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1.
SAGE Open Med Case Rep ; 10: 2050313X221091391, 2022.
Article in English | MEDLINE | ID: covidwho-1950591

ABSTRACT

Pneumocystis jiroveci pneumonia is a common pathology in HIV-infected but also in uninfected immunocompromised individuals. The pandemic coronavirus disease 2019 (COVID-2019) is a new type of coronavirus disease caused by SARS-COV-2, and the chest imaging is often used as complementary tool in patients' evaluation. The imaging finding is similar with many pulmonary pathologies. Chest computed tomography scan is gold standard imaging and shows a central and diffuse distribution, ground- glass pattern with septal thickening with "crazy paving pattern." We reported a case of 57-year-old man patient, followed in oncology for laryngeal cancer who presented of Pneumocystis jiroveci pneumonia during his follow-up. The diagnosis is confirmed by polymerase chain reaction with bronchoalveolar lavage fluid. Other immunochemical tests can be performed but are less specific. Both curative and preventive treatment in subjects at risk remains trimethoprim-sulfamethoxazole. Corticosteroid therapy may be associated depending on the case.

2.
BMJ Open ; 12(7), 2022.
Article in English | ProQuest Central | ID: covidwho-1950192

ABSTRACT

IntroductionThe WHO End-TB Strategy calls for the development of novel diagnostics to detect tuberculosis (TB) earlier and more accurately. Better diagnostics, together with tools to predict disease progression, are critical for achieving WHO End-TB targets. The Early Risk Assessment in TB Contacts by new diagnoStic tEsts (ERASE-TB) study aims to evaluate novel diagnostics and testing algorithms for early TB diagnosis and accurate prediction of disease progression among household contacts (HHCs) exposed to confirmed index cases in Mozambique, Tanzania and Zimbabwe.Methods and analysisA total of 2100 HHCs (aged ≥10 years) of adults with microbiologically-confirmed pulmonary TB will be recruited and followed up at 6-month intervals for 18–24 months. At each time point, a WHO symptom screen and digital chest radiograph (dCXR) will be performed, and blood and urine samples will be collected. Individuals screening positive (WHO symptom screen or dCXR) will be requested to provide sputum for Xpert MTB/Rif Ultra. At baseline, HHCs will also be screened for HIV, diabetes (HbA1c), chronic lung disease (spirometry), hypertension and anaemia. Study outcomes will be coprevalent TB (diagnosed at enrolment), incident TB (diagnosed during follow-up) or no TB at completion of follow-up. Novel diagnostics will be validated using fresh and biobanked samples with a nested case–control design. Cases are defined as HHCs diagnosed with TB (for early diagnosis) or with incident TB (for prediction of progression) and will be matched by age, sex and country to HHCs who remain healthy (controls). Statistical analyses will include assessment of diagnostic accuracy by constructing receiver operating curves and calculation of sensitivity and specificity.Ethics and disseminationERASE-TB has been approved by regulatory and ethical committees in each African country and by each partner organisation. Consent, with additional assent for participants <18 years, is voluntary. Attestation by impartial witnesses is sought in case of illiteracy. Confidentiality of participants is being maintained throughout. Study findings will be presented at scientific conferences and published in peer-reviewed international journals.Trial registration numberNCT04781257.Cite Now

3.
Arch Dis Child ; 107(8): 752-754, 2022 08.
Article in English | MEDLINE | ID: covidwho-1950043

ABSTRACT

OBJECTIVE: To investigate the validity and home use of a personal ultrasonic spirometer. METHODS: Supervised spirometry was performed using laboratory equipment and a personal ultrasonic spirometer. In addition, the ability of children to perform acceptable spirometry during supervised telehealth appointments at home was assessed. RESULTS: 59 children completed spirometry on both devices. There was high between-device intraclass correlation coefficient (ICC) for forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC): ICC 0.991 (95% CI 0.985 to 0.995) and 0.989 (95% CI 0.981 to 0.993), respectively. Bland-Altman analysis revealed mean bias and limits of agreement of -0.01 (-0.22 to 0.24) L for FEV1 and -0.02 (-0.30 to 0.33) L for FVC. 125 of 140 (89%) supervised telehealth spirometry sessions were acceptable. CONCLUSION: There was excellent reliability in between-device measurements; however, the limits of agreement were wide. Therefore, caution is needed if the device is used interchangeably with laboratory equipment. High success rates of telehealth spirometry sessions indicate the device is suitable for this application.


Subject(s)
Telemedicine , Ultrasonics , Child , Forced Expiratory Volume , Humans , Reproducibility of Results , Spirometry , Vital Capacity
4.
BMJ Open ; 12(6): e059326, 2022 06 23.
Article in English | MEDLINE | ID: covidwho-1909760

ABSTRACT

OBJECTIVE: The Respiratory Health Strategic Clinical Network (RHSCN) was launched to facilitate respiratory and sleep health through implementation of innovative, patient-centred, evidence-informed coordinated services in Alberta. In collaboration with project partners, the RHSCN aimed to determine the respiratory research priorities for Alberta. DESIGN: The four phases of this research prioritisation project were (1) identifying research questions from stakeholders, (2) determining which research questions had been answered in existing literature, (3) prioritising unanswered questions and (4) finalising the priorities through an inperson workshop. SETTING: The study occurred in Alberta, Canada over a 2-year period beginning in March 2017. PARTICIPANTS: A total of 448 patients, clinicians and other stakeholders consented to participate in the survey. RESULTS: A total of 595 possible questions were submitted, with 343 unique questions identified. Of the questions, 94 were out of scope, 155 answered by existing literature and 10 were combined with others, while 83 were determined to be unanswered in the literature. Stakeholders were surveyed again to prioritise the remaining 83 questions and they were reviewed by the project's Steering Committee (clinicians and patients). At the inperson workshop, the Steering Committee identified 17 research topics as priority areas for respiratory and sleep research in Alberta. CONCLUSION: A stakeholder-led research prioritisation process identified optimal clinical management/follow-up, equitable access to services, and management of social, psychological and mental health issues related to respiratory/sleep health as priority research areas.


Subject(s)
Health Priorities , Research Design , Alberta , Humans , Referral and Consultation , Surveys and Questionnaires
5.
BMJ Case Rep ; 15(6)2022 Jun 21.
Article in English | MEDLINE | ID: covidwho-1901953

ABSTRACT

A man in his 40s was admitted to his local hospital 6 days after the first vague symptoms of COVID-19. His general condition deteriorated, and he was treated in the intensive care unit but did not require mechanical ventilation. During his recovery, he experienced a cough spell, after which his dyspnoea recurred and rapidly increased. CT pulmonary angiogram showed a 10×18 cm cavitary lesion with an air-fluid level and surrounding atelectasis of the right lower lobe. A one-way valve mechanism had developed, leading to the formation of a pneumatocele. The patient was treated by occlusion of all bronchial segments of the right lower lobe with endobronchial valves, and the pneumatocele was evacuated with a pigtail catheter. The valves were removed 4 weeks after insertion, and the right lower lobe re-expanded. Six months after treatment, the patient had recovered completely and almost regained his former lung function.


Subject(s)
COVID-19 , Cysts , Bronchi , Humans , Male , Neoplasm Recurrence, Local , Prostheses and Implants
6.
BMJ Case Rep ; 15(6)2022 Jun 23.
Article in English | MEDLINE | ID: covidwho-1901950

ABSTRACT

COVID-19 infection in children is relatively mild and is associated with fewer complications compared with adults. Here we report the case of a previously healthy preteen girl who presented with active COVID-19 and shock. On day 1, ultrasound of the thorax revealed a right-sided pleural effusion with haemorrhagic pus on diagnostic tap, which improved clinically with appropriate hospital treatment. Even at discharge, the chest X-ray barely changed, indicating a fibrotic area and a collapsed lung. The patient had persistent thrombocytosis, her inflammatory markers (C reactive protein, ESR, interleukin 6, serum ferritin, D-dimer and procalcitonin) were elevated, and a high-resolution CT scan of the thorax at discharge revealed fibro-infiltrative patches with cavitary lesions in COVID-19 pneumonia, which are unusual findings. The patient was discharged on clinical improvement and was doing fine on follow-up after 2 weeks.


Subject(s)
COVID-19 , Pleural Effusion , Pneumonia , Thrombocytosis , Adult , COVID-19/complications , Child , Female , Humans , Lung/diagnostic imaging , Lung/pathology , Pleural Effusion/diagnostic imaging , Pleural Effusion/etiology , Pneumonia/complications , Thrombocytosis/complications
7.
Clin Case Rep ; 2020 Jul 15.
Article in English | MEDLINE | ID: covidwho-1898588

ABSTRACT

COVID-19 usually demonstrates the specific pattern of chest CT findings (GGO, inverted-halo sign, etc). However, some COVID-19 cases show atypical CT findings. Physicians should make comprehensive judgments.

8.
EBioMedicine ; 76: 103856, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1894987

ABSTRACT

BACKGROUND: Many repurposed drugs have progressed rapidly to Phase 2 and 3 trials in COVID19 without characterisation of Pharmacokinetics /Pharmacodynamics including safety data. One such drug is nafamostat mesylate. METHODS: We present the findings of a phase Ib/IIa open label, platform randomised controlled trial of intravenous nafamostat in hospitalised patients with confirmed COVID-19 pneumonitis. Patients were assigned randomly to standard of care (SoC), nafamostat or an alternative therapy. Nafamostat was administered as an intravenous infusion at a dose of 0.2 mg/kg/h for a maximum of seven days. The analysis population included those who received any dose of the trial drug and all patients randomised to SoC. The primary outcomes of our trial were the safety and tolerability of intravenous nafamostat as an add on therapy for patients hospitalised with COVID-19 pneumonitis. FINDINGS: Data is reported from 42 patients, 21 of which were randomly assigned to receive intravenous nafamostat. 86% of nafamostat-treated patients experienced at least one AE compared to 57% of the SoC group. The nafamostat group were significantly more likely to experience at least one AE (posterior mean odds ratio 5.17, 95% credible interval (CI) 1.10 - 26.05) and developed significantly higher plasma creatinine levels (posterior mean difference 10.57 micromol/L, 95% CI 2.43-18.92). An average longer hospital stay was observed in nafamostat patients, alongside a lower rate of oxygen free days (rate ratio 0.55-95% CI 0.31-0.99, respectively). There were no other statistically significant differences in endpoints between nafamostat and SoC. PK data demonstrated that intravenous nafamostat was rapidly broken down to inactive metabolites. We observed no significant anticoagulant effects in thromboelastometry. INTERPRETATION: In hospitalised patients with COVID-19, we did not observe evidence of anti-inflammatory, anticoagulant or antiviral activity with intravenous nafamostat, and there were additional adverse events. FUNDING: DEFINE was funded by LifeArc (an independent medical research charity) under the STOPCOVID award to the University of Edinburgh. We also thank the Oxford University COVID-19 Research Response Fund (BRD00230).


Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Benzamidines/therapeutic use , COVID-19/drug therapy , Guanidines/therapeutic use , Administration, Intravenous , Adult , Aged , Aged, 80 and over , Anti-Inflammatory Agents, Non-Steroidal/pharmacokinetics , Benzamidines/adverse effects , Benzamidines/pharmacokinetics , Biomarkers/blood , Biomarkers/metabolism , COVID-19/mortality , COVID-19/virology , Drug Administration Schedule , Female , Guanidines/adverse effects , Guanidines/pharmacokinetics , Half-Life , Humans , Immunophenotyping , Kaplan-Meier Estimate , Male , Middle Aged , SARS-CoV-2/isolation & purification , SARS-CoV-2/physiology , Treatment Outcome , Viral Load
9.
BMJ Open ; 12(6): e059110, 2022 06 13.
Article in English | MEDLINE | ID: covidwho-1891837

ABSTRACT

OBJECTIVE: This study aimed to propose a simple, accessible and low-cost predictive clinical model to detect lung lesions due to COVID-19 infection. DESIGN: This prospective cohort study included COVID-19 survivors hospitalised between 30 March 2020 and 31 August 2020 followed-up 6 months after hospital discharge. The pulmonary function was assessed using the modified Medical Research Council (mMRC) dyspnoea scale, oximetry (SpO2), spirometry (forced vital capacity (FVC)) and chest X-ray (CXR) during an in-person consultation. Patients with abnormalities in at least one of these parameters underwent chest CT. mMRC scale, SpO2, FVC and CXR findings were used to build a machine learning model for lung lesion detection on CT. SETTING: A tertiary hospital in Sao Paulo, Brazil. PARTICIPANTS: 749 eligible RT-PCR-confirmed SARS-CoV-2-infected patients aged ≥18 years. PRIMARY OUTCOME MEASURE: A predictive clinical model for lung lesion detection on chest CT. RESULTS: There were 470 patients (63%) that had at least one sign of pulmonary involvement and were eligible for CT. Almost half of them (48%) had significant pulmonary abnormalities, including ground-glass opacities, parenchymal bands, reticulation, traction bronchiectasis and architectural distortion. The machine learning model, including the results of 257 patients with complete data on mMRC, SpO2, FVC, CXR and CT, accurately detected pulmonary lesions by the joint data of CXR, mMRC scale, SpO2 and FVC (sensitivity, 0.85±0.08; specificity, 0.70±0.06; F1-score, 0.79±0.06 and area under the curve, 0.80±0.07). CONCLUSION: A predictive clinical model based on CXR, mMRC, oximetry and spirometry data can accurately screen patients with lung lesions after SARS-CoV-2 infection. Given that these examinations are highly accessible and low cost, this protocol can be automated and implemented in different countries for early detection of COVID-19 sequelae.


Subject(s)
COVID-19 , Adolescent , Adult , Brazil/epidemiology , COVID-19/diagnosis , Humans , Lung/diagnostic imaging , Prospective Studies , SARS-CoV-2 , Survivors
10.
Pulmonology ; 2022 Jun 12.
Article in English | MEDLINE | ID: covidwho-1886044

ABSTRACT

The COVID-19 pandemic crisis, among so many social, economic and health problems, also brought new opportunities. The potential of telemedicine to improve health outcomes had already been recognised in the last decades, but the pandemic crisis has accelerated the digital revolution. In 2020, a rapid increase in the use of remote consultations occurred due to the need to reduce attendance and overcrowding in outpatient clinics. However, the benefit of their use extends beyond the pandemic crisis, as an important tool to improve both the efficiency and capacity of future healthcare systems. This article reviews the literature regarding telemedicine and teleconsultation standards and recommendations, collects opinions of Portuguese experts in respiratory medicine and provides guidance in teleconsultation practices for Pulmonologists.

11.
Health Sci Rep ; 5(3): e654, 2022 May.
Article in English | MEDLINE | ID: covidwho-1881411

ABSTRACT

Background and Aims: Identification of factors responsible for severe illness related to coronavirus disease 2019 (COVID-19) could help in the early management of patients with high risk, especially in developing countries with poor medical care systems. To date, no data have been published concerning the factors associated with COVID-19 severity in Lebanon. In this study, we aimed at investigating the relation between sociodemographic variables, health status, and the clinical outcomes of COVID-19 in a sample of Lebanese adults. Methods: In our cross-sectional study, 1052 patients (563 male and 489 female, with the median age of 42.83 ± 17.88 years), tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between January and March 2021, were recruited from a hospital in Byblos, Lebanon. Basic demographic data, medical history, clinical data, and selfreported symptoms related to COVID-19 were collected. Clinical classification of COVID-19 severity was carried out according to the WHO interim guidance on May 27, 2020. Multi and bivariate regression analysis were performed. Results: When comparing patients with moderate symptoms versus mild, the results showed that older age (aOR = 1.05; 95% CI: 1.03-1.06) and having dyslipidemia (aOR = 1.89; 95% CI: 1.01-3.49) were significantly associated with higher odds of having moderate symptoms. When comparing patients with severe symptoms versus mild, older age (aOR = 1.08; 95% CI: 1.06-1.10), higher body mass index (aOR = 1.09; 95% CI: 1.04-1.15) and having respiratory diseases (aOR = 2.57; 95% CI: 1.03-6.36) were significantly associated with higher odds of having severe symptoms, whereas female gender (aOR = 0.56; 95% CI: 0.32-0.98) was significantly associated with lower odds of having severe symptoms compared to males. Finally, when comparing patients with severe symptoms versus moderate, older age (aOR = 1.03; 95% CI: 1.01-1.05) was found to be significantly associated with higher odds of having severe symptoms. Conclusion: Identification of risk factors may contribute to a better understanding of the COVID-19 pathogenesis and provide clinical reference for early prognosis and management of patients.

12.
Health Science Reports ; 5(3), 2022.
Article in English | ProQuest Central | ID: covidwho-1857155

ABSTRACT

Background and AimsIdentification of factors responsible for severe illness related to coronavirus disease 2019 (COVID‐19) could help in the early management of patients with high risk, especially in developing countries with poor medical care systems. To date, no data have been published concerning the factors associated with COVID‐19 severity in Lebanon. In this study, we aimed at investigating the relation between sociodemographic variables, health status, and the clinical outcomes of COVID‐19 in a sample of Lebanese adults.MethodsIn our cross‐sectional study, 1052 patients (563 male and 489 female, with the median age of 42.83 ± 17.88 years), tested positive for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) between January and March 2021, were recruited from a hospital in Byblos, Lebanon. Basic demographic data, medical history, clinical data, and selfreported symptoms related to COVID‐19 were collected. Clinical classification of COVID‐19 severity was carried out according to the WHO interim guidance on May 27, 2020. Multi and bivariate regression analysis were performed.ResultsWhen comparing patients with moderate symptoms versus mild, the results showed that older age (aOR = 1.05;95% CI: 1.03–1.06) and having dyslipidemia (aOR = 1.89;95% CI: 1.01–3.49) were significantly associated with higher odds of having moderate symptoms. When comparing patients with severe symptoms versus mild, older age (aOR = 1.08;95% CI: 1.06–1.10), higher body mass index (aOR = 1.09;95% CI: 1.04–1.15) and having respiratory diseases (aOR = 2.57;95% CI: 1.03–6.36) were significantly associated with higher odds of having severe symptoms, whereas female gender (aOR = 0.56;95% CI: 0.32–0.98) was significantly associated with lower odds of having severe symptoms compared to males. Finally, when comparing patients with severe symptoms versus moderate, older age (aOR = 1.03;95% CI: 1.01–1.05) was found to be significantly associated with higher odds of having severe symptoms.ConclusionIdentification of risk factors may contribute to a better understanding of the COVID‐19 pathogenesis and provide clinical reference for early prognosis and management of patients.

13.
BMJ Case Rep ; 15(4)2022 Apr 29.
Article in English | MEDLINE | ID: covidwho-1854260

ABSTRACT

A transgender man in his late teens presented with signs of multisystem disease, including hepatitis, mucositis and bone marrow suppression. He later developed dyspnoea, leucocytosis and bilateral pulmonary infiltrates on chest radiograph. He was treated for community-acquired pneumonia. After several days of treatment, he developed hypoxaemic respiratory failure due to bronchoscopy-confirmed diffuse alveolar haemorrhage (DAH). The differential diagnosis and workup were extensive, and he was ultimately treated with intravenous steroids and five sessions of plasmapheresis for a presumed autoimmune aetiology. Investigations were remarkable only for elevated IgM and IgG to Mycoplasma pneumoniae (MP). This case represents a rare presentation of multisystem disease secondary to MP in adults. Clinicians should consider Mycoplasma infection in cases of multisystem disease and observe for DAH even after initiation of appropriate therapy.


Subject(s)
Community-Acquired Infections , Lung Diseases , Adolescent , Adult , Bronchoscopy , Hemorrhage/etiology , Hemorrhage/therapy , Humans , Lung Diseases/diagnosis , Lung Diseases/etiology , Male , Mycoplasma pneumoniae
14.
BMJ Case Rep ; 15(5)2022 May 17.
Article in English | MEDLINE | ID: covidwho-1846364

ABSTRACT

In critically ill patients with COVID-19, established therapies in the setting of respiratory failure include invasive mechanical ventilation and extracorporeal membrane oxygenation (ECMO). This case report describes a pregnant woman in her 30s who was hospitalised at 35 weeks gestation with moderate COVID-19 disease. Her condition worsened following delivery, and she required intubation, maximum ventilatory support and ECMO. Because of the severe and irreversible nature of her lung disease, she ultimately underwent bilateral lung transplantation. This case showcases lung transplantation as an alternative life-saving option for patients with severe COVID-19 associated respiratory failure refractory to ECMO and mechanical ventilation. Further studies are needed to develop a multidisciplinary approach for patient selection for transplantation within the context of COVID-19 and to assess long-term outcomes.


Subject(s)
COVID-19 , Extracorporeal Membrane Oxygenation , Lung Transplantation , Respiratory Insufficiency , Extracorporeal Membrane Oxygenation/adverse effects , Female , Humans , Lung Transplantation/adverse effects , Postpartum Period , Pregnancy , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy
15.
Arch Dis Child ; 2022 May 12.
Article in English | MEDLINE | ID: covidwho-1846361

ABSTRACT

BACKGROUND: Medication review is recommended at asthma appointments. The presence of propellant in the metered dose inhalers (MDIs) makes it challenging to identify when the inhaler is empty. The COVID-19 pandemic has resulted in move towards more virtual monitoring of care. We aimed to evaluate if patients identify when the inhaler is empty and the method of inhaler disposal. METHODS: Prospective, multicentre quality improvement project. Data collected from children with asthma and other respiratory conditions. OUTCOME MEASURES: Children/carers attending hospital were asked how they identify an empty salbutamol inhaler; dose counters in the preventer inhalers and disposal practices were reviewed. RESULTS: 157 patients recruited. 125 (73.5%) patients deemed an empty inhaler as either full/partially full. 12 of 66 (18.2%) preventer inhalers with a dose counter were empty. 83% disposed their inhalers in a dustbin. CONCLUSIONS: Patients cannot reliably identify when their MDI is empty. There is an urgent need for improving inhaler technology and providing appropriate guidance on how to identify when an MDI is empty.

16.
BMJ Open ; 11(8), 2021.
Article in English | ProQuest Central | ID: covidwho-1842709

ABSTRACT

IntroductionRegardless of having effective vaccines against COVID-19, containment measures such as enhanced physical distancing and good practice of personal hygiene remain the mainstay of controlling the COVID-19 pandemic. Countries across Asia have imposed these containment measures to varying extents. However, residents in different countries would have a differing degree of compliance to these containment measures potentially due to differences in the level of awareness and motivation in the early phase of pandemic.ObjectivesIn our study, we aimed to describe and correlate the level of knowledge and attitude with the level of compliance with personal hygiene and physical distancing practices among Asian countries in the early phase of pandemic.MethodsA multinational cross-sectional study was carried out using electronic surveys between May and June 2020 across 14 geographical areas. Subjects aged 21 years and above were invited to participate through social media, word of mouth and electronic mail.ResultsAmong the 2574 responses obtained, 762 (29.6%) participants were from East Asia and 1812 (70.4%) were from Southeast Asia (SEA). A greater proportion of participants from SEA will practise physical distancing as long as it takes (72.8% vs 60.6%). Having safe distancing practices such as standing more than 1 or 2 m apart (AdjOR 5.09 95% CI (1.08 to 24.01)) or more than 3 or 4 m apart (AdjOR 7.05 95% CI (1.32 to 37.67)), wearing a mask when they had influenza-like symptoms before the COVID-19 pandemic, preferring online news channels such as online news websites/applications (AdjOR 1.73 95% CI (1.21 to 2.49)) and social media (AdjOR 1.68 95% CI (1.13 to 2.50) as sources of obtaining information about COVID-19 and high psychological well-being (AdjOR 1.39 95% CI (1.04 to 1.87)) were independent factors associated with high compliance.ConclusionsWe found factors associated with high compliance behaviour against COVID-19 in the early phase of pandemic and it will be useful to consider them in risk assessment, communication and pandemic preparedness.

18.
Chron Respir Dis ; 19: 14799731221081857, 2022.
Article in English | MEDLINE | ID: covidwho-1785081

ABSTRACT

In the last 6 months, home non-invasive ventilation (NIV) services have faced several unanticipated challenges to their effectiveness and delivery as the result of a 'perfect storm' of the COVID-19 pandemic demands. We developed and delivered an innovative follow-up service, to support home NIV delivery, and improve cost-effectiveness and sustainability during COVID-19. Between Feb-2019 and Nov-2020, 92 post-acute patients were issued with home NIV; 25 (27%) out of the 92 patients had unused NIV machines successfully retrieved. The median (IQR) days of home NIV usage were 207 (98) for patients who had their machines returned. All the unused NIV machines retrieved were within the 5-year working life guaranteed by the manufacturer and were all redeployed after appropriate reconditioning and infection control measures. Without the home-visiting and recycling pilot, we would have relied on patients and families to return the unused machines. Given the expected disruption to NIV machine supply for at least the foreseeable 12-18 months, we feel it is important to get this important message out to other home NIV services urgently. Wider implementation of this novel approach could increase the availability of this vital resource and help meet the current demand on home NIV services.


Subject(s)
COVID-19 , Noninvasive Ventilation , Pulmonary Disease, Chronic Obstructive , Respiratory Insufficiency , COVID-19/epidemiology , Humans , Pandemics
19.
BMJ Case Rep ; 15(4)2022 Apr 06.
Article in English | MEDLINE | ID: covidwho-1779332

ABSTRACT

A man in his 70s was admitted to hospital due to a fall, urinary tract infection and delirium. The patient had a 'do not attempt cardiopulmonary resuscitation' order in place and a ward-based ceiling of care was agreed. He tested positive for COVID-19 while on a geriatric ward and subsequently developed bilateral pulmonary emboli with haemodynamic instability. The patient had a significant bleeding risk; however, the expected morbidity and mortality risk from the pulmonary emboli was high. A decision was made to give the patient low-dose thrombolysis on the geriatric ward, following which he made a full recovery. Acute thrombolysis is normally performed in emergency department, high dependency unit (HDU) or intensive care unit (ICU) settings; however, this was not possible in this case due to the burden the COVID-19 pandemic had placed on HDU/ICU services and bed capacity. Adaptation of treatment guidelines allowed for emergency life-saving treatment to be delivered to this patient.


Subject(s)
COVID-19 , Pulmonary Embolism , Aged , Hospitals , Humans , Male , Pandemics , Pulmonary Embolism/diagnostic imaging , Pulmonary Embolism/drug therapy , Thrombolytic Therapy
20.
BMJ Open ; 12(3): e058238, 2022 03 31.
Article in English | MEDLINE | ID: covidwho-1769918

ABSTRACT

OBJECTIVE: SARS-CoV-2 has caused a pandemic claiming more than 4 million lives worldwide. Overwhelming COVID-19 respiratory failure placed tremendous demands on healthcare systems increasing the death toll. Cost-effective prognostic tools to characterise the likelihood of patients with COVID-19 to progress to severe hypoxemic respiratory failure are still needed. DESIGN: We conducted a retrospective cohort study to develop a model using demographic and clinical data collected in the first 12 hours of admission to explore associations with severe hypoxemic respiratory failure in unvaccinated and hospitalised patients with COVID-19. SETTING: University-based healthcare system including six hospitals located in the Galveston, Brazoria and Harris counties of Texas. PARTICIPANTS: Adult patients diagnosed with COVID-19 and admitted to one of six hospitals between 19 March and 30 June 2020. PRIMARY OUTCOME: The primary outcome was defined as reaching a WHO ordinal scale between 6 and 9 at any time during admission, which corresponded to severe hypoxemic respiratory failure requiring high-flow oxygen supplementation or mechanical ventilation. RESULTS: We included 329 participants in the model cohort and 62 (18.8%) met the primary outcome. Our multivariable regression model found that lactate dehydrogenase (OR 2.36), Quick Sequential Organ Failure Assessment score (OR 2.26) and neutrophil to lymphocyte ratio (OR 1.15) were significant predictors of severe disease. The final model showed an area under the curve of 0.84. The sensitivity analysis and point of influence analysis did not reveal inconsistencies. CONCLUSIONS: Our study suggests that a combination of accessible demographic and clinical information collected on admission may predict the progression to severe COVID-19 among adult patients with mild and moderate disease. This model requires external validation prior to its use.


Subject(s)
COVID-19 , Oxygen , Adult , COVID-19/epidemiology , COVID-19/therapy , Cohort Studies , Hospitalization , Humans , Oxygen/therapeutic use , Oxygen Inhalation Therapy , Retrospective Studies , SARS-CoV-2 , Texas/epidemiology
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