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Naz A, Salman B, Javed S, Khan SS, Tariq M, Baig MS, Kumar V. Air Leak Syndrome In Patients With Severe Covid Pneumonia. J Ayub Med Coll Abbottabad 2022; 34(Suppl 1):S1021-6. [PMID: 36550666 DOI: 10.55519/JAMC-04-S4-10269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract There are number of emerging studies that link the air leak syndrome (ALS) with COVID 19 disease but still data to explain the association, incidence and outcome in these patients is lacking. We aim to understand the risk factors and clinical outcome of these air leakage events in COVID 19 patients admitted to our institution. Methods This is a single-centered case series conducted at the COVID unit of the SMBBIT in Karachi, Pakistan. Data collection was done from April 24, 2020 to June 10, 2021. Results There were 19 patients with severe COVID pneumonia who developed air leaks. Most common finding was subcutaneous emphysema 94%. Four patients (21%) didn't receive positive pressure ventilation in any form. Median time of developing air leak from admission is 5 [2-9] and from PPV is 2 [1-3] days. There was high percentage of mortality 84.5 % in these patients.
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Leidinger G, Flockerzi F, Hohneck J, Bohle RM, Fieguth A, Tschernig T. TRPC6 is altered in COVID-19 pneumonia. Chem Biol Interact 2022; 362:109982. [PMID: 35598647 PMCID: PMC9119708 DOI: 10.1016/j.cbi.2022.109982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/25/2022] [Accepted: 05/09/2022] [Indexed: 12/16/2022]
Abstract
In this Letter to the Editor supportive data were presented to a recent paper published in this journal reporting the involvement of TRP channels in COVID-19 pneumonia and its role for new therapies. Since gene expression of TRP channels was found in human lung tissues the protein was not being reported so far. TRP channels are supposed to be involved in the pulmonary inflammation and its symptoms such as fever, cough and others. Here, TRPC6 was investigated in tissues of normal human lungs and of SARS-Cov-2 infected lungs in a preliminary study. Tissue was obtained post mortem from anatomical body donations during dissections and during pathological dissections (13 normal, 4 COVID-19 pneumoniae) and processed for immunohistochemistry. In normal lungs TRPC6 was found in the ciliated epithelium, in the wall of larger lung vessels and in the alveolar septa. In COVID-19 pneumonia the distribution of TRPC6 was different. Inflammatory lesions, cellular infiltrates, hyaline membranes and fibrosis were labelled intensively as well as dilated capillaries. These observations are from four patients with COVID-19 pneumonia.The observations do not elucidate the molecular mechanisms but support the view that TRPC6 channels are involved in normal physiology of normal human lungs and in COVID-19 pneumonia. TRPC6 might aggravate SARS-2 induced inflammation and could be a target for inhibiting drugs.
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Affiliation(s)
- Gina Leidinger
- Institute of Anatomy and Cell Biology, Saarland University, Homburg, Saar, Germany
| | - Fidelis Flockerzi
- Institute of Pathology, Saarland University Medical Center, Homburg, Saar, Germany
| | - Johannes Hohneck
- Institute of Pathology, Saarland University Medical Center, Homburg, Saar, Germany
| | - Rainer M Bohle
- Institute of Pathology, Saarland University Medical Center, Homburg, Saar, Germany
| | - Armin Fieguth
- Institute of Forensic Medicine, Hanover Medical School, Hannover, Germany
| | - Thomas Tschernig
- Institute of Anatomy and Cell Biology, Saarland University, Homburg, Saar, Germany.
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Singh P, Mandal A, Singh D, Kumar S, Kumar A, Rakesh A, Ranjan R, Verma M, Rai DK, Bhushan D, Shankar A, Sinha A, Saini R, Saha A, Thovarayi A, Baral AK, Chauhan S, Kumar R, Kakoty P, Modak B, Ranjan A. Interim Analysis of Impact of Adding Low Dose Pulmonary Radiotherapy to Moderate COVID-19 Pneumonia Patients: IMpaCt-RT Study. Front Oncol 2022; 12:822902. [PMID: 35425707 PMCID: PMC9002137 DOI: 10.3389/fonc.2022.822902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/22/2022] [Indexed: 11/13/2022] Open
Abstract
Background Treatment for coronavirus disease 2019 (COVID-19) pneumonia remains largely supportive till date and multiple clinical trials took place within the short span of time to evaluate the role of investigational therapies. The anti-inflammatory effect of low dose whole lung radiation in treating pneumonia has been documented earlier. This clinical trial analyzed the effect of low dose radiation therapy (LDRT) in a moderately affected COVID-19 pneumonia patient cohort and has evaluated its effect in stopping the conversion of moderate disease into severe disease. Methods Patients with moderate COVID-19 pneumonia as characterized by the Ministry of Health and Family Welfare (MOHFW), Government of India, were randomized (1:1) to low dose whole lung radiation versus no radiation. All treatment of patients was concurrently being given as per institutional protocol. Patients were followed up with clinical and laboratory parameters monitored on Days 1, 3, 7, and 14. Computed tomography scan (CT scan) of thorax was performed on Days 1 and 7. Patients were evaluated for conversion of moderate into severe disease as per National Early Warning Score-2 (NEWS-2 score) as the primary end point. The secondary endpoints included changes in ratio between peripheral capillary oxygen saturation and fraction of inspired oxygen (SpO2/FiO2), biochemical markers, 25-point CT severity score, and radiation induced acute pulmonary toxicities. Findings At the interim analysis, there were seven patients in the radiation arm and six in the control. A whole lung LDRT improved the outcome of SpO2/FiO2 at Day 3; however it did not convert into a statistically significant improvement for the NEWS-2 score. The serum levels of LDH, CRP, Ferritin and D-dimer were significantly reduced on 14 days in the LDRT arm in comparison to the baseline value but were not significant between the two groups. Interpretation LDRT seems to have the potential to prevent moderate COVID-19 pneumonia from a deteriorating to severe category. However, further randomized clinical trial with an adequate number of such patients is warranted to establish the definitive role of LDRT in the management of COVID-19 pneumonia. Funding An intramural research project bearing code: I-27/621, was sanctioned from the All India Institute of Medical Sciences, Patna, India. Clinical Trial Registration Clinical Trials Registry-India (CTRI/2021/06/033912, 25th May 2021) ctri.nic.in/Clinicaltrials/login.php.
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Affiliation(s)
- Pritanjali Singh
- Department of Radiation Oncology, All India Institute of Medical Sciences, Patna, India
| | - Avik Mandal
- Department of Radiation Oncology, All India Institute of Medical Sciences, Patna, India
| | - Dharmendra Singh
- Department of Radiation Oncology, All India Institute of Medical Sciences, Patna, India
| | - Subhash Kumar
- Department of Radio-diagnosis, All India Institute of Medical Sciences, Patna, India
| | - Amarjeet Kumar
- Department of Anaesthesiology, All India Institute of Medical Sciences, Patna, India
| | - Amrita Rakesh
- Department of Radiation Oncology, All India Institute of Medical Sciences, Patna, India
| | - Rakesh Ranjan
- Department of Radiation Oncology, All India Institute of Medical Sciences, Patna, India
| | - Manika Verma
- Department of Radiation Oncology, All India Institute of Medical Sciences, Patna, India
| | - Deependra Kumar Rai
- Department of Pulmonary Medicine, All India Institute of Medical Sciences, Patna, India
| | - Divendu Bhushan
- Department of General Medicine, All India Institute of Medical Sciences, Patna, India
| | - Abhishek Shankar
- Department of Radiation Oncology, All India Institute of Medical Sciences, Patna, India
| | - Arkaprava Sinha
- Department of Radiation Oncology, All India Institute of Medical Sciences, Patna, India
| | - Rohit Saini
- Department of Radiation Oncology, All India Institute of Medical Sciences, Patna, India
| | - Arijit Saha
- Department of Radiation Oncology, All India Institute of Medical Sciences, Patna, India
| | - Ashwin Thovarayi
- Department of Radiation Oncology, All India Institute of Medical Sciences, Patna, India
| | - Anindya Kumar Baral
- Department of Radiation Oncology, All India Institute of Medical Sciences, Patna, India
| | - Samyak Chauhan
- Department of Radiation Oncology, All India Institute of Medical Sciences, Patna, India
| | - Rajhans Kumar
- Department of Radiation Oncology, All India Institute of Medical Sciences, Patna, India
| | - Priya Kakoty
- Department of Radiation Oncology, All India Institute of Medical Sciences, Patna, India
| | - Bithika Modak
- Department of Radiation Oncology, All India Institute of Medical Sciences, Patna, India
| | - Alok Ranjan
- Department of Community and Family Medicine, All India Institute of Medical Sciences, Patna, India
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Jha OK, Kumar S, Mehra S, Sircar M, Gupta R. Helmet NIV in Acute Hypoxemic Respiratory Failure due to COVID-19: Change in PaO 2/FiO 2 Ratio a Predictor of Success. Indian J Crit Care Med 2021; 25:1137-1146. [PMID: 34916746 PMCID: PMC8645804 DOI: 10.5005/jp-journals-10071-23992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
In acute respiratory failure due to severe coronavirus disease 2019 (COVID-19) pneumonia, mechanical ventilation remains challenging and may result in high mortality. The use of noninvasive ventilation (NIV) may delay required invasive ventilation, increase adverse outcomes, and have a potential aerosol risk to caregivers. Data of 30 patients were collected from patient files and analyzed. Twenty-one (70%) patients were weaned successfully after helmet-NIV support (NIV success group), and invasive mechanical ventilation was required in 9 (30%) patients (NIV failure group) of which 8 (26.7%) patients died. In NIV success vs failure patients, the mean baseline PaO2/FiO2 ratio (PFR) (147.2 ± 57.9 vs 156.8 ± 59.0 mm Hg; p = 0.683) and PFR before initiation of helmet (132.3 ± 46.9 vs 121.6 ± 32.7 mm Hg; p = 0.541) were comparable. The NIV success group demonstrated a progressive improvement in PFR in comparison with the failure group at 2 hours (158.8 ± 56.1 vs 118.7 ± 40.7 mm Hg; p = 0.063) and 24 hours (PFR-24) (204.4 ± 94.3 vs 121.3 ± 32.6; p = 0.016). As predictor variables, PFR-24 and change (delta) in PFR at 24 hours from baseline or helmet initiation (dPFR-24) were significantly associated with NIV success in univariate analysis but similar significance could not be reflected in multivariate analysis perhaps due to a small sample size of the study. The PFR-24 cutoff of 161 mm Hg and dPFR-24 cutoff of -1.44 mm Hg discriminate NIV success and failure groups with the area under curve (confidence interval) of 0.78 (0.62-0.95); p = 0.015 and 0.74 (0.55-0.93); p = 0.039, respectively. Helmet interface NIV may be a safe and effective tool for the management of patients with severe COVID-19 pneumonia with acute respiratory failure. More studies are needed to further evaluate the role of helmet NIV especially in patients with initial PFR <150 mm Hg to define PFR/dPFR cutoff at the earliest time point for prediction of helmet-NIV success. How to cite this article Jha OK, Kumar S, Mehra S, Sircar M, Gupta R. Helmet NIV in Acute Hypoxemic Respiratory Failure due to COVID-19: Change in PaO2/FiO2 Ratio a Predictor of Success. Indian J Crit Care Med 2021;25(10):1137-1146.
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Affiliation(s)
- Onkar K Jha
- Department of Pulmonology and Critical Care, Fortis Hospital, Noida, Uttar Pradesh, India
| | - Sunny Kumar
- Department of Pulmonology and Critical Care, Fortis Hospital, Noida, Uttar Pradesh, India
| | - Saurabh Mehra
- Department of Pulmonology and Critical Care, Fortis Hospital, Noida, Uttar Pradesh, India
| | - Mrinal Sircar
- Department of Pulmonology and Critical Care, Fortis Hospital, Noida, Uttar Pradesh, India
| | - Rajesh Gupta
- Department of Pulmonology and Critical Care, Fortis Hospital, Noida, Uttar Pradesh, India
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Rawat D, Roy A, Maitra S, Shankar V, Khanna P, Baidya DK. "Vitamin D supplementation and COVID-19 treatment: A systematic review and meta-analysis". Diabetes Metab Syndr 2021; 15:102189. [PMID: 34217144 PMCID: PMC8236412 DOI: 10.1016/j.dsx.2021.102189] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 06/21/2021] [Accepted: 06/23/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Vitamin-D is an immune-modulator which might be linked to disease severity by SARS-CoV-2. METHODS Meta-analysis of RCTs and quasi-experimental studies, evaluating the role of vitamin-D supplementation in COVID patients was done. RESULTS Total 5 studies (3 RCTs and 2 Quasi-experimental) including n = 467 patients were included. Vitamin D didn't reduce mortality (RR 0.55, 95%CI 0.22 to 1.39, p = 0.21), ICU admission rates (RR 0.20, 95% CI 0.01-4.26, p = 0.3) and need for invasive ventilation (RR 0.24, 95% CI 0.01-7.89, p = 0.42). CONCLUSION No significant difference with vitamin-D supplementation on major health related outcomes in COVID-19. Well-designed RCTs are required addressing this topic.
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Affiliation(s)
- Dimple Rawat
- Clinical Epidemiology Unit, All India Institute of Medical Sciences, New Delhi, India.
| | - Avishek Roy
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
| | - Souvik Maitra
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
| | - Vivek Shankar
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India.
| | - Puneet Khanna
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
| | - Dalim Kumar Baidya
- Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.
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Bai G, Furushima D, Niki T, Matsuba T, Maeda Y, Takahashi A, Hattori T, Ashino Y. High Levels of the Cleaved Form of Galectin-9 and Osteopontin in the Plasma Are Associated with Inflammatory Markers That Reflect the Severity of COVID-19 Pneumonia. Int J Mol Sci 2021; 22:ijms22094978. [PMID: 34067072 PMCID: PMC8125627 DOI: 10.3390/ijms22094978] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/01/2021] [Accepted: 05/03/2021] [Indexed: 01/08/2023] Open
Abstract
Numbers of patients with coronavirus disease 2019 (COVID-19) have increased rapidly worldwide. Plasma levels of full-length galectin-9 (FL-Gal9) and osteopontin (FL-OPN) as well as their truncated forms (Tr-Gal9, Ud-OPN, respectively), are representative inflammatory biomarkers. Here, we measured FL-Gal9, FL-OPN, Tr-Gal9, and Ud-OPN in 94 plasma samples obtained from 23 COVID-19-infected patients with mild clinical symptoms (CV), 25 COVID-19 patients associated with pneumonia (CP), and 14 patients with bacterial infection (ID). The four proteins were significantly elevated in the CP group when compared with healthy individuals. ROC analysis between the CV and CP groups showed that C-reactive protein had the highest ability to differentiate, followed by Tr-Gal9 and ferritin. Spearman's correlation analysis showed that Tr-Gal9 and Ud-OPN but not FL-Gal9 and FL-OPN, had a significant association with laboratory markers for lung function, inflammation, coagulopathy, and kidney function in CP patients. CP patients treated with tocilizumab had reduced levels of FL-Gal9, Tr-Gal9, and Ud-OPN. It was suggested that OPN is cleaved by interleukin-6-dependent proteases. These findings suggest that the cleaved forms of OPN and galectin-9 can be used to monitor the severity of pathological inflammation and the therapeutic effects of tocilizumab in CP patients.
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Affiliation(s)
- Gaowa Bai
- Research Institute of Health and Welfare, Kibi International University, Takahashi 716-8508, Japan; (G.B.); (A.T.)
| | - Daisuke Furushima
- Department of Drug Evaluation and Informatics, Graduate School of Pharmaceutical Sciences, University of Shizuoka, Shizuoka 422-8526, Japan;
| | - Toshiro Niki
- Department of Immunology, Kagawa University, Kagawa 761-0793, Japan;
| | - Takashi Matsuba
- Department of Microbiology and Immunology, Faculty of Medicine, Tottori University, Tottori 683-8503, Japan;
- Department of Animal Pharmaceutical Science, School of Pharmaceutical Science, Kyusyu University of Health and Welfare, Nobeoka, Miyazaki 882-8508, Japan
| | - Yosuke Maeda
- Viral Section, Department of Microbiology, Faculty of Life Sciences, Kumamoto University, Kumamoto 860-8556, Japan;
| | - Atsushi Takahashi
- Research Institute of Health and Welfare, Kibi International University, Takahashi 716-8508, Japan; (G.B.); (A.T.)
| | - Toshio Hattori
- Research Institute of Health and Welfare, Kibi International University, Takahashi 716-8508, Japan; (G.B.); (A.T.)
- Correspondence: (T.H.); (Y.A.); Tel.: +81-866-22-9469 (T.H.); +81-22-308-7111 (Y.A.); Fax: +81-866-22-9469 (T.H.); +81-22-308-9921 (Y.A.)
| | - Yugo Ashino
- Department of Respiratory Medicine, Sendai City Hospital, Miyagi 982-8502, Japan
- Correspondence: (T.H.); (Y.A.); Tel.: +81-866-22-9469 (T.H.); +81-22-308-7111 (Y.A.); Fax: +81-866-22-9469 (T.H.); +81-22-308-9921 (Y.A.)
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Salama C, Kaplan-Lewis E, Durrance R, Wong L, Arumugam V, Fabbri M. Tocilizumab for Severe and Critical COVID-19 Pneumonia in Queens, NYC. Infect Dis Clin Pract (Baltim Md) 2021; 29:e215-20. [PMID: 34276173 DOI: 10.1097/IPC.0000000000000988] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Supplemental digital content is available in the text. New York City was hard hit by COVID-19. Elmhurst Hospital is a public hospital in Queens where more than 1500 patients were hospitalized with COVID. During the pandemic, various treatments were used with hopes of reducing the need for mechanical ventilation and death.
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Sukhija A, Mahajan M, Joshi PC, Dsouza J, Seth NDN, Patil KH. Radiographic findings in COVID-19: Comparison between AI and radiologist. Indian J Radiol Imaging 2021; 31:S87-S93. [PMID: 33814766 PMCID: PMC7996692 DOI: 10.4103/ijri.ijri_777_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 09/20/2020] [Accepted: 10/15/2020] [Indexed: 12/15/2022] Open
Abstract
CONTEXT As the burden of COVID-19 enhances, the need of a fast and reliable screening method is imperative. Chest radiographs plays a pivotal role in rapidly triaging the patients. Unfortunately, in low-resource settings, there is a scarcity of trained radiologists. AIM This study evaluates and compares the performance of an artificial intelligence (AI) system with a radiologist in detecting chest radiograph findings due to COVID-19. SUBJECTS AND METHODS The test set consisted of 457 CXR images of patients with suspected COVID-19 pneumonia over a period of three months. The radiographs were evaluated by a radiologist with experience of more than 13 years and by the AI system (NeuraCovid, a web application that pairs with the AI model COVID-NET). Performance of AI system and the radiologist were compared by calculating the sensitivity, specificity and generating a receiver operating characteristic curve. RT-PCR test results were used as the gold standard. RESULTS The radiologist obtained a sensitivity and specificity of 44.1% and 92.5%, respectively, whereas the AI had a sensitivity and specificity of 41.6% and 60%, respectively. The area under curve for correctly classifying CXR images as COVID-19 pneumonia was 0.48 for the AI system and 0.68 for the radiologist. The radiologist's prediction was found to be superior to that of the AI with a P VALUE of 0.005. CONCLUSION The specificity and sensitivity of detecting lung involvement in COVID-19, by the radiologist, was found to be superior to that by the AI system.
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Affiliation(s)
- Arsh Sukhija
- Department of Radiodiagnosis and Imaging, Bharati Vidyapeeth Deemed to be University Medical College and Hospital, Pune, Maharashtra, India
| | - Mangal Mahajan
- Department of Radiodiagnosis and Imaging, Bharati Vidyapeeth Deemed to be University Medical College and Hospital, Pune, Maharashtra, India
| | - Priscilla C Joshi
- Department of Radiodiagnosis and Imaging, Bharati Vidyapeeth Deemed to be University Medical College and Hospital, Pune, Maharashtra, India
| | - John Dsouza
- Department of Radiodiagnosis and Imaging, Bharati Vidyapeeth Deemed to be University Medical College and Hospital, Pune, Maharashtra, India
| | - Nagesh D N Seth
- Department of Radiodiagnosis and Imaging, Bharati Vidyapeeth Deemed to be University Medical College and Hospital, Pune, Maharashtra, India
| | - Karamchand H Patil
- Department of Community Medicine, Bharati Vidyapeeth Deemed to be University Medical College and Hospital, Pune, Maharashtra, India
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Abstract
How to cite this article: Kumar N, Kumar A, Pradhan S, Kumar A, Singh K. Painful Blisters of Left Hand Following Extravasation of Remdesivir Infusion in COVID-19. Indian J Crit Care Med 2021;25(2):240–241.
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Affiliation(s)
- Neeraj Kumar
- Department of Trauma & Emergency, AIIMS Patna, Patna, Bihar, India
| | - Abhyuday Kumar
- Department of Anaesthesiology, AIIMS Patna, Patna, Bihar, India
| | | | - Amarjeet Kumar
- Department of Trauma & Emergency, AIIMS Patna, Patna, Bihar, India
| | - Kunal Singh
- Department of Anaesthesiology, AIIMS Patna, Patna, Bihar, India
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Nasa P. Coronavirus Disease 2019 Treatment: It is Time for Stewardship! Indian J Crit Care Med 2020. [PMID: 33281308 DOI: 10.5005/jp-journals-10071-23622.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
How to cite this article: Nasa P. Coronavirus Disease 2019 Treatment: It is Time for Stewardship! Indian J Crit Care Med 2020;24(10):895-896.
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Affiliation(s)
- Prashant Nasa
- Department of Critical Care Medicine, NMC Specialty Hospital, Dubai, UAE
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Nasa P, Singh A, Upadhyay S, Bagadia S, Polumuru S, Shrivastava PK, Sankar R, Vijayan L, Soliman MA, Ali A, Patidar S. Tocilizumab Use in COVID-19 Cytokine-release Syndrome: Retrospective Study of Two Centers. Indian J Crit Care Med 2020. [PMID: 33132558 DOI: 10.5005/jp-journals-10071-23566.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Introduction Cytokine-release syndrome (CRS) in COVID-19 patients can cause multiorgan failure and higher mortality. We used a structured protocol based on clinical, biochemical, and interleukin 6 (IL-6) criteria for the identification of the subset of patients with CRS and analyzed the use of tocilizumab for their treatment. Materials and methods We did a retrospective case-control analysis of all COVID-19 patients between 15 March and 15 May 2020 with severe to critical disease in ICU. They were evaluated for CRS, and 22 patients who met the criterion were given tocilizumab. The primary objective was to evaluate the effect of tocilizumab on escalation of respiratory support and ICU mortality. The secondary objectives were ICU length of stay, trends of inflammatory markers, and any adverse effects. Results The need for escalation of respiratory support was significantly lower in the tocilizumab group as compared to standard treatment (p = 0.001). The mortality at day 7 and 28 was also significantly lower in the tocilizumab group (p = 0.007 and p = 0.001 respectively). There was a significant reduction in C-reactive protein (CRP) who received tocilizumab (p = 0.033). Conclusion In our limited number of patients, timely intervention with tocilizumab in COVID-19 patients with CRS significantly improved overall ICU outcome by reducing the need for invasive ventilation and mortality. How to cite this article Nasa P, Singh A, Upadhyay S, Bagadia S, Polumuru S, Shrivastava PK, et al. Tocilizumab Use in COVID-19 Cytokine-release Syndrome: Retrospective Study of Two Centers. Indian J Crit Care Med 2020;24(9):771-776.
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Affiliation(s)
- Prashant Nasa
- Department of Critical Care Medicine, NMC Specialty Hospital, Dubai, United Arab Emirates
| | - Aanchal Singh
- Department of Critical Care Medicine, NMC Specialty Hospital, Dubai, United Arab Emirates
| | - Surjya Upadhyay
- Department of Anaesthesiology, NMC Royal Hospital, Dubai, United Arab Emirates
| | - Sukhant Bagadia
- Department of Pulmonary Medicine, NMC Royal Hospital, Dubai, United Arab Emirates
| | - Srinivasa Polumuru
- Department of Critical Care Medicine, NMC Specialty Hospital, Dubai, United Arab Emirates
| | - Pavan K Shrivastava
- Department of Internal Medicine, NMC Speciality Hospital, United Arab Emirates
| | - Rakesh Sankar
- Department of Internal Medicine, NMC Speciality Hospital, United Arab Emirates
| | - Lexy Vijayan
- Department of Internal Medicine, NMC Speciality Hospital, United Arab Emirates
| | - Mohamed A Soliman
- Department of Internal Medicine, NMC Speciality Hospital, United Arab Emirates
| | - Alaeldin Ali
- Department of Cardiology, NMC Speciality Hospital, Dubai, United Arab Emirates
| | - Saroj Patidar
- Department of Critical Care Medicine, NMC Specialty Hospital, Dubai, United Arab Emirates
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Nasa P. Coronavirus Disease 2019 Treatment: It is Time for Stewardship! Indian J Crit Care Med 2020; 24:895-896. [PMID: 33281308 PMCID: PMC7689120 DOI: 10.5005/jp-journals-10071-23622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
How to cite this article: Nasa P. Coronavirus Disease 2019 Treatment: It is Time for Stewardship! Indian J Crit Care Med 2020;24(10):895-896.
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Affiliation(s)
- Prashant Nasa
- Department of Critical Care Medicine, NMC Specialty Hospital, Dubai, UAE
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Nasa P, Singh A, Upadhyay S, Bagadia S, Polumuru S, Shrivastava PK, Sankar R, Vijayan L, Soliman MA, Ali A, Patidar S. Tocilizumab Use in COVID-19 Cytokine-release Syndrome: Retrospective Study of Two Centers. Indian J Crit Care Med 2020; 24:771-776. [PMID: 33132558 PMCID: PMC7584850 DOI: 10.5005/jp-journals-10071-23566] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Cytokine-release syndrome (CRS) in COVID-19 patients can cause multiorgan failure and higher mortality. We used a structured protocol based on clinical, biochemical, and interleukin 6 (IL-6) criteria for the identification of the subset of patients with CRS and analyzed the use of tocilizumab for their treatment. MATERIALS AND METHODS We did a retrospective case-control analysis of all COVID-19 patients between 15 March and 15 May 2020 with severe to critical disease in ICU. They were evaluated for CRS, and 22 patients who met the criterion were given tocilizumab. The primary objective was to evaluate the effect of tocilizumab on escalation of respiratory support and ICU mortality. The secondary objectives were ICU length of stay, trends of inflammatory markers, and any adverse effects. RESULTS The need for escalation of respiratory support was significantly lower in the tocilizumab group as compared to standard treatment (p = 0.001). The mortality at day 7 and 28 was also significantly lower in the tocilizumab group (p = 0.007 and p = 0.001 respectively). There was a significant reduction in C-reactive protein (CRP) who received tocilizumab (p = 0.033). CONCLUSION In our limited number of patients, timely intervention with tocilizumab in COVID-19 patients with CRS significantly improved overall ICU outcome by reducing the need for invasive ventilation and mortality. HOW TO CITE THIS ARTICLE Nasa P, Singh A, Upadhyay S, Bagadia S, Polumuru S, Shrivastava PK, et al. Tocilizumab Use in COVID-19 Cytokine-release Syndrome: Retrospective Study of Two Centers. Indian J Crit Care Med 2020;24(9):771-776.
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Affiliation(s)
- Prashant Nasa
- Department of Critical Care Medicine, NMC Specialty Hospital, Dubai, United Arab Emirates
- Prashant Nasa, Department of Critical Care Medicine, NMC Specialty Hospital, Dubai, United Arab Emirates, Phone: +971501425022, e-mail:
| | - Aanchal Singh
- Department of Critical Care Medicine, NMC Specialty Hospital, Dubai, United Arab Emirates
| | - Surjya Upadhyay
- Department of Anaesthesiology, NMC Royal Hospital, Dubai, United Arab Emirates
| | - Sukhant Bagadia
- Department of Pulmonary Medicine, NMC Royal Hospital, Dubai, United Arab Emirates
| | - Srinivasa Polumuru
- Department of Critical Care Medicine, NMC Specialty Hospital, Dubai, United Arab Emirates
| | - Pavan K Shrivastava
- Department of Internal Medicine, NMC Speciality Hospital, United Arab Emirates
| | - Rakesh Sankar
- Department of Internal Medicine, NMC Speciality Hospital, United Arab Emirates
| | - Lexy Vijayan
- Department of Internal Medicine, NMC Speciality Hospital, United Arab Emirates
| | - Mohamed A Soliman
- Department of Internal Medicine, NMC Speciality Hospital, United Arab Emirates
| | - Alaeldin Ali
- Department of Cardiology, NMC Speciality Hospital, Dubai, United Arab Emirates
| | - Saroj Patidar
- Department of Critical Care Medicine, NMC Specialty Hospital, Dubai, United Arab Emirates
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Abstract
COVID-19 outbreak has caused a pandemonium in modern world. As the virus has spread its tentacles across nations, territories, and continents, the civilized society has been compelled to face an unprecedented situation, never experienced before during peacetime. We are being introduced to an ever-growing new terminologies: "social distancing," "lockdown," "stay safe," "key workers," "self-quarantine," "work-from-home," and so on. Many countries across the globe have closed their borders, airlines have been grounded, movement of public transports has come to a grinding halt, and personal vehicular movements have been restricted or barred. In the past couple of months, we have witnessed mayhem in an unprecedented scale: social, economic, food security, education, business, travel, and freedom of movements are all casualties of this pandemic. Our experience about this virus and its epidemiology is limited, and mostly the treatment for symptomatic patients is supportive. However, it has been observed that COVID-19 not only attacks the respiratory system; rather it may involve other systems also from the beginning of infection or subsequent to respiratory infection. In this article, we attempt to describe the systemic involvement of COVID-19 based on the currently available experiences. This description is up to date as of now, but as more experiences are pouring from different corners of the world, almost every day, newer knowledge and information will crop up by the time this article is published. HOW TO CITE THIS ARTICLE Munjal M, Das S, Chatterjee N, Setra AE, Govil D. Systemic Involvement of Novel Coronavirus (COVID-19): A Review of Literature. Indian J Crit Care Med 2020;24(7):565-569.
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Affiliation(s)
| | - Samaresh Das
- Yeovil District Hospital NHS, Yeovil, Somerset, United Kingdom
| | | | | | - Deepak Govil
- Institute of Critical Care and Anesthesia, Medanta The Medicity, Gurugram, Haryana, India
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Jog S, Kelkar D, Bhat M, Patwardhan S, Godavarthy P, Dhundi U, Pawar HS, Rajhans P, Pawar B, Telbhare VS, Ranade G, Upadhye V, Prayag PS, Purandare B, Purandare S, Bhavsar R. Preparedness of Acute Care Facility and a Hospital for COVID-19 Pandemic: What We Did! Indian J Crit Care Med 2020; 24:385-392. [PMID: 32863628 PMCID: PMC7435084 DOI: 10.5005/jp-journals-10071-23416] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background and aim India is facing the pandemic of coronavirus disease (COVID-19) just like the whole world. The private sector is the backbone of a healthcare facility in India. Presently, only a few major hospitals in the country are actively dealing with the COVID-19 patients while others are facing troubles due to lack of manpower, management, and required experience to face the pandemic. Despite the lockdown, the cases are ever increasing and each and every hospital in the country should be prepared to face this pandemic the world has never seen before. As one of the largest multispecialty hospitals and a designated COVID center, we have developed and adopted some strategies for better preparedness to face the surge of this pandemic. We would like to share our experience and hope that the strategies laid down and adopted by us will help many other acute care facilities in many parts of India. Materials and methods Different strategies are adopted to deal with the crisis situation of the COVID-19 pandemic. Our adopted strategies were directed to mitigate the challenges of administration, hospital space organization, management of staff and supplies, maintenance of standard of care, and specific COVID care and ethics during this pandemic. Results Based on strategies adopted by us, we feel more confident and prepared to deal with COVID-19 pandemic. Conclusion Our approach for preparing for the COVID-19 pandemic may not be the best one but we believe that the basic managerial principles we adopted will guide many other institutions to find their path in tackling the pandemic in the best possible way. How to cite this article Jog S, Kelkar D, Bhat M, Patwardhan S, Godavarthy P, Dhundi U, et al. Preparedness of Acute Care Facility and a Hospital for COVID-19 Pandemic: What We Did! Indian J Crit Care Med 2020;24(6):385-392.
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Affiliation(s)
- Sameer Jog
- Department of Critical Care and Emergency Medicine, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - Dhananjay Kelkar
- Department of Oncosurgery, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - Madhav Bhat
- Department of Ophthalmology, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - Sampada Patwardhan
- Department of Microbiology, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - Purushotham Godavarthy
- Department of Critical Care and Emergency Medicine, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - Ujwal Dhundi
- Department of Critical Care and Emergency Medicine, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - Harshwardhan S Pawar
- Department of Critical Care and Emergency Medicine, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - Prasad Rajhans
- Department of Critical Care and Emergency Medicine, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - Balasaheb Pawar
- Department of Critical Care and Emergency Medicine, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - Vishnudas S Telbhare
- Department of Critical Care and Emergency Medicine, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - Gouri Ranade
- Department of Critical Care and Emergency Medicine, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - Vaibhavi Upadhye
- Department of Post Graduate Certification, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - Parikshit S Prayag
- Department of Transplant Infectious Diseases, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - Bharat Purandare
- Department of Infectious Disease, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - Sukrut Purandare
- Department of Medicine, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
| | - Rajesh Bhavsar
- Department of Cardiology, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
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Jain AC, Kansal S, Sardana R, Bali RK, Kar S, Chawla R. A Retrospective Observational Study to Determine the Early Predictors of In-hospital Mortality at Admission with COVID-19. Indian J Crit Care Med 2020; 24:1174-1179. [PMID: 33446968 PMCID: PMC7775949 DOI: 10.5005/jp-journals-10071-23683] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Introduction Coronavirus disease-2019 (COVID-19) systemic illness caused by a novel coronavirus severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has been spreading across the world. The objective of this study is to identify the clinical and laboratory variables as predictors of in-hospital death at the time of admission in a tertiary care hospital in India. Materials and methods Demographic profile, clinical, and laboratory variables of 425 patients admitted from April to June 2020 with symptoms and laboratory-confirmed diagnosis through real-time polymerase chain reaction (RT-PCR) were studied. Descriptive statistics, an association of these variables, logistic regression, and CART models were developed to identify early predictors of in-hospital death. Results Twenty-two patients (5.17%) had expired in course of their hospital stay. The median age [interquartile range (IQR)] of the patients admitted was 49 years (21–77 years). Gender distribution was male — 73.38% (mortality rate 5.83%) and female—26.62% (mortality rate 3.34%). The study shows higher association for age (>47 years) [odds ratio (OR) 4.52], male gender (OR 1.78), shortness of breath (OR 2.02), oxygen saturation <93% (OR 9.32), respiratory rate >24 (OR 5.31), comorbidities like diabetes (OR 2.70), hypertension (OR 2.12), and coronary artery disease (OR 3.18) toward overall mortality. The significant associations in laboratory variables include lymphopenia (<12%) (OR 8.74), C-reactive protein (CRP) (OR 1.99), ferritin (OR 3.18), and lactate dehydrogenase (LDH) (OR 3.37). Using this statistically significant 16 clinical and laboratory variables, the logistic regression model had an area under receiver operating characteristic (ROC) curve of 0.86 (train) and 0.75 (test). Conclusion Age above 47 years, associated with comorbidities like hypertension and diabetes, with oxygen saturation below 93%, tachycardia, and deranged laboratory variables like lymphopenia and raised CRP, LDH, and ferritin are important predictors of in-hospital mortality. How to cite this article Jain AC, Kansal S, Sardana R, Bali RK, Kar S, Chawla R. A Retrospective Observational Study to Determine the Early Predictors of In-hospital Mortality at Admission with COVID-19. Indian J Crit Care Med 2020;24(12):1174–1179.
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Affiliation(s)
- Aakanksha Chawla Jain
- Department of Respiratory, Critical Care and Sleep Medicine, Indraprastha Apollo Hospitals, New Delhi, India
| | - Sudha Kansal
- Department of Respiratory, Critical Care and Sleep Medicine, Indraprastha Apollo Hospitals, New Delhi, India
| | - Raman Sardana
- Department of Microbiology, Indraprastha Apollo Hospitals, New Delhi, India
| | - Roseleen K Bali
- Department of Respiratory, Critical Care and Sleep Medicine, Indraprastha Apollo Hospitals, New Delhi, India
| | - Sujoy Kar
- Department of Corporate IT, Apollo Hospitals, Hyderabad, Telangana, India
| | - Rajesh Chawla
- Department of Respiratory, Critical Care and Sleep Medicine, Indraprastha Apollo Hospitals, New Delhi, India
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Abstract
Prone positioning has been shown to improve oxygenation for decades. However, proning in awake, non-intubated patients gained acceptance in the last few months since the onset of coronavirus (COVID-19) pandemic. To overcome the shortage of ventilators, to decrease the overwhelming burden on intensive care beds in the pandemic era, and also as invasive ventilation was associated with poor outcomes, proning of awake, spontaneously breathing patients gathered momentum. Being an intervention with minimal risk and requiring minimum assistance, it is now a globally accepted therapy to improve oxygenation in acute hypoxemic respiratory failure in COVID-19 patients. We thus reviewed the literature of awake proning in non-intubated patients and described a safe protocol to practice the same. How to cite this article: Sodhi K, Chanchalani G. Awake Proning: Current Evidence and Practical Considerations. Indian J Crit Care Med 2020;24(12):1236-1241.
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Affiliation(s)
| | - Gunjan Chanchalani
- Department of Critical Care Medicine, Bhatia Hospital, Mumbai, Maharashtra, India
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