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1.
Journal of the Nepal Medical Association ; 60(248):352-355, 2022.
Article in English | EMBASE | ID: covidwho-1822737

ABSTRACT

Introduction: The COVID-19 is caused by a coronavirus. COVID-19 patients present with lymphopenia, thrombocytopenia, and elevated inflammatory markers. This study aims to find out the prevalence of COVID-19 infection among patients attending the fever clinic of a tertiary care centre. Methods: This was a descriptive cross-sectional study conducted from 15th July, 2020 to 15th January, 2021 in the Department of Pathology at a tertiary care centre. The ethical clearance was obtained from the Institutional Review Committee of a tertiary care centre (Reference number: 2007021388). The patients who attended the fever clinic during the study period were subjected to the COVID-19 reverse transcriptase polymerase chain reaction test. A total of 1431 samples were taken using the convenience sampling method. All data were filled into a predesigned proforma and entered into Microsoft Excel. The data were analyzed using Statistical Package for the Social Sciences version 24.0. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data and mean and standard deviation for continuous data. Results: Among 1431 patients attending the fever clinic, the prevalence of COVID-19 was found in 277 (19.31%) (17.26-21.36 at 95% Confidence Interval). Most patients belonged to the age group of 20-29 years. There were 113 (40.79%) females and 164 (59.21%) males. Conclusions: The prevalence of COVID-19 infection in this study was higher than similar studies done in similar settings. Most cases had a low hematocrit with anemia. The total count, absolute neutrophil count, and absolute leukocyte count showed a wide range of variation.

2.
Dermatology Online Journal ; 28(1), 2022.
Article in English | EMBASE | ID: covidwho-1822545

ABSTRACT

The COVID-19 pandemic stimulated adoption of teledermatology via video and telephone modalities by outpatient dermatology clinics. However, it was unknown how patient-related factors may have impacted, whether video or phone visits were used, and if visit modality impacted management. Consequently, we conducted a retrospective cross-sectional study of teledermatology visits occurring between March 30, 2020 and May 30, 2020 at an urban tertiary care center. A total of 788 teledermatology visits including 525 video visits and 263 telephone visits, mostly supplemented by patient-uploaded images, were analyzed. Patient age (P<0.001) and visit type (new versus return patient status), (P<0.001) were significant predictors of likelihood of video visit. No significant difference between video and telephone visits was found with regard to frequency of treatment modification (P=0.52), frequency of biopsy referral (P=0.73), biopsy noncompliance rate (P=0.44), or proportion of biopsies showing a new malignant lesion (P=0.92). With age as a significant predictor of visit modality, maintaining both video and phone modalities could prove useful to maximize patient participation. It appears either can be used without concern that choice of modality would impair the ability to change treatment, recognize a lesion requiring biopsy, recognize a new malignant lesion, or negatively affect compliance with biopsy.

3.
Journal of SAFOG ; 14(1):59-62, 2022.
Article in English | EMBASE | ID: covidwho-1822540

ABSTRACT

Purpose: The purpose of the study is to determine the maternal and fetal outcomes among the coronavirus disease-2019 (COVID-19)-positive pregnant women. Methodology: This is a retrospective cross-sectional study conducted among all the COVID-19 pregnant women who were admitted at Chamarajanagar Institute of Medical Sciences for delivery. Results: The mean age of the study subjects was 26.00 ± 4.89 years, and it ranged between 19 and 37 years. Most of the patients were gravida 2 (51.6%) and primigravida (41.9%);Lower segment cesarean section was the commonest mode of delivery (38.7%). Cough and breathlessness were the symptoms recorded in 1.6% of the patients. Premature rupture of membranes (PROM) (9.7%) and decreased saturation (6.5%) were the maternal complications noted. A majority of the neonates weighed 2.5–3.5 kg (46/63, 73.0%). The mean birth weight of the neonates was 2.97 ± 4.89 kg with the minimum weight recorded being 1.75 kg and maximum was 3.8 kg. The commonest neonatal complication (14.3%) noted was low birth weight (LBW), and among them, eight of them had COVID-19 negative status but for one who was diagnosed COVID-19 positive. There were no deaths recorded among both mother and the neonates. Conclusion: Our results suggest that there are no maternal and neonatal deaths noted among COVID-19 pregnant women, and PROM and decreased saturation were the maternal complications affecting 10.0 and 7.0% of them and LBW was the neonatal complication found among 14.0% of them. Vertical transmission cannot be ruled out 100.0 as 1.6% (1/63) newborn was found to be COVID-19 positive.

4.
Journal of Acute Disease ; 11(2):71-76, 2022.
Article in English | EMBASE | ID: covidwho-1822497

ABSTRACT

Objective: To determine the association between body weight and COVID-19 outcomes. Methods: This is a retrospective cohort study of COVID-19 patients admitted in a dedicated COVID-19 hospital, a tertiary health care center, between May and June 2021. Demographic data and baseline variables, including age, sex, body mass index (BMI), and comorbidities were collected. Outcomes (death or mechanical ventilation) of the patients with different BMI, age, comorbidities, and qSOFA scores were compared. Besides, the risk factors for death or mechanical ventilation were determined. Results: The mean age of the subjects was (51.8±14.7) years old, and 233 (74.2%) were male. There were 103 (32.8%) patients with normal weight, 143 (45.5%) patients were overweight, and 68 (21.7%) patients were obese. In-hospital deaths and need of mechanical ventilations were significantly higher in the obese and the overweight group compared to the normal weight group, in age group ≥65 years compared to <65 years, in patients with ≥1 comorbidities compared to patients without comorbidities, in patients with qSOFA scores ≥2 compared to patients with qSOFA scores<2. There was a significantly increased risk of death (RR: 4.1, 95% CI 1.0-17.4, P=0.04) and significantly increased need of mechanical ventilation (RR: 5.2, 95% CI 1.8-15.2, P=0.002) in the obese patients compared with those with normal weight after controlling other covariates. Conclusion: Obesity is one of the significant risk factors for adverse outcomes in COVID-19 patients and should be considered during management.

5.
Vaccines ; 10(4), 2022.
Article in English | EMBASE | ID: covidwho-1822458

ABSTRACT

The presence of neutralizing antibodies (NAbs) against SARS-CoV-2 represent a surrogate marker of immunologic protection in populations at high risk of infection such as healthcare workers caring for hospitalized patients with COVID-19. As recommended by CDC and the European CDC, the use of rapid diagnostic tests during population-based evaluations offers an opportunity to identify individuals with serologic evidence of natural infection or who have undergone vaccination. We carried out a cross-sectional study to assess the presence of neutralizing antibodies against SARS-CoV-2 among medical providers at an intensive care unit of a large referral hospital in Alicante, Spain. In addition, we tested for the presence of neutralizing antibodies compared to serum of uninfected individuals from a Biobank. We were also interested in evaluating the use of a rapid lateral flow immunochromatography (LFIC) test against a surrogate ELISA viral neutralization test (sVNT). This rapid test demonstrated a specificity of 1.000 95% CI (0.91–1.00) and the sensitivity of 0.987 95% CI (0.93–1.00). The negative predictive value was 95%. After six months, this rapid test demonstrated that those immunized with two doses of BioNTech/Pfizer vaccine, maintained optimal levels of neutralizing antibodies. We concluded that all Health Care Workers develop NAbs and the use of this rapid immunochromatographic test represents a potential tool to be used in population-based studies to detect serological antibody responses to vaccination. Vaccination policies could benefit from this tool to assess additional doses of vaccine or boosters among high-risk populations.

6.
Vaccines ; 10(4), 2022.
Article in English | EMBASE | ID: covidwho-1822457

ABSTRACT

Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), or 2019 coronavirus disease (COVID-19), was declared as pandemic in early 2020. While several studies reported the short-term adverse events (AE) of the mRNA COVID-19 vaccines, medium-term AE have not been extensively evaluated. This study aimed to evaluate the 6-month side effect profiles of the BNT162b2 mRNA vaccine. Methods: This was a descriptive cross-sectional study conducted in a tertiary hospital. Hospital workers who received two doses of the Cominarty (BNT162b2) mRNA vaccine, six months post-vaccination, were invited to participate in this study. All participants completed a self-reported survey assessing AEs occurrence and severity, duration of onset and recovery and if they previously reported these AEs. Results: Of the 670 respondents who completed the survey, 229 (34.2%) experienced at least one AEs, with a total of 937 AEs reported during the 6-month period. After the first dose, the most common reported localized symptoms were pain (n = 106, 27.2%), swelling (n = 38, 9.8%) and erythematous (n = 12, 3.1%) at injection site. Systemic symptoms reported include fatigue (n = 72, 18.5%), fever (n = 55, 14.1%) and headache (n = 46, 11.8%). After the second dose, pain at site of injection (n = 112, 20.4%), swelling (n = 42, 7.7%) and erythematous (n = 14, 2.6%) were among the localized AE reported, while fever (n = 121, 22.1%), fatigue (n = 101, 18.4%) and headache (n = 61, 11.1%) were the most common systemic AE. The proportion of respondents who experienced moderate (first dose: 156 events;second dose: 272 events) and severe (1st dose: 21 events;2nd dose: 30 events) AEs were higher after the second dose. Most AEs commonly resolved within 1–2 days, and none required hospitalization. No new onset of AE was observed 7 days post-vaccination. A total of 137 (59.8%) participants did not proceed to formal AE reporting. Conclusion: Most of the AEs reported were of mild to moderate intensity and short-term, consistent with those reported in previous studies. No medium-term finding was detected in the survey. AE reporting was not routinely performed, necessitating the attention of health authorities in order to enhance pharmacovigilance.

7.
European Journal of Molecular and Clinical Medicine ; 9(3):1672-1678, 2022.
Article in English | EMBASE | ID: covidwho-1820632

ABSTRACT

Introduction: Globally anemia is one of the most important health problems. Adolescents are young people between the ages of 10 to 19 years. Anemia in adolescence may cause a wide range of functional consequences across the life course, including reduced resistance to infection, impaired physical performance and neurodevelopment, and suboptimal schooling outcomes. Aims and objectives: To estimate the prevalence of anemia, to determine the morphological types and patterns of anemia and to assess the etiological factors for different types of anemia among adolescent age group of Eastern India. Materials and methods: It is a retrospective observational study conducted in the department of Hematology at a tertiary care center in Bihar with a sample size of 200 cases. All patients belonging to adolescent age group (10-19 years) having sign and symptoms of anemia were chosen for study whereas children less than 10 years, patients on hematinic and Covid and viral positive cases were excluded. Clinical and demographic data along with hematological findings were retrieved from medical records and data were analysed by SPSS version 25. Results: 55% (n=110) patients were males while 45% (n=90) were females. Amongst males, 31.9% (n=23) were anemic in early adolescent age group and 39.4% (n=15) were anemic in age group 15-19years. While in females, 48.8% (n=21) were anemic in early adolescents and 78.7% (n=37) were anemic in late adolescent age group. Overall prevalence of anaemia among the study subjects was found to be 40.9 %. The prevalence of mild and moderate anaemia was almost similar, each comprising of 39.1% and 39 % respectively whereas 3.1% cases had severe anaemia. Conclusion: The prevalence of anemia amongst adolescents was a moderate public health problem. Factors associated with anemia were low socioeconomic status, rural background, larger family size, poor dietary habits and personal hygiene.

8.
European Journal of Molecular and Clinical Medicine ; 9(3):2605-2612, 2022.
Article in English | EMBASE | ID: covidwho-1820595

ABSTRACT

Introduction: Mortality rates for COVID-19-related mucormycosis vary greatly in reported studies. A systematic evaluation of 101 cases revealed a fatality rate of 30.7 percent. However, research on the determinants of death in COVID-19 associated mucormycosis is insufficient. The purpose of this study was to find out what factors contributed to in-hospital mortality in patients with COVID-19-related mucormycosis. Objectives: To study the the Clinical profile, Haematological,Biochemical and Radiological changes associated with mortality in patients with covid-19 associated mucormycosis. Methodology: In this single-center, observational study, 130 patients diagnosed with COVID-19 associated mucormycosis were recruited from a tertiary level intensive care unit from Bowring and Lady Curzon hospital, Bangalore, India. Results: Proportion of HTN, IHD, CKD and HIV was significantly more in non survivors compared to survivors. ICU admission and Oxygen requirement was scientifically higher in Non Survivors and had significant association with the outcome.. There was no significant difference in the levels of Hb, Neutrophils, Lymphocytes, Monocytes, Eosinophils, and Platelets as p>0.05. Total count (17191±7764), ESR (57.6±12.4), CRP levels (199.0±69.5), and S.Ferritin (624.6±268.0) were significantly higher among the Non survivors. S.LDH (355.7±108.9), S.Free Iron (51.7±13.3), HBA1C (11.4±2.4), and S.Urea (36.9±35.3) were also found to be significantly higher among the non survivors. Conclusion: The current study highlights that a multidisciplinary approach in COVID-19 associated mucormycosis patients that includes timely and effective surgical debridement coupled with appropriate antifungal therapy and diligent sugar monitoring with intrahospital glycemic control may help to lower mortality.

9.
Pakistan Journal of Medical and Health Sciences ; 16(3):393-395, 2022.
Article in English | EMBASE | ID: covidwho-1819184

ABSTRACT

Background: In covid-19 related ARDS patients, early approach to proper health care facility and non-invasive ventilation lead to better outcome. Objective: To determine the outcome of covid-19 related ARDS patients at a tertiary care hospital, Rahim Yar Khan. Methodology: This retrospective study was carried out at department of ICU & anesthesiology in collaboration with department of Pulmonology, Sheikh Zayed Medical College/Hospital, Rahim Yar Khan. A total of 74 (confirmed positive PCR) covid-19 ARDS patients with age of 18-90 years of either sex were admitted in covid ICU from June – December 2020. Patients with negative PCR for covid-19 or who presented in gasping condition or received dead were excluded from the study. Outcomes were labelled as recovered (survivors) or died (non-survivors) and treatment outcome was observed in both groups those who were on non-invasive ventilation (NIV) and on invasive mechanical ventilation (IMV). Data was analyzed by using SPSS version 23.0 Results: Out of 74 patients, 60 (81.08%) were male and 14 (18.02%) were female. Middle and old age patients were more affected as compared to young age group (p-value 0.01) and more than half 41 (55.40%) patients went in to severe ARDS. Regarding treatment outcome 44 (59.5%) patients received NIV and 30 (40.5%) patients received IMV. Survival rate better (35.4%) among the patients on NIV as compared to those on IMV (6.7%) respectively. Conclusion: Survival was better among the covid-19 ARDS patients who received NIV as compared to those on IMV. Keeping an eye on respiratory rate and SpO2 is the main factor for the early recognition of ARDS development and severity.

10.
Pakistan Journal of Medical and Health Sciences ; 16(3):289-291, 2022.
Article in English | EMBASE | ID: covidwho-1819182

ABSTRACT

Introduction: Corona virus disease 2019 (COVID-19) is currently diagnosed mainly using reverse transcriptase polymerase chain reaction (RT-PCR). Yet a significant proportion of patients have negative RT-PCR result. A comparative study of RT-PCR negative patients with RT-PCR positive patients will help understand clinical characteristic and differences of this diseased population. Objective: To compare the clinical and laboratory features of RT-PCR Positive and RT-PCR negative patients admitted in high dependency unit. Patients and methods: In this retrospective cohort study, the data of 128 patients (59 patients with RT-PCR positive result and 69 patients with RT-PCR negative results) was obtained. These patients had been admitted in high dependency unit of a community hospital. Demographics, clinical characteristics and laboratory abnormalities were noted and a comparison was done using statistical analysis. Results: In our study-total 128 patients were enrolled out of which 68 (53.1%) were males and 60 (46.9%) were females. 59 (46.1%) patients were RT-PCR positive and 69 (53.9%) patients were RT-PCR negative. Median age was 55.34 years (18 to 95). No significant difference was noted in most of clinical symptoms (fever, sputum production, rhinorrhea, dyspnea, myalgia, nasal congestion, vomiting, diarrhea, urinary symptoms, altered level of consciousness), comorbidities (diabetes mellitus, hypertension, prior lung disease, prior ischemic heart disease, prior kidney disease), laboratory abnormalities (elevated creatinine, elevated liver enzymes, elevated ferritin, elevated C-reactive protein, elevated d-dimers, elevated procalcitonin, abnormal electrocardiogram). Cough was significantly found to be more prevalent in RT-PCR positive patients (p=0.042) and severe disease was also more prevalent in these patients significantly (p=0.000). Conclusion: Our study shows that patients admitted and diagnosed to be suffering from COVID-19 infection had remarkable similarities in clinical features and laboratory parameters regardless of RT-PCR status, however RT-PCR positive patients suffered from more severe pneumonia as compared to RT-PCR negative patients.

11.
Journal of the Liaquat University of Medical and Health Sciences ; 21(1):44-49, 2022.
Article in English | EMBASE | ID: covidwho-1818978

ABSTRACT

OBJECTIVE: To assess the psychological impact of the COVID-19 pandemic on health care workers in tertiary care hospitals of Karachi. METHODOLOGY: This is a multicentric cross-sectional study conducted at tertiary care hospitals of Karachi (Pakistan). A total of 350 health care workers, including both males and females, from different private and Government tertiary care hospitals, were approached and enrolled after fulfilling the selection criteria from May to Aug 2020. The semi-structured Performa was used for demographic details while the Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder (GAD 7) were administered to evaluate depression and anxiety, respectively. RESULTS: Out of 350 participants, 220 (62.8%) have depression in this study, while 206 (58.8%) have anxiety. The degree of depression was mild in 81 (23.1%) of health care workers, moderate in59 (16.8%), moderately severe in 50 (14.2%), severe in 30 (8.6%). Similarly, mild anxiety was present in 75 (21.4%), moderate in 74 (21.1%), and severe anxiety in 57 (16.3%) persons. The most common problem they faced is ―Fear of transmission of disease family /close friends, being present in 311 (88.9%) p-value = 0.014. CONCLUSION: It is evident that health care workers are affected with depression and anxiety due to pandemic. It is necessary to take appropriate steps to manage the psychological impact of the stress to be more productive in their respective fields.

12.
Journal of Clinical and Diagnostic Research ; 16(4):LC10-LC15, 2022.
Article in English | EMBASE | ID: covidwho-1818678

ABSTRACT

Introduction: Coronavirus Disease 2019 (COVID-19), the new contagious novel coronavirus, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), pandemic in 2020-21 has had a devastating impact on human race. The most common cause of death among hospitalised patient was COVID-19 pneumonia or lung injury. Various studies have shown diurnal variation in human mortality due to all causes with or without intervention. Aim: To identify existence of diurnal variations for mortality among the hospitalised patients with COVID-19 pneumonia. Materials and Methods: This hospital-record based, retrospective study was conducted in a tertiary referral centre of north east India (Assam Medical College, Dibrugarh, Assam, India) which was a dedicated COVID-19 hospital during the pandemic. The study was conducted from September 2021 to December 2021 and the data was collected and recorded from the Cadaver slips issued to families of patient dying of COVID-19 pneumonia during the period January 2021 to August 2021. The data were generated by plotting the number of deaths of COVID-19 cases for each two hour interval as a percent of the mean number of deaths per two-hour interval and as a percentage of cumulative deaths per two-hour interval on a 24 hour scale. The deaths were sub grouped according to gender, age, and reported co-morbid causes of death along with pneumonia. Comparisons of data i.e., mean deaths/2 hour interval (mean±SD) were performed by one-way Analysis of Variance (ANOVA), followed by Bartlett's test for equal variances. The p-value <0.05 was considered as statistically significant. Results: Total 743 deaths, with 537 males and 206 females were included in the study. Mean age of the deaths was 56.39 years. There was rise of deaths during 4 PM to 6 PM (16:00 to 18:00) interval for all deaths due to COVID-19 pneumonia. The increase in deaths during this period was mainly due to deaths among males equal or above 65 years and females below age 65 years. However, the deaths of females equal or above the age of 65 years did not show significant diurnal variation. Only 26.51% (n=197) of pneumonia deaths were without co-morbidity. Conclusion: There exists a diurnal variation in mortality among COVID-19 pneumonia patients with evening rise of deaths. Diurnal variation is significantly more among males rather than females above 65 years.

13.
Geriatric Orthopaedic Surgery and Rehabilitation ; 12:76-77, 2021.
Article in English | EMBASE | ID: covidwho-1817117

ABSTRACT

Introduction: COVID-19 has led to a change in the health-seeking behaviour and the delivery of healthcare. Globally, fragility fracture admissions have reduced by 0-54% depending on location. When Malaysia implemented the third movement control order on 3 May 2021 in response to increasing COVID-19 cases, the number of orthopaedic beds in the University Malaya Medical Centre was reduced from over a hundred to twenty-eight. To date, the impact of COVID-19 on fragility fracture admission in Malaysia is unknown. This study aims to investigate the relationship between COVID-19 cases and fragility fracture admissions to a tertiary hospital in Malaysia. Methods: This retrospective study was conducted from April to June 2021 in the University Malaya Medical Centre. The patients admitted to the University Malaya Medical Centre with fragility fractures between April and June 2021 were identified and compared to the corresponding periods in 2018. Patients <50 years old and those who had fractures due to cancer were excluded. The relationship between the total number of COVID-19 cases per week and weekly fragility fractures admissions were determined. Results: A total of 406,479 COVID-19 cases were reported over 3 months (April, n = 63,213;May, n = 163,644;June, n = 179,622). Fifty-five patients [mean age (78.9±8.6), female (44/55,80%), hip fractures (36/55,65.5%)] were admitted in April-June 2021, which was a 35.3% reduction when compared to the same period in 2018 [n = 85, mean age (75.1±9.9), female (62/85,72.9%), hip fractures (53/85,62.4%)], although no significant difference was found between the baseline characteristics. However, both fragility fracture and hip fracture admissions were found to be negatively correlated (r =-0.76 and r =-0.75) with the COVID-19 cases (P < 0.01). Twelve (12/51,23.5%) patients admitted in 2021 due to post-fall fragility fractures presented to the hospital more than a day after their injury. The proportion of patients with delayed presentation (>1 day post-fall) increased over the study period (April = 5/26, 19.2%;May = 3/13, 23.1%;June = 4/12, 33.3%). Conclusion: There was a reduction in fragility fracture admissions during the COVID outbreak in Malaysia. There might be a rebound in cases after the COVID crisis is over, reorganising medical services may be warranted to ensure effective fracture care delivery.

14.
Blood Purification ; 50(SUPPL 1):20, 2021.
Article in English | EMBASE | ID: covidwho-1816960

ABSTRACT

Background: Until the present time, the effect of hemoperfusion to mitigate inflammatory response and improve outcome in severe COVID-19 is still unknown. Therefore, we aimed to investigate the effects of early HA-330 hemoperfusion in combination with standard therapy in severe COVID-19 patients. Methods: We conducted a single center, prospective cohort study on patients who diagnosed with severe COVID-19 patients and admitted to ICU. Patients in hemoperfusion group (defined as patients who were treated with hemoperfusion therapy at least 3 sessions in combination with standard therapy) were compared with the control group (defined as patients who received standard treatment alone or received less than 3 sessions of hemoperfusion therapy). We assessed C-reactive protein, oxygenation assessment (PaO2 and ratio of PaO2/FiO2) , severity scoring of lung infiltration on the chest x-ray (CXR RALE score) and organ failure score (SOFA score) daily. Those were defined as a primary outcome. The secondary outcomes were ventilator free day, hospital mortality and 28-day mortality. All outcome was adjusted by regression analysis to reduce the confounders due to some difference in baseline characteristics. Results: Between April 7,2021 and May 31,2021, a total number of 29 severe and critical COVID-19 confirmed patients were enrolled. Fifteen patients were defined as hemoperfusion group and 14 were control group. The median of C-reactive protein and SOFA score at the baseline (the day after severe pneumonia diagnosis or before hemoperfusion) in hemoperfusion and control groups were comparable, 96.79 mg/L and 87.3 mg/L, p=0.53, 3.53 ± 0.99 VS 4.3 ±1.89, p=0.15, respectively. Clinical improvement associated with decreased SOFA score and improvement of CXR RALE score were found in hemoperfusion group compared to control group (p=0.008 and p=0.005, respectively). The 28-day mortality rate was significantly lower in hemoperfusion group compared to control group (6.67 % vs 85.71 %, p<0.001) and adjusted HR of death was 0.017 (95 % CI = 0.008-0.351, p=0.008) Conclusion: In severe COVID-19 patients, the addition of at least 3 sessions of hemoperfusion therapy to standard COVID-19 therapy seemed to improve severity of organ failure, CXR severity score, ventilator-free day and reduced the mortality rate.

15.
Blood Purification ; 50(SUPPL 1):4, 2021.
Article in English | EMBASE | ID: covidwho-1816953

ABSTRACT

Background: Approximately 5 to 10% of patients with AKI require RRT during their stay in the intensive care unit (ICU). The mortality ranges from 30 to 70% so we consider it as high. A common factor that these patients present is hemodynamic instability. Continuous renal replacement therapy (CRRT) has provided physicians with a versatile tool for the care of critically ill patients with hemodynamic instability with indications for RRT such as acid-base disorders, fluid and electrolyte abnormalities, uremia, and / or fluid overload. The CRRT presents different modalities for its application and allows the use of different membranes and cartridges, which is why it is frequently used in patients with multiple organ failure and sepsis with different indication, based upon De basal disease and the need for extracorporeal support. The pathophysiological understanding of this last entity has generated new strategies as a measure for the decrease of inflammatory cytosines. For these reasons, the TRRC has earned a place in the ICU during the SARS-CoV-2 pandemic. Currently, a mortality of 50% is described in the patient with critical Covid-19 and a decrease in it has been reported when they undergo CRRT with the use of the oXiris® membrane. Therefore, the following study was carried out to describe our experience with the oXiris® membrane in patients with Covid-19 in the ICU of a tertiary hospital in northeast Mexico. Methods: Observational, retrospective, and analytical study. Thirteen patients older than 18 years hospitalized in the ICU with a diagnosis of Covid-19 by real-time PCR test were included, who required CRRT with the oXiris® filter between January 2020 and August 2021. Sociodemographic data, number of days total hospital stay (EIH) and ICU;duration and specifications of the TRRC, and its outcome. Results: 13 patients were included, of which 10 were men (76.9%). The mean age was 59.4 ± 12.9 years. The most frequent comorbidities were arterial hypertension (53.8%) and type 2 diabetes mellitus (38.4%);in 7 and 5 patients, respectively. The mean EIH was 60.3 ± 44.9 and 45.8 ± 30 days in the ICU. The median duration of the days with CRRT was 8 (3-11). The main indication for the initiation of CRRT was anuria (61.5%), followed by fluid overload (23%) and uremia (15.4%). Of the total population, 4 (30.7%) recovered kidney function, 5 (38.4%) were discharged with intermittent hemodialysis, and 8 (61.5%) died. In the first 48 hours of the initiation of CRRT with oXiris® the vasopressor requirements decreases besides the creatinine and urea. Conclusions: Despite the use of the oXiris® filter in the patient with critical covid-19, mortality exceeds 50%, even if there is a good response in hemodynamical improvement at the begging of the therapy. We consider that this outcome is dependent on multiple comorbidities and clinical situations not included, so its application should continue to be investigated.

16.
Journal of Neurological Surgery, Part B Skull Base ; 83(SUPPL 1), 2022.
Article in English | EMBASE | ID: covidwho-1815669

ABSTRACT

Objective: The purpose of this study was to evaluate the change in clinical spectrum and outcomes of invasive fungal disease involving the anterior skull base region. Study Design: This study represents a retrospective review of the patients diagnosed with acute and chronic invasive fungal rhinosinusitis based on imaging, fungal staining and culture, biochemical analysis, and histopathology report. Assessment of anterior, central skull base including orbital involvement was done clinicoradiologically and/or intraoperative findings. Setting: A tertiary referral hospital. Results: There was a total of 79 patients, of which 67% had skull base mucormycosis, 33% had invasive aspergillosis. In the skull base mucormycosis group, there were 53 patients, with 33 males and 20 females. 88% of patients had a history of COVID-19 infection. 98% of patients had type 2 diabetes mellitus. The mean duration of symptoms was 36 days, and 68% of them presented 30 days after onset of symptom. Mortality was seen in 7 (14%) patients. The most common symptom of the presentation was facial swelling followed by facial numbness, vision loss and headache. The most common area of skull base involved was pterygopalatine fossa (88%), followed by infratemporal fossa (71%), anterior and posterior cribriform area (60% each). The most common vessel involved was the sphenopalatine artery (75%), and the neural structure involved was infraorbital nerve (64%) and maxillary division of trigeminal nerve (52%). 13 patients had an intracranial disease, with 2 having cerebritis and rest with parenchymal abscess including one patient with cerebellar abscess. All patients had radical debridement with antifungal treatment. In the invasive aspergillosis group, there were 26 patients with 12 males and 14 females with a mean age of 42 years. The mean duration of presentation after the onset of the symptom was 33 weeks. Only 26% of patients had diabetes mellitus (type 2), and one patient had COVID-associated aspergillosis who presented within 28 days after onset of symptom with intracranial extension. Tissue diagnosis for confirmation of aspergillosis was obtained in 62% of patients, while the use of galactomannan assay and clinicoradiological diagnosis was done in 38%. A similar trend of skull base involvement was seen.

17.
Israel Medical Association Journal ; 24(1):5-8, 2022.
Article in English | EMBASE | ID: covidwho-1813102

ABSTRACT

Background: In response to the coronavirus disease-2019 (COVID-19) pandemic, routine clinical visits to the ophthalmic emergency department (OED) were deferred, while emergency cases continued to be seen. Objectives: To assess the consequences of the COVID-19 pandemic for ophthalmic emergencies. Methods: A retrospective chart analysis of patients who presented to the OED during the peak of the COVID-19 pandemic was conducted. The proportions of traumatic, non-traumatic-urgent, and non-traumatic-non-urgent presentations in 2020 were compared to those of the same time period in 2019. Duration of chief complains and best-corrected visual acuity were also assessed. Results: There were 144 OED visits in 2020 compared to 327 OED visits during the same 3-week-period in 2019. Lower mean age of OED patients was present in 2020. Logarithmic expression (LogMAR) best corrected visual acuity (BVCA) was similar in both years. In 2020 there was a reduction in traumatic, non-traumatic-urgent, and non-traumatic-non-urgent cases compared to 2019 (15.4% reduction, P= 0.038;57.6% reduction, P= 0.002;74.6% reduction, P= 0.005, respectively). There was a higher proportion of same-day presentations at commencement of symptoms in 2020 compared with 2019 (52.8% vs. 38.8%, respectively P= 0.006). Conclusions: During the COVID-19 pandemic, the number of OED visits at a tertiary hospital dropped by more than half. Although the drop in visits was mostly due to decrease in non-traumatic-non-urgent cases, there was also decrease in non-traumatic-urgent presentations with possible important visual consequences. Additional studies should elucidate what happened to these patients.

18.
Clinical Neurosurgery ; 68(SUPPL 1):141, 2022.
Article in English | EMBASE | ID: covidwho-1812787

ABSTRACT

INTRODUCTION: Second wave of covid19 affected India significantly with total numbers of cases 31,440,950 and total death 4,21,224. As India acheived stablity in fight against covid, another challenge emerged in the form of Mucormycosis. Mucormycosis is a serious angioinvasive infection caused by the order Mucorales and class of Mucormycetes. It is associated with high mortality in immunocompromised mainly diabetic patients if not treated agressively. METHODS: Our Hospital, IGIMS was declared exclusive covid facility in April 2021 and subsequently was declared dedicated hospital for Mucormycosis.During this two month period demographic, Clinical details and outcome were collected prospectively. RESULTS: During two month period, 500 cases were seen in OPD, 300 patients were admitted and 120 patients were operated. 47 patients have cerebral involvement. 11 patients with extensive involvement of brain including cavernous sinus were not offered surgery, because of poor pronosis. 4 patients of this group improved 5 patients died and 2 patients were discharged in moribund condition. Another 26 patients with only meningeal involvement and small lesion, with no mass effect and was treated conservatively. 16 of this group improved, Four (with poor coma score expired. Another 4 patients were transferred to other medical facilities and details of these patients are not available. 10 patients having large fungal lesion in non eloquent area along with mass effect were operated. six patients were operated with microscopic technique and 4 patients with endoscopic technique. eight patients were earlier, Covid RT-PCR positive and was treated with steroid and oxygen inhalation. Another two patient had fever , but Covid RT-PCR was negative and was treated at home with oxygen cylinder.All of them were treated with liposomal amphotrecin B. Sinus surgery was performed in all patients. Eight patient did well and was discharged from hospital in good condition. One patient, in which endoscopic cerebral exploration was done expired. Another patient was discharged with severe neurological sequlae. CONCLUSIONS: Patients with Rhincerebral Mucormycosis spreading outside sinonasal cavity to the base of the brain can be treated by neurosurgical intervention.

19.
Journal of Clinical and Diagnostic Research ; 16(SUPPL 2):35, 2022.
Article in English | EMBASE | ID: covidwho-1798730

ABSTRACT

Introduction: There is growing evidence of neuropsychiatric presentations in patients of COVID-19, but literature is scarce on laboratory biomarkers for its objectivity as diagnostic or prognostic purpose and how they are impacted in clinical course of systemic outcome in COVID-19 infection. Materials and methods: Authors screened 430 ICU patients admitted to our tertiary care hospitals, out of whom 67 were diagnosed positively with definitive neuropsychiatric sequalae and receive psychotropic interventions during their hospital stay. Authors compared their D-dimer levels, C-reactive proteins, serum ferritin levels, serum procalcitonin and Vitamin D levels and further analyzed CORADS severity score with psychiatric severity and outcome. Results: Among the clinical laboratory biomarkers only D-dimer levels were found to be significantly impacting the variability among various psychiatric diagnosis (F=2.479, p <0.033). while serum ferritin levels were just marginally close to significance (F= 2.221, p=0.053). We observed that serum CRP, vitamin D levels and serum procalcitonin levels were not significantly variable between seven domains of psychiatric disorders. These laboratory biomarkers were considered to be useful not only for early suspicion of neuropsychiatric disorders and identifying high risk cohorts but also rationalizing therapies, predicting outcome and framing ICU admissions. Conclusions: The present study has found significant association of elevated levels of D-dimer variability but not the other laboratory biomarkers among various neuropsychiatric comorbid sequalae in ICU admitted COVID-19 patients. This particular observation might have potential for serum D-dimer levels to be possibly used as an early biomarker to screen or suspect for comorbid neuropsychiatric presentations and their prognosis.

20.
Journal of Clinical and Diagnostic Research ; 16(SUPPL 1):10-11, 2022.
Article in English | EMBASE | ID: covidwho-1798702

ABSTRACT

Background: Any information which will affect adversely and drastically a patient's view of his/her future is called as bad news. Breaking a bad news involves ethical, legal, professional and human rights related issues. But there was no proper training currently among most of the postgraduate medical students of India. This results in miscommunication of information and ultimately lack of trust and piling up of legal cases. Medical fraternity including postgraduates of clinical departments has had some experience of breaking bad news at any point of time. There was limited mixed method study to explore this aspect of communication skills in India. Description: It was a Mixed Method Study conducted among 122 medical postgraduates excluding non-clinical postgraduates of a tertiary care hospital, Tamil Nadu by Universal Sampling Method using Focus Group Discussion with FGD Guide and a pre-validated questionnaire through Google forms. Quantitative data analysed through SPSS software and qualitative data analysed through manual thematic analysis. Outcome: Around 51% were from non-Tamil origin and 53% were aware of some type of communication models. SPIKE, ABCDE and BREAK were the models mentioned by the participants About 89% had experience of delivering bad news in the past and among the bad news delivered 75.3% was declaring deaths, 67.1% was communicating the patients about COVID positivity status, 64.7% was communicating the patients about a non-reversible complication of a disease, 38.8% was about communication of cancer diagnosis, 18.8% was about HIV positivity status and 10.6% was communication of positive genetic test results. Challenges mentioned by the participants were language issues, lack of better communication skills, not expertise in the field to answer the questions of the patients/relatives, fear of physical assault, fear of legal issues, personal mental health issues, lack of counselling skills, lack of self-confidence, fear of losing reputation of a life-saving Doctor and fear of questions faced in death audit/case audit. About 58% of the participants did not feel comfortable in delivering bad news and 57.7% felt empathic towards them. In addition, 96.5% maintained privacy while delivering the bad news. Before conveying the bad news, 42% of them agreed that warning shots should be given and 52% felt that after communicating the bad news, the patients should be encouraged to express their feeling and they should clarify their doubts. Around 80% felt that breaking a bad news is a skill and it needs training and expressed that they want to undergo intense training on the same. Conclusion: Breaking a bad news is a skill and half of the participants felt uncomfortable in delivering bad news. Three fourth of them mentioned that they need further training for delivering bad news even after though they have undergone initial training during PG orientation program and expressed various challenges including language issues and lack of communication and counselling skills. Hence, reinforcement of training in breaking bad news should be part of their teaching to reduce ethical and legal issues in future.

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