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1.
Turkish Journal of Emergency Medicine ; 22(3):149-155, 2022.
Article in English | Academic Search Complete | ID: covidwho-1954252

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) virus usually spreads through aerosol and close contact. Frontline health-care workers handle aerosol-generating procedures like endotracheal intubation. To reduce this risk, COVID-19 barrier box came into the picture. However, the COVID-19 barrier box may compromise easy and successful intubation, and their limitation must be studied. OBJECTIVES: The objective of this study was to assess the time to successful intubation with or without the COVID-19 barrier box using the Macintosh laryngoscope and King Vision video laryngoscope (KVVL). We also assessed the first-pass success rate, ease of intubation, Cormack- Lehane (CL) grade, and requirement of external laryngeal manipulation. METHODS: We conducted this manikin-based randomized crossover study to assess the time to successful intubation by anesthesiologists (22) and emergency physicians (11) having 1 year or more experience with or without COVID-19 barrier box by using the Macintosh laryngoscope and KVVL. Our study randomized the sequence of the four different intubation scenarios. RESULTS: The comparison of mean duration of intubation between KVVL (13.21 ± 4.05 s) and Macintosh laryngoscope (12.89 ± 4.28 s) with COVID-19 barrier box was not statistically significant (95% confidence interval: 1.21-0.97). The ease of intubation, number of attempts, and requirement of external laryngeal manipulation were not statistically significant. Intubations were statistically significant more difficult with barrier box in view of higher CL grade. CONCLUSION: Time to intubation was longer with COVID-19 barrier box using KVVL as compared to Macintosh laryngoscope which was statistically not significant. [ FROM AUTHOR] Copyright of Turkish Journal of Emergency Medicine is the property of Elsevier B.V. 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.)

2.
Diabetes ; 71, 2022.
Article in English | ProQuest Central | ID: covidwho-1952110

ABSTRACT

Recent reports suggest a potential relationship between COVID-and onset of diabetes (DM) . We present the case of a 35 yr old female with type 1 DM (T1DM) who following COVID-pneumonia (COVP) developed worsening insulitis suggesting a potential direct effect of COVID-on beta cell function. The patient is a 35 yr old Caucasian female with T1DM first diagnosed 5 yrs ago. She had some residual beta cell secretory function with fasting C-peptide;0.51 (0-8-3.85ng/ml) . She also has hemochromatosis, thyroiditis with thyroid nodular disease and +ve history of T1DM in her older brother and maternal cousin. Since diagnosis she has been on insulin pump therapy and a CGMS device with excellent glycemic control and HBA1c of 6.7-7.1. She had not received the COVID-vaccine and had COVP in July 2021 requiring inpatient care but not intubation. She received oral steroids and Remdesivir with salutary response. She has not had post-acute sequelae of SARS-CoV (PASC) but ˜ 2 months post discharge had acute thyroiditis with no thyroid abscess, elevated sed rate, leucocytosis and peak thyroglobulin;158 (3-40ng/ml) . Since discharge she noted persistent global hyperglycemia requiring increased basal and bolus insulin therapy with peak HBA1c of 8.3. Further evaluation showed active insulitis with reduced C-peptide 0.and increase in islet related antibodies compared to titers obtained at the time of initial diagnosis 5 yrs prior. The clinical presentation of our patient suggests a potential role of COVID-in inducing insulitis with significant implications for at risk patients including T1DM patients with preserved islet function but also type 2 DM and LADA patients. This case provides another compelling reason for advocating COVID-vaccination in at risk patients. The duration of this effect on islet function and whether beta cell functional recovery is possible over time remains to be seen. The insulitis manifests with worsening glycemic profiles as well as possibly impacting islet mediated counterregulatory glycemic responses.

3.
Crit Care ; 26(1): 124, 2022 05 06.
Article in English | MEDLINE | ID: covidwho-1951295

ABSTRACT

BACKGROUND: Some academic organizations recommended that physicians intubate patients with COVID-19 with a relatively lower threshold of oxygen usage particularly in the early phase of pandemic. We aimed to elucidate whether early intubation is associated with decreased in-hospital mortality among patients with novel coronavirus disease 2019 (COVID-19) who required intubation. METHODS: A multicenter, retrospective, observational study was conducted at 66 hospitals in Japan where patients with moderate-to-severe COVID-19 were treated between January and September 2020. Patients who were diagnosed as COVID-19 with a positive reverse-transcription polymerase chain reaction test and intubated during admission were included. Early intubation was defined as intubation conducted in the setting of ≤ 6 L/min of oxygen usage. In-hospital mortality was compared between patients with early and non-early intubation. Inverse probability weighting analyses with propensity scores were performed to adjust patient demographics, comorbidities, hemodynamic status on admission and time at intubation, medications before intubation, severity of COVID-19, and institution characteristics. Subgroup analyses were conducted on the basis of age, severity of hypoxemia at intubation, and days from admission to intubation. RESULTS: Among 412 patients eligible for the study, 110 underwent early intubation. In-hospital mortality was lower in patients with early intubation than those with non-early intubation (18 [16.4%] vs. 88 [29.1%]; odds ratio, 0.48 [95% confidence interval 0.27-0.84]; p = 0.009, and adjusted odds ratio, 0.28 [95% confidence interval 0.19-0.42]; p < 0.001). The beneficial effects of early intubation were observed regardless of age and severity of hypoxemia at time of intubation; however, early intubation was associated with lower in-hospital mortality only among patients who were intubated later than 2 days after admission. CONCLUSIONS: Early intubation in the setting of ≤ 6 L/min of oxygen usage was associated with decreased in-hospital mortality among patients with COVID-19 who required intubation. Trial Registration None.


Subject(s)
COVID-19 , Hospital Mortality , Humans , Hypoxia , Intubation, Intratracheal , Oxygen , Retrospective Studies , SARS-CoV-2
4.
Glob Health Med ; 4(2): 116-121, 2022 Apr 30.
Article in English | MEDLINE | ID: covidwho-1955544

ABSTRACT

Emergency physicians perform endotracheal intubations for patients with COVID-19. However, the trends in the intubation for COVID-19 patients in terms of success rate, complications, personal protective equipment (PPE) information, barrier enclosure use, and its transition have not been established. We conducted a retrospective study of COVID-19 cases that required tracheal intubation at four hospitals in the Tokyo metropolitan area between January 2020 and August 2021. The overall intubation success rate, operator experience, and infection control methods were investigated. We then compared the early and late phases of the pandemic for a period of 8 months each. A total of 211 cases met the inclusion criteria, and 133 were eligible for analysis. The intubation success rate increased from 85% to 94% from early to late phase, although the percentage of intubations performed by emergency medicine residents increased significantly in the late phase (p = 0.03). The percentage of light PPE use significantly increased from 65% to 91% from early to late phase (p < 0.01), whereas the percentage of barrier enclosure use significantly decreased from 26% to 0% (p < 0.01). Furthermore, the infection prevention methods during intubation became more simplified from early to late phase.

5.
J Thorac Dis ; 14(5): 1319-1331, 2022 May.
Article in English | MEDLINE | ID: covidwho-1955259

ABSTRACT

Background: Clinical outcome in patients with coronavirus disease 2019 (COVID-19) requiring treatment on intensive care units (ICU) remains unfavourable. The aim of this retrospective study was to exploratively identify potential predictors of unfavourable outcome in ICU patients diagnosed with COVID-19. Methods: In all patients with COVID-19 (n=50) or severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) as comorbidity (n=11) at our ICU we assessed clinical, respiratory and laboratory parameters with a potential role for outcome. Main outcome variables were intubation and mortality rates. Results: Between March 2020 and March 2021, 573 patients were hospitalized with SARS-CoV-2 infection. Of these, 61 patients (10.6%, 44.3% women) aged 66.4±13.3 were admitted to ICU. A proportion of 73.8% of patients had moderate or severe acute respiratory distress syndrome (ARDS). COVID-19 patients differed clinically from those with SARS-CoV-2 as comorbidity, such as severe heart or renal failure or sepsis as the leading cause of ICU admission, despite similar mortality rates (44.0% vs. 45.5%, P>0.5). Among COVID-19 patients, those who died had more often severe ARDS (91% vs. 46%, P=0.001), longer non-invasive ventilation (NIV) therapy prior to ICU (6.3±5.9 vs. 2.5±2.0 days, P=0.046), and higher interleukin-6 (IL-6) and lactate dehydrogenase (LDH) values as compared to survivors. In multivariable analysis, NIV duration ≥5 days on admission [odds ratio (OR): 42.20, 95% confidence interval (CI): 1.22 to >99, P=0.038] and IL-6 [OR: 4.08, 95% CI: 1.16-14.33, P=0.028] remained independently predictive of mortality. In worsening tertiles of partial pressure of oxygen (pO2)/inspiratory oxygen fraction (FiO2) on admission (≥161.5, 96.5 to <161.5, <96.5) we observed a stepwise increase in intubation rates (P=0.0034) and mortality rates (P=0.031). Conclusions: As inflammation, ARDS severity and longer NIV duration prior to ICU are associated with intubation and mortality rates, prognosis appears to be largely determined by disease severity. Whether NIV aggravates ARDS or if it indicates lack of recovery independent from type of ventilation, or both should be clarified in a prospective trial.

6.
Indian J Otolaryngol Head Neck Surg ; : 1-7, 2021 Aug 15.
Article in English | MEDLINE | ID: covidwho-1943027

ABSTRACT

This study aimed to evaluate the experience of tracheostomy in COVID-19 patients in a Southern Europe tertiary hospital. Retrospective observational study in tracheostomized patients from April 1, 2020 to February 28, 2021. Data related to tracheostomy were evaluated in patients with and without COVID-19, including infections in healthcare professionals involved in patient care. Forty-two tracheostomies were performed in COVID-19 patients aged 68.4 ± 11.1 years, predominantly men (71%) and caucasians (81%). They had at least 1 comorbidity (93%), on average 3. The most frequent were heart disease (71%), age > 65 years (67%) diabetes (40%) and obesity (33%). The greater number of comorbidities was associated with the lesser probability of the patient's recovery (p = .001). Age (p = .047) and renal failure (p = .013) were associated with higher mortality. Patients were tracheostomized by prolonged endo-tracheal intubation (50%), pneumonia (33%) and extubation failure (10%). Ventilation time before the tracheostomy (22.9 ± 6.5 days) was higher than ventilation time after the tracheostomy (7.1 ± 15.1 days) (p < 0.001). No differences were found in ventilation time (p = 0.094) and tracheostomy time (p = 0.514) in the different indications. There were 3 minor complications (7.1%), 25 discharges (60%) and 11 deaths (26%). During the same period 49 tracheostomies were performed in patients without COVID-19, with a homogeneous gender and age distribution, 31% without comorbidities, with an average of 1 comorbidity per patient and higher mortality (43%). Tracheostomy in COVID-19 patients proved to be a safe procedure for both patients and healthcare professionals and improves the clinical outcome of patients with severe infection. The 21-day procedure timing seems adequate. Comorbidities played an essential role in patient´s recovery. Age and renal failure are associated with a worse vital prognosis.

7.
Am J Otolaryngol ; 43(5): 103522, 2022 Jun 02.
Article in English | MEDLINE | ID: covidwho-1944083

ABSTRACT

Coronavirus disease (COVID-19) is associated with severe acute respiratory illness, often requiring intensive care unit admission. Some patients require prolonged intubation and mechanical ventilation. Post-intubation laryngotracheal stenosis occurs in approximately four to 13 % of adult patients after prolonged intubation in the absence of COVID-19 infection. The rate of COVID-19 related post-intubation laryngotracheal stenosis may be higher. Of 339 pregnant patients with COVID-19, we identified seven who required intubation and mechanical ventilation. Four of the seven developed persistent airway complications, and laryngotracheal stenosis, the most severe, was present in three. Each patient had variations in duration of intubation, endotracheal tube size, re-intubation, presence of superimposed infections, and pre-existing comorbidities. We speculate that underlying physiologic changes of pregnancy in addition to the increased inflammatory state caused by COVID-19 are associated with an increased risk of post-intubation laryngotracheal stenosis. Otolaryngology physicians should have a low threshold for considering this pathophysiology when consulting on obstetric patients who have previously been intubated with COVID-19. Otolaryngologists can educate obstetricians when caring for pregnant patients who have laryngotracheal stenosis, especially those who may require emergency airway management for obstetric indications.

8.
Curr Emerg Hosp Med Rep ; : 1-5, 2022 May 11.
Article in English | MEDLINE | ID: covidwho-1943522

ABSTRACT

Purpose of Review: Adult respiratory distress syndrome is a life-threatening complication from severe COVID-19 infection resulting in severe hypoxic respiratory failure. Strategies at improving oxygenation have evolved over the course of the pandemic. Recent Findings: Although non-invasive respiratory support reduces the need for intubation, a significant number of patients with COVID-19 progress to invasive mechanical ventilation. Once intubated, a lung protective ventilation strategy should be employed that limits tidal volumes to 6 ml/kg of predicted body weight and employs sufficient positive end-expiratory pressure to maximize oxygen delivery while minimizing the fraction of inspired oxygen. Intermittent prone positioning is effective at improving survival, and there is a growing body of evidence that it can be safely performed in spontaneously breathing patients to reduce the need for invasive mechanical ventilation. Inhaled pulmonary vasodilators have not been shown to improve survival or cost-effectiveness in COVID-19 and should be used selectively. Summary: Finally, the best outcomes are likely achieved at centers with experience at severe ARDS management and protocols for escalation of care.

9.
Sleep Science ; 15:76, 2022.
Article in English | EMBASE | ID: covidwho-1935162

ABSTRACT

Introduction: The inflammatory process and multisystemic manifestation caused by Covid-19 infection can involve multiple sequelae with damage on physical, cognitive, psychological, and biological aspects. This condition results on poor quality of life, fatigue, dyspnea and sleep difficulties. The focus on sleep difficulties, the most common symptoms are related to night drowsiness and insomnia, but little is known about the clinical characteristics of these patients who develop this complication. Objective: Evaluate the main complaints and clinical signs in patients after COVID-19. - Rate the quality of sleep in post-COVID-19 Syndrome patients who have had mild, moderate and/or severe symptoms of the disease. Methods: Observational study and descriptive, with a quantitative approach to data. A general and a specific sleep quality questionnaire were applied to patients undergoing rehabilitation after the diagnosis of COVID-19, who did or did not need to be hospitalized, with symptoms that had started at least 5 weeks before the questionnaire response date. Participants who were unable to answer the questionnaires due to a deficit in understanding the questions asked, or who gave up on completing the questionnaires without finishing, were excluded. Results: 177 participants participated in the research, 124 men (70%) and 53 women (30%). 62.7% of participants reported at least one comorbidity and only 23 people (12.9%) were not vaccinated with any dose until participation in this study. With regard to hospital admission, 109 participants (61.6%) required admission to the ICU and of these, 57.8% (63) required orotracheal intubation, with prolonged hospital stay for more than 12 days. The most common symptoms after covid-19 were muscle fatigue (78.3%), excessive daytime sleepiness (51.4%), persistent cough (47.4%) and headache (47.1%). 81.4% of participants reported that they felt their sleep quality had worsened after the diagnosis of COVID-19. And after applying a specific questionnaire (PSQI), 93.7% of participants were classified as poor sleepers. There was a very strong correlation (r>0.9) with participants who assessed hospitalized and in invasive mechanical ventilation, with bad sleep quality. Conclusion: The post-COVID-19 Syndrome, associated with age, comorbidities, length of stay and use of invasive mechanical ventilation, were factors that are associated with a higher prevalence of sleep disorders.

10.
Dysphagia ; 2022 Jul 16.
Article in English | MEDLINE | ID: covidwho-1935771

ABSTRACT

To explore laryngeal function of tracheostomised patients with COVID-19 in the acute phase, to identify ways teams may facilitate and expedite tracheostomy weaning and rehabilitation of upper airway function. Consecutive tracheostomised patients underwent laryngeal examination during mechanical ventilation weaning. Primary outcomes included prevalence of upper aerodigestive oedema and airway protection during swallow, tracheostomy duration, ICU frailty scores, and oral intake type. Analyses included bivariate associations and exploratory multivariable regressions. 48 consecutive patients who underwent tracheostomy insertion as part of their respiratory wean following invasive ventilation in a single UK tertiary hospital were included. 21 (43.8%) had impaired airway protection on swallow (PAS ≥ 3) with 32 (66.7%) having marked airway oedema in at least one laryngeal area. Impaired airway protection was associated with longer total artificial airway duration (p = 0.008), longer tracheostomy tube duration (p = 0.007), multiple intubations (p = 0.006) and was associated with persistent ICU acquired weakness at ICU discharge (p = 0.03). Impaired airway protection was also an independent predictor for longer tracheostomy tube duration (p = 0.02, Beta 0.38, 95% CI 2.36 to 27.16). The majority of our study patients presented with complex laryngeal findings which were associated with impaired airway protection. We suggest a proactive standardized scoring and review protocol to manage this complex group of patients in order to maximize health outcomes and ICU resources. Early laryngeal assessment may facilitate weaning from invasive mechanical ventilation and liberation from tracheostomy, as well as practical and objective risk stratification for patients regarding decannulation and feeding.

11.
INDIAN JOURNAL OF CRITICAL CARE MEDICINE ; 26(7):791-797, 2022.
Article in English | Web of Science | ID: covidwho-1939282

ABSTRACT

Objective: To determine whether high-flow nasal oxygen (HFNO) or noninvasive ventilator (NIV) can avoid invasive mechanical ventilation (IMV) in COVID-19-related acute respiratory distress syndrome (ADRS), and the outcome predictors of these modalities. Design: Multicenter retrospective study conducted in 12 ICUs in Pune, India. Patients: Patients with COVID-19 pneumonia who had PaO2/FiO(2) ratio <150 and were treated with HFNO and/or NIV. Intervention: HFNO and/or NIV. Measurements: The primary outcome was to assess the need of IMV. Secondary outcomes were death at Day 28 and mortality rates in different treatment groups. Main results: Among 1,201 patients who met the inclusion criteria, 35.9% (431/1,201) were treated successfully with HFNO and/or NIV and did not require IMV. About 59.5% (714/1,201) patients needed IMV for the failure of HFNO and/or NIV. About 48.3, 61.6, and 63.6% of patients who were treated with HFNO, NIV, or both, respectively, needed IMV. The need of IMV was significantly lower in the HFNO group (p <0.001). The 28-day mortality was 44.9, 59.9, and 59.6% in the patients treated with HFNO, NIV, or both, respectively (p <0.001). On multivariate regression analysis, presence of any comorbidity, SpO(2) <90%, and presence of nonrespiratory organ dysfunction were independent and significant determinants of mortality (p <0.05). Conclusions: During COVID-19 pandemic surge, HFNO and/or NIV could successfully avoid IMV in 35.5% individuals with PO2/FiO(2) ratio <150. Those who needed IMV due to failure of HFNO or NIV had (87.5%) mortality.

12.
Medical Journal of Bakirkoy ; 18(2):225-229, 2022.
Article in English | EMBASE | ID: covidwho-1939262

ABSTRACT

Objective: The clinical course of coronavirus infection in liver transplant patients is not known accurately. The aim of this study was to examine the epidemiological incidence and outcomes of liver transplant patients after coronavirus disease-2019 (COVID-19) infection who have been registered in the data system of the Tissue, Organ Transplant and Dialysis Services Department. Methods: In this study, which was designed non-interventional, retrospective, and observational;the demographic information, clinical and radiological parameters, lifetime, hospital service and intensive care requirements and length of stay of the patients who were recorded in the information systems of the Ministry of Health, have were examined. A total of 3,426 liver transplant patients who were admitted to the hospital with suspected COVID-19 in Turkey between April 2020 and April 2021 were included in the study. Results: Between April 2020-April 2021, 3,426 cases of liver transplant who admitted to hospitals with symptoms of COVID-19 infection in Turkey were examined. The ratio of patients diagnosed with COVID-19 infection was 24.69% (846), with a mean age of 52.3%. The 13.48% (462 people) of 3,426 people who had liver transplants were hospitalized. The mean age of the hospitalized patients was 46.6, and the average length of hospital stay was 8.64 days. When the thorax computed tomography scans of 3,426 people with suspected COVID-19 and liver transplant were examined, pneumonia was detected in 344 (10%) people and they were treated as an inpatient. The mean age of the patients with pneumonia was 59 years. The number of liver transplant patients who died was 108 (3.1%), with a mean age of 65 years. The ratio of followup in the intensive care unit for organ transplant recipients was 0.32%, and 0.26% of them were intubated patients. Conclusion: Despite the use of immunosuppressive drugs in patients with liver transplant, the requirement for intensive care and the length of stay in the intensive care unit was found to be low, and the importance of strict follow-up and treatment in such patients was recognized once again.

13.
Open Access Macedonian Journal of Medical Sciences ; 10:187-190, 2022.
Article in English | EMBASE | ID: covidwho-1939089

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) has distracted the global health system due to significant morbidity and mortality. There are increasing mortality rates related to the existence of comorbidities. Due to immunologic conditions, other infectious diseases, such as multidrug-resistant tuberculosis (MDR-TB), might coinfect with COVID-19. We describe a case of MDR-TB with diabetes mellitus and critical COVID-19 patient with fatal outcome. CASE REPORT: A 60-year-old man was admitted to our hospital with shortness of breath for 2 days. A history of recurrent shortness of breath has had developed for about 7 months. Room air oxygen saturation was at 66%. RT-PCR SARS-CoV-2 nasopharynx swab result was positive. The chest X-ray series result showed destroyed left lung with increasing infiltrate in the lower right lung. The patient was diagnosed with pulmonary MDR-TB based on GeneXpert and LPA (Line Probe Assay) test 6 months prior and also has had history of diabetes mellitus for 7 years. Then, the patient was diagnosed with COVID-19, pulmonary MDR-TB, and diabetes mellitus. MDR-TB regimen, anti-diabetic medication, and management of COVID-19 were carried out. On the 6th day, the patient’s condition worsened to the point, where he needed intubation. The patient eventually passed away. CONCLUSION: The treatment outcome was highly related to the severity of COVID-19 symptoms and complications of comorbidities when patients are admitted to the hospital. The early screening and treatment of COVID-19 are important to prevent deteriorating clinical conditions caused by comorbidities.

14.
Alcoholism: Clinical and Experimental Research ; 46:283A, 2022.
Article in English | EMBASE | ID: covidwho-1937898

ABSTRACT

Alcohol misuse is associated with the development of respiratory failure, including the acute respiratory distress syndrome (ARDS), with attendant poorer outcomes. Epidemiologic data suggest that alcohol consumption increased during the COVID-19 pandemic;however, consumption habits among critically ill patients are not well-described. We hypothesized that the prevalence of alcohol consumption and misuse among patients with respiratory failure would be greater during the pandemic relative to years prior. Patients with respiratory failure requiring mechanical ventilation in a single academic hospital were enrolled from 2015-19 (pre-pandemic) and 2020-21 (pandemic). Data regarding demographics and alcohol use were obtained from the medical record. Phosphatidylethanol (PEth) was measured in a subset of patients in red blood cells collected within 48 hours of intubation. Patients were characterized as follows: (1) likely drinking: patient or proxy endorsed any drinking on the Alcohol Use Disorders Identification Test (AUDIT) or in social history;or patient was admitted for an alcohol-related diagnosis;or patient had detectable blood alcohol or PEth;(2) likely alcohol misuse: PEth ≥ 250;or AUDIT-C ≥3 (women) or ≥4 (men);or AUDIT ≥5 (women) or ≥ 8 (men);or patient was admitted for an alcohol-related diagnosis;(3) likely severe alcohol misuse: PEth ≥400. Univariable statistics were utilized as appropriate (Fisher's Exact Test, Kruskal- Wallis Test). The prevalence of likely drinking in the study population (n = 195) varied over time (p <0.0001). When pandemic (n = 67) and pre-pandemic patients (n = 128) were compared, the prevalence of likely drinking (93% vs 58%, p <0.0001), likely alcohol misuse (49% vs 33%, p <0.03) and likely severe alcohol misuse (32% vs 10%, p <0.003) were all greater during the pandemic. Among likely drinking patients with available PEth data (n = 97), median PEth was significantly higher during the pandemic compared to pre-pandemic years (251 [135-702] versus 87 [16-374], p = 0.002). Among the subset of patients enrolled during the pandemic, the prevalence of likely current drinking was 100% in those with COVID-19 compared to 76% among non-COVID patients (p = 0.002), but alcohol misuse did not differ. We conclude that alcohol consumption, and alcohol misuse, have increased during the pandemic in this patient cohort. These changes in drinking patterns are concerning and warrant additional research regarding their impact on susceptibility and outcomes for respiratory failure.

15.
Alcoholism: Clinical and Experimental Research ; 46:161A, 2022.
Article in English | EMBASE | ID: covidwho-1937894

ABSTRACT

Introduction: In-hospital delirium is a risk factor for worse critical care outcomes. Alcohol misuse contributes to increased risk of critical illness and greater pneumonia severity. We sought to determine if alcohol misuse was associated with increased risk of critical illness or complications of critical illness including delirium amongst hospitalized COVID-19 patients. Methods: Retrospective study across 12 University of Colorado hospitals (March 2020-April 2021). Adults with a COVID-19 diagnosis were included. Alcohol misuse was defined by validated ICD-10 codes (F10.1∗, F10.2∗, F10.9∗). Multivariable, mixed effects logistic regression models were used to estimate effects of alcohol misuse adjusting for age, sex, body mass index, diabetes and liver disease. Results: We included 6,454 hospitalized COVID-19 patients aged 60 (SD 18 years) with 53% male. Twenty-four percent (n = 1561) required ICU admission, 14.4% (n = 927) endotracheal intubation with a median ICU stay of 6 days [IQR 2 to 15] and duration of mechanical ventilation of 10 days [IQR 5 to 18]. Ten percent of the cohort (n = 644) died in hospital. Delirium was identified in 4% (n = 254) and 257 patients (4%) had alcohol misuse. Patients with misuse were younger (52 vs 60 p < 0.01), men (77 vs 52%, p < 0.01), had more co-morbid liver disease (p-value < 0.01) and received less remdesivir (29 vs 50%, p < 0.01). There was no difference in dexamethasone or vasopressor use. In adjusted analyses, alcohol misuse was associated with 54% increased odds of ICU admission (aOR, 1.54, 95%CI 1.13 to 2.09, p < 0.01) and 46% increased odds of mechanical ventilation (aOR. 1.46, 95% CI 1.03 to 2.08, p < 0.01) compared to patients without misuse. There was a significant interaction between misuse and in-hospital delirium on in-hospital death with odds of death highest amongst patients with both alcohol misuse and identified delirium. Conclusions: Alcohol misuse was associated with increased need for critical care including ICU admission and mechanical ventilation. Delirium was an important modifiable risk factor for worse outcomes in hospitalized patients with alcohol misuse, and the odds of in-hospital death were significantly increased in the presence of bothmisuse and delirium.

16.
Journal of Hypertension ; 40:e170, 2022.
Article in English | EMBASE | ID: covidwho-1937712

ABSTRACT

Objective: The patient was a 59-year-old man who was referred to the hospital due to shortness of breath due to increased activity, accompanied by cough, weakness, and lethargy. The patient also had a history of diabetes, hypertension, hyperlipidemia, and asthma. The patient also underwent cardiac stenting last year. LCX and LAD stenting Design and method: He had a continuous pan-systolic murmur on cardiac examination diagnosed with valvular dysfunction. Severe aortic regurgitation was reported on echo. The patient underwent a CT scan of the lungs and a PCR test to rule out Covid-19, which was negative. Finally, the patient was diagnosed with severe aortic regurgitation and underwent aortic valve replacement surgery. Echocardiography was performed before the operation, and the diagnosis was confirmed. Results: Echocardiography was performed postoperatively, which showed good valve function and no valve leakage. From the 5th day after the operation, the patient developed fever and increased leukocytosis. Suspected of having Covid19 and accordingly underwent PCR test, the test result was positive;the patient underwent a CT scan of the lungs. After that, he was transferred to the corona ICU. The patient was treated with Remdesivir, and after two weeks, his PCR was negative, and he was almost ready to be discharged. The patient had completed the entire course of treatment and developed pulmonary fibrosis due to Covid disease, but suddenly, after two weeks from the onset of the illness, she developed severe shortness of breath, which led to intubation. We find severe pulmonary fibrosis in the re-CT scan, especially in the left lung, where the entire left lung had fibrosis. Prednisolone was started at a dose of 50 mg three times a day. The patient was intubated for ten days, then gradually removed from the device. Now the patient is extubated and ready for discharge. Conclusions: Risk factors such as Past cardiac surgery and present cardiac intervention with diabetes mellitus increase the risk of developing lung failure in these Covid19 patients. Elective intubation is better than emergency intubation in patients with comorbidities. Corticosteroids can be effective in treating pulmonary insufficiency.

17.
European Stroke Journal ; 7(1 SUPPL):361, 2022.
Article in English | EMBASE | ID: covidwho-1928102

ABSTRACT

Background: Paediatric Cov-2 infections have been less severe than in adults, however some have developed a newly defined syndrome, Paediatric Inflammatory Multisystem Syndrome associated with CoV-2 (PIMS -TS). Its presentation is variable and can cause multi-system involvement. It belongs to the common spectrum of pathogen-triggered hyperinflammatory states, including atypical Kawasaki disease. Case summary: 17 year old male of Ghanaian origin, with no significant past medical history, presented with a one-week history of general malaise, fevers and sore throat. He developed severe chest pain and cardiogenic shock, with a CRP of 200, raised troponin and global hypokinesia on echocardiogram with an ejection fraction of 20%. He was positive for SARS-CoV-2 antibodies (though PCR-antigen negative at admission) and fit the criteria for myocarditis secondary to PIMS-TS. He was treated for sepsis, commenced on IV methylprednisolone and needed intubation, sedation and cardiothoracic ICU level care. On weaning sedation after 3 days, he was found to have left middle cerebral artery syndrome with NIHSS 16. CT head and CT angiogram showed a left MCA ischaemic stroke, and a thrombus in the Sylvian MCA branch. This was treated with antiplatelets. His disease markers and motor deficits improved significantly, however he has cognitive impairment and low mood. Conclusion: PIMS-TS related LVO anterior circulation infarct is rare. It necessitates urgent recognition and multi-specialty involvement as currently management is not standardised. Axial DWI (A), ADC (B) MRI demonstrate large left MCA territory infarct. Axial MRA (C) shows occlusion of the left M2 branches, signal drop-out on SWI (D).

18.
European Stroke Journal ; 7(1 SUPPL):189, 2022.
Article in English | EMBASE | ID: covidwho-1928080

ABSTRACT

Background and aims: Intensive Care Units(ICUs) are a necessary resource for many patients with large vessel occlusion stroke(LVOS) after endovascular treatment(EVT). However, ICUs have a limited availability of beds and ventilators, situation that has been worsened by the current Covid-19 pandemic. We analyze predicting factors for prolonged mechanical ventilation(PMV) after EVT in patients with LVOS. Methods: Retrospective study of patients admitted to our stroke center from 2012-2019 for LVOS who were treated with EVT. We identified patients that required PMV(defined as >24h intubation with admission in ICU) after EVT, and evaluated the association with clinical and radiological factors on admission. Results: N=438. 236(53.9%) women. Mean age 69(DE 14.6). 411(93.8%) anterior circulation stroke, 27(6.2%) posterior. 82(19%) required general anesthesia and intraprocedural intubation, and 47 of them(10.7%) required PMV. Median length of stay(LOS) in ICU: 3 days(1-7). 12/47(25.5%) had prolonged LOS for another reason (6 neurological worsening, 4 hemodynamic instability, 1 respiratory infection, 1 no available beds at Stroke Unit). 19/47(44%) died and 22/47(52.4%) were functionally dependent at three months. Factors associated to a higher risk of PMV after EVT were: basilar occlusion (OR=12.3, IC95%[5.3-28.4],p<0,001);ASPECTS ≤7 (OR=3, IC95%[1.4-6.1],p=0,003) and NIHSS ≥18 (OR=2.8, IC95%[1.3- 5.8],p=0,006). Patients with PMV had a higher risk of mortality (OR=6.5, IC95%[3.3-12.8],p<0,001) and functional dependence (OR=5.1, IC95%[2.4-1],p<0,001) at three months. Conclusions: In our study, patients with basilar occlusion, high NIHSS and lower ASPECTS had higher probability of requiring PMV after EVT, which also led to worse outcome. These are aspects to consider in scenarios with limited availability of ICU beds.

19.
European Stroke Journal ; 7(1 SUPPL):499-500, 2022.
Article in English | EMBASE | ID: covidwho-1928066

ABSTRACT

A fifty-one-year-old previously fit and well man presented with a threeweek history of persistent loin pain. The loin pain could not be explained despite several visits to his medical practitioners and abdominal CT imaging which was reported as normal. He subsequently presented to the emergency department with severe hypertension, acute kidney injury, visual loss and seizure of uncertain aetiology requiring urgent intubation, labetalol infusion and transfer to the intensive care unit. Acute CT head imaging showed radiological features consistent with posterior reversible encephalopathy syndrome (PRES). CT angiogram identified segments of poor opacification in the left-sided renal arterial branches suggestive of thrombus with associated peripheral wedge-shaped areas of hypoattenuation in keeping with renal infarcts. After thorough investigations and careful consideration of various differential diagnoses, it was revealed that the initial symptoms of loin pain occurred two weeks after he had received his Oxford-AstraZeneca ChAdOx1 nCov-19 vaccine. A screen for anti-heparin-PF4 complex antibodies (eight weeks since vaccine administration) was positive at 0.74 OD units [Normal range 0.0-0.4 OD]. In this case, we discuss the investigations and important considerations that led to the patient's diagnosis, as well as details of subsequent management and follow-up of two rare conditions that have occurred concurrently following COVID-19 vaccination. To our knowledge, this is the first case report of two rare conditions: renal artery thrombosis secondary to vaccine-induced immune thrombotic thrombocytopenia (VITT), and posterior reversible encephalopathy syndrome (PRES) that has occurred following ChAdOx1 nCov-19 vaccination.

20.
European Stroke Journal ; 7(1 SUPPL):354-355, 2022.
Article in English | EMBASE | ID: covidwho-1928063

ABSTRACT

Cerebral microbleeds (CMB) emerged as a possible complication of COVID-19. We aimed to assess CMB presence, distribution, and potential underlying pathophysiological mechanisms in hospitalised COVID-19 patients. In a cohort of 112 COVID-19 patients with neurological symptoms admitted to the Geneva University Hospital between March 2020 and May 2021, we assessed CMB distribution, and associations with clinical/ radiological variables. Neuroimaging was performed on a 1.5 T MRI with susceptibility-weighted images, 3D time-of-flight angiography, and 3D-contrast-enhanced fat-saturated T1 black blood VISTA sequences. Two neurologists rated CMB using the Microbleed Anatomic Rating Scale and white matter hyperintensities using the Age-Related White Matter Changes score. 53 patients (47.0%) had CMB;in 45.3% of cases, CMB were found in lobar regions with a predilection for temporal (58.3%) and frontal (29.2%) lobes. Deep CMB were present in 18.9%, with corpus callosum CMB found in 15.0%, in 35.9% CMB distribution was mixed. CMB presence was not related to intubation, pulmonary involvement, nor to radiologic signs of endothelitis. Patients with CMB were more likely to have a higher burden of white matter hyperintensities (OR 1.13, p=0.005, 95% CI: 1.03- 1.24), to have hypertension as a comorbidity (OR= 2.34, p= 0.04, 95% CI: 1.04 - 5.30) and to suffer from an acute stroke during hospitalisation (OR: 3.50 p= 0.012, 95% CI:1.31-9.18). In our sample, COVID-19 patients with neurological symptoms had a high burden of CMB. Their distribution suggests that they may be related to cardiovascular risk factors and cerebral amyloid angiopathy. CMB were also associated with an increased risk of acute stroke.

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