scholarly journals Ko-infeksi Jamur pada COVID-19 dengan Terapi Steroid

2020 ◽  
Vol 12 (3) ◽  
pp. 49-56
Author(s):  
Septian Adi Permana ◽  
Adhrie Sugiarto ◽  
Muhammad Husni Thamrin ◽  
Purwoko Purwoko ◽  
Arifin Arifin ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Virus Disease ◽  
High Sensitivity ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Corona Virus

Latar belakang: Ko-infeksi jamur pada pasien Corona Virus Disease 2019 (COVID-19) acapkali terjadi. Hal itu dikarenakan kegagalan sistem imun karena infeksi COVID-19 maupun karena pengobatan anti inflamasi yang diberikan.Kasus: Seorang laki-laki 39 tahun dengan acute respiratory distress syndrome (ARDS) berat akibat infeksi COVID-19 dan disertai dengan ko-infeksi jamur. Pasien ini mendapatkan pengobatan steroid dari awal masuk dan pada hari ke-6 hasil kultur sputumnya menunjukkan adanya ko-infeksi jamur. Pasien ini memiliki komorbid berupa riwayat diabetes mellitus. Dari pemeriksaan fisik ditemukan dispnea, takipnea, takikardia sejak hari pertama. Dari hasil laboratorium menunjukkan angka leukosit, high sensitivity c-reactive protein (HsCRP), serum glutamic oxaloacetic (SGOT), gula darah, d-dimmer, lactat dehydrogenase (LDH) dan limfosit netrophyl ratio (LNR) yang tinggi. Pada pasien ini didapatkan rasio PaO2 / FiO2 rendah dan procalcitonin (PCT) yang normal. Dari kultur sputum ditemukan adanya infeksi jamur dan dari hasil rontgen toraks (CXR) menunjukkan pneumonia bilateral. Pasien ini dirawat dengan terapi standar dan mendapatkan dexametason 5 mg / 8 jam, setelah kultur sputum menunjukkan infeksi jamur, pasien juga mendapat mycafungin untuk pengobatan jamurnya.Diskusi: Kecurigaan terhadap ko-infeksi jamur pada pasien COVID-19 yang mendapatkan terapi steroid dalam jangka waktu lama maupun adanya penyerta diabetes harus dipikirkan. Penggunaan terapi anti jamur empiris pun acapkali diperlukan untuk mengurangi morbiditas dan mortalitas.Kesimpulan: Infeksi COVID-19 memiliki risiko terjadinya ko-infeksi, salah satunya adalah infeksi jamur. Insiden koinfeksi jamur diperberat dengan pemberian pengobatan steroid dan riwayat diabetes mellitus. 

scholarly journals Predictors of Mortality Among COVID-19 Patients With or Without Comorbid Diabetes Mellitus

2021 ◽  
Author(s):  
Seyedreza Mirsoleymani ◽  
Erfan Taherifard ◽  
Ehsan Taherifard ◽  
Mohammad Hossein Taghrir ◽  
Milad Ahmadi Marzaleh ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Acute Respiratory Distress Syndrome ◽  
Serum Creatinine ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Neutrophil Count ◽  
Distress Syndrome ◽  
Diabetic Patients ◽  
C Reactive Protein ◽  
Reactive Protein

Late in 2019, the first case of COVID-19 was detected in China, and the disease caused a pandemic state worldwide. Up to now, many studies have investigated the impact of comorbid diseases, especially diabetes mellitus, on COVID-19 outcomes. In this study, we aimed to assess the para-clinic characteristics of COVID-19 patients with or without diabetes mellitus to identify factors indicative of poor prognoses. In this prospective study, 153 in-patients with COVID-19 were followed up from 1 March to 19 April. Paraclinical information of these patients was gathered from their medical records. Afterward, the association between these factors among both diabetic and non-diabetic patients was assessed in the correlation analyses. Discharge and expiration of 77.1% and 22.9% of the study participants resulted in a 1063 person-day follow-up for patients who were discharged healthily and 384 person-day follow-ups for expired patients. 41.8% of the participants had diabetes mellitus. Lymphocytopenia and Neutrolhilia prevalences increased during hospitalization; comparing with their initial prevalences. Thirty-seven patients got acute respiratory distress syndrome; of those, 35 died. The mean of the initial C reactive protein level was 42.49, and serum creatinine of 1.39. The study showed that higher initial neutrophil count, increasing neutrophil count more than 15000 and decreasing lymphocyte count below 1000 during hospitalization; development of acute respiratory distress syndrome and being intubated; initial C reactive protein and serum creatinine level were associated with higher mortality rates in COVID-19 victims.

scholarly journals Combined effects of Tocilizumab and Remdesivir in severe COVID- 19 patient with cytokine release syndrome: A case-report (Preprint)

2021 ◽  
Author(s):  
Sabahat Ali ◽  
Sundas Khalid ◽  
Maham Afridi ◽  
Samar Akhtar ◽  
Yousef S. Khader ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Severe Acute Respiratory Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Virus Disease ◽  
Cytokine Release ◽  
Cytokine Release Syndrome ◽  
Treatment Regimens ◽  
Corona Virus

BACKGROUND Novel corona virus (nCoV) or Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is known to cause severe bilateral pneumonia and acute respiratory distress syndrome (ARDS) or Corona virus disease-2019 (COVID-19) in patients that can be debilitating and even fatal. With no drugs or vaccines available yet, a wide range of treatment regimens used are being repurposed. The need of the hour is to analyze various regimens available and devise a treatment plan most effective against SARS-CoV-2. OBJECTIVE Patient concerns: A 68-year-old hypertensive, diabetic male, exhibiting symptoms of cough and shortness of breath presented at the emergency department of our hospital. Diagnosis: Chest CT revealed bilateral ground glass opacities indicative of COVID-19 and the CT score of 24 indicated severe pulmonary pneumonia. He tested positive for COVID-19. METHODS Interventions: The treatment regimen included use of convalescent plasma, oxygen therapy, steroids, high dose antibiotics, broad spectrum antiviral Remdesivir, and anti-interleukin-6 monoclonal antibody/Tocilizumab at various stages of the disease. RESULTS Outcomes: Oxygen support was required at the time of admission. The patient initially developed cytokine release storm and mechanical ventilation was used to manage his condition. Supportive care and multiple treatment regimens were used to successfully recover the patient’s health. CONCLUSIONS Lessons: With a rapid increase in number of confirmed cases worldwide, COVID-19 has become a major challenge to our healthcare system. With no available vaccines currently, finding a combination of therapeutic drugs which are effective in reducing progression of disease is of utmost importance. CLINICALTRIAL Abbreviations:COVID-19=Corona virus disease 2019, nCoV=Novel corona virus (nCoV), SARS-CoV-2=Severe acute respiratory syndrome coronavirus 2, ARDS=acute respiratory distress syndrome, RT PCR= real-time polymerase chain reaction, SPO2= oxygen saturation, ICU=Intensive Care Unit, GGO=ground glass opacities, TDS=thrice daily, OD=once daily, BD= twice daily, CRS= cytokine release syndrome, CPAP=continuous positive airway pressure,FiO2= fraction of inspired oxygen, PEEP=positive end-expiratory pressure, PSV= pressure support ventilation.

Abstract 2693: An Inflammatory Paradox in Acute Respiratory Distress Syndrome? Plasma C-reactive Protein Concentrations are Strongly Associated with Survival in ARDS

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
James L Januzzi ◽  
Ednan Bajwa ◽  
Uzma Khah ◽  
Michelle Gong ◽  
B. T Thompson ◽  
...  
Keyword(s):  
Experimental Data ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Organ Dysfunction ◽  
Systemic Inflammation ◽  
Distress Syndrome ◽  
Protective Role ◽  
C Reactive Protein ◽  
Reactive Protein

C-reactive protein (CRP) is a marker of systemic inflammation, and potently predicts adverse outcome in a number of diseases, but little is known about its characteristics in Acute Respiratory Distress Syndrome (ARDS). Experimental data suggest CRP may play a protective role in alveolitis; clinical correlates are lacking. We measured CRP in 177 patients within 48 hours of ARDS onset and tested the association of protein level with 60-day mortality, 28-day daily organ dysfunction scores, and number of ventilator-free days. CRP was significantly lower in non-survivors when compared with survivors (176.5 [IQR 173.0] vs.133.5 [IQR 161.0] mg/L; P = .02). Mortality rate decreased with increasing C-reactive protein decile ( P = .02). After adjustment for age, APACHE score, and relevant covariates in a multivariable model, plasma CRP concentrations independently and potently predicted survival in ARDS (Hazard ratio=0.996; P = .009). When stratified into groups by higher or lower CRP level, patients with CRP had significantly higher probability of survival at 60 days ( P = .005). Also, patients with higher CRP levels had lower organ dysfunction scores ( P = .001) and more ventilator-free days ( P = .02). Consistent with experimental data suggesting a possible protective role of CRP in experimental alveolitis, higher plasma levels of CRP within 48 hours of ARDS are associated with improved survival, lower organ failure scores, and fewer days of mechanical ventilation. These data appear to be contrary to the established view of CRP solely as a non-specific marker of systemic inflammation, and raise the potential for a therapeutic role for CRP in ARDS.

scholarly journals Penggunaan Heparin Dosis Tinggi pada Pasien COVID-19 dengan ARDS dan Hipertensi di Unit Perawatan Intensif (ICU)

2020 ◽  
Vol 12 (3) ◽  
pp. 1-8
Author(s):  
Taufik Eko Nugroho ◽  
Mochamat Mochamat ◽  
Famila Famila
Keyword(s):  
Intensive Care Unit ◽  
Acute Respiratory Distress Syndrome ◽  
Intensive Care ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Virus Disease ◽  
Corona Virus ◽  
D Dimer

Latar Belakang: Corona Virus Disease 2019 (COVID-19), pertama kali dilaporkan pada bulan Desember 2019 di Cina, merupakan penyakit yang disebabkan oleh virus SARS-CoV-2 yang menyebar lebih cepat pada populasi manusia dan dalam waktu singkat berkembang menjadi pandemi di seluruh dunia. Sebagian besar kasus yang berujung pada kematian dilaporkan terkomplikasi dengan koagulopati dan disseminated intravascular cogulation (DIC).Kasus: Seorang laki-laki terkonfirmasi positif COVID-19 berusia 50 tahun dengan sesak, batuk dan demam dan komorbiditas hipertensi dirujuk ke intensive care unit (ICU), selama di ICU pasien mendapat terapi heparin dengan dosis terapi dengan melihat kadar aPTT. Setelah perawatan intensif selama 14 hari, pasien mengalami perbaikan yang signifikan.Pembahasan: Pasien dengan infeksi COVID-19 yang progresif dan parah dengan acute respiratory distress syndrome (ARDS) seringkali ditemukan dengan kadar D-dimer dan fibrinogen yang sangat tinggi, yang berujung pada keadaan hiperkoagulasi. Penggunaan antikoagulan untuk pasien dengan COVID-19 yang parah telah. Banyak institusi telah menerapkan penggunaan antikoagulan dosis penuh secara empiris berdasarkan risiko venous thrombo embolism (VTE) dan insiden rendah perdarahan (3-5%).Kesimpulan: Penggunaan antikoagulan, khususnya unfractionatedheparin (UFH) dengan dosis lebih tinggi, direkomendasikan untuk pasien dengan COVID-19 yang parah, meskipun belum ada panduan yang mutlak. 

scholarly journals Patients with acute respiratory distress syndrome due to pandemic Coronavirus disease 2019 (COVID-19)

2021 ◽  
Vol 2 (3) ◽  
Author(s):  
Julia Seeger ◽  
◽  
Volker Wenzel ◽  
Jochen Wöhrle ◽  
◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Troponin T ◽  
Prone Positioning ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
High Sensitive Troponin

We report on a case study of patients with Coronavirus disease 2019 (COVID-19). Evaluation of factors predicting outcome in patients with COVID-19 are very important. Both patients developed respiratory failure complicated by acute respiratory distress syndrome. Patients were intubated and invasively ventilated, underwent prone positioning and careful ventilation according to criteria for acute respiratory distress syndrome. In addition, biomarkers were daily evaluated including C-reactive protein, d-dimer and high-sensitive troponin T. Although treatment did not differ between patients, one patient survived whereas the other one died. The patient who survived had a faster onset of invasive ventilation with prone positioning, a lower maximal level of C-reactive protein and a lower value of high-sensitive troponin T. The use of mechanical ventilation in combination with a high PEEP and an early start of prone positioning in patients with severe ARDS may be beneficial. The values of C-reactive protein and troponin T levels seems to be predictive for the clinical course. Keywords: Coronavirus disease 2019; COVID-19; Troponin; C-reactive protein; Mechanical ventilation.

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