scholarly journals Impact of three consecutive intravenous doses of tocilizumab in severe COVID-19 pneumonia: a retrospective cohort study

2021 ◽  
Vol 1 ◽  
pp. e1251
Author(s):  
Raihan Rabbani ◽  
Md Jahidul Hasan ◽  
Ahmad Mursel Anam ◽  
Shihan Mahmud Redwanul Huq
Keyword(s):  
Mortality Rate ◽  
Clinical Outcomes ◽  
Distress Syndrome ◽  
Invasive Mechanical Ventilation ◽  
Supplemental Oxygen ◽  
Intravenous Dose ◽  
Blood Oxygen ◽  
Blood Oxygen Saturation ◽  
Ventilation Support ◽  
Mechanical Ventilation Support

Background. Acute respiratory distress syndrome (ARDS) in severe COVID-19 pneumonia is mostly responsible for high mortality rate. Tocilizumab, an interleukin-6 (IL-6) inhibitors, down-regulates the progression of cytokine storm leading to ARDS. Objectives. The study aimed to assess the clinical outcomes of three consecutive intravenous doses of tocilizumab in patients with severe COVID-19 pneumonia. Methods. This retrospective observational study was conducted on severe COVID-19 pneumonia patients in a single-center who were treated with three intravenous dose of tocilizumab (8 mg/Kg of body weight, max 800 mg per dose × 3) along with intravenous dexamethasone. Three doses of tocilizumab-associated changes in respiratory function, clinical outcomes and mortality rate were analyzed. Results. Seventy-four patients (N) received intravenous tocilizumab therapy. After third intravenous dose of tocilizumab (48-72 h apart from the second dose), SpO2 (blood oxygen saturation) was increased and the requirement of supplemental oxygen (RSO) was decreased more than after the second dose [Median: 96.5% (IQR: 96-98%) and Median: 0 (IQR: 0-1 L), respectively versus Median: 92% (IQR: 91-92%) and Median: 6 L (IQR: 5-7.2 L, respectively] (P <0.05). SpO2 was normalized in 78.4% of patients (P=0.001) treated with three doses of tocilizumab. Further RSO and demand of invasive mechanical ventilation support were increased in 21.6% (58/74 patients) and 14.8% (11/74 patients) of patients, respectively with a 30-day mortality rate of 4% (3/74 patients). Tocilizumab therapy was well tolerated in all patients. Conclusions. An additional third intravenous dose of tocilizumab improved clinical outcomes and reduced mortality rate in patients with severe COVID-19 pneumonia.

scholarly journals Automatic Oxygen Delivery System for Premature Babies

2010 ◽  
Vol 4 (2) ◽  
Author(s):  
Thao P. Do ◽  
Lindsey J. Eubank ◽  
Devin S. Coulter ◽  
John M. Freihaut ◽  
Carlos E. Guevara ◽  
...  
Keyword(s):  
Oxygen Saturation ◽  
Oxygen Concentration ◽  
Delivery System ◽  
Pulse Oximeter ◽  
Oxygen Delivery ◽  
Supplemental Oxygen ◽  
Saturation Level ◽  
Blood Oxygen ◽  
Blood Oxygen Saturation ◽  
Oxygen Saturation Level

When an infant is born prematurely, there are a number of health risks. Among these are underdeveloped lungs, which can lead to abnormal gas exchange of oxygen or hypoxemia. Hypoxemia is treated through oxygen therapy, which involves the delivery of supplemental oxygen to the patient but there are risks associated with this method. Risks include retinopathy, which can cause eye damage when oxygen concentration is too high, and brain damage, when the concentration is too low [1]. Supplemental oxygen concentration must be controlled rigorously. Currently healthcare staff monitors infants’ blood oxygen saturation level using a pulse oximeter. They manually adjust the oxygen concentration using an air-oxygen blender. Inconsistent manual adjustments can produce excessive fluctuations and cause the actual oxygen saturation level to deviate from the target value. Precision and accuracy are compromised. This project develops an automatic oxygen delivery system that regulates the supplemental oxygen concentration to obtain a target blood oxygen saturation level. A microprocessor uses a LABVIEW® program to analyze pulse oximeter and analyzer readings and control electronic valves in a redesigned air-oxygen blender. A user panel receives a target saturation level, displays patient data, and signals alarms when necessary. The prototype construction and testing began February 2010.

Spinal cord infarction in a young patient with methamphetamine abuse

2021 ◽  
Vol 14 (3) ◽  
pp. e241031
Author(s):  
Seek Yang Lee ◽  
Irene Looi ◽  
Mahedzan Mat Rabi ◽  
Mohamed Azlam Mohamed Micdhadhu
Keyword(s):  
Spinal Cord ◽  
Invasive Mechanical Ventilation ◽  
Sudden Onset ◽  
Spinal Cord Infarction ◽  
High Signal ◽  
Limb Weakness ◽  
Thoracic Level ◽  
Lower Limb Weakness ◽  
Ventilation Support ◽  
Mechanical Ventilation Support

We report a case of a 20-year-old man who was diagnosed with spontaneous spinal cord infarction after abusing methamphetamine for a year. He presented with sudden onset of bilateral upper and lower limb weakness. His MRI spine showed a long segment of high signal intensity seen predominantly in the anterior spinal cord from medulla to mid thoracic level as well as a pencil-like hyperintensity seen postcontrast suggestive of spinal cord ischaemia or infarct. Thus, he was empirically treated for presumed anterior spinal cord infarction. He then developed autonomic dysfunction and went into respiratory distress, which required invasive mechanical ventilation support. Subsequently, he developed cardiac arrythmia with supraventricular tachycardiac followed by asystole and succumbed to illness on day 9 despite maximal resuscitative efforts. This case report illustrates a rare spinal cord infarction caused by methamphetamine intoxication and the importance of identifying and treating it early.

Hyperoxia, hyperglycemia, and photoreceptor sensitivity in normal and diabetic subjects

2006 ◽  
Vol 23 (3-4) ◽  
pp. 651-661 ◽  
Author(s):  
ANNE KURTENBACH ◽  
HELMUT M. MAYSER ◽  
HERBERT JÄGLE ◽  
ANDREAS FRITSCHE ◽  
EBERHART ZRENNER
Keyword(s):  
Dark Adaptation ◽  
Normal Subjects ◽  
Supplemental Oxygen ◽  
Serum Glucose ◽  
Control Group ◽  
Diabetic Patients ◽  
Blood Oxygen ◽  
Blood Oxygen Saturation ◽  
Test Spot ◽  
Cone Sensitivity

The aim of this study was to investigate the effects of an increase in the saturation of blood oxygen (SaO2) and/or serum glucose on photoreceptor sensitivity in normal subjects and in patients with diabetes mellitus. We monitored cone and rod sensitivity by recording dark-adaptation curves to both green and red test stimuli while inhaling either air (20% O2 + 80% N2) or 100% oxygen in 12 normal subjects and 12 diabetic patients with no (10) or mild (2) retinopathy. We also repeated the experiment in 10 of the normal subjects under hyperglycemia (mean serum glucose: 161 mg/dl). Results show that in normal subjects the dark-adapted cone sensitivity is improved by an increase in SaO2 or by hyperglycemia. Final rod sensitivity is unchanged during hyperoxia and during hyperglycemia when measured with a green test spot. However the kinetics of dark adaptation are altered during hyperglycemia, and an increase in final sensitivity is observed when measured with the red test spot. Inhalation of oxygen during hyperglycemia in normal subjects reduces cone sensitivity compared to that found during hyperglycemia alone (Pasteur effect). In diabetic subjects the dark-adapted cone threshold is comparable to that found in normal subjects, and sensitivity also increases with an increase in SaO2. The final rod threshold, however, is impaired compared to that of the control group, and rod sensitivity is improved by increasing the SaO2. The results suggest that the metabolism of rods and cones may differ in normal subjects: in cones, the rate of metabolism can be augmented by increasing the available oxygen or glucose, whereas rods appear more insensitive to increased blood oxygen saturation and hyperglycemia. In diabetic subjects, both cone and rod metabolism can be increased by supplemental oxygen, indicative of an early rod deficit. The study lends weight to the hypothesis that dark-adapted rods in diabetics are hypoxic before the onset of retinopathy.

scholarly journals Additional baricitinib loading dose improves clinical outcome in COVID-19

Open Medicine ◽  
2020 ◽  
Vol 16 (1) ◽  
pp. 041-046
Author(s):  
Md Jahidul Hasan ◽  
Raihan Rabbani ◽  
Ahmad Mursel Anam ◽  
Shihan Mahmud Redwanul Huq
Keyword(s):  
Clinical Outcome ◽  
Janus Kinase ◽  
Control Group ◽  
Case Group ◽  
Loading Dose ◽  
Blood Oxygen Saturation ◽  
Oxygen Saturation Level ◽  
Ventilation Support ◽  
Mechanical Ventilation Support ◽  
Control Study

AbstractPneumonia associated with coronavirus disease 2019 (COVID-19) has been accounted for high mortality rate in severe COVID-19 worldwide, and additional serious scarcity of standard and effective anti-inflammatory drug in COVID-19 pneumonia management is a big challenge. Baricitinib, a Janus kinase (JAK) inhibitor, is a promising drug in COVID-19 pneumonia. This study aims to compare the clinical outcome of moderate-to-severe COVID-19 pneumonia treated with baricitinib with or without a loading dose. This prospective case-control study enrolled 37 adult patients where 17 patients (control) received baricitinib at 4 mg oral daily dose and 20 patients (case) received an additional single 8 mg oral loading dose. The median day to gain blood oxygen saturation level ≥95% (in room air) and return in normal breathing function were lower in case group than the control group. The requirement of intensive care unit and mechanical ventilation support was higher in the control group than in the case group [29.4% (N = 17)/10% (N = 20), P < 0.05; 11.8% (N = 17)/5% (N = 20), P > 0.05), respectively]. Thus, an additional loading dose of baricitinib revealed better clinical outcome of patients with COVID-19 pneumonia.

scholarly journals Association of hyperlipidemia and statin use with severity of COVID-19

2020 ◽  
Author(s):  
Wilnard YT Tan ◽  
Barnaby E Young ◽  
David Chien Lye ◽  
Daniel EK Chew ◽  
Rinkoo Dalan
Keyword(s):  
Clinical Outcomes ◽  
Statistical Tests ◽  
Statistical Significance ◽  
Invasive Mechanical Ventilation ◽  
Statin Treatment ◽  
Supplemental Oxygen ◽  
Logistic Regression Models ◽  
Icu Admission ◽  
Treatment Models ◽  
Statin Use

Abstract Background and Aims: We aim to study the association of hyperlipidemia and statin use with COVID-19 severity.Methods: We analysed a retrospective cohort of 717 patients admitted to a tertiary centre in Singapore for COVID-19 infection. Clinical outcomes of interest were oxygen saturation ≤94% requiring supplemental oxygen, intensive-care unit (ICU) admission , invasive mechanical-ventilation and death. Logistic regression models were used to study the association between hyperlipidemia and clinical outcomes adjusted for age, gender and ethnicity. Statin treatment effect was determined , in a nested case-control design, through logistic treatment models with 1:3 propensity matching for age, gender and ethnicity. All statistical tests were two-sided, and statistical significance was taken as p < 0.05.Results: One hundred fifty-six (21.8%) patients had hyperlipidemia and 97% were on statins. There were no significant associations between hyperlipidemia and clinical outcomes. Logistic treatment models showed a lower chance of ICU admission for statin users when compared to non-statin users (ATET: b-0.12(-0.23,-0.01); p=0.028). There were no other significant differences in other outcomes.Conclusion: Treated hyperlipidemia was not an independent risk factor for severe COVID-19. Statin use independently associated with lower ICU admission. This supports current practice to continue prescription of statins in COVID-19 patients.

scholarly journals Management strategy for hematological malignancy patients with acute respiratory failure

2021 ◽  
Vol 26 (1) ◽  
Author(s):  
Li Jiang ◽  
Qunfang Wan ◽  
Hongbing Ma
Keyword(s):  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Management Strategy ◽  
Distress Syndrome ◽  
Hematological Malignancy ◽  
Invasive Mechanical Ventilation ◽  
Selection Procedure ◽  
Multiple Organ ◽  
Ventilation Support ◽  
Optimal Setting

AbstractAcute respiratory failure (ARF) is still the major cause of intensive care unit (ICU) admission for hematological malignancy (HM) patients although the advance in hematology and supportive care has greatly improved the prognosis. Clinicians have to make decisions whether the HM patients with ARF should be sent to ICU and which ventilation support should be administered. Based on the reported investigations related to management of HM patients with ARF, we propose a selection procedure to manage this population and recommend hematological ICU as the optimal setting to recuse these patients, where hematologists and intensivists can collaborate closely and improve the outcomes. Moreover, noninvasive ventilation (NIV) still has its own place for selected HM patients with ARF who have mild hypoxemia and reversible causes. It is also crucial to monitor the efficacy of NIV closely and switch to invasive mechanical ventilation at appropriate timing when NIV shows no apparent improvement. Otherwise, early IMV should be initiated to HM with ARF who have moderate and severe hypoxemia, adult respiratory distress syndrome, multiple organ dysfunction, and unstable hemodynamic. More studies are needed to elucidate the predictors of ICU mortality and ventilatory mode for HM patients with ARF.

Retrospective evaluation of critical geriatric and adult COVID-19 patients

2021 ◽  
pp. 79-82
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Geriatric Patients ◽  
Invasive Mechanical Ventilation ◽  
Adult Patients ◽  
Retrospective Evaluation ◽  
Intensive Care Patients ◽  
Significant Difference ◽  
Ventilation Support ◽  
Mechanical Ventilation Support

Background: 5% of cases in COVID 19 disease require hospitalization in an intensive care unit. COVID -19 has a high mortality rate in the intensive care unit (ICU). There are many factors that affect this. There is no study on whether aging is one of these factors for intensive care patients. Objective: With this study, the data of critical geriatric and adult COVID-19 patients we followed up in the covid intensive care unit were evaluated and it was aimed to recognize the characteristics of critically ill patients. Material and Method: The files of 70 geriatric and 67 adult patients followed in the COVID-19 ICU were scanned and evaluated. Results: When evaluated in terms of developing organ dysfunction, cardiac arrhythmia was found to be statistically significant in adult patients (P=.01). 53 (75%) of 70 geriatric patients and 45 (67.1%) of 67 adult patients required invasive mechanical ventilation support. Intensive care mortality was 74.2% (52) in geriatric patients and 67.1% (45) in adult patients. There was no significant difference between the two groups in terms of mortality. Conclusion: It turned out that old age and being an adult are not important in terms of mortality in COVID-19 patients who need to be followed up in the intensive care unit.

scholarly journals Impact of Comorbidities on Clinical Outcome of Patients with COVID-19: Evidence From a Single-center in Bangladesh

Health Scope ◽  
2021 ◽  
Vol In Press (In Press) ◽  
Author(s):  
Md Jahidul Hasan ◽  
Ahmad Mursel Anam ◽  
Shihan Mahmud Redwanul Huq ◽  
Raihan Rabbani
Keyword(s):  
Intensive Care Unit ◽  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Positive Association ◽  
Medical Data ◽  
Single Center ◽  
Increased Risk ◽  
Ventilation Support ◽  
Mechanical Ventilation Support ◽  
The Impact

Background: COVID-19 patients with preexisting comorbidities are at increased risk of exacerbated symptoms. Objectives: The current study aimed to firstly assess the impact of predisposed comorbidities on the severity of COVID-19, and secondly investigating the associated clinical outcome of patients with COVID-19 infection in Bangladesh. Methods: In this single-center retrospective study, the medical data of 157 hospitalized COVID-19 patients, including their preexisting comorbidities, from April 30, 2020, to June 15, 2020, are analyzed. Patients’ clinical outcomes in moderate-to-critical COVID-19 infections need for Intensive Care Unit (ICU) and mechanical ventilation support, and mortality were evaluated, with emphasis on predisposed chronic diseases. Results: Approximately 40.1 and 7.6% of patients (n = 157) presented severe and critical COVID-19 symptoms, respectively (P = 0.001). The most common comorbidity was diabeties (24.8%), followed by hypertension (23.2). Patients with one or two comorbidities did not present critical symptoms. Most of the critical cases had at least five comorbidities compared to those with 3 or 4 comorbidities (33.3% versus 8.3%; P = 0.038). The highest incidence of critical COVID-19 (41.7%) was among those with 7 comorbidities. Compared to patients with 4 or fewer comorbidities, patients with 5 (n = 15), 6 (n = 4), and 7 (n = 7) comorbidities were more hospitalized at ICU (above 70%, P = 0.025) and had a higher need for intubation support (above 60%, P = 0.038), and presented higher 30-day mortality (6.7, 25, and 28.6%, respectively; P = 0.002), which can be attributed to the declined clinical outcome of patients with 5 or more comorbidities in moderate-to-critical COVID-19 infection. Conclusions: This study demonstrated a positive association between the severity of COVID-19 and the number of predisposed comorbidities, which leads to poor clinical outcomes.

scholarly journals Statin use is associated with lower disease severity in COVID-19 infection

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Wilnard Y. T. Tan ◽  
Barnaby E. Young ◽  
David Chien Lye ◽  
Daniel E. K. Chew ◽  
Rinkoo Dalan
Keyword(s):  
Clinical Outcomes ◽  
Statistical Tests ◽  
Statistical Significance ◽  
Invasive Mechanical Ventilation ◽  
Statin Treatment ◽  
Supplemental Oxygen ◽  
Risk Difference ◽  
Icu Admission ◽  
Treatment Models ◽  
Statin Use

Abstract We aim to study the association of hyperlipidemia and statin use with COVID-19 severity. We analysed a retrospective cohort of 717 patients admitted to a tertiary centre in Singapore for COVID-19 infection. Clinical outcomes of interest were oxygen saturation ≤ 94% requiring supplemental oxygen, intensive-care unit (ICU) admission, invasive mechanical-ventilation and death. Patients on long term dyslipidaemia medications (statins, fibrates or ezetimibe) were considered to have dyslipidaemia. Logistic regression models were used to study the association between dyslipidaemia and clinical outcomes adjusted for age, gender and ethnicity. Statin treatment effect was determined, in a nested case–control design, through logistic treatment models with 1:3 propensity matching for age, gender and ethnicity. All statistical tests were two-sided, and statistical significance was taken as p < 0.05. One hundred fifty-six (21.8%) patients had dyslipidaemia and 97% of these were on statins. Logistic treatment models showed a lower chance of ICU admission for statin users when compared to non-statin users (ATET: Coeff (risk difference): − 0.12 (− 0.23, − 0.01); p = 0.028). There were no other significant differences in other outcomes. Statin use was independently associated with lower ICU admission. This supports current practice to continue prescription of statins in COVID-19 patients.

scholarly journals Retrospective analysis of the application of the Braden Q scale in pediatric intensive care

2020 ◽  
Author(s):  
Marcelli Cristine Vocci ◽  
Amanda Sayuri Sitoo Onary ◽  
Meire Cristina Novelli e Castro ◽  
Amanda Fabíola de Oliveira Spadotto ◽  
Cassiana Mendes Bertoncello Fontes
Keyword(s):  
Mechanical Ventilation ◽  
Intensive Care ◽  
Invasive Mechanical Ventilation ◽  
Secondary Data ◽  
Pediatric Intensive Care ◽  
Risk Scores ◽  
Ventilation Support ◽  
Mechanical Ventilation Support ◽  
Developed Pressure ◽  
Sedative Drugs

Objective: to characterize the profile of patients who developed pressure injuries and to analyze the retrospective scores obtained in the application of the Braden Q Scale in pediatric intensive care. Method: retrospective cohort study with analysis of secondary data from 34 electronic medical records of patients admitted to pediatric intensive care. Results: from the analysis of the scores obtained with the application of the Braden Q Scale, six records of pressure injuries were identified; the average age was 8.1 years; 66.6% were male; average of 41 days of hospitalization; main diagnoses are related to diseases of the respiratory, cardiac and neurological systems; all used invasive mechanical ventilation support and had a fasting prescription and use of a nasogastric tube. Conclusion: the clinical profile is correlated with the male gender, the higher frequency of respiratory diseases requiring mechanical ventilation, the use of vasoactive, vasopressor and sedative drugs, and the tube as a route of dietary administration. All of them had high risk scores for developing pressure injuries.

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