Does Route of Full Feeding Affect Outcome among Ventilated Critically Ill COVID-19 Patients: A Prospective Observational Study

The outbreak of the new coronavirus strain SARS-CoV-2 (COVID-19) highlighted the need for appropriate feeding practices among critically ill patients admitted to the intensive care unit (ICU). This study aimed to describe feeding practices of intubated COVID-19 patients during their second week of hospitalization in the First Department of Critical Care Medicine, Evaggelismos General Hospital, and evaluate potential associations with all cause 30-day mortality, length of hospital stay, and duration of mechanical ventilation. We enrolled adult intubated COVID-19 patients admitted to the ICU between September 2020 and July 2021 and prospectively monitored until their hospital discharge. Of the 162 patients analyzed (52.8% men, 51.6% overweight/obese, mean age 63.2 ± 11.9 years), 27.2% of patients used parenteral nutrition, while the rest were fed enterally. By 30 days, 34.2% of the patients in the parenteral group had died compared to 32.7% of the patients in the enteral group (relative risk (RR) for the group receiving enteral nutrition = 0.97, 95% confidence interval = 0.88–1.06, p = 0.120). Those in the enteral group demonstrated a lower duration of hospital stay (RR = 0.91, 95% CI = 0.85-0.97, p = 0.036) as well as mechanical ventilation support (RR = 0.94, 95% CI = 0.89–0.99, p = 0.043). Enteral feeding during second week of ICU hospitalization may be associated with a shorter duration of hospitalization and stay in mechanical ventilation support among critically ill intubated patients with COVID-19.

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

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.

Multiple Organ Failure Associated with SARS-CoV-2 Infection in a Child with Down Syndrome: Is Trisomy 21 Associated with an Unfavourable Clinical Course?

Introduction. Down syndrome (DS) is one of the most frequent genomic disorders around the globe (∼1:700 births). During the COVID-19 pandemic, it has been recognized that children with DS are patients with a greater risk of presenting SARS-CoV-2 infection-related poor outcomes. Nonetheless, a few cases with DS and SARS-CoV-2 infection have been reported. Our aim is to describe the unfavorable clinical course of a child with DS infected with SARS-CoV-2 virus. Case. Female, 2 years old, karyotype 47,XX,+21[30], previously diagnosed with a cyanotic congenital heart disease (tricuspid atresia and infundibular pulmonary stenosis, type Ib) who started with diarrhea, developed shortness of breath, and cyanosis and was admitted to the hospital presenting low-oxygen saturation (33%) requiring invasive mechanical ventilation support. The patient tested positive for SARS-CoV-2 infection. During hospitalization, the patient presented hypotension, anuria, retarded capillary filling, and metabolic acidosis; management with vasoactive drugs was needed. Nonetheless, the patient developed respiratory and cardiac failure, acute renal injury (AKIN-III), and septic shock. After 24 days of hospitalization, the patient died. Conclusions. Multiple organ failure observed in the patient presented could be related to the triple gene dose of four interferon receptors (IFNAR1, IFNAR2, IFNGR2, and IL10RB) located at 21q22.11. Additionally, overexpression of TMPRSS2 at the pulmonary level, located also at 21q22.3, could be related with an increased susceptibility for the development of SARS-CoV-2 infection in DS patients.

EVALUATION OF EYE CARE AND OCULAR FINDINGS IN CRITICALLY ILL COVID-19 PATIENTS

Objective: The current study aimed to evaluate eye care needs along with ocular findings in patients treated in intensive care units due to Covid-19 infection. Materials and Methods: A total of 93 patients, 58 men and 35 women, who were under follow-up and treatment in intensive care due to COVID-19 infection between 01/01/2021 and 02/15/2021 were included in the study. Detailed eye examinations of the patients were performed with a portable handheld biomicroscope and direct and indirect ophthalmoscope. Cases requiring treatment for eye diseases were identified and treated. Results: The mean patient age was 68.32 ± 9.97 years; 35 patients were followed-up and treated with non-invasive mechanical ventilation and 58 patients with invasive mechanical ventilation support. Mild, moderate, and severe chemosis was observed in 19 patients (20.4%), 10 patients (10.8%), and 4 patients (4.3%), respectively. Conjunctivitis (8.6%) was observed in 8 patients. Corneal abrasion was present in 7 patients (7.5%). Keratitis secondary to exposure keratopathy was observed in one patient. Eye care and medical treatment was initiated for these patients. We noted 8 patients (8.6%) with retinal haemorrhage; however, to the best of our knowledge, these patients may show acute retinal involvement secondary to systemic diseases or have previous retinal findings other than Covid-19 infection or treatments. Conclusion: Findings of ocular involvement due to COVID-19 infection were detected in the present study. Retinal haemorrhages were detected in addition to the common findings in viral infections. Especially in patients supported with mechanical ventilation, the detection and treatment of conditions that require eye care for exposure keratopathy is very important for recovering from the disease and the quality of vision.

Retrospective evaluation of critical geriatric and adult COVID-19 patients

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.

Panel of COVID-19 phenotypes: systematic review protocol

Background The pandemic caused by the SARS-CoV-2 virus, called coronavirus disease 2019 (COVID-19), had an unexpected impact on much of the world, especially Brazil. People diagnosed with the virus manifest different levels of respiratory symptoms, ranging from mild to severe, and may need mechanical ventilation support. The interaction different factors lead to the development of a spectrum of time-related diseases in different phenotypes. Methods This review will consider observational studies published from December 2019 to July 2021, without language restrictions. Studies involving human subjects, adult participants (18 years and older), with subjects who have received a COVID-19 diagnosis using the reverse transcriptase polymerase chain reaction (RT-PCR) test as a reference for the detection of the SARS- CoV-2 virus, according to World Health Organization (WHO) guidance. The databases to be searched will include PubMed/MEDLINE, EMBASE, and CINAHL. The grey literature will also be searched for published research and unpublished studies, using Google Scholar. wo reviewers will independently screen all citations, full-text articles and abstract data. Potential conflicts will be resolved through discussion. Findings will be reported using a narrative synthesis of the results will be carried out around the prevalence, severity of the disease, mortality and risk among the different phenotypes of COVID-19. The I 2 statistic will be used to examine the heterogeneity between the studies, if possible, the meta-analysis will be conducted using the RStudio® statistical software package, and the data will be displayed using forest graphics. Discussion This review will disclose a panel of the different manifestations of the disease COVID-19, and to identify the real risk factor for the most serious phenotypes. Systematic review registration This protocol has been registered within the International Prospective Register of Systematic Reviews (PROSPERO)(CRD42020211439)

The role of leptospiremia and specific immune response in severe leptospirosis

Leptospirosis can cause a high mortality rate, especially in severe cases. This multicenter cross-sectional study aimed to examine both host and pathogen factors that might contribute to the disease severity. A total of 217 leptospirosis patients were recruited and divided into two groups of non-severe and severe. Severe leptospirosis was defined by a modified sequential organ failure assessment (mSOFA) score of more than two or needed for mechanical ventilation support or had pulmonary hemorrhage or death. We found that leptospiremia, plasma neutrophil gelatinase-associated lipocalin (pNGAL), and interleukin 6 (IL-6) at the first day of enrollment (day 1) and microscopic agglutination test (MAT) titer at 7 days after enrollment (days 7) were significantly higher in the severe group than in the non-severe group. After adjustment for age, gender, and the days of fever, there were statistically significant associations of baseline leptospiremia level (OR 1.70, 95% CI 1.23–2.34, p = 0.001), pNGAL (OR 9.46, 95% CI 4.20–21.33, p < 0.001), and IL-6 (OR 2.82, 95% CI 1.96–4.07, p < 0.001) with the severity. In conclusion, a high leptospiremia, pNGAL, and IL-6 level at baseline were associated with severe leptospirosis.

Role of Serum B-type Natriuretic Peptide before and after 2hours of Spontaneous Breathing Trial among Patients under Mechanical Ventilation

Background: Weaning of a patient from mechanical ventilation is very important for the outcomes of the patients. Objective: The purpose of the study was to evaluate the serum level of BNP before and after 2hours of spontaneous breathing trial (SBT) among patients under mechanical ventilation. Methodology: This prospective cohort study was conducted in the Department of Anesthesia, Analgesia and Intensive Care Medicine at Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh over a period of 2 years. Study population was selected for weaning from mechanical ventilation support for the first time in the age group of more than 18 years with both sexes. Plasma BNP level of all patients was measured before and after 2 hours of spontaneous breathing trial. Results: A total number of 30 patients were recruited for this study. One-third (33.3%) of the patients failed on SBT. The mean percent changes of BNP (pg/ml) during 2-h of SBT in weaning success and failure groups were 38.41±9.379 and 59.51±2.940 respectively (p=0.01). The receiver-operating characteristic curve analysis for BNP as a predictor of weaning outcome, showed that the area under the curve (AUC) was 0.89. Conclusion: In conclusion BNP is currently a good predictor of different cardiac diseases. Journal of Current and Advance Medical Research, July 2021;8(2):125-129

IN-HOSPITAL AND SHORT-TERM OUTCOMES OF ENDOVASCULAR TREATMENT IN PATIENTS WITH ACUTE THROMBOEMBOLIC OCCLUSION OF THE SUPERİOR MESENTERİC ARTERY

Objectives: To investigate the outcome of endovascular treatment in acute thromboembolic occlusion of the superior mesenteric artery. Methodology: Eighteen consecutive patients who underwent endovascular treatment in acute thromboembolic occlusion of the superior mesenteric artery from January 2013 to September 2019 were included in the study. Thirty-day mortality, avoidance of laparotomy, angiographic success, length of hospital stay and complication rates were assessed. Results: The patients were 46 to 87 (70.5 ± 13.0) year-old, and 9 (50%) were male. In our study, 30-day mortality rate was 33.3%. The remaining patients were discharged uneventfully. Our complete and partial success rates was 61.1% and 38.9% respectively on angiographic assessment. The mean length of hospital stay was 7.8 ± 5.0 days in the remaining patients. Short bowel syndrome, respiratory failure requiring mechanical ventilation support or renal failure requiring dialysis were not observed in remaining patients. Laparotomy was needed for eight patients after endovascular treatment. Conclusion: The data showed that endovascular treatment is a technically feasible, effective and reliable alternative treatment method in a selected group of patients with acute thromboembolic occlusion of the superior mesenteric artery.

The COVID-19 lab score: an accurate dynamic tool to predict in-hospital outcomes in COVID-19 patients

Deterioration is sometimes unexpected in SARS-CoV2 infection. The aim of our study is to establish laboratory predictors of mortality in COVID-19 disease which can help to identify high risk patients. All patients admitted to hospital due to Covid-19 disease were included. Laboratory biomarkers that contributed with significant predictive value for predicting mortality to the clinical model were included. Cut-off points were established, and finally a risk score was built. 893 patients were included. Median age was 68.2 ± 15.2 years. 87(9.7%) were admitted to Intensive Care Unit (ICU) and 72(8.1%) needed mechanical ventilation support. 171(19.1%) patients died. A Covid-19 Lab score ranging from 0 to 30 points was calculated on the basis of a multivariate logistic regression model in order to predict mortality with a weighted score that included haemoglobin, erythrocytes, leukocytes, neutrophils, lymphocytes, creatinine, C-reactive protein, interleukin-6, procalcitonin, lactate dehydrogenase (LDH), and D-dimer. Three groups were established. Low mortality risk group under 12 points, 12 to 18 were included as moderate risk, and high risk group were those with 19 or more points. Low risk group as reference, moderate and high patients showed mortality OR 4.75(CI95% 2.60–8.68) and 23.86(CI 95% 13.61–41.84), respectively. C-statistic was 0–85(0.82–0.88) and Hosmer–Lemeshow p-value 0.63. Covid-19 Lab score can very easily predict mortality in patients at any moment during admission secondary to SARS-CoV2 infection. It is a simple and dynamic score, and it can be very easily replicated. It could help physicians to identify high risk patients to foresee clinical deterioration.