Severe Neonatal COVID Pneumonia With Cytokine Storm

2022 ◽  
pp. 097321792110722
Author(s):  
Vineet Kumar Singh ◽  
Shalini Tripathi ◽  
Mala Kumar
Keyword(s):  
Preterm Neonate ◽  
Good Prognosis ◽  
Published Data ◽  
Cytokine Storm ◽  
Perinatal Complications ◽  
Poor Outcomes ◽  
Second Wave

COVID infection is not as common in children as in adults. In the first wave, symptomatic SARS-CoV-2 infection was less common with mild symptoms in children and neonates. But in the second wave, more children and neonates were affected with severe manifestations. COVID infection in neonates is mostly asymptomatic and published data from various neonatal units of India shows that most COVID positive newborns have good prognosis; poor outcomes are due to perinatal complications and rarely due to COVID. 1 However, in the second wave, newborns too were affected. We are presenting the case of a preterm neonate who developed severe COVID pneumonia on day 10 of life with cytokine storm and succumbed to death.

scholarly journals Clinically Suspected Myocarditis in COVID-19 Patients: Case Series and Review of Literature

2021 ◽  
Author(s):  
Ahmad Amin ◽  
Seyed Parsa Eftekhar ◽  
Naghmeh Ziaei ◽  
Soudeh Roudbari ◽  
Pegah Salehi ◽  
...  
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Left Ventricle ◽  
Ejection Fraction ◽  
Case Series ◽  
Female Gender ◽  
Good Prognosis ◽  
Left Ventricle Ejection Fraction ◽  
Review Of Literature ◽  
Younger Age ◽  
Poor Outcomes

We described eleven patients positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The younger age and female gender seem to contribute to poor outcomes possibly. Furthermore, the left ventricle ejection fraction and pro-BNP improvement within the first week of treatment might indicate a good prognosis.

scholarly journals Autologous Placenta-derived Mesenchymal Stem Cell Transplantation for Labored Pregnant Patients With COVID-19

2021 ◽  
Vol 4 (1) ◽  
pp. 17-20
Author(s):  
Nazanin Ashtar Nakhaei ◽  
◽  
Amir Hossein Norooznezhad ◽  
Keyword(s):  
Proinflammatory Cytokine ◽  
Preterm Labor ◽  
Inflammatory Diseases ◽  
Autologous Transplantation ◽  
Cytokine Storm ◽  
Health Issues ◽  
Cytokine Release ◽  
Mesenchymal Stem Cell Transplantation ◽  
The World ◽  
Poor Outcomes

Coronavirus Disease 2019 (COVID-19) is one of the most critical health issues in the world. According to the findings, systemic proinflammatory cytokine release is associated with the pathogenesis of cytokine storm, contributing to morbidities and even mortality in patients diagnosed with COVID-19. Among pregnant patients diagnosed with COVID-19, preterm labor is one of the most crucial side effects, with a prevalence of up to 63.8% in some studies. As well as cytokine storm, proinflammatory cytokines are involved in preterm labor. Mesenchymal Stem Cells (MSCs) transplantation has been used in different trials to suppress inflammation in many inflammatory diseases. MSCs have also been successfully applied to treat patients diagnosed with COVID-19, considering the cytokine storm in these patients. So, it is possible to use the transplantation of MSCs derived from the maternal side of the placenta as an autologous product to suppress cytokine storm in critically ill patients diagnosed with COVID-19. The autologous transplantation of MSCs helps to suppress cytokine storm and systemic inflammation. Inhibition of systemic cytokine release could prevent poor outcomes, especially mortality and morbidities in the mentioned patients.

Abstract TP32: Endovascular Therapy for Acute Ischemic Stroke Beyond the 6 Hour Window

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Yi Mao ◽  
Sameer Sharma ◽  
Hesham Masoud ◽  
Julius G Latorre
Keyword(s):  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Endovascular Therapy ◽  
Current Data ◽  
Posterior Circulation ◽  
Published Data ◽  
Advanced Imaging ◽  
Poor Outcomes ◽  
Mr Clean ◽  
Insight Into

Background: Recent randomized trials demonstrated the efficacy of endovascular therapy (EVT) in managing acute ischemic stroke (AIS), though EVT was initiated <6 hours from time last seen well in nearly all patients, and posterior circulation strokes were excluded. Current data is limited for patients receiving EVT >6 hours, and more so for those with posterior circulation strokes. We aim to assess safety and clinical outcome of EVT in patients presenting >6 hours, with anterior or posterior circulation strokes. Methods: We conducted a retrospective review of patients with AIS receiving EVT >6 hours between 2012-2015, including those with unknown time of onset and wake-up strokes. Outcomes observed include mRS at ≥90 days, rates of recanalization (TICI 2b-3), sICH and mortality. Results: A total of 34 patients were identified presenting with AIS and receiving EVT >6 hours, including 25 anterior and 9 posterior circulation strokes. See Table 1 for comparison with published data from recent EVT trials. Conclusion: Our results are not significantly different from some of the recent trials. MR CLEAN, the only trial that did not employ advanced imaging in patient selection, had similar outcomes. The IV-tPA only groups of recent trials (where data is available) also produced comparable results. It should be noted that the patients in our study all have large vessel occlusions and high NIHSS, are mostly ineligible for tPA, and thus would be expected to have very poor outcomes without treatment. Our data supports the possibility of expanding the EVT window to >6 hours, and with advanced imaging screening, better rates of functional outcome/mortality may still be achieved. DAWN and DEFUSE3 trials currently underway should provide further insight into this subject.

Abstract 355: Performance of Inclusion and Exclusion Criteria Based on Prognosis in an Interventional Out-of-Hospital Cardiac Arrest Study

Circulation ◽  
2018 ◽  
Vol 138 (Suppl_2) ◽  
Author(s):  
Nick Krehel ◽  
Clifton W Callaway ◽  
Ankur Doshi ◽  
Jonathan Elmer ◽  
Francis X Guyette ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Poor Prognosis ◽  
Tertiary Care ◽  
Good Prognosis ◽  
Spontaneous Circulation ◽  
Relative Paucity ◽  
Poor Outcomes ◽  
Cardiac Arrest Study ◽  
Tertiary Care Centers ◽  
Hospital Cardiac Arrest

Introduction: Selection of out-of-hospital cardiac arrest (OHCA) patients for inclusion in randomized control trials (RCT) presents a challenge. The goal is to enroll patients with severe injury warranting intervention yet exclude those with extreme irreversible disease. Selection early after return of spontaneous circulation (ROSC) is complicated by a relative paucity of prognostic variables. We examined the accuracy of enrollment criteria in the iNO OHCA study (NCT03079102) in excluding patients likely to have good or poor outcomes within three hours (3h) of ROSC. Methods: OHCA patients arriving to two tertiary care centers in Pittsburgh were screened within 3h of ROSC. We excluded subjects that followed commands (good prognosis expected) and subjects expected to have poor prognosis based on: Full Outline of UnResponsiveness Brainstem (FOUR B) score <2; CPR time >40 min; investigator estimate of >95% mortality; CT evidence of cerebral edema or intracranial hemorrhage; clinical evidence of myoclonic status epilepticus; or traumatic OHCA etiology. We also excluded subjects not within 3h of ROSC. We compared discharge survival and good neurologic outcome based on disposition (location). Results: Over a nine-month period we screened 155 patients with ROSC following OHCA, 20 subjects (13%) were included in the study and 135 (87%) were excluded ( Table ). The odds ratio (OR) of survival if excluded for poor prognosis was 0.03 (95% CI: 0.01 - 0.08) and worsened when >1 criteria were met. Exclusion for good prognosis was associated with improved survival (OR = 67.2 [95% CI: 14.3 - 316.3]). Conclusions: Our criteria reliably exclude OHCA subjects with good or poor prognosis within 3h of ROSC, yielding a study population with intermediate survival which can be applicable to future OHCA trials. Our criteria selected a minority (13%) of OHCA patients likely to benefit from intervention while reserving resources.

scholarly journals Weather the Cytokine Storm: A Report of Successful Management of a Colon Cancer Survivor and a Critically Ill Patient with COVID-19

2020 ◽  
Vol 13 (2) ◽  
pp. 754-759
Author(s):  
Mansoor Khalid ◽  
Tarek Dernaika ◽  
Lirin Jacob ◽  
Pavan Annamaraju ◽  
Achuta K. Guddati
Keyword(s):  
Critically Ill ◽  
Cancer Survivor ◽  
Critically Ill Patient ◽  
Cytokine Storm ◽  
Ventilator Support ◽  
X Ray ◽  
Chest X Ray ◽  
Underlying Mechanisms ◽  
Poor Outcomes

Patients with novel corona virus infection (COVID-19) can develop acute respiratory failure secondary to acute respiratory distress syndrome. Cytokine storm is suggested as one of underlying mechanisms for the rapid clinical decline. Immunocompromised patients and cancer patients are at particular risk for poor outcomes due to COVID-19 infection. This case report describes the presentation and clinical course of a cancer survivor who became critically ill and required mechanical ventilation. The patient was treated with hydroxychloroquine, azithromycin, and ceftriaxone; however, he remained febrile, hypoxemic, continued to require full mechanical ventilator support and his chest X-ray showed increased bilateral infiltrates. The patient was treated with tocilizumab, after which he improved and was successfully extubated. This report illustrates a possible role of tocilizumab in management of cytokine storm in critically ill patients with COVID-19 infection.

scholarly journals Harnessing the immune system to overcome cytokine storm and reduce viral load in COVID-19: a review of the phases of illness and therapeutic agents

2020 ◽  
Vol 17 (1) ◽  
Author(s):  
Sumanth Khadke ◽  
Nayla Ahmed ◽  
Nausheen Ahmed ◽  
Ryan Ratts ◽  
Shine Raju ◽  
...  
Keyword(s):  
Immune System ◽  
Viral Replication ◽  
Tissue Injury ◽  
Phase 1 ◽  
Therapeutic Interventions ◽  
World Health ◽  
Published Data ◽  
Cytokine Storm ◽  
Host Interactions ◽  
Immunological Mechanisms

Abstract Background Coronavirus disease 2019 (COVID-19) is caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2, previously named 2019-nCov), a novel coronavirus that emerged in China in December 2019 and was declared a global pandemic by World Health Organization by March 11th, 2020. Severe manifestations of COVID-19 are caused by a combination of direct tissue injury by viral replication and associated cytokine storm resulting in progressive organ damage. Discussion We reviewed published literature between January 1st, 2000 and June 30th, 2020, excluding articles focusing on pediatric or obstetric population, with a focus on virus-host interactions and immunological mechanisms responsible for virus associated cytokine release syndrome (CRS). COVID-19 illness encompasses three main phases. In phase 1, SARS-CoV-2 binds with angiotensin converting enzyme (ACE)2 receptor on alveolar macrophages and epithelial cells, triggering toll like receptor (TLR) mediated nuclear factor kappa-light-chain-enhancer of activated B cells (NF-ƙB) signaling. It effectively blunts an early (IFN) response allowing unchecked viral replication. Phase 2 is characterized by hypoxia and innate immunity mediated pneumocyte damage as well as capillary leak. Some patients further progress to phase 3 characterized by cytokine storm with worsening respiratory symptoms, persistent fever, and hemodynamic instability. Important cytokines involved in this phase are interleukin (IL)-6, IL-1β, and tumor necrosis factor (TNF)-α. This is typically followed by a recovery phase with production of antibodies against the virus. We summarize published data regarding virus-host interactions, key immunological mechanisms responsible for virus-associated CRS, and potential opportunities for therapeutic interventions. Conclusion Evidence regarding SARS-CoV-2 epidemiology and pathogenesis is rapidly evolving. A better understanding of the pathophysiology and immune system dysregulation associated with CRS and acute respiratory distress syndrome in severe COVID-19 is imperative to identify novel drug targets and other therapeutic interventions.

Tympanoplasty Results in Patients with Cleft Palate: An Age- and Procedure-Matched Comparison of Preliminary Results with Patients without Cleft Palate

2002 ◽  
Vol 126 (5) ◽  
pp. 518-523 ◽  
Author(s):  
Edward Gardner ◽  
John L. Dornhoffer
Keyword(s):  
Cleft Palate ◽  
Published Data ◽  
Otologic Surgery ◽  
Significant Difference ◽  
Cleft Palate Repair ◽  
Palate Repair ◽  
Poor Outcomes ◽  
Matched Comparison ◽  
And Control ◽  
Palate Patient

OBJECTIVE: Because of continued eustachian tube abnormalities, the presence of a cleft palate repair has been thought to be associated with poor outcomes after tympanoplastic surgery. However, little published data exist regarding the results of major otologic surgery in patients with cleft palate. The objective of this study was to review our results of otologic surgery in these patients and compare results with those of age- and procedure-matched controls. METHODS: Our otologic database was used to identify patients with a repaired cleft palate who underwent otologic surgery between March 1994 and December 1999. Two control patients were identified for each cleft palate patient. Results of hearing, graft take, and need for postoperative pressure-equalizing tubes were compared. RESULTS: No significant difference existed between patients with a repaired cleft palate and control patients with regard to postoperative air-bone gap ( P = 0.6805), graft survival rate ( P = 1.00), and need for postoperative intubation ( P = 0.457). CONCLUSION: Results in patients with cleft palate appear to be similar to those in patients without cleft palate.

scholarly journals Prognostic value of cytokines in COVID-19 associated pneumonia

2021 ◽  
Vol 13 (1) ◽  
pp. 59-69
Author(s):  
Olga Yu. Tkachenko ◽  
Margarita Yu. Pervakova ◽  
Sergey V. Lapin ◽  
Aleksandra V. Mazing ◽  
Darya A. Kuznetsova ◽  
...  
Keyword(s):  
High Risk ◽  
Prognostic Value ◽  
Roc Analysis ◽  
Area Under The Curve ◽  
Superior Performance ◽  
Cytokine Storm ◽  
Point Scale ◽  
Single Marker ◽  
Commercial Kits ◽  
Poor Outcomes

BACKGROUND: Coronavirus disease 2019 (COVID-19) is often complicated by cytokine storm syndrome. Although many interleukins (IL) have predictive value, the sensitivity and specificity of a single marker is limited. AIM: The purpose of the study is to develop an objective and informative cytokine storm scale for assessing the risk of developing a critical course in patients with COVID-19 associated pneumonia. MATERIALS AND METHODS: A total of 226 cases of COVID-19 were investigated, 36 (16 %) of which were with poor outcomes. The cytokines IL-1b, IL-2, IL-6, IL-8, IL-10, IL-18, TNF-, IFN, IFN- were studied by enzyme immunoassay, commercial kits manufactured by Vector-Best, RF. RESULTS: Since IL-6, IL-10, IL-18, and procalcitonin were associated with disease severity and death, these indicators were integrated into a 12-point scale called the cytokine storm scale. The patients who scored more than 6 points had a high risk of a poor outcome of the disease. According to ROC analysis, the area under the curve for the cytokine storm scale was larger than for each of the four markers separately [AUC 0.90 (95% CI 0.84550.9592), p 0.001]. CONCLUSIONS: Thus, the cytokine storm scale system presents superior performance in determining patients with favorable and fatal outcomes to each individual cytokine.

scholarly journals First Clinical Use of Lenzilumab to Neutralize GM-CSF in Patients with Severe and Critical COVID-19 Pneumonia

2020 ◽  
Author(s):  
Zelalem Temesgen ◽  
Mariam Assi ◽  
Paschalis Vergidis ◽  
Stacey A. Rizza ◽  
Philippe R. Bauer ◽  
...  
Keyword(s):  
Adverse Events ◽  
Myeloid Cells ◽  
Patient Characteristics ◽  
Cytokine Storm ◽  
Gm Csf ◽  
Cytokine Analysis ◽  
Single Use ◽  
Macrophage Colony Stimulating Factor ◽  
Macrophage Colony ◽  
Poor Outcomes

ABSTRACTBackgroundIn COVID-19, high levels of granulocyte macrophage-colony stimulating factor (GM-CSF) and inflammatory myeloid cells correlate with disease severity, cytokine storm, and respiratory failure. With this rationale, we used lenzilumab, an anti-human GM-CSF monoclonal antibody, to treat patients with severe and critical COVID-19 pneumonia.MethodsHospitalized patients with COVID-19 pneumonia and risk factors for poor outcomes were treated with lenzilumab 600 mg intravenously for three doses through an emergency single-use IND application. Patient characteristics, clinical and laboratory outcomes, and adverse events were recorded. All patients receiving lenzilumab through May 1, 2020 were included in this report.ResultsTwelve patients were treated with lenzilumab. Clinical improvement was observed in 11 out of 12 (92%), with a median time to discharge of 5 days. There was a significant improvement in oxygenation: The proportion of patients with SpO2/FiO2 < 315 at the end of observation was 8% vs. compared to 67% at baseline (p=0.00015). A significant improvement in mean CRP and IL-6 values on day 3 following lenzilumab administration was also observed (137.3 mg/L vs 51.2 mg/L, p = 0.040; 26.8 pg/mL vs 16.1 pg/mL, p = 0.035; respectively). Cytokine analysis showed a reduction in inflammatory myeloid cells two days after lenzilumab treatment. There were no treatment-emergent adverse events attributable to lenzilumab, and no mortality in this cohort of patients with severe and critical COVID-19 pneumonia.ConclusionsIn high-risk COVID-19 patients with severe and critical pneumonia, GM-CSF neutralization with lenzilumab was safe and associated with improved clinical outcomes, oxygen requirement, and cytokine storm.

scholarly journals Profiling COVID-19 pneumonia progressing into the cytokine storm syndrome: results from a single Italian Centre study on tocilizumab versus standard of care

2020 ◽  
Author(s):  
Luca Quartuccio ◽  
Arianna Sonaglia ◽  
Dennis McGonagle ◽  
Martina Fabris ◽  
Maddalena Peghin ◽  
...  
Keyword(s):  
Inflammatory Markers ◽  
Conflicts Of Interest ◽  
Standard Of Care ◽  
Good Prognosis ◽  
Care Group ◽  
List Type ◽  
Cytokine Storm ◽  
Prognostic Features ◽  
The Impact ◽  
Bacterial Superinfection

AbstractObjectiveApproximately 5% of patients with coronavirus disease 2019 (COVID-19) develop a life-threatening pneumonia that often occurs in the setting of increased inflammation or “cytokine storm”. Anti-cytokine treatments are being evaluated but optimal patient selection remains unclear, and the aim of our study is to address this point.MethodsBetween February 29 to April 6, 2020, 111 consecutive hospitalized patients with COVID-19 pneumonia were evaluated in a single centre retrospective study. Patients were divided in two groups: 42 severe cases (TOCI) with adverse prognostic features including raised CRP and IL-6 levels, who underwent anti-cytokine treatments, mostly tocilizumab, and 69 standard of care patients (SOC).ResultsIn the TOCI group, all received anti-viral therapy and 40% also received glucocorticoids. In TOCI, 62% of cases were ventilated and there were 3 deaths (17.8±10.6 days, mean follow up) with 7/26 cases remaining on ventilators, without improvement, and 17/26 developed bacterial superinfection. One fatality occurred in the 15 TOCI cases treated on noninvasive ventilation and 1 serious bacterial superinfection. Of the 69 cases in SOC, there was no fatalities and no bacterial complications. The TOCI group had higher baseline CRP and IL-6 elevations (p<0.0001 for both) and higher neutrophils and lower lymphocyte levels (p= 0.04 and p=0.001, respectively) with the TOCI ventilated patients having higher markers than non-ventilated TOCI patients.ConclusionHigher inflammatory markers, more infections and worse outcomes characterized ventilated TOCI cases compared to ward based TOCI. Despite the confounding factors, this suggests that therapy time in anti-cytokine randomized trials will be key.FundingThis research received no external funding.Conflicts of Interest“The authors declare no conflict of interest.”HighlightsThere is an urgent need for markers of prognosis in COVID-19.Higher inflammatory markers best select tocilizumab treatment.The ward based tocilizumab group showed better responses and less infections than ICU tocilizumab group.The former group may be the best for evaluating the impact of anti-cytokine therapy in COVID-19.The known poor risk factors for COVID-19 infection were present in the TOCI treated rather than in the good prognosis standard of care group.

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