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1.
Cells ; 11(16), 2022.
Article in English | EMBASE | ID: covidwho-2032864

ABSTRACT

Neurofilament light chain (NfL) is a specific biomarker of neuro-axonal damage. Matrix metalloproteinases (MMPs) are zinc-dependent enzymes involved in blood–brain barrier (BBB) integrity. We explored neuro-axonal damage, alteration of BBB integrity and SARS-CoV-2 RNA presence in COVID-19 patients with severe neurological symptoms (neuro-COVID) as well as neuro-axonal damage in COVID-19 patients without severe neurological symptoms according to disease severity and after recovery, comparing the obtained findings with healthy donors (HD). Overall, COVID-19 patients (n = 55) showed higher plasma NfL levels compared to HD (n = 31) (p < 0.0001), especially those who developed ARDS (n = 28) (p = 0.0005). After recovery, plasma NfL levels were still higher in ARDS patients compared to HD (p = 0.0037). In neuro-COVID patients (n = 12), higher CSF and plasma NfL, and CSF MMP-2 levels in ARDS than non-ARDS group were observed (p = 0.0357, p = 0.0346 and p = 0.0303, respectively). SARS-CoV-2 RNA was detected in four CSF and two plasma samples. SARS-CoV-2 RNA detection was not associated to increased CSF NfL and MMP levels. During COVID-19, ARDS could be associated to CNS damage and alteration of BBB integrity in the absence of SARS-CoV-2 RNA detection in CSF or blood. CNS damage was still detectable after discharge in blood of COVID-19 patients who developed ARDS during hospitalization.

2.
Critical Care Medicine ; 50(9):1411-1415, 2022.
Article in English | EMBASE | ID: covidwho-2032195
3.
ASAIO Journal ; 68:146, 2022.
Article in English | EMBASE | ID: covidwho-2032192

ABSTRACT

Background: Revised guidelines clarify indications for extracorporeal membrane oxygenation (ECMO) support in patients with COVID-19-related acute respiratory distress syndrome (ARDS). Commercially available ECMO analytics software records granular perfusion data continuously throughout the run. To date, electronic-medical record (EMR) clinical data has not been integrated with ECMO perfusion data and analyzed with machine learning-based algorithms to improve patient care. Methods: Retrospective chart review was performed on all SARS-CoV2 positive patients cannulated to veno-venous ECMO at an urban highvolume regional referral center from March 1st, 2020, through December 31st, 2021. Categorical data including patient demographics, clinical outcomes, and laboratory data (complete blood count, basic metabolic panel, arterial blood gas, lactate, anticoagulation assays) and vital signs (pulse, arterial line blood pressure, oxygen saturation) were collected for the entirety of the ECMO run. Time-series perfusion data (arterial flow normalized to body surface area (BSA), sweep gas, delta pressures normalized to arterial flow) were captured every 60-120 seconds. We constructed a predictive long-short term memory (LSTM) predictive model that integrated clinical and time-series data using an extended machine learning (ML) framework with neural network. Primary outcome was successful ECMO decannulation. Data were truncated to discrete and relative timepoints (7, 14, 21 days, or percent of the run). Receiver operating characteristic (ROC) curves show the model's diagnostic accuracy. Results: 42 patients were included in the analysis (30 male, 12 female). Mean age was 43.9 (SD=11.5) years old, and mean duration of ECMO run was 36.2 (SD=30.1) days. 24 patients were successfully decannulated and 4 are currently supported on ECMO. When provided the complete data, the LSTM model showed an area under the ROC curve >0.95, demonstrating strong diagnostic accuracy in predicting successful ECMO decannulation (Figure 1A). When data were truncated to only the first two weeks of the ECMO run, the area under the ROC curve was 0.93 (Fig. 1B). Patterns of arterial flow normalized to BSA and sweep gas normalized to flow also appear different in patients with divergent clinical outcomes (Fig 2). Conclusion: Characterizing key determinants of ECMO support may offer intensive care unit healthcare teams potentially lifesaving information in real-time. Our machine-learning model successfully integrates clinical and perfusion data from the mind's eye of a clinician managing the care of a patient supported with ECMO. We have identified critical variables with the most meaningful impact on the mechanics of ECMO support. Our model may also help predict patient outcomes into and offer clinicians opportunities for interventions to improve care. (Figure Presented).

4.
ASAIO Journal ; 68:66, 2022.
Article in English | EMBASE | ID: covidwho-2032186

ABSTRACT

Background: SARS-CoV-2 (i.e., COVID-19) has brought extracorporeal membrane oxygenation (ECMO) into the forefront of critical care. Its unique pathophysiology has added a level of complexity to ECMO therapy, particularly, the hematologic manifestations. Here we detail the spectrum and outcomes of bleeding complications in ECMO for COVID-19 and identify potential contributing factors. Methods: All patients who received ECMO for SARS-CoV-2 pneumonia severe acute respiratory distress syndrome at our institution between March 1, 2020 and April 12, 2021 were reviewed. Patient characteristics, laboratory results, and overall outcomes were recorded. Bleeding events were reviewed with regard to the type/location and intervention required. Severity was graded according to the degree of intervention for treatment (1 [conservative or minor] - 3 [major, life-threatening, or operative]). Laboratory results and patient characteristics were compared between patients with bleeding events and those without to identify factors associated with bleeding risk. Results: Fifty-four patients (mean age 53.2 years, 61.1% female, 51.9% Caucasian) underwent ECMO cannulation for SARSCoV-2 pneumonia at our institution. Thirty-eight (70.4%) received veno-pulmonary artery ECMO. The mean duration of support was 33.2 days with an in-hospital mortality of 42.6%. 68.5% of patients experienced at least one bleeding event during their ECMO course with 92 bleeding events (n=23 [grade 1], n=31 [grade 2], n=38 [grade 3]) over 1804 cannulation days. The most common types of bleeding types were nasal/oropharyngeal (n=30, 32.6%), pulmonary (n=18, 19.6%), and gastrointestinal (n=11, 12.0%). Eight (16.0%) patients required operative intervention and 11 (20.3%) died as a result of a bleeding event, mainly due to intracranial hemorrhages (n=5, 9.3%). There was no difference in the mean cumulative function for bleeding events between different ECMO support modalities (p=0.85) which demonstrated a linear pattern over time. Factors that increased the risk of bleeding included patient cumulative volume balance (OR 1.22 per 1000 mL increase from admission, p<0.001) while higher platelet count (OR 0.83 per 50x103/uL increase, p=0.03) was protective. Conclusion: ECMO for SARS-CoV-2 pneumonia is associated with a diverse and unique profile of bleeding complications. The incidence of bleeding complications is linearly related to cannulation duration. Certain patient factors may affect the risk of bleeding while on ECMO.

5.
ASAIO Journal ; 68:66, 2022.
Article in English | EMBASE | ID: covidwho-2032185

ABSTRACT

Background: The COVID-19 pandemic has led to a significant increase in the use of Veno-venous extracorporeal membrane oxygenation (VV ECMO) as a bridge to various outcomes including transplantation or recovery. Unlike other etiologies of acute respiratory distress syndrome (ARDS), utilization of VV ECMO in COVID-19 has been associated with longer duration of ECMO support requirements. Our team sought to evaluate outcomes associated with prolonged duration of ECMO support in this patient population. Methods: Single-center retrospective review of patients who were placed on ECMO due to COVID-19 associated ARDS. Specifically examining outcomes-mortality, transplantation and discharge rates-of patients requiring VV ECMO support more than 50 days in duration. Data collected between February 15,2020 to February 15, 2022. Results: Reviewed outcomes in 18 patients who required VV support for >50 days. Twenty three percent (n=4) mortality rate within cohort. Three patients (16%) continue to require ECMO support at time of submission. Sixty-one percent (n=11) patients were discharged, of which sixteen percent (n=3) required a lung transplant (Table). Summary: Prolonged VV ECMO at our center was associated with comparable outcomes to the national ELSO pulmonary ECMO cohort. With availability of device and staffing, prolonged ECMO runs can potentially be justified in a highly selected patient population (Table Presented).

6.
ASAIO Journal ; 68:65, 2022.
Article in English | EMBASE | ID: covidwho-2032184

ABSTRACT

Objectives: The purpose of this study was to compare the outcomes of chest tubes (CT) inserted via three approaches in COVID-19 patients undergoing extracorporeal membrane oxygenation (ECMO): open thoracostomies (OT), percutaneously at bedside (PERC), and percutaneously by interventional radiology (PERC IR). Methods: We conducted an institutional review board - approved retrospective study of all COVID-19 patients who required CT placement while undergoing ECMO in our institution from February 2020 till February 2022. Insertions prior to ECMO cannulation or after decannulation, and those related to post-operative lung transplantation during ECMO were excluded from our analysis. Depending on the insertion approach, eligible CT insertion events were divided in three groups: OT, PERC and PERC IR. Data regarding patients' demographics and CT characteristics, clinical indications and associated complications for each group were collected and analyzed. Bleeding related to CT insertion was diagnosed based on requirement of blood transfusion, cessation of anticoagulation and/or ongoing bloody CT output. Results: Study criteria were met by 43 patients, with 35 (83.7%) of male sex. Mean age was 45 years. Mean BMI was 31.6 kg/m2. Forty patients (93.0%) had COVID-related acute respiratory distress syndrome as primary diagnosis. All patients but one had been receiving therapeutic anticoagulation which was held prior to CT insertion. Eighty-seven CT insertion events were recorded, of which 34 (39.1%) comprised the OT group, 20 (23.0%) the PERC group, and 33 (37.9%) the PERC IR group. Table 1 demonstrates a descriptive comparison of CT and insertion data among the three groups. Table 2 depicts the major outcomes among the three groups. Conclusions: For COVID-19 patients on ECMO, insertion of CTs percutaneously by IR is associated with significantly fewer bleeding episodes, transfusions, thoracic consults and explorations in the operating room compared to bedside OT or percutaneous CTs. One third of the percutaneously placed CTs by IR required tube upsizing in the IR suite, a rate still lower compared to the overall CT manipulations or repeat interventions required for CTs inserted via OT or percutaneously at bedside. (Table Presented).

7.
ASAIO Journal ; 68:63, 2022.
Article in English | EMBASE | ID: covidwho-2032181

ABSTRACT

Background: In patients with COVID-19 and respiratory failure, class 3 obesity (body mass index > 40 kg/m2) has been associated with worse survival. Obese patients on mechanical ventilation with progressively more severe acute respiratory syndrome (ARDS) may be offered venovenous (VV) extracorporeal membrane oxygenation (ECMO) therapy. The impact of morbid obesity on the outcome of COVID-19 patients supported with VV ECMO has been underexplored. Methods: This is a multicenter, retrospective observational cohort analysis of critically ill adults with COVID-19 ARDS requiring advanced mechanical ventilation with or without VV ECMO. Data was collected from 236 international institutions forming the COVID-19 Critical Care Consortium international registry. Patients were admitted between January 2020 to December 2021. Included patients were stratified by ECMO status and a BMI threshold at 40 kg/m2. Median values with interquartile range (IQR) were used to summarize continuous variables and multi-state analysis was used to explore the effect of Class 3 obesity on the study endpoints of patient survival to discharge or death. Results: Complete data was available on 8851 of 9059 patients on mechanical ventilation, of which 767 patients required VV ECMO. For the entire study group, older age and male gender were associated with an increased risk of death. The demographics and comorbidities of the higher BMI (H >40 kg/m2) and lower BMI (L ≤40 kg/m2) cohorts were similar with the exception of age and weight. Patients with a higher BMI were younger. The median age of the H, non-ECMO cohort was 56 years (46-64), and the H, ECMO cohort was 41 years (35-51) versus the L, non-ECMO cohort of 64 years(55-71), and the L, ECMO cohort of 53years (45-60). Patients requiring VV ECMO had higher SOFA scores, experienced longer ICU and hospital lengths of stay, and a longer duration of total mechanical ventilation. Table The median time to intubation was longer in the mechanical ventilation only group (2 versus 0 days). Predictors for requiring ECMO included younger age, higher BMI and male gender. Risk factors for death included advancing age (every 10 years), male gender and increasing BMI (every 5kg/m2). The association between BMI and a higher rate of death was reduced in the mechanical ventilation only group (HR 0.92, 95% confidence interval 0.85 to 0.99). Conclusion: In patients with severe ARDS due to COVID-19 requiring mechanical ventilation, the likelihood of progressing to VV ECMO therapy or experiencing death is impacted by age, gender and higher BMI. The cohort of COVID-19 patients that ultimately required ECMO appear to be sicker at time hospital admission owing to the shorter time until mechanical ventilation. It appears the association between increasing BMI and death differs among the ECMO and mechanical ventilation alone cohorts. We would advocate for a prospective study to determine the benefit of VVECMO for the obese patient requiring VV-ECMO for COVID-19 ARDS. (Figure Presented).

8.
ASAIO Journal ; 68:62, 2022.
Article in English | EMBASE | ID: covidwho-2032180

ABSTRACT

Background: Veno-venous (VV) extracorporeal membrane oxygenation (ECMO) is increasingly being utilized to manage critical COVID-19 associated ARDS (CCAA) in patients who fail medical optimization and mechanical ventilatory support. The aim of this study was to determine the probability of weaning patients from ECMO over time and whether a subset of patients should be considered for lung transplantation. Additionally, we investigated when lung transplant should be considered after VV ECMO support. Methods: 49 patients with CCAA who required ECMO between January 2020 and September 2021 were investigated. Baseline patient demographics, clinical, laboratory, and follow-up data were compared. The change in probability of ECMO weaning based on duration of ECMO support was studied using a univariate analysis. Additionally, patients who received lung transplantation following VV ECMO for COVID-19 during this same period were studied to compare outcomes to those of patients with only VV ECMO support. Cox proportion hazard analysis was performed to determine predictors of survival in patients who required greater than 28 days of ECMO support. Yuden index was used to determine change in probability of survival with time on ECMO. Results: Of 49 patients, 17 (35%) received lung transplants and 32 (65%) remained on ECMO for >28 days. The probability of weaning patients from ECMO was highest within the first 10 days (60%);beyond 40 days, it was 5.1% (Fig. A). The probability of successfully weaning patients from ECMO significantly decreased over time and ECMO support greater than 28 days (Yuden index, Hazard ratio: 1.09, 95% CI;1.00-1.03) was associated with a significantly increased risk of mortality. Additionally, both survival to hospital discharge (p<0.001, Fig. B) and post-discharge survival (p<0.001, Fig. C) were significantly greater in those who were weaned from ECMO prior to 28 days than those who were weaned after 28 days. In those who could not be weaned from ECMO, lung transplantation (HR:0.47, p<0.01, 95% CI 0.17-0.94), ECMO duration (HR:1.09, p=0.01, 95% CI 1.00-1.03) and higher BUN levels (HR:1.02, p<0.01, 95% CI 1.01- 1.46) prior to ECMO initiation were independent predictors of survival. ECMO support of greater than 8 days was associated with a statistically significant increase in mortality compared to those who received fewer than 8 days of support (Yuden index, HR 1.96, CI 1.06-5.51). Furthermore, the projected survival of patients on ECMO support for greater than 8 days was substantially worse than those requiring fewer than 8 days of support (Fig. C and D). Conclusion: This study suggests that survival and accompanying lung recovery is more probable in patients who require a short duration of ECMO support whereas those who require longer durations, particularly exceeding 28 days, is associated with a lower rate of survival. (Figure Presented).

9.
ASAIO Journal ; 68:5, 2022.
Article in English | EMBASE | ID: covidwho-2032177

ABSTRACT

Hypercapnia and respiratory acidosis lead to increased morbidity and mortality in critically ill patients. Extracorporeal CO2 removal (ECCO2R) can rapidly correct pH and PaCO2 as a treatment for refractory, hypercapnic respiratory failure. Current clinical evidence for the benefits of ECCO2R is primarily limited to case series and single-center studies. The Hemolung (ALung Technologies, Inc., Pittsburgh, PA) is the only FDA cleared ECCO2R system and has been utilized to treat greater than 1,000 patients world-wide. The purpose of this study was to evaluate real-world evidence of the Hemolung ECCO2R system for the treatment of hypercapnic respiratory failure across a range of primary diagnoses. Methods: The Hemolung Registry was queried for patients with a baseline, pre-Hemolung pH < 7.35. Patients receiving either noninvasive or invasive ventilation were included in the analysis. Physiological benefits of Hemolung therapy were evaluated using a mixed model for repeated measures based on changes in pH and PaCO2 after 4-6 hrs and 16-35 hrs of Hemolung therapy compared to the baseline value. The model was used to calculate two-sided 95% confidence intervals and associated nominal p-values. Additional markers of clinical improvement included avoidance of intubation, survival to decannulation, and Hemolung CO2 removal rate and duration of use. Adverse events were also analyzed based on patient harm. Results: 176 Hemolung patients were included in the analysis. Multiple primary diagnoses were represented: 31% ARDS, 22% COPD exacerbation, 32% COVID-19, and 15% Other. Median CO2 removal by the Hemolung during the first day of therapy was 88 mL/min and resulted in a concomitant correction of pH from a median of 7.20 to 7.35 (p<0.001) and median PaCO2 correction of 81.7 to 57.0 mmHg (p<0.001). Correction of respiratory acidosis was independent of primary diagnosis, age, and BMI. 69% (112/162) of patients survived to de-cannulation. 86% (19/22) of patients failing NIV avoided intubation. There were no unanticipated complications, and the majority of adverse events did not require medical intervention or discontinuation of Hemolung therapy. 3 deaths associated with Hemolung therapy occurred. Conclusion: These data represent the largest reported analysis of ECCO2R therapy to treat a diverse population of hypercapnic respiratory failure patients. The results demonstrate significant correction of pH and PaCO2 within the first day of Hemolung therapy without significant adverse events. Data from forthcoming RCTs will shed further light on whether these physiologic benefits translate to improved outcomes compared to current standard of care.

10.
Multiple Sclerosis and Related Disorders ; 65, 2022.
Article in English | EMBASE | ID: covidwho-2031581
11.
Trials ; 23(1):784, 2022.
Article in English | PubMed | ID: covidwho-2029733

ABSTRACT

BACKGROUND: Corticosteroids are one of the few drugs that have shown a reduction in mortality in coronavirus disease 2019 (COVID-19). In the RECOVERY trial, the use of dexamethasone reduced 28-day mortality compared to standard care in hospitalized patients with suspected or confirmed COVID-19 requiring supplemental oxygen or invasive mechanical ventilation. Evidence has shown that 30% of COVID-19 patients with mild symptoms at presentation will progress to acute respiratory distress syndrome (ARDS), particularly patients in whom laboratory inflammatory biomarkers associated with COVID-19 disease progression are detected. We postulated that dexamethasone treatment in hospitalized patients with COVID-19 pneumonia without additional oxygen requirements and at risk of progressing to severe disease might lead to a decrease in the development of ARDS and thereby reduce death. METHODS/DESIGN: This is a multicenter, randomized, controlled, parallel, open-label trial testing dexamethasone in 252 adult patients with COVID-19 pneumonia who do not require supplementary oxygen on admission but are at risk factors for the development of ARDS. Risk for the development of ARDS is defined as levels of lactate dehydrogenase > 245 U/L, C-reactive protein > 100 mg/L, and lymphocyte count of < 0.80 × 10(9)/L. Eligible patients will be randomly assigned to receive either dexamethasone or standard of care. Patients in the dexamethasone group will receive a dose of 6 mg once daily during 7 days. The primary outcome is a composite of the development of moderate or more severe ARDS and all-cause mortality during the 30-day period following enrolment. DISCUSSION: If our hypothesis is correct, the results of this study will provide additional insights into the management and progression of this specific subpopulation of patients with COVID-19 pneumonia without additional oxygen requirements and at risk of progressing to severe disease. TRIAL REGISTRATION: ClinicalTrials.gov NCT04836780. Registered on 8 April 2021 as EARLY-DEX COVID-19.

12.
Anaesthesia, Pain & Intensive Care ; 26(4):535-545, 2022.
Article in English | Academic Search Complete | ID: covidwho-2026668

ABSTRACT

COVID-19 cases in Indonesia seemed to be increasing by each passing day at the time of writing this review, more positive cases discovered than the recovered ones. With the highest rank within all ASEAN countries, and also a home of many variants of COVID-19, Indonesia had become a break off destination to others. Along with the problem associated with the pandemic, which all people had to face, the purpose of this review is to elaborate the use of convalescent plasma therapy on treatment against COVID-19, especially its different variants. We overview the evidence that we obtained from several databases using specific keywords. A large amount of evidence points out that the convalescent plasma therapy has shown a promising outcome against COVID-19 infection, as it did for infectious diseases. Although in COVID-19 variants of concern, convalescent plasma therapy showed a reduction in neutralization ~ 3-fold against P.1, and 7-13 folds against B.1.351 variant, it still can be used as a treatment for COVID-19 and its variants. Abbreviations: PPE - personal protective equipment;VoC - Variants of concern;VoI - Variants of interest;CPT - convalescent plasma therapy;RBD - receptor-binding domain;ARDS - Acute Respiratory Distress Syndrome;ICU - Intensive Care Unit;IQR - Interquartile Range;RCT - Randomized Clinical Trial;RT-PCR - Reverse Transcriptase- Polymerase Chain Reaction;NAbs - neutralizing antibodies [ FROM AUTHOR] Copyright of Anaesthesia, Pain & Intensive Care is the property of Department of Anaesthesia, Pain & Intensive Care 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.)

13.
Archives of Clinical Neuropsychology ; 37(6):1428-1428, 2022.
Article in English | Academic Search Complete | ID: covidwho-2017727

ABSTRACT

Objective: The neuropsychological impact of COVID-19 is a budding area of research. Studies suggest greater neurological abnormalities in patients presenting with a severe illness course, particularly those with acute respiratory distress syndrome. The purpose of this case study was to characterize the neurocognitive and psychological profile of a 57-year-old male following prolonged hospitalization for COVID-19 in March 2020, including 42 days on mechanical ventilation. Method: Relevant data were collected via clinical interview, neuropsychological testing, and medical record review. Hospital course was notable for hypertension, acute kidney failure, and pressure ulcers. Computerized tomography and electroencephalogram revealed mild cortical atrophy and mild to moderate generalized slowing, respectively. Approximately 15 months post-discharge, subjective complaints during the evaluation included cognitive "fogginess," increased impulsivity, decreased frustration tolerance, forgetfulness, fatigue, mobility difficulties, and dyspnea upon exertion. Results: Neuropsychological testing, within the context of likely average premorbid functioning, revealed declines in motor functioning, confrontation naming, phonemic fluency, planning/organization, visual memory, and aspects of verbal memory. Poor performance on select memory tasks was likely driven by executive dysfunction. Behaviorally, the patient presented as disinhibited, impulsive and labile. Emotionally, he endorsed symptoms of posttraumatic stress, anxiety, and depression. These post-COVID-19 sequelae have impacted functioning across multiple domains including ability to work, medication and finance management, and complex decision-making. Conclusions: Results suggest bilateral frontal and temporal dysfunction rather than subcortical deficits from hypoxia. Similar to post-intensive care syndrome, the etiology of functional impairment in severely ill, hospitalized COVID-19 patients appears multifactorial. Likely mediating factors include COVID-19 itself, associated complications, intervention methods, and psychological distress. [ FROM AUTHOR] Copyright of Archives of Clinical Neuropsychology is the property of Oxford University Press / USA 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.)

14.
Obshchaya Reanimatologiya ; 18(4):11-19, 2022.
Article in Russian | EMBASE | ID: covidwho-2010542

ABSTRACT

One of the main problems facing intensivists when treating patients with COVID-19 is severe and critical acute respiratory distress syndrome (ARDS) with the underlying viral pneumonia. The current guidelines of the Russian Ministry of Health (Version 15 of 22.02.22) do not include drugs with a lung protective effect. This issue could be solved by administration of a synthetic analogue of leu-enkephalin. Aim. Study the efficacy of a synthetic analogue of leu-enkephalin in ARDS in patients with COVID-19. Materials and methods. The study included 35 patients divided into 2 groups. Group 1 (main) patients (n=15) in addition to standard therapy received a continuous infusion of synthetic analogue of leu-enkephalin at a rate of 5 µg/kg/hour for 5 days. Patients from group 2 (control, n=20) were treated according to the Temporary Guidelines of the Ministry of Health (V.15), but without the synthetic analogue of leu-enkephalin. The radiological data, frequency, severity and evolution of respiratory complications, changes in P/F (PaO2/FiO2) ratio, as well as changes in the scores of prognostic APACHE II, SOFA, and NEWS scales were evaluated. Results. In patients taking the studied drug, the percentage of lung damage did not change with the median (IQR) of 0 [–8;0], while in the control group it increased by approximately 10% with the median (IQR) of +10,0 [+2;+20] (P=0.001). The proportion of patients in group 1 with positive disease evolution within 5–9 days after treatment initiation was significantly higher and reached 46.7 [24.8;69.9]%, whereas in group 2 it was 15.0 [5.2;36.0]% (P=0.04). Also, in group 1, starting from day 4, the median P/F ratio was significantly higher than in group 2 reaching 220 [185;245] versus 127 [111;158], respectively (P=0.014). The need for non-invasive lung ventilation in group 1 on day 7 averaged 6.7%, while in group 2 it was as high as 45.0%, which was significantly higher than in the main group (P=0.013). Conclusions. The use of synthetic analogue of leu-enkephalin according to the specified regimen had a significant impact on the main parameters of the viral pneumonia severity. The results serve as a rationale for the development of a novel effective treatment strategy to supplement the current standard COVID-19 management.

15.
Journal of Xi'an Jiaotong University (Medical Sciences) ; 43(5):791-796, 2022.
Article in Chinese | EMBASE | ID: covidwho-2010484

ABSTRACT

COVID-19 is seriously endangering people's health and has become a global public crisis. The main target of the disease is the respiratory system. Acute respiratory distress syndrome and diffuse alveolar hemorrhage are the main clinical manifestations, which have aroused broad concern. However, SARS-CoV-2 involves multiple organs including the kidney. Acute renal injury caused by the virus is common, but is often underestimated or even overlooked. Acute renal injury is more common in critical patients with COVID-19 and is an independent risk factor for adverse prognosis. The latest research results at home and abroad on COVID-19 complicated with acute renal injury include epidemiology, risk factors, pathogenesis, pathological manifestations, prevention and treatment schemes, which help strengthen clinicians' understanding of acute renal injury, formulate targeted management strategies, and improve the overall prognosis of patients.

16.
Journal of SAFOG ; 14(4):424-428, 2022.
Article in English | EMBASE | ID: covidwho-2010443

ABSTRACT

Background: The new coronavirus disease 2019 (COVID-19) is a worldwide pandemic. Concerns have been raised about the influence of SARS-CoV-2 infections on pregnant mothers and their fetuses, and patient care in the setting of COVID-19 is difficult. As a result, the current study was conducted to determine the outcomes of pregnant females with COVID-19 infection and their obstetric care of COVID-19. Materials and methods: The study enrolled 8622 pregnant women from April 1st, 2020 to September 30th, 2020 at Lokmanya Tilak Medical College and Sion Hospital, a tertiary care hospital. There were 455 women who tested positive for COVID, whereas the remaining 8167 patients tested negative for COVID. The results obtained were compared in both groups. Results: The percentage of pregnant women who tested positive for COVID was determined to be 5.27%. Most patients were delivered by LSCS in the COVID-positive group (49.45%) than in the COVID-negative group (43.95%) (p >0.05). Among 455 COVID-positive women, 401 were asymptomatic, whereas 54 patients showed COVID-19 symptoms like fever and cough (12%). All patients with mild symptoms were adequately handled with a multivitamin supplement, high-protein diet, fluid-electrolyte balance, regular vitals monitoring, and prophylactic antibiotic therapy. In total, 23 women were admitted to the intensive care unit after developing severe COVID-19 pneumonia with ARDS. The risk of maternal mortality in COVID-positive patients was somewhat higher 16 (3.51%) than in COVID-negative pregnant women 39 (0.47%) (p <0.05). In the majority of neonates in both the COVID-positive and-negative women, Apgar score was normal 7–10, and birth weight between 2.6 and 3 kg. Low Apgar scores (0–3) were seen in 6 (1.43%) of COVID-positive mothers’ neonates and 197 (2.60%) of COVID-negative mothers’ neonates. Overall, the majority of the newborns were healthy. Swabs from seven neonates were first determined to be positive, but were retested on day five and proved to be negative. Conclusions: In times of global pandemic, quick and judicious management of COVID-19 positive pregnant women is a critical notion for safe motherhood and healthy children. However, our findings reveal that COVID infection has no substantial influence on maternal and fetal outcomes in pregnancy, and there is no indication of vertical transmission of the COVID-19 infection, but long-term monitoring of these newborns is suggested.

17.
Clinical obstetrics and gynecology ; 2022.
Article in English | MEDLINE | ID: covidwho-2008650

ABSTRACT

In the last 2 decades, the use of venovenous (VV) and venoarterial (VA) extracorporeal membrane oxygenation (ECMO) during pregnancy and the postpartum period has increased, mirroring the increased utilization in nonpregnant individuals worldwide. VV ECMO provides respiratory support for patients with acute respiratory distress syndrome (ARDS) who fail conventional mechanical ventilation. With the COVID-19 pandemic, the use of VV ECMO has increased dramatically and data during pregnancy and the postpartum period are overall reassuring. In contrast, VA ECMO provides both respiratory and cardiovascular support. Data on the use of VA ECMO during pregnancy are extremely limited.

18.
Annals of the Rheumatic Diseases ; 81:332, 2022.
Article in English | EMBASE | ID: covidwho-2009139

ABSTRACT

Background: Dermatomyositis (DM) patients have fewer risks of COVID-19 infection compared to the general population, however, certain subgroups with DM have worse outcomes. Men. African Americans, those with interstitial lung disease, exhibited higher risks of severe COVID-19. DMARD and glucocorticoid use was associated with frequent hospitalisations and severe sepsis. Objectives: Rheumatic diseases (RDs) like DM, are previously known to be vulnerable towards various types of infections due to its aggressive activity mandating high dose immunosuppressive therapy. The severity of COVID-19 in RDs is limited in literature due to the heterogeneous nature of the condition. Therefore, specifc details on mortality is essential to navigate any precautions required in the treatment. Methods: Retrospective data of individuals with DM and COVID-19 and the general population with COVID-19 between January 2020 to August 2020 was retrieved from the TriNetX database. A one-to-one matched COVID-19 positive control was selected using propensity score (PS) matching. We assessed COVID-19 outcomes such as mortality, hospitalisation, ICU admission, severe COVID-19, mechanical ventilation (MV), acute kidney injury (AKI), venous thromboembo-lism (VTE), ischemic stroke, acute respiratory distress syndrome (ARDS), renal replacement therapy (RRT) and sepsis. Subgroup analyses included gender, race, ILD, cancer patients, disease-modifying rheumatic drugs (DMARDs) use, and glucocorticoids (GC) use (Figure 1). Results: We identifed 5,574 DM patients with COVID-19, and 5,574 general population with COVID-19 (controls). DM with COVID-19 had a lower risk of mortality in comparison to controls [RR 0.76], hospitalisation [RR 0.8], severe COVID-19 [RR 0.76], AKI [RR 0.83], and sepsis [RR 0.73]. Males and African Americans were more likely to develop AKI [RR 1.35, 1.65], while African Americans had higher odds for severe COVID-19 [RR 1.62] and VTE [RR 1.54]. DM with ILD group also experienced higher odds for severe COVID-19 infection [RR 1.64], and VTE [RR 2.06] (Figure 1). DM patients receiving DMARDs and glucocorticoids had higher odds for hospitalisation [RR 1.46, 2.12], and sepsis [RR 3.25] Subgroup analysis of neoplasms amongst DM patients with COVID-19 was inadequate for meaningful comparison (Figure 1). Conclusion: DM patients are protected for certain aspects of COVID-19 disease, including severe COVID-19, hospitalization, and mortality. The African American race, male gender, ILD, DMARDS and glucocorticoid users, are associated with poor outcomes.

19.
Annals of the Rheumatic Diseases ; 81:957, 2022.
Article in English | EMBASE | ID: covidwho-2009037

ABSTRACT

Background: At the beginning of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease 2019 (COVID-19) pandemic, the influence of anti-infammatory therapy on the course of SARS-CoV-2 infection in patients with infammatory rheumatic diseases (IRD) was unknown. In the meantime, several data indicate an association of severe courses of COVID-19 with the use of ritux-imab (RTX). Objectives: To gather further knowledge about SARS-CoV-2 infections in RTX-treated IRD patients, data from the German COVID-19-IRD-registry were analysed. Methods: Hospitalisation was used as a surrogate of COVID-19 severity. Baseline characteristics, disease features, medication and outcome of COVID-19 were compared in RTX-treated inpatients and outpatients. Results: In total, 3592 cases were reported in the registry, which included 130 RTX patients (3.6%) for our analysis. RTX-treated inpatients were older than RTX-treated outpatients (median age 63 y vs 56 y, p=0.007). Patients with granulomatosis with polyangiitis treated with RTX (n=32) showed a significant higher COVID-19 related hospitalisation rate (33% vs 11%, p=0.005), which was not the case for patients with rheumatoid arthritis (49% vs 50%). Cardiovascular comorbidities were reported more frequently in hospitalised RTX-treated patients (20% vs. 6%, p=0.032). More than 50% of the RTX-treated inpatients developed COVID-19 related complications, e.g. acute respiratory distress syndrome. The median time period between the last RTX treatment and SARS-CoV-2 infection was shorter in inpatients than in non-hospitalised patients (3 (range 0-17) vs. 4 months (range-29), p=0.039). The COVID-19 related mortality rate was 14% (n=19) in RTX-treated IRD patients. In RTX-treated inpatients and outpatients, there were no relevant differences with respect to the use of concomitant glucocor-ticoids or other disease modifying anti-rheumatic drugs, disease activity, median last RTX dose or median number of immunomodulatory drugs prior to RTX treatment. Conclusion: In addition to general risk factors, such as age and comorbidities, it is already known that IRD patients treated with RTX show a higher rate of severe COVID-19. In our registry, RTX-treated patients with granulomatosis with polyangiitis appear to be at even higher risk to develop severe COVID-19 compared to other IRD. Moreover, the shorter the time since the last RTX treatment, the higher seems to be the risk of developing severe COVID-19. This might be explained by a more profound B-cell depletion in the frst weeks after RTX treatment warranting further studies.

20.
Annals of the Rheumatic Diseases ; 81:1680-1681, 2022.
Article in English | EMBASE | ID: covidwho-2009008

ABSTRACT

Background: South East Asia was one of the frst regions affected by the SARS-CoV-2 virus causing COVID-19 however data on the impact of COVID-19 infection in patients with systemic rheumatic diseases (SRD) in South East Asia remains scarce. Objectives: To evaluate basic demographics, clinical features and outcomes of COVID-19 infection in patients with SRD from a tertiary rheumatology centre in West Malaysia. Methods: A retrospective observational study of 77 patients with SRD diagnosed with COVID-19 between 1st December 2020 to the 31st of December 2021 was performed. Demographic details, type of SRD, number and type of disease-modifying antirheumatic drugs (DMARD), dose of glucocorticoid, comorbidities, SARS-CoV-2 vaccine (type and number of doses) hospitalisation, oxygen requirement, type of COVID-19 related complication and death were recorded. Results: A total of 55 (71%) patients were hospitalised and 9 (12%) died. Mean age at time of COVID-19 diagnosis was 51 ± 14. Amongst these patients, 32 (42%) were Chinese, 30 (39%) Malays and 15 (19%) Indians. Majority of these patients had infammatory arthritis (58%) which included rheumatoid arthritis and seronegative spondyloarthropathy. The most common DMARDs used was meth-otrexate (51%), hydroxychloroquine (46%), sulfasalazine (22%), lefunomide (13%), azathioprine and mycophenolate mofetil (5% each). Two patients were on Janus Kinase (JAK) inhibitors and 3 on biologic DMARDS (tumour necrosis factor inhibitor, IL-6 inhibitors and IL-17 inhibitors). There were 38 patients (49%) vaccinated with two doses of SARS-CoV-2 vaccine (Pfzer n=29, CoronoVac n=7 and AstraZeneca n=2) prior to admission and amongst those unvaccinated, 15 (20%) contracted COVID-19 before the vaccine was released in Malaysia. Among hospitalised patients, those more than 60 years and those with more than one comorbid had a higher chance of admission (n= 21, 88%;p=0.036 and n=28, 88%;p=0.001) and death (n=8, 33%;p<0.001 and n=7, 22%;p<0.001). Comorbidities associated with higher risk of hospitalisation was diabetes mel-litus (85%, p=0.06), hypertension (92%, p<0.001) and coronary artery disease (100%, p=0.03) and those associated with death was obesity (33%, p=0.01) and hypertension (22%, p=0.007). Use of conventional DMARD, JAK, biologics and glucocorticoid were not associated with hospitalisation or morbidity. However, we found that patients who developed acute respiratory distress syndrome secondary to COVID-19 were mostly on sulfasalazine compared to other DMARDS (35%, p=0.01). Conclusion: In our multiethnic cohort of patients with SRD we found that age and multiple comorbidities such as diabetes mellitus, hypertension, obesity and coronary artery disease were associated with hospitalisation and morbidity. Disease activity and glucocorticoid use which have been shown to be associated with morbidity [1] was not seen in our cohort. The association between sulfasala-zine and poor outcomes have been reported [2] however further studies are still needed to investigate the causal relationship between the two.

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