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1.
Ochsner Journal ; 22(1):85-88, 2022.
Article in English | EMBASE | ID: covidwho-1822732

ABSTRACT

Background: The common dermatologic manifestations seen in patients with coronavirus disease 2019 (COVID-19) include mor-billiform, pernio-like, urticarial, macular erythematous, vesicular, and papulosquamous disorders, as well as retiform purpura. Although cases of acro-ischemia have been demonstrated, they are not well studied or reported. Case Report: A 73-year-old male was admitted for acute hypoxic respiratory failure secondary to COVID-19 infection. During the patient’s hospital course, his oxygen requirement progressively increased, and he developed painful, violaceous purpura on his right lower extremity digits. The patient was treated with therapeutic doses of enoxaparin and nitroglycerin ointment in the hospital and apixaban on discharge. The patient was lost to follow-up. Conclusion: The multiorgan dysfunction associated with COVID-19 includes dermatologic manifestations. This case illustrates that acro-ischemia can resolve with guideline-based medical treatment.

2.
Frontiers in Pediatrics ; 10, 2022.
Article in English | EMBASE | ID: covidwho-1822391

ABSTRACT

Acute interstitial nephritis (AIN) has been recently recognized as one of the infrequent kidney involvement phenotypes among adult patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Although SARS-CoV-2 associated intrinsic kidney disease has been scarcely reported in children, only one case of AIN temporally associated with the infection has been described in the pediatric population so far. We presented a case of a 12-year old boy who presented with fatigue, anorexia, and polydipsia following an RT-PCR that confirmed SARS-CoV-2 infection seven weeks prior to admission. Initial workup revealed increased serum creatinine (235 μmol/L), glucosuria, low-molecular-weight proteinuria, mild leukocyturia, and microhematuria with hyaline and granular casts on microscopy. Antibodies against the SARS-CoV-2 S protein receptor-binding domain confirmed prior infection with high titers. Kidney biopsy showed diffuse active interstitial nephritis with negative immunofluorescence and positive immunohistochemistry for SARS-CoV-2 in the inflammatory cells within the interstitium. Electron microscopy revealed several SARS-CoV-2-like particles. Kidney function continued to deteriorate despite several days of supportive therapy only (peak serum creatinine 272 μmol/L);thus, treatment with methylprednisolone pulse-dose therapy was initiated and was followed by oral prednisolone with gradual tapering. Kidney function completely recovered after 3 weeks post-discharge and remained normal after 11 weeks of follow-up (last estimated glomerular filtration rate 106 ml/min/1.73 m2) with only residual microhematuria. Our case adds to the emerging evidence of SARS-CoV-2 as a potential etiological agent of AIN in children and also suggests that interstitial kidney injury may result from secondary inflammatory damage. Epidemiological history, serologic testing, and SARS-CoV-2 detection in biopsy should be considered in the work-up of children with AIN of unknown etiology.

3.
Sinapse ; 22(1):34-37, 2022.
Article in English | EMBASE | ID: covidwho-1819157

ABSTRACT

Myelitis is a rare neurological complication of COVID-19. We will describe a patient with post-COVID-19 myelitis manifesting as partial Brown-Séquard syndrome. A 33-year-old male presented with progressive weakness of the lower limbs, evolving over the previous week. Six weeks before, the patient had had COVID-19, from which he had already recovered. Neurological examination revealed right lower limb weakness and reduced pain sensation on the left lower limb, with a T5-T6 sensory level. Thoracic magnetic resonance imaging (MRI) revealed a right intra-medullary lesion spanning from T3 to T4 with T2 signal hyperintensity. Cerebrospinal fluid study was normal, and SARS-CoV-2 was undetected. After excluding active infection, the patient received methylprednisolone and the symptoms improved. One month later, the neurological exam was considered normal and there was a significant lesion reduction on MRI. SARS-CoV-2 infection should be considered as a possible aetiology for myelitis in all patients, even in those with mild infection or asymptomatic.

4.
Infection and Drug Resistance ; 15:1121-1126, 2022.
Article in English | EMBASE | ID: covidwho-1817636

ABSTRACT

Background: Mucormycosis is a fulminant and rapidly progressing fungal infection associated with a high mortality rate. Mucormycosis is primarily seen in immunocompromised patients, especially those with uncontrolled diabetes mellitus (DM), and recently in coronavirus disease 2019 (COVID-19) patients. Case Presentation: In this case report, we present a rare case of fatal mucormycosis in Palestine. A 34-year-old Palestinian female patient presented to the emergency department one-month post-COVID-19 infection with left facial pain. During her hospital stay, she deteriorated, with a random blood sugar level of 400 mg/dl and a hemoglobin A1c of 18% with metabolic acidosis and the appearance of swelling and black eschar on her left side of her face. Finally, she was diagnosed with mucormycosis and expired two days later. Conclusion: In this unfortunate case report of mucormycosis, severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) infection, delayed diagnosis, misuse of corticosteroids, inappropriate use of antibiotics, and uncontrolled diabetes with ketoacidosis contributed to patient mortality and fatality. Therefore, appropriate patient assessment, rapid diagnosis, and selection of appropriate treatment are important and lifesaving.

5.
Egyptian Journal of Radiology and Nuclear Medicine ; 53(1), 2022.
Article in English | EMBASE | ID: covidwho-1817311

ABSTRACT

Background: Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which was declared a pandemic by the World Health Organization on 11 March 2020 has been reported in most countries around the world since its origins in Wuhan, China. As of September 2021, there have been over 229 million cases of COVID-19 reported worldwide, with over 4.7 million COVID-19–associated deaths. Body: The devastating second wave of the COVID-19 pandemic in India has seen a rise in various extrapulmonary manifestations. One of key components in the pathogenesis of COVID-19 is downregulation of ACE-2, which is expressed on many organs and counterbalances the pro-inflammatory effects of ACE/angiotensin-II axis. This leads to influx of inflammatory cells into alveoli, increased vascular permeability and activation of prothrombotic mediators. Imaging findings such as ground glass opacities, interlobular septal thickening, vascular dilatation and pulmonary thrombosis correlate well with the pathogenesis. Conclusion: We hypothesize that the systemic complications of COVID-19 are caused by either direct viral invasion or effect of cytokine storm leading to inflammation and thrombosis or a combination of both. Gaining insights into pathobiology of SARS-CoV-2 will help understanding the various multisystemic manifestations of COVID-19. To date, only a few articles have been published that comprehensively describe the pathophysiology of COVID-19 along with its various multisystemic imaging manifestations.

6.
BMC Rheumatology ; 5(1), 2021.
Article in English | EMBASE | ID: covidwho-1817296

ABSTRACT

Background: Adult-onset Still’s disease (AOSD) is an autoinflammatory multi-systemic syndrome. Macrophage activation syndrome (MAS) is a potentially life-threatening complication of AOSD with a mortality rate of 10–20%. Especially viral infection is thought to be a common trigger for development of MAS. On the other hand, the occurrence of MAS following vaccinations is extremely rare and has been described in a few cases after measles or influenza vaccinations and more recently after ChAdOx1 nCoV-19 (COVID-19 viral vector vaccine, Oxford-AZ). Case presentation: We report the case of a twenty-year-old female with adult-onset Still’s disease (AOSD), who developed a MAS six days after receiving her first COVID-19 vaccine dose of BNT162b2 (mRNA vaccine, BioNTech/Pfizer) with ferritin levels of 136,680 µg/l (ref.: 13–150 µg/l). Conclusions: To the best of our knowledge, this is the first case report of development of MAS in a patient with preexisting AOSD after vaccination in general, and SARS-CoV-2 vaccination in particular. The new mRNA vaccines have generally shown a reassuring safety profile, but it has been shown that nucleic acids in general, including mRNA can act as pathogen-associated molecular patterns that activate toll-like receptors with extensive production of pro-inflammatory cytokines and further activation of immune cells. Proving an interferon 1 response in our patient directly after vaccination, we think that in this particular case the vaccination might have acted as trigger for the development of MAS. Even if it remains difficult to establish causality in the case of rare adverse events, especially in patients with autoimmune or autoinflammatory conditions, these complications are important to monitor and register, but do not at all diminish the overwhelming positive benefit-risk ratio of licensed COVID-19 vaccines.

7.
J Assoc Physicians India ; 70(4):11-12, 2022.
Article in English | PubMed | ID: covidwho-1801479

ABSTRACT

The progression of the severity of COVID-19 caused by the SARS-Cov-2 virus is through an exaggerated host immune response called the cytokine storm. Corticosteroids can reduce this storm through their anti-inflammatory action, thus preventing lung damage. However the efficacy and side effect profile of the two commonly used corticosteroids- dexamethasone and methylprednisolone against COVID-19 have to be compared, to enable the selection of the appropriate drug with better outcomes. Thus the objective was to compare the efficacy of adjuvant parenteral methylprednisolone and dexamethasone in reducing COVID-19 disease severity and mortality among the moderate to critical patients. MATERIAL: A retrospective comparative study was done among 162 adult patients who were COVID-19 RTPCR positive with moderate or severe illness, among whom 100 patients had received parenteral dexamethasone and 62 patients had received parenteral methylprednisolone. The radiological changes, inflammatory markers and outcomes -duration of hospital stay, rate of discharges, deaths improvement in oxygen requirement, blood glucose post steroids were compared between the two groups. The same parameters were compared for duration of either steroid of less than five days and more than five days respectively. OBSERVATION: Both corticosteroids had a significant improvement in the inflammatory markers of serum LDH, D-Dimer and CRP (p<0.001) with a significant improvement in D-Dimer levels in the methylprednisolone group compared to the dexamethasone group (p =0.04). Methylprednisolone was found to have significant improvement in the oxygen requirement (p=0.01), disease severity (p= 0.015) and radiological changes (p=0.002) compared to dexamethasone. Both corticosteroids were associated with an increase in blood glucose levels post treatment, but no significant difference in the glucose levels between the two groups (p=0.469). No significant difference was seen in the outcomes on comparing the duration of steroids of either group for less than five days with a duration of more than five days. CONCLUSION: Parenteral Methylprednisolone is associated with a better improvement in the severity of moderate and severe COVID-19 compared to dexamethasone. Both steroids cause a similar increase in blood glucose levels, indicating that either steroid holds the risk of hyperglycemia and its potential complications. A longer duration of steroids is not associated with a significant difference in outcome compared to shorter duration of steroids, it also has a hyperglycemia risk similar to the latter.

8.
Brazilian Journal of Infectious Diseases ; 26(1):6, 2022.
Article in English | Web of Science | ID: covidwho-1800182

ABSTRACT

Objective: To estimate the effect of tocilizumab or glucocorticoids in preventing death and intubation in patients hospitalized with SARS-CoV-2 pneumonia.Methods: This was a retrospective cohort study enrolling all consecutive patients hospitalized at Reggio Emilia AUSL between February the 11th and April 14th 2020 for severe COVID19 and treated with tocilizumab or glucocorticoids (at least 80 mg/day of methylprednisolone or equivalent for at least 3 days).The primary outcome was death within 30 days from the start of the considered therapies. The secondary outcome was a composite outcome of death and/or intubation. All patients have been followed-up until May 19th 2020, with a follow-up of at least 30 days for every patient. To reduce confounding due to potential non-comparability of the two groups, those receiving tocilizumab and those receiving glucocorticoids, a propensity score was calculated as the inverse probability weighting of receiving treatment conditional on the baseline covariates.Results and conclusion: Therapy with tocilizumab alone was associated with a reduction of deaths (OR 0.49, 95% CI 0.21-1.17) and of the composite outcome death/intubation (OR 0.35, 95% CI 0.13-0.90) compared to glucocorticoids alone. Nevertheless, this result should be cautiously interpreted due to a potential prescription bias.(c) 2021 Sociedade Brasileira de Infectologia. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

9.
Front Med (Lausanne) ; 9: 807981, 2022.
Article in English | MEDLINE | ID: covidwho-1798932

ABSTRACT

Background: Corticosteroids are the cornerstone of the treatment of patients with COVID-19 admitted to hospital. However, whether corticosteroids can prevent respiratory worsening in hospitalized COVID-19 patients without oxygen requirements is currently unknown. Aims: To assess the efficacy of methylprednisolone pulses (MPP) in hospitalized COVID-19 patients with increased levels of inflammatory markers not requiring oxygen at baseline. Methods: Multicenter, parallel, randomized, double-blind, placebo-controlled trial conducted in Spain. Patients admitted for confirmed SARS-CoV-2 pneumonia with raised inflammatory markers (C-reactive protein >60 mg/L, interleukin-6 >40 pg/ml, or ferritin >1,000 µg/L) but without respiratory failure after the first week of symptom onset were randomized to receive a 3-day course of intravenous MPP (120 mg/day) or placebo. The primary outcome was treatment failure at 14 days, a composite variable including mortality, the need for ICU admission or mechanical ventilation, and clinical worsening, this last parameter defined as a PaO2/FiO2 ratio below 300; or a 15% decrease in the PaO2 from baseline, together with an increase in inflammatory markers or radiological progression. If clinical worsening occurred, patients received tocilizumab and unmasked corticosteroids. The secondary outcomes were 28-day mortality, adverse events, need for ICU admission or high-flow oxygen, length of hospital stay, SARS-CoV-2 clearance, and changes in laboratory parameters. Results: A total of 72 patients were randomized and 71 patients were analyzed (34 in the MPP group and 37 in the placebo group). Twenty patients presented with treatment failure (29.4 in the MPP group vs. 27.0% in the placebo group, p = 0.82), with no differences regarding the time to treatment failure between groups. There were no cases of death or mechanical ventilation requirements at 14 days post-randomization. The secondary outcomes were similar in MPP and placebo groups. Conclusions: A 3-day course of MPP after the first week of disease onset did not prevent respiratory deterioration in hospitalized COVID-19 patients with an inflammatory phenotype who did not require oxygen.

10.
Journal of Heart and Lung Transplantation ; 41(4):S295, 2022.
Article in English | EMBASE | ID: covidwho-1796810

ABSTRACT

Introduction: Acute pericarditis is frequently encountered in the immediate post-operative period following lung transplant, however when seen following recovery it is often in the context of infection. We present a case of a patient 12 years out from lung transplant who presented with findings compatible with acute pericarditis, ultimately diagnosed with acute cellular rejection (ACR). Case Report: A 60 year old man 12 years post bilateral lung transplant for smoking related COPD with CLAD, stage I, BOS phenotype and prior history of probable antibody-mediated rejection (AMR), presented to the emergency department with acute onset dyspnea (<24h), pleurisy, and a leukocytosis. CT angiogram of his chest revealed no evidence of pulmonary embolism, but new bilateral ground glass and consolidative opacities. Infectious studies, including COVID-19, were negative. Multiple EKGs demonstrated diffuse ST elevations without reciprocal changes. Serial high sensitivity troponin assays were negative, and transthoracic echocardiogram did not reveal any findings compatible with myocardial injury. Once ischemia was excluded he underwent bronchoscopy with biopsies, which demonstrated A2 ACR. Screening for donor specific antibodies indicated new C1q-binding class II HLA antibodies. He was treated for acute pericarditis with colchicine and prednisone. He also received high dose methylprednisolone for ACR, as well as IVIG and rituximab for possible AMR. His chest pain and pleurisy dramatically improved after the first dose of methylprednisolone. The initial insult was thought to be an interruption of immunosuppression coupled with cigarette use. This case represents a novel presentation of ACR with concurrent findings of acute pericarditis. Symptoms of pericarditis and rejection can overlap and this case highlights that the two entities can present simultaneously.

11.
Journal of Sexual Medicine ; 19(4):S66, 2022.
Article in English | EMBASE | ID: covidwho-1796415

ABSTRACT

Introduction: Inflatable penile prosthesis (IPP), an implantable device for treatment of ED, historically have always been done in a hospital setting or outpatient setting. These surgeries are now done more frequently around the world as an in-office procedures. With the increase risk of COVID infections and the improvement of IPP technique we began performing this procedure in the office under local and total intravenous anesthesia. Objective: To present the nuances of office based 3 piece penile prosthesis and the outcome data for the feasibility of in-office implants while minimizing complications. Methods: A retrospective chart review was performed on the 10 IPP patients who had surgery in the office based setting in our clinic. The age ranges varied from 34-58 years of age. All pateints who opted for IPP in the office were screened for any and history of pelvic surgery, renal failure, cardiac stents or heart failure. Preoperatively, Antibiotics used were Vancomycin, Amikacin and oral Fluconazole and oral Neurontin for analgesia. All patients had a preoperative COVID nasal swab or had the vaccine prior to surgery. Intraoperatively Vancomycin, Amikacin and Fluconazole were used for irrigation and implant prep. Smaller table sets with stacking sterile field was used with headlights and loupes. IV sedation was used with the assistance of an anesthesiologist who used Propofol for sedation. A propofol bolus was given prior to entering the space of retzius. The patients also received a penile and pudendal block with a mixture of 1% Lidocaine, 0.5% Marcaine and 1mg Solumedrol for post-op pain management. Postoperatively, Neurontin and Tylenol were given PO and Toradol was given IV. Results: Of the 10 patients selected, 0 patients had infections we had even with a drain being in place 2 patients suffered a hematoma. 1 patient suffered urinary retention, resolving after 24 hours. Patients were cleared for device use between 5 to 8 weeks. 1 patient's implant was recalled;however, the patient did not have a desire for re-operation and has the device and works around the valve. The average procedure time was 53.5 minutes. Incision size range was 1.7 cm to 2.5 cm in length.Drains were placed in all patients for 24 to 48 hours with out puts of 90-160cc. Patients were discharged after 90 minutes in recovery phase. Conclusions: Office based penile prosthesis is safe and feasible in the post COVID world. Nuances such was headlights, loupes and adequate block-aid and sterile field efficiency with preloading and stacking are a necessity. With careful patient selection, in-office implantable penile prosthesis implant can be a safe feasible alternative for patients that have severe ED, have gone through alternative therapies, but either cannot afford and or insurance does not cover this procedure. Disclosure: Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast

12.
Critical Care ; 26(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1793874

ABSTRACT

Introduction: Organising pneumonia (OP) diagnosis is histological, however may be inferred by CT pattern [1, 2]. OP due to COVID-19 has been reported but its role remains unknown. Methods: A single-centre, ethical commission approved, retrospective study was conducted in a tertiary university hospital. Data was collected from patients admitted to ICU with severe COVID-19 between March 2020 and February 2021. OP was defined according to CT chest findings. OP patients were treated with 1 mg/kg/day methylprednisolone as per our protocol. Data was analysed using STATA 15.1. Results: We included 338 patients admitted due to COVID-19 pneumonia, mainly male (68%) with mean age 65.0 ± 13.1 years, 71% underwent invasive mechanical ventilation (IMV) for a median time of 13 days and 84% received corticosteroid treatment, 107 dexamethasone only, the remainder methylprednisolone. 126 patients (37%) featured CT compatible with OP. There were no differences between OP and non- OP regarding age, gender, SAPSII or comorbidities. Although patients with OP more frequently underwent IMV (p < 0.01), time from symptoms until IMV was longer (10.1 ± 6.1 in C vs 11.9 ± 6.1 days, p = 0.02). Interestingly, duration of IMV and length of stay (LOS) were increased in the OP group (24.5 ± 20.7 vs 14.2 ± 13.9 days, p < 0.001;LOS: 28.2 ± 27.6 vs 14.4 ± 15.6 p < 0.001), although no difference in ICU (30% vs 29% in OP) or hospital mortality ( 42% vs 53% in OP, p = 0.126) was observed. Not surprisingly, delirium (22 vs 36%, p = 0.01), ICU acquired weakness (20 vs 43%, p < 0.01) and nosocomial infections (41vs 69%, p < 0.01) were more frequent in OP patients. Of note, 87% versus 45% of C patients were still on corticosteroids at the time of ICU discharge. Conclusions: High prevalence of OP was demonstrated in this severe COVID cohort associated with longer IMV time but not a significant increase in mortality. More data is required to determine adequate treatment and impact on prognosis.

13.
Critical Care ; 26(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1793854

ABSTRACT

Introduction: It's known that immunosuppressant agents such as pulse methylprednisolone (PMP), dexamethasone (DXM) and interleukin- blockers (IL-B) are used in COVID-19 [1-3]. The aim of this study is to investigate the effect of these immunosuppressant agents on secondary infections in patients with COVID-19 in intensive care units (ICU). Methods: This study was retrospectively designed and all data between March 2020 and October 2021 of six tertiary ICU was evaluated. All patients were divided by three groups as Group I (GI, no immunosuppressant or MP ≤ 1.0 mg/kg), Group II (GII, PMP and/or DXM) and Group III (GIII, only IL-B and PMP and/or DXM). Demographic data, PaO2/FiO2 (P/F) ratio, C-reactive protein (CRP) and procalcitonin, hemogram parameters, ferritin and d-dimer, culture results and outcomes were recorded. For comparison between GI-GII and GI-GIII, propensity score matching (PSM) was used by matching 14 parameters [age, gender, BMI, CCI, APACHE II, P/F ratio, CRP, procalcitonin, hemogram parameters, ferritin, d-dimer and invasive mechanical ventilation (IMV) requirements]. Results: 412 ICU patients were included in the study (GI = 118, GII = 184, GIII = 110). Mortality rates were 27.1%, 39.7% and 55.5% respectively. After PSM, in GII and GIII, the number of ( +) tracheal cultures, ( +) bloodstream cultures, detected different microorganisms during ICU period, neuropathy, tracheotomized patients, duration of IMV and length of ICU stay were significantly higher than GI. Mortality rate and ( +) CMV-DNA-PCR were similar in GI and GII whereas they were significantly higher in GIII than GI. Conclusions: The usage of immunosuppressant agents in COVID-19 causes increased secondary infections. Moreover, increased secondary infections appear as a reason for prolonged ICU stay and duration of IMV, and also, increased mortality.

14.
Critical Care ; 26(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1793840

ABSTRACT

Introduction: Timeliness of diagnosis and treatment of MIS-C has increased amid the COVID-19 pandemic. Methods: A child was admitted to our clinic (male, 14 years old). He was in contact with a COVID-19 patient 17 days before. Upon admission, the patient complained of a rise in body temperature to 40° C, abdominal pain, vomiting, and diarrhea. Hemorrhagic rash on the skin of the upper and lower extremities, hyperemia of the mucous membrane of the lips and tongue, arterial hypotension were found. Hospitalized at ICU. In laboratory tests: WBC 3.42 × 109/ l, RBC 4 × 1012/ l, HB 111 g/l, HTC 31, PLT 31 × 109/ l, CRP 283 mg/l, PCT 6.66, D-dimer 9.2, LDG 194 U/l, ferritin 989 mcg/l, ALT 54 U/l, GGT 79 IU/l, albumin 32 g/l;proteinuria 0.75 g\l, hematuria. Diagnosis: MIS-C associated with COVID-19. Results: Prescribed: Meropenem 20 mg/kg/d, methylprednisolone 2 mg/kg/d. After 8 h-septic shock. 0.3 μg/kg/min norepinephrine was started. ECG-a violation of repolarization with ST elevation up to 0.3 mm. Echocardiography-a decrease in the left ventricular ejection fraction to 47%, pericardial effusion. Ultrasound examination of the abdominal cavity: hepatosplenomegaly. Dobutamine 3 μg/kg/min was added to the therapy. An increase in PCT up to 19.8 was found. IV IgG 2 g/kg was added to the therapy. On the 3rd day of therapy, regression of all symptoms was obtained. On the 8th day, the child was transferred from the ICU to the pediatric department. On the 12th day he was discharged home. Conclusions: Thus, the timely diagnosis of MIS-C associated with COVID-19 and the appointment of intensive therapy with the inclusion of methylprednisolone and IV IgG allows achieving a positive result in the shortest possible time. Consent to Publish: Written informed consent was obtained from the next of kin.

15.
Iran J Public Health ; 49(8): 1411-1421, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-1791606

ABSTRACT

BACKGROUND: We aimed to examine the available evidence regarding the efficacy and safety of corticosteroids on the management of coronavirus disease 2019 (COVID-19), severe acute respiratory syndrome (SARS-CoV) and Middle East respiratory syndrome (MERS-CoV). METHOD: An extensive search was conducted in Medline, Embase, and Central databases until the end of March 2020, using keywords related to corticosteroids, COVID-19, SARS-CoV and MERS-CoV. The main outcome was considered to be the mortality rate, length of stay, virus clearance time, symptom improvement, and lung function improvement. The findings are presented as odds ratio (OR) with 95% confidence interval (95% CI). RESULTS: Fifteen paper compromising 5 studies on COVID-19, 8 studies on SARS-CoV and 2 studies on MERS-CoV were included. One study was clinical trial and the rest were cohort. The analyses showed that corticosteroids were not reduce the mortality rate of COVID-19 (OR=1.08; 95% CI: 0.34 to 3.50) and SARS-CoV (OR=0.77; 95% CI: 0.34 to 1.3) patients, while they were associated with higher mortality rate of patients with MERS-CoV (OR = 2.52; 95% CI: 1.41 to 4.50). Moreover, it appears that corticosteroids administration would not be effective in shortening viral clearance time, length of hospitalization, and duration of relief symptoms following viral severe acute respiratory infections. CONCLUSION: There is no evidences that corticosteroids are safe and effective on the treatment of severe acute respiratory infection when COVID-19 disease is suspected. Therefore, corticosteroids prescription in COVID-19 patients should be avoided.

16.
Anesteziologie a Intenzivni Medicina ; 33(1):7-13, 2022.
Article in Czech | EMBASE | ID: covidwho-1780464

ABSTRACT

Study objective: Administration of systemic corticosteroids in patients with severe COVID-19 (Coronavirus Disease 2019) has been recommended by World Health Organization (WHO) according to the RECOVERY trial results. However, there is still ongoing debate regarding the evidence supporting the dose, timing, route of administration and type of corticosteroid. This survey aimed to describe the current clinical practice of administration of systemic corticosteroids for patients with COVID-19 within Intensive Care Units (ICU) in Czech Republic. Study design: cross-sectional survey Material and methods: Electronic survey containing 15 questions was sent to the members of Czech Society of Anaesthesiol-ogy, Resuscitation and Intensive Care, Czech Society of Intensive care and Czech Pneumological and Phthisiological Society members. The results were analysed by descriptive statistic methods. Results: The survey fulfilled 233 respondents and 231 answers were eligible for analysis. The most prevalent group was attending physician with completed training in anaesthesiology and intensive care medicine (AIM) (32 %, n = 74). The most prevalent indication for initiation of corticosteroid treatment was oxygen therapy (face mask or nasal cannula) (59,3 %, n = 137) and high-flow nasal oxygen therapy (HFNC) (21,6 %, n = 50). The most preferred corticosteroid was dexamethasone (75,8 %, n = 175) at dose of 8 mg intravenously (i. v.) (48,6 %, n = 85), or dose of 6 mg i. v. (32,0 %, n = 56) followed by methylprednis-olone (25,5 %, n= 59) at dose of 80 mg i. v. (35,6 %, n = 21), and 40 mg i. v. (13,6 %, n = 8), respectively. The preferred duration of therapy was 10 days (dexamethasone 60,6 %, n = 106, methylprednisolone 20,3 %, n = 12). Conclusion: Administration of corticosteroid was dominantly initiated in patients with severe COVID-19 receiving supplemental oxygen. The corticosteroid of first choice was intravenous dexamethasone at dose of 8 mg and 6 mg for 10 days, respectively.

17.
J Investig Med ; 2022 Apr 04.
Article in English | MEDLINE | ID: covidwho-1774977

ABSTRACT

Since the outbreak of COVID-19, research has been focused on establishing effective treatments, especially for patients with severe pneumonia and hyperinflammation. The role and dose of corticosteroids remain obscure. We evaluated 58 patients with severe COVID-19 during two periods. 24 patients who received methylprednisolone pulses (250 mg/day intravenously for 3 days) were compared with 34 patients treated according to the standard dexamethasone protocol of 6 mg/day. Among non-intubated patients, the duration of hospitalization was shorter for those who received methylprednisolone pulses (9.5 vs 13.5, p<0.001). In a subgroup analysis of patients who required intubation, those treated with the dexamethasone protocol demonstrated a relative risk=1.89 (p=0.09) for dying, in contrast to the other group which showed a tendency towards extubation and discharge from the hospital. A 'delayed' need for intubation was also observed (6 vs 2 days, p=0.06). Treatment with methylprednisolone pulses significantly reduced hospitalization time. Although there was no statistically significant influence on the necessity for intubation, methylprednisolone pulses revealed a tendency to delay intubation and hospital discharges. This treatment could benefit patients in the hyperinflammatory phase of the disease.

18.
Journal of the American College of Cardiology ; 79(9):2136, 2022.
Article in English | EMBASE | ID: covidwho-1768638

ABSTRACT

Background: Since the emergence of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), a new multisystem inflammatory syndrome in children (MIS-C) has been described amongst patients with recent past SARS-CoV-2 infection. The primary objective of this study is to describe a single center experience in relation to cardiac manifestations of MIS-C in an ethnically diverse pediatric population. Methods: We conducted a retrospective chart review of pediatric patients less than 21 of age meeting MIS-C criteria who presented to a tertiary care children's hospital from May 2020 to March 2021. Results: Seventy-eight patients diagnosed with MIS-C (average age 9.7 +/- 4.6 years, 57% male) were included in this study (60 Hispanic, 9 non-Hispanic White, 7 Black, and 1 American Indian). The most common presenting symptoms were nausea and vomiting (76%), abdominal pain (71%), appetite changes (69%), fatigue (64%), and conjunctivitis (63%). The average length of intensive care unit stay was 2.5 days while average total hospitalization was 7.3 days. Forty-nine patients (62%) underwent echocardiography. Of those evaluated, there was systolic dysfunction in 45% with an average ejection fraction of 48%, diastolic dysfunction in 14%, valvular disease in 53%, coronary involvement in 16%, and pericardial effusion in 22%. Electrocardiogram was completed on 37 patients (47%) which revealed heart block in 23% and arrhythmia in 3%. Troponin T was elevated in 32% and pro-BNP was elevated in 89%. Ninety-five percent of patients received immunomodulators during their hospitalization, while 94% received methylprednisolone, 59% received intravenous immunoglobulin, and 19% received Anakinra. There was one mortality. Conclusion: The results of this retrospective study contribute to a growing knowledge base in the literature that MIS-C can exhibit a wide spectrum of cardiac manifestations further underscoring the importance of thorough cardiac workup and regular outpatient follow-up in patients diagnosed with MIS-C.

19.
Work: Journal of Prevention, Assessment & Rehabilitation ; 67(4):763-765, 2020.
Article in English | APA PsycInfo | ID: covidwho-1766644

ABSTRACT

Background: During the coronavirus disease (COVID-19) pandemic, people volunteered for sewing hand-made face masks. However, sewing-machine operating might be associated with high ergonomic risk and a negative impact on musculoskeletal health. Objective and Methods: This paper describes an ultrasonographic diagnosis of a foot ganglion - after sewing 300 face masks within two months using a foot-operated sewing machine. Results: The patient significantly improved after an ultrasound-guided aspiration and corticosteroid injection. Conclusion: In short, we highlight the importance of ultrasound examination in the management of work (overuse)- related disorders in occupational medicine practice. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

20.
Indian Journal of Clinical Biochemistry ; 36(SUPPL 1):S5, 2021.
Article in English | EMBASE | ID: covidwho-1767691

ABSTRACT

Multiple laboratory parameters have been Mproposed for use in the diagnosis and prognosis in COVID-19. They are useful as prognostic factors, in choosing certain therapeutic agents and in determining trophism of the disease in particular organ systems or particular inflammatory syndrome like secondary hemophagocytic lymphohistiocytosis (S-HLH). ?ISARIC 4C? score, using 8 variables, including 2 laboratory markers (CRP and urea) is used in predicting disease outcome. However, to capture nuances in disease behaviour, wider biomarker assessment is required. Ddimer, Lactate dehydrogenase, Ferritin all represented disease severity. Procalcitonin can differentiate bacterial infection from inflammation. Troponin has been associated with mortality in patients with and without underlying coronary artery disease. This is also associated with myocarditis. IL-6 and CRP (cutoff>75mg/dL in RECOVERY trial) has been used in selecting patients for Tocilizumab. Ferritin has been shown to predict Methyl Prednisolone response and in identifying S-HLH. Neutrophil:Lymphocytic ratio and Red Cell Distribution Width (RDW) trajectory have been shown to be useful predictor of disease outcome. Circulatory histone has been shown to play important role in COVID-associated coagulopathy and mortality. In ISARIC study, multiple markers (GM-CSF, CCL-4, CXCL 10 )have been shown to have role in prognostication. Genomic study showed strong genetic predisposition towards mortality in critically ill patients, suggesting accurate prognostication is impossible without genetic data. Given that multiple laboratory parameters have role in COVID-19 in variable degree, there is a need for a holistic view of the patients, keeping in mind their demographic and physiological factors and also the subtle interplay between different laboratory features.

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