Acute Respiratory Syndrome Coronavirus Disease Research Articles

Acute angle-closure glaucoma before, during, and after the outbreak of COVID-19 in China

ObjectivesAcute angle-closure glaucoma (AACG) is a major cause of irreversible and severe visual function loss. Robust rise in AACG was observed in the ophthalmic outpatient clinics concomitant with the outbreak of COVID-19 infection in China after the relaxing of “zero-COVID policy” in early December 2022. Here we compared the demographic and clinical profiles of patients with AACG before, during and after the COVID-19 outbreak. Underlying mechanisms were tentatively investigated. MethodsThis is a retrospective comparative study. Consecutive cases with newly diagnosed AACGs in a tertiary eye hospital were retrospectively collected during December 17, 2022 to January 8, 2023. Data from the same period in 2018–2019 and 2019–2020, 2020–2021 and 2021–2022, and 2023–2024 were collected as pre-pandemic, pandemic-control, and post-pandemic control, respectively. For the patients in 2022–2023 outbreak group, COVID-19 infection was confirmed by reversed transcriptase-polymerase chain reaction or antibody test for severe acute respiratory syndrome coronavirus disease 2 (SARS-CoV-2) from nasopharyngeal swabs. Ocular parameters, serum electrolytes and coagulative parameters were compared between COVID-19 positive and negative AACGs in observational group. SARS-CoV-2 nucleic acid in the aqueous humor was detected. ResultsA total of 106 AACG cases were diagnosed during the outbreak period in 2022–2023. In contrast, 18 (in 2018–2019) and 22 (in 2019–2020) cases were included during pre-pandemic period, and 21 (in 2023–2024) during the post-pandemic period. Only 13 and 4 newly onset AACG were included in 2020–2021 and 2021–2022 during the pandemic-control period, respectively. Younger age and higher proportion of bilateral involvement were detected in COVID-19 outbreak group than that of other groups (p = 0.034 and p = 0.080). Sixty-eight (64.2 %) patients in the outbreak group had a confirmed COVID-19 infection. Intervals between infection and AACG attack was 52 ± 85h (0-15d). Fifty-three patients (77.9 %) reported the applications of ibuprofen or other antipyretic medications and 25 (36.8 %) reported large volume water intake before AACG attack. COVID-19-positive AACG patients had higher level of D-dimer than their negative counterparts (1.13 ± 2.60 mg/L vs. 0.46 ± 0.43 mg/L, p = 0.083). No difference in IOP, serum electrolytes, and coagulative parameters other than D-dimer was observed between COVID-19 positive and negative cases. SARS-CoV-2 were negative in the aqueous humor from 14 COVID-19 positive and 8 negative patients. ConclusionCOVID-19 infection surged the onset of AACG in patients at risk. Mental stress, water intake, increased choroidal thickness due to SARS-CoV-2 induced ACE receptor activation, and hyper-coagulation, may contribute to the disease onset. Ocular involvement should not be ignored in both routine and new systemic emergent conditions.

Characteristics and outcomes of COVID-19 in pregnant women during the COVID-19 pandemic

Abstract Background: Pregnant women with severe acute respiratory syndrome coronavirus-2 disease 2019 [COVID-19] appear to be at greater risk of morbidity and mortality complications in pregnancy. Objective: This prospective analysis aimed to assess maternal and neonatal outcomes among hospitalized pregnant women with COVID-19. Methods: The present prospective study included COVID-19-positive pregnant women referred to our tertiary care centre. Data related to demographics, clinical characteristics, diagnosis, laboratory parameters, histopathological findings, procedure, treatment regimen and clinical outcomes were recorded. and analysed. We studied maternal and neonatal outcomes among hospitalised pregnant women with COVID-19. Results: During the period from April 2020 to April 2022, we studied 83 women clinically diagnosed with COVID-19. Placenta previa (n = 3), decrease in foetal movement (n = 2) and premature rupture of membranes (n = 1) were observed among pregnant women with COVID-19. A total of 31 women had pre-term delivery (<37 weeks gestation), 33 had normal term delivery (>37–<40 weeks gestation) and two had post-term delivery (>40 weeks gestation). Of these 83 patients, 17.6% had pneumonia, 14.7% had hypothyroidism, 8.8% had gestational diabetes mellitus and 5.9% had gestational hypertension. Elevated baseline C-reactive protein (21.6 mg/dL) and interleukin-6 (16.6 pg/mL) levels were observed. Mother-to-child COVID-19 transmission was observed in one neonate. The length of hospital stay had ranged from 2 to 77 days in COVID-19 positive mothers. Eighty two patients (98.8%) were managed conservatively and were successfully discharged. Conclusions: Our observations suggest that pregnant women with COVID-19 have a significant impact on maternal health and pregnancy outcomes.

Impact of COVID-19 pandemic in the Brazilian maternal mortality ratio: A comparative analysis of Neural Networks Autoregression, Holt-Winters exponential smoothing, and Autoregressive Integrated Moving Average models.

The acute respiratory infection caused by severe acute respiratory syndrome coronavirus disease (COVID-19) has resulted in increased mortality among pregnant, puerperal, and neonates. Brazil has the highest number of maternal deaths and a distressing fatality rate of 7.2%, more than double the country's current mortality rate of 2.8%. This study investigates the impact of the COVID-19 pandemic on the Brazilian Maternal Mortality Ratio (BMMR) and forecasts the BMMR up to 2025. To assess the impact of the COVID-19 pandemic on the BMMR, we employed Holt-Winters, Autoregressive Integrated Moving Average (ARIMA), and Neural Networks Autoregression (NNA). We utilized a retrospective time series spanning twenty-five years (1996-2021) to forecast the BMMR under both a COVID-19 pandemic scenario and a controlled COVID-19 scenario. Brazil consistently exhibited high maternal mortality values (mean BMMR [1996-2019] = 57.99 ±6.34/100,000 live births) according to World Health Organization criteria. The country experienced its highest mortality peak in the historical BMMR series in the second quarter of 2021 (197.75/100,000 live births), representing a more than 200% increase compared to the previous period. Holt-Winter and ARIMA models demonstrated better agreement with prediction results beyond the sample data, although NNA provided a better fit to previous data. Our study revealed an increase in BMMR and its temporal correlation with COVID-19 incidence. Additionally, it showed that Holt-Winter and ARIMA models can be employed for BMMR forecasting with lower errors. This information can assist governments and public health agencies in making timely and informed decisions.

COVID-19 PANDEMIYASI DAVRIDA TIBBIYOT SOHASIDA AXBOROT KOMMUNIKATSIYA TEXNOLOGIYALARIDAN FOYDALANISHNING HUQUQIY JIHATLARI

Since the introduction of information and telecommunication technologies into the health sector, the demand for medical services has been increasing, and the health system has been developing. In our country and around the world, in early 2020, the severe acute respiratory syndrome coronavirus disease COVID-19 began to spread and the normal life of the whole world came to a standstill. The COVID-19 pandemic has created the need for people around the world to change their usual lifestyle, in particular, self-isolation, staying at home, reducing human activity, including minimizing contact with people. With the spread of the COVID-19 pandemic, the whole world has realized how necessary it is to develop telemedicine services. In this article, we will study the practice of telemedicine and telemedicine services in the period of the COVID-19 pandemic and what laws are regulated by the states, as well as the digitalization in the health sector during the COVID-19 pandemic. The pros and cons of the process of the COVID-19 pandemic, licensing, and its structure process, statistical data provided by the World Health Organization, payment of fees to doctors for these services, procedures of patients using telemedicine services, and directions of telemedicine services are considered in detail.

Unveiling Nature’s Resilience: Exploring Vegetation Dynamics during the COVID-19 Era in Jharkhand, India, with the Google Earth Engine

The Severe Acute Respiratory Syndrome Coronavirus Disease 2019 (COVID-19) pandemic has presented unprecedented challenges to global health and economic stability. Intriguingly, the necessary lockdown measures, while disruptive to human society, inadvertently led to environmental rejuvenation, particularly noticeable in decreased air pollution and improved vegetation health. This study investigates the lockdown’s impact on vegetation health in Jharkhand, India, employing the Google Earth Engine for cloud-based data analysis. MODIS-NDVI data were analyzed using spatio-temporal NDVI analyses and time-series models. These analyses revealed a notable increase in maximum vegetation greenery of 19% from April 2019 to 2020, with subsequent increases of 13% and 3% observed in March and May of the same year, respectively. A longer-term analysis from 2000 to 2020 displayed an overall 16.7% rise in vegetation greenness. While the maximum value remained relatively constant, it demonstrated a slight increment during the dry season. The Landsat data Mann–Kendall trend test reinforced these findings, displaying a significant shift from a negative NDVI trend (1984–2019) to a positive 17.7% trend (1984–2021) in Jharkhand’s north-west region. The precipitation (using NASA power and Merra2 data) and NDVI correlation were also studied during the pre- and lockdown periods. Maximum precipitation (350–400 mm) was observed in June, while July typically experienced around 300 mm precipitation, covering nearly 85% of Jharkhand. Interestingly, August 2020 saw up to 550 mm precipitation, primarily in Jharkhand’s southern region, compared to 400 mm in the same month in 2019. Peak changes in NDVI value during this period ranged between 0.6–0.76 and 0.76–1, observed throughout the state. Although the decrease in air pollution led to improved vegetation health, these benefits began to diminish post-lockdown. This observation underscores the need for immediate attention and intervention from scientists and researchers. Understanding lockdown-induced environmental changes and their impact on vegetation health can facilitate the development of proactive environmental management strategies, paving the way towards a sustainable and resilient future.

Clinical characteristics and risk factors for COVID-19-related adverse outcomes in patients with type 2 diabetes mellitus

Abstract Background: The association between risk factors and severe acute respiratory syndrome coronavirus-2 disease (COVID-19) related mortality among people with diabetes mellitus (DM) is uncertain. Methods: Consecutive patients with COVID-19 with type 2 DM admitted to our tertiary care centre from July 2020 to January 2021 were included in this cross-sectional study. Data including clinical, laboratory, respiratory, inflammatory biomarkers and radiological parameters were collected and compared between non-survivors and survivors. Cox-proportional hazards regression analyses were performed to analyse the risk factors associated with the mortality in COVID-19 patients with diabetes. Results: Two hundred and sixty three patients with COVID-19 were included. Of these, 173 (65.8%) had survived. Demographic, laboratory, inflammatory and pulmonary parameters were significantly different between the survivors and non-survivors (P < 0.05 for all). Time to hospitalisation from symptom onset (days) was longer in non-survivors compared to survivors (7 Vs 4 days; P = 0.0001). Computed tomography severity scores were higher in non-survivors than survivors (P = 0.0001). The hospital stay was prolonged in non-survivors (P < 0.0001). Adjusted cox-proportional hazard model showed increased neutrophil count and intensive care unit (ICU) admission were independent factors associated with COVID-19-related mortality in diabetic patients. Conclusions: We found that the non survivors as compared to the survivors showed multiple negative outcomes in terms of laboratory, inflammatory and pulmonary findings. ICU admission and elevated neutrophil count were independently associated with death in COVID-19 patients with DM.

Prospects of Using Machine Learning and Diamond Nanosensing for High Sensitivity SARS-CoV-2 Diagnosis

The worldwide death toll claimed by Acute Respiratory Syndrome Coronavirus Disease 2019 (SARS-CoV), including its prevailed variants, is 6,812,785 (worldometer.com accessed on 14 March 2023). Rapid, reliable, cost-effective, and accurate diagnostic procedures are required to manage pandemics. In this regard, we bring attention to quantum spin magnetic resonance detection using fluorescent nanodiamonds for biosensing, ensuring the benefits of artificial intelligence-based biosensor design on an individual patient level for disease prediction and data interpretation. We compile the relevant literature regarding fluorescent nanodiamonds-based SARS-CoV-2 detection along with a short description of viral proliferation and incubation in the cells. We also propose a potentially effective strategy for artificial intelligence-enhanced SARS-CoV-2 biosensing. A concise overview of the implementation of artificial intelligence algorithms with diamond magnetic nanosensing is included, covering this roadmap’s benefits, challenges, and prospects. Some mutations are alpha, beta, gamma, delta, and Omicron with possible symptoms, viz. runny nose, fever, sore throat, diarrhea, and difficulty breathing accompanied by severe body pain. The recommended strategy would deliver reliable and improved diagnostics against possible threats due to SARS-CoV mutations, including possible pathogens in the future.

Analysis of High Flow Nasal Cannula Utilization During Pediatric Critical Care Transport

ObjectiveThere are limited studies on the safety and efficacy of high flow nasal cannula (HFNC) use in pediatrics during interfacility critical care transport. This 15-month retrospective study aims to describe our transport team's utilization of HFNC within the pediatric population and evaluates the need for patient escalation in respiratory support within 24 hours of hospital admission including increased liter flow, transition to noninvasive ventilation, or intubation. MethodsRetrospective charts were reviewed by study members from January 1, 2019, through March 31, 2020. Study dates were specifically chosen to reflect when HFNC was implemented in the transport department and before the beginning of the severe acute respiratory syndrome coronavirus disease 2019 (SARS-COVID-19) pandemic because of variability in respiratory support recommendations at the beginning of the pandemic. Patients were screened for inclusion criteria and were included if they were >30 days and <18 years of age, required HFNC at ≥4 L/min during transport, and were admitted to Children's Mercy Hospital. ResultsDuring the study period, we completed 6,279 pediatric transports, of which 382 had documented HFNC use and 358 met the inclusion criteria. Our HFNC patients had a median age of 0.7 years with an interquartile range (IQR) of 0.3 to 1 year, a median weight of 8.4 kg with an IQR of 6.2 to 11 kg, a median liter flow of 10 L/min and 1.2 L/kg/min, and required a median transport time of 80 minutes with an IQR of 69 to 115 min. Patients were tracked for 24 hours post-admission for any escalations in care; 33% required an escalation, 76% of those had an increase in flow, 24% required noninvasive ventilation, and 0% required intubation. ConclusionOur study suggests HFNC is a safe and effective means for providing respiratory support to the pediatric population during interfacility critical care transport. Our data support utilization of 1 to 2 L/kg/min in the smaller pediatric population (<10 kg) during transport. There was minimal risk of escalation to noninvasive ventilation, and no patients required intubation within 24 hours post drop-off, likely because of the appropriate utilization of HFNC during transport. Additional studies, especially multicenter pediatric studies, are needed to analyze HFNC utilization with non-restricting circuits and vibrating mesh nebulizers.

Maternal SARS-CoV-2, Placental Changes and Brain Injury in 2 Neonates.

Long-term neurodevelopmental sequelae are a potential concern in neonates following in utero exposure to severe acute respiratory syndrome coronavirus disease 2 (SARS-CoV-2). We report 2 neonates born to SARS-CoV-2 positive mothers, who displayed early-onset (day 1) seizures, acquired microcephaly, and significant developmental delay over time. Sequential MRI showed severe parenchymal atrophy and cystic encephalomalacia. At birth, neither infant was SARS-CoV-2 positive (nasopharyngeal swab, reverse transcription polymerase chain reaction), but both had detectable SARS-CoV-2 antibodies and increased blood inflammatory markers. Placentas from both mothers showed SARS-CoV-2-nucleocapsid protein and spike glycoprotein 1 in the syncytiotrophoblast, fetal vascular malperfusion, and significantly increased inflammatory and oxidative stress markers pyrin domain containing 1 protein, macrophage inflammatory protein 1 βη, stromal cell-derived factor 1, interleukin 13, and interleukin 10, whereas human chorionic gonadotropin was markedly decreased. One infant (case 1) experienced sudden unexpected infant death at 13 months of age. The deceased infant's brain showed evidence of SARS-CoV-2 by immunofluorescence, with colocalization of the nucleocapsid protein and spike glycoprotein around the nucleus as well as within the cytoplasm. The constellation of clinical findings, placental pathology, and immunohistochemical changes strongly suggests that second-trimester maternal SARS-CoV-2 infection with placentitis triggered an inflammatory response and oxidative stress injury to the fetoplacental unit that affected the fetal brain. The demonstration of SARS-CoV-2 in the deceased infant's brain also raises the possibility that SARS-CoV-2 infection of the fetal brain directly contributed to ongoing brain injury. In both infants, the neurologic findings at birth mimicked the presentation of hypoxic-ischemic encephalopathy of newborn and neurologic sequelae progressed well beyond the neonatal period.

The Role of Ubiquitin-Proteasome System in the Pathogenesis of Severe Acute Respiratory Syndrome Coronavirus-2 Disease.

Different protein degradation pathways exist in cells. However, the bulk of cellular proteins are degraded by the ubiquitin-proteasome system (UPS), which is one of these pathways. The upkeep of cellular protein homeostasis is facilitated by the ubiquitin-proteasome system, which has a variety of important functions. With the emergence of eukaryotic organisms, the relationship between ubiquitylation and proteolysis by the proteasome became apparent. Severe acute respiratory syndrome coronavirus-2 (SARS-Coronavirus-2) hijacks the ubiquitin-proteasome system and causes their viral proteins to become ubiquitinated, facilitating assembly and budding. Ubiquitination of the enzyme keratin-38 (E-K38) residue gave the virion the ability to engage with at least one putative cellular receptor, T-cell immunoglobin-mucin (TIM-1), boosting virus entry, reproduction, and pathogenesis. A fraction of infectious viral particles produced during replication have been ubiquitinated. The ubiquitin system promotes viral replication. In order to replicate their viral genome after entering the host cell, viruses combine the resources of the host cell with recently generated viral proteins. Additionally, viruses have the ability to encode deubiquitinating (DUB)-active proteins that can boost viral replication through both direct and indirect means. The SARS-Coronavirus-2 papain-like protease (PLpro) protein is a DUB enzyme that is necessary for breaking down viral polyproteins to create a working replicase complex and promote viral propagation. The ubiquitin-like molecule interferon-stimulated gene 15 (ISG15), which is likewise a regulator of the innate immune response and has antiviral characteristics, can also be broken down by this enzyme. However, limiting the E1-activating enzyme's ability to suppress the ubiquitination pathway prevented virus infection but did not prevent viral RNA genome translation. Numerous investigations have revealed that the use of proteasome inhibitors has a detrimental effect on the replication of SARS-Coronavirus-2 and other viruses in the host cell. Studies have shown that the use of proteasome inhibitors is also known to deplete free cellular ubiquitin, which may have an impact on viral replication and other vital cellular functions.

Chest CT diagnostic potential as a tool for early detection of suspected COVID-19 cases in pandemic peaks.

The emergence of severe acute respiratory syndrome coronavirus disease (COVID-19) in China at the end of 2019 caused a massive global outbreak that has become a major public health issue. Our aim was to investigate the diagnostic potential of chest CT in screening patients suspected of having COVID-19 in high-prevalence settings. This is a real-life, prospective, observational study involving 260 patients. All patients received chest CT scan at the emergency department (ED) of Kaspela University Hospital, Plovdiv, Bulgaria and RT-PCR testing for suspected COVID-19 from March 27 to December 31, 2020. COVID-19 likelihood was assessed by assigning each CT scan to a particular category of the COVID-19 Reporting and Data System (CO-RADS). IBM SPSS v. 26 was used to process the data. The male-to-female distribution ratio was 1.4:1 - 150 (57.7%) males vs. 110 (42.3%) females (p=0.014). The median age was 55 yrs (range 46-65 yrs). Discharged patients were 247 (95.0%), the rest died in the COVID-19 intensive care unit. Males were 4.13 times more likely to be diagnosed with CO-RADS≥3 score than females. Increasing age was associated with an increased likelihood of being classified with higher CO-RADS scores. The ROC curves analysis demonstrated that CO-RADS ≥3 was the optimal cutoff for discrimi-nating between a positive and negative PCR (Youden's index J=0.67), with an AUC of 0.825 (95% CI 0.72-0.93), sensitivity of 91.9% (95% CI 87.7%-95.1%), specificity of 75.0% (95% CI 53.3%-90.2%) and accuracy of 76.4% (95% CI 70.7%-81.4%). The results of this study reveal that a CT examination can provide a quick and accurate diagnosis of patients with sus-pected COVID-19 infection, whereas the PCR test is time-consuming, and the delay in receiving results can be substantial when the incidence curve begins to grow rapidly.

COVID-19 and Biomarkers: The Contribution of the Journal

Three years after coronavirus disease 2019 (COVID-19) was declared a pandemic by the World Health Organization (WHO), several features of the pathogenesis and innate immune response to SARS-CoV-2 (severe acute respiratory syndrome coronavirus disease 2) have now been clarified [...].

Finding positive SARS-CoV-2 RT-PCR in cerebrospinal fluid of two pediatric patients with severe COVID-19: a brief case report

BackgroundThere is growing evidence of nervous system involvement and related complaints in children with coronavirus disease 2019 (COVID-19). However, it seems that attempts to track of the virus in the nervous system have so far been unsuccessful.Case presentationHere we describe two pediatric cases of severe COVID-19 who had positive cerebrospinal fluid (CSF) and nasopharyngeal polymerase chain reaction (PCR) tests for severe acute respiratory syndrome coronavirus disease 2019 (SARS-CoV-2). A 36-month-old girl who presented with fever, diarrhea, mild left ventricular dysfunction and bizarre movements, and a five-month-old boy who presented with fever, watery diarrhea, severe dehydration, mottling, and two episodes of seizure. Their CSF analyses and cultures were normal. They admitted in intensive care unit (ICU) for near four days and discharged after ten days without any complaint.ConclusionThis is one of the first reports of the presence of coronavirus in the central nervous system in COVID-19 pediatric patients, emphasizing the neurotropism and neuroinvasion characteristics of the virus.

Intraoperative modifications done to continue performing traumatic maxillofacial surgery during COVID-19 times

Abstract Background: Operating on maxillofacial trauma cases in the severe acute respiratory syndrome coronavirus-2 disease 2019 (COVID-19) era comes with its own disadvantages to operating teams with the current standard operating protocol. Methods: We present the various modification in techniques we have devised in a step-wise manner to overcome these difficulties while operating in COVID-19 times. Twenty-eight cases of maxillofacial fracture were operated in a span of 1 COVID year, i.e., from March 2020 to February 2021. Intraoperative modifications were applied for the techniques of drilling, implants used associated with aerosol generation (AG). Results: Of the 28 cases that had undergone maxillofacial injury, 20 were mandible fractures, 6 are midface, 2 are upperface/midface and 1 upper face fracture, of the mandible fractures, 12 were single sites and 8 were fractures involving two sites. Conclusions: Using microplating with self-drilling screws appear to be the first choice for fixing mandible fractures in COVID times, reducing AG by decreasing the duration of drilling and containing the aerosol spread by an adequate protective barrier around the drill apparatus should be considered. Intraoperative stability of fracture fixation sites post-fixation with mini and microplate as individual and in combination was found to be helpful.

A diagnostic accuracy study comparing RNA LAMP, direct LAMP, and rapid antigen testing from nasopharyngeal swabs.

During the coronavirus disease 2019 (COVID-19) pandemic, the early detection and isolation of individuals infected with severe acute respiratory syndrome coronavirus disease 2 (SARS-CoV-2) through mass testing can effectively prevent disease transmission. SARS-CoV-2 nucleic acid rapid detection based on loop-mediated isothermal amplification (LAMP) may be appropriate to include in testing procedures. We used 860 nasopharyngeal specimens from healthcare workers of Huashan Hospital and COVID-19 patients collected from April 7th to 21st, 2022, to assess the clinical diagnostic performance of the LAMP assay marketed by Shanghai GeneSc Biotech and compared it to the result of a rapid antigen test (RAT) head-to-head. Overall, the diagnostic performance of LAMP assay and RAT were as follows. The LAMP assay represented higher sensitivity and specificity than RAT, especially in the extracted RNA samples. The sensitivity was 70.92% and 92.91% for direct LAMP and RNA-LAMP assay, respectively, while the specificity was 99.86% and 98.33%. The LAMP assay had overall better diagnostic performance on the specimens with relatively lower C t values or collected in the early phase (≤7 days) of COVID-19. The combination of LAMP assay and RAT improved diagnostic efficiency, providing new strategies for rapidly detecting SARS-CoV-2. The LAMP assay are suitable for mass screenings of SARS-CoV-2 infections in the general population.

Pneumothorax/pneumomediastinum and pre-existing lung pathology in ventilated COVID-19 patients: a cohort study.

There is an increasing number of reports on developing pneumothorax/pneumomediastinum among severe acute respiratory syndrome coronavirus disease 2019 (SARS-COVID-19) patients. The aim of our study was whether pre-existing diffuse lung pathology increases visceral pleural vulnerability resulting in pneumomediastinum and pneumothorax among mechanically ventilated COVID-19 patients? A total of 138 consecutive COVID-19 patients admitted to the Intensive Care Unit of Petz Aladár University Teaching Hospital between 1st March 2020 and 1st February 2021 were included. Sixty/138 (43.48%) patients had one or more computer tomography scans of the chest. Analysis was focused on the image defined lung conditions during artificial ventilation. Thirteen out of 60 ventilated patients developed pneumothorax or pneumomediastinum proven by computer tomography (9.42%). Three/13 patients suffered from pre-existing lung parenchyma pathology, while 10/13 had only COVID-19 infection-related image abnormality. Forty-three/60 patient had healthy lung pre-COVID. Kruskal-Wallis test, Spearman correlation and Cox regression calculations did not reveal any statistically significant result proving increased vulnerability during pressure support therapy and visceral pleural breakdown in patients with pre-existing lung pathologies. Pre-existing lung pathology does not increase the risk of onset of pneumothorax or pneumomediastinum in comparation with previously healthy lungs of ventilated COVID-19 patients.

Prevalence and Antimicrobial Susceptibility Pattern of Secondary Gram-negative Bacteria Isolated from Severe Acute Respiratory Syndrome Coronavirus Disease 2 Patients in A Tertiary Care Hospital

Prior to the Severe Acute Respiratory Syndrome Coronavirus Disease 2 (SARS-CoV-2) pandemic, the rise in antimicrobial resistance was a major source of concern in public health. However, due to the novelty of SARS-CoV-2 infection during the pandemic, antibiotics were administered prior to laboratory testing for secondary gram-negative bacteria (SGNB) in order to avoid or reduce the occurrence of SGNB infection. The purpose of this study was to investigate the etiology, prevalence, and antimicrobial susceptibility pattern of gram-negative bacteria (GNB) isolated from SARS-CoV-2 positive patients. Respiratory and blood samples were collected from confirmed SARS-CoV-2 positive patients. They were subsequently cultured and bacterial isolates identified according to standard microbiological protocols. Antimicrobial susceptibility testing (AST) was performed and interpreted according to Clinical &amp; Laboratory Standards Institute (CLSI) 2021 guidelines. A total of sixty-four non-repetitive GNB were isolated from respiratory samples and twenty-two GNB from blood samples. K. pneumoniae was the major cause of SGNB, followed by Acinetobacter species. K. pneumoniae had over 60% resistance to β-Lactam combination agents, cephalosporin, and the carbapenem group of antibiotics. In the current study, we observed that K. pneumoniae was the major cause of SGNB and had high resistance to the antimicrobial agents. Hence, it is important that the epidemiology and susceptibility patterns of circulating organisms causing SGNB infection are always monitored to inform clinical treatment and decrease the occurrence of antibiotic-resistant bacteria.

Use of synchronous kidney and lung extracorporeal support for severe COVID-19: A single-center retrospective study.

Infection with severe acute respiratory syndrome coronavirus disease 2019 (COVID-19) has been associated with both kidney and respiratory failure. During the early phase of the coronavirus disease pandemic, patients often required the use of mechanical assistance to provide adequate kidney and lung function. In this paper we describe the clinical outcomes of patients who required synchronous kidney and lung extracorporeal support for COVID-19. All patients admitted to Baylor University Medical Center, Dallas, between February 1, 2020, to April 23, 2021, with COVID-19 who required both extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT) were retrospectively analyzed. Patients who were on hemo- or peritoneal dialysis prior to admission or who required veno-arterial (VA) ECMO were excluded. 35 patients with COVID-19 required ECMO and CRRT support. Four patients (11%) were excluded, 2 due to being on dialysis prior to admission and 2 due to the requirement of VA-ECMO. The median time on CRRT was 33 days (IQR 13-51). The median time on ECMO was 28 days (IQR 10.5-59.5). At 90 days, 9 patients had died (29%), 4 patients remained hospitalized, and 18 patients had been discharged: 10 to long-term acute care, 2 to inpatient rehabilitation, and 6 to home. Patients with severe COVID-19 requiring concurrent ECMO and CRRT in this institution had a 29% mortality at 90 days.

Ongoing Dizziness Following Acute COVID-19 Infection: A Single Center Pediatric Case Series.

Dizziness is a common concern discussed at adolescent medical visits. In this series, we describe 9 pediatric patients with postacute sequelae of severe acute respiratory syndrome coronavirus disease 2 (SARS-CoV-2) who presented with persistent, debilitating dizziness for weeks to months after their acute infection. Among the 9 patients, median age was 14 years (range: 11 to 17), 6 were female, and 8 had not received any SARS-CoV-2 vaccines. Five patients met diagnostic criteria for postural orthostatic tachycardia syndrome (POTS) by active standing testing and benefited from a combination of nonpharmacologic therapy (NPT) and medication. NPT alone did not improve symptoms in any patients. Patients who did not meet conventional criteria for POTS, but continued to have symptoms despite NPT compliance, also demonstrated subjective improvement in dizziness when medications were initiated. The majority of patients experienced improvement in dizziness and quality of life, including returning to sports teams and a regular school schedule. A review of the postacute sequelae of SARS-CoV-2 literature demonstrates increasing recognition of a subset of patients who develop autonomic dysfunction, including POTS, although the etiology and prognosis are not completely understood. Our case series aims to highlight the phenomenon of dysautonomia after acute SARS-CoV-2 infection and its response to therapy.

A rare care of post covid thromboembolic disease involving both arterial and venous system

The severe acute respiratory syndrome coronavirus disease (COVID-19) pandemic is caused by the novel severe acute respiratory syndrome coronavirus 2 and is affecting all civilizations. At present, there is an availability of minimum data highlighting the occurrence of thromboembolism in patients infected with COVID-19. Here, we report a rare case involving a 49-year-old female patient with thrombotic occlusion of the infrapopliteal artery and venous systems associated with COVID-19.