C-Reactive Protein (CRP): A poor prognostic biomarker in COVID-19.

Introduction: The COVID-19 pandemic continues to be rampant with considerable morbidity and mortality worldwide since its emergence in December 2019. Several studies have focused on identifying different predictive factors of poor prognosis, including biological markers, such as C Reactive Protein among others. The objective of our work was to determine whether the CRP levels on admission to the intensive care unit are predictive of an unfavorable evolution of patients with COVID-19 through the experience of the Anesthesia and Intensive Care Unit of the University Hospital of Oujda and to compare our results with those reported in the literature. Methods: We conducted a retrospective, monocentric, descriptive and analytical study in the Department of Anesthesia and Intensive Care of the Mohammed VI University Hospital of Oujda, Morocco, between March 2020 and October 2021, including all critically ill patients admitted to the department during this period and meeting the inclusion criteria. The baseline admission CRP value was arbitrarily set at 100mg/d, thus conditioning the division of our patients into two groups (group 1: CRP < 100mg/L, group 2: CRP ≥ 100mg/L). Results: Among our 1035 included patients, 291 patients with had a CRP<100mlg/L (group 1) and 744 presented a CRP level equal or superior to 100mg/L (group 2). Lung parenchymal involvement was more severe or even critical (CT involvement > 75%) in group 2 (60.8%) compared to group 1 (39.2%). In group 2, 79.8% of patients were mechanically ventilated, compared to 20.2% of patients in group 1. Finally, the mortality rate in patients with a CRP ≥ 100mg/l was 77.4%, compared with 22.6% for patients with a CRP < 100mg/l. These findings are all statistically highly significant (p<0.001). Conclusion: Given the high contagiousness of the virus and the emergence of several variants, the management of the COVID-19 pandemic has focused more on prevention through vaccination against the virus, but also on an early identification of patients likely to evolve unfavorably for a personalized management.

Bilateral spontaneous pneumothorax in critically-ill COVID-19 infants: About two cases.

INTRODUCTION: COVID-19 is an emerging infection, it is the first large-scale pandemic of the 21st century. Several complications have been described during this infection but spontaneous pneumothorax remains an uncommon complication, even more so in infants. CLINICAL PRESENTATION: We report two cases of a 9-month-old and 18-month-old males admitted to our department for the management of an acute respiratory distress due to a COVID-19 infection associated to a spontaneous pneumothorax successfully drained.While one patient had a favorable outcome, the other was readmitted to our department for the management of a septic shock secondary to a urinary tract infection with a deadly outcome. DISCUSSION: In this paragraph we describe known causes behind spontaneous pneumothorax, before detailing the different pathogenesis hypotheses linking pneumothorax to COVID-19, all while comparing data to the literature related to the adult population. CONCLUSION: Spontaneous pneumothorax is a serious complication associated with severe COVID-19 that can occur in infants and must be considered in the event of a respiratory aggravation or a persistent hypoxia.

Diabetes as a predictive factor for severe form and high mortality risk of COVID-19: Retrospective cohort study of 188 cases.

INTRODUCTION: Since the appearance of the first case of the SARS CoV 2 infection, several studies have been conducted to identify the predictive factors of mortality in patients with COVID-19. According to previous reports, diabetes seems to be associated with severe clinical forms of the new coronavirus (SARS CoV 2).Our study aimed to identify the epidemiological, clinical, radiological and prognostic profile of diabetic patients with COVID-19. METHODS: This retrospective study included diabetic patients diagnosed with COVID-19 and admitted to the Resuscitation Department of our university hospital center From Mars 1st 2020, to December 31st, 2020. RESULTS AND DISCUSSION: In this study, we collected the data of 600 patients admitted to the Anesthesia and Resuscitation Department of the Mohammed VI University Hospital of Oujda, a group of 188 (31.3%) had diabetes.The median age of our patients was 67 [25-75]. Were noted in the majority, of patients 69.6% with diabetes have developed a severe or critical injuries in the Chest CT Scan. Furthermore, we found that the mortality rate in this category of patients was higher 65/188 (34.60%) compared to non-diabetic patients, 130/412 (31.60%) (34.60%vs 31.60%; p: 0.464). CONCLUSION: Based on the results of this retrospective study, we concluded that diabetes is predictive factor for the need of an intensive care as well as a high risk of mortality related to COVID-19.Practically speaking, diabetic patients should be monitored more closely and need an aggressive preventive management protocols in order to prevent severe forms of the disease and a drastic evolution.More research is direly needed to identify patients of a higher risk of developing severe forms of COVID-19.

Acute Disseminated Encephalomyelitis: A rare form of COVID-19's neurotropism.

INTRODUCTION: the COVID-19 pandemic still accounts for thousands of cases every day. It's neurological involvement has been well documented most likely due to auto-immune mechanisms than the virus itself. CASE REPORT: we report the case of a 38 years old women who developed an Acute Disseminated Encephalomyelitis following a COVID-19 infection, with a favorable outcome after immunosuppressive therapy. DISCUSSION: In this chapter, we discuss ADEM's pathogenesis as well as its clinical and radiological features before detailing its relationship with infectious and vaccination episodes. We also discuss how our patient disease evolved. CONCLUSION: Acute Disseminated Encephalomyelitis is an immune-mediated disorder in which the widespread inflammation of the brain and spinal cord is responsible for a variety of symptoms. The novel COVID-19 virus and its vaccine are both a newly incriminated etiologies of this demyelinating disorder.

Incidental diagnosis of a large cardiac thrombus swinging through an interatrial communication in a COVID-19 patient: Case report and literature review.

INTRODUCTION: The hypercoagulability state induced by COVID-19 has been well established and various forms of subsequent thromboembolic events have been reported throughout literature including multiple cases of intracardiac thrombi, four of which in our center alone, this case being the fifth. CASE REPORT: We report the case of a 38-year-old male with no prior cardiovascular history who -subsequently to a COVID-19 infection-developped a right atrial thrombosis associated to a pulmonary embolism, and in whom cardiography revealed an interatrial communication. Management relied upon curative doses of low molecular weight heparin (LMWH) with favourable outcome. DISCUSSION: In our discussion, we lay out the various physiopathological mechanisms incriminated throughout literature in the genesis of a hypercoagulability state distinctive of COVID-19, before highlighting the incidence of an interatrial communication (whether a Potent Foramen Ovale or Atrial Septal Defect) discovered in patients with COVID-19, and the potential paradoxical embolization risks they imply as well as reported cases. A mention of hemostatic parameters monitored was also warranted. Finally we discuss the guidelines in terms of prophylactic and therapeutic anticoagulation in hospitalized patients before discussing cardiac thrombosis's therapeutic options. CONCLUSION: Our case highlights various key points which could change the prognosis of COVID-19 patients, whether related to the underdiagnosis of interatrial abnormalities or with regards to the diagnosis to thromboembolic events, but also the indisputable place of anticoagulation in COVID-19 management.

Therapeutic plasma exchange in patients with COVID-19 pneumonia in intensive care unit: Cases series.

INTRODUCTION: COVID 19 pneumonia can lead to an inappropriate inflammatory response, and can be complicated by acute respiratory distress syndrome, multivisceral failure with a high mortality rate. OBJECTIVE: To observe the effect of therapeutic plasma exchange on the excessive inflammatory response. MATERIALS AND METHODS: In this study, we included 7 confirmed cases of COVID-19 in the intensive care unit (ICU) department of the university hospital of Oujda. COVID-19 cases were confirmed by RT PCR (reverse transcription-polymerase chain) and CT (computerized tomography) imaging according to WHO guidelines. Therapeutic plasma exchange was performed decrease cytokine storm-induced ARDS (Acute respiratory distress syndrome). Inflammation marker assays were performed before and after therapeutic plasma exchange to assess its efficacy. RESULTS: Levels of inflammatory cytokines (IL-6) and acute phase response proteins, including ferritin and CRP, were elevated before therapeutic plasma exchange.After therapeutic plasma exchange, levels of acute phase reactants, inflammatory mediators, were significantly reduced (p < 0.05). CONCLUSION: Our data suggest that therapeutic plasma exchange reduces the inflammatory response in patients with severe COVID-19 not undergoing mechanical ventilation. Further studies are needed to explore the efficacy of therapeutic plasma exchange in patients with COVID-19.

Dexamethasone or methylprednisolone therapy in covid-19 pneumonia: A retrospective and comparative study of 513 cases.

BACKGROUNDS: Corona virus disease 19 (Covid-19) affects especially the respiratory tract, and induces lung injury which may progress to the acute respiratory distress syndrome (ARDS). Various treatment options were tried all over the world, corticosteroids had showed beneficial effects.The Objective of this study, is to compare the safety and efficiency of two corticosteroids: dexamethasone and prednisolone in the treatment of Covid-19 infection. METHODS: This retrospective and comparative study included 513 patients diagnosed with Covid-19 infection and were admitted to intensive care unit of our university hospital center of MOHAMMED VI Oujda from March 1, 2020, to December 31st, 2020. RESULTS: In this study, 513 cases were included, 230 patients were received methylprednisolone, and 283 were treated with dexamethasone. The median age in methylprednisolone group was 64 years, and 63 years in the second group treated with dexamethasone. Patients treated with dexamethasone had more critically lesions compared to patients treated with methylprednisolone (67.6%), these patients had a good evolution with a significant reduction of oxygen supplementation, lower use of invasive ventilation and a significant improvement in biological parameters. The difference in outcome between the two groups in terms of mortality was significantly reduced in the second group. CONCLUSION: Both steroids are efficient in the management of mild, moderate and severe Covid-19 pneumonia with a clear superiority of dexamethasone especially in severe forms.

Acute limb ischemia with concomitant splenic and renal infarcts: Thromboembolic events revealing COVID-19.

INTRODUCTION: Since December 2019, the coronavirus 19 (COVID-19) pandemic continues to spread worldwide and has caused millions of deaths. Although the main manifestation of the disease is acute respiratory distress syndrome, hypercoagulability resulting from hypoxemia leads to venous thromboembolism and arterial thrombosis, which have a fatal prognosis for COVID-19. CASE REPORT MANAGEMENT: We report the case of patient admitted to our unit for management of a concomitant limb ischemia, splenic and renal infarcts associated to a COVID-19 infection with favorable outcomes after thrombectomy and therapeutic doses of heparin. CONCLUSION: Systemic procoagulant manifestations related to a COVID-19 infection is a newly described phenomenon responsible of cardiovascular and neurological disorders.

Acute pancreatitis as an atypical manifestation of COVID-19: A report of 2 cases.

INTRODUCTION: Respiratory signs are the main revealing symptoms of the COVID-19 infection, however extra respiratory symptoms might as well occur, including digestive manifestations. CASE REPORT: In this paper, we report two cases of acute pancreatitis at the front line of the patient's symptomatology revealing a COVID-19 infection. Both patients had respiratory symptoms suggestive of COVID-19 and abdominal symptoms consistent with acute pancreatitis later-on confirmed through laboratory and CT findings. Our conservative management led to an improvement of the pancreatitis, though the first patient suffered from a severe form of COVID-19 justifying the using of mechanical ventilation and ECMO, while the second patient exhibited a milder form of COVID-19. Although both patients improved in terms of pancreatitis, the overall evolution was very different due to the extent of the respiratory involvement of COVID-19, as one patient exhibited a spectacular improvement of her respiratory state leading to a full recovery, the other patient suffered a rapid worsening of her acute respiratory distress leading to death following ECMO complications. Our two cases join only few cases of COVID-19-induced pancreatitis that have been reported in the literature. DISCUSSION: in our discussion we highlight the association of COVID-19 and acute pancreatitis as it has been reported throughout literature, we then dive into the suggested physiopathological mechanisms that lay grounds for that association, before discussing our two cases, and emphasizing on the need of further studies to fully apprehend the scale of COVID-19's extra-pulmonary involvement in general, and pancreatic in particular. CONCLUSION: Acute pancreatitis is a sever condition involving potentially severe complications, COVID-19 is an emergent rare etiology recently identified as a causality.

Spontaneous gas effusions: A rare complication of covid 19.

Spontaneous gas effusion unrelated to assisted ventilation is a newly recognized complication of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The objective of the present study was to examine the incidence, risk factors and the outcomes of Spontaneous gas effusions. 610 cases were analyzable, with 3 patients developing spontaneous gas effusion. This latter was associated with increased intubation and a trend towards death in one case. Drainage was required in two cases. In conclusion, spontaneous gas effusions appeared to be a rare complication of severe acute respiratory syndrome. Further research is needed to investigate its pathogenesis.

Criteria deemed important by the relatives for designating a reference person for patients hospitalized in ICU.

PURPOSE: We investigated the criteria that patients' relatives deem important for choosing, among themselves, the person best qualified to interact with the caregiving staff. METHODS: Exploratory, observational, prospective, multicentre study between 1st March and 31st October 2018 in 2 intensive care units (ICUs). A 12-item questionnaire was completed anonymously by family members of patients hospitalized in the ICU 3 and 5 days after the patient's admission. Relatives were eligible if they understood French and if no surrogate had been appointed by the patient prior to ICU admission. More than one relative per patient could participate. RESULTS: In total, 87 relatives of 73 patients completed the questionnaire, average age of relatives was 58 ± 15 years, 46% were the spouse, 30% were children/grandchildren. Items classed as being the most important attributes for a reference person were: good knowledge of the patient's wishes and values; an emotional attachment to the patient; being a family member; and having an adequate understanding of the clinical status and clinical history. CONCLUSION: This study identifies the attributes considered by relatives to be most important for designating, among themselves, a reference person for a patient hospitalized in the ICU.