due to high risks of thromboembolic events and superimposed infections. Steroid was later switched to methotrexate. She was discharged to a rehab unit. Conclusion Necrotising Autoimmune Myopathy is a rare form of idiopathic inflammatory myopathy. Risk factors include statins, cancer, connective tissue diseases, autoimmune diseases, and infections such as HIV2. Diagnosis includes clinical features, serum creatine kinase, HMG CoA reductase antibody (HMGCR-Ab), electromyography, and muscle biopsy. The first-line treatment options are steroids and immunosuppressive agents. Early use of immunoglobulin achieves good outcome. It is still under investigation for the recommended choice for immunosuppressive therapy and the duration of the therapy.

18.
Age and Ageing ; 51, 2022.
Article in English | ProQuest Central | ID: covidwho-1901101

ABSTRACT

Introduction Muscle strength is one crucial determinant of functional activity among older adults. While COVID-19 infection is often described as an acute respiratory disease with potential multiorgan involvement, its severe inflammatory nature may lead to changes to structure and function of skeletal muscles. This present study aimed to evaluate grip strength among post COVID-19 elderly with exploration of factors influencing the change in grip strength. Method Patients with history of COVID-19 infection aged ≥65 years were recruited in the COVID-19 follow up clinic. Grip strength was assessed using Jamar dynamometer following standard protocol while baseline clinical information was collected from hospital electronic medical record. Data collected were analysed to evaluate grip strength in relation to participants’ demographics, comorbidity, length of hospital stay and steroids medication use. Total steroids equivalent doses were calculated and dichotomy of 400 mg was selected based on its median. Results Ninety-three participants (mean [SD] age: 73 [6], 52.7% males) were recruited at an average (SD) of 55 (37) days after hospital discharge, with 79.6% participants hospitalized with COVID-19 of clinical category 4. Majority (74.2%) of the participants recorded measurements lower than diagnostic cut-off for low grip strength recommended by Asian Working Group for Sarcopenia (AWGS) 2019. Results showed that increasing age was associated with a decrease in grip strength (r = −0.30, p = 0.003). Besides, increase in hospital stay (r = −0.22, p = 0.035) and Charlson Comorbidity Index (CCI) score (r = −0.42, p = 0.000) were associated with decreasing grip strength measurements. No significant discrepancy in grip strength was observed between subgroups of patients receiving total steroids equivalent doses of <400 mg and ≥ 400 mg (p = 0.881). Conclusion Low grip strength readings were recorded among post COVID-19 elderly particularly patients of older age, with longer hospital stay and higher CCI. This suggests the need for close monitoring and provision of rehabilitation intervention to older adults affected by COVID-19 infection.

19.
Infectious Diseases in Clinical Practice ; 30(4):6, 2022.
Article in English | Web of Science | ID: covidwho-1895849

ABSTRACT

Background The global pandemic caused by severe acute respiratory syndrome coronavirus 2 resulted in a large burden of critically ill patients, a population with an increased risk of both developing and dying from secondary infections. We investigated the clinical characteristics, risk factors, and outcomes associated with developing bloodstream infections (BSIs) among those admitted to the intensive care unit (ICU) for coronavirus disease 2019 (COVID-19) during the peak of the first surge in New York City, before the standardization of treatment regimens limited the ability to analyze differences. Methods We performed a retrospective case-control study including all patients 18 years or older who were admitted to the ICU because of COVID-19 in April 2020 in New York City. Demographic characteristics, risk factors, and outcomes were analyzed between cases, those who developed BSI during ICU admission, and matched controls who did not develop BSI, using a logistic regression. Results Thirty-two cases and 64 controls, all with COVID-19, were matched on sex, age, and the length of ICU stay before BSI. Cases who developed BSI had higher odds of longer corticosteroid use and a preexisting diagnosis of hypertension at the time of hospital admission than controls without BSI. Conclusions We found a positive association between the duration of corticosteroids and the development of BSI. Considering immunosuppression is now the cornerstone of guidelines for COVID-19 treatment, further studies are needed to evaluate risks and mitigation strategies for these therapies.

20.
Indian J Pediatr ; 2022 Jun 14.
Article in English | MEDLINE | ID: covidwho-1889047

ABSTRACT

OBJECTIVE: To determine the outcomes in children with MIS-C receiving different immunomodulatory treatment. METHODS: In this multicentric, retrospective cohort study, data regarding treatment and outcomes of children meeting the WHO case definition for MIS-C, were collected. The primary composite outcome was the requirement of vasoactive/inotropic support on day 2 or beyond or need of mechanical ventilation on day 2 or beyond after initiation of immunomodulatory treatment or death during hospitalization in the treatment groups. Logistic regression and propensity score matching analyses were used to compare the outcomes in different treatment arms based on the initial immunomodulation, i.e., IVIG alone, IVIG plus steroids, and steroids alone. RESULTS: The data of 368 children (diagnosed between April 2020 and June 2021) meeting the WHO case definition for MIS-C, were analyzed. Of the 368 subjects, 28 received IVIG alone, 82 received steroids alone, 237 received IVIG and steroids, and 21 did not receive any immunomodulation. One hundred fifty-six (42.39%) children had the primary outcome. On logistic regression analysis, the treatment group was not associated with the primary outcome; only the children with shock at diagnosis had higher odds for the occurrence of the outcome [OR (95% CI): 11.4 (5.19-25.0), p < 0.001]. On propensity score matching analysis, the primary outcome was comparable in steroid (n = 45), and IVIG plus steroid (n = 84) groups (p = 0.515). CONCLUSION: While no significant difference was observed in the frequency of occurrence of the primary outcome in different treatment groups, data from adequately powered RCTs are required for definitive recommendations.

SELECTION OF CITATIONS
SEARCH DETAIL