Pneumonia Requiring Oxygen Therapy Research Articles

Pulmonary actinomycosis complicating COVID-19 pneumonia in an immunocompetent patient: a case report.

Several co-infections have been described in the context of COVID-19 but only few cases of actinomycosis following SARS-CoV-2 infection have been reported in the literature. We report here the observation of a 48-year-old man, a smoker, who presented, in the aftermath of COVID-19 pneumonia requiring oxygen therapy a pyopneumothorax treated with antibiotic therapy and chest drainage. A few days later, he presented with hemoptysis. The diagnosis of actinomycosis was made based on histopathological data from endoscopic biopsies. The outcome was favorable under adapted and prolonged antibiotic therapy with amoxicillin. Pulmonary actinomycosis, although rare, should be suspected in front of lingering respiratory symptoms and/or atypical radiological findings in the context of a COVID-19.

Zinc deficiency is a potential risk factor for COVID-19 progression to pneumonia requiring oxygen therapy

IntroductionVarious risk factors for developing severe coronavirus disease 2019 (COVID-19) have been reported. However, studies on the nutritional-related risk factors are limited. In this study, we investigated the effects of serum zinc deficiency on the severity of COVID-19. MethodsThe study included a total of 60 COVID-19 patients who were admitted to Tsuyama Chuo Hospital between March 2020 and April 2021. We divided the patients into two categories based on serum levels of zinc (normal and latent zinc deficiency vs. zinc deficiency [<60 μg/dL]) at the time of diagnosis. Severity of COVID-19 was defined as the most exaggerated disease status during admission. The associations between serum zinc deficiency and the severity of COVID-19 were examined using a logistic regression model adjusted for potential confounders. ResultsPatients who required oxygen therapy had a higher prevalence of comorbidities and poorer nutritional status, including zinc deficiency, than those who did not require oxygen therapy. Zinc deficiency was associated with an increased risk of COVID-19 severity, with an adjusted odds ratio of 7.29 (95% confidence interval: 1.70–31.18). This result remained significant in the sensitivity analyses conducted after adjusting for patient background factors. ConclusionsZinc deficiency at the time of COVID-19 diagnosis is an independent risk factor for severe disease. Our findings need to be validated in external studies.

ANTIVIRAL DRUGS IN THE TREATMENT FOR COVID-19

Introduction. Covid-19 is an infectious contagious disease of viral etiology caused by SARS-COv-2.&#x0D; Covid-19 is a highly infectious viral disease caused by SARS-CoV-2. The management of Covid-19 presents significant challenges, and the decision regarding the level of medical care provided, whether in outpatient or hospital settings, relies primarily on the clinical assessment of the patient's condition.&#x0D; The aim of this paper is to review and analyze the pharmacological properties of antiviral drugs used in the treatment regimens for Covid-19.&#x0D; Materials and Methods: In this research, internet resources such as PubMed, Google Scholar, and CrossRef were utilized. The focus was on providing an up-to-date review of the pharmacokinetic and pharmacodynamic characteristics of antiviral drugs used in the treatment of Covid-19.&#x0D; Monlupiravir is an antiviral prodrug with activity against SARS-CoV-2. It is prescribed for patients with mild to moderate Covid-19 who are at high risk of developing severe forms of the disease or death. Ribavirin is a nucleoside analogue with broad-spectrum antiviral activity. Remdesivir is a direct-acting antiviral drug that inhibits the RNA-dependent RNA polymerase, and it is indicated for seriously ill Covid-19 patients with pneumonia requiring oxygen therapy, as well as for patients with comorbidities such as diabetes mellitus, respiratory and cardiovascular diseases, immunosuppressive conditions, and renal failure.&#x0D; Favipiravin is a direct-acting synthetic antiviral drug, selective RNA polymerase inhibitor, which is indicated for the treatment of moderate and severe COVID-19, pandemic infections caused by influenza virus, and also when other drugs are ineffective.&#x0D; Lopinavir/ritonavir is a combination drug, a protease inhibitor, which is used in the treatment charts for seriously ill patients with COVID-19.&#x0D; Conclusion. The search for effective etiotropic drugs for treatment of patients with COVID-19 is still continuing. Monlupiravir, ribavirin, remdesivir, favipiravin, plitidepsin, lopinavir / ritonavir are used for treatment. Mechanism of drugs’ action, peculiarities of their pharmacokinetics and pharmacodynamics, possible side effects, dosage forms are required for the choice of the drug.&#x0D; Favipiravir is a synthetic antiviral drug that acts as a selective RNA polymerase inhibitor. It is indicated for the treatment of moderate to severe Covid-19, as well as for pandemic influenza infections when other drugs are ineffective. Lopinavir/ritonavir is a combination drug and a protease inhibitor used in the treatment of severely ill patients with Covid-19.

Preliminary study regarding the predicted body weight-based dexamethasone therapy in patients with COVID-19 pneumonia

BackgroundThe RECOVERY clinical trial reported that 6 mg of dexamethasone once daily for up to 10 days reduces the 28-day mortality in patients with coronavirus disease 2019 (COVID-19) receiving respiratory support. In our clinical setting, a fixed dose of dexamethasone has prompted the question of whether inflammatory modulation effects sufficiently reduce lung injury. Therefore, preliminary verification on the possibility of predicted body weight (PBW)-based dexamethasone therapy was conducted in patients with COVID-19 pneumonia. MethodsThis single-center retrospective study was conducted in a Japanese University Hospital to compare the treatment strategies/management in different periods. Consecutive patients (n = 90) with COVID-19 pneumonia requiring oxygen therapy and were treated with dexamethasone between June 2020 and May 2021 were analyzed. Initially, 60 patients administered a fixed dexamethasone dose of 6.6 mg/day were defined as the conventional group, and then, 30 patients were changed to PBW-based therapy. The 30-day discharged alive rate and duration of oxygen therapy were analyzed using the Kaplan–Meier method and compared using the log-rank test. The multivariable Cox regression was used to evaluate the effects of PBW-based dexamethasone therapy on high-flow nasal cannula (HFNC), noninvasive ventilation (NIV), or mechanical ventilation (MV). ResultsIn the PBW-based group, 9, 13, and 8 patients were administered 6.6, 9.9, and 13.2 mg/day of dexamethasone, respectively. Additional respiratory support including HFNC, NIV, or MV was significantly less frequently used in the PBW-based group (P = 0.0046), with significantly greater cumulative incidence of being discharged alive and shorter oxygen demand within 30 days (92 vs. 89%, log-rank P = 0.0094, 90 vs. 92%, log-rank P = 0.0002, respectively). Patients treated with PBW-based therapy significantly decreased the use of additional respiratory support after adjusting for baseline imbalances (adjusted odds ratio, 0.224; 95% confidence interval, 0.062–0.813, P = 0.023). Infection occurred in 13 (21%) and 2 (7%) patients in the conventional and PBW-based groups, respectively (P = 0.082). ConclusionsIn patients with COVID-19 pneumonia requiring oxygen therapy, PBW-based dexamethasone therapy may potentially shorten the length of hospital stay and duration of oxygen therapy and risk of using HFNC, NPPV, or MV without increasing serious adverse events or 30-day mortality.

SARS-CoV-2 infection in patients with β-thalassemia: The French experience.

IntroductionBecause of iron overload complications, thrombosis and infectious predisposition, patients with severe forms of thalassemia are likely to be at increased risk of COVID-19 complications.ResultsA national survey conducted during the year 2020 across the French reference centers for hemoglobinopathies identified 16 cases of COVID-19 confirmed by RT-PCR in beta-thalassemia patients. Their age ranged from 11 months to 60 years. 15 patients were transfusion-dependent and 6 were splenectomized. Concerning iron overload related complications, none had diabetes or cirrhosis and only one had experienced heart failure. All 4 pediatric patients were pauci-symptomatic during the viral episode. Three patients (41, 49 and 57 years old) developed COVID-19 pneumonia requiring oxygen therapy without the need for mechanical ventilation. Neutropenia (absolute neutrophils count < 0.5 10 9/L) was observed in 2 patients receiving long-term treatment with hydroxycarbamide and deferiprone. No thrombosis event, organ failure or death occurred. All patients recovered.ConclusionSeverity of COVID-19 in this population of young and middle-aged patients appeared increased compared to the general population but remained mild to moderate as already described in the few series reported in the literature. Occurrence of adverse events related to chronic treatment administered in thalassemia disease may be favored by the infectious episode.

Intravenous methylprednisolone with or without tocilizumab in patients with severe COVID-19 pneumonia requiring oxygen support: A prospective comparison

BackgroundCytokine storm is a marker of severity and severe mortality in patients with coronavirus disease 2019 (COVID-19) pneumonia. Immunomodulatory treatments may reduce morbidity and mortality. ObjectivesTo determine whether a 7-day course of methylprednisolone (MP) administered with and without tocilizumab improves outcomes in patients with severe COVID-19 (SARS-CoV-2) pneumonia requiring oxygen therapy, relative to historical controls. Study design and methodIn this randomized controlled study, patients hospitalized with severe COVID-19 at Rashid Hospital, Dubai, in June 2020 were randomized 1:1 to receive intravenous MP (40 mg twice daily for 7 days) with or without a single dose of intravenous tocilizumab (400 mg). While data from the control arm, consisting of patients administered usual care, were obtained through retrospective review of their electronic medical records. The patients in the three arms were matched by disease severity and inclusion and exclusion criteria. The primary outcomes were day 45 all-cause mortality after randomization, rate of admission to the intensive care unit (ICU), length of ICU stay, days on ventilators, and length of hospital stay. ResultsIn total, 76 patients were recruited, including 23 treated with MP, 26 with MP plus tocilizumab, and 27 historical controls. The rates of admission to the ICU and invasive mechanical ventilation were lowest in patients treated with MP alone, with the rates in this group being significantly lower than the rates in the control group (p = 0.04). Time on a ventilator was lowest in the MP group (1.09 ± 3.68 days) and highest in the control group (7.93 ± 14.86 days). The number of days in the ICU was significantly lower in the MP group than in the control and MP plus tocilizumab groups (p = 0.043). One patient (4.3%) in the MP group and five (18.5%) in the control arm died within 45 days. Survival was highest in patients treated with MP alone, with the addition of tocilizumab not improving survival or any of the other outcomes significantly. Interpretation/conclusionIn patients with severe COVID-19 pneumonia on oxygen support, administration of MP daily for 7 days had reduced mortality at 45 days and was associated with significantly lower ICU admission and ventilation rates compared with usual. Adding tocilizumab to MP did not improve any of the studied outcomes significantly.

Anakinra in hospitalized patients with severe COVID-19 pneumonia requiring oxygen therapy: Results of a prospective, open-label, interventional study

ObjectiveThe aim of this study was to evaluate the efficacy of anakinra in patients who were admitted to hospital for severe COVID-19 pneumonia requiring oxygen therapy. MethodsA prospective, open-label, interventional study in adults hospitalized with severe COVID-19 pneumonia was conducted. Patients in the interventional arm received subcutaneous anakinra (100 mg twice daily for 3 days, followed by 100 mg daily for 7 days) in addition to standard treatment. Main outcomes were the need for mechanical ventilation and in-hospital death. Secondary outcomes included successful weaning from supplemental oxygen and change in inflammatory biomarkers. Outcomes were compared with those of historical controls who had received standard treatment and supportive care. ResultsA total of 69 patients were included: 45 treated with anakinra and 24 historical controls. A need for mechanical ventilation occurred in 14 (31%) of the anakinra-treated group and 18 (75%) of the historical cohort (p < 0.001). In-hospital death occurred in 13 (29%) of the anakinra-treated group and 11 (46%) of the historical cohort (p = 0.082). Successful weaning from supplemental oxygen to ambient air was attained in 25 (63%) of the anakinra-treated group compared with 6 (27%) of the historical cohort (p = 0.008). Patients who received anakinra showed a significant reduction in inflammatory biomarkers. ConclusionIn patients with severe COVID-19 pneumonia and high oxygen requirement, anakinra could represent an effective treatment option and may confer clinical benefit. Trial registration numberISRCTN74727214.

Abstract P-594: CLINICAL EFFECTIVENESS OF EARLY HHFNC IN UNDER5 CHILDREN ATTENDING THE PEDIATRIC EMERGENCY ROOM WITH SEVERE COMMUNITY ACQUIRED PNEUMONIA - CENTURI TRIAL CTRI/2016/04/006788 -INTERIM ANALYSIS REPORT

Aims & Objectives: To study the clinical effectiveness of HHFNC compared to simple low flow nasal cannula oxygen as a first contact respiratory support measure in UNDER5 children hospitalized with severe pneumonia Methods All UNDER5 children presenting with acute respiratory symptoms were screened for eligibility. Those with “Severe Pneumonia requiring oxygen therapy” were enrolled after informed consent and randomized to ‘High Flow therapy’ (HFNC) and ‘Standard Flow therapy’ (SFNC) groups. Pre-enrolment therapy was standardized and similar in both groups. ‘Failure of therapy’ was considered as primary outcome and was defined as ‘Need to intubate or to escalate to next level of respiratory support as per pre-defined criteria’. Time to clinical stability, Time to respiratory stability and FO% (Fluid overload %) were compared among the groups Results Of 200 children enrolled at II Interim analysis point, 24 children failed first contact respiratory support measure, of which 8/24 were in HFNC group and 16/24 were in SFNC group. Baseline variables like, age, sex and RDS score at admission, RDS score categories were comparable among groups. ‘Failure of therapy’ were higher in the SFNC group despite no difference in time to clinical stability, time to respiratory stability, FO% at 24 hours and 48 hours. Conclusions On preliminary observation, early initiation of HFNC in UNDER5 children with severe pneumonia seem to have lesser ‘Failure of First Respiratory Support Therapy’ circumstances despite similar ‘time to clinical stability’ and ‘time to respiratory stability’ in non-intubated children