We describe the endovascular management of a patient with a massive renal arteriovenous fistula and a huge venous aneurysmal sac, who presented with features of cardiac failure and fever. The challenges faced and the outcomes are discussed with relevant literature review.
Introduction
The role of NIV in SARS-CoV2 (COVID-19) related acute respiratory failure (C-ARF) is unclear.
Methods
C-ARF patients managed on NIV were categorised as NIV success or failure (death or intubation). Factors associated with failure were explored using regression analysis and expressed as Odds ratio (OR) with 95% Confidence Interval (CI).
Results
Between 1
st
April 2020 and 15
th
September 2020, 286 patients, age (Mean, SD) 53.1±11.6 years and APACHE-II score 11.1±5.5 were initiated on NIV. Of the 182 patients (63.6%) successfully managed on NIV alone, 118 had moderate or severe Acute Respiratory Distress Syndrome (ARDS). When compared with NIV success, NIV failure was associated with lower admission PaO
2
/FiO
2
ratio (p<0.001) and higher respiratory rate (p<0.001). On penalized logistic regression analysis, NIV failure was associated with higher APACHE (OR 1.12; 95%CI 1.01-1.24), severe ARDS (OR 3.99; 1.24-12.9), D-dimer ≥1000 ng/ml (OR 2.60; 1.16-5.87), need for inotropes or dialysis (OR 12.7; 4.3-37.7) and nosocomial infections (OR 13.6; 4.06-45.9). Overall mortality was 30.1%. In patients requiring intubation, time to intubation was longer in non-survivors than survivors (Median IQR 5 (3-8) vs. 3 (2-3) days, p<0.001).
Conclusions
NIV can be used successfully in C-ARF. Illness severity and need for non-respiratory organ support predict NIV failure.
ObjectivesTo compare the clinical severity and outcome of hospitalised patients during the two waves of the COVID-19 pandemic in India.SettingA tertiary care referral hospital in South India.ParticipantsSymptomatic SARS CoV-2 reverse transcriptase PCR positive patients presenting to the emergency department during the two waves were recruited. The first wave spanned between April and December 2020 and the second wave between April and May 2021.Primary and secondary outcome measuresThe primary outcome of interest was mortality. Secondary outcomes included illness severity at presentation, need for oxygen therapy, non-invasive ventilation (NIV) and hospital or intensive care unit admission.ResultsThe mean (SD) age of the 4971 hospitalised patients in the first wave was similar to the 2293 patients in the second wave (52.5±15.4 vs 52.1±15.1 years, p=0.37). When compared with the first wave, during the second wave, a higher proportion of patients presented with critical illness (11% vs 1.1%, p<0.001) and needed supplemental oxygen therapy (n=2092: 42.1% vs n=1459: 63.6%; p<0.001), NIV (n=643; 12.9% vs n=709; 30.9%; p<0.001) or inotropes/vasoactive drugs (n=108; 2.2% vs n=77: 3.4%; p=0.004). Mortality was higher during the second wave (19.2% vs 9.3%; p<0.001). On multivariable regression analysis, age >60 years (risk ratio, RR 2.80; 95% CI 2.12 to 3.70), D-dimer >1000 ng/mL (RR 1.34; 95% CI 1.15 to 1.55), treatment with supplemental oxygen (RR 14.6; 95% CI 8.98 to 23.6) and presentation during the second wave (RR 1.40; 95% CI 1.21 to 1.62) were independently associated with mortality.ConclusionThe second wave of the COVID-19 pandemic in India appeared to be associated with more severe presentation and higher mortality when compared with the first wave. Increasing age, elevated D-dimer levels and treatment with supplemental oxygen were independent predictors of mortality.
ObjectiveTo study and compare the maternal and neonatal outcomes of COVID‐19 in pregnancy during the two waves of the pandemic in India.MethodsThis observational, retrospective cohort study on pregnant women with SARS‐CoV‐2 infection was conducted in a 2700‐bed tertiary referral center in South India from March 1, 2020 to June 30 2021. The clinical presentation, severity, and maternal and neonatal outcomes of COVID‐19 were compared between the two waves.ResultsA total of 623 pregnant women tested positive for SARS‐CoV‐2 infection in our institute; 379 (60.8%) were diagnosed during the first wave and 244 (39.2%) in the second wave. Most of the affected women (81.1%) were in their third trimester. Maternal mortality rate was 823 per 100 000 live births. Composite maternal outcome (increasing requirement for ventilation, pulmonary embolism, disease progression) were more pronounced during the second wave (2.1% vs 6.1%). Between the two waves, both maternal (1 vs 3; P = 0.162) and perinatal (3.2% vs 6.7%; P = 0.065) deaths were higher during the second wave. The cesarean section rate was high during the first wave (48% vs 32.4%; P < 0.001). Preterm births were comparable between the two waves (19.5% vs 22%; P < 0.500).ConclusionThe women presented with more severe illness during the second wave of COVID‐19. There was higher perinatal mortality, but the maternal mortality was similar between the two waves.
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