Clinical Implications of Airway Anomalies and Stenosis in Patients with Heterotaxy Syndrome

In heterotaxy syndrome, bronchopulmonary situs usually reflects atrial situs, resulting in either right (RAI) or left atrial isomerism (LAI). This study determines airway anomalies and its implications in patients with heterotaxy. This retrospective study included 223 patients with heterotaxy syndrome who received an integrated cardiac computed tomography evaluation. Patient database from 1995 to 2020 was reviewed. The patients were examined by a congenital heart disease team comprising pediatric cardiologists, radiologists, pulmonologists, and cardiovascular surgeons. Among the 223 patients, 189 (84.8%, M/F=1.66) had RAI and 29 had LAI (13.0%, M/F=0.71). Five patients had indeterminate isomerism (2.2%, M/F=1.5). Discordant bronchopulmonary and atrial situs occurred in 4% patients, while discordant bronchopulmonary, atrial, and splenic situs occurred in 23.2% patients. Lower airway stenosis was observed in 61 patients (27.4%), including 27.5%, 20.7%, and 60% RAI, LAI, and indeterminate isomerism patients, respectively (p=0.189). One patient had an intrinsic long segment lower tracheal stenosis and received slide tracheoplasty. Initial cardiac operation was performed in 213 patients. Higher surgical mortality occurred in patients with RAI (19.5% vs. none for LAI and indeterminate isomerism, p=0.038). In patients with RAI, lower airway anomaly/stenosis increased the duration of ventilator usage (p=0.030) but did not affect surgical mortality. Total anomalous pulmonary venous return to systemic veins and pulmonary venous stenosis were major surgical risk factors. Bronchopulmonary isomerism shares a similar isomeric pattern to cardiac atrial appendage. Lower airway anomalies/stenosis was common in patients with heterotaxy, resulting in prolonged ventilator therapy in patients with RAI.

Mechanical ventilation affects the microecology of the rat respiratory tract

Background: The most common 'second strike' in mechanically ventilated patients is a pulmonary infection caused by the ease with which bacteria can invade and colonize the lungs due to mechanical ventilation. At the same time, metastasis of lower airway microbiota may have significant implications in the development of intubation mechanical ventilation lung inflammation. Thus, we establish a rat model of tracheal intubation with mechanical ventilation and explore the effects of mechanical ventilation on lung injury and microbiological changes in rats. Methods: Sprague-Dawley rats were randomized into control, Spontaneously Breathing (1, 3, 6 hours), Mechanical ventilation(1, 3, 6 hours) groups. Lung wet to dry weight ratio (W/D weight ratio) and Lung histopathological injury score were evaluated.16SrDNA sequencing was performed to explore respiratory flora changes. Results: Bacterial diversity was comparable between healthy and intubation mechanical ventilation rats, with time relation. Ordination analyses revealed that samples clustered more dispersing by tracheal intubation and mechanical ventilation. Finally, predicted metagenomes suggested a substantial increase in biofilm formation phenotype during early tracheal intubation and mechanical ventilation. Conclusion: Collectively, these results establish a link between the duration of mechanical ventilation and alterations to the respiratory tract microecology. In future studies, we hope to discover the effectiveness of new immunomodulatory or probiotic bacteria to prevent airway diseases associated with ventilator therapy.

Clinical Profile and Demographic Features of COVID-19 Patients in a Tertiary Care Hospital of Pakistan

Background and Objective: The COVID-19 pandemic is an ongoing health challenge for both developed and developing countries worldwide. The epidemiological and clinical features of COVID-19 should be analyzed in our country. The current study aims to evaluate the demographic features and clinical profile of COVID-19 patients ina Tertiary Care Hospital of Rahim Yar Khan, Pakistan. Materials and Methods: This observational, cross-sectional study was conducted on 85 patients with positive real-time reverse transcriptase-polymerase chain reaction (RT-PCR) verified by nasopharyngeal swabs and throat at Covid 19 setup in Sheikh Zayed Hopsital, Rahim Yar Khan, Pakistan for period of six months i.e from September 2020 to February 2021. Institutional consensus protocol and COVID-19 SOPs were followed to investigate each individual. Various parameters such as symptom presentation, demographics’ details, ventilator therapy and oxygen required, and co-morbidities were studied. Results: The mean age of the patients was 37.6±5.7 years with an age range of 15 to 81 years. Of the total 104 patients enrolled, 60 (58%)were male and 44 (42%). The prevalence of COVID-19 caused by contact was 67 (65%).Symptomatic patients out of enrolled were 49 (47.1%). In this study, a significant association was found between severe COVID-19 and parameters such ashypertension and diabetes history, and patients having age above 65 years. Out of104 COVID-19 positive patients, symptomatic complaints were as follows; Cough 29(27.9%), fever 63 (60.6%), and breathe shortness 12 (11.5%). Tachypnea (RR>24), hypoxia and comorbid illness were found 32 (31%), 27 (25.8%), and 45 (43.2%)respectively. About 19 (18.2%) patients needed intensive care unit admission with 5 (4.8%) required immediate ventilation assistance. Mortality was 3.8% (4 patients) observed in this study. Conclusion: The COVID-19 pandemic mortalityrate is higher among patients above 60 years of age and with co-morbidities. TheCOVID-19 majority of patients presented in our hospital were of young or average age and asymptomatic. Respiratory symptoms were present in half and fever was recorded in more than half patients. Comorbidities patients were more venerableto the COVID_19 complications. Early admission and aggressive treatment must beprovided to COVID-19 patients to help reduce the mortality rate. Keywords: COVID-19,Comorbidities, Hypoxia

Clinical Profile of First 1000 COVID-19 Cases Admitted at Tertiary Care Hospitals and the Correlates of their Mortality: An Indian Experience

ABSTRACTObjectiveTo describe the clinical profile and factors leading to increased mortality in coronavirus disease (COVID-19) patients admitted to a group of hospitals in India.DesignA records-based study of the first 1000 patients with a positive result on real-time reverse transcriptase-polymerase-chain-reaction assay for SARS-CoV-2 admitted to our facilities. Various factors such as demographics, presenting symptoms, co-morbidities, ICU admission, oxygen requirement and ventilator therapy were studied.ResultsOf the 1000 patients, 24 patients were excluded due to lack of sufficient data. Of the remaining 976 in the early phase of the epidemic, males were admitted twice as much as females (67.1% and 32.9%, respectively). Mortality in this initial phase was 10.6% and slightly higher for males and steeply higher for older patients. More than 8% reported no symptoms and the most common presenting symptoms were fever (78.3%), productive cough (37.2%), and dyspnea (30.64%). More than one-half (53.6%) had no co-morbidity. The major co-morbidities were hypertension (23.7%), diabetes without (15.4%), and with complications (9.6%). The co-morbidities were associated with higher ICU admissions, greater use of ventilators as well as higher mortality. A total of 29.9% were admitted to the ICU, with a mortality rate of 32.2%. Mortality was steeply higher in those requiring ventilator support (55.4%) versus those who never required ventilation (1.4%). The total duration of hospital stay was just a day longer in patients admitted to the ICU than those who remained in wards.ConclusionMale patients above the age of 60 and with co-morbidities faced the highest rates of mortality. They should be admitted to the hospital in early stage of the disease and given aggressive treatment to help reduce the morbidity and mortality associated with COVID-19.

EFFICACY AND SAFETY OF REMDESIVIR IN THE TREATMENT OF COVID 19: A RETROSPECTIVE STUDY

Background: No specic antiviral drug has been proven effective for treatment of patients with severe coronavirus disease 2019 (COVID-19).The aim of this study was to summarize the antiviral activities of remdesivir against SARS-CoV-2, the causative agent of COVID-19. We present our observations on remdesivir use. Methods: In a retrospective case control study total 74 patients of moderate to severe covid 19 infection admitted to Dhiraj hospital were enrolled. Out of total 74 patients, 37 were given remdesivir assigned as group A and 37 patients were not given remdesivir assigned as group B. Data was collected from the case record form and analyzed with respect to inammatory markers, mortality, length of ICU stay and days on ventilator support. Results: Out of 74 moderate to severe RT PCR positive Covid 19 patients, 37 patients were in remdesivir group and others were in non remdesivir group. Mean age was 55.08 + 8.98 years and 22 were male in remdesivir group. Statistically signicant improvement was noted with ESR, CRP and Sr.LDH only. Other laboratory parameters (TLC, NLR, D-Dimer, and Sr.Ferrtin) showed minor improvement only (p value =>0.05).Less mortality was observed with remdesivir treatment, along with ICU stay and less days on ventilator therapy without any safety concerns. Conclusion: Remdesivir use along with standard therapy had showed signicant improvement in terms of clinical, laboratory parameters and recovery in patients with moderate to severe Covid 19 infection.

Evidence of Abnormally Low Lymphocyte-To-Monocyte Ratio In COVID-19-Induced Severe Acute Respiratory Syndrome

It is known that lung injury due to COVID-19 responsible for the respiratory distress would mainly depend on host inflammatory response, depending on the excessive production of inflammatory cytokines, such as IL-6, and TNF-alpha, rather than direct virus-induced tissue damage, as well as for other forms of respiratory distress. Moreover, it is known that the inflammatory cytokines may induce profound changes in the behavior of the hematic cells, namely neutrophils, monocytes, and lymphocytes, with a following enhanced tissue infiltration by their inflammatory cells. According to the data available up to now, IL-6 and TNF-alpha would be the main cytokines involved in determining COVID-19-induced lung injury, as well as in other coronavirus infections, and most in general in all conditions of respiratory distress. Since it is known that the functionlessness of the whole immune system is namely depending on the interactions between lymphocyte and macrophage system, a preliminary study was planned to analyze the lymphocyte-to-monocyte ratio (LMR) in COVID-19 infective disease. The study included 17 consecutive patients, who underwent ventilator therapy for COVID-19-induced respiratory distress, and 100 healthy subjects, as a control group. Lymphocytopenia and monocytosis occurred in 14/17 (82%) and in 8/17(47%), respectively. Then, abnormally low values of LMR was found in 12/17 (71%) patients, and LMR men values observed in patients were significantly lower than in control (P<0.001). Therefore, by reflecting the interactions between lymphocyte and monocyte-macrophage systems, LMR could constitute a simple and less expensive biomarker to monitor the clinical evolution of COVID-19 infection.

Effects of China-Germany Follow Up Systems on Ventilator Therapy in Patients with Obstructive Sleep Apnea Syndrome

Objective: To investigate the effects of different follow-up systems in China and Germany on ventilator therapy in patients with obstructive sleep apnea syndrome. Method: From March 2013 to October 2015, three hundred patients with moderate to severe obstructive sleep apnea syndrome and those who are suitable for ventilator treatment were followed up according to the follow-up system of both China and Germany. The follow-up was carried out for one year to compare the rate of loss to follow-up, ventilator therapy compliance, treatment effect, ventilator side effects and others in the two groups of patients. Statistical analysis was performed using x2 test, P<0.05 for the difference was statistically significant. Results: The rate of loss to follow-up in the German group was lower than that in the Chinese group. The compliance of the German group with respiratory therapy was lower than that of the Chinese group. The side effects of ventilator treatment were lower than those in the Chinese group (P<0.05). Conclusion: The German follow-up system is more effective than the Chinese follow-up system in improving the compliance and effectiveness of ventilator therapy in patients with obstructive sleep apnea syndrome.