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Alshamrani MM, El-Saed A, Alalmai A, Almanna MA, Alqahtani SMD, Asiri MS, Almasoud SS, Othman F. Clinical characteristics and outcomes of COVID-19 cases admitted to adult intensive care units during the pandemic: A single center experience. J Infect Public Health 2024; 17:102475. [PMID: 39024896 DOI: 10.1016/j.jiph.2024.102475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/20/2024] [Accepted: 06/06/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND COVID-19 is the largest recorded pandemic in history. It causes several complications such as shock, pneumonia, acute respiratory distress syndrome, and organ failure. The objective was to determine COVID-19 outcomes and risk factors in the intensive care (ICU) setting. METHODS A retrospective review of prospectively collected data was conducted. Adult patients with a positive RT-PCR test for COVID-19 admitted to ICUs of a tertiary care hospital between 2020 and 2022 were included. Patients who had severe complex trauma were excluded. The outcomes examined included ventilation use and duration, length of stay (LOS), and mortality. RESULTS A total of 964 patients were included. The mean ( ± standard deviation, SD) age was 63.7 ± 16.9 years. The majority of the patients were males (59.0 %) and Saudi (75.7 %). Ventilation use was documented in 443 (57.1 %) patients, with a mean ( ± SD) ventilation duration of 9.7 ± 8.4 days. Death occurred in 361 (37.4 %) patients after a mean ( ± SD) of 33.3 ± 44.5 days from infection. The mean ( ± SD) LOS was 30.6 ± 54.1 days in hospital and 5.2 ± 5.4 days in ICU. Ventilation use was associated with older age, males, longer ICU LOS, mortality, and admission to medical-surgical ICU. Crude mortality use was associated with older age, longer ICU LOS, use of ventilator, shorter ventilation duration, and admission to medical-surgical or respiratory ICUs. CONCLUSIONS COVID-19 patients admitted to adult ICUs are at high risk of death and mechanical ventilation. The crude risks of both outcomes are higher in older age and longer ICU LOS and are very variable by ICU type.
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Affiliation(s)
- Majid M Alshamrani
- Infection Prevention and Control Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
| | - Aiman El-Saed
- Infection Prevention and Control Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; Community Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
| | - Abdulrahman Alalmai
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Saudi Arabia.
| | | | | | - Mohammed Saad Asiri
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Saudi Arabia.
| | | | - Fatmah Othman
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
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Cheney MA, Smith MP, Burkhardt JN, Davis WT, Brown DJ, Horn C, Hare J, Alderman M, Nelson E, Proctor M, Goodman M, Sams V, Thiele R, Strilka RJ. The Ability of Military Critical Care Air Transport Members to Visually Estimate Percent Systolic Pressure Variation. Mil Med 2024; 189:1514-1522. [PMID: 37489875 DOI: 10.1093/milmed/usad281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/02/2023] [Accepted: 07/11/2023] [Indexed: 07/26/2023] Open
Abstract
INTRODUCTION Inappropriate fluid management during patient transport may lead to casualty morbidity. Percent systolic pressure variation (%SPV) is one of several technologies that perform a dynamic assessment of fluid responsiveness (FT-DYN). Trained anesthesia providers can visually estimate and use %SPV to limit the incidence of erroneous volume management decisions to 1-4%. However, the accuracy of visually estimated %SPV by other specialties is unknown. The aim of this article is to determine the accuracy of estimated %SPV and the incidence of erroneous volume management decisions for Critical Care Air Transport (CCAT) team members before and after training to visually estimate and utilize %SPV. MATERIAL AND METHODS In one sitting, CCAT team providers received didactics defining %SPV and indicators of fluid responsiveness and treatment with %SPV ≤7 and ≥14.5 defining a fluid nonresponsive and responsive patient, respectively; they were then shown ten 45-second training arterial waveforms on a simulated Propaq M portable monitor's screen. Study subjects were asked to visually estimate %SPV for each arterial waveform and queried whether they would treat with a fluid bolus. After each training simulation, they were told the true %SPV. Seven days post-training, the subjects were shown a different set of ten 45-second testing simulations and asked to estimate %SPV and choose to treat, or not. Nonparametric limits of agreement for differences between true and estimated %SPV were analyzed using Bland-Altman graphs. In addition, three errors were defined: (1) %SPV visual estimate errors that would label a volume responsive patient as nonresponsive, or vice versa; (2) incorrect treatment decisions based on estimated %SPV (algorithm application errors); and (3) incorrect treatment decisions based on true %SPV (clinically significant treatment errors). For the training and testing simulations, these error rates were compared between, and within, provider groups. RESULTS Sixty-one physicians (MDs), 64 registered nurses (RNs), and 53 respiratory technicians (RTs) participated in the study. For testing simulations, the incidence and 95% CI for %SPV estimate errors with sufficient magnitude to result in a treatment error were 1.4% (0.5%, 3.2%), 1.6% (0.6%, 3.4%), and 4.1% (2.2%, 6.9%) for MDs, RNs, and RTs, respectively. However, clinically significant treatment errors were statistically more common for all provider types, occurring at a rate of 7%, 10%, and 23% (all P < .05). Finally, students did not show clinically relevant reductions in their errors between training and testing simulations. CONCLUSIONS Although most practitioners correctly visually estimated %SPV and all students completed the training in interpreting and applying %SPV, all groups persisted in making clinically significant treatment errors with moderate to high frequency. This suggests that the treatment errors were more often driven by misapplying FT-DYN algorithms rather than by inaccurate visual estimation of %SPV. Furthermore, these errors were not responsive to training, suggesting that a decision-making cognitive aid may improve CCAT teams' ability to apply FT-DYN technologies.
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Affiliation(s)
- Mark A Cheney
- Center for Sustainment of Trauma and Readiness Skills, University of Cincinnati, Cincinnati, OH 45219, USA
- Department of Anesthesiology, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Maia P Smith
- Air Force Research Laboratory, Wright-Patterson Air Force Base, Dayton, OH 45324, USA
| | - Joshua N Burkhardt
- Center for Sustainment of Trauma and Readiness Skills, University of Cincinnati, Cincinnati, OH 45219, USA
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH 45219, USA
| | - William T Davis
- United States Air Force En Route Care Research Center, 59th Medical Wing, Science and Technology, Lackland AFB TX 78236, USA
| | - Daniel J Brown
- Department of Emergency Medicine, Wright State University, Dayton, OH 45324, USA
| | - Christopher Horn
- Department of Surgery, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Jonathan Hare
- Center for Sustainment of Trauma and Readiness Skills, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Mark Alderman
- Center for Sustainment of Trauma and Readiness Skills, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Eric Nelson
- Center for Sustainment of Trauma and Readiness Skills, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Melissa Proctor
- Center for Sustainment of Trauma and Readiness Skills, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Michael Goodman
- Department of Surgery, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Valerie Sams
- Center for Sustainment of Trauma and Readiness Skills, University of Cincinnati, Cincinnati, OH 45219, USA
- Department of Surgery, University of Cincinnati, Cincinnati, OH 45219, USA
| | - Robert Thiele
- Department of Anesthesiology, University of Virginia Health Sciences Center, Charlottesville, VA 22903, USA
| | - Richard J Strilka
- Center for Sustainment of Trauma and Readiness Skills, University of Cincinnati, Cincinnati, OH 45219, USA
- Department of Surgery, University of Cincinnati, Cincinnati, OH 45219, USA
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Trisyani Y, Mahendra D, Nuraeni A. Lessons Learned from the Lived Experiences of COVID-19 ICU Survivors Who are Struggling Through Critical Conditions and Surviving to Champion Life: A Qualitative Study. J Multidiscip Healthc 2024; 17:2659-2669. [PMID: 38828267 PMCID: PMC11141573 DOI: 10.2147/jmdh.s380389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 04/24/2024] [Indexed: 06/05/2024] Open
Abstract
Background Due to the coronavirus disease 2019 (COVID-19) pandemic, millions of lives were lost globally, including in Indonesia. Some patients with COVID-19 may experience severe symptoms of hypoxia, while some may be critically ill and admitted to the intensive care unit (ICU) for survival. Purpose This study aimed to understand the lived experiences of COVID-19 ICU survivors who were in a critical condition. Methods This phenomenological study used semistructured interviews with nine participants who were COVID-19 ICU survivors. Data analysis was performed using the Colaizzi approach. Results The phenomenon of the lived experiences of COVID-19 ICU survivors was presented in seven subthemes and four main themes: struggling in a state of helplessness, fostering a positive spirit from within, amplifying the support from nurses and doctors, and strengthening the connection with family and the Almighty. These themes indicated the essential aspects of psychosocial support needed to boost strength and energy and elevate the body's immune system, which is crucial to champion life through critical conditions. Conclusion The new insight resulting from the study is shown in the four main themes, which play a significant role in elevating the healing process and enabling patients to survive critical conditions. Therefore, this study recommends the importance of psychosocial support for patients with critical conditions, which involves family and their significant others, and facilitating the connection between the patient and God.
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Affiliation(s)
- Yanny Trisyani
- Department of Critical Care and Emergency Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, Jawa Barat, Indonesia
| | - Donny Mahendra
- Vocational Faculty, Universitas Kristen Indonesia, Jakarta, Indonesia
| | - Aan Nuraeni
- Department of Critical Care and Emergency Nursing, Faculty of Nursing, Universitas Padjadjaran, Sumedang, Jawa Barat, Indonesia
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Garbin JRT, Leite FMC, Dell'Antonio CSS, Dell'Antonio LS, Dos Santos APB, Lopes-Júnior LC. Hospitalizations for coronavirus disease 2019: an analysis of the occurrence waves. Sci Rep 2024; 14:5777. [PMID: 38459098 PMCID: PMC10924092 DOI: 10.1038/s41598-024-56289-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 03/05/2024] [Indexed: 03/10/2024] Open
Abstract
The pandemic has been characterized by several waves defined by viral strains responsible for the predominance of infections. We aimed to analyze the mean length of hospital stay for patients with COVID-19 during the first three waves of the pandemic and its distribution according to sociodemographic and clinical variables. This retrospective study used the notifications of patients hospitalized for COVID-19 in a Brazilian state during the period of the three waves of the disease as the data source. There were 13,910 hospitalizations for confirmed COVID-19 cases. The first wave was the longest, with 4101 (29.5%) hospitalizations, while the third, although shorter, had a higher number of hospitalized patients (N = 6960). The average length of stay in the hospital in all waves was associated with age groups up to 60 years old., elementary, high school and higher education, residents of the periurban area Regarding the presence of comorbidities, there was a statistically significant difference in the mean number of days of hospitalization among patients with chronic cardiovascular disease and obesity (P < 0.001). In conclusion, the COVID-19 pandemic has been distinctly revealed among the waves.
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Affiliation(s)
- Juliana Rodrigues Tovar Garbin
- Graduate Program in Public Health at the Universidade Federal do Espírito Santo (PPGSC/UFES), Vitória, ES, Brazil
- Instituto Federal de Educação, Ciência e Tecnologia do Espírito Santo (IFES Campus Vitória), Vitória, ES, Brazil
| | | | | | | | | | - Luís Carlos Lopes-Júnior
- Graduate Program in Public Health at the Universidade Federal do Espírito Santo (PPGSC/UFES), Vitória, ES, Brazil.
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Asamoah I, Adusei-Poku M, Vandyck-Sey P, Steele-Dadzie A, Kuffour AS, Turkson A, Asante IA, Addo-Osafo K, Mohktar Q, Adu B, Afrane YA, Sagoe KWC. COVID-19 in patients presenting with malaria-like symptoms at a primary healthcare facility in Accra, Ghana. PLoS One 2024; 19:e0298088. [PMID: 38335209 PMCID: PMC10857731 DOI: 10.1371/journal.pone.0298088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 01/17/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Malaria is a common and severe public health problem in Ghana and largely responsible for febrile symptoms presented at health facilities in the country. Other infectious diseases, including COVID-19, may mimic malaria due to their shared non-specific symptoms such as fever and headache thus leading to misdiagnosis. This study therefore investigated COVID-19 among patients presenting with malaria-like symptoms at Korle-Bu Polyclinic, Accra, Ghana. METHODS This study enrolled 300 patients presenting with malaria-like symptoms aged ≥18yrs. After consent was obtained from study patients, two to three millilitres of whole blood, nasopharyngeal and oropharyngeal swab samples, were collected for screening of Plasmodium falciparum using malaria rapid diagnostic test, microscopy and nested PCR, and SARS-CoV-2 using SARS-CoV-2 antigen test and Real-time PCR, respectively. The plasma and whole blood were also used for COVID-19 antibody testing and full blood counts using hematological analyser. SARS-CoV-2 whole genome sequencing was performed using MinIon sequencing. RESULTS The prevalence of malaria by microscopy, RDT and nested PCR were 2.3%, 2.3% and 2.7% respectively. The detection of SARS-CoV-2 by COVID-19 Rapid Antigen Test and Real-time PCR were 8.7% and 20% respectively. The Delta variant was reported in 23 of 25 SARS-CoV-2 positives with CT values below 30. Headache was the most common symptom presented by study participants (95%). Comorbidities reported were hypertension, asthma and diabetes. One hundred and thirteen (37.8%) of the study participants had prior exposure to SARS CoV-2 and (34/51) 66.7% of Astrazeneca vaccinated patients had no IgG antibody. CONCLUSION It may be difficult to use clinical characteristics to distinguish between patients with COVID-19 having malaria-like symptoms. Detection of IgM using RDTs may be useful in predicting CT values for SARS-CoV-2 real-time PCR and therefore transmission.
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Affiliation(s)
- Issabella Asamoah
- Department of Medical Microbiology, University of Ghana Medical School, University of Ghana, Korle-Bu, Accra, Ghana
| | - Mildred Adusei-Poku
- Department of Medical Microbiology, University of Ghana Medical School, University of Ghana, Korle-Bu, Accra, Ghana
| | - Priscilla Vandyck-Sey
- Korle Bu Polyclinic Family Medicine Department, Korle Bu Teaching Hospital, Accra, Ghana
| | - Allen Steele-Dadzie
- Korle Bu Polyclinic Family Medicine Department, Korle Bu Teaching Hospital, Accra, Ghana
| | - Atta Senior Kuffour
- Department of Medical Microbiology, University of Ghana Medical School, University of Ghana, Korle-Bu, Accra, Ghana
| | - Albert Turkson
- Department of Medical Microbiology, University of Ghana Medical School, University of Ghana, Korle-Bu, Accra, Ghana
| | - Ivy Asantewaa Asante
- Department of Virology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
| | - Kantanka Addo-Osafo
- Department of Medical Microbiology, University of Ghana Medical School, University of Ghana, Korle-Bu, Accra, Ghana
| | - Quaneeta Mohktar
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
| | - Bright Adu
- Department of Immunology, Noguchi Memorial Institute for Medical Research, University of Ghana, Legon, Accra, Ghana
| | - Yaw A. Afrane
- Department of Medical Microbiology, University of Ghana Medical School, University of Ghana, Korle-Bu, Accra, Ghana
| | - Kwamena W. C. Sagoe
- Department of Medical Microbiology, University of Ghana Medical School, University of Ghana, Korle-Bu, Accra, Ghana
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Li X, Patel V, Duan L, Mikuliak J, Basran J, Osgood ND. Real-Time Epidemiology and Acute Care Need Monitoring and Forecasting for COVID-19 via Bayesian Sequential Monte Carlo-Leveraged Transmission Models. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:193. [PMID: 38397684 PMCID: PMC10888645 DOI: 10.3390/ijerph21020193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/24/2023] [Accepted: 02/03/2024] [Indexed: 02/25/2024]
Abstract
COVID-19 transmission models have conferred great value in informing public health understanding, planning, and response. However, the pandemic also demonstrated the infeasibility of basing public health decision-making on transmission models with pre-set assumptions. No matter how favourably evidenced when built, a model with fixed assumptions is challenged by numerous factors that are difficult to predict. Ongoing planning associated with rolling back and re-instituting measures, initiating surge planning, and issuing public health advisories can benefit from approaches that allow state estimates for transmission models to be continuously updated in light of unfolding time series. A model being continuously regrounded by empirical data in this way can provide a consistent, integrated depiction of the evolving underlying epidemiology and acute care demand, offer the ability to project forward such a depiction in a fashion suitable for triggering the deployment of acute care surge capacity or public health measures, and support quantitative evaluation of tradeoffs associated with prospective interventions in light of the latest estimates of the underlying epidemiology. We describe here the design, implementation, and multi-year daily use for public health and clinical support decision-making of a particle-filtered COVID-19 compartmental model, which served Canadian federal and provincial governments via regular reporting starting in June 2020. The use of the Bayesian sequential Monte Carlo algorithm of particle filtering allows the model to be regrounded daily and adapt to new trends within daily incoming data-including test volumes and positivity rates, endogenous and travel-related cases, hospital census and admissions flows, daily counts of dose-specific vaccinations administered, measured concentration of SARS-CoV-2 in wastewater, and mortality. Important model outputs include estimates (via sampling) of the count of undiagnosed infectives, the count of individuals at different stages of the natural history of frankly and pauci-symptomatic infection, the current force of infection, effective reproductive number, and current and cumulative infection prevalence. Following a brief description of the model design, we describe how the machine learning algorithm of particle filtering is used to continually reground estimates of the dynamic model state, support a probabilistic model projection of epidemiology and health system capacity utilization and service demand, and probabilistically evaluate tradeoffs between potential intervention scenarios. We further note aspects of model use in practice as an effective reporting tool in a manner that is parameterized by jurisdiction, including the support of a scripting pipeline that permits a fully automated reporting pipeline other than security-restricted new data retrieval, including automated model deployment, data validity checks, and automatic post-scenario scripting and reporting. As demonstrated by this multi-year deployment of the Bayesian machine learning algorithm of particle filtering to provide industrial-strength reporting to inform public health decision-making across Canada, such methods offer strong support for evidence-based public health decision-making informed by ever-current articulated transmission models whose probabilistic state and parameter estimates are continually regrounded by diverse data streams.
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Affiliation(s)
- Xiaoyan Li
- Department of Computer Science, University of Saskatchewan, Saskatoon, SK S7N 5C9, Canada; (V.P.); (L.D.); (J.M.); (N.D.O.)
| | - Vyom Patel
- Department of Computer Science, University of Saskatchewan, Saskatoon, SK S7N 5C9, Canada; (V.P.); (L.D.); (J.M.); (N.D.O.)
| | - Lujie Duan
- Department of Computer Science, University of Saskatchewan, Saskatoon, SK S7N 5C9, Canada; (V.P.); (L.D.); (J.M.); (N.D.O.)
| | - Jalen Mikuliak
- Department of Computer Science, University of Saskatchewan, Saskatoon, SK S7N 5C9, Canada; (V.P.); (L.D.); (J.M.); (N.D.O.)
| | - Jenny Basran
- Saskatchewan Health Authority, Saskatoon, SK S7K 0M7, Canada;
| | - Nathaniel D. Osgood
- Department of Computer Science, University of Saskatchewan, Saskatoon, SK S7N 5C9, Canada; (V.P.); (L.D.); (J.M.); (N.D.O.)
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Hassan Salman F, Zainelabdin Mohamed Elmahdi Z, Elnour SMB. Psychological repercussions of COVID-19 on health care workers, Sudan. Int J Soc Psychiatry 2024; 70:182-189. [PMID: 37753906 DOI: 10.1177/00207640231199406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
Healthcare workers around the world were confronted with innumerable torments with the emergence of COVID-19. Amid the pandemic, frontline healthcare personnel serve crucial responsibilities and endure significant social, psychological and economic consequences. This cross-sectional study collected demographic data for 1 year from 385 healthcare officials from all the hospitals spread across the state of Khartoum to research the factors that affected the healthcare workers and doctors who were on the frontline to diagnose and treat the patients with potential or confirmed COVID-19. The degree of symptoms of depression, anxiety and insomnia was also assessed through validated measurement tools. The female participants showed more vulnerability to depression, anxiety and insomnia than their male counterparts. It was reported by the end of the study that the healthcare workers in Sudan are under immense psychological hazards.
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Modjo R, Lestari F, Tanjung H, Kadir A, Putra RS, Rahmadani M, Chaeruman AS, Lestari F, Sutanto J. COVID-19 infection prevention and control for hospital workers in Indonesia. Front Public Health 2024; 11:1276898. [PMID: 38259732 PMCID: PMC10800904 DOI: 10.3389/fpubh.2023.1276898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 12/12/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction The outbreak of SARS-CoV-2 in 2019 led to a global pandemic, posing unprecedented challenges to healthcare systems, particularly in hospitals. Purpose This study explores the intricacies of strategies employed for preventing and controlling COVID-19 in Indonesian hospitals, with a particular focus on the protocols, challenges, and solutions faced by healthcare professionals. Methods Using a cross-sectional analysis, we examined 27 hospitals and uncovered disparities in their preparedness levels. During our investigation, we observed the robust implementation of infection prevention measures, which encompassed stringent protocols, adequate ventilation, and proper use of personal protective equipment. However, shortcomings were identified in areas such as surveillance, mental health support, and patient management. Discussion This study underscores the importance of addressing these gaps, suggesting tailored interventions, and continuous training for healthcare staff. Effective leadership, positive team dynamics, and adherence to comprehensive policies emerge as pivotal factors. Hospitals should strengthen weak areas, ensure the ethical execution of emergency protocols, and integrate technology for tracking and improving standard operating procedures. By enhancing the knowledge and skills of healthcare workers and maintaining strong management practices, hospitals can optimize their efforts in COVID-19 prevention and control, thereby safeguarding the wellbeing of professionals, patients, and communities.
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Affiliation(s)
- Robiana Modjo
- Occupational Health and Safety Department, Faculty of Public Health, Universitas Indonesia, Depok, West Java, Indonesia
- Indonesia Occupational Health Experts Association, Jakarta, Indonesia
| | - Fatma Lestari
- Occupational Health and Safety Department, Faculty of Public Health, Universitas Indonesia, Depok, West Java, Indonesia
- Disaster Risk Reduction Center, Universitas Indonesia, Depok, West Java, Indonesia
| | - Hendra Tanjung
- Occupational Health and Safety Department, Faculty of Public Health, Universitas Indonesia, Depok, West Java, Indonesia
- Indonesia Occupational Health Experts Association, Jakarta, Indonesia
| | - Abdul Kadir
- Occupational Health and Safety Department, Faculty of Public Health, Universitas Indonesia, Depok, West Java, Indonesia
| | | | - Meilisa Rahmadani
- Indonesia Occupational Health Experts Association, Jakarta, Indonesia
- Universitas Indonesia Hospital, Depok, West Java, Indonesia
| | | | - Fetrina Lestari
- Indonesia Occupational Health Experts Association, Jakarta, Indonesia
| | - Juliana Sutanto
- Department of Human Centred Computing, Monash University, Melbourne, VIC, Australia
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Bakr OB, El-Feky AH, Abdelazim IA, El-Skaan RG. Menstrual changes after the thrombo-prophylaxis or anticoagulants used during the COVID-19 infection. PRZEGLAD MENOPAUZALNY = MENOPAUSE REVIEW 2023; 22:179-185. [PMID: 38239401 PMCID: PMC10793612 DOI: 10.5114/pm.2023.133594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 05/10/2023] [Indexed: 01/22/2024]
Abstract
Introduction To detect the menstrual changes after the thrombo-prophylaxis or anticoagulants used during the COVID-19 infection. Material and methods A total of 176 diagnosed with COVID-19 infection, were included in this retrospective study after giving informed consent. Participants were asked to complete an online questionnaire, and the collected participants` data were analysed using the χ2 test to detect the menstrual changes after the thrombo-prophylaxis or anticoagulants used during the COVID-19 infection. Results The number of participants` number who reported menstrual flow for 2 to < 5 days, and menstrual flow > 7 days after the COVID-19 infection [31/176 (17.6%), and 42/176 (23.9%), respectively] was significantly higher compared to the number of participants` who reported menstrual flow for 2 to < 5 days, and menstrual flow > 7 days before the COVID-19 infection [12/176 (6.8%), and 15/176 (8.5%), respectively], (p = 0.005, and 0.0009, respectively). The use of thrombo-prophylaxis or anticoagulants during the COVID-19 infection was also associated with significant menstrual pattern changes (37.8% increased menstrual flow, 18.5% menstrual flow for 2 to < 5 days, 59.7% menstrual flow > 7 days, 5.9% contact bleeding, and 6.7% abnormal menstrual pattern for one cycle). Conclusions Significant menstrual changes were observed in this study after the COVID-19 infection infection (17.6% reported menstrual flow for 2 to < 5 days, and 23.9% reported menstrual flow > 7 days). The use of thrombo-prophylaxis or anticoagulants during the COVID-19 infection infection was associated with significant menstrual changes (37.8% increased menstrual flow, 18.5% menstrual flow for 2 to < 5 days, 59.7% menstrual flow > 7 days, 5.9% contact bleeding, and 6.7% abnormal menstrual pattern for one cycle).
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Affiliation(s)
- Omnia B. Bakr
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Alaa H. El-Feky
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ibrahim A. Abdelazim
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Rania G. El-Skaan
- Department of Obstetrics and Gynaecology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Xu Y, Xi Y, Cai S, Yu Y, Chen S, Guan W, Liang W, Wu H, He W, Deng X, Xu Y, Zhang R, Li M, Pan J, Liang Z, Wang Y, Kong S, Liu X, Lv Z, Li Y. Venovenous extracorporeal membrane oxygenation for COVID-19 and influenza H1N1 associated acute respiratory distress syndrome: A comparative cohort study in China. JOURNAL OF INTENSIVE MEDICINE 2023; 3:326-334. [PMID: 38028638 PMCID: PMC10658037 DOI: 10.1016/j.jointm.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 06/22/2023] [Accepted: 07/07/2023] [Indexed: 12/01/2023]
Abstract
Background Venovenous extracorporeal membrane oxygenation (VV-ECMO) has been demonstrated to be effective in treating patients with virus-induced acute respiratory distress syndrome (ARDS). However, whether the management of ECMO is different in treating H1N1 influenza and coronavirus disease 2019 (COVID-19)-associated ARDS patients remains unknown. Methods This is a retrospective cohort study. We included 12 VV-ECMO-supported COVID-19 patients admitted to The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Eighth People's Hospital, and Wuhan Union Hospital West Campus between January 23 and March 31, 2020. We retrospectively included VV-ECMO-supported patients with COVID-19 and H1N1 influenza-associated ARDS. Clinical characteristics, respiratory mechanics including plateau pressure, driving pressure, mechanical power, ventilatory ratio (VR) and lung compliance, and outcomes were compared. Results Data from 25 patients with COVID-19 (n=12) and H1N1 (n=13) associated ARDS who had received ECMO support were analyzed. COVID-19 patients were older than H1N1 influenza patients (P=0.004). The partial pressure of arterial carbon dioxide (PaCO2) and VR before ECMO initiation were significantly higher in COVID-19 patients than in H1N1 influenza patients (P <0.001 and P=0.004, respectively). COVID-19 patients showed increased plateau and driving pressure compared with H1N1 subjects (P=0.013 and P=0.018, respectively). Patients with COVID-19 remained longer on ECMO support than did H1N1 influenza patients (P=0.015). COVID-19 patients who required ECMO support also had fewer intensive care unit and ventilator-free days than H1N1. Conclusions Compared with H1N1 influenza patients, COVID-19 patients were older and presented with increased PaCO2 and VR values before ECMO initiation. The differences between ARDS patients with COVID-19 and influenza on VV-ECMO detailed herein could be helpful for obtaining a better understanding of COVID-19 and for better clinical management.
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Affiliation(s)
- Yonghao Xu
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, Guangdong, China
| | - Yin Xi
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, Guangdong, China
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Shuijiang Cai
- Department of Critical Care Medicine, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yuheng Yu
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, Guangdong, China
- Department of Critical Care Medicine, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Sibei Chen
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, Guangdong, China
| | - Weijie Guan
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, Guangdong, China
| | - Weibo Liang
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, Guangdong, China
| | - Hongkai Wu
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, Guangdong, China
| | - Weiqun He
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, Guangdong, China
- Department of Critical Care Medicine, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xilong Deng
- Department of Critical Care Medicine, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yuanda Xu
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, Guangdong, China
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Rong Zhang
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, Guangdong, China
| | - Manshu Li
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, Guangdong, China
| | - Jieyi Pan
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, Guangdong, China
| | - Zhenting Liang
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, Guangdong, China
| | - Ya Wang
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, Guangdong, China
| | - Shaofeng Kong
- Department of Radiology, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xiaoqing Liu
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, Guangdong, China
| | - Zheng Lv
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yimin Li
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, State Key Laboratory of Respiratory Diseases, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, Guangzhou, Guangdong, China
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11
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Paiva JRB, Pacheco VMG, Barbosa PS, Almeida FR, Wainer GA, Gomes FA, Coimbra AP, Calixto WP. Complexity measure based on sensitivity analysis applied to an intensive care unit system. Sci Rep 2023; 13:14602. [PMID: 37669946 PMCID: PMC10480223 DOI: 10.1038/s41598-023-40149-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 08/05/2023] [Indexed: 09/07/2023] Open
Abstract
This work proposes a system complexity metric and its application to Intensive Care Unit (ICU) system. The methodology for applying said complexity metric comprises: (i) parameters sensitivity indices calculation, (ii) mapping connections dynamics between system components, and (iii) system's complexity calculation. After simulating the ICU computer model and using the proposed methodology, we obtained results regarding: number of admissions, number of patients in the queue, length of stay, beds in use, ICU performance, and system complexity values (in regular or overloaded operation). As the number of patients in the queue increased, the ICU system complexity also increased, indicating a need for policies to promote system robustness.
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Affiliation(s)
- Joao R B Paiva
- School of Electrical, Mechanical and Computer Engineering (EMC), Federal University of Goias (UFG), Goiania, GO, 74605-010, Brazil.
- Studies and Researches in Science and Technology Group (GCITE), Federal Institute of Goias (IFG), Goiania, GO, 74130-012, Brazil.
| | - Viviane M G Pacheco
- School of Electrical, Mechanical and Computer Engineering (EMC), Federal University of Goias (UFG), Goiania, GO, 74605-010, Brazil
- Studies and Researches in Science and Technology Group (GCITE), Federal Institute of Goias (IFG), Goiania, GO, 74130-012, Brazil
| | - Poliana S Barbosa
- Studies and Researches in Science and Technology Group (GCITE), Federal Institute of Goias (IFG), Goiania, GO, 74130-012, Brazil
| | - Fabiana R Almeida
- Studies and Researches in Science and Technology Group (GCITE), Federal Institute of Goias (IFG), Goiania, GO, 74130-012, Brazil
| | - Gabriel A Wainer
- Visualization and Simulation Centre (VSIM), Carleton University (CU), Ottawa, ON, K1S 5B6, Canada
| | - Flavio A Gomes
- School of Electrical, Mechanical and Computer Engineering (EMC), Federal University of Goias (UFG), Goiania, GO, 74605-010, Brazil
- Studies and Researches in Science and Technology Group (GCITE), Federal Institute of Goias (IFG), Goiania, GO, 74130-012, Brazil
| | - Antonio P Coimbra
- Systems and Robotics Institute (ISR), Coimbra University (UC), 3030-790, Coimbra, DC, Portugal
| | - Wesley P Calixto
- School of Electrical, Mechanical and Computer Engineering (EMC), Federal University of Goias (UFG), Goiania, GO, 74605-010, Brazil.
- Studies and Researches in Science and Technology Group (GCITE), Federal Institute of Goias (IFG), Goiania, GO, 74130-012, Brazil.
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12
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Kumar Y, Kumari A, Kumar T, Jha K, Zabihullah M. Role of Hematological Parameters in the Grading of COVID-19 and a Model to Predict the Outcome in Inpatients. Cureus 2023; 15:e45276. [PMID: 37846240 PMCID: PMC10576849 DOI: 10.7759/cureus.45276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 10/18/2023] Open
Abstract
Introduction Human coronaviruses, identified in the 1960s, are known culprits of respiratory infections. Classified into alpha, beta, gamma, and delta subgroups, these viruses have the capacity to transition from animal reservoirs to causing severe respiratory ailments in humans. Notable outbreaks like the 2003 severe acute respiratory distress syndrome (SARS) epidemic and the ongoing coronavirus disease 2019 (COVID-19) pandemic underscore the recurring emergence of novel coronaviruses with severe human infection potential. COVID-19, driven by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has rapidly become a leading global cause of severe acute respiratory syndrome. Immune system disruptions and cytokine imbalances contribute to severe cases, necessitating early diagnosis and precise severity assessment. Methodology This retrospective cross-sectional study encompassed 211 COVID-19 patients admitted to AIIMS Patna from May to July 2020. Clinical and hematological parameters, including neutrophils, eosinophils, basophils, lymphocytes, monocytes, red and white blood cell counts, platelet count, C-reactive protein (CRP), serum ferritin, and d-dimer, were meticulously recorded. Patients were categorized into non-severe and severe groups using the National Early Warning Score (NEWS) 2. Results Our findings underscore the pivotal role of hematological markers in gauging COVID-19 severity. Notably, markers such as neutrophil-to-lymphocyte ratio (NLR), derived NLR, lymphocyte monocyte ratio, platelet lymphocyte ratio, d-dimer, CRP, and serum ferritin exhibited notable elevation in severe cases. Survival analysis further established the predictive potential of these markers in assessing disease progression and mortality risk. We advocate for the integration of these markers into existing severity assessment frameworks to foster objective clinical evaluations. Conclusion In conclusion, our study unravels the intricate connection between COVID-19 severity and hematological parameters. We emphasize the early warning capabilities of NLR, derived NLR, platelet lymphocyte ratio, and other markers in predicting disease progression. This research underscores the imperative need to incorporate hematological markers into the evaluation of COVID-19 severity, thereby providing invaluable insights for enhancing clinical practice and patient outcomes.
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Affiliation(s)
- Yogesh Kumar
- Physiology, All India Institute of Medical Sciences, Patna, Patna, IND
| | - Amita Kumari
- Physiology, All India Institute of Medical Sciences, Deoghar, Deoghar, IND
| | - Tribhuwan Kumar
- Physiology, All India Institute of Medical Sciences, Patna, Patna, IND
| | - Kamlesh Jha
- Physiology, All India Institute of Medical Sciences, Patna, Patna, IND
| | - Md Zabihullah
- Physiology, All India Institute of Medical Sciences, Patna, Patna, IND
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Luca RD, Rifici C, Terranova A, Orecchio L, Castorina MV, Torrisi M, Cannavò A, Bramanti A, Bonanno M, Calabrò RS, Cola MCD. Healthcare worker burnout during the first COVID-19 lockdown in Italy: experiences from an intensive neurological rehabilitation unit. J Int Med Res 2023; 51:3000605231182664. [PMID: 37486238 PMCID: PMC10369104 DOI: 10.1177/03000605231182664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
OBJECTIVE The study aim was to investigate the prevalence of behavioral symptoms and burnout in healthcare workers in an intensive neurological rehabilitation unit in Messina, Italy, during the first COVID-19 lockdown in Italy. METHODS Forty-seven healthcare workers (including neurologists, physiatrists, nurses and rehabilitation therapists) were enrolled in this cross-sectional study from February 2020 to June 2020. Participants were administered the following psychometric tests to investigate burnout and related symptoms: the Maslach Burnout Inventory, which measures emotional exhaustion, depersonalization and reduced personal accomplishment; the Zung Self-Rating Depression Scale (SDS); the Pre-Sleep Arousal Scale (PSAS); the Dyadic Adjustment Scale; and the Buss-Perry Aggression Questionnaire (BPAQ). RESULTS We found several correlations between test scores and burnout subdimensions. Emotional exhaustion was correlated with SDS (r = 0.67), PSAS-Cognitive (r = 0.67) and PSAS-Somatic (r = 0.70) scores, and moderately correlated with all BPAQ dimensions (r = 0.42). Depersonalization was moderately correlated with SDS (r = 0.54), PSAS-Cognitive (r = 0.53) and PSAS-Somatic (r = 0.50) scores. CONCLUSION During the first COVID-19 lockdown in Italy, healthcare workers were more exposed to physical and mental exhaustion and burnout. Research evaluating organizational and system-level interventions to promote psychological well-being at work for healthcare workers are needed.
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14
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Misra A, Pawar R, Pal A. Effect of Balloon-Blowing Exercise on Oxygen Saturation in COVID-19 Patients. Cureus 2023; 15:e40250. [PMID: 37440814 PMCID: PMC10334858 DOI: 10.7759/cureus.40250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2023] [Indexed: 07/15/2023] Open
Abstract
Background Balloon therapy is an empirical example that patients with respiratory tract diseases can use to improve their daily care. The diaphragm and ribs are expanded and raised by the intercostal muscles, which are activated during the balloon-blowing exercise. This makes it possible for the lungs to inhale oxygen and exhale carbon dioxide. Therefore, this study aimed to investigate the impact of balloon-blowing exercise on blood oxygen saturation in stable, non-intubated COVID-19 patients. Methodology Considering the guidelines approved by the Ministry of Health and the Government of India, 250 COVID-19 patients with an age group between 20 and 80 years based on the inclusion criteria were taken. After the collection of baseline data consisting of oxygen saturation (SpO2) measured with a portable pulse oximeter, the balloon-blowing exercise with conventional physiotherapy was given for 30 minutes, and clinical data of SpO2 were re-collected. Results The pre- and post-results of balloon blowing exercise, along with conventional physiotherapy in 250 patients, were assessed by measuring SpO2. The results demonstrated that the balloon exercise was found to be effective, as oxygen saturation improved after the application of the balloon exercise. Analysis revealed that pre- and post-values involving 95.685±1.645 and 98.123±1.445, respectively, differed significantly. The results demonstrated that the application of balloon exercise to COVID-19 patients led to a considerable improvement in SpO2. Conclusion The difference between the pre- and post-values of SpO2 was found to be significant, which suggests that balloon exercise is a low-cost physiotherapy strategy that can be utilized to enhance oxygen saturation in COVID-19 patients. This demonstrates that the need for ICU treatment can be lessened, and consequently, the burden on healthcare facilities can be reduced.
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Affiliation(s)
- Anand Misra
- Department of Physiotherapy, Sri Aurobindo Institute of Allied Health and Paramedical Sciences, Sri Aurobindo University, Indore, IND
| | - Rajni Pawar
- Department of Physiotherapy, Sri Aurobindo Institute of Allied Health and Paramedical Sciences, Sri Aurobindo University, Indore, IND
| | - Akshay Pal
- Department of Physiotherapy, Sri Aurobindo Institute of Allied Health and Paramedical Sciences, Sri Aurobindo University, Indore, IND
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15
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Vengalil A, Nizamutdinov D, Su M, Huang JH. Mechanisms of SARS-CoV-2-induced Encephalopathy and Encephalitis in COVID-19 Cases. Neurosci Insights 2023; 18:26331055231172522. [PMID: 37255742 PMCID: PMC10225804 DOI: 10.1177/26331055231172522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 04/12/2023] [Indexed: 06/01/2023] Open
Abstract
The SARS-CoV-2 virus caused an unprecedented pandemic around the globe, infecting 36.5 million people and causing the death of over 1 million in the United States of America alone. COVID-19 patients demonstrated respiratory symptoms, cardiovascular complications, and neurologic symptoms, which in most severe cases included encephalopathy and encephalitis. Hypoxia and the uncontrolled proliferation of cytokines are commonly recognized to cause encephalopathy, while the retrograde trans-synaptic spread of the virus is thought to cause encephalitis in SARS-CoV-2-induced pathogenesis. Although recent research revealed some mechanisms explaining the development of neurologic symptoms, it still remains unclear whether interactions between these mechanisms exist. This review focuses on the discussion and analysis of previously reported hypotheses of SARS-CoV-2-induced encephalopathy and encephalitis and looks into possible overlaps between the pathogenesis of both neurological outcomes of the disease. Promising therapeutic approaches to prevent and treat SARS-CoV-2-induced neurological complications are also covered. More studies are needed to further investigate the dominant mechanism of pathogenesis for developing more effective preventative measures in COVID-19 cases with the neurologic presentation.
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Affiliation(s)
- Aaron Vengalil
- Neurosurgery, Texas A&M University,
College of Medicine, Temple, TX, USA
| | - Damir Nizamutdinov
- Neurosurgery, Texas A&M University,
College of Medicine, Temple, TX, USA
- Neurosurgery, Baylor Scott and White
Health, Neuroscience Institute, Temple, TX, USA
| | - Matthew Su
- Department of BioSciences, Rice
University, Houston, TX, USA
| | - Jason H Huang
- Neurosurgery, Texas A&M University,
College of Medicine, Temple, TX, USA
- Neurosurgery, Baylor Scott and White
Health, Neuroscience Institute, Temple, TX, USA
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16
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Žulpaitė G, Rimševičius L, Jančorienė L, Zablockienė B, Miglinas M. The Association between COVID-19 Infection and Kidney Damage in a Regional University Hospital. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050898. [PMID: 37241132 DOI: 10.3390/medicina59050898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/01/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: Kidneys are one of the main targets for SARS-CoV-2. Early recognition and precautionary management are essential in COVID-19 patients due to the multiple origins of acute kidney injury and the complexity of chronic kidney disease management. The aims of this research were to investigate the association between COVID-19 infection and renal injury in a regional hospital. Materials and Methods: The data of 601 patients from the Vilnius regional university hospital between 1 January 2020 and 31 March 2021 were collected for this cross-sectional study. Demographic data (gender, age), clinical outcomes (discharge, transfer to another hospital, death), length of stay, diagnoses (chronic kidney disease, acute kidney injury), and laboratory test data (creatinine, urea, C-reactive protein, potassium concentrations) were collected and analyzed statistically. Results: Patients discharged from the hospital were younger (63.18 ± 16.02) than those from the emergency room (75.35 ± 12.41, p < 0.001), transferred to another hospital (72.89 ± 12.06, p = 0.002), or who died (70.87 ± 12.83, p < 0.001). Subsequently, patients who died had lower creatinine levels on the first day than those who survived (185.00 vs. 311.17 µmol/L, p < 0.001), and their hospital stay was longer (Spearman's correlation coefficient = -0.304, p < 0.001). Patients with chronic kidney disease had higher first-day creatinine concentration than patients with acute kidney injury (365.72 ± 311.93 vs. 137.58 ± 93.75, p < 0.001). Patients with acute kidney injury and chronic kidney disease complicated by acute kidney injury died 7.81 and 3.66 times (p < 0.001) more often than patients with chronic kidney disease alone. The mortality rate among patients with acute kidney injury was 7.79 (p < 0.001) times higher than among patients without these diseases. Conclusions: COVID-19 patients who developed acute kidney injury and whose chronic kidney disease was complicated by acute kidney injury had a longer hospital stay and were more likely to die.
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Affiliation(s)
- Giedrė Žulpaitė
- Faculty of Medicine, Vilnius University, M. K. Ciurlionio 21, 03101 Vilnius, Lithuania
| | - Laurynas Rimševičius
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Ciurlionio 21, 03101 Vilnius, Lithuania
| | - Ligita Jančorienė
- Clinic of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Ciurlionio 21, 03101 Vilnius, Lithuania
| | - Birutė Zablockienė
- Clinic of Infectious Diseases and Dermatovenerology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Ciurlionio 21, 03101 Vilnius, Lithuania
| | - Marius Miglinas
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, M. K. Ciurlionio 21, 03101 Vilnius, Lithuania
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Ashmawy R, Kamal E, Amin W, Sharaf S, Kabeel S, Albiheyri R, El-Maradny YA, Hassanin E, Elsaka N, Fahmy O, Awd A, Aboeldahab H, Nayle M, Afifi M, Ibrahim M, Rafaat R, Aly S, Redwan EM. Effectiveness and Safety of Inactivated SARS-CoV-2 Vaccine (BBIBP-CorV) among Healthcare Workers: A Seven-Month Follow-Up Study at Fifteen Central Hospitals. Vaccines (Basel) 2023; 11:vaccines11050892. [PMID: 37242996 DOI: 10.3390/vaccines11050892] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 04/17/2023] [Accepted: 04/20/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND During a pandemic, healthcare workers are at high risk of contracting COVID-19. To protect these important individuals, it is highly recommended that they receive the COVID-19 vaccine. Our study focused on evaluating the safety and efficacy of Egypt's first approved vaccine, the Sinopharm vaccine (BBIBP-CorV), and comparing these findings with other vaccines. METHODS An observational study was conducted in fifteen triage and isolation hospitals, from the 1st of March until the end of September 2021. The study included fully vaccinated and unvaccinated participants, and we measured vaccine effectiveness (using 1-aHR), the incidence rate of severely to critically ill hospitalized cases, COVID-19-related work absenteeism, and the safety of the vaccine as outcomes. RESULTS Of the 1364 healthcare workers who were interviewed, 1228 agreed to participate. After taking the hazard ratio into account, the vaccine effectiveness was found to be 67% (95% CI, 80-43%) for symptomatic PCR-confirmed cases. The incidence rate ratio for hospitalization was 0.45 (95% CI, 0.15-1.31) in the vaccinated group compared to the unvaccinated group, and there was a significant reduction in absenteeism among the vaccinated group (p < 0.007). Most adverse events were mild and well tolerated. Vaccinated pregnant and lactating mothers did not experience any sentinel adverse events. CONCLUSION Our study found that the BBIBP-CorV vaccine was effective in protecting healthcare workers from COVID-19.
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Affiliation(s)
- Rasha Ashmawy
- Clinical Research Department, Maamora Chest Hospital, MoHP, Alexandria 21923, Egypt
- Infectious Diseases Administration, Directorate of Health Affairs, MoHP, Alexandria 21554, Egypt
| | - Ehab Kamal
- Medical Research Division, National Research Center, Giza 12622, Egypt
| | - Wagdy Amin
- General Administration of Chest Diseases, MoHP, Cairo 11516, Egypt
| | - Sandy Sharaf
- Clinical Research Department, Maamora Chest Hospital, MoHP, Alexandria 21923, Egypt
| | - Samar Kabeel
- Clinical Research Department, Directorate of Health Affairs, MoHP, Damietta 34711, Egypt
| | - Raed Albiheyri
- Biological Science Department, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Centre of Excellence in Bio Nanoscience Research, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Yousra A El-Maradny
- Protein Research Department, Genetic Engineering and Biotechnology Research Institute, City of Scientific Research and Technological Applications (SRTA-City), Alexandria 21934, Egypt
- Microbiology and Immunology, Faculty of Pharmacy, Arab Academy for Science, Technology and Maritime Transport (AASTMT), Alamein 51718, Egypt
| | - Ebtisam Hassanin
- Clinical Pathology Department, Faculty of Medicine, New Valley University, New Valley 72713, Egypt
| | - Noura Elsaka
- Clinical Research Department, Directorate of Health Affairs, MoHP, Sharkia 71529, Egypt
| | - Ola Fahmy
- Egyptian Drug Authority, Alexandria 21532, Egypt
| | - Ahmed Awd
- Physical Therapy Department, Kafr El-Sheikh General Hospital, MoHP, Kafr El-Sheikh 33511, Egypt
| | - Heba Aboeldahab
- Clinical Research Department, Kom El-Shokafa Chest Hospital, MoHP, Alexandria 21572, Egypt
| | - Mai Nayle
- Clinical Research Department, Kafr El-Sheikh Chest Hospital, MoHP, Kafr El-Sheikh 33511, Egypt
| | - Magda Afifi
- General Administration of Chest Diseases, MoHP, Cairo 11516, Egypt
| | - Marwa Ibrahim
- Clinical Research Department, Fakous Central Hospital, MoHP, Sharkia 71529, Egypt
| | - Raghda Rafaat
- Clinical Research Department, Fakous Central Hospital, MoHP, Sharkia 71529, Egypt
| | - Shahinda Aly
- Clinical Research Department, Maamora Chest Hospital, MoHP, Alexandria 21923, Egypt
| | - Elrashdy M Redwan
- Biological Science Department, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Protein Research Department, Genetic Engineering and Biotechnology Research Institute, City of Scientific Research and Technological Applications (SRTA-City), Alexandria 21934, Egypt
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Rooimans T, Damen M, Markesteijn CMA, Schuurmans CCL, de Zoete NHC, van Hasselt PM, Hennink WE, van Nostrum CF, Hermes M, Besseling R, Vromans H. Development of a compounded propofol nanoemulsion using multiple non-invasive process analytical technologies. Int J Pharm 2023; 640:122960. [PMID: 37061210 PMCID: PMC10101488 DOI: 10.1016/j.ijpharm.2023.122960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/25/2023] [Accepted: 04/11/2023] [Indexed: 04/17/2023]
Abstract
Propofol is the preferred anaesthetic for induction and maintenance of sedation in critically ill mechanically ventilated COVID-19 patients. However, during the outbreak of the COVID-19 pandemic, regular supply chains could not keep up with the sudden increase in global demand, causing drug shortages. Propofol is formulated as an oil-in-water emulsion which is administered intravenously. This study explores the extemporaneous preparation of a propofol emulsion without specialized manufacturing equipment to temporally alleviate such shortages. A commercially available lipid emulsion (IVLE, SMOFlipid 20%), intended for parenteral nutrition, was used to create a propofol loaded nanoemulsion via addition of liquid propofol drug substance and subsequent mixing. Critical quality attributes such as mean droplet size and the volume-weighted percentage of large-diameter (>5µm) droplets were studied. The evolution of droplet size and propofol distribution was monitored in situ and non-destructively, maintaining sterility, using Spatially Resolved Dynamic Light Scattering and Near Infrared Spectroscopy, respectively. Using response surface methodology, an optimum was found for a 4% w/v propofol formulation with a ∼15 minute mixing time in a flask shaker at a 40° shaking angle. This study shows that extemporaneous compounding is a viable option for emergency supply of propofol drug product during global drug shortages.
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Affiliation(s)
- T Rooimans
- Research and Development Department, Tiofarma BV, Oud-Beijerland, the Netherlands; Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands.
| | - M Damen
- InProcess-LSP, Oss, the Netherlands
| | - C M A Markesteijn
- Research and Development Department, Tiofarma BV, Oud-Beijerland, the Netherlands
| | | | - N H C de Zoete
- Research and Development Department, Tiofarma BV, Oud-Beijerland, the Netherlands
| | - P M van Hasselt
- Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - W E Hennink
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - C F van Nostrum
- Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - M Hermes
- InProcess-LSP, Oss, the Netherlands
| | | | - H Vromans
- Research and Development Department, Tiofarma BV, Oud-Beijerland, the Netherlands; Department of Pharmaceutics, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
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19
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Feng C, Wenlin Y, Qiangyong K, Li L, Jingjing Q. Clinical efficacy of combination therapy of FuXi-Tiandi-Wuxing Decoction and anti-viral drugs in the treatment of novel coronavirus pneumonia: A prospective interventional study. J Herb Med 2023; 38:100627. [PMID: 36644210 PMCID: PMC9831664 DOI: 10.1016/j.hermed.2023.100627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 08/13/2021] [Accepted: 01/09/2023] [Indexed: 01/12/2023]
Abstract
Introduction The National Administration of Traditional Chinese Medicine of the People's Republic of China (NATCM) and the State Administration of Traditional Chinese medicine (TCM) advocated a combination therapy of TCM and anti-viral drugs for novel coronavirus pneumonia (NCP) to improve the efficacy of clinical treatment. Methods Forty-six patients diagnosed with NCP were sequentially divided into intent-to-treat population: the experimental group (combination of FuXi-Tiandi-Wuxing Decoction and anti-viral drugs; n = 23) and the control group (anti-viral drugs only) (n = 23). The two groups were compared in terms of duration of fever, cough symptom score, fatigue, appetite, dyspnea, out-of-bed activities, chest computer tomography (CT) recovery, virological clearance, average length of hospital stay, and clinical effective rate of drug. After 6 days of observation, patients from the control group were divided into as-treated population: experimental subgroup (n = 14) to obtain clinical benefit and control subgroup (n = 9). Results There was a significant improvement in the duration of fever (1.087 ± 0.288 vs 4.304 ± 2.490), cough (0.437 ± 0.589 vs 2.435 ± 0.662; P < 0.05), chest CT evaluation (82.6% vs 43.4%; P < 0.05), and virological clearance (60.8% vs 8.7%; P < 0.05) in patients of the experimental group compared with patients in the control group. Further observation in as-treated population reported that cough (0.742 ± 0.463 vs 1.862 ± 0.347; P < 0.05) and fatigue (78.5% vs 33.3%; P < 0.05) were significantly relieved after adding FuXi-Tiandi-Wuxing Decoction to the existing treatment. Conclusion An early treatment with combination therapy of FuXi-Tiandi-Wuxing Decoction and anti-viral drugs significantly relieves the clinical symptoms of NCP, shows improvement in chest CT scan, improves virological clearance, shortens average length of hospital stay, and reduces the risk of severe illness. The effect of FuXi-Tiandi-Wuxing Decoction in NCP may be clinically important and require further consideration.
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Key Words
- ARDS, acute respiratory distress syndrome
- Anti-viral drug
- COVID-19
- CRS, cytokine release syndrome
- CT, computed tomography
- ELISA, enzyme-linked immunosorbent assay
- H1N1, Hemagglutinin Type 1 and Neuraminidase Type 1
- ITT, intent-to-treat
- NATCM, National Administration of Traditional Chinese Medicine of the People’s Republic of China
- NCP, novel coronavirus pneumonia
- Novel coronavirus pneumonia
- PG, Platycodon grandiflorum
- Prospective
- RT-PCR, reverse transcriptase polymerase chain reaction
- RdRp, RNA-dependent RNA polymerase
- TCM, traditional Chinese medicine
- TNF, tumor necrosis factor
- Traditional Chinese medicine
- WHO, World Health Organization
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Affiliation(s)
- Chen Feng
- People's Hospital of Xiang Zhou District, Lanpu Rd, Xiangzhou, ICP No. 09154174, Zhuhai, Guangdong Province, China
| | - Yao Wenlin
- People's Hospital of Xiang Zhou District, Lanpu Rd, Xiangzhou, ICP No. 09154174, Zhuhai, Guangdong Province, China
| | - Kou Qiangyong
- People's Hospital of Xiang Zhou District, Lanpu Rd, Xiangzhou, ICP No. 09154174, Zhuhai, Guangdong Province, China
| | - Lanting Li
- Shanghai Palan DataRx Co., Ltd, Room 611, Building A, No. 3501 Hechuan Road, Minhang District, 200110 Shanghai, China
| | - Qi Jingjing
- People's Hospital of Xiang Zhou District, Lanpu Rd, Xiangzhou, ICP No. 09154174, Zhuhai, Guangdong Province, China
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20
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Gupta P, Rani V. The Surging Mechanistic Role of Angiotensin Converting Enzyme 2 in Human Pathologies: A Potential Approach for Herbal Therapeutics. Curr Drug Targets 2023; 24:1046-1054. [PMID: 37861036 DOI: 10.2174/0113894501247616231009065415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 07/27/2023] [Accepted: 09/15/2023] [Indexed: 10/21/2023]
Abstract
Advancements in biological sciences revealed the significant role of angiotensin-converting enzyme 2 (ACE2), a key cell surface receptor in various human pathologies. ACE2 is a metalloproteinase that not only functions in the regulation of Angiotensin II but also possesses some non-catalytic roles in the human body. There is considerable uncertainty regarding its protein expression, despite its presence in virtually all organs. The level of ACE2 expression and its subcellular localisation in humans may be a key determinant of susceptibility to various infections, symptoms, and outcomes of numerous diseases. Therefore, we summarize the distribution and expression pattern of ACE2 in different cell types related to all major human tissues and organs. Moreover, this review constitutes accumulated evidences of the important resources for further studies on ACE2 Inhibitory capacity via different natural compounds in order to understand its mechanism as the potential drug target in disease pathophysiology and to aid in the development of an effective therapeutic approach towards the various diseases.
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Affiliation(s)
- Priyadarshini Gupta
- Transcriptome laboratory, Centre of Emerging Diseases, Department of Biotechnology, Jaypee Institute of Information Technology, Sector-62, Noida, Uttar Pradesh, India
| | - Vibha Rani
- Transcriptome laboratory, Centre of Emerging Diseases, Department of Biotechnology, Jaypee Institute of Information Technology, Sector-62, Noida, Uttar Pradesh, India
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21
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Al Sulaiman K, Aljuhani O, Korayem GB, Altebainawi AF, Vishwakarma R, AlFaifi M, Alsohimi S, Alrayes A, Albishi S, Alqahtani R, Alalawi M, Al Sulaihim I, Alanazi TA, Alqahtani RA, Almagthali A, Jomah S, Alshlowi A, Alshammari TR, Alzahrani SS, Abdulqader MI. The Impact of Recombinant Human Erythropoietin Administration in Critically ill COVID-19 Patients: A Multicenter Cohort Study. Clin Appl Thromb Hemost 2023; 29:10760296231218216. [PMID: 38073058 PMCID: PMC10714884 DOI: 10.1177/10760296231218216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/08/2023] [Accepted: 11/16/2023] [Indexed: 12/18/2023] Open
Abstract
The use of erythropoietin-stimulating agents (ESAs) as adjunctive therapy in critically ill patients with COVID-19 may have a potential benefit. This study aims to evaluate the effect of ESAs on the clinical outcomes of critically ill COVID-19 patients. A multicenter, retrospective cohort study was conducted from 01-03-2020 to 31-07-2021. We included adult patients who were ≥ 18 years old with a confirmed diagnosis of COVID-19 infection and admitted to intensive care units (ICUs). Patients were categorized depending on ESAs administration during their ICU stay. The primary endpoint was the length of stay; other endpoints were considered secondary. After propensity score matching (1:3), the overall included patients were 120. Among those, 30 patients received ESAs. A longer duration of ICU and hospital stay was observed in the ESA group (beta coefficient: 0.64; 95% CI: 0.31-0.97; P = < .01, beta coefficient: 0.41; 95% CI: 0.12-0.69; P = < .01, respectively). In addition, the ESA group's ventilator-free days (VFDs) were significantly shorter than the control group. Moreover, patients who received ESAs have higher odds of liver injury and infections during ICU stay than the control group. The use of ESAs in COVID-19 critically ill patients was associated with longer hospital and ICU stays, with no survival benefits but linked with lower VFDs.
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Affiliation(s)
- Khalid Al Sulaiman
- Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Saudi Critical Care Pharmacy Research (SCAPE) Platform, Riyadh, Saudi Arabia
| | - Ohoud Aljuhani
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ghazwa B. Korayem
- Department of Pharmacy Practice, College of Pharmacy, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Ali F. Altebainawi
- Pharmaceutical Care Services, King Salman Specialist Hospital, Hail Health Cluster, Ministry of Health, Hail, Saudi Arabia
- Department of Clinical Pharmacy, College of Pharmacy, University of Hail, Hail, Saudi Arabia
| | | | - Mashael AlFaifi
- Pharmaceutical Care Department, King Saud Medical City, Riyadh, Saudi Arabia
| | - Samiah Alsohimi
- Pharmaceutical Care Services, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
- Pharmaceutical Care Services, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Aljoharah Alrayes
- Department of Pharmacy Practice, College of Pharmacy, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Sara Albishi
- Department of Pharmacy Practice, College of Pharmacy, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Reem Alqahtani
- Department of Pharmacy Practice, College of Pharmacy, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Mai Alalawi
- Department of Pharmaceutical Sciences, Fakeeh College for Medical Sciences, Jeddah, Saudi Arabia
- Pharmaceutical Care Department, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Ibrahim Al Sulaihim
- Pharmaceutical Care Department, Presidency of State Security, Central Security Hospital, Riyadh, Saudi Arabia
| | - Thamer A. Alanazi
- Respiratory Therapy Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Rahaf A. Alqahtani
- Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Alaa Almagthali
- Pharmaceutical Care Services, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Shahamah Jomah
- Pharmaceutical Care Department, Dr Sulaiman Al-Habib Medical Group, Riyadh, Saudi Arabia
| | - Areej Alshlowi
- Department of Pharmacy Practice, College of Pharmacy, Almaarefa University, Riyadh, Saudi Arabia
| | - Tahani R. Alshammari
- Pharmaceutical Care Services, King Salman Specialist Hospital, Hail Health Cluster, Ministry of Health, Hail, Saudi Arabia
| | - Shahad S. Alzahrani
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Marwa I. Abdulqader
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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22
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Lumlertgul N, Baker E, Pearson E, Dalrymple KV, Pan J, Jheeta A, Weerapolchai K, Wang Y, Leach R, Barrett NA, Ostermann M. Changing epidemiology of acute kidney injury in critically ill patients with COVID-19: a prospective cohort. Ann Intensive Care 2022; 12:118. [PMID: 36575315 PMCID: PMC9794481 DOI: 10.1186/s13613-022-01094-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 12/08/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is common in critically ill patients with coronavirus disease-19 (COVID-19). We aimed to explore the changes in AKI epidemiology between the first and the second COVID wave in the United Kingdom (UK). METHODS This was an observational study of critically ill adult patients with COVID-19 in an expanded tertiary care intensive care unit (ICU) in London, UK. Baseline characteristics, organ support, COVID-19 treatments, and patient and kidney outcomes up to 90 days after discharge from hospital were compared. RESULTS A total of 772 patients were included in the final analysis (68% male, mean age 56 ± 13.6). Compared with wave 1, patients in wave 2 were older, had higher body mass index and clinical frailty score, but lower baseline serum creatinine and C-reactive protein (CRP). The proportion of patients receiving invasive mechanical ventilation (MV) on ICU admission was lower in wave 2 (61% vs 80%; p < 0.001). AKI incidence within 14 days of ICU admission was 76% in wave 1 and 51% in wave 2 (p < 0.001); in wave 1, 32% received KRT compared with 13% in wave 2 (p < 0.001). Patients in wave 2 had significantly lower daily cumulative fluid balance (FB) than in wave 1. Fewer patients were dialysis dependent at 90 days in wave 2 (1% vs. 4%; p < 0.001). CONCLUSIONS In critically ill adult patients admitted to ICU with COVID-19, the risk of AKI and receipt of KRT significantly declined in the second wave. The trend was associated with less MV, lower PEEP and lower cumulative FB. TRIAL REGISTRATION NCT04445259.
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Affiliation(s)
- Nuttha Lumlertgul
- grid.425213.3Department of Critical Care, King’s College, Guy’s & St Thomas’ Hospital, NHS Foundation Trust, 249 Westminster Bridge Road, London, SE1 7EH UK ,grid.411628.80000 0000 9758 8584Division of Nephrology and Excellence Centre for Critical Care Nephrology, King Chulalongkorn Memorial Hospital, Bangkok, Thailand ,grid.7922.e0000 0001 0244 7875Centre of Excellence in Critical Care Nephrology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Eleanor Baker
- grid.425213.3Department of Critical Care, King’s College, Guy’s & St Thomas’ Hospital, NHS Foundation Trust, 249 Westminster Bridge Road, London, SE1 7EH UK
| | - Emma Pearson
- grid.425213.3Department of Critical Care, King’s College, Guy’s & St Thomas’ Hospital, NHS Foundation Trust, 249 Westminster Bridge Road, London, SE1 7EH UK
| | - Kathryn V. Dalrymple
- grid.13097.3c0000 0001 2322 6764Department of Population Health Sciences, King’s College London, London, UK
| | - Jacqueline Pan
- grid.425213.3Department of Critical Care, King’s College, Guy’s & St Thomas’ Hospital, NHS Foundation Trust, 249 Westminster Bridge Road, London, SE1 7EH UK
| | - Anup Jheeta
- grid.425213.3Department of Critical Care, King’s College, Guy’s & St Thomas’ Hospital, NHS Foundation Trust, 249 Westminster Bridge Road, London, SE1 7EH UK
| | - Kittisak Weerapolchai
- grid.425213.3Department of Critical Care, King’s College, Guy’s & St Thomas’ Hospital, NHS Foundation Trust, 249 Westminster Bridge Road, London, SE1 7EH UK ,grid.420545.20000 0004 0489 3985Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Yanzhong Wang
- grid.13097.3c0000 0001 2322 6764Department of Population Health Sciences, King’s College London, London, UK
| | - Richard Leach
- grid.425213.3Department of Critical Care, King’s College, Guy’s & St Thomas’ Hospital, NHS Foundation Trust, 249 Westminster Bridge Road, London, SE1 7EH UK
| | - Nicholas A. Barrett
- grid.425213.3Department of Critical Care, King’s College, Guy’s & St Thomas’ Hospital, NHS Foundation Trust, 249 Westminster Bridge Road, London, SE1 7EH UK
| | - Marlies Ostermann
- grid.425213.3Department of Critical Care, King’s College, Guy’s & St Thomas’ Hospital, NHS Foundation Trust, 249 Westminster Bridge Road, London, SE1 7EH UK
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23
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Amoo OS, Onyia N, Onuigbo TI, Vitalis SU, Davies-Bolorunduro OF, Oraegbu JI, Adeniji ET, Obi JC, Abodunrin ON, Ikemefuna AS, Adegbola RA, Audu RA, Salako BL. Significance of hematologic abnormalities in COVID-19 severity among infected patients in Lagos, Nigeria. BULLETIN OF THE NATIONAL RESEARCH CENTRE 2022; 46:275. [PMID: 36474930 PMCID: PMC9716510 DOI: 10.1186/s42269-022-00959-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 11/14/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND There have been suggestions that hematologic abnormalities in COVID-19 are linked with the progression and severity of diseases and mortality. Lymphopenia, sepsis, and thrombocytopenia were highly reported in patients with COVID-19. This study investigated the significance of hematologic abnormalities in patients with COVID-19 in Lagos, Nigeria, and its potential as a diagnostic tool for COVID-19 severity. RESULTS This was a retrospective observational study with a total of 340 patients with COVID-19 (236 patients included in the analysis). These patients were categorized into two groups, comprising 71 patients with severe COVID-19 (SCP) and 165 patients with non-severe COVID-19 (NSCP). The majority were males in both categories (SCP 74.6% and NSCP 63.6%). The mean ± SD ages for SCP and NSCP were 52.28 ± 16.87 and 42.44 ± 17.18 years, respectively. The SCP (52.1%) and NSCP (20.0%) had underlying health conditions. The SCP exhibited significantly higher neutrophil counts (P < 0.05) and significantly lower mean hemoglobin, red blood cell (RBC), packed cell volume (PCV), and lymphocyte values (P < 0.05). Anemia and lymphocytopenia were more prominent in the SCP group than in the NSCP group (P < 0.05). Hemoglobin, RBC, PCV, and lymphocytes were inversely correlated with age-group in the SCP, while only lymphocytes and platelets were inversely correlated with age-group in the NSCP. The highest area under the ROC curve (AUC) for neutrophils was 0.739 with a sensitivity of 62.0% and specificity of 80.0%, while white blood cells had an AUC of 0.722 with a sensitivity of 73.2% and specificity of 61.2%. The AUC for neutrophil-lymphocyte ratio (NLR) was 0.766 with a sensitivity of 63.3% and specificity of 83.5%, while that for the platelet-lymphocyte ratio (PLR) was 0.695 with a sensitivity and specificity of 61.7% and 77.8%. CONCLUSIONS COVID-19 affected the levels of hemoglobin, RBC, PCV, and lymphocytes in the blood, and the differences were significant between the SCP and NSCP. The significant changes in neutrophil and lymphocyte counts may be useful in the prognosis and management of COVID-19 severity in hospital settings. Furthermore, NLR and PLR may be used in the prognosis and management of severe COVID-19 infection, as well as provide an objective basis for early identification and management in low-resource settings.
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24
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Iron Deficiency Anemia and COVID-19. JOURNAL OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASES 2022. [DOI: 10.52547/jommid.10.4.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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25
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Shankar V, Rajan PG, Krishnamoorthy Y, Sriram DK, George M, Sahay SMI, Nathan BJ. Development and validation of prognostic scoring system for COVID-19 severity in South India. Ir J Med Sci 2022; 191:2823-2831. [PMID: 34993834 PMCID: PMC8736307 DOI: 10.1007/s11845-021-02876-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 11/29/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Development of a prediction model using baseline characteristics of COVID-19 patients at the time of diagnosis will aid us in early identification of the high-risk groups and devise pertinent strategies accordingly. Hence, we did this study to develop a prognostic-scoring system for predicting the COVID-19 severity in South India. METHODS We undertook this retrospective cohort study among COVID-19 patients reporting to Hindu Mission Hospital, India. Multivariable logistic regression using the LASSO procedure was used to select variables for the model building, and the nomogram scoring system was developed with the final selected model. Model discrimination, calibration, and decision curve analysis (DCA) was performed. RESULTS In total, 35.1% of the patients in the training set developed severe COVID-19 during their follow-up period. In the basic model, nine variables (age group, sex, education, chronic kidney disease, tobacco, cough, dyspnea, olfactory-gustatory dysfunction [OGD], and gastrointestinal symptoms) were selected and a nomogram was built using these variables. In the advanced model, in addition to these variables (except OGD), C-reactive protein, lactate dehydrogenase, ferritin, D-dimer, and CT severity score were selected. The discriminatory power (c-index) for basic model was 0.78 (95%CI: 0.74-0.82) and advanced model was 0.83 (95%CI: 0.79-0.87). DCA showed that both the models are beneficial at a threshold probability around 10-95% than treat-none or treat-all strategies. CONCLUSION The present study has developed two separate prognostic-scoring systems to predict the COVID-19 severity. This scoring system could help the clinicians and policymakers to devise targeted interventions and in turn reduce the COVID-19 mortality in India.
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Affiliation(s)
- Vishnu Shankar
- Department of General Medicine, Hindu Mission Hospital, Chengalpattu, India
| | | | - Yuvaraj Krishnamoorthy
- Department of Community Medicine, ESIC Medical College & PGIMSR, K.K. Nagar, Chennai, India.
| | | | - Melvin George
- Clinical Research, Hindu Mission Hospital, Chengalpattu, India
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Bijelić K, Hitl M, Kladar N. Phytochemicals in the Prevention and Treatment of SARS-CoV-2-Clinical Evidence. Antibiotics (Basel) 2022; 11:1614. [PMID: 36421257 PMCID: PMC9686831 DOI: 10.3390/antibiotics11111614] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/06/2022] [Accepted: 11/10/2022] [Indexed: 11/16/2022] Open
Abstract
The first case of SARS-CoV-2 infection was reported in December 2019. Due to the rapid spread of the disease and the lack of adequate therapy, the use of plants that have a long history in the treatment of viral infections has often been considered. The aim of this paper is to provide a brief review of the literature on the use of phytochemicals during the new pandemic. An extensive search of published works was performed through platforms Google Scholar, PubMed, Science Direct, Web of Science and Clinicaltrials.gov. Numerous preclinical studies on the use of phytochemicals (quercetin, curcumin, baicalin, kaempferol, resveratrol, glycyrrhizin, lycorine, colchicine) against SARS-CoV-2 have shown that these components can be effective in the prevention and treatment of this infection. Clinical research has proven that the use of black cumin and green propolis as well as quercetin has positive effects. As for other phytochemicals, in addition to preclinical testing which has already been carried out, it would be necessary to conduct clinical tests in order to assert their effectiveness. For those phytochemicals whose clinical efficacy has been proven, it would be necessary to conduct research on a larger number of patients, so that the conclusions are more representative.
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Affiliation(s)
- Katarina Bijelić
- Department of Pharmacy, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia
| | - Maja Hitl
- Department of Pharmacy, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia
| | - Nebojša Kladar
- Department of Pharmacy, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia
- Center for Medical and Pharmaceutical Investigation and Quality Control, Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, 21000 Novi Sad, Serbia
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27
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Meurisse M, Van Oyen H, Blot K, Catteau L, Serrien B, Klamer S, Cauët E, Robert A, Van Goethem N. Evaluating methodological approaches to assess the severity of infection with SARS-CoV-2 variants: scoping review and applications on Belgian COVID-19 data. BMC Infect Dis 2022; 22:839. [PMID: 36368977 PMCID: PMC9651100 DOI: 10.1186/s12879-022-07777-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Differences in the genetic material of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants may result in altered virulence characteristics. Assessing the disease severity caused by newly emerging variants is essential to estimate their impact on public health. However, causally inferring the intrinsic severity of infection with variants using observational data is a challenging process on which guidance is still limited. We describe potential limitations and biases that researchers are confronted with and evaluate different methodological approaches to study the severity of infection with SARS-CoV-2 variants. METHODS We reviewed the literature to identify limitations and potential biases in methods used to study the severity of infection with a particular variant. The impact of different methodological choices is illustrated by using real-world data of Belgian hospitalized COVID-19 patients. RESULTS We observed different ways of defining coronavirus disease 2019 (COVID-19) disease severity (e.g., admission to the hospital or intensive care unit versus the occurrence of severe complications or death) and exposure to a variant (e.g., linkage of the sequencing or genotyping result with the patient data through a unique identifier versus categorization of patients based on time periods). Different potential selection biases (e.g., overcontrol bias, endogenous selection bias, sample truncation bias) and factors fluctuating over time (e.g., medical expertise and therapeutic strategies, vaccination coverage and natural immunity, pressure on the healthcare system, affected population groups) according to the successive waves of COVID-19, dominated by different variants, were identified. Using data of Belgian hospitalized COVID-19 patients, we were able to document (i) the robustness of the analyses when using different variant exposure ascertainment methods, (ii) indications of the presence of selection bias and (iii) how important confounding variables are fluctuating over time. CONCLUSIONS When estimating the unbiased marginal effect of SARS-CoV-2 variants on the severity of infection, different strategies can be used and different assumptions can be made, potentially leading to different conclusions. We propose four best practices to identify and reduce potential bias introduced by the study design, the data analysis approach, and the features of the underlying surveillance strategies and data infrastructure.
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Affiliation(s)
- Marjan Meurisse
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium.
- IREC - EPID, Université Catholique de Louvain, Bruxelles, Belgium.
| | - Herman Van Oyen
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Koen Blot
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Lucy Catteau
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Ben Serrien
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Sofieke Klamer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Emilie Cauët
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Annie Robert
- IREC - EPID, Université Catholique de Louvain, Bruxelles, Belgium
| | - Nina Van Goethem
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
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Birhanu T, Gemeda LA, Fekede MS, Hirbo HS. Early versus late intubation on the outcome of intensive care unit-admitted COVID-19 patients at Addis Ababa COVID-19 treatment centers, Addis Ababa, Ethiopia: A multicenter retrospective cohort study. INTERNATIONAL JOURNAL OF SURGERY OPEN 2022; 47:100561. [PMID: 36159206 PMCID: PMC9490954 DOI: 10.1016/j.ijso.2022.100561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 09/13/2022] [Accepted: 09/17/2022] [Indexed: 11/25/2022]
Abstract
Background Coronavirus disease 2019 (COVID-19) has resulted in severe acute respiratory failure, requiring intubation and an invasive mechanical ventilation. However, the time for initiation of intubation remains debatable. Therefore, this study aimed to compare early and late intubation on the outcome of COVID-19 patients admitted to the intensive care unit (ICU) of selected Addis Ababa COVID-19 treatment centers, Ethiopia. Methods A multicenter retrospective cohort study was conducted on 94 early and late intubated ICU-admitted COVID-19 patients from October 1, 2020, to October 31, 2021, in three selected COVID-19 treatment centers in Addis Ababa, Ethiopia. A simple random sampling technique was used to select study participants. An independent t-test, Mann Whitney U test and Fisher's exact test were used for statistical analysis, as appropriate. A P value < 0.05 was used to declare a statistical significance. Results A total of 94 patients participated, for a response rate of 94.68%. There was a statistically insignificant difference in the rates of death between the early intubated (47.2%) and the late intubated (46.1%) groups (P = 0.678). There was no difference in the median length of stay on a mechanical ventilator (in days) between the groups (P = 0.11). However, the maximum length of stay in the ICU to discharge was significantly shorter in the early intubated (33.1 days) than late intubated groups (63.79 days) (P < 0.001). Conclusion Outcomes (death or survival) were similar whether early or late intubation was used. Early intubation did appear to improve length of ICU stay in ICU-admitted COVID-19 patients.
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The effectiveness of dexamethasone as a combination therapy for COVID-19. ACTA PHARMACEUTICA (ZAGREB, CROATIA) 2022; 72:345-358. [PMID: 36651541 DOI: 10.2478/acph-2022-0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/28/2022] [Indexed: 01/26/2023]
Abstract
Coronavirus disease 2019 (COVID-19) was reported as a global pandemic in March 2020 after invading many countries and leaving behind tens of thousands of infected patients in a brief time span. Approval of a few vaccines has been obtained and their efficacy of varying degrees established. Still, there is no effective pharmaceutical agent for the treatment of COVID-19 though several drugs are undergoing clinical trials. Recent studies have shown that dexamethasone, a corticosteroid, can reduce the rate of COVID-19-related mortality in the intensive care unit by 35 % for patients who are on mechanical ventilation. Although variable efficacy of other combination therapies has been reported for treating COVID-19 associated with acute respiratory distress syndrome (ARDS), dexamethasone is an extensively used drug in many treatment regimens against COVID-19. The current review aims to explore the role of dexamethasone as an efficient combination treatment for COVID-19.
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Sadidi M, Zare A, Nasrollahzadehsabet M, Dastan F, Mosadegh Khah A, Jafari Asheyani M. The roles of dipeptidyl peptidase-4 inhibitors in prognosis of COVID-19 infection in patients with type 2 diabetes mellitus. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2022; 27:62. [PMID: 36353337 PMCID: PMC9639723 DOI: 10.4103/jrms.jrms_71_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/02/2022] [Accepted: 03/08/2022] [Indexed: 01/09/2023]
Abstract
Background COVID-19 is responsible for the latest pandemic. Dipeptidyl peptidase-4 (DPP-4) is one of the cellular receptors of interest for coronavirus. The aim of this study was to assess the roles of DPP-4 inhibitors in prognosis of COVID-19 infection in patients with type 2 diabetes mellitus. Materials and Methods retrospective cohort study was performed in 2020 in military medical centers affiliated to AJA University of Medical Sciences in Tehran on 220 patients with type 2 diabetes mellitus who were admitted in medical centers with COVID-19 infection. We collected demographic data of patients including age, gender, drug history, usage of DPP-4 inhibitors, clinical presentations at the time of the first visit, and the disease outcome including hospitalization duration and need for respiratory assist. Results The study population consisted of 133 males (60.5%) and 87 females (39.5%), with a mean age of 66.13 ± 12.3 years. Forty-four patients (20%) consumed DPP-4 inhibitors (sitagliptin and linagliptin). Patients who were treated with DPP-4 inhibitors required less oxygen (O2) therapies compared to other cases (76.7% vs. 88.6%, P = 0.04). Patients who were treated with DPP-4 inhibitors had significantly lower hospitalization duration compared to other cases (6.57 ± 2.3 days vs. 8.03 ± 4.4 days, respectively, P = 0.01). There were no significant differences between the two groups of patients regarding survival rates (P = 0.55). Age was a predictive factor for survival (odds ratio, 1.13; 95% confidence interval, 1.04-1.23; P = 0.004). Conclusion DPP-4 inhibitors could significantly decrease hospitalization days in patients with type 2 diabetes mellitus who were hospitalized for COVID-19. However, DPP-4 inhibitor usage showed no statistically significant impact on survival. Age was the important prognostic factor.
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Affiliation(s)
- Mohammad Sadidi
- Department of Internal Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Ahad Zare
- Department of Immunology, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
- Sarem Cell Research Center (SCRC), Sarem Women's Hospital, Tehran, Iran
| | | | - Farzaneh Dastan
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Mosadegh Khah
- MD. Endocrinologist, Aja University of Medical Sciences, Tehran, Iran
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Shang Y, Wu J, Liu J, Long Y, Xie J, Zhang D, Hu B, Zong Y, Liao X, Shang X, Ding R, Kang K, Liu J, Pan A, Xu Y, Wang C, Xu Q, Zhang X, Zhang J, Liu L, Zhang J, Yang Y, Yu K, Guan X, Chen D, Chinese Society of Critical Care Medicine, Chinese Medical Association. Expert consensus on the diagnosis and treatment of severe and critical coronavirus disease 2019 (COVID-19). JOURNAL OF INTENSIVE MEDICINE 2022; 2:199-222. [PMID: 36785648 PMCID: PMC9411033 DOI: 10.1016/j.jointm.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 07/24/2022] [Indexed: 12/16/2022]
Affiliation(s)
- You Shang
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
| | - Jianfeng Wu
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510010, China
| | - Jinglun Liu
- Department of Emergency and Critical Care Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Yun Long
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing 100730, China
| | - Jianfeng Xie
- Department of Critical Care Medicine, Jiangsu Provincial Key Laboratory of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, China
| | - Dong Zhang
- Department of Critical Care Medicine, The First Hospital of Jilin University, Changchun, Jilin 130021, China
| | - Bo Hu
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, China
| | - Yuan Zong
- Department of Critical Care Medicine, Shaanxi Provincial Hospital, Xi'an, Shannxi 710068, China
| | - Xuelian Liao
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
| | - Xiuling Shang
- Department of Critical Care Medicine, Fujian Provincial Hospital, Fujian Provincial Center for Critical Care Medicine, Fuzhou, Fujian 350001, China
| | - Renyu Ding
- Department of Critical Care Medicine, The First Hospital of China Medical University, Shenyang, Liaoning 110001, China
| | - Kai Kang
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, China
| | - Jiao Liu
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
| | - Aijun Pan
- Department of Critical Care Medicine, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, Anhui 230001, China
| | - Yonghao Xu
- Department of Critical Care Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, China
| | - Changsong Wang
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, Harbin, Heilongjiang 150001, China
| | - Qianghong Xu
- Department of Critical Care Medicine, Zhejiang Hospital Affiliated to Medical College of Zhejiang University, Hangzhou, Zhejiang 310013, China
| | - Xijing Zhang
- Department of Critical Care Medicine, Xijing Hospital, Fourth Military Medical University, Xi'an, Shannxi 710032, China
| | - Jicheng Zhang
- Department of Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Ling Liu
- Department of Critical Care Medicine, Jiangsu Provincial Key Laboratory of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, China
| | - Jiancheng Zhang
- Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
| | - Yi Yang
- Department of Critical Care Medicine, Jiangsu Provincial Key Laboratory of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, China
| | - Kaijiang Yu
- Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, China
- Corresponding authors: Dechang Chen, Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China. Xiangdong Guan, Department of Critical Care Medicine, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China. Kaijiang Yu, Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, China.
| | - Xiangdong Guan
- Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong 510010, China
- Corresponding authors: Dechang Chen, Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China. Xiangdong Guan, Department of Critical Care Medicine, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China. Kaijiang Yu, Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, China.
| | - Dechang Chen
- Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
- Corresponding authors: Dechang Chen, Department of Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China. Xiangdong Guan, Department of Critical Care Medicine, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong 510080, China. Kaijiang Yu, Department of Critical Care Medicine, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, China.
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Sallam M, Snygg J. Human albumin solution utilization patterns prior and during COVID-19 pandemic in United Arab Emirates: Time to develop and implement national guidelines on prescription and utilization. NARRA J 2022; 2:e82. [PMID: 38449699 PMCID: PMC10914072 DOI: 10.52225/narra.v2i2.82] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 07/24/2022] [Indexed: 03/08/2024]
Abstract
The human albumin solution (HAS) has limited but important indications in clinical practices. However, the inappropriate use of HAS can be costly. Thus, it is imperative to establish a practical protocol to use albumin products and rationalize its usage. The aim of this study was to identify HAS utilization patterns in a multi-specialty private hospital in Dubai, United Arab Emirates (UAE), before and during the COVID-19 pandemic. In addition, the objective was to demonstrate the importance of reconsidering the prescribing strategies for HAS administration. All data on 20% HAS administration in Mediclinic Welcare Hospital (MWEL) were retrieved between January 2019 and May 2021, including the total quantities administered and data on primary diagnosis. A total of 579 patient admissions with various diagnoses were included in this study. Our data suggested that the percentage of clinically indicated 20% HAS administrations decreased from 13.0% in the pre-COVID-19 phase to 1.5% in the COVID-19 phase (p<0.001). An increase in the administration of 20% HAS not backed by agreed clinical evidence followed the increase in new number of COVID-19 cases in the UAE. Our study suggests a large proportion of administered HAS, that drastically increased during COVID-19 with lack of evidence of its benefit. This study can be helpful to refine the institutional guidelines of HAS use, and frequent audits and interactive educational interventions are recommended to tackle this issue. In turn, the refinement of HAS administration guidelines could help to reduce the unjustified cost of inappropriate HAS use.
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Affiliation(s)
- Mohammed Sallam
- Department of Pharmacy, Mediclinic Welcare Hospital, Mediclinic Middle East, Dubai, United Arab Emirates
| | - Johan Snygg
- Mediclinic Welcare Hospital, Mediclinic Middle East, Dubai, United Arab Emirates
- The Sahlgrenska Academy at The University of Gothenburg, Gothenburg, Sweden
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Mal P, Mukherjee T, Upadhyay AK, Mohanty S, Pattnaik AK. Connecting the dots between inflammatory cascades of obesity and COVID-19 in light of mortal consequences-a review. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:57040-57053. [PMID: 35731430 PMCID: PMC9213647 DOI: 10.1007/s11356-022-21461-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/10/2022] [Indexed: 06/15/2023]
Abstract
Obesity is a term that has recently been referred to describe a condition in which a person has become a diseased vessel. Obesity's internal pathology is too mysterious as it has a close resemblance with fatal diseases pathology. Obesity and coronavirus disease 2019 (COVID-19) are simultaneous epidemics declared by many organizations after observing their rampage in the recent world. Oxidative stress, cytokine storm, interleukin, and their contribution to the internal adipocyte environment implicated in the cascades of inflammatory pathology are portrayed here. Major determinants like angiotensin-converting enzyme 2 (ACE2) and renin-angiotensin-aldosterone system (RAAS) axis are highly sensitive molecular factors. Data from various countries suggested a clinical overview of how greater body mass index (BMI) is related to greater COVID-19 risk. It also gives insight into how obese individuals are obligately getting admitted and combating COVID-19 in intensive care unit including children less than 13 years of age under ultimate therapeutic options. There are numerous studies currently taking place for finding a cure for obesity which are mainly focused on natural resources and novel therapies like photobiomodulation (PBM) consisting of laser treatment, infrared treatment, etc. as current pharmacological treatments are reported to have fatal adverse effects. Finally, it is discussed how attenuating obesity will be a solution for future combat strategy. This review gives light on the areas of coagulation, inflammatory parameters, cardiometabolic complications, endothelial dysfunctions, immunological infirmity due to COVID-19 in obese individuals. A conceptual outline about correlation between the inflammatory pathophysiological steps triggering the aggravation of fatal consequences has been drawn in this review.
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Affiliation(s)
- Payel Mal
- Division of Pharmacology, Department of Pharmaceutical Sciences and Technology, Birla Institute of Technology, Mesra, Ranchi, 835215, Jharkhand, India
| | - Tuhin Mukherjee
- Division of Pharmacology, Department of Pharmaceutical Sciences and Technology, Birla Institute of Technology, Mesra, Ranchi, 835215, Jharkhand, India
| | - Abhay K Upadhyay
- Division of Pharmacology, Department of Pharmaceutical Sciences and Technology, Birla Institute of Technology, Mesra, Ranchi, 835215, Jharkhand, India
| | - Satyajit Mohanty
- Division of Pharmacology, Department of Pharmaceutical Sciences and Technology, Birla Institute of Technology, Mesra, Ranchi, 835215, Jharkhand, India
| | - Ashok K Pattnaik
- Division of Pharmacology, Department of Pharmaceutical Sciences and Technology, Birla Institute of Technology, Mesra, Ranchi, 835215, Jharkhand, India.
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Choudhary H, Sinha LN, Belodu R, Solanki S, Kumar HRS, Bishnoi R. Patterns of RT-PCR Test Conversion and Implications on Time of Discharge in a District Hospital and a COVID-19 Care Centre in Pali, Rajasthan, India. Cureus 2022; 14:e27325. [PMID: 36043024 PMCID: PMC9411711 DOI: 10.7759/cureus.27325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Although coronavirus disease 2019 (COVID-19) first appeared in 2019, the symptoms are similar to common viral illnesses, and if undiagnosed or there is a delay in treatment, it may prove fatal because of the virus's propensity to attack the respiratory and cardiovascular system. The antigenic conversion status of reverse transcription-polymerase chain reaction (RT-PCR) was an important criterion for discharge among the COVID-19 patients of the two hospitals in the study. Aim The aim of the study was to assess the time taken to antigenic conversion from positive to negative in RT-PCR test for COVID-19 done on patients admitted to the two hospitals where the study took place. Materials and methods A prospective cross-sectional study with repeated sampling for antigenic conversion by RT-PCR was done on 117 patients of different age groups admitted to Bangur Hospital and Agarsen Bhavan in Pali, Rajasthan, India, from April 27 to June 30, 2020. Pharyngeal and nasal swabs were analyzed by real-time RT-PCR for COVID-19 infection. The patients' first positive sample was taken as “zero sample”. If the repeat sample taken on the fifth day was positive, sampling was repeated after 48 hours on consecutive days 7, 9, 11, 13, and 15 of admission till the RT-PCR test returned negative. Results Among the 117 patients, 92 (78.63%) were treated as mild, 10 (8.54%) were moderately severe, and 15 (12.82%) were very severe requiring ICU care. The median rate of conversion of RT-PCR test (positive to negative) from the day of admission was quite variable as five patients converted to negative by RT-PCR test on day seven of admission, one on day eight of admission, 26 on day nine, 30 on day 10, five on day 11, 13 on day 12, 10 on day 13, 11 on day 14, five on day 15, six on day 16, three on day 17, and one on day 18 of admission. Conclusion The study proved that follow-up of patients, prompt and comprehensive treatment, and repeated sampling ensures fast recovery with implications on time to discharge of such patients in a pandemic. The study justified and heralds the message that the inherent immunity of an individual corresponds to the time taken to conversion from positive to negative in the RT-PCR test.
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Tacchini-Jacquier N, Bonvin E, Monnay S, Verloo H. Perceived stress, trust, safety and severity of SARS-CoV-2 infection among patients discharged from hospital during the COVID-19 pandemic's first wave: a PREMs survey. BMJ Open 2022; 12:e060559. [PMID: 35710249 PMCID: PMC9207576 DOI: 10.1136/bmjopen-2021-060559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIM To investigate experiences of stress, feelings of safety, trust in healthcare staff and perceptions of the severity of a SARS-CoV-2 infection among inpatients discharged from Valais Hospital, Switzerland, during the COVID-19 pandemic's first wave. METHODS Discharged patients aged 18 years or more (n=4665), hospitalised between 28 February and 11 May 2020, whether they had been infected by SARS-CoV-2 or not, were asked to complete a self-reporting questionnaire, as were their informal caregivers, if available (n=866). Participants answered questions from Cohen's Perceived Stress Scale (PSS) (0=no stress, 40=severe stress), Krajewska-Kułak et al's Trust in Nurses Scale and Anderson and Dedrick's Trust in Physician Scale (10=no trust, 50=complete trust), the severity of a SARS-CoV-2 infection (1=not serious, 5=very serious), as well as questions on their perceived feelings of safety (0=not safe, 10=extremely safe). RESULTS Of our 1341 respondents, 141 had been infected with SARS-CoV-2. Median PSS score was 24 (IQR1-3=19-29), median trust in healthcare staff was 33 (IQR1-3=31-36), median perceived severity of a SARS-CoV-2 infection was 4 (IQR1-3=3-4) and the median feelings of safety score was 8 (IQR1-3=8-10). Significant differences were found between males and females for PSS scores (p<0.001) and trust scores (p<0.001). No significant differences were found between males and females for the perceived severity of SARS-CoV-2 infection scores (p=0.552) and the feelings of safety (p=0.751). Associations were found between age and trust scores (Rs=0.201), age and perceived SARS-CoV-2 severity scores (Rs=0.134), sex (female) and perceived stress (Rs=0.114), and sex (female) and trust scores (Rs=0.137). Associations were found between SARS-CoV-2 infected participants and the perceived SARS-CoV-2 severity score (Rs=-0.087), between trust scores and feelings of safety (Rs=0.147), and perceived severity of a SARS-CoV-2 infection (Rs=0.123). DISCUSSION The results indicated that inpatients experienced significant feelings of stress regarding perceived symptoms of the illness, yet this did not affect their feelings of safety, trust in healthcare staff or perception of the severity of SARS-CoV-2 infection. Future patient-reported experience measures research is needed to give a voice to healthcare users and facilitate comparison measures internationally.
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Affiliation(s)
| | - Eric Bonvin
- General Direction, Valais Hospital, Sion, Switzerland
| | | | - Henk Verloo
- Department of Nursing, Haute Ecole Specialisee de Suisse Occidentale, Delemont, Switzerland
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Peng J, Li Q, Dong J, Yuan G, Wang D. Case Report: The Experience of Managing a Moderate ARDS Caused by SARS-CoV-2 Omicron BA.2 Variant in Chongqing, China: Can We Do Better? Front Med (Lausanne) 2022; 9:921135. [PMID: 35755038 PMCID: PMC9218179 DOI: 10.3389/fmed.2022.921135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 05/18/2022] [Indexed: 12/03/2022] Open
Abstract
Background The severe coronavirus disease 2019 (COVID-19) pandemic is still raging worldwide, and the Omicron BA.2 variant has become the new circulating epidemic strain. However, our understanding of the Omicron BA.2 variant is still scarce. This report aims to present a case of a moderate acute respiratory distress syndrome (ARDS) caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) Omicron BA.2 variant and to discuss some management strategies that may benefit this type of case. Case Presentation A 78-year-old man, who had four negative nucleic acid tests and a fifth positive, was admitted to our hospital. This patient was generally good upon admission and tested negative for anti-SARS-CoV-2 antibodies even after receiving two doses of the COVID-19 vaccine. On the 7th day of hospitalization, he developed a moderate ARDS. Improved inflammatory index and decreased oxygen index were primarily found in this patient, and a series of treatments, including anti-inflammation and oxygen therapies, were used. Then this patient's condition improved soon and reached two negative results of nucleic acid tests on the 18th day of hospitalization. Conclusion At-home COVID-19 rapid antigen test could be complementary to existing detection methods, and the third booster dose of COVID-19 vaccine may be advocated in the face of the omicron BA.2 variant. Anti-inflammatory and oxygen therapies are still essential treatments for ARDS patients infected with SARS-CoV-2 Omicron BA.2 variant.
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Affiliation(s)
- Junnan Peng
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qiaoli Li
- Department of Intensive Care Medicine, Chongqing Public Health Medical Center, Chongqing, China
| | - Jing Dong
- Department of Intensive Care Medicine, Chongqing Public Health Medical Center, Chongqing, China
| | - Guodan Yuan
- Department of Intensive Care Medicine, Chongqing Public Health Medical Center, Chongqing, China
| | - Daoxin Wang
- Department of Respiratory and Critical Care Medicine, Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Evidence Based Management of Acute Heart Failure in the Era of COVID-19 Pandemic. INTENSIVE CARE RESEARCH 2022. [PMID: 37521441 PMCID: PMC9126099 DOI: 10.1007/s44231-022-00003-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This editorial is to highlight current issues of heart failure management during COVID-19 pandemic.
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Grecco BH, Araújo-Rossi PA, Nicoletti CF. Nutritional therapy for hospitalized patients with COVID-19: A narrative and integrative review. JOURNAL OF INTENSIVE MEDICINE 2022; 2:249-256. [PMID: 36785649 PMCID: PMC9110372 DOI: 10.1016/j.jointm.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/18/2022] [Accepted: 04/21/2022] [Indexed: 12/07/2022]
Abstract
Hospitalized patients affected by coronavirus disease 19 (COVID-19) have a sustained pro-inflammatory state and recurrent gastrointestinal symptoms that correlate with a decline in the nutritional status, which is directly related to poor immune response and clinical evolution. Nutritional therapy has proven crucial in COVID-19 treatment through the provision of adequate amounts of nutrients. Since the beginning of the pandemic, medical societies have mobilized to provide practical nutritional guidelines to support decision-making; despite this, there are only a few studies dedicated to compiling the most relevant recommendations. In this narrative review, we aimed to summarize and stratify the current scientific literature on nutritional support for hospitalized COVID-19 patients. We carried out a literature review from three databases between January 2020 and July 2021, using nutrition therapy (or medical nutrition or enteral nutrition or parental nutrition or nutritional support) and COVID-19 (SARS-CoV-2 infection) as the search terms. Only those studies that evaluated adult hospitalized patients with admissions to wards, specific clinics, or intensive care units were included. The nutritional intervention considered was that of specific nutritional support via oral, enteral, or parenteral modes. A total of 37 articles were included. In general, the nutritional care provided to COVID-19 patients follows the same premises as for other patients, i.e., it opts for the most physiological route and meets nutritional demands based on the clinical condition. However, some protocols that minimize the risk of contamination exposure for the health team have to be considered. Energy requirements varied from 15 kcal/kg/day to 30 kcal/kg/day and protein goals from 1.2 g/kg/day to 2 g/kg/day. In both cases, the ramp protocol for increased supply should be considered. In cases of enteral therapy, ready-to-use diet and continuous mode are recommended. Attention to refeeding syndrome is essential when parenteral nutrition is used.
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Affiliation(s)
- Beatriz H. Grecco
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, SP, Brazil
| | - Paula A.O. Araújo-Rossi
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo, SP, Brazil
| | - Carolina F. Nicoletti
- Applied Physiology and Nutrition Research Group, Rheumatology Division, Faculty of Medicine, University of São Paulo, Av Dr Arnaldo 455, São Paulo, SP 01246-903, Brazil,Corresponding author: Carolina F. Nicoletti, Applied Physiology and Nutrition Research Group, Rheumatology Division, Faculty of Medicine, University of São Paulo, Av Dr Arnaldo 455, São Paulo, SP 01246-903, Brazil.
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Su Y, Qiu ZS, Chen J, Ju MJ, Ma GG, He JW, Yu SJ, Liu K, Lure FYM, Tu GW, Zhang YY, Luo Z. Usage of compromised lung volume in monitoring steroid therapy on severe COVID-19. Respir Res 2022; 23:105. [PMID: 35488261 PMCID: PMC9051749 DOI: 10.1186/s12931-022-02025-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 04/14/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Quantitative computed tomography (QCT) analysis may serve as a tool for assessing the severity of coronavirus disease 2019 (COVID-19) and for monitoring its progress. The present study aimed to assess the association between steroid therapy and quantitative CT parameters in a longitudinal cohort with COVID-19. METHODS Between February 7 and February 17, 2020, 72 patients with severe COVID-19 were retrospectively enrolled. All 300 chest CT scans from these patients were collected and classified into five stages according to the interval between hospital admission and follow-up CT scans: Stage 1 (at admission); Stage 2 (3-7 days); Stage 3 (8-14 days); Stage 4 (15-21 days); and Stage 5 (22-31 days). QCT was performed using a threshold-based quantitative analysis to segment the lung according to different Hounsfield unit (HU) intervals. The primary outcomes were changes in percentage of compromised lung volume (%CL, - 500 to 100 HU) at different stages. Multivariate Generalized Estimating Equations were performed after adjusting for potential confounders. RESULTS Of 72 patients, 31 patients (43.1%) received steroid therapy. Steroid therapy was associated with a decrease in %CL (- 3.27% [95% CI, - 5.86 to - 0.68, P = 0.01]) after adjusting for duration and baseline %CL. Associations between steroid therapy and changes in %CL varied between different stages or baseline %CL (all interactions, P < 0.01). Steroid therapy was associated with decrease in %CL after stage 3 (all P < 0.05), but not at stage 2. Similarly, steroid therapy was associated with a more significant decrease in %CL in the high CL group (P < 0.05), but not in the low CL group. CONCLUSIONS Steroid administration was independently associated with a decrease in %CL, with interaction by duration or disease severity in a longitudinal cohort. The quantitative CT parameters, particularly compromised lung volume, may provide a useful tool to monitor COVID-19 progression during the treatment process. Trial registration Clinicaltrials.gov, NCT04953247. Registered July 7, 2021, https://clinicaltrials.gov/ct2/show/NCT04953247.
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Affiliation(s)
- Ying Su
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ze-Song Qiu
- School of Information Science and Technology, ShanghaiTech University, Shanghai, China
| | - Jun Chen
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Min-Jie Ju
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guo-Guang Ma
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jin-Wei He
- School of Information Science and Technology, ShanghaiTech University, Shanghai, China
| | - Shen-Ji Yu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Kai Liu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | | | - Guo-Wei Tu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Yu-Yao Zhang
- School of Information Science and Technology, ShanghaiTech University, Shanghai, China.
| | - Zhe Luo
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
- Department of Critical Care Medicine, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China.
- Shanghai Key Lab of Lung Inflammation and Injury, Shanghai, China.
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Su Y, Qiu ZS, Chen J, Ju MJ, Ma GG, He JW, Yu SJ, Liu K, Lure FYM, Tu GW, Zhang YY, Luo Z. Usage of compromised lung volume in monitoring steroid therapy on severe COVID-19. Respir Res 2022. [PMID: 35488261 DOI: 10.21203/rs.3.rs-698051/v1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Quantitative computed tomography (QCT) analysis may serve as a tool for assessing the severity of coronavirus disease 2019 (COVID-19) and for monitoring its progress. The present study aimed to assess the association between steroid therapy and quantitative CT parameters in a longitudinal cohort with COVID-19. METHODS Between February 7 and February 17, 2020, 72 patients with severe COVID-19 were retrospectively enrolled. All 300 chest CT scans from these patients were collected and classified into five stages according to the interval between hospital admission and follow-up CT scans: Stage 1 (at admission); Stage 2 (3-7 days); Stage 3 (8-14 days); Stage 4 (15-21 days); and Stage 5 (22-31 days). QCT was performed using a threshold-based quantitative analysis to segment the lung according to different Hounsfield unit (HU) intervals. The primary outcomes were changes in percentage of compromised lung volume (%CL, - 500 to 100 HU) at different stages. Multivariate Generalized Estimating Equations were performed after adjusting for potential confounders. RESULTS Of 72 patients, 31 patients (43.1%) received steroid therapy. Steroid therapy was associated with a decrease in %CL (- 3.27% [95% CI, - 5.86 to - 0.68, P = 0.01]) after adjusting for duration and baseline %CL. Associations between steroid therapy and changes in %CL varied between different stages or baseline %CL (all interactions, P < 0.01). Steroid therapy was associated with decrease in %CL after stage 3 (all P < 0.05), but not at stage 2. Similarly, steroid therapy was associated with a more significant decrease in %CL in the high CL group (P < 0.05), but not in the low CL group. CONCLUSIONS Steroid administration was independently associated with a decrease in %CL, with interaction by duration or disease severity in a longitudinal cohort. The quantitative CT parameters, particularly compromised lung volume, may provide a useful tool to monitor COVID-19 progression during the treatment process. Trial registration Clinicaltrials.gov, NCT04953247. Registered July 7, 2021, https://clinicaltrials.gov/ct2/show/NCT04953247.
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Affiliation(s)
- Ying Su
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ze-Song Qiu
- School of Information Science and Technology, ShanghaiTech University, Shanghai, China
| | - Jun Chen
- Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, China
| | - Min-Jie Ju
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Guo-Guang Ma
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Jin-Wei He
- School of Information Science and Technology, ShanghaiTech University, Shanghai, China
| | - Shen-Ji Yu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Kai Liu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | | | - Guo-Wei Tu
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China.
| | - Yu-Yao Zhang
- School of Information Science and Technology, ShanghaiTech University, Shanghai, China.
| | - Zhe Luo
- Department of Critical Care Medicine, Zhongshan Hospital, Fudan University, Shanghai, China. .,Department of Critical Care Medicine, Xiamen Branch, Zhongshan Hospital, Fudan University, Xiamen, China. .,Shanghai Key Lab of Lung Inflammation and Injury, Shanghai, China.
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Vanassche T, Orlando C, Vandenbosch K, Gadisseur A, Hermans C, Jochmans K, Minon JM, Motte S, Peperstraete H, Péters P, Sprynger M, Lancellotti P, Dehaene I, Emonts P, Vandenbriele C, Verhamme P, Oury C. Belgian clinical guidance on anticoagulation management in hospitalised and ambulatory patients with COVID-19. Acta Clin Belg 2022; 77:280-285. [PMID: 33012274 DOI: 10.1080/17843286.2020.1829252] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES COVID-19 predisposes patients to thrombotic disease. The aim of this guidance document is to provide Belgian health-care workers with recommendations on anticoagulation management in COVID-19 positive patients. METHODS These recommendations were based on current knowledge and a limited level of evidence. RESULTS We formulated recommendations for the prophylaxis and treatment of COVID-related venous thromboembolism in ambulatory and hospitalised patients, as well as recommendations for the use of antithrombotic drugs in patients with prior indication for anticoagulation who develop COVID-19. CONCLUSIONS These recommendations represent an easy-to-use practical guidance that can be implemented in every Belgian hospital and be used by primary care physicians and gynaecologists. Of note, they are likely to evolve with increased knowledge of the disease and availability of data from ongoing clinical trials.
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Affiliation(s)
- Thomas Vanassche
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Christelle Orlando
- Department of Haematology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Kristel Vandenbosch
- Department of Laboratory Haematology, CHU University Hospital of Liège, Liège, Belgium
| | - Alain Gadisseur
- Department of Haematology, Antwerp University Hospital, Antwerp, Belgium
| | - Cédric Hermans
- Department of Haematology, Cliniques Universitaires St-Luc, Brussels, Belgium
| | - Kristin Jochmans
- Department of Haematology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Jean-Marc Minon
- Department of Laboratory Medicine, Thrombosis-haemostasis and Transfusion Unit, CHR Citadelle, Liège, Belgium
| | - Serge Motte
- Department of Vascular Diseases, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Pierre Péters
- Department of Laboratory Haematology, CHU University Hospital of Liège, Liège, Belgium
| | - Muriel Sprynger
- Department of Cardiology, CHU University Hospital of Liège, Liège, Belgium
| | | | - Isabelle Dehaene
- Vlaamse Vereniging voor Obstetrie en Gynaecologie, Universitair Ziekenhuis Gent, Ghent, Belgium
| | - Patrick Emonts
- Groupement des Gynécologues Obstétriciens de Langue Française de Belgique, CHU University Hospital of Liège
| | | | - Peter Verhamme
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Cécile Oury
- Laboratory of Cardiology, GIGA Institute, University of Liège, Liège, Belgium
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Wang C, Chen L, Chen Y, Jia W, Cai X, Liu Y, Ji F, Xiong P, Liang A, Liu R, Guan Y, Cheng Z, Weng Y, Wang W, Duan Y, Kuang D, Xu S, Cai H, Xia Q, Yang D, Wang MW, Yang X, Zhang J, Cheng C, Liu L, Liu Z, Liang R, Wang G, Li Z, Xia H, Xia T. Abnormal global alternative RNA splicing in COVID-19 patients. PLoS Genet 2022; 18:e1010137. [PMID: 35421082 PMCID: PMC9089920 DOI: 10.1371/journal.pgen.1010137] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 05/10/2022] [Accepted: 03/08/2022] [Indexed: 12/25/2022] Open
Abstract
Viral infections can alter host transcriptomes by manipulating host splicing machinery. Despite intensive transcriptomic studies on SARS-CoV-2, a systematic analysis of alternative splicing (AS) in severe COVID-19 patients remains largely elusive. Here we integrated proteomic and transcriptomic sequencing data to study AS changes in COVID-19 patients. We discovered that RNA splicing is among the major down-regulated proteomic signatures in COVID-19 patients. The transcriptome analysis showed that SARS-CoV-2 infection induces widespread dysregulation of transcript usage and expression, affecting blood coagulation, neutrophil activation, and cytokine production. Notably, CD74 and LRRFIP1 had increased skipping of an exon in COVID-19 patients that disrupts a functional domain, which correlated with reduced antiviral immunity. Furthermore, the dysregulation of transcripts was strongly correlated with clinical severity of COVID-19, and splice-variants may contribute to unexpected therapeutic activity. In summary, our data highlight that a better understanding of the AS landscape may aid in COVID-19 diagnosis and therapy.
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Affiliation(s)
- Changli Wang
- Department of Pathology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lijun Chen
- Department of Pathology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yaobin Chen
- Institute of Artificial Intelligence and Automation, Huazhong University of Science and Technology, Wuhan, China
| | - Wenwen Jia
- Institute for Regenerative Medicine, Shanghai East Hospital, School of Life Sciences and Technology, Tongji University, Shanghai, China
| | - Xunhui Cai
- Institute of Artificial Intelligence and Automation, Huazhong University of Science and Technology, Wuhan, China
| | - Yufeng Liu
- Institute of Artificial Intelligence and Automation, Huazhong University of Science and Technology, Wuhan, China
| | - Fenghu Ji
- Institute of Artificial Intelligence and Automation, Huazhong University of Science and Technology, Wuhan, China
| | - Peng Xiong
- Institute of Artificial Intelligence and Automation, Huazhong University of Science and Technology, Wuhan, China
| | - Anyi Liang
- Institute of Artificial Intelligence and Automation, Huazhong University of Science and Technology, Wuhan, China
| | - Ren Liu
- Department of Research and Development, Hugobiotech Co. Ltd., Beijing, China
| | - Yuanlin Guan
- Department of Research and Development, Hugobiotech Co. Ltd., Beijing, China
| | - Zhongyi Cheng
- Jingjie PTM BioLab (Hangzhou) Co. Ltd., Hangzhou, China
| | - Yejing Weng
- Jingjie PTM BioLab (Hangzhou) Co. Ltd., Hangzhou, China
| | - Weixin Wang
- Jingjie PTM BioLab (Hangzhou) Co. Ltd., Hangzhou, China
| | - Yaqi Duan
- Institute of Artificial Intelligence and Automation, Huazhong University of Science and Technology, Wuhan, China
| | - Dong Kuang
- Institute of Artificial Intelligence and Automation, Huazhong University of Science and Technology, Wuhan, China
| | - Sanpeng Xu
- Institute of Artificial Intelligence and Automation, Huazhong University of Science and Technology, Wuhan, China
| | - Hanghang Cai
- Institute of Artificial Intelligence and Automation, Huazhong University of Science and Technology, Wuhan, China
| | - Qin Xia
- Department of Pathology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dehua Yang
- The National Center for Drug Screening, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China
| | - Ming-Wei Wang
- The National Center for Drug Screening, Shanghai Institute of Materia Medica, Chinese Academy of Sciences, Shanghai, China
| | - Xiangping Yang
- Department of Pathology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jianjun Zhang
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
- Department of Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Chao Cheng
- Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
| | - Liang Liu
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhongmin Liu
- Institute for Regenerative Medicine, Shanghai East Hospital, School of Life Sciences and Technology, Tongji University, Shanghai, China
| | - Ren Liang
- Department of Forensic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guopin Wang
- Institute of Artificial Intelligence and Automation, Huazhong University of Science and Technology, Wuhan, China
| | | | - Han Xia
- Department of Research and Development, Hugobiotech Co. Ltd., Beijing, China
- School of Automation Science and Engineering, Faculty of Electronic and Information Engineering, Xi’an Jiaotong University, Xi’an, China
| | - Tian Xia
- Department of Pathology, School of Basic Medicine, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Institute of Artificial Intelligence and Automation, Huazhong University of Science and Technology, Wuhan, China
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Leonardi Vinci D, Meccio A, Provenzani A, Faggiano ME, Miljković N, Makridaki D, Horák P, Polidori P. The European COVID-19 drugs calculation tool: an aid for the estimation of the drugs needed during the SARS-CoV 2 pandemic. Eur J Hosp Pharm 2022; 29:e23-e29. [PMID: 33619027 PMCID: PMC7902324 DOI: 10.1136/ejhpharm-2020-002633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/19/2021] [Accepted: 02/02/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To create an informatics supportive tool, which can assist healthcare professionals in estimating potential requirements for essential drug supplies to respond to the current SARS-CoV-2 pandemic based on epidemiological forecasting. METHODS The tool was based on a Susceptible-Infected-Removed (SIR) epidemiological model in which the population is divided into three compartments and transmission parameters are specified to define the rate at which people move between stages. Appropriate data entry was guaranteed by the creation of structured guided paths. The drugs needed for the forecasted patients were estimated according to a list of critical care drugs compiled by consulting previous published scientific works, national and international guidelines. For each drug, an estimation was made of the percentage average ICU uptake for each therapeutic group and active principle. RESULTS The tool consists of a Microsoft Excel template that is based on the initial epidemiological situation, the non-pharmaceutical interventions applied, the risk of hospitalisation based on the population age distribution, and the hospital beds available. The tool provides a forecast of which patients with COVID-19 will need to be treated in a hospital setting. The number of patients is used to estimate the drugs needed based on the average daily dose and the treatment length of each drug. The possibility of editing the type of distribution (exponential or linear) of the number of patients at the beginning of the analysis, the percentage adherence with non-pharmaceutical interventions and their delayed effect, and all the key epidemiological parameters make the estimation tailorable to different clinical contexts and needs. CONCLUSIONS This model might be an effective supporting tool that could be easily implemented within the workflow of health professionals. All the information reported in this paper could be useful in developing new strategies to tackle the COVID-19 pandemic.
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Affiliation(s)
- Daniele Leonardi Vinci
- School of Specialization in Hospital Pharmacy, University of Palermo, Palermo, Sicilia, Italy
| | - Adriano Meccio
- Chemical Engineering, University of Palermo, Palermo, Sicilia, Italy
| | | | | | - Nenad Miljković
- Hospital Pharmacy, Institute of Orthopaedic Surgery "Banjica", Belgrade, Serbia
| | - Despina Makridaki
- Pharmacy Services, "Sismanoglio- Amalia Fleming", General Hospital of Attica, Athens, Greece
| | - Petr Horák
- Hospital Pharmacy, Motol University Hospital, Praha, Praha, Czech Republic
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Efendi D, Hasan F, Natalia R, Utami AR, Sonko I, Asmarini TA, Yuningsih R, Wanda D, Sari D. Nursing care recommendation for pediatric COVID-19 patients in the hospital setting: A brief scoping review. PLoS One 2022; 17:e0263267. [PMID: 35113925 PMCID: PMC8812980 DOI: 10.1371/journal.pone.0263267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/14/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The hospitalization of children during the COVID-19 pandemic has affected their physical and mental health. Pediatric nurses have faced challenges in providing high-quality nursing care for children and their families. However, the pediatric nursing care recommendations for COVID-19 patients in the hospital setting remain unclear. The current scoping review provides recommendations for nursing interventions for pediatric COVID-19 patients in the hospital setting. METHODS AND FINDINGS The selected articles containing management and nursing recommendations for COVID-19 that have occurred in pediatric patients ages 0-19 years old. A search strategy was developed and implemented in seven databases. We included peer-reviewed articles that reported observational or interventional studies, as well as policy papers, guides or guidelines, letters and editorials, and web articles. A total of 134 articles and other documents relevant to this review were included. We categorized the results based on The Nursing Intervention Classification (NIC) taxonomy which consists of six domains (e.g., Physiological: Basic); eleven classes (e.g., Nutrition Support); and eighteen intervention themes (e.g., Positioning, Family Presence Facilitation, Family Support, and Discharge Planning). CONCLUSION Apart from the intervention of physical problems, there is a need to promote patient- and family-centered care, play therapy, and discharge planning to help children and families cope with their new situation.
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Affiliation(s)
- Defi Efendi
- Department of Pediatric Nursing, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
- Neonatal Intensive Care Unit, Universitas Indonesia Hospital, Depok, Indonesia
| | - Faizul Hasan
- School of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Regina Natalia
- School of Nursing, Mitra Bunda Health Institute, Batam, Indonesia
| | - Ayuni Rizka Utami
- Department of Pediatric Nursing, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
| | - Ismaila Sonko
- School of Nursing, Taipei Medical University, Taipei, Taiwan
- Ministry of Health and Social Welfare, The Quadrangle, Banjul, The Gambia, West Africa
| | - Titik Ambar Asmarini
- Department of Pediatric Nursing, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
- Neonatal and Pediatric Intensive Care Unit, Gatot Soebroto Indonesian Central of Army Hospital, Jakarta, Indonesia
| | - Risna Yuningsih
- Neonatal Intensive Care Unit, Dr. Dradjat Prawiranegara General Hospital, Banten, Indonesia
| | - Dessie Wanda
- Department of Pediatric Nursing, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
| | - Dian Sari
- School of Nursing, Prima Nusantara Health Institute, Bukittinggi, Indonesia
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Romito JW, Atem FD, Manjunath A, Yang A, Romito BT, Stutzman SE, McDonagh DL, Venkatachalam AM, Premachandra L, Aiyagari V. Comparison of Bispectral Index Monitor Data Between Standard Frontal-Temporal Position and Alternative Nasal Dorsum Position in the Intensive Care Unit: A Pilot Study. J Neurosci Nurs 2022; 54:30-34. [PMID: 35007261 DOI: 10.1097/jnn.0000000000000635] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT BACKGROUND: The Bispectral (BIS) monitor is a validated, noninvasive monitor placed over the forehead to titrate sedation in patients under general anesthesia in the operating room. In the neurocritical care unit, there is limited room on the forehead because of incisions, injuries, and other monitoring devices. This is a pilot study to determine whether a BIS nasal montage correlates to the standard frontal-temporal data in this patient population. METHODS: This prospective nonandomized pilot study enrolled 10 critically ill, intubated, and sedated adult patients admitted to the neurocritical care unit. Each patient had a BIS monitor placed over the standard frontal-temporal location and over the alternative nasal dorsum with simultaneous data collected for 24 hours. RESULTS: In the frontal-temporal location, the mean (SD) BIS score was 50.9 (15.0), average minimum BIS score was 47.0 (15.0), and average maximum BIS score was 58.4 (16.7). In the nasal dorsum location, the mean BIS score was 54.8 (21.6), average minimum BIS score was 52.8 (20.9), and average maximum BIS score was 58.0 (22.2). Baseline nonparametric tests showed nonsignificant P values for all variables except for Signal Quality Index. Generalized linear model analysis demonstrated significant differences between the 2 monitor locations (P < .0001). CONCLUSION: The results of this pilot study do not support using a BIS nasal montage as an alternative for patients in the neurocritical care unit.
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Shemies RS, Nagy E, Younis D, Sheashaa H. Renal replacement therapy for critically ill patients with COVID-19-associated acute kidney injury: A review of current knowledge. Ther Apher Dial 2022; 26:15-23. [PMID: 34378870 PMCID: PMC8420218 DOI: 10.1111/1744-9987.13723] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 08/02/2021] [Accepted: 08/09/2021] [Indexed: 01/08/2023]
Abstract
The outbreak of coronavirus disease 2019 (COVID-19) has rapidly evolved into a global pandemic. A significant proportion of COVID-19 patients develops severe symptoms, which may include acute respiratory distress syndrome and acute kidney injury as manifestations of multi-organ failure. Acute kidney injury (AKI) necessitating renal replacement therapy (RRT) is increasingly prevalent among critically ill patients with COVID-19. However, few studies have focused on AKI treated with RRT. Many questions are awaiting answers as regards AKI in the setting of COVID-19; whether patients with COVID-19 commonly develop AKI, what are the underlying pathophysiologic mechanisms? What is the best evidence regarding treatment approaches? Identification of the potential indications and the preferred modalities of RRT in this context, is based mainly on clinical experience. Here, we review the current approaches of RRT, required for management of critically ill patients with COVID-19 complicated by severe AKI as well as the precautions that should be adopted by health care providers in dealing with these cases. Electronic search was conducted in MEDLINE, PubMed, ISI Web of Science, and Scopus scientific databases. We searched the terms relevant to this review to identify the relevant studies. We also searched the conference proceedings and ClinicalTrials.gov database.
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Affiliation(s)
| | - Eman Nagy
- Mansoura Nephrology and Dialysis UnitMansoura UniversityMansouraEgypt
| | - Dalia Younis
- Mansoura Nephrology and Dialysis UnitMansoura UniversityMansouraEgypt
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Singh J, Malik P, Patel N, Pothuru S, Israni A, Chakinala RC, Hussain MR, Chidharla A, Patel H, Patel SK, Rabbani R, Patel U, Chugh S, Kichloo A. Kidney disease and COVID-19 disease severity-systematic review and meta-analysis. Clin Exp Med 2022; 22:125-135. [PMID: 33891214 PMCID: PMC8063780 DOI: 10.1007/s10238-021-00715-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/16/2021] [Indexed: 01/08/2023]
Abstract
We aimed to identify prevalence and association of comorbid chronic kidney disease (CKD), acute kidney injury (AKI) and utilization prevalence of continuous renal replacement therapy (CRRT) in COVID-19-hospitalized patients as a function of severity status. With the ongoing struggle across the globe to combat COVID-19 disease, published literature has described the role of kidney disease in COVID-19 patients based on single/multicenter experiences across the globe. We extracted data from observational studies describing comorbid CKD, AKI and CRRT and outcomes and severity of COVID-19-hospitalized patients from December 1, 2019-August 20, 2020 following PRISMA guidelines. Severity of COVID-19 includes intensive care unit admission, oxygen saturation < 90%, invasive mechanical ventilation utilization, in-hospital admission and mortality. Meta-analysis was performed using a random-effects model to calculate pooled estimates, and forest plots were created. In total, 29 studies with 15,017 confirmed COVID-19 patients were included. The overall prevalence of AKI was 11.6% [(430/3693)], comorbid CKD 9.7% [(1342/13,728)] and CRRT 2.58% [(102/3946)] in our meta-analysis. We also found higher odds of comorbid CKD (pooled OR: 1.70; 95%CI: 1.21-2.40; p = 0.002), AKI (8.28; 4.42-15.52; p < 0.00001) and utilization of CRRT (16.90; 9.00-31.74; p < 0.00001) in patients with severe COVID-19 disease. Conclusion Our meta-analysis suggests that comorbid CKD, AKI and utilization of CRRT were significantly associated with COVID-19 disease severity. Clinicians should focus on early triaging of COVID-19 patients with comorbid CKD and at risk for AKI to prevent complication and mortality.
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Affiliation(s)
- Jagmeet Singh
- Geisinger Commonwealth School of Medicine, Scranton, PA USA
| | - Preeti Malik
- Department of Public Health, Icahn School of Medicine At Mount Sinai, 1 Gustave L. Levy Pl, New York, NY USA
| | - Nidhi Patel
- Drexel University College of Medicine, Philadelphia, PA USA
| | | | | | | | - Maryam Rafaqat Hussain
- Department of Public Health, Icahn School of Medicine At Mount Sinai, 1 Gustave L. Levy Pl, New York, NY USA
| | - Anusha Chidharla
- University of Illinois College of Medicine Peoria, Champaign, IL USA
| | - Harshil Patel
- Ascension Providence Hospital/Michigan State University College of Human Medicine, East Lansing, USA
| | | | | | - Urvish Patel
- Department of Public Health, Icahn School of Medicine At Mount Sinai, 1 Gustave L. Levy Pl, New York, NY USA
| | | | - Asim Kichloo
- College of Medicine, Central Michigan University, Saginaw, MI USA
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Viana MV, Pantet O, Charrière M, Favre D, Piquilloud L, Schneider AG, Hurni C, Berger MM. Specific nutritional and metabolic characteristics of COVID‐19 persistent critically ill patients. JPEN J Parenter Enteral Nutr 2022; 46:1149-1159. [PMID: 35048374 PMCID: PMC9015259 DOI: 10.1002/jpen.2334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 12/19/2021] [Accepted: 01/03/2022] [Indexed: 11/09/2022]
Abstract
Background Little is known about metabolic and nutrition characteristics of patients with coronavirus disease 2019 (COVID‐19) and persistent critical illness. We aimed to compare those characteristics in patients with PCI and COVID‐19 and patients without COVID‐19 infection (non‐CO)—primarily, their energy balance. Methods This is a prospective observational study including two consecutive cohorts, defined as needing intubation for >10 days. We collected demographic data, severity scores, nutrition variables, length of stay, and mortality. Results Altogether, 104 patients (52 per group) were included (59 ± 14 years old [mean ± SD], 75% men) between July 2019 and May 2020. SAPSII, Nutrition Risk Screening (NRS) score, proportion of obese patients, duration of intubation (18.2 ± 11.7 days), and mortality rates were similar. Patients with COVID‐19 (vs non‐CO) had lower SOFA scores (P = 0.013) and more frequently needed prone position (P < 0.0001) and neuromuscular blockade (P < 0.0001): lengths of ICU (P = 0.03) and hospital stays were shorter (P < 0.0001). Prescribed energy targets were below those of the ICU protocol. The energy balance of patients with COVID‐19 was significantly more negative after day 10. Enteral nutrition (EN) started earlier (P < 0.0001). During the first 10 days, COVID‐19 patients received more lipid (propofol sedation) and less protein. Higher admission C‐reactive protein (P = 0.002) decreased faster (P < 0.001). Whereas intestinal function was characterized by constipation in both groups during the first 10 days, diarrhea was less common in patients with COVID‐19 thereafter. Conclusion Compared with non‐CO patients, COVID‐19 patients were not more obese, had lower SOFA scores, and were fed more rapidly with EN, because of a more normal gastrointestinal function possibly due to fewer non–respiratory organ failures: their energy balances were more negative after the first 10 days. Propofol sedation reduced protein delivery.
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Affiliation(s)
- Marina V Viana
- Service of Adult Intensive care Medicine Lausanne University Hospital (CHUV) Lausanne Switzerland
- Critical Care Unit, Hospital de Clínicas de Porto Alegre Universidade Federal do Rio Grande do Sul Porto Alegre RS Brazil
| | - Olivier Pantet
- Service of Adult Intensive care Medicine Lausanne University Hospital (CHUV) Lausanne Switzerland
| | - Mélanie Charrière
- Service of Adult Intensive care Medicine Lausanne University Hospital (CHUV) Lausanne Switzerland
- Clinical Nutrition, Department of Endocrinology, Diabetology and Metabolism Lausanne University Hospital (CHUV) Lausanne Switzerland
| | - Doris Favre
- Service of Adult Intensive care Medicine Lausanne University Hospital (CHUV) Lausanne Switzerland
- Clinical Nutrition, Department of Endocrinology, Diabetology and Metabolism Lausanne University Hospital (CHUV) Lausanne Switzerland
| | - Lise Piquilloud
- Service of Adult Intensive care Medicine Lausanne University Hospital (CHUV) Lausanne Switzerland
| | - Antoine G Schneider
- Service of Adult Intensive care Medicine Lausanne University Hospital (CHUV) Lausanne Switzerland
| | - Claire‐Anne Hurni
- Service of Adult Intensive care Medicine Lausanne University Hospital (CHUV) Lausanne Switzerland
| | - Mette M Berger
- Service of Adult Intensive care Medicine Lausanne University Hospital (CHUV) Lausanne Switzerland
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Abdelsalam M, Abd El Wahab AM, Nassar MK, Samaan E, Eldeep A, Abdalbary M, Tawfik M, Saleh M, Shemies RS, Sabry A. Kidneys in SARS-CoV-2 Era; a challenge of multiple faces. Ther Apher Dial 2022; 26:552-565. [PMID: 34989119 DOI: 10.1111/1744-9987.13792] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 12/31/2021] [Accepted: 01/03/2022] [Indexed: 01/08/2023]
Abstract
INTRODUCTION With the evolution of SARS-CoV-2 pandemic, it was believed to be a direct respiratory virus. But, its deleterious effects were observed on different body systems, including kidneys. AIM OF WORK In this review, we tried as much as we can to summarize what has been discussed in the literature about the relation between SARS-CoV-2 infection and kidneys since December, 2019. METHODS Each part of the review was assigned to one or two authors to search for relevant articles in three databases (Pubmed, Scopus and Google scholar) and collected data were summarized and revised by two independent researchers. CONCLUSION The complexity of COVID-19 pandemic and kidney could be attributed to the direct effect of SARS-CoV-2 infection on the kidneys, different clinical presentation, difficulties confronting dialysis patients, restrictions of the organ transplant programs, poor outcomes and bad prognosis in patients with known history of kidney diseases who got infected with SARS-CoV-2. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Mostafa Abdelsalam
- Mansoura Nephrology and Dialysis Unit, Mansoura University, Mansoura, Egypt
| | | | | | - Emad Samaan
- Mansoura Nephrology and Dialysis Unit, Mansoura University, Mansoura, Egypt
| | - Ahmed Eldeep
- Mansoura Nephrology and Dialysis Unit, Mansoura University, Mansoura, Egypt
| | - Mohamed Abdalbary
- Mansoura Nephrology and Dialysis Unit, Mansoura University, Mansoura, Egypt.,Division of Nephrology, Bone and Mineral Metabolism, University of Kentucky, US
| | - Mona Tawfik
- Mansoura Nephrology and Dialysis Unit, Mansoura University, Mansoura, Egypt
| | - Marwa Saleh
- Mansoura Nephrology and Dialysis Unit, Mansoura University, Mansoura, Egypt
| | | | - Alaa Sabry
- Mansoura Nephrology and Dialysis Unit, Mansoura University, Mansoura, Egypt
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Bohorquez-Rivero JD, García-Ballestas E, Janjua T, Moscote-Salazar L. Liberal Versus Conservative Fluid Therapy in COVID-19 Patients: What is the Best Strategy for the Treatment of Critically ill Patients? JOURNAL OF TRANSLATIONAL CRITICAL CARE MEDICINE 2022. [PMCID: PMC9070581 DOI: 10.4103/jtccm.jtccm_1_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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