Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 58
Filter
1.
Atmospheric Environment ; 279, 2022.
Article in English | EMBASE | ID: covidwho-1821144

ABSTRACT

A full-scale school ventilation performance test-bed is newly constructed to evaluate the effects of internal airflow on IAQ and cross-infection among students. The indoor airflow is controlled by return diffusers installed on the ceiling or the floor of a classroom. The removal performance of PM2.5 is measured according to the location of return diffusers in the school classroom, and the indoor airflow is analyzed using numerical simulation. The airflow angle is introduced to evaluate the possibility of cross-infection of infectious diseases between students at the height of their respiratory line. It is confirmed that the floor return is successfully reduced compared to the upper return at the height of the students' breathing line in the horizontal airflow, which has a high possibility of infection between students. The floor return reduces the dust removal time by 35% from the ‘Unhealthy’ level to the ‘Good’ level for PM2.5 compared to the upper return, which is due to the optimal control of airflow inside the classrooms. Through a study on the optimization of the direction of indoor airflow in school classrooms, this paper can provide a basic design guide for the direction of airflow that can improve classroom air quality, which can improve students' right to learn, and reduce cross-infection between students due to infectious diseases.

2.
European Journal of Molecular and Clinical Medicine ; 9(3):2809-2818, 2022.
Article in English | EMBASE | ID: covidwho-1820648

ABSTRACT

Aim: To evaluate neutrophilic lymphocyte ratio and lymphocyte monocyte ratio as prognostic markers in COVID 19. Material and method: The present retrospective observational studyconducted in the department of Medicine, Government Medical College, Jammu for a period of one year. The study comprised of 100 Covid 19 RT PCR positive cases admitted patient in ICU as well as Ward, in covid care centre of Government Medical College, Jammu. Patients characteristics were obtained from the hospital covid care centre satisfying inclusion criteria from electronic medical records and demographic, clinical, laboratory data were extracted included age, sex clinical features, signs and symptoms, comorbidities, exposure history, oxygen support during hospitalization, duration of oxygen support during hospitalization,imaging features of the chest (CT scoring), laboratory findings (Hemogram, Total leucocyte count, differential counts, NLR and LMR. Complete blood count including NLR and LMR collected at day of admission and day 3 of admission and documented on a standardized proforma. Two outcomes were evaluated: “discharge” or “died.” Results:In majority (53%) of patients, ventilation given was high flow followed by bipap (21%), ventimask (19%) and ventilator (5%). Ventilation given was room air in only 2 out of 100 patients (2%). In present study, only 10 out of 100 patients (10.00%) died.Discriminatory power of neutrophil lymphocyte ratio (AUC 0.865;95% CI: 0.781 to 0.925) was excellent and discriminatory power of lymphocyte monocyte ratio (AUC 0.791;95% CI: 0.698 to 0.867) was acceptable. Among both the parameters, neutrophil lymphocyte ratio was the best predictor of CTSI severity at cut off point of >3.57 with 86.50% chances of correctly predicting CTSI severity. Conclusion: It can be concluded from the results that NLR may be a rapid, widely available, useful prognostic factor in the early screening of critical illness in patients with confirmed COVID-19.

3.
Lung India ; 39(2):191-194, 2022.
Article in English | EMBASE | ID: covidwho-1818451

ABSTRACT

Pulmonary veno-occlusive disease (PVOD) is an important cause of pulmonary arterial hypertension (PAH) and is classified under idiopathic cause of PAH. Over a period of time, PVOD has been studied in detail in the western countries and various diagnostic criteria are formulated. Being a rapidly progressive disease, early diagnosis is of utmost importance which helps to initiate appropriate treatment. Recent studies suggest that PVOD has a genetic predisposition and has an autosomal recessive pattern of inheritance. Here, we discuss the case of siblings diagnosed with PVOD to have such genetic predisposition for this disease.

4.
International Journal of Environmental Research and Public Health ; 19(9), 2022.
Article in English | EMBASE | ID: covidwho-1818130

ABSTRACT

Numerous studies have reported a significant increase in stress experienced by students owing to the COVID-19 pandemic. Recently, interest in stress management using nature-derived substances has increased. However, studies examining the effects of olfactory stimulation by fir are lacking. The aim of this study was to investigate the physiological and psychological effects of inhaling fir essential oil. Additionally, differences between male and female participants were com-pared. Twenty-six university students (16 female and 10 male students;mean age, 21.5 ± 1.9 years) participated in this study. Fir essential oil was used for olfactory stimulation, with normal room air as the control. The odor was administered for 3 min. Heart rate variability and heart rate were used as indicators of autonomic nervous system activity. The Profile of Mood States and State-Trait Anxiety Inventory were used as psychological indicators. The ln(Low Frequency/High Frequency) ratio, which is an indicator of sympathetic nervous activity reflecting a stressful or aroused state during stimulation with fir essential oil, was significantly lower than during the control condition. Assessment of psychological indicators showed that the positive mood of “vigor” improved significantly and negative moods of “tension–anxiety”, “depression”, “anger–hostility”, “fatigue” and anxiety levels reduced significantly after inhaling fir essential oil compared to the control condition. This study showed that inhalation of fir essential oil has physiologically and psychologically relaxing effects, with differences in results depending on the sex of the participants.

5.
Scientific African ; : e01201, 2022.
Article in English | ScienceDirect | ID: covidwho-1805110

ABSTRACT

Air pollution remains one of the leading global environmental-health challenges the world is facing today, particularly within urban environments. Amid the COVID-19 pandemic, air pollution has been brought back into the spotlight as both attack the human respiratory systems. The purpose of the study was to investigate the quality of ambient air in a low-income urban settlement of Jabavu during the year 2018. Air pollution and meteorological data were gathered from the South African Air Quality System (SAAQIS) network. The study focused on 3 pollutants namely PM10, SO2 and O3. Findings were that mean seasonal ambient concentrations for PM10 in summer was (28.99µg/m3), autumn (33.32µg/m3), winter (61.71µg/m3) and spring (48.44µg/m3). On the other hand, the mean seasonal ambient concentrations for SO2 was summer (4.45ppb), autumn (3.19ppb), winter (5.65ppb) and spring (3.54ppb). The O3 concentrations were summer (40.97ppb), autumn (21.01ppb), winter (15.90ppb) and spring (33.59ppb). Furthermore, the study observed that in summer, winter and spring the dominant long-range transport air masses originated from the South Atlantic Ocean, Madagascar Island-India Ocean and the Indian Ocean while in autumn the dominant air masses are short-range inland air masses. For SO2 and PM10, ambient concentrations were found to be more problematic during winter;while for O3 substantial levels were unexpectedly recorded in summer. When analysing the diurnal profiles of PM10, SO2 and O3, each of these pollutants revealed a unique distribution pattern, which, despite having seasonal variance, was consistent throughout the year. For instance, irrespective of the season, PM10 mostly peaked in the mornings and evenings;meanwhile SO2 and O3 often spiked during the midday and mid-afternoon, respectively. These findings indicate that air quality within this low-income settlement is poor. To improve air quality within low-income settlements there is a need for a shift from reliance on solid fuels to cleaner energy sources such as LP gas, biogas and solar accompanied by an increase in community awareness about air quality issues. This study contributes to knowledge building within the air quality monitoring scientific community while for policymakers it assists in policy formulation to enable air quality management.

6.
Molecular Genetics and Metabolism ; 132:S325, 2021.
Article in English | EMBASE | ID: covidwho-1768662

ABSTRACT

Background: The clinical spectrum of coronavirus disease 2019 (COVID19) is wide. While some individuals have severe disease, themajority of individuals are either asymptomatic or have mildsymptoms with minimal hypoxia. There is emerging evidence thatrare genetic variation can contribute to risk for more severe COVID19infection. The goal of this study was to investigate if rare geneticvariation was contributing to severe disease presentation in a familywith varying clinical responses to COVID19 infection.Methods: This case series describes clinical, laboratory and radiographicfeatures in a three generation family of seven individualswithout previous known immunodeficiency that were all directlyexposed to COVID19. Four individuals developed COVID19 infection:three individuals had critical disease, and one had mild symptoms.Three exposed family members were asymptomatic and did not haveclinical evidence of COVID19 infection. All family members werepreviously healthy and did not have a history ofmajor chronic diseaseincluding respiratory disease, known immunodeficiency, or any othergenetic disorder. Exome sequencing analysis was completed toinvestigate monogenic risk factors segregating with severe diseasein this family.Results: Seven family members spanning three generations wereincluded in final analysis. Individuals with severe COVID19 diseasewere male, had a mean age of 71 years old (range 61–87), and a meanbody mass index (BMI) of 27 (range 28–32). All three severely affectedmales were intubated and died within 33 days of presentation (mean25 days, range 16–33 days). One female family member with COVID19infection and a milder clinical coursewas 68 years old on presentationand had a BMI of 34. She did not require intubation but was mildlyhypoxic on room air requiring nasal cannula for oxygenation. All fourfamily members with symptomatic COVID19 infection receivedRemdesivir antiviral therapy and systemic steroids as part of thetreatment course. Unaffected family members (n = 3) had a mean ageof 35 years old (range 30–58). All were exposed to affected familymembers and all remained clinically asymptomatic. Whole exomesequencing and segregation analysis of this family identified amissense alteration of SPDEF that segregated with family memberswith severe COVID19 infection and was not detected in the mildlyaffected and unaffected family members. SPDEF is a transcriptionfactor that is highly intolerant to loss of function (pLI 0.97). Thealteration detected in this family (c.830G>A;p.Gly277Asp) is withinthe functional DNA binding domain of the protein product, and ispredicted to be damaging by in-silico models.Conclusions: Here we report exome findings from a family withvariable clinical response to COVID19 infection and describe a raremissense alteration in SPDEF segregating with severe COVID19infection. SPDEF is essential for goblet cell differentiation andmucociliary clearance within respiratory epithelial cells and has arole in mediating innate immune response. This report demonstratesthat studying large families with variable clinical outcomes can be auseful approach for identifying rare genetic variation associated withincreased risk for severe COVID19 infection. Moreover, our findingsprovide insight into the putative link between the altered inflammatoryresponse and respiratory comprise observed in some individualswith severe COVID19 infection

7.
Endocrine Practice ; 27(12 SUPPL):S44, 2021.
Article in English | EMBASE | ID: covidwho-1768069

ABSTRACT

Objective(s): To evaluate the association of diabetes with clinical characteristics, severity, and mortality among hospitalized patients with COVID-19. Material(s) and Method(s): We conducted a retrospective, singlecenter evaluation of 68 patients hospitalised due to COVID-19 for comparison of the clinical, radiological, biochemical parameters between the T2DM and nonT2DM groups. Result(s): 24 (35.2%) were T2DM and 44 (64.7%) did not have diabetes (nonT2DM). 4 T2DM were also hypertensives. Among the 68 patients, 53 (77.9%) were discharged and 15 (22%) died. Of the patients who died, 6 (40%) were T2DM. The difference in mortality in T2DM and non T2DM was comparable (p=0.76 ns). The mean age (years) was 54.2 (±16.45, minimum 18, maximum 81, 95% CI 50.3 to 58.2). There was a significant difference between the mean age of T2DM 61.8 (±14.7, 95% CI 55.6 to 68) as compared to nonT2DM 50.1 (±50.1, 95% CI 45.2 to 55), p= 0.0042. The mean D Dimer levels were comparable between the T2DM (1108±2352, 95% CI 114.7 to 2101) and nonT2DM groups (1287±8538, 95% CI 754.3 to 5946);p=0.21. D dimer was higher than the threshold of 250 ng/mL in 18 (75.9%) in T2DM, as compared to 31 (70.4%) in nonT2DM. There were 14 males (20.5%) and 10 females (14.71%) with T2DM, and 28 males (41.18%) and 16 females (23.53%), who were non-diabetic. There was no significant association between the gender and diabetes (p=0.79). There was a significant difference for the grade of severity as assessed by symptoms at hospitalization (mild, moderate, severe) (p=0.46). There were 11 (16.1%), 10 (14.7%) and 3 (4.4%) T2DM patients who were mild, moderate, and severe respectively. The mean CT severity score was comparable across the T2DM (10.54±4.4, 95% CI 8.6 to 12.4) and nonT2DM (12.34±3.9, 95% CI 11.15 to 13.5). Based on CT severity score 18, there was a single case of T2DM who died as compared to three cases of nonT2DM, of which two expired. The mean change in the SpO2 at room air from at hospitalization to discharge was comparable in T2DM, n=18 (9.7±3.8, 95% CI 8.3 to 11) and nonT2DM, n=35 (12.2±7.5, 95% CI 8.4 to 16);p=0.11 ns. In both groups SpO2 at discharge was >96%. The mean number of days of hospitalization (9.6±3.8, 95% CI 8 to 11.3) was comparable between the T2DM and non T2DM (10.3±4.7, 95% CI 8.8 to 11.7);p=0.55 ns. 60 (88.2%) were on Remdesivir. Based on the number of patients administered Remdesivir, there were 20 (29.4%) in T2DM as compared to 40 (58.8%) in nonT2DM;p=0.43 ns. Of the patients who survived, 47 (69.1%) were administered Remdesivir. Conclusion(s): In our study there was an extensive usage of Remdesivir, irrespective of diabetes, gender, clinical characteristics, and risk factors. We attribute comparable outcomes in T2DM and nonT2DM, to the early administration of Remdesivir along with the standard care approach. Our findings might further guide recommendations for COVID-19 management.

8.
Indian Journal of Clinical Biochemistry ; 36(SUPPL 1):S143, 2021.
Article in English | EMBASE | ID: covidwho-1767679

ABSTRACT

Introduction : Coronavirus disease-2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). It is a respiratory disease, which can develop into multi-organ dysfunction, leading to death. Due to SARS-CoV-2 infection, several biochemical alterations occurs in covid patients and have been associated with the severity of the disease. Objectives: To evaluate the biochemical alterations in covid-19 patients. Methodology: This study was carried out in 80 covid-19 patients who were admitted in covid tertiary care hospital after RT-PCR or RAT positive test for SARS-CoV-2. The moderate disease was defined as presence of dyspnoea with respiratory rate more than 24/min or maintain oxygen saturation between 90 and 94% on room air and the severe disease was defined as presence of dyspnoea with respiratory rate more than 30/min or oxygen saturation less than 90% on room air, presence of ARDS, severe sepsis or sepsis shock. Estimation of urea, creatinine, total bilirubin, total protein, alkaline phosphatase, SGOT, SGPT, CRP, ferritin, CPK, LDH and D-dimer were carried out using automated analyser. p<0.05 was considered as significant level. Results: A significant higher levels of urea, creatinine, total bilirubin, total protein, alkaline phosphatase, SGOT, SGPT, CRP, ferritin, CPK, LDH and D-dimer were found in severe COVID-19 patients as compared to moderate COVID-19 patients. A significant correlation was found between the levels of CRP and other biochemical parameters. Conclusions: Increased alteration of renal, liver, cardiac, inflammatory and coagulation parameters in COVID-19 patients due to SARS-CoV-2 infection indicate its multi-organ involvement and these alterations may helpful to predict the severity and development of disease in patients with COVID-19.

9.
European Journal of Molecular and Clinical Medicine ; 9(3):766-771, 2022.
Article in English | EMBASE | ID: covidwho-1766814

ABSTRACT

BACKGROUND Easily accessible, inexpensive, and widely used laboratory tests that demonstrate the severity of COVID-19 are important. Therefore, in this study, we aimed to investigate the relationship between mortality in COVID-19 and platelet count, Mean Platelet Volume (MPV), and platelet distribution width. METHODS In total, 100 COVID-19 patients were included in this study. The patients were divided into two groups. Patients with room air oxygen saturation < 90% were considered as severe COVID-19, and patients with ≥90% were considered moderate COVID-19. Patient medical records and the electronic patient data monitoring system were examined retrospectively. Analyses were performed using the SPSS statistical software. A p-value <0.05 was considered significant. RESULTS The patients’ mean age was 64,32 ± 16,07 years. According to oxygen saturation, 38 patients had moderate and 62 had severe COVID-19. Our findings revealed that oxygen saturation at admission and the MPV difference between the first and third days of hospitalization were significant parameters in COVID-19 patients for predicting mortality. While mortality was 8.4 times higher in patients who had oxygen saturation under 90 % at hospital admission, 1 unit increase in MPV increased mortality 1.76 times. CONCLUSION In addition to the lung capacity of patients, the mean platelet volume may be used as an auxiliary test in predicting the mortality in COVID-19 patients.

10.
Open Forum Infectious Diseases ; 8(SUPPL 1):S250-S251, 2021.
Article in English | EMBASE | ID: covidwho-1746705

ABSTRACT

Background. The COVID-19 pandemic has disproportionately impacted minorities in the United States. John H. Stroger Jr. Hospital (JSH) is a tertiary care hospital within the safety-net system for Cook County in Chicago, Illinois. In this study we report demographics, clinical characteristics and outcomes of patients admitted with COVID-19 in our hospital during the spring surge of 2020. Methods. A retrospective study was done including patients > 18 years of age admitted to JSH with positive PCR for SARS-CoV2 from March 18 to May 30th, 2020. Outcomes, clinical and demographic characteristics were extracted from the electronic medical record. Moderate and severe disease were defined as radiographic evidence of pulmonary infiltrates and SpO2 > 94% on room air or SpO2< 94% on room air, respectively. Bivariate analysis and logistic regression were performed to assess for risk factors for admission to the intensive care unit and mortality. Results. 625 patients were included, 424 (68%) were male. Median age was 44 years (44,63). 364 (58%) were Hispanic and 222 (36%) non-Hispanic Blacks. 113 (18%) of patients presented with mild disease, 204 (33%) with moderate disease, 298 (48%) with severe disease. 73 patients (12%) died. 153 (24%) required ICU admission, 84 (13%) required intubation [Table 1]. In bivariate analysis, increasing age and diabetes (DM) were associated with increased mortality and ICU admission (p=0.001, Tables 2 and 3). Race/ethnicity was not associated with increased mortality or ICU admission. In the multivariate analysis, elevated glucose on admission regardless of DM and CKD were associated with mortality (p < 0.001). Conclusion. JSH is a safety net hospital that provides care for the most vulnerable population of Chicago. The proportion of Hispanic patients increased in the later weeks of the pandemic until they represented most of the inpatient population and presented with more severe disease (Figure 1). Although race was not associated with mortality or ICU admission, the high prevalence of chronic diseases such as hypertension and DM in our population may explain the higher rate of admissions. Strengthening of preventive medicine and social engagement with minorities must be a crucial effort to decrease the burden of COVID-19 in this population. Graph showing disease severity on admission by Race/Ethnicity (upper). Notice the predominance of severe disease (orange) in Hispanic patients. Graph showing Race/ Ethnicity Distribution by Week (lower). Notice the gradual increase and predominance of Hispanic patients (orange) in the later weeks of the study period compared to Black (blue) and White (green) patients.

11.
Open Forum Infectious Diseases ; 8(SUPPL 1):S308-S309, 2021.
Article in English | EMBASE | ID: covidwho-1746578

ABSTRACT

Background. At the onset of the COVID-19 pandemic, hospitals implemented infection control measures with limited data on predictors of nosocomial SARS-CoV-2 transmission. We aimed to quantify SARS-CoV-2 presence in an inpatient setting to understand nosocomial risk. Methods. Patients admitted with confirmed SARS-CoV-2 infection at an urban academic hospital were enrolled. Demographic/clinical characteristics, a PCR nasal swab(NS), and air samples on filter media in the near- (< 6ft) and far-field ( >6ft) of each patient for 3.5 hours were collected. PCR was used to detect SARS-CoV-2 on filter media. Associations between clinical characteristics and presence of SARS-CoV-2 in air samples used Fisher's exact and Wilcoxon rank sum tests. Results. Of 52 subjects, 46% had no detectable virus by nasal swab on the day of sampling. Of 104 room air samples, 16% had detectable virus from 25% of rooms, including 10 near and 7 far field samples. Subjects with a positive room air sample had fewer days from symptom-onset compared with those with a negative air sample (median 6 vs. 8, p=0.24). Being on room air and having a nasal swab positive increased the odds of detecting virus in air samples but were not statistically significant. Conclusion. A small number of air samples with detectable SARS-CoV-2 may suggest lower nosocomial risk than previously anticipated. Multiple subject and environmental factors may have contributed to this finding including patient source control masking, anti-viral therapies and HEPA filtration. The decreased association of virus in the air of those with more days of symptoms but with the need for supplemental oxygen may be related to what is now known about the COVID-19 inflammatory response after the infectious period.

12.
Open Forum Infectious Diseases ; 8(SUPPL 1):S318-S319, 2021.
Article in English | EMBASE | ID: covidwho-1746563

ABSTRACT

Background. Skilled nursing facility (SNF) residents comprised 11% of all COVID-19 cases in the United States;however, they account for 43% of deaths with case fatality rates (CFR) of 26.0-33.7%. Methods. We report an outbreak of COVID-19, from June 15 to July 21, 2020 in a 159-bed SNF with a staff of 172 that resulted in an infection rate of 97% in residents and 23% in HCWs (Figure 1). A retroactive review outlined mitigation efforts, discussed challenges, identified risk factors among residents and health care workers (HCW) for acquisition of COVID-19, and reviewed opportunities for improvement (Figure 2). Results. Factors that contributed to the outbreak: delay in test results had an impact on cohorting;suboptimal adherence to the principles of infection prevention and control (IPC) and minimal adherence monitoring;strict criteria were used to screen for infection;the underappreciated transmissibility of COVID-19 from presymptomatic and asymptomatic persons;symptomatic HCWs who continued to work;the changing guidance on, the suboptimal use of, and an inadequate supply of personal protective equipment;poor indoor air quality due to ventilation challenges;and the important role of community/family/interfacility spread on the outbreak. Whole genome sequencing, performed in 52 samples, identified a common strain that was also found in clusters of 2 other facilities: 1 in the same geographic location, the other in a different geographic location but whose HCWs had the same zip codes as the facility (Figure 3). Certified nursing and restorative nursing assistants had the highest risk of infection with an odds ratio (OR) of 4.02 (confidence interval 1.29-12.55, p value: 0.02) when compared to registered and licensed vocational nurses. The residents' CFR was 24%. The OR for death was increased by 10.5 (10.20-11.00) for every decade of life as was morbid obesity (BMI > 35) with an OR of 8.50. BMI as a continuous variable increased risk of mortality for every additional unit, OR 1.07 (Tables 1, 2). Conclusion. While implementation of optimal IPC measures in the pre-COVID-19 vaccination era had no impact on the infections in residents who were likely already infected or exposed at the onset of the outbreak, these measures along with non-pharmacologic strategies were effective in halting the spread among HCWs.

13.
Open Forum Infectious Diseases ; 8(SUPPL 1):S350-S351, 2021.
Article in English | EMBASE | ID: covidwho-1746499

ABSTRACT

Background. Patients affected by COVID-19 pneumonia who present severe symptoms with manifest hypoxemia and cytokine storm have a high mortality rate, which is why therapies focused on reducing inflammation and improving lung function have been used, one of them being jakinibs through of the blocking of the JAK tracks. Methods. Patients who presented data of severe pneumonia due to COVID-19 with data of severe hypoxemia and cytokine storm were selected, from June to August 2020, to whom the SaO2/FiO2 ratio is measured at the beginning, intermediate and end of treatment, as well as D dimer and serum ferritin. Comorbidity and drugs taken previously are analyzed. The patients being cared for at home. Results. We included data from 30 patients, 8 (27%) women and 22 (73%) men, with a median age of 58.5 (46.5 - 68.0) years. 23 patients (77%) had comorbidities, the most frequent being arterial hypertension (43%), followed by obesity (30%), type 2 diabetes mellitus (27%), among others. In the laboratory, the medians of D-Dimer 982 ng/ mL, Ferritin 1,375 ng/mL and C-Reactive Protein 10.0 mg/dL. Regarding the use of previous medications, we found that 29 (97%) patients had treatment with some medication, the most frequent: azithromycin (77%), ivermectin (53%) and dexamethasone (47%). The median number of medications received was 3. The initial pulse oximetry (SaO2) measurement with room air had a median of 80.5% and the median SaO2/FiO2 (SAFI) was 134;Regarding the type of SIRA, 90% had moderate SIRA and 10% had severe SIRA. The median day of evolution on which baricitinib was started was 10 days, all received 4 mg/day, and the median days of treatment with baricitinib was 14.0 days. At follow-up, SaO2 at 7 days had a median of 93.0% and the median SAFI at 7 days was 310.0;the median SaO2 at 14 days was 95.0% and the median SAFI at 14 days was 452.0. In comparative analysis, baseline SaO2/SAFI was significantly lower compared to 7 and 14 days (p = 0.001 for both comparisons). The outcomes, 27 (90%) patients improved and there were 3 (10%) who died. Conclusion. Baricitinib therapy in these patients with severe COVID-19 pneumonia who present with severe hypoxemia and cytokine storm presented good results by improving clinical status and pulmonary failure, with patients being cared for at home and avoiding mechanical ventilation.

14.
Open Forum Infectious Diseases ; 8(SUPPL 1):S363, 2021.
Article in English | EMBASE | ID: covidwho-1746473

ABSTRACT

Background. (i) Remdesivir (RDV) shortens recovery time among COVID-19 patients in an inpatient setting. (ii) Treatments for outpatients diagnosed with COVID-19 are limited. (iii) In early 2021, there was a national surge in COVID-19 hospitalizations, which resulted in hospital bed and staff shortages. (iv) In the face of this pandemic surge, we piloted a program to expand our RDV treatment capacity by establishing an off-label, outpatient infusion tent (OIT) for patients with severe COVID-19. (v) This is a retrospective, descriptive report examining the safety and efficacy of this program, with outcomes of interest being 30-day mortality and hospital admission within the subsequent 30 days Methods. (i) The OIT, consisting of 11 chairs capable of treating 35 patients per day, was operational from January 1 to February 19, 2021. (ii) Patients were referred to the outpatient RDV program primarily from urgent care (UC) and the emergency department (ED), and from the inpatient setting to complete therapy. Patients received at least one dose prior to referral. (iii) Eligibility criteria included a confirmed COVID-19 diagnosis, radiographic evidence of viral pneumonia, and an oxygen saturation less than or equal to 94 on room air. (iv) Exclusion criteria included pregnancy, sepsis, end-stage renal disease or GFR < 30, hepatitis with transaminases 10 times the limit of normal. Patients with BMI > 40, age > 75, chronic lung disease, dementia, were considered on a case by case basis. (v) Patients received dexamethasone and deep vein thrombosis prophylaxis Results. (i) A total of 88 patients received 258 infusions. The average number of outpatient infusions per participant was 2.9. (ii) Four out of 88 patients died (4.5%) within 30 days of first dose in the infusion tent. No deaths occurred in the outpatient setting. (iii) Fourteen out of 88 patients were admitted to the hospital within the subsequent 30 days (15.9%). (iv) 11/14 admissions (78.6%) were due to progression of COVID-19. There were no admissions due to adverse drug reactions Table 1. Patient Characteristics Table 2. Admissions Within Subsequent 30 Days Conclusion. Mortality rate in outpatients with severe COVID-19 treated with RDV was similar to that reported in inpatients. In this cohort of patients with severe COVID, a majority (84.1%) avoided hospitalization while still receiving appropriate treatment. Results suggest RDV can be safely delivered to outpatients with severe COVID-19.

15.
Open Forum Infectious Diseases ; 8(SUPPL 1):S364, 2021.
Article in English | EMBASE | ID: covidwho-1746470

ABSTRACT

Background. Remdesivir (RDV) was approved by FDA in October 2020 for use in hospitalized patients with COVID-19. We examined the association between RDV treatment and ICU admission in patients hospitalized with COVID-19 pneumonia requiring supplemental oxygen (but not advanced respiratory support) in MN. Methods. COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) is population-based surveillance of hospitalized laboratory confirmed cases of COVID-19. We analyzed COVID-NET cases ≥18 years hospitalized between Mar 23, 2020 and Jan 23, 2021 in MN for which medical record reviews were complete. On admission, included cases had evidence of COVID-19 pneumonia on chest imaging with oxygen saturation < 94% on room air or requiring supplemental oxygen. Cases were excluded if treated with RDV after ICU admission. Multivariable logistic regression was performed to assess the association between RDV treatment and ICU admission. Results. Complete records were available for 8,666 cases (36% of admissions statewide). 1,996 cases were included in the analysis, of which 908 were treated with RDV. 83% of cases were residents of the 7-county metro area of Minneapolis-St. Paul. Mean age was 59.7 years (IQR 48-72), 55% were male, and the mean RDV treatment duration was 4.8 days (range 2-15). The proportion of cardiovascular disease (30.6% vs 23.9%, p=.003), renal disease (16.6% vs 7.6%, p< .001), and diabetes (34.7% vs 29.5%, p=0.01) was higher in the RDV untreated group, while obesity (22.3% vs 8.4%, p< .001) and dexamethasone use (54.7% vs 15%, p< .001) was more common in the RDV treated group. RDV untreated patients were more likely to be admitted to an ICU (18% vs 8.9%, p< .001) and had higher inpatient mortality than those treated with RDV (11% vs 4.4%, p< .001). After adjustment for dexamethasone use, age, sex and diabetes, treatment with RDV was associated with 48% lower odds of ICU admission (OR 0.52, 0.39-0.7, p< .001). Conclusion. We found RDV treatment associated with a significantly lower risk of ICU admission in patients admitted to hospital requiring supplemental oxygen, suggesting that treatment may prevent disease progression in this group. Further studies should assess the potential benefit of RDV combination treatment with dexamethasone.

16.
Open Forum Infectious Diseases ; 8(SUPPL 1):S372, 2021.
Article in English | EMBASE | ID: covidwho-1746456

ABSTRACT

Background. The COVID-19 pandemic has negatively affected our healthcare system. Our hospitals have reached maximum capacity on several occasions. Because of the need to make beds available to new patients, some patients with severe COVID-19 who were on low flow O2 supplementation have been discharged home prior to completion of the standard (≥ 5-day) RDV course. To date, data are limited regarding clinical outcomes on these patients. Because of this, we conducted a retrospective study to assess the clinical outcomes of patients who received an abbreviated treatment course of RDV. Methods. Retrospective (chart review) study Subject population. All nonpregnant adult patients who were hospitalized at Kaiser Permanente Riverside Medical Center and Kaiser Permanente Moreno Valley Medical Center in 2020 with severe COVID-19 who required low flow O2 supplement during hospitalization who received RDV and discharged from hospital alive. Severe COVID-19 = positive SARS-CoV-2 PCR + evidence of lung involvement on lung imaging (X-ray or CT) + O2 saturation ≤ 94% on room air or requirement of O2 supplement. Inclusion criteria. Age ≥ 18 years;Hospitalized with severe COVID-19;Given RDV Exclusion criteria. Pregnancy;O2 requirement > 6 L including high flow and mechanical ventilation (noninvasive or invasive);discontinuation of RDV due to adverse effects Figure 1. Patient Section. Results. Mortality rate: no difference (2.1% vs 1.8%, p=0.84). 30 day post-discharge ED visit: twice more likely in the abbreviated RDV group as compared to the group receiving the standard duration (16.1% vs 8.5%, p=0.03). 30 day readmission: almost 10 times more likely in the abbreviated RDV group as compared to the group receiving the standard duration (11.9% vs 1.2%, p=< 0.001). Table 1. Patient's Characteristics Table 2. Clinical Outcomes. ∗8 Patients Who Died Within 30-Day from Discharge Were Excluded Conclusion. Though there is no difference in 30 day mortality rate, the patients who received the abbreviated RDV course are twice more likely to have ER visit and 10 times more likely to have readmission within 30 day post discharge despite more patients in the abbreviated course receiving steroids. The findings suggest that completing an at least 5-day course of RDV may be beneficial even in patients who demonstrate a clinical response earlier in course.

17.
Open Forum Infectious Diseases ; 8(SUPPL 1):S378-S379, 2021.
Article in English | EMBASE | ID: covidwho-1746446

ABSTRACT

Background. Growing evidence supports the use of remdesivir and tocilizumab for the treatment of hospitalized patients with severe COVID-19. The purpose of this study was to evaluate the use of remdesivir and tocilizumab for the treatment of severe COVID-19 in a community hospital setting. Methods. We used a de-identified dataset of hospitalized adults with severe COVID-19 according to the National Institutes of Health definition (SpO2 < 94% on room air, a PaO2/FiO2 < 300 mm Hg, respiratory frequency > 30/min, or lung infiltrates > 50%) admitted to our community hospital located in Evanston Illinois, between March 1, 2020, and March 1, 2021. We performed a Cox proportional hazards regression model to examine the relationship between the use of remdesivir and tocilizumab and inpatient mortality. To minimize confounders, we adjusted for age, qSOFA score, noninvasive positive-pressure ventilation, invasive mechanical ventilation, and steroids, forcing these variables into the model. We implemented a sensitivity analysis calculating the E-value (with the lower confidence limit) for the obtained point estimates to assess the potential effect of unmeasured confounding. Figure 1. Kaplan-Meier survival curves for in-hospital death among patients treated with and without steroids The hazard ratio was derived from a bivariable Cox regression model. The survival curves were compared with a log-rank test, where a two-sided P value of less than 0.05 was considered statistically significant. Figure 2. Kaplan-Meier survival curves for in-hospital death among patients treated with and without remdesivir The hazard ratio was derived from a bivariable Cox regression model. The survival curves were compared with a log-rank test, where a two-sided P value of less than 0.05 was considered statistically significant. Results. A total of 549 patients were included. The median age was 69 years (interquartile range, 59 - 80 years), 333 (59.6%) were male, 231 were White (41.3%), and 235 (42%) were admitted from long-term care facilities. 394 (70.5%) received steroids, 192 (34.3%) received remdesivir, and 49 (8.8%) received tocilizumab. By the cutoff date for data analysis, 389 (69.6%) patients survived, and 170 (30.4%) had died. The bivariable Cox regression models showed decreased hazard of in-hospital death associated with the administration of steroids (Figure 1), remdesivir (Figure 2), and tocilizumab (Figure 3). This association persisted in the multivariable Cox regression controlling for other predictors (Figure 4). The E value for the multivariable Cox regression point estimates and the lower confidence intervals are shown in Table 1. The hazard ratio was derived from a bivariable Cox regression model. The survival curves were compared with a log-rank test, where a two-sided P value of less than 0.05 was considered statistically significant. The hazard ratios were derived from a multivariable Cox regression model adjusting for age as a continuous variable, qSOFA score, noninvasive positive-pressure ventilation, and invasive mechanical ventilation. Table 1. Sensitivity analysis of unmeasured confounding using E-values CI, confidence interval. Point estimate from multivariable Cox regression model. The E value is defined as the minimum strength of association on the risk ratio scale that an unmeasured confounder would need to have with both the exposure and the outcome, conditional on the measured covariates, to explain away a specific exposure-outcome association fully: i.e., a confounder not included in the multivariable Cox regression model associated with remdesivir or tocilizumab use and in-hospital death in patients with severe COVID-19 by a hazard ratio of 1.64-fold or 1.54-fold each, respectively, could explain away the lower confidence limit, but weaker confounding could not. Conclusion. For patients with severe COVID-19 admitted to our community hospital, the use of steroids, remdesivir, and tocilizumab were significantly associated with a slower progression to in-hospital death while controlling for other predictors included in the models.

18.
Indian Journal of Medical Microbiology ; 39:S56-S57, 2021.
Article in English | EMBASE | ID: covidwho-1734461

ABSTRACT

Background:The COVID-19 has been a severe pandemic all around the world. During this pandemic, very few cases of SARS-CoV-2 co-infected with HIV and Hepatitis C are reported. Here we report two rare cases of SARS-CoV-2 co-infected with HIV and Hepatitis C. According to the limited literature available, HIV patients co-infected with COVID-19 have a high mortality rate and poor clinical outcomes, but we report special cases of SARS -COV-2/HIV and SARS-COV2/ Hepatitis C, both cases were already on antivirals and had good clinical outcome. Methods:CASE 1: 58 year old male, known case of HIV diagnosed two years ago with normal CD4+T cell count. Present- ed with chief complaints of cough and shortness of breath. On examination had respiratory rate of 28/min and spo2 89 % on room air and was hemodynamically stable. CASE 2: 50 year old male, known case of Hepatitis C diagnosed one year ago presented with chief complaints of cough and shortness of breath. On examination had respiratory rate of 26/ min and spo2 91 % on room air and was hemodynamically stable. His liver function tests were mildly deranged. Sus- pecting COVID 19 pneumonitis in both the cases, samples were sent and both patients were found to be SARS -CoV-2 positive using real-time Polymerase Chain Reaction (RT-PCR). Both patients were already on antivirals, at the time of admission. There was no co-morbidity in both the cases and X-ray showed bilateral pneumonitis, typical of COVID 19 and CT scan showed ground glass opacities bilaterally in basal areas. Routine investigations for COVID 19 were sent and were started on i/v Remdesivir, steroids and routine treatment was given. Results:Present study supports that SARS- COV-2/HIV and SARS-COV-2/Hepatitis C co-infected patients have a favorable prognosis and less severe clinical presentation of COVID 19 when already under treatment with anti-viral therapies. Conclusions:Same as results

19.
Indian Journal of Medical Microbiology ; 39:S40-S41, 2021.
Article in English | EMBASE | ID: covidwho-1734455

ABSTRACT

Background:During the ongoing COVID19 pandemic period, any new cases of acute-onset respiratory illness are likely to be treated as suspected COVID-19 by default. Methods:A 42year-old lady was admitted with a 4-week history of fever and cough, followed by a 4-days history of increasing short- ness of breath. Fever was intermittent, high grade and was associated with chills and rigor. The patient had a history of uncontrolled type II diabetes mellitus and on admission HbA1C was 15.5%. On examination she had a temperature of 102° F, blood pressure (BP) of 101/67mm Hg, heart rate of 130 beats per minute, respiratory rate (RR) of 24 breaths per minute and O2 saturations of 92% in room air. On respiratory examination, there were crackles in the left infrascapular and infraaxillary area. The patient was admitted in the COVID suspect ward with an impression of moderate COVID-19 infection and nasopharyngeal swab was sent for SARS-CoV-2 on RT-PCR. The patient underwent a CECT scan of thorax, abdomen and pelvis that revealed consolidation in bilateral lung fields with a cavity in lingular lobe with presence of air-fluid level. Mediastinal and hilar lymphadenopathy were present. [Formula presented] Results: SARS-CoV-2 RT-PCR was negative. The patient’s sputum sample revealed pure growth of purple, flat, dry, wrinkled colonies on Ashdown agar after 48 hours which was identified as Burkholderia pseudomallei. The Isolate was susceptible to ceftazidime, mero- penem, co-trimoxazole, amox-clav and chloramphenicol. The patient was started on I.V Meropenem 500mg every 8hourly for 21 days and was discharged on co-trimoxazole tablet. Conclusions: The case definitions of COVID-19 such as fever, cough and shortness of breath can be associated with other infectious etiologies. The role of the microbiology laboratory is thus very crucial in COVID-19 from overshadowing other infec- tious diseases, particularly in endemic areas, hence preventing misdiagnosis and consequent adverse outcomes for patients.

20.
International Journal of Pharmaceutical and Clinical Research ; 13(5):298-304, 2021.
Article in English | EMBASE | ID: covidwho-1733208

ABSTRACT

Aim: Quantitative Assessment of Interleukin-6 and Ferritin Levels and its Clinical Correlation among COVID-19 Patients. Methods: The cross-sectional analytical study was conducted in the Department of Pathology, Darbhanga Medical College and Hospital, Darbhanga, Bihar, India for 1 year after taking the approval of the protocol review committee and Institutional Ethics Committee. 120 COVID-19 positive patients, diagnosed upon admission by RT-PCR of oropharyngeal swabs with or without respiratory symptoms were included in the study group. Results: Group A had 55 patients among which 7 patients were asymptomatic and 48 had mild symptoms with RR <24/m and SpO2 >94% in room air, the number of patients with co-morbidities like type 2 diabetes mellitus were 15, with hypertension and cardiac disorders were 10 and with respiratory disorders were 5 in Group A, Group B there were 30 patients among which 9 had mild symptoms and 21 patients had moderate symptoms with RR: 24-30/m (or) SpO2: 90%-94% at room air. The mean levels with standard deviation of Serum IL-6 and serum ferritin in Group A, Group B and Group C patients, respectively has depicted in. table 2. On pairwise comparison by Mann-Whitney U test among the groups it shows that the mean IL-6 levels are significantly different in all the three groups. Kruskal Wallis pairwise comparison shows IL-6 levels to be significantly increased in Group C (35) patients with severe disease compared to Group A and Group B patients with mild and moderate disease respectively (p-value <0.001). Serum Ferritin levels did not show any statistically significant difference among Group A, Group B and Group C;however, ferritin levels were markedly increased in Group C patients with severe disease (p-value=0.44). Conclusion: Serum IL-6 levels independently showed a good correlation with disease severity among COVID-19 patients, and serum ferritin levels was elevated only in severely symptomatic individuals with COVID-19 infections. Hence, Serum IL-6 could have a significant role in assessment of disease severity and Prognosis among COVID-19 patients.

SELECTION OF CITATIONS
SEARCH DETAIL