Requiring Oxygen Support Research Articles

COVID-19: An Update on the Latest Therapeutic Agents

The COVID-19 pandemic has plagued the world for over three years since discovering the causative virus, SARS-CoV-2, in China. The rampant spread of the virus led to the loss of livelihoods of millions across the globe. This public health emergency prompted the rapid development of vaccines and treatments to fight against viral infection. Vaccines against the viral infection started rolling out in late 2020, and the distribution of the vaccines worldwide managed to reduce the symptoms of COVID-19 and prevent outbreaks in local communities. However, COVID-19 infections are still prevalent, with patients suffering from severe symptoms which require oxygen support or mechanical ventilation. Thus, therapeutic agents for COVID-19 play a significant role in reducing the risk of disease progression into severe disease and improving hospitalized patients' clinical outcomes. Existing drugs such as remdesivir, molnupiravir, baricitinib, anakinra, and tocilizumab have been repurposed to treat COVID-19 earlier during the pandemic to meet the urgent demand for treatment. There are also novel antiviral and immunomodulating treatments (nirmatrelvir plus ritonavir, ensitrelvir, regdanvimab, sotrovimab, and vilobelimab) that were developed during the pandemic to fight against COVID-19 infections. These therapeutic agents have been reported to be effective and safe for use to treat COVID-19 infections of different severity. Nevertheless, continuous surveillance is imperative in ensuring that these treatment methods maintain efficacy and safety profiles in treating COVID-19 caused by different variants of the virus.

Different degree of cytokinemia and T-cell activation according to serum IL-6 levels in critical COVID-19.

Tocilizumab, a humanized anti-interleukin-6 receptor (IL-6R) antibody, is recommended for the treatment of severe to critical coronavirus diseases 2019 (COVID-19). However, there were conflicting results on the efficacy of tocilizumab. Therefore, we hypothesized that the differences in tocilizumab efficacy may stem from the different immune responses of critical COVID-19 patients. In this study, we described two groups of immunologically distinct COVID-19 patients, based on their IL-6 response. We prospectively enrolled critical COVID-19 patients, requiring oxygen support with a high flow nasal cannula or a mechanical ventilator, and analyzed their serial samples. An enzyme-linked immunosorbent assay and flow cytometry were used to evaluate the cytokine kinetics and cellular immune responses, respectively. A total of nine patients with critical COVID-19 were included. The high (n = 5) and low IL-6 (n = 4) groups were distinguished by their peak serum IL-6 levels, using 400 pg/mL as the cut-off value. Although the difference of flow cytometric data did not reach the level of statistical significance, the levels of pro-inflammatory cytokines and the frequencies of intermediate monocytes (CD14+CD16+), IFN-γ+ CD4+ or CD8+ T cells, and HLA-DR+PD-1+ CD4+ T cells were higher in the high IL-6 group than in the low IL-6 group. There were distinctive two groups of critical COVID-19 according to serum IL-6 levels having different degrees of cytokinemia and T-cell responses. Our results indicate that the use of immune modulators should be more tailored in patients with critical COVID-19.

Real-world effect of casirivimab and imdevimab cocktail in patients infected with SARS-CoV-2 delta and omicron variants.

The casirivimab and imdevimab antibody cocktail has proven to be extremely effective against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) delta variant. Currently, no data on the clinical outcomes of antibody cocktail with the newer omicron form is available. This retrospective study evaluated the effectiveness of casirivimab and imdevimab antibody cocktail in patients infected with SARS-CoV-2 delta and omicron variants. Data of 85 patients of age < 60 years, with comorbid conditions and BMI > 25 kg/m2 were identified from a database of 871 patients. Most of the patients in both delta and omicron groups were administered 600 mg casirivimab + 600 mg imdevimab intravenously. SARS-CoV-2 symptoms started resolving from the 3rd day and by the end of the 14th day most patients in both groups did not report any symptoms. There was no significant difference between delta and omicron group with respect to average symptom onset days, number of hospitalized days post cocktail and number of days post cocktail administration to reverse transcription polymerase chain reaction (RT-PCR) negative status. Forty (58%) patients in the delta group and 16 (94%) patients in the omicron group had the high-resolution computed tomography (HRCT) score of zero. No patient required oxygen support during hospitalization and no mortality was reported. There was no difference in effectiveness and safety of casirivimab and imdevimab antibody cocktail in the patients infected with SARS-CoV-2 delta or omicron.

Criteria for Hyperinflammation Developing in COVID-19: Analysis of 2 Cohorts From Different Periods of the Pandemic.

Hyperinflammation (HI) that develops in week 2 of COVID-19 contributes to a worse outcome. Because week 2 laboratory findings can be relatively mild, the available criteria for classification of hemophagocytic lymphohistiocytosis or macrophage activation syndrome are not helpful. Our study included a discovery cohort of patients from Turkey with symptomatic COVID-19 who were followed up while hospitalized during the initial wave and a replication cohort of hospitalized patients from a later period, all of whom required oxygen support and received glucocorticoids. Diagnosis of HI was made by an expert panel; most patients with COVID-19-associated HI (HIC) received tocilizumab or anakinra. Clinical and laboratory data from start day of treatment with tocilizumab or anakinra in HIC patients were compared with the data from day 5-6 in patients without HIC. Values maximizing the sensitivity and specificity of each parameter were calculated to determine criteria items. The discovery cohort included 685 patients, and the replication cohort included 156 patients, with 150 and 61 patients receiving treatment for HI, respectively. Mortality rate in HI patients in the discovery cohort (23.3%) was higher than the rate in patients without HI (3.7%) and the rate in patients in the overall replication cohort (10.3%). The 12-item criteria that we developed for HIC showed that a score of 35 provided 85.3% sensitivity and 81.7% specificity for identification of HIC. In the replication cohort, the same criteria resulted in 90.0% sensitivity for HIC; however, lower specificity values were observed because of the inclusion of milder cases of HIC responding only to glucocorticoids. The use of the 12-item criteria for HIC can better define patients with HIC with reasonable sensitivity and specificity and enables an earlier treatment start.

Risk of hospitalization and sequelae in patients with COVID-19 treated with 3-day early remdesivir vs. controls in the vaccine and Omicron era: a real-life cohort study.

Recently, a benefit from administration of a 3-day course of early remdesivir (ER) in the outpatients' setting was reported. However, real-life data on its use is scarce. Therefore, we explored the ER clinical outcome in our outpatients' s cohort, compared to untreated controls. We included all patients who were prescribed ER from February to May 2022 and followed them up for three months and compared patients who received treatment with untreated controls. In the two groups the following outcomes were investigated: hospitalization and mortality rate, time of negativization and symptom's resolution, and post-acute COVID-19 syndrome prevalence. Overall, 681 patients were analyzed, mostly females (53.6%), and with a median age of 66 years (IQR: 54-77), 316 (46.4%) patients received ER, and 365 (53.6%) did not receive antiviral treatment (control group). Overall, 8.5% patients eventually required oxygen support, 8.7% were hospitalized for COVID-19, and 1.5% died. SARS-CoV-2 immunization and ER (aOR 0.049 [0.015; 0.16], p<0.001) independently reduced hospitalization risk. ER was significantly associated with a shorter duration of SARS-CoV-2 positivity at nasopharyngeal swabs (aβ -8.15 [-9.21; -7.09], p<0.001) and of symptoms (aβ -5.11 [-5.82; -4.39], p<0.001), and with lower rate of COVID-19 sequelae compared to control group (aOR 0.18 [0.10;0.31], p<0.001). Even in the SARS-CoV-2 vaccination and Omicron era, in patients at high risk of developing severe disease, ER demonstrated to have a good safety profile and to significantly reduce the risk of disease progression and COVID-19 sequelae compared to untreated controls. This article is protected by copyright. All rights reserved.

Clinical profile and outcome of critically ill COVID-19 patients with diabetic ketoacidosis: A single-centre cross-sectional study in South India.

Clinical profile and outcome of critically ill COVID-19 patients with diabetic ketoacidosis: A single-centre cross-sectional study in South India.

Breakthrough SARS-CoV-2 infections and prediction of moderate-to-severe outcomes during rituximab therapy in patients with rheumatic and musculoskeletal diseases in the UK: a single-centre cohort study.

Concerns have been raised regarding the reduced immunogenicity of vaccines against COVID-19 in patients with autoimmune diseases treated with rituximab. However, the incidence and severity of breakthrough infections in unbiased samples of patients with specific rheumatic and musculoskeletal diseases are largely unknown. We aimed to assess the incidence of breakthrough SARS-CoV-2 infection, compare rates of moderate-to-severe COVID-19 with any severe infection event, and evaluate predictors of moderate-to-severe COVID-19 outcomes in patients treated with rituximab. We did a retrospective cohort study in all rituximab-treated patients with rheumatic and musculoskeletal diseases in a single centre in Leeds, UK between March 1, 2020 (the index date), and April 1, 2022. Adults aged 18 years and older, who fulfilled classification criteria for established rheumatic and musculoskeletal diseases, and received therapy with at least one rituximab infusion between Sept 1, 2019 (6 months before the pandemic in the UK), and April 1, 2022, were eligible for inclusion in the study. SARS-CoV-2 infection was defined by antigen test or PCR. COVID-19 outcomes were categorised as mild (from ambulatory to hospitalised but not requiring oxygen support) or moderate-to-severe (hospitalised and requiring oxygen support or death). The primary outcome was breakthrough COVID-19 infection, which was defined as an infection occurring 14 days or more after the second vaccine dose. Predictors of moderate-to-severe COVID-19 outcomes were analysed using Cox regression proportional hazards. Of the 1280 patients who were treated with at least one cycle of rituximab since Jan 1, 2002, 485 (38%) remained on rituximab therapy on April 1, 2022. Of these patients, 400 fulfilled all inclusion criteria and were included in our final analysis. The mean age at the index date was 58·9 years (SD 14·6), 288 (72%) of 400 patients were female and 112 (28%) were male, 333 (83%) were White, and 110 (28%) had two or more comorbidities. 272 (68%) of 400 patients had rheumatoid arthritis, 48 (12%) had systemic lupus erythematosus, 48 (12%) had anti-neutrophil cytoplasmic antibody-associated vasculitis, and 46 (12%) had other rheumatic and musculoskeletal diseases. During the study, 798 rituximab cycles were administered. Of the 398 (>99%) of 400 patients with vaccine data, 372 (93%) were fully vaccinated. Over the 774·6 patient-years of follow-up, there was an incremental increase in all SARS-CoV-2 severity types over the three pandemic phases (wild-type or alpha, delta, and omicron), but most infections were mild. The rates of moderate-to-severe COVID-19 were broadly similar across these three variant phases. Of 370 patients who were fully vaccinated and with complete data, 110 (30%) had all severity type breakthrough COVID-19, 16 (4%) had moderate-to-severe breakthrough COVID-19, and one (<1%) died. In the post-vaccination phase (after Dec 18, 2020), the incidence rates of all severity type and moderate-to-severe COVID-19 were substantially lower in those who were fully vaccinated compared with unvaccinated or partially vaccinated individuals (22·83 per 100 person-years [95% CI 18·94-27·52] in those who were fully vaccinated vs 89·46 per 100 person-years [52·98-151·05] in those who were partially vaccinated or unvaccinated for infections of all severities, and 3·32 per 100 person-years [2·03-5·42] in those who were fully vaccinated vs 25·56 per 100 person-years [9·59-68·10] in those who were partially vaccinated or unvaccinated for moderate-to-severe infections). The rate of moderate-to-severe COVID-19 was broadly similar to other severe infection events in this cohort (5·68 per 100 person-years [95% CI 4·22-7·63]). In multivariable Cox regression analysis, factors associated with an increased risk of moderate-to-severe COVID-19 were the number of comorbidities (hazard ratio 1·46 [95% CI 1·13-1·89]; p=0·0037) and hypogammaglobulinaemia (defined by a pre-rituximab IgG concentration of <6 g/L; 3·22 [1·27-8·19]; p=0·014). This risk was reduced with each vaccine dose received (0·49 [0·37-0·65]; p<0·0001). Other factors, including concomitant prednisolone use, rituximab-associated factors (eg, rituximab dose and time to vaccination since last rituximab dose), and vaccine-associated factors (eg, vaccine type and peripheral B-cell depletion) were not predictive of moderate-to-severe COVID-19 outcomes. This study presented detailed analyses of rituximab-treated patients during various phases of the COVID-19 pandemic. In later stages of the pandemic, the SARS-CoV-2 breakthrough infection rate was high but severe COVID-19 rates were similar to any severe infection event rate in patients who were vaccinated. The risk-benefit ratio might still favour rituximab in vaccinated patients with severe rheumatic and musculoskeletal diseases who have few other treatment options. Increased vigilance is needed in the presence of comorbidities and hypogammaglobulinaemia for all infection types. Wellcome Trust and Eli Lilly.

Descriptive characteristics of continuous oximetry measurement in moderate to severe covid-19 patients

Non-invasive oxygen saturation (SpO2) is a central vital sign used to shape the management of COVID-19 patients. Yet, there have been no report quantitatively describing SpO2 dynamics and patterns in COVID-19 patients using continuous SpO2 recordings. We performed a retrospective observational analysis of the clinical information and 27 K hours of continuous SpO2 high-resolution (1 Hz) recordings of 367 critical and non-critical COVID-19 patients hospitalised at the Rambam Health Care Campus, Haifa, Israel. An absolute SpO2 threshold of 93% most efficiently discriminated between critical and non-critical patients, regardless of oxygen support. Oximetry-derived digital biomarker (OBMs) computed per 1 h monitoring window showed significant differences between groups, notably the cumulative time below 93% SpO2 (CT93). Patients with CT93 above 60% during the first hour of monitoring, were more likely to require oxygen support. Mechanical ventilation exhibited a strong effect on SpO2 dynamics by significantly reducing the frequency and depth of desaturations. OBMs related to periodicity and hypoxic burden were markedly affected, up to several hours before the initiation of the mechanical ventilation. In summary, OBMs, traditionally used in the field of sleep medicine research, are informative for continuous assessment of disease severity and response to respiratory support of hospitalised COVID-19 patients. In conclusion, OBMs may improve risk stratification and therapy management of critical care patients with respiratory impairment.

Исходы беременностей высокого риска врастания плаценты в зависимости от порядка оказания помощи при родоразрешении

Aim: To compare the outcomes of pregnancies with a high risk of placenta accreta depending on the order of delivery in a tertiary obstetric center. Study design: Retrospective single-center cohort comparative study. Materials and methods. We analyzed the outcomes of singleton pregnancies complicated by placenta previa (ICD-10 codes O44.0–O44.1) and suspected placenta accreta (ICD-10 code O43.2) according to antenatal diagnostics at the tertiary Perinatal Center of the State Budgetary Healthcare Institution "KKB No. 2" in Krasnodar in 2014–2020. Cohorts were stratified according to order of delivery. To determine the statistical significance of frequency differences, a two-tailed Fisher test was used. Comparison of two groups on a quantitative basis was made using the Student's t-test for parametric data and the Mann-Whitney U-test for non-parametric data. Comparisons of means of three or more groups were made using the Kruskal-Wallis H test. The relationship between two quantitative characteristics was determined using the Spearman correlation coefficient. Differences were considered statistically significant at p = 0,05. Results. Of the 547 patients, 131 (23,9%) delivered in an emergency manner. During emergency caesarean section (emCS), no statistically significant differences were found in the volume of blood loss during childbirth (p = 0,518 for placenta previa and p = 0,830 for placenta accreta), however, it differed significantly in groups formed by prevalence (p &lt; 0,001) and depth of placental invasion (p &lt; 0,001). Regardless of the presence of placenta previa or placenta accreta, statistically significant differences in the volume of blood loss were associated with different stages of pregnancy (p = 0,013 for placenta previa, p &lt; 0,001 for accreta): a decrease in the volume of blood loss was noted as the gestational age increased (p = –0,303; p &lt; 0,001). Massive blood loss (≥ 1500 ml) increased the risk of hysterectomy (odds ratio = 8,40 (95% confidence interval – 4,99–17,68), p &lt; 0,001). Children born by elective caesarean section (elCS) had higher gestational age, birth weight (p &lt; 0,001) and most parameters characterizing neonatal outcomes. Low birth weight infants were more common in the emCS group (weight ≤ 10th percentile, p = 0,011). Children after elCS at 36+0-6 weeks required oxygen support and transfer to the intensive care unit more often than after elCS at full term (p = 0,020 and p = 0,030, respectively). Conclusion. The urgency of delivery in a tertiary obstetric center with pathological placental attachment does not entail an increase in the volume of blood loss, the number of hysterectomies, or a deterioration in the performance of newborns. The incidence of neonatal complications depends on the gestational age of the fetus (p &lt; 0,001). The presented study substantiates the possibility of prolonging pregnancy until full term (37 weeks) for women who do not have invasive forms of placenta accreta with a low risk of preterm birth. Keywords: placenta accreta, preterm birth, emergency cesarean section, neonatal outcomes, obstetric risk.

Correlation between Serum Vitamin D3 Levels and Severity of COVID-19, Experience from a COVID-19-Dedicated Tertiary Care Hospital from Western India.

It is postulated that 25(OH)D deficiency is associated with a worse prognosis of COVID-19. We aimed to find out whether baseline serum 25-hydroxy vitamin D levels were correlated with COVID-19 disease severity or not in Indian population. It is a prospective observational study. We prospectively recruited 200 COVID-19-positive adult patients and measured their baseline vitamin D levels on admission and prospectively followed their clinical course for their outcome and correlated the association. The continuous data were represented as mean (±SD) or median (IQR), while the categorical data were represented as proportions. Parametric data were analysed using unpaired T-test and ANOVA for two and more than two groups, and for categorical, nonparametric data, Chi-square test were applied. A two-sided P value of <0.05 was considered as statistically significant with 95% confidence interval. Eighty-six per cent (172/200) of patients had hypovitaminosis D (<30 ng/mL). The prevalence of 25(OH) severe deficiency, deficiency and vitamin D insufficiency was 23%, 41% and 22%, respectively. Clinical severity was graded as asymptomatic (11%), mild (14%), moderate (14.5%), severe (37.5%) and critical (22%). Sixty per cent of patients had clinically severe or critical disease requiring oxygen support with eleven per cent (n = 22) mortality overall. Age (P: 0.001), HTN (P: 0.049) and DM (P: 0.018) were negatively associated with clinical severity. No linear association was found between vitamin D levels and clinical severity. Low vitamin D levels had a significant inverse association with inflammatory markers like neutrophil-lymphocyte ratio (NLR, P: 0.012) and IL-6 (P: 0.002). Vitamin D deficiency was not associated with worse outcomes of COVID-19 infection in Indian population.

Prediction of neonatal respiratory distress by evaluating the colour doppler of the foetal pulmonary artery

Background: Colour doppler of foetal pulmonary artery is non-invasive tool in predicting neonatal respiratory distress. Materials and Methods: This was a hospital based observational study conducted among 110 pregnant women who presented for institutional delivery in Department of Obstetrics & Gynaecology, Department of Radiodiagnosis & Department of Paediatrics Mahatma Gandhi Medical College & Research Institute, Pondicherry, India, over a period of two years from January 2021 to June 2022 after obtaining clearance from Institutional Ethics Committee & written informed consent from study participants. Results: In this observational study difference in proportion of foetal MPA Pulsatility index (PI), Resistive Index (RI), acceleration time/ejection time ratio (AT/ET), neonate oxygen support >24 hours, & APGAR score < 7 between neonate respiratory distress was statistically significant. Difference in proportion of PI between NRD is statistically significant with a p value < 0. 001. Difference in proportion of RI between NRD is statistically significant with a p value < 0. 001. Difference in proportion of AT/ET between neonatal RD is statistically significant with a p value < 0.001. AT/ET ratio had a sensitivity of 95.31 %, specificity of 93.48 %, PPV of 95.31 % & NPV of 93.48 % in predicting NRD. Difference in proportion of neonates requiring oxygen support >24 hours between NRD is statistically significant with p value < 0.001. Conclusion: Difference in proportion of neonatal pulmonary artery AT/ET between neonatal RD is statistically significant with a p value < 0.001. AT/ET ratio had a sensitivity of 95.31 %, specificity of 93.48 %, PPV of 95.31 %, & NPV of 93.48 % in predicting RD in neonates.

Demographic profile and outcomes in hospitalized COVID-19 patients in a tertiary care teaching hospital

Background: Coronavirus disease-19 (COVID-19), a novel viral infection has proved to dismantle the lives of people worldwide and has inflicted a major health crisis making it crucial to study its demographic and outcome profile to safeguard the future generations to the best of our capabilities. Aims and Objectives: The objective of this study was to analyze observational outcomes of the hospitalized COVID-19 patients. Materials and Methods: Study was conducted at Shri Guru Ram Rai Institute of Medical and Health Sciences, Dehradun from October 1, 2020, to September 30, 2021, after approval from the Institutional Ethics Committee. It was a cross-sectional, open-label, and retrospective study that included hospitalized COVID-19 patients confirmed by reverse-transcription polymerase chain reaction testing. Records of patients were obtained with permission from concerned authorities. Appropriate statistical tools were used for analysis. P ≤ 0.05 was considered statistically significant. Results: Records of 606 hospitalized COVID-19 patients were analyzed and indicated that 359 (59.24%) patients were male and 247 (40.76%) were female. The male: female ratio is 1.45:1. The majority of the patients 228 (37.62%) belonged to age group of 46–60 years. Two hundred and seventy-one (44.72%) patients suffered from associated comorbidities of which diabetes mellitus 87 (32.10%) followed by hypertension 70 (25.83%) were most common. 217 (35.81%) patients required oxygen support. Of 86(14.19%) reported deaths, 60 (69.77%) were male with statistically significant P-value belonged to age group of 61–75 years. Median length of stay of the patients was 7 days. Conclusion: Majority of patients hospitalized were male and belonged to middle-aged group. Majority of mortalities were among males and belonged to elderly age-group. Most patients with comorbidities were from elderly age-group and diabetes being most common. Continued study on infectivity profile of infected individuals may contribute largely in assessment and formulation of various norms to fight the disease in the future.

CLINICAL CHARACTERISTICS AND MORTALITY IN ADULTS 85 YEARS AND OLDER HOSPITALIZED WITH SARS-COV-2

Abstract Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) places older adults at increased risk of hospitalization and mortality due to coronavirus disease 2019 (COVID-19). To date, research and regulatory data describe adults 65 years and older, with few reporting on characteristics specific to older adults 85 and older (“oldest-old”). A consecutive 12-month case series including 1,510 oldest-old patients hospitalized with SARS-CoV-2 is presented to describe clinical characteristics, Intensive Care Unit (ICU) utilization and in-hospital mortality from 26 urban, suburban and rural-serving hospitals in an integrated health system in Texas. Known predictors of poor prognosis in COVID-19 include older age, male sex, metabolic risk factors (dyslipidemia, obesity, diabetes) and respiratory failure requiring oxygen support. Compared with hospitalized patients &amp;lt; 85 years, oldest-old patients more often had 4+ chronic conditions (31% vs 12%, p&amp;lt; 0.0001), but less often had metabolic risk factors associated with increased risk for mechanical ventilation and mortality. Specifically, diabetes prevalence was similar between age groups (27% oldest-old vs 30%, NS), while obesity prevalence was lower (18% oldest-old vs 55%, p&amp;lt; 0.0001). Oxygen support requirements were largely similar to the general population, with 4 of 5 hospitalized patients requiring oxygenation support. Of 1,510 oldest-old patients hospitalized for SARS-CoV-2, 269 (18%) required admission to an ICU, 1,206 (80%) required oxygen support, and 1,221 (81%) survived. Following hospitalization, 78% required supportive care, including hospice (15%). Hospitalization characteristics across the lifespan suggest an accelerated and compounded need for ICU recovery and post-hospitalization rehabilitation attributed to the COVID-19 pandemic.

Neurological Complications Associated With SARS-CoV-2 Infection: A Single-Centre Experience.

The clinical presentation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can range from mild or moderate disease (80% of the cases) to severe disease (15%) requiring oxygen support, and critical disease (5%), associated with acute respiratory distress syndrome and admission to the intensive care unit (ICU).In critically ill patients, prone positioning can be used to optimize oxygenation. Although there is a favourable response to this strategy, being a life-saving measure, additional associated complications may appear, including compressive neuropathies.Despite respiratory affection being more common, SARS-CoV-2 infection can also attack othersystems and can, under certain conditions, affect the central or peripheral nervous system. It has been described that neurological manifestations can result from the neuroinvasive properties of the SARS-CoV-2 or as an indirect consequence of multiorgan dysfunction. We intend to report the patients who presented with neurological complicationsassociated with coronavirus disease 2019 (COVID-19) and/or complications of its treatment, followed in our physical and rehabilitation medicine (PRM) service. A retrospective analysis of patients admitted to the PRM ward with outpatient consultation in the context of post-COVID-19 statusbetween April 2020 and November 2021 (the period of the highest prevalence of infection) was carried out. Patients with neurological complications after SARS-CoV-2 infectionandconsequentlya decline in previous functionality were identified. Thirteen patients (23.6%)admitted to the PRM ward had peripheral neurological complications, documented by electroneuromyography, includingGuillain-Barré syndrome, sensory-motor polyneuropathy, peroneal nerve injury, femoral nerve injury, and lumbar plexus injury.The neurological complications of the patients followed in a post-COVID-19 consultation were also evaluated. Eight patients (20%) reported neurological sequelae. Five patients presented peripheral nerve damage (peroneal, accessory, ulnar, and recurrent laryngeal) of undefined aetiology, diagnosed after the acute phase of hospitalization. Two patients had COVID-19 infection followed by ischemic stroke (vertebrobasilar and middle cerebral artery), requiring hospitalization in the acute phase. One patient had COVID-19 infectionfollowed by longitudinal myelitis, with positive anti-myelin oligodendrocyte glycoprotein (MOG). All patients required follow-up by the rehabilitation team with partial recovery of deficits. All patients admitted to the PRM ward with neurological manifestations had critical disease and symptoms compatible with peripheral nervous system involvement. Patients admitted to the PRM consultation had different levels of viral disease severityand had sequelae related to peripheral and central nervous system disorders. Identifying the aetiology of these injuries is essential for us to act on their prevention, particularly with regard to indirect complications, such as compressive neuropathies.It will be necessary to maintain the follow-up of these patients to understand the evolution of the neurological consequences associated with COVID-19.

Case study on the effect of T-AYU-HM Premium with modern medicine in severe Covid-19 Patient

Indian traditional system of medicine has a definite role in the treatment of Covid-19. This case report presents the outcome of Ayurvedic interventions along with modern medicines in a severe covid-19 infected patient with breathlessness. A patient with a history of cough, breathing difficulty and generalized weakness tested positive for the rapid antigen test and prescribed the standard treatment of care with 14 days of strict home quarantine. During follow-up, there was no clinical improvement and oxygen saturation was fluctuating and required oxygen support. Therefore, the patient sought ayurvedic intervention at the covid-19 healthcare center with supportive oxygen therapy. The patient was managed with ayurvedic intervention along with modern medicines. On the date of admission to the covid-19 care center, the patient's SpO2 72% on room air, HRCT 80-90%, and ESR, CRP, and LDH were 40(mm/hour), 11.47(mg/L), and 306(Units/L) respectively. By adhering to the integrated therapy patient’s oxygen saturation and clinical profile were improved with time. On the 11th day of treatment patient, SpO2 was sustained at 95% and HRCT report was 70-80%, and clinical profile improved remarkably. The patient’s HRCT after one month was50-60% compared to the previous report suggestive of remarkable improvement. The effect on inflammatory markers and oxygen saturation suggests that integration of modern medicines along with ayurvedic medicine in the patient was significant and deserves further studies. Integrating ayurvedic treatment along with modern medicine might be considered as an effective approach in the management of severe covid-19 patients.

The Outcomes of Covid-19 in Patients with CLL during the Omicron Sub-Variants Surge

Introduction: Patients with chronic lymphocytic leukemia (CLL) infected with SARS-CoV-2 are at increased risk of severe Covid-19 and death, because of an impaired immune system and suboptimal immunity after vaccination. Despite recent studies, the outcomes of patients with CLL infected with the Omicron sub-variants are not fully elucidated. Methods: In this single-center retrospective study, we analyzed the clinical outcomes of CLL patients infected with SARS-CoV-2 from December 2021 through July 2022. The entire cohort was divided into three groups according to the SARS-CoV-2 variants dominating periods in Israel; period #1, since December 15th, 2021 until March 13th, 2022 (B.1.1.529, BA.1), period #2, since March 14th until June 5th, 2022 (BA.2) and period #3, since June 6th until July 24th, 2022 (BA.5). Results: A total of 90 patients were included in this study (Table 1). The median age was 72 years (range 39-93) and 66 were males (73.3%). Thirty-four patients (37.8%) were treatment naïve, 45 (50.0%) on active treatment (28 treated with Bruton's tyrosine kinase inhibitors [BTKi], 16 with venetoclax+anti-CD20 therapy, and 1 with venetoclax monotherapy), and 11 (12.2%) previously treated. Eighty-seven patients (96.7%) had Covid-19-related symptoms, most commonly fatigue (n=50, 55.6%), followed by cough (n=43, 47.8%) and fever (n=37, 41.1%). Eighty-five patients (94.4%) were vaccinated with at least 3 doses of the BNT162b2 mRNA vaccine. During the study's follow-up period (median=120 days, range 4-221), 2 patients (2.2%) were re-infected with SARS-CoV-2. The severity of Covid-19 on detection was mild in 78 patients (86.7%) and moderate/severe in 12 patients (13.3%). Forty-eight patients (53.3%) were treated with oral antiviral drugs or monoclonal antibodies (40 with paxlovid, 7 with molnupiravir and 1 with casirivimab/imdevimab) outside the hospital. Nine patients developed mild Covid-19 despite administration of pre-exposure prophylaxis with tixagevimab/cilgavimab (median=49 days [range, 7-102] prior to infection). Twenty-seven patients (30.0%) were hospitalized, 15 (55.6%) of them due to severe/critical Covid-19. The median time from SARS-CoV-2 diagnosis to hospitalization was 9 days (range, 0-36). Fifteen hospitalized patients (55.6%) required oxygen support and 2 (7.4%) eventually needed mechanical ventilation. Nine patients (33.3%, 9/27) were readmitted because of persistent SARS-CoV-2 infection, including 6 patients (66.7%) who were hospitalized twice and 3 patients (33.3%) three times. Four patients with persistent Covid-19 after a course of antiviral therapy were subsequently successfully treated with paxlovid and remdesivir. The overall 30-day mortality due to Covid-19 was 6.7% (6/90, 22.2% [6/27] of the hospitalized patients). In comparison between the 3 different time periods (Figure 1), both the hospitalization and death rates were higher in the period #1 (hospitalization rate of 42.9% [21/49] vs. 20.0% [5/25] vs. 6.3% [1/16] in period #1, #2, and #3, respectively and a mortality rate of 12.2% [6/49] in period #1 compared with 0% [0/25] in period #2 and 0% [0/16] in period #3). In univariate analysis, the independent variables associated with hospitalization included: period #1 (OR=4.4, 95% CI 1.6-12.3; p=0.007), active anti-CLL therapy (OR=3.8, 95% CI 1.3-8.9; p=0.021), and fever (OR=3.7, 95% CI 1.4-9.4; p=0.012). Conclusions: In patients with CLL, the rates of hospitalization and mortality due to Covid-19 were lower during the BA.2 and BA.5 sub-variants dominating period compared to the period dominated by the Omicron (B.1.1.529) and the BA.1 sub-variant. The improved outcomes may be attributed to better clinical management (e.g. pre-exposure prophylaxis and antiviral therapies) and viral strain properties. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Clinical characteristics and outcomes of incident cases of COVID-19 in unvaccinated adult cystic fibrosis patients in southern Brazil: a prospective cohort study conducted during the first year of the COVID-19 pandemic.

There is still limited information on the clinical characteristics and outcomes of cystic fibrosis (CF) patients with COVID-19 in Brazil. The objective of this study was to describe the cumulative incidence of COVID-19 in CF patients, as well as their clinical characteristics and outcomes. This was a prospective cohort study involving unvaccinated adult CF patients and conducted during the first year of the SARS-CoV-2 pandemic in the city of Porto Alegre, in southern Brazil. The clinical course of the disease was rated on the WHO Ordinal Scale for Clinical Improvement. The primary outcome was the number of incident cases of COVID-19. Between April 30, 2020 and April 29, 2021, 98 CF patients were included in the study. Seventeen patients were diagnosed with COVID-19. For the CF patients, the annual cumulative incidence of COVID-19 was 17.3%, similar to that for the general population, adjusted for age (18.5%). The most common symptoms at diagnosis of COVID-19 were cough (in 59%), dyspnea (in 53%), fatigue (in 53%), and fever (in 47%). Only 6 (35%) of the patients required hospitalization, and 3 (17.6%) required oxygen support. Only 1 patient required mechanical ventilation, having subsequently died. During the first year of the SARS-CoV-2 pandemic in southern Brazil, the cumulative incidence rate of COVID-19 was similar between CF patients and the general population. More than 50% of the CF patients with SARS-CoV-2 infection had a mild clinical presentation, without the need for hospital admission, and almost the entire sample recovered completely from the infection, the exception being 1 patient who had advanced lung disease and who died.

Retrospective epidemiological surveillance of COVID-19 patients in the Department of Radiodiagnosis in M. G. M. Medical College and Associated Hospitals: an audit

Background: Epidemiological surveillance is the cornerstone for the prevention and control of any pandemic. The purpose of the study was using clinical and radiological data of COVID-19 positive patients to describe the clinical features, risk factors, grading of severity on the basis of chest X-ray and their survival outcome. Methods: A retrospective observational study comprising 9100 COVID-19 positive patients was done in the Department of Radiodiagnosis, M.G.M. Medical College and M.Y. Hospital, Indore. Patients' data including demography, clinical findings, vaccination status and imaging findings was collected and assessed in between March 2020 and March 2022. In the descriptive statistical analysis, continuous variables were noted in terms of the mean and standard deviation and nominal variables were noted in terms of percentage.Results: In our study, there were 9100 patients proven with positive COVID-19 disease had abnormal CXRs were detected in 7553 of 9100 patients (83%). In our study, B/L lung involvement (69%) was found to be more with lower lung zone predominance (86.5%) and peripheral predominance opacities (83.7%). The most common finding of chest X-ray pattern is consolidation (65.7%), followed by ground glass opacity (29.0%). Most of the vaccinated patients were found to be in mild category and majority of mild cases didn’t require oxygen support. The chi-square statistic is 79.3372. The result is significant at p&lt;0.05Conclusions: The chest x-ray severity scoring (CXR-SS) system used in this study is a valuable method of disease prognostication in COVID-19. In our study, we found a significant reverse relationship between chest X-ray severity score and oxygen saturation, which has great clinical importance.

Antiviral drugs against SARS-CoV-2.

The use of antiviral drugs represents an important progress in the therapeutic management of COVID-19, leading to a substantial reduction of SARS-CoV-2-related complications and mortality. In immunocompetent host, peak viral replication occurs around the symptom's onset, and it prolongs for 5 to 7 days that is the window of opportunity for giving an antiviral. Accordingly, early and rapid diagnostic of the infection in the outpatient clinic is essential as well as the availability of oral agents that can be easily prescribe. Remdesivir has demonstrated its efficacy in hospitalized patients requiring oxygen support and in mild/moderate cases to avoid the hospitalization, however, the intravenous administration limits its use among outpatients. Molnupiravir and nirmatrelvir/ritonavir are potent oral antiviral agents. In the present review we discuss the potential targets against SARS-CoV-2, and an overview of the main characteristics and clinical results with the available antiviral agents for the treatment of SARS-CoV-2.

Association between prehospital medication and fatal outcomes in a cohort of hospitalized patients due to coronavirus disease-2019 in a referral hospital in Peru

BackgroundTo explore the association between the use of prehospital medications and the development of fatal outcomes in patients who required hospitalization due to coronavirus disease-2019 (COVID-19). MethodsThis retrospective cohort study included adult patients who were hospitalized due to COVID-19. Demographic, clinical, and laboratory data, prehospital medication history, and fatal outcome development (use of high-flow oxygen therapy, intensive care unit [ICU] admission, or mortality) were extracted from the medical records of patients who were admitted due to COVID-19 to the Carlos Seguín Escobedo National Hospital of Arequipa, Peru during July to September 2021, the period after the second wave of COVID-19 cases in Peru. Survival was analyzed using the Cox proportional hazards model, and crude hazard ratios and adjusted hazard ratios (aHR) with their respective 95% confidence intervals (95% CI) were calculated. ResultsA total of 192 patients were evaluated, of whom 62% were males and 46.9% did not require oxygen support at admission. Additionally, 64.6% used nonsteroidal anti-inflammatory drugs, 35.4% used corticosteroids, 28.1% used macrolides or ceftriaxone, 24.5% used ivermectin, and 21.9% used warfarin before hospitalization. Of the patients, 30.2% developed a fatal outcome during follow-up. The multivariate analysis revealed that prehospital corticosteroid use was independently associated with the fatal outcome due to COVID-19 with an aHR = 5.29 (95%CI: 1.63–17.2). ConclusionPrehospital corticosteroid use was associated with a 5-fold increased risk of fatal outcome development.