Requiring Oxygen Therapy Research Articles

Coronavirus disease-2019 morbidity and mortality among health care workers in Uganda.

Health care workers (HCWs) are at increased risk of acquiring coronavirus disease 2019 (COVID-19). This study aimed to determine and compare the morbidity and mortality rates due to COVID-19 among the HCWs and the general population (non-HCWs). We conducted a retrospective chart review. We accessed electronic database of participants admitted at Mulago National Referral Hospital COVID-19 Treatment Unit (CTU) between March 2020 and September 2021. Participants with missing occupations were excluded. Of 594 eligible participants, 6.4% (n = 38) were HCWs. Compared with non-HCWs, HCWs were much younger (48 versus 55 years, p = 0.020). The proportion of participants with severe disease (73.7% versus 77.6%, p = 0.442), who had not received COVID-19 vaccine (91.2% versus 94.7%, p = 0.423), mortality rate (44.7% versus 54.8%, p = 0.243) and the median length of hospitalization (6 versus 7 days, p = 0.913) were similar among HCWs and non-HCWs, respectively. A higher proportion of HCWs required oxygen therapy (24.3% versus 9.7%, p < 0.01). At admission, the presence of cough (p = 0.723), breathlessness (p = 0.722), fever (p = 0.19), sore throat (p = 0.133), comorbidities (p = 0.403) and headache (p = 0.162) were similar across groups. Rhinorrhoea was more common among HCWs (34.4% versus 16.6%, p = 0.017). Among HCWs, nurses had the highest morbidity (52.6%) and mortality (58.8%). The morbidity and mortality among HCWs in Uganda were substantial, with a low COVID-19 vaccination rate and a higher requirement for oxygen therapy despite a younger age.

Steroid therapy and antiviral treatment in SARS-CoV-2 pneumonia: clinical contexts and indications.

Critically ill patients with COVID-19 face a higher risk of disease progression and complications. The current standard of care includes supportive care measures and fluid management. The Recovery trial observed a reduction in all-cause, 28-day mortality (p<0.001) when patients with COVID-19 requiring oxygen therapy received 6 mg of dexamethasone per day for 10 days. In contrast, in patients not requiring oxygen, no benefit was observed: 28-day mortality rates for the dexamethasone and routine care groups were 17.8% and 14%, respectively. To corroborate these results, the World Health Organization (WHO) performed a meta-analysis. The study showed that the use of systemic corticosteroids compared with routine care placebo was associated with a decrease in all-cause, 28-day mortality. With respect to the effectiveness of remdesivir, the ACTT-1 trial found that the drug conferred a benefit on time to clinical improvement. The subgroup analysis in the clinical trial also showed a benefit per mortality in patients requiring supplemental oxygen, albeit not those in need of mechanical ventilation.

2021 update of the EULAR points to consider on the use of immunomodulatory therapies in COVID-19

ObjectivesTo update the EULAR points to consider (PtCs) on the use of immunomodulatory therapies in COVID-19.MethodsAccording to the EULAR standardised operating procedures, a systematic literature review up to 14 July...

The effect of casirivimab with imdevimab on disease progression in nonsevere COVID-19 patients in a single hospital in Japan.

BackgroundRecent randomized trials have revealed that neutralizing monoclonal antibodies can reduce disease progression in mild–moderate COVID‐19 patients. However, no studies have investigated the effect of neutralizing monoclonal antibodies on clinical outcomes in Japan.MethodsA single‐center retrospective and prospective cohort study was conducted. All consecutive febrile nonsevere COVID‐19 patients with at least one risk factor were included. The primary outcome was progression to severe COVID‐19. Severe COVID‐19 cases were defined as patients requiring oxygen therapy and dexamethasone. The differences in the primary outcomes between the patients who were treated with casirivimab with imdevimab (treatment group) and those who were not (control group) were compared using the chi‐squared test.ResultsA total of 128 patients were included. Of those, the mean age was 53.6 years old (SD 9.9), and 52 (40.6%) were women. Fifty‐three patients were treated with casirivimab with imdevimab, and 75 patients were given the standard treatment only. The primary outcome occurred in eight (15.1%) of the 53 patients in the treatment group and 33 (44.0%) of the 75 patients in the control group (odd ratio [OR] 0.23, 95% CI 0.09 to 0.55). The multivariate analysis revealed that the use of casirivimab with imdevimab (OR 0.21, 95% CI 0.08 to 0.54) was the only independent risk factor associated with progression to severe COVID‐19. No patients died during hospitalization in either group.ConclusionSimilar to other countries, casirivimab with imdevimab significantly reduced disease progression in early nonsevere COVID‐19 patients with fever and risk factors in Japan.

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.

Pulmonary and Extrapulmonary Manifestations in Hospitalized Children with Mycoplasma Pneumoniae Infection.

Mycoplasma pneumoniae (MP) is one of the main causes of both upper and lower respiratory infections in school-aged children, accounting for up to 40% of community-acquired pneumonia. Younger children are also affected, and extrapulmonary manifestations have been recently reported in the pediatric population. We carried out a retrospective analysis of MP-positive patients admitted to the Pediatric Emergency Unit of S. Orsola Malpighi University Hospital in Bologna, the largest tertiary pediatric referral center in the Emilia–Romagna region, Northern Italy, between 2012 and 2020. We identified 145 patients with MP infection (82 males and 63 females), 27% of which were younger than 2 years; the median age was 5 years (interquartile range 1–9). The clinical presentation partially differed between age groups. School-aged children were more likely to have a chest X-ray-confirmed pneumonia (p = 0.013), while younger children required oxygen therapy more often (p = 0.048). Seventy-four children (51%) showed extrapulmonary manifestations, mainly gastrointestinal (30%) and dermatological (14%). Neurological symptoms were more frequent in children older than 6 years (p = 0.006). The rate of other extrapulmonary manifestations did not differ significantly between age groups. This study shows that MP infection is a frequent cause of pediatric hospitalization, including of children younger than 2 years. Clinicians should be aware of the variable clinical expressions of MP, including extrapulmonary manifestations, to achieve a correct diagnosis and determine appropriate treatment.

COVID-19 and Dengue Co-infection in a Young Girl: A Case Report

During COVID-19 pandemic, the increasing incidence of dengue in Monsoon season has become a further threat especially in the dengue endemic countries of Southeast Asia like Bangladesh. Co-infection of dengue with COVID-19 has created a number of practical challenges to combat the diseases simultaneously, especially at a time when healthcare resources are already exhausted tackling the COVID pandemic. We are presenting the case report of a 14 year old girl who suffered from both RT-PCR positive COVID -19 infection &amp; NS1 positive Dengue. She was managed in a Private Hospital of Dhaka as Dengue fever Group C (due to severe plasma leakage) with severe COVID-19 infection (as required oxygen therapy). She had a critical course of illness, having continued fever, cough, breathlessness, desaturation along with thrombocytopenia &amp; plasma leakage. However, to our great satisfaction, the patient was ultimately improved &amp; could be discharged in a happy face. Bangladesh J Medicine July 2022; 33(1) : 104-108

Retrospective evaluation of an observational cohort by the Central and Eastern Europe Network Group shows a high frequency of potential drug-drug interactions among HIV-positive patients receiving treatment for coronavirus disease 2019(COVID-19).

The aim of this international multicentre study was to review potential drug-drug interactions (DDIs) for real-life coadministration of combination antiretroviral therapy (cART) and coronavirus disease 2019 (COVID-19)-specific medications. The Euroguidelines in Central and Eastern Europe Network Group initiated a retrospective, observational cohort study of HIV-positive patients diagnosed with severe acute respiratory syndromecoronavirus 2 (SARS-CoV-2) infection. Data were collected through a standardized questionnaire and DDIs were identified using the University of Liverpool's interaction checker. In total, 524 (94.1% of 557) patients received cART at COVID-19 onset: 117 (22.3%) were female, and the median age was 42 (interquartile range 36-50) years. Only 115 (21.9%) patients were hospitalized, of whom 34 required oxygen therapy. The most frequent nucleoside reverse transcriptase inhibitor (NRTI) backbone was tenofovir disoproxil fumarate (TDF)/tenofovir alafenamide (TAF) with lamivudine or emtricitabine (XTC) (79.3%) along with an integrase strand transfer inhibitor (INSTI) (68.5%), nonnucleoside reverse transcriptase inhibitor (NNRTI) (17.7%), protease inhibitor (PI) (13.7%) or other (2.5%). In total, 148 (28.2%) patients received COVID-19-specific treatments: corticosteroids (15.7%), favipiravir (7.1%), remdesivir (3.1%), hydroxychloroquine (2.7%), tocilizumab (0.6%) and anakinra (0.2%). In total, 62 DDI episodes were identified in 58 patients (11.8% of the total cohort and 41.9% of the COVID-19-specific treatment group). The use of boosted PIs and elvitegravir accounted for 43 DDIs (29%), whereas NNRTIs were responsible for 14 DDIs (9.5%). In this analysis from the Central and Eastern European region on HIV-positive persons receiving COVID-19-specific treatment, it was found that potential DDIs were common. Although low-dose steroids are mainly used for COVID-19 treatment, comedication with boosted antiretrovirals seems to have the most frequent potential for DDIs. In addition, attention should be paid to NNRTI coadministration.

Therapeutic implications of ongoing alveolar viral replication in COVID-19.

In patients with moderate-to-severe COVID-19 pneumonia, an aberrant post-viral alveolitis with excessive inflammatory responses and immunothrombosis underpins use of immunomodulatory therapy (eg, corticosteroids and interleukin-6 receptor antagonism). By contrast, immunosuppression in individuals with mild COVID-19 who do not require oxygen therapy or in those with critical disease undergoing prolonged ventilation is of no proven benefit. Furthermore, a window of opportunity is thought to exist for timely immunosuppression in patients with moderate-to-severe COVID-19 pneumonia shortly after clinical presentation. In this Viewpoint, we explore the shortcomings of a universal immunosuppression approach in patients with moderate-to-severe COVID-19 due to disease heterogeneity related to ongoing SARS-CoV-2 replication, which can manifest as RNAaemia in some patients treated with immunotherapy. By contrast, immunomodulatory therapy has overall benefits in patients with rapid SARS-CoV-2 clearance, via blunting of multifaceted, excessive innate immune responses in the lungs, potentially uncontrolled T-cell responses, possible autoimmune responses, and immunothrombosis. We highlight this therapeutic dichotomy to better understand the immunopathology of moderate-to-severe COVID-19, particularly the role of RNAaemia, and to refine therapy choices.

Clinical Picture and Risk Factors of Severe Respiratory Symptoms in COVID-19 in Children.

Children with COVID-19 develop moderate symptoms in most cases. Thus, a proportion of children requires hospital admission. The study aimed to assess the history, clinical and laboratory parameters in children with COVID-19 concerning the severity of respiratory symptoms. The study included 332 children (median age 57 months) with COVID-19. History data, clinical findings, laboratory parameters, treatment, and outcome, were evaluated. Children were compared in the groups that varied in the severity of symptoms of respiratory tract involvement. Children who required oxygen therapy represented 8.73%, and intensive care 1.5% of the whole cohort. Comorbidities were present in 126 patients (37.95%). Factors increasing the risk of oxygen therapy included comorbidities (odds ratio (OR) = 92.39; 95% confidence interval (95% CI) = (4.19; 2036.90); p < 0.00001), dyspnea (OR = 45.81; 95% CI (4.05; 518.21); p < 0.00001), auscultation abnormalities (OR = 34.33; 95% CI (2.59; 454.64); p < 0.00001). Lactate dehydrogenase (LDH) > 280 IU/L and creatinine kinase > 192 IU/L were parameters with a good area under the curve (0.804-LDH) and a positive predictive value (42.9%-CK). The clinical course of COVID-19 was mild to moderate in most patients. Children with comorbidities, dyspnea, or abnormalities on auscultation are at risk of oxygen therapy. Laboratory parameters potentially useful in patients evaluated for the severe course are LDH > 200 IU/L and CK > 192 IU/L.

Evaluation of COVID-19 patients requiring oxygen therapy in a tertiary care teaching hospital

Background: COVID-19 disease is a public health emergency and declared as a pandemic in March 2020 by World Health Organization (WHO). Our aim was to study the clinical features, laboratory profile and outcome of COVID-19 patients needing oxygen therapy.Methods: All patients diagnosed to be having COVID-19 and SpO2 less than 94% on admission were included in the study. Detailed history, systemic examination and investigations were done and data was analyzed.Results: Out of 100 patients studied, 66% were males and 34% were females. Comorbidity was seen in 83% of cases, predominantly hypertension (30%) followed by diabetes mellitus (27%) and ischemic heart disease IHD (11%). Most common presenting complaints were breathlessness (84%) followed by dry cough (63%) and fever (48%). Mean values of absolute counts of neutrophils, lymphocytes, eosinophils and basophils were 4,835 cells/cu.mm, 1,332 cells/cumm, 66 cells/cumm and 86.5 cells/cumm respectively. Serum C-reactive protein (CRP) was raised in 90%, lactate dehydrogenase (LDH) in 96% and D-dimer in 64 % of cases on admission. Incidence of happy hypoxia was 16%. Mortality in our study was 2%. Greater the values of serum CRP, LDH, ferritin, lesser was the SpO2 of patients and greater the oxygen requirement. However no such correlation was found between D-Dimer and SpO2 of patients and their oxygen requirement.Conclusions: COVID-19 has varied presentations. The most common comorbidity was hypertension followed by diabetes mellitus. Serum inflammatory markers are raised in COVID disease. Eosinopenia can be a pointer towards COVID disease. One should be aware of the entity happy hypoxia seen in these patients.

Arterial and Venous Thrombosis Complicated in COVID-19: A Retrospective Single Center Analysis in Japan.

Background: Thrombosis is a characteristic complication in coronavirus disease 2019 (COVID-19). Since coagulopathy has been observed over the entire clinical course, thrombosis might be a clue to understanding the specific pathology in COVID-19. Currently, there is limited epidemiological data of COVID-19-associated thrombosis in the Japanese population and none regarding variant strains of SARS-CoV-2. Here, we elucidate the risk factors and the pattern of thrombosis in COVID-19 patients.Methods: The patients consecutively admitted to Tokyo Medical and Dental University Hospital with COVID-19 were retrospectively analyzed. SARS-CoV-2 variants of concern/interest (VOC/VOI) carrying the spike protein mutants E484K, N501Y, or L452R were identified by PCR-based analysis. All thrombotic events were diagnosed by clinical symptoms, ultrasonography, and/or radiological tests.Results: Among the 516 patients, 32 patients experienced 42 thromboembolic events. Advanced age, severe respiratory conditions, and several abnormal laboratory markers were associated with the development of thrombosis. While thrombotic events occurred in 13% of the patients with a severe respiratory condition, those events still occurred in 2.5% of the patients who did not require oxygen therapy. Elevated D-dimer and ferritin levels on admission were independent risk factors of thrombosis (adjusted odds ratio 9.39 and 3.11, 95% confidence interval 2.08–42.3, and 1.06–9.17, respectively). Of the thrombotic events, 22 were venous, whereas 20 were arterial. While patients with thrombosis received anticoagulation and antiinflammatory therapies with a higher proportion, the mortality rate, organ dysfunctions, and bleeding complications in these patients were higher than those without thrombosis. The incidence of thrombosis in COVID-19 became less frequent over time, such as during the replacement of the earlier strains of SARS-CoV-2 by VOC/VOI and during increased use of anticoagulatory therapeutics.Conclusion: This study elucidated that elevated D-dimer and ferritin levels are useful biomarkers of thrombosis in COVID-19 patients. The comparable incidence of arterial thrombosis with venous thrombosis and the development of thrombosis in less severe patients required further considerations for the management of Japanese patients with COVID-19. Further studies would be required to identify high-risk populations and establish appropriate interventions for thrombotic complications in COVID-19.

RELATIONSHIP BETWEEN RFC GENE VARIANTS (RS1051266) AND CLINICAL FEATURES OF SEVERE INTRAVENTRICULAR HEMORRHAGE IN PRETERM INFANTS

The physiological function of the RFC gene is to ensure the processes of intracellular folic acid transport that are extremely important not only for the processes of reproduction, but also for the embryonic develop-ment of a growing foetus. The aim of this study is to investigate the association between the RFC (G80A, rs1051266) gene variants and the features of the neonatal course in premature infants with severe intraven-tricular haemorrhage. Materials and methods. The study included 24 preterm infants with severe intraven-tricular haemorrhages that received standard clinical, laboratory and instrumental examination. Determina-tion of RFC gene variants was performed using the polymerase chain reaction- restriction fragment length polymorphism method. Results. The following frequencies of genotypes were determined according to the G80A variant of the RFC gene: GG – 8 (33.3%), GA – 9 (37.5%) and AA – 7 (29.2%) in the study group. Children with the A allele of the RFC gene had an increased risk of developing hypertension and a higher mean concentration of ionized calcium. Preterm infants with the A allele were more likely to require oxygen therapy with maximum oxygen concentration and in the presence of this allele in a homozygous state (AA genotype) required nCPAP and non-invasive mechanical ventilation. Conclusion. The obtained results sup-port a hypothesis about the influence on variants of RFC genes on severe neonatal period in preterm infants with intraventricular haemorrhages. However, further multifaceted research in this area is required to give more ground in supporting hypothesis.

Effect of Prone Positioning on Clinical Outcomes of Non-Intubated Subjects With COVID-19.

Awake prone positioning (APP) has been recently proposed as an adjunctive treatment for non-intubated coronavirus disease 2019 (COVID-19) patients requiring oxygen therapy to improve oxygenation and reduce the risk of intubation. However, the magnitude of the effect of APP on clinical outcomes in these patients remains uncertain. We performed a comparative systematic review and meta-analysis to evaluate the effectiveness of APP to improve the clinical outcomes in non-intubated subjects with COVID-19. The primary outcomes were the need for endotracheal intubation and mortality. The secondary outcome was hospital length of stay. Pooled risk ratio (RR) and mean difference with the corresponding 95% CI were obtained by the Mantel-Haenszel method within a random-effect model. A total of 14 studies (5 randomized controlled trials [RCTs] and 9 observational studies) involving 3,324 subjects (1,495 received APP and 1,829 did not) were included. There was a significant reduction in the mortality rate in APP group compared to control (RR 0.68 [95% CI 0.51-0.90]; P = .008, I2 = 52%) with no significant effect on intubation (RR 0.85 [95% CI 0.66-1.08]; P = .17, I2 = 63%) or hospital length of stay (mean difference -3.09 d [95% CI-10.14-3.96]; P = .39, I2 = 97%). Subgroup analysis of RCTs showed significant reduction in intubation rate (RR 0.83 [95% CI 0.72-0.97]; P = .02, I2 = 0%). APP has the potential to reduce the in-hospital mortality rate in COVID-19 subjects with hypoxemia without a significant effect on the need for intubation or length of hospital stay. However, there was a significant decrease in the need for intubation on subgroup analysis of RCTs. More large-scale trials with a standardized protocol for prone positioning are needed to better evaluate its effectiveness in this select population.

SARS-CoV-2 acute bronchiolitis in hospitalized children: Neither frequent nor more severe.

IntroductionEndemic coronaviruses have been found in acute bronchiolitis, mainly as a coinfecting virus. Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) has been responsible for respiratory illness in hospitalized children. The characteristics of patients with bronchiolitis have not been extensively described.MethodsCross‐sectional study of patients with bronchiolitis and SARS‐CoV‐2 infection enrolled in a prospective multicenter cohort of children hospitalized with COVID‐19 in Spain from March 1, 2020 to February 28, 2021.ResultsTwelve of 666 children infected with SARS‐CoV‐2 who required hospital admission met the diagnostic criteria for bronchiolitis (1.8%). Median age was 1.9 months (range: 0.4–10.1). Six cases had household contact with a confirmed or probable COVID‐19 case. Main complaints were cough (11 patients), rhinorrhea (10), difficulty breathing (8), and fever (8). Eleven cases were classified as mild or moderate and one as severe. Laboratory tests performed in seven patients did not evidence anemia, lymphopenia, or high C‐reactive protein levels. Chest X‐rays were performed in six children, and one case showed remarkable findings. Coinfection with metapneumovirus was detected in the patient with the most severe course; Bordetella pertussis was detected in another patient. Seven patients required oxygen therapy. Albuterol was administered in four patients. One patient was admitted to the pediatric intensive care unit. Median length of admission was 4 days (range: 3–14). No patient died or showed any sequelae at discharge. Two patients developed recurrent bronchospasms.ConclusionSARS‐CoV‐2 infection does not seem to be a main trigger of severe bronchiolitis, and children with this condition should be managed according to clinical practice guidelines.

Colchicine treatment in COVID-19: the remaining unsolved question

Colchicine treatment in COVID-19: the remaining unsolved question

Clinical features of Mycoplasma pneumoniae pneumonia with adenovirus infection in children.

To study the clinical features of Mycoplasma pneumoniae pneumonia (MPP) with adenovirus (ADV) infection in children. A retrospective analysis was performed on the medical data of 228 children with MPP alone and 28 children with MPP and ADV infection. The two groups were compared in terms of clinical features, laboratory results, and treatment outcome. Compared with the MPP group, the MPP+ADV group had significantly longer duration of fever and length of hospital stay, a significantly higher proportion of patients with severe lesions (erosion and exfoliation) of the airway mucosa under bronchoscopy, a significantly higher clinical pulmonary infection score, and a significantly higher proportion of patients requiring oxygen therapy (P<0.05). There were no significant differences between the two groups in white blood cell count, C-reactive protein, Mycoplasma pneumoniae DNA copy number in bronchoalveolar lavage fluid, and the incidence rates of pleural effusion and extrapulmonary complications (P>0.05). Compared with children with MPP alone, children with MPP and ADV infection tend to have more severe clinical manifestations and airway mucosal lesions and are more likely to require oxygen therapy, but most of the laboratory markers lack specificity.

DIFFUSE ALVEOLAR DAMAGE COMPLICATING ELECTROCONVULSIVE THERAPY

TOPIC: Diffuse Lung Disease TYPE: Fellow Case Reports INTRODUCTION: Electroconvulsive therapy (ECT) has been increasingly used over the last few years for various indications, of the rare complications described in the literature is pulmonary edema, only 9 case reports described this complication, 8 of which were attributed to none cardiogenic cause and one had a cardiology component. Here we present a case of pulmonary edema and diffuse alveolar damage (DAD) with hemorrhage with no cardiac component CASE PRESENTATION: 41 years old female smoker, known to have fibromyalgia, systemic lupus erythematosus (SLE) in remission for years, diabetes and severe bipolar disorder refractory to medical therapy' Patient were admitted to the hospital for ECT, shortly after the procedure she developed hemoptysis and shortness of breath requiring oxygen therapy, chest tomography ruled out pulmonary embolism but showed evidence of diffuse alveolar process with ground glass pacification (Image 2). no inhaled medications were used in anesthesia and other inhalational injuries ruled out by history, also vasculitis and infectious process were ruled out. bronchoscopy suggestive of DAD with hemorrhage (Image 1). review of the patient's anesthesia report showed no variation in vital signs during the procedure and ECHO was within normal. the patient recovered with supportive care and advised to be intubated on subsequent sessions DISCUSSION: None cardiogenic pulmonary edema has been described as a complication of ECT, while most cases describe it as a subsequence of variation in blood pressure during the procedure few described it as a result of pressure variation. The theory used to explain the development of pulmonary edema / diffuse alveolar damage is explained as the partially paralyzed diaphragm (Paralytic in smaller dose are used that doesn't result in complete paralysis of the diaphragm as the procedure is aimed to be short with minimal sedation) contract against a close epiglottis with abducted vocal cords from the ECT current. This will result in negative pressure inside the chest cavity and the development of shearing force resulting in damage of the small blood vessels and extravasation of blood and plasma into the alveolar space, which was the case in our patient. Other contributory causes were ruled out. recurrence is not common but precautions in subsequent sessions are warranted. the development of noncardiogenic edema is not a contraindication for further sessions. CONCLUSIONS: ECT is being widely used as a new modality for therapy for refractory psychiatric diseases, precautions to the possible complications are warranted, shortness of breath or hemoptysis post the procedure should raise the suspension of noncardiogenic pulmonary edema / diffuse alveolar damage. treatment is supportive with diuretics being the first line. no other therapies have been described. this complication warranted precautions in the following sessions but doesn't contraindicate them. REFERENCE #1: Manne JR, Kasirye Y, Epperla N, Garcia-Montilla RJ. Non-cardiogenic pulmonary edema complicating electroconvulsive therapy: a short review of the pathophysiology and diagnostic approach. Clin Med Res. 2012 Aug;10(3) 131-136. doi:10.3121/cmr.2011.1030. PMID: 22031475; PMCID: PMC3421372. REFERENCE #2: Hatta K, Kitajima A, Ito M, Usui C, Arai H. Pulmonary edema after electroconvulsive therapy in a patient treated for long-standing asthma with a beta2 stimulant. J ECT. 2007 Mar;23(1) 26-27. doi:10.1097/01.yct.0000263258.52162.63. PMID: 17435570. REFERENCE #3: Myers, Christopher & Gopalka, Ajay & Glick, David & Goldman, Morris & Dinwiddie, Stephen. (2008). A Case of Negative-Pressure Pulmonary Edema After Electroconvulsive Therapy. The journal of ECT. 23. 281-3. 10.1097/yct.0b013e3180de5d44. DISCLOSURES: No relevant relationships by Amro Alastal, source=Web Response No relevant relationships by Rami Batarseh, source=Web Response No relevant relationships by Christopher Lipinski, source=Web Response

Understanding inequalities in COVID-19 outcomes following hospital admission for people with intellectual disability compared to the general population: a matched cohort study in the UK

ObjectivesThis study explores the hospital journey of patients with intellectual disabilities (IDs) compared with the general population after admission for COVID-19 during the first wave of the pandemic (when demand...

PRONE POSITIONING IN NONINTUBATED PATIENTS WITH COVID-19: A SYSTEMATIC REVIEW AND META-ANALYSIS

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: Prone positioning (PP) in awake patients has been recently proposed as an adjunctive treatment for spontaneously breathing non-intubated coronavirus disease 2019 (COVID-19) patients requiring oxygen therapy to reduce the risk of intubation. However, the magnitude of the effect of PP on clinical outcomes (e.g., the risk of endotracheal intubation, intensive care unit [ICU] admission, or mortality) in these patients remains uncertain. Therefore, we performed a systematic review and meta-analysis to evaluate the effectiveness of PP to improve the clinical outcomes in non-intubated patients with COVID-19. METHODS: We performed a comprehensive literature search using PubMed, Embase, and Cochrane Library databases from inception through February 24, 2020 for all the studies all studies that all compared PP versus no PP in non-intubated patients with COVID-19. The primary outcome of interest was the rate of endotracheal intubation. The secondary outcomes were in-hospital mortality and intensive care unit (ICU) rates. Pooled odds risk (OR) and 95% confidence intervals (CIs) were obtained by the Mantel-Haenszel method within a random-effect model. RESULTS: A total of five studies (two randomized controlled trials and three observational studies), involving 470 non-intubated patients with COVID-19 (185 patients received PP and 285 did not) were included. The mean age was 59.82 years, and males represented 67% of total patients. The follow-up period ranged from 14 to 30 days. The endotracheal intubation rate was similar between PP and control groups (OR 0.75, 95% CI 0.41-1.35, P = 0.33, I2 = 20%). There was no difference in the in-hospital mortality rate between the two groups (OR 0.68, 95% CI 0.16-2.85, P = 0.60, I2 = 60%). Four studies reported the risk of ICU admission and demonstrated no difference between the two groups (OR 0.77, 95% CI 0.30-1.95, P = 0.58, I2 = 37%). CONCLUSIONS: Our meta-analysis demonstrated that prone positioning in non-intubated COVID-19 patients did not reduce the risk of endotracheal intubation. Furthermore, PP failed to reduce in-hospital mortality and ICU admission rates. CLINICAL IMPLICATIONS: Although our meta-analysis showed that prone positioning might not reduce the risks of intubation, in-hospital mortality, or ICU admission rate in spontaneously breathing non-intubated COVID-19 patients, more large-scale trials with a standardized protocol for prone positioning are needed to better evaluate the effectiveness of prone positioning in this select population. DISCLOSURES: No relevant relationships by Ragheb Assaly, source=Web Response No relevant relationships by Hazem Ayesh, source=Web Response No relevant relationships by Azizullah Beran Beran, source=Web Response No relevant relationships by Sami Ghazaleh, source=Web Response No relevant relationships by Waleed Khokher, source=Web Response No relevant relationships by Saif-Eddin Malhas, source=Web Response No relevant relationships by Aadil Maqsood, source=Web Response No relevant relationships by Reem Matar, source=Web Response No relevant relationships by Mohammed Mhanna, source=Web Response No relevant relationships by Omar Sajdeya, source=Web Response No relevant relationships by Omar Srour, source=Web Response