Fifth Day Of Admission Research Articles

Serum High-Density Lipoprotein Cholesterol level in patients suffering from sepsis, measured on the first and fifth day of admission, and its relation with prognosis

Serum High-Density Lipoprotein Cholesterol level in patients suffering from sepsis, measured on the first and fifth day of admission, and its relation with prognosis

Diagnostic Value of Serum Procalcitonin and Diastolic Dysfunction for Evaluating the Mortality of Sepsis Patients Admitted in the Intensive Care

Background: Sepsis is a serious condition that can be fatal and has become more common in recent times. The impact of diastolic dysfunction on the early mortality rate of septic patients has not been extensively researched. This study aimed to assess the accuracy of serum procalcitonin (PCT) levels and diastolic dysfunction in predicting the mortality rate of patients diagnosed with sepsis and admitted to the intensive care unit.
 Methods: In this cross-sectional study, 40 sepsis patients admitted to the ICU were examined. Their characteristics were meticulously recorded using the APACHE II and SOFA score questionnaires, and only those who met the criteria underwent echocardiography. In order to evaluate the serum levels of PCT, it was required to take 40 ml of venous blood samples from the patients on the first and fifth days of admission. 
 Results: Out of 40 patients, the average age was 63±17 years. Of these patients, 23 (57.5%) were discharged, while 17 (42.5%) unfortunately passed away. Results showed a notable correlation between diastolic dysfunction, CRP, SOFA score on days 1 and 2, APACHE II score, and PCT on day 5 (P˂0.05). However, when analyzed using logistic regression, only PCT on day 5 showed a significant association with mortality.
 Conclusion: Based on our research, we found that PCT is an essential indicator in predicting the mortality rate of sepsis patients. While there was no significant correlation between diastolic dysfunction and mortality, it should still be considered a critical factor in determining the mortality rate.

The effect of regular nursing rounds on patients' comfort and satisfaction, and violence against nurses in surgical ward

BackgroundPatients' satisfaction and comfort are known as the quality indicators of nursing care. Nowadays, violence against nurses has an increasing trend. Regular nursing rounds are one of the caring programs that help improve these indicators. This study aimed to examine the effect of regular nursing rounds on patients' comfort, satisfaction, and violence against nurses. Materials and methodsThis quasi-experimental study was conducted in two groups consisting of 100 patients and 35 nurses in a surgery ward in the northwest of Iran. The satisfaction with nursing care quality questionnaire, Kolcaba's general comfort questionnaire, and work environment violence were used for data collection. In the present study, the control and intervention groups were selected using a simple sampling method. The control group received routine care only; however, the intervention group received a regular nursing round program every 2 h from the second day of their admission for three days. The satisfaction questionnaire and comfort scale were completed on the second and fifth days of admission, and the evaluation of violence against nurses was performed from the second to the fourth day. The results were analyzed using chi-square, Fisher, independent t, and paired t tests. ResultsBefore the intervention, no statistically significant difference was observed between the two groups in terms of demographic and dependent variables (p > 0/05). After the intervention, statistically significant differences were observed among the mean scores of satisfaction with nursing care (p < 0/001), comfort (p < 0.001), and violence against nurses (p = 0.041) between the two study groups, so that in the intervention group, the patients’ satisfaction and comfort increased and violence against nurses reduced during the intervention period. ConclusionsThe use of regular nursing rounds had a positive effect on the study results. Therefore, it is recommended that nurse managers design, implement, encourage, and evaluate regular nursing rounds to improve nursing care.

Opsoclonus Associated With Cat Scratch Disease

A 49-year-old woman presented with fever, malaise, and enlarged left axillary lymph nodes after a cat bit her left hand, leading to the diagnosis of cat scratch disease. On the fifth day of admission, she had rapid, chaotic, and impulsive eye movements that appeared to be opsoclonus. Opsoclonus is a characteristic and rare ocular manifestation that occurs in association with infections and other diseases, and which will be shown in the accompanying video.

Ischemic stroke in the setting of supratherapeutic International Normalized Ratio following coronavirus disease 2019 infection: a case report

BackgroundSARS-CoV-19 infection is associated with an increased risk of thrombotic events. We present a case of acute middle cerebral artery ischemic stroke in a patient with SARS-CoV-19 infection despite being on warfarin with supratherapeutic INR (International Normalized Ratio).Case presentationA 68-year-old Caucasian female with multiple comorbidities was admitted to the hospital with symptoms of upper respiratory tract infection. A rapid antigen test confirmed the diagnosis of COVID-19 pneumonia, and intravenous remdesivir was initiated. On the fifth day of admission, the patient experienced sudden onset confusion, slurred speech, left-sided hemiplegia, right-sided eye deviation, and left-sided facial droop. Imaging studies revealed an occlusion of the distal anterior M2 segment of the right middle cerebral artery, and an MRI of the brain confirmed an acute right MCA infarction. Notably, the patient was receiving warfarin therapy with a supratherapeutic INR of 3.2.ConclusionsThis case report highlights the potential for thromboembolic events, including stroke, in patients with COVID-19 infection, even when receiving therapeutic anticoagulation therapy. Healthcare providers should be vigilant for signs of thrombosis in COVID-19 patients, particularly those with pre-existing risk factors. Further research is necessary to understand the pathophysiology and optimal management of thrombotic complications in COVID-19 patients.

Outcome in TBI Patients with Early Physiotherapy and Post-discharge Rehabilitation: Indian Experience

Abstract Introduction Traumatic brain injury (TBI) is a major cause of death and disability worldwide and early initiation of physiotherapy with continuing rehabilitation may improve outcomes. Methods All adult TBI patients with GCS 5–12 admitted from May 2018 to December 2019 were included. Early physiotherapy was initiated before the fifth day of admission and continued post discharge. Patients and families were educated in a rehabilitation program with printed handouts and video clips. All patients are followed up via telephone/video calls after discharge. We assessed the Glasgow Outcome Score (GOS) and disability at 15, 30, and 90 days post discharge, and 180 days follow-up was also suggested but only a few (38) patients reported. Data were compared with matched patients treated in previous years. Results A total of 1,233 patients were studied. At 3-month follow-up by telephonic and video calls, GOS 5 was noted (63.7%; 174/ 273) in 2019 compared with (41.3%; 41/ 98) in 2018. The number of discharges increased after initiation of physiotherapy and rehabilitation programs (38%; 288/759 in 2019 versus 24%; 115/474 in 2018). Post-discharge deaths were also less (5.9%; 17/288) in 2019 compared with (14.8%; 17/115) in 2018. Conclusion Early rehabilitation and post-discharge therapy are associated with improved outcomes of TBI patients. Refinements in data collection and communication improve patient follow-up and functional outcomes.

Bilateral Spontaneous Pneumothorax in a Child with Multisystem Inflammatory Syndrome Associated with COVID-19

Introduction: Spontaneous pneumothorax is a rare complication of coronavirus disease 2019 (COVID-19), primarily reported in adults. Pediatric cases with bilateral pneumothorax are much less reported. Case Presentation: We presented the case of a five-year-old previously healthy boy who developed persistent fever, abdominal pain, generalized maculopapular rash, and dyspnea before admission. His chest computed tomography (CT) showed a viral involvement pattern of pneumonia suggestive of COVID-19. Subsequently, he was confirmed with multisystem inflammatory syndrome in children (MIS-C). While he responded well to the therapies, on the fifth day of admission, he developed respiratory distress again. A chest roentgenogram showed bilateral spontaneous pneumothorax. Bilateral chest tubes were inserted, and his condition improved significantly after five days of admission to the intensive care unit. Two weeks later, he was discharged in good condition. Conclusions: Children with MIS-C associated with COVID-19 may develop primary spontaneous pneumothorax. Owing to the clinical picture overlapping with MIS-C associated with COVID-19, the timely diagnosis of pneumothorax may be challenging in such patients.

Stress Level of Parents of Hospitalized Preterm Neonates

Background: Preterm birth is an unexpected event, which is very stressful for the parents and family members as they are never prepared for this situation. The major stressors of parental stress such as the appearance of the neonate, neonatal intensive care unit (NICU) environment, condition of the neonate, behaviour of care professionals and financial implications are well documented. Objective: To assess the level of stress among the parents of preterm hospitalized neonates admitted in the NICU, Nehru Hospital, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh. Methods: Data were collected by interviewing 17 parents on the fifth day of admission to the NICU, PGIMER, Chandigarh, after taking informed written consent from them. The Parental Stress Scale–NICU (PSS-NICU) and the fathers stress scale were used to assess the stress level of parents of hospitalized preterm neonates. Data were analysed by using SPSS (version 20). Results: The mean age of mothers was 28.24 ± 4.96 and that of the fathers was 30.29 ± 4.25. The total mean mothers’ stress score was 171.76 ± 33.44, and the total mean fathers’ stress score was 125.02 ± 36.16. Conclusion: The study showed that mothers and fathers were very stressful during the period of hospitalization of their preterm neonates.

S3188 The Tale of an Ancient Herb: A Stress Reliever or a Liver Stressor

Introduction: Ashwagandha is found in several herbal products today. However, there is a paucity of literature regarding its safety. Our case serves to remind physicians about the potential liver toxicity of Ashwagandha and to illustrate how early recognition of drug-induced liver injury (DILI) and discontinuation of the offending substance can be lifesaving. Case Description/Methods: A 58-year-old man with a remote history of hepatitis B and C presented with nausea, vomiting, and right upper quadrant abdominal pain of one day duration. He reported using an herbal supplement called “Primal Male,” which contained Ashwagandha as a main ingredient, over the past two weeks. He was normotensive, tachycardic up to 120 beats per minute (bpm), and febrile. The initial laboratory studies were notable for elevated AST level of 954 U/L, ALT level of 860 U/L, and a normal alkaline phosphatase level of 101 U/L. He had a normal total bilirubin level and an international normalized ratio of 1.3. His complete blood count and renal function were unremarkable. His creatinine kinase (CK) level was also within the normal range. His drug test, alcohol level, and acetaminophen level were unremarkable. The viral panel did not suggest active viral infections. His autoimmune panel was negative. An abdominal CT scan did not reveal any acute abnormality. In the following days, his symptoms worsened, and he became more encephalopathic. His AST, ALT, total bilirubin, and INR levels continued to rise. He developed hypotension and received intravenous fluids and midodrine. He also completed a course of N-acetylcysteine treatment. On the fifth day of admission, he underwent a transjugular liver biopsy. Liver histology showed active lymphocytic hepatitis with moderate inflammation (primarily lymphocytes, abundant neutrophils, and occasionally eosinophils) around the portal tract. On the sixth day of hospitalization, he reported decreasing pain and was more hemodynamically stable. His liver enzymes also showed improvement. The cause of acute liver injury was suspected to be drug-induced liver injury from Ashwagandha use. He was counseled to avoid the use of the herbal supplement and other hepatotoxic products. One month later, his liver enzymes were in normal range. Discussion: DILI is a less common form of liver injury but is a leading cause of acute liver failure in the United States. Ashwagandha has been reported in a few cases of DILI. It is important to have an early suspicion of the offending agent and avoid further substance exposure.

Urinary sodium excretion is low prior to acute kidney injury in patients in the intensive care unit.

The incidence of acute kidney injury (AKI) is high in intensive care units (ICUs), and a better understanding of AKI is needed. Early chronic kidney disease is associated with urinary concentration inability and AKI recovery with increased urinary solutes in humans. Whether the inability of the kidneys to concentrate urine and excrete solutes at appropriate levels could occur prior to the diagnosis of AKI is still uncertain, and the associated mechanisms have not been studied. In this single-center prospective observational study, high AKI risk in ICU patients was followed up for 7 days or until ICU discharge. They were grouped as "AKI" or "No AKI" according to their AKI status throughout admission. We collected daily urine samples to measure solute concentrations and osmolality. Data were analyzed 1 day before AKI, or from the first to the fifth day of admission in the "No AKI" group. We used logistic regression models to evaluate the influence of the variables on future AKI diagnosis. The expression of kidney transporters in urine was evaluated by Western blotting. We identified 29 patients as "No AKI" and 23 patients as "AKI," the latter being mostly low severity AKI. Urinary sodium excretion was lower in "AKI" patients prior to AKI diagnosis, particularly in septic patients. The expression of Na+/H+ exchanger (NHE3), a urinary sodium transporter, was higher in "AKI"patients. Urinary sodium excretion is low before an AKI episode in ICU patients, and high expressions of proximal tubule sodium transporters might contribute to this.

A Randomized Trial of Sitagliptin and Spironolactone With Combination Therapy in Hospitalized Adults With COVID-19.

ContextCOVID-19 may cause respiratory distress syndrome and death. Treatment of COVID-19 to prevent complications remains a priority.ObjectiveOur investigation sought to determine whether combination of spironolactone and sitagliptin could reduce mortality for inpatients with SARS-CoV-2 infection.MethodsThis single-blind, 4-arm, prospective randomized clinical trial was conducted at Shiraz and Bushehr University of Medical Sciences hospitals between December 2020 and April 2021. We randomized hospitalized adult patients with COVID-19 pneumonia into 4 groups: control, combination therapy, sitagliptin add-on, or spironolactone add-on. The primary outcome was the clinical improvement of the patients in the hospital as measured on an 8-point numerical scale. The secondary outcomes included intubation, ICU admission, end organ damages, CT findings, and paraclinical information.ResultsA total of 263 admitted patients were randomly assigned to control group (87 patients), combination group (60 patients), sitagliptin group (66 patients), and spironolactone group (50 patients). There were no significant differences in baseline characteristics, except for higher age in control group. The intervention groups, especially combination therapy, had better clinical outcomes (clinical score on fifth day of admission: 3.11 ± 2.45 for controls, 1.33 ± 0.50 for combination, 1.68 ± 1.02 for sitagliptin, and 1.64 ± 0.81 for spironolactone; P = 0.004). However, the mortality rate was lower in patients who received spironolactone (21.84% control, 13.33% combination, 13.64% sitagliptin, 10.00% spironolactone; P = 0.275). Our intervention reduced lung infiltration but not the area of involvement in lungs.ConclusionSitagliptin and spironolactone can potentially improve clinical outcomes of hospitalized COVID-19 patients.

Leriche syndrome diagnosed due to polytrauma: a case report

BackgroundLeriche syndrome is caused by atherosclerosis and is often characterized by symptoms such as intermittent claudication and numbness and coldness of the lower limbs. Its exact prevalence and incidence are unknown because it is a rare disease. We report a case of Leriche syndrome diagnosed incidentally on trauma pan-scan computed tomography (CT).Case presentationA 61-year-old Asian male was driving a passenger car and had a head-on collision with a dump truck that required an emergency call. The patient was transported to our hospital in a doctor’s helicopter. Physical examination revealed the following vital signs: respiratory rate, 23 breaths per min; SpO2, 98% under a 10-L administration mask; pulse rate, 133 beats per min; blood pressure, 142/128 mmHg; Focused Assessment with Sonography for Trauma, positive; Glasgow Coma Scale assessment, E3V5M6; and body temperature, 35.9 °C.Trauma pan-scan CT showed bilateral mandibular fractures, bilateral multiple rib fractures, bilateral pneumothorax, sternal fractures, hematoma around thoracic spine, small bowel perforation, mesenteric injury, right clavicle fracture, right ankle debridement injury, and thrombotic occlusion from just above the abdominal aortic bifurcation to the bilateral common iliac arteries. Although thrombotic occlusion needed to be differentiated from traumatic aortic injury, the presence of collateral blood vessels led to the diagnosis of Leriche syndrome, and conservative treatment was performed.Damage control surgery was required for the small bowel injuries. From the second day of admission, the patient was treated with continuous intravenous heparin and prostaglandin preparations. However, impaired blood flow and reperfusion injury in the right lower extremity progressed. On the fifth day of admission, right thigh amputation was performed. The patient required renal replacement therapy for 2 weeks starting from the third day of admission.ConclusionsIn this case, conservative therapy was initially chosen for Leriche syndrome. However, the complex factors in the acute phase of trauma led to development of hemorrhagic necrosis, requiring amputation of the lower extremity. Our findings indicate the need to carefully consider the unique factors affecting Leriche syndrome patients when considering treatment indications and choices for trauma.

Concurrent pulmonary arteriovenous malformation and pulmonary embolism causing stroke: a therapeutic dilemma

BackgroundAs pulmonary arteriovenous malformation (PAVM) include a right-to-left shunt, it can be accompanied by fatal complications such as stroke and brain abscess due to paradoxical embolism. A concurrent PAVM and pulmonary embolism (PE) is a rare condition. Therefore, the sequence of management has not been established.Case presentationA 62-year-old female patient was transferred to our hospital with a sporadic simple PAVM and concurrent bilateral PE. On chest computed tomography (CT), the acute PE was extended to the segmental pulmonary artery where the feeding artery of PAVM originated. Despite the anticoagulation, the patient complained of left sided weakness on the fifth day of admission, and magnetic resonance imaging revealed an acute infarction in the right lateral thalamus, which was thought to be caused by paradoxical embolism. This situation could lead to a dilemma between the risk of thrombus migration during PAVM embolization and another embolic event due to delayed shunt occlusion during anticoagulation. After a multidisciplinary discussion, a delayed endovascular embolization was performed for PAVM after confirming the complete resolution of PE with 4 months of anticoagulation. The cause of PE in this patient was eventually diagnosed as antiphospholipid syndrome.ConclusionThe authors reported a rare case of concurrent PAVM and PE that led to an embolic stroke during hospitalization. This patient was managed with delayed endovascular embolization for PAVM after an anticoagulation for PE and stroke. It is thought to be valuable in deciding for a treatment plan for this rare condition.

Inhaled Budesonide in Neonatal Respiratory Distress Syndrome of Near-Term Neonates: A Randomized, Placebo-Controlled Trial.

This study evaluates the value of inhaled budesonide (BUD) administration in neonatal respiratory distress syndrome (RDS) cases especially for near-term neonates. A randomized controlled trial involving 120 neonates with respiratory distress, which was diagnosed as RDS, was conducted from July 2016 to March 2018. The neonates studied were divided into 2 groups: group 1 (the inhaled BUD group), consisting of 60 neonates who received BUD (2 mL, 0.25-mg/mL suspension) inhalation, twice daily for 5 days; and group 2 (the placebo group), consisting of 60 neonates with RDS who received humidified distilled sterile water inhalation (2 mL). Downes score, RDS grades, and interleukin 8 (IL-8) levels were monitored and measured on the first and fifth days of incubation. Statistically significant differences (SSDs) in RDS grades, Downes score, and IL-8 levels on the fifth day of admission were observed between groups 1 and 2 (p = 0.001) and between the first and fifth days of incubation in group 1 (p = 0.001). The SSDs in the duration of hospitalization (p = 0.001) and the number of neonates receiving mechanical ventilation (p = 0.032) were found between both groups. Budesonide inhalation is associated with improvements in clinical and laboratory parameters in neonates with RDS.

Dose of furosemide before admission predicts diuretic efficiency and long-term prognosis in acute heart failure.

AimsThe outpatient diuretic dose is a marker of diuretic resistance and prognosis in chronic heart failure (HF). Still, the impact of the preadmission dose on diuretic efficiency (DE) and prognosis in acute HF is not fully known.Methods and resultsWe conducted an observational and prospective study. All patients admitted for acute HF treated with intravenous diuretic and at least one criterion of congestion on admission were evaluated. Decongestion [physical examination, hemoconcentration, N‐terminal pro‐brain natriuretic peptide (NT‐proBNP) change, and lung ultrasound], DE (weight loss and urine output per unit of 40 mg furosemide), and urinary sodium were monitored on the fifth day of admission. DE was dichotomized into high–low based on the median value. A multivariate Cox regression analysis was conducted to find predictors of HF readmission or mortality. A total of 105 patients were included between July 2017 and July 2019. Mean age was 74.5 ± 12.0 years, 64.8% were male, 33.3% had de novo HF, and mean left ventricular ejection fraction was 46 ± 17%. Median follow‐up was 26 [15–35] months. Low DE based on weight loss was associated with a higher previous dose of furosemide (odds ratio [OR] 1.01 [1.00–1.02]), thiazide treatment before admission (OR 9.37 [2.19–40.14]), and lower diastolic blood pressure (OR 0.95 [0.91–0.98]) in the multivariate regression model. Only previous dose of furosemide (OR 1.01 [1.00–1.02]) and haemoglobin at admission (OR 0.76 [0.58–0.99]) were associated with low DE based on urine output in the multivariate analysis. The correlation between the previous dose of furosemide and DE based on weight loss was poor (r = −0.12; P = 0.209) and with DE based on urine output was weak to moderate (r = −0.33; P < 0.001). Low DE based on weight loss and urine output was associated with lesser decongestion measured by NT‐proBNP (P = 0.011; P = 0.007), hemoconcentration (P = 0.006; P = 0.044), and lung ultrasound (P = 0.034; P = 0.029), but not by physical examination (P = 0.506; P = 0.560). Survival and event‐free survival in acute decompensated HF (ADHF) were lower than in de novo HF; a preadmission dose of furosemide > 80 mg in ADHF identified patients with particularly poor prognosis (log‐rank < 0.001). In ADHF, the preadmission dose of furosemide (hazard ratio [HR] 1.34 [1.08–1.67] per 40 mg) and NT‐proBNP at admission (HR 1.03 [1.01–1.06] per 1000 pg/mL) were independently associated with mortality or HF readmission in the multivariate Cox regression analysis.ConclusionsThe outpatient dose of furosemide before acute HF admission predicts DE and must be taken into account when deciding on the initial diuretic dose. In ADHF, the outpatient dose of furosemide can predict long‐term prognosis better than DE during hospitalization.

THROMBOCYTOPENIA AMONG TRAUMA PATIENTS ADMITTED IN ICU: FREQUENCY AND RELATIONSHIP WITH OUTCOME

Objective: To assess the frequency of thrombocytopenia among the patients of trauma at an intensive care unit and to look for its relationship and other socio-demographic factors with the outcome.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Intensive Care Unit, Combined Military Hospital Peshawar, from Mar to Aug 2017.&#x0D; Methodology: Thrombocytopenia was defined as platelet count of &lt;150,000/μl and was performed on the fifth day of admission in the Intensive Care Unit. Age, gender, presence of thrombocytopenia, history of platelet transfusion, and length of stay in the Intensive Care Unit were correlated with the outcome in our study population.&#x0D; Results: A total of 107 patients admitted to intensive care unit with traumatic injuries during the study period were included in analysis. Mean age of the patients was 37.93 ± 6.697 years. Thrombocytopenia developed in 35 (32.7%) of the patients while 72 (67.3%) had normal platelet count. Less than 18% patients died in the intensive care unit. Long duration of Intensive Care Unit stay and presence of thrombocytopenia were statistically significantly associated (p&lt;0.05) with the presence of poor outcome in our sample population.&#x0D; Conclusion: Frequency of thrombocytopenia was high among patients admitted with trauma in intensive care unit and was also related to poor outcome in these patients.

PROGNOSTIC VALUE OF PRO-ADM BIOMARKER IN PATIENTS WITH COVID-19.

This study was performed at the analytical laboratory of the Hospital SS. Antonio e Biagio e Cesare Arrigo" Hospital in Alessandria (AL) in the period March-June 2020. This is an observational, prospective, single-center study carried out on a cohort of patients diagnosed with ARDS secondary to SARS-CoV2 infection admitted in the first wave of the pandemic at the Sub-Intensive Care Unit of the Hospital of Alessandria. OBJECTIVE The aim of this study was to assess plasma concentrations of the regional mean proadrenomedullin biomarker (MR-proADM) at the time of patient access to the Emergency Department and subsequently 1, 3 and 5 days after admission, to verify its prognostic value in terms of short-term mortality. The second objective of the study was to compare this biomarker with other commonly used biomarkers such as PCR and Procalcitonin, to evaluate the effectiveness of MR-proADM in risk stratification in these patients. METHODOLOGY Samples used in this study were collected in a tube containing the anticoagulant EDTA, and measurements were performed using a fully automated instrument: the Kryptor Compact Plus. RESULTS Among the various Biomarkers assayed only MR-proADM and LDH concentrations were significantly higher in deceased patients than in surviving patients while no statistically significant difference was observed for PCR PCT concentrations. Increasing levels of MRproADM between the second and fifth day of admission to the intensive care unit represent the key to determining mortality risk. CONCLUSIONS Mr-proADM was found to be a more effective biomarker than other commonly used biomarkers (PCR, WBC, Procalcitonin) in identifying Covid-19 patients with poor prognosis at an early stage. This study allowed clinicians to routinely include the assay of this biomarker, useful in the stratification of these patients and in predicting a higher or lower risk of mortality, in the second wave of the epidemic.

P0235 / #981: EXTRACORPOREAL MEMBRANE OXYGENATION AS A TREATMENT FOR REFRACTORY LACTIC ACIDOSIS DUE TO GLYCOGEN STORAGE DISEASE TYPE 1A: A CASE REPORT

Aims & Objectives: Glycogen storage disease (GSD) type Ia (Von Gierke’s Disease) is an infrequent metabolic disease characterized by the deficient activity of glucose-6-phosphate-a. This deficiency causes the accumulation of glycogen in the body leading to hypoglycemia, lactic acidosis, failure to thrive, hepatomegaly, hepatic adenomas, renal failure and inflammatory bowel disease. The aim of this study is to describe a case of GSD type Ia and to evaluate the utility of Extracorporeal Membrane Oxygenation (ECMO) to treat this condition. Methods: We present a 7-year-old male patient with a history of GSD type 1a. The patient arrived at the hospital due to diarrhea and emesis. Patient is treated with intravenous fluids and glucose infusion, however, clinical stabilization is not met after 24-hours. Patient develops hemodynamic instability secondary to lactic and metabolic acidosis and is transferred to the pediatric intensive care unit (PICU). At the fifth day of admission at the PICU hemodynamic and respiratory status worsens. Results: Mechanical ventilation and vasopressor therapy are initiated. Patient is placed into hemodialysis (PRISMA FLEX®) to treat refractory lactic acidosis, fluid overload, and acute kidney injury. 48-hours later the PICU team emergently cannulated for veno-arterial (VA) ECMO support. During the following days patient’s hemodynamic and metabolic status improves. Patient ECMO support was stopped 7 days after initiation. PRISMAFLEX® management continued for 9 days until renal function normalized. Patient was discharged 58 days after hospital admission with no neurological complications. Conclusions: This case emphasizes the efficacy of ECMO as a therapy to stabilize pediatric patients with metabolic diseases such as GSD Type 1a

Evaluation of the Efficacy of Arbidol in Comparison with the Standard Treatment Regimen of Hospitalized Patients with Covid-19: A Randomized Clinical Trial

Background: Coronavirus disease 2019 (COVID-19) is an infectious illness that causes severe respiratory disease of varying severity. The disease was first reported in Wuhan (China) and caused the first pandemic of the new millennium. Still, a global push is on the way to develop a treatment for COVID-19. Arbidol (Umifenovir) is an orally administered antiviral agent approved for the prophylaxis and treatment of influenza types A and B, SARS, and Lassa viruses in Russia and China. Objectives: The current study aimed to investigate the effectiveness of Arbidol in patients with mild to moderate and severe symptoms suffering from COVID-19. Methods: The first phase of the research was a retrospective study on 47 patients (18 females and 29 males) with mild to moderate symptoms suffering from COVID-19 who were admitted to Labafinejad Hospital in Tehran, Iran, from March to April 2020. Patients were separated into two groups of Hydroxicholoroquine and Kaletra as control (7 subjects) (1a) and intervention. The experiment group who were 20 COVID-19 patients (16 males and 4 females) with mild to moderate symptoms were received Hydroxicholoroquine, Kaletra, and Arbidol (1b). Also, two groups comprised of 17 patients (13 males and 4 females) with severe symptoms of COVID-19 infection who received Hydroxicholoroquine, Kaletra, and Ribavirin as the control group (2a) and 17 patients (13 males and 4 females) with severe symptoms who received Hydroxicholoroquine, Kaletra, Ribavirin, and Arbidol (2b) were compared. Results: The average temperature of patients in groups 1a and 1b (both suffering from mild to moderate illness) on the fifth day of admission was 37.3 and 36.4°C, respectively, which was statistically significant (P value = 0.07). Concerning the respiratory rate, patients in group 1b were significantly different on the fifth day of admission (P value = 0.015). The comparison of neutrophil to lymphocyte (N/L) ratio in the complete blood cell count on the fifth day of admission showed a significant difference (P value = 0.024) between the two groups. Mean O2 saturation on the fifth day of admission in groups 1a and 1b was 91.9% and 94%, respectively, which was significant (P value = 0.04). In groups suffering from severe disease, no significant difference was found regarding the O2 saturation, respiratory rate, and temperature. Also, in laboratory tests, no significant difference was observed in N/L and Plt/L ratios five days after admission. This study demonstrated that Arbidol didn’t cause any significant change in the hospitalization period and mortality rate of COVID-19 patients. Conclusions: In COVID-19 patients with mild to moderate symptoms, treatment with Arbidol could decrease the duration of fever and improved O2 saturation and respiratory rate on the fifth day of admission. The N/L ratio was significantly different in patients with mild to moderate symptoms who received Arbidol, but in patients with severe symptoms, Arbidol couldn’t improve O2 saturation and respiratory rate and was not associated with decreased temperature. Moreover, there was no significant difference concerning the N/L and plt/L ratios and severely of the disease.

Control of a Nosocomial Outbreak of COVID-19 in a University Hospital.

BackgroundNosocomial spread of coronavirus disease 2019 (COVID-19) causes clusters of infection among high-risk individuals. Controlling this spread is critical to reducing COVID-19 morbidity and mortality. We describe an outbreak of COVID-19 in Keio University Hospital, Japan, and its control and propose effective control measures.MethodsWhen an outbreak was suspected, immediate isolation and thorough polymerase chain reaction (PCR) testing of patients and health care workers (HCWs) using an in-house system, together with extensive contact tracing and social distancing measures, were conducted. Nosocomial infections (NIs) were defined as having an onset or positive test after the fifth day of admission for patients and having high-risk contacts in our hospital for HCWs. We performed descriptive analyses for this outbreak.ResultsBetween March 24 and April 24, 2020, 27 of 562 tested patients were confirmed positive, of whom 5 (18.5%) were suspected as NIs. For HCWs, 52 of 697 tested positive, and 40 (76.9%) were considered NIs. Among transmissions, 95.5% were suspected of having occurred during the asymptomatic period. Large-scale isolation and testing at the first sign of outbreak terminated NIs. The number of secondary cases directly generated by a single primary case found before March 31 was 1.74, compared with 0 after April 1. Only 4 of 28 primary cases generated definite secondary infection; these were all asymptomatic.ConclusionsViral shedding from asymptomatic cases played a major role in NIs. PCR screening of asymptomatic individuals helped clarify the pattern of spread. Immediate large-scale isolation, contact tracing, and social distancing measures were essential to containing outbreaks.