ABSTRACT
Introduction: Acute respiratory distress syndrome (ARDS) due to Coronavirus Disease 2019 (COVID-19) causes high mortality. The objective of this study is to determine whether the arterial pressure of oxygen/inspiratory fraction of oxygen (PaO2/FiO2) 24 h after invasive mechanical ventilation (IMV) and the difference between PaO2/FiO2 at 24 h after IMV and PaO2/FiO2 before admission to IMV (ΔPaO2/FiO2 24 h) are predictors of survival in patients with ARDS due to COVID-19. Methods: A retrospective cohort study was conducted that included patients with ARDS due to COVID-19 in IMV admitted to the intensive care unit (ICU) of a hospital in southern Peru from April 2020 to April 2021. The ROC curves and the Youden index were used to establish the cut-off point for PaO2/FiO2 at 24 h of IMV and ΔPaO2/FiO2 at 24 h associated with mortality. The association with mortality was determined by Cox regression, calculating the crude (cHR) and adjusted (aHR) risk ratios, with their respective 95% confidence intervals (95% CI). Results: Two hundred patients were analyzed. The average age was 54.29 years, 79% were men, and 25.5% (n = 51) died. The cut-off point calculated for PaO2/FiO2 24 h after IMV and ΔPaO2/FiO2 24 h was 222.5 and 109.5, respectively. Those participants with a value below the cut-off point of ΔPaO2/FiO2 24 h and PaO2/FiO2 24 h after IMV had higher mortality, aHR = 3.32 (CI 95% [1.82-6.07]) and aHR = 2.87 (CI 95% [1.48-5.57]) respectively. Conclusion: PaO2/FiO2 24 h after IMV and ΔPaO2/FiO2 24 h in patients diagnosed with ARDS due to COVID-19 on IMV were associated with higher hospital mortality. These findings are helpful to identify those patients with a higher risk of dying on admission to the ICU.
Subject(s)
COVID-19 , Respiratory Distress Syndrome , Male , Humans , Middle Aged , Female , Respiration, Artificial , COVID-19/complications , Retrospective Studies , Respiratory Distress Syndrome/therapy , OxygenABSTRACT
Information on the effects of a heterologous booster in adult patients first vaccinated with the BBIBP-CorV vaccine is limited. This prospective cohort study evaluated the humoral response of 152 healthcare workers (HCWs) from a private laboratory in Lima (Peru) before and after receiving the BNT162b2 vaccine, with a seven-month interval since the BBIBP-CorV doses. We employed the Elecsys® anti-SARS-CoV-2 S and the cPass™ SARS-CoV-2 Neutralization Antibody (NAbs) assays to evaluate anti-S-RBD IgG and NAbs, respectively. Of the 152 HCWs, 79 (51.98%) were previously infected (PI) with SARS-CoV-2 and 73 (48.02%) were not previously infected (NPI). The proportion of HCWs with positive NAbs, seven months after the BBIBP-CorV immunization, was 49.31% in NPI and 92.40% in PI. After the booster, this ratio increased to 100% in both groups. The anti-S-RBD IgG and NAbs in the HCWs' NPI increased by 32.7 and 3.95 times more, respectively. In HCWs' PI, this increment was 5 and 1.42 times more, respectively. There was no statistical association between the history of previous SARS-CoV-2 infection and the titer of anti-S-RBD IgG and NAbs after the booster. The humoral immunity presented a robust increase after receiving the BNT162b2 booster and was more pronounced in NPI.
ABSTRACT
RESUMEN Los medios de contraste iodados pueden presentar diferentes efectos adversos, siendo los más frecuentes daño renal y reacciones de hipersensibilidad. La ceguera cortical y amnesia global transitoria son complicaciones neurológicas raras descritas tras la administración de medios de contraste. Reportamos el caso de un paciente de 63 años, hipertenso que acude por cianosis, frialdad del segundo y tercer dedo de mano izquierda. Es sometido a arteriografía de miembro superior, usando 50 mL de iopamidol e inmediatamente desarrolla cefalea occipital asociada a visión borrosa bilateral que progresa rápidamente a ceguera; la tomografía cerebral reveló hiperdensidades subaracnoideas occipitales, sin efecto de masa. A las dieciocho horas del evento, el paciente presenta amnesia anterógrada con persistencia de amaurosis. Su tomografía cerebral de control no muestra trastornos focales. El paciente cursa con evolución favorable, la amaurosis bilateral y la cefalea ceden a las treinta horas del evento y es dado de alta sin mayores eventualidades a los diez días.
ABSTRACT Iodinated contrast substances may cause different adverse events, most frequently renal involvement and hypersensitivity reactions. Transient cortical blindness and global amnesia are rarely described neurological complications after the administration of contrast substances. We report the case of a 63-year old patient with high blood pressure who presented with cyanosis and cold sensation affecting the second and third digits of his left hand. The patient underwent an arteriography of the left arm, where 50-mL of iopamidol was used as a contrast substance, and he immediately developed occipital headache associated to bilateral blurred vision that rapidly progressed to blindness. A cerebral computed tomography (CT) scan showed occipital subarachnoid hypodense areas, with no mass effect. Eighteen hours after the event, the patient showed retrograde amnesia with persistent amaurosis. His control cerebral CT scan did now show any focal disorder. The patient had a good progression, both bilateral amaurosis and headache subsided thirty hours after the event, and the patient was uneventfully discharged after ten days.
