COVID-19 and ARDS: Update on Preventive and Therapeutic Venues.

A novel coronavirus SARS-CoV-2, which initially originated in China, has outstretched to all nations and turned out to be an intense global concern for both the governments and the public. In addition to the health concerns, the COVID-19 pandemic has caused a tremendous impact on the economic and political conditions of every nation. Ever since the start of the pandemic, the physicians were constrained to rely on the management strategies due to a lack of clear understanding of the disease pathogenesis caused by SARS-CoV-2 infection. Scientists are working tirelessly to gather maximum information about the deadly virus and come up with various strategies, which can be used against COVID-19 infection in terms of therapeutics and vaccine development. It is quite evident that the virus infection leads to acute respiratory distress syndrome (ARDS), and most of the deaths occur due to respiratory failure. As the virus spreads through respiratory droplets, the strenuous exercise of preventive measures and diagnosis at a large scale has been in practice across the globe to prevent transmission. This review amalgamates the various updates and acts as an umbrella to provide insights on SARS-CoV-2 mediated ARDS pathogenesis, the impact of co-morbidities, diagnostics, current progress in vaccine development, and promising therapeutics and immuno-modulatory strategies, highlighting various concerns and gaps that need to be addressed to fight current and future pandemics effectively.

Sonographic assessment of diaphragmatic thickening and excursion as predictors of weaning success in the intensive care unit: A prospective observational study.

Background and Aims: Ultrasonographic assessment of diaphragmatic function can be a useful bedside tool in the weaning and extubation of mechanically ventilated patients, especially in patients with difficult weaning, in whom diaphragmatic weakness is suspected. Thus, this study was planned to assess the role of bedside sonographic assessment of diaphragmatic indices such as diaphragmatic thickening fraction (DTf) and diaphragmatic excursion (DE) in predicting successful extubation or extubation failure in weaning eligible patients by comparing the measurements with outcome. Methods: This prospective observational study was conducted on 50 mechanically ventilated, weaning-ready patients during the spontaneous breathing trial (SBT). The DE and DTf of patients were noted along with conventional parameters of weaning. Probability value <0.05 was considered statistically significant. Receiver operating characteristic (ROC) curves were used for analysis. Area under the curve (AUC) was measured, and sensitivity and specificity for different cut-off values were estimated. Results: Out of 50 patients, 15 (30%) had SBT failure and 4 had extubation failure. The group with SBT failure had significantly higher rapid shallow breathing index (RSBI) and airway occlusion pressure (P0.1s), whereas DE and DTf were lower compared to the SBT successful group. Strong correlation existed between RSBI, DTf, DE and P0.1s. DTf of nearly 24% (sensitivity 93.5%, specificity 94.7%) and DE of 1.10 cm (84% sensitivity, 89.5% specificity) were associated with best outcome. Conclusion: Along with conventional parameters of weaning, sonographic assessment of diaphragmatic parameters can be useful in predicting the success of SBT and in avoiding unnecessary extubation failures and thereby help in achieving a successful weaning outcome.

Assessing a chip based rapid RTPCR test for SARS CoV-2 detection (TrueNat assay): A diagnostic accuracy study.

COVID-19 testing is required before admission of a patient in the hospitals, invasive procedures, major and minor surgeries etc. Real Time Polymerase chain reaction is the gold standard test for the diagnosis, but requires well equipped biosafety laboratory along with trained manpower. In this study we have evaluated the diagnostic accuracy of novel TrueNat molecular assay for detecting SARS CoV-2. TrueNat is a chip-based real time PCR test and works on portable, light weight, battery powered equipment and can be used in remote areas with poor infrastructure. In this study 1807 patients samples were collected for both TrueNat and RTPCR COVID-19 testing during study period. Of these 174 (9.7%) and 174 (15%) were positive by RTPCR and TrueNat respectively and taking results of RTPCR as gold standard TrueNat test showed a sensitivity, specificity and diagnostic accuracy of 69.5, 90.9% and 89.2% respectively. It can be concluded that TrueNat is a simple, easy to use, good rapid molecular diagnostic test for diagnosis of COVID-19 especially in resource limited settings and will prove to be a game changer of molecular diagnostics in future.

Bedside Ultrasonographic Assessment of Optic Nerve Sheath Diameter As a Means of Detecting Raised Intracranial Pressure in Neuro-Trauma Patients: A Cross-Sectional Study.

BACKGROUND: Optic nerve sheath diameter (ONSD) measurement is emerging as a noninvasive method to estimate raised ICP. It is helpful in situations where imaging of brain or direct ICP monitoring is not available or feasible. Use of ONSD is still limited, so this study was planned to determine whether the bedside sonographic measurement of ONSD can reliably predict elevated ICP in neuro-trauma patients. METHODOLOGY: After approval from Hospital Ethics Committee, this cross-sectional study was conducted in hundred traumatic brain injury (TBI) patients with suspected elevated ICP, admitted to neurosurgical ICU. The severity of brain injury was assessed according to Glasgow coma scale (GCS), initial CT scan findings, and revised trauma score (RTS). All patients underwent ONSD sonography of the eye and CT scan subsequently. ONSD of ≥5.0 mm was considered as a benchmark of raised ICP. RESULTS: Mean ONSD of the study group with ONSD ≥5.0 mm was 5.6 ± 0.3 mm. ONSD was raised in 46% of patients, more so in patients with low GCS (3-6). The relationship of ONSD with GCS, CT scan findings, and RTS was highly significant. The sensitivity of the bedside sonographic measurement ONSD to detect raised ICP was 93.2% and specificity was 91.1% when compared with CT scan. Positive Predictive Value of the ONSD measurement was 89.1% and the negative predictive value was 94.4%. CONCLUSION: Ultrasonographic assessment of ONSD is a reliable modality to detect raised ICP in neurotrauma patients. It can be helpful in the early initiation of treatment of elevated ICP, thus preventing secondary brain damage.

COVID-19 Severity: Lung-Heart Interplay.

In December 2019, a novel COVID-19 infection caused by SARS-CoV-2 has emerged as a global emergency. In a few months, the pathogen has infected millions of people in the world. Primarily SARS-CoV-2 infects the pulmonary system which ultimately leads to ARDS and lung failure. The majority of patients develop milder symptoms but the infection turns severe in a huge number of people, which ultimately results in enhanced mortality in COVID-19 patients. Co-morbid conditions, primarily cardiovascular complications and diabetes, have been reported to show a strong correlation with COVID-19 severity. Further, the onset of myocardial injury secondary to pulmonary damage has been observed in critically ill patients who have never reported heart-related ailments before. Due to drastic health risks associated with virus infection, the unprecedented disruption in normal business throughout the world has caused economic misery. Apparently, newer treatments are urgently needed to combat the virus particularly to reduce the severity burden. Therefore, understanding the crosstalk between lung and heart during COVID-19 might give us better clarity for early diagnosis followed by appropriate treatment in patients with the likelihood of developing severe symptoms. Accordingly, the present review highlights the potential mechanisms that may explain the crosstalk between lung and heart so that effective treatment/management strategies can be evolved swiftly in this direction.

Retained intra- thoracic surgical pack mimicking as recurrent aspergilloma.

An intrathoracic gossypiboma is a rare condition. We are reporting a case of intrathoracicgossypiboma which was misdiagnosed as a recurrent aspergilloma. In our patient, the gossypiboma manifested as a pleural- based extra pulmonary mass which had a large contact area with the pleura and it displayed an extra pulmonary location. A retained surgical swab (gossypiboma) is a rare but an important complication of an intra- thoracic surgery. The diagnosis is usually overlooked, as in our case, resulting in delay of treatment, complications and a prolonged hospitalization.

Aneurysmal bone cyst of sternum.

Aneurysmal bone cyst (ABC) is a benign but locally destructive lesion of the bone characterized by the presence of spongy or multi-loculated cystic tissue filled with blood. It accounts for 2.5% of all bone tumors. An ABC may involve almost any bone, but the most frequent sites are long tubular bones and vertebrae. The sternum is a rare location for an ABC. Here we present a case with sternal ABC, discuss the clinical manifestations and treatment, and review the literature. Radical wide resection of primary sternal tumors and reconstruction with appropriately rigid prosthetic material are necessary to avoid chest wall instability and minimize local recurrence.