BackgroundAcute respiratory distress syndrome (ARDS) is a frequent complication of COVID-19 and is associated with a component of thrombo-inflammation and cytokine storm. COVID-19 also affects the hemostatic system causing multiple coagulation abnormalities that is a cause of concern and needs to be addressed.
Background and Aims: Several factors determine the success of dural puncture. We aimed to assess the association of first puncture success and number of attempts with characteristics of the patient, provider, technique and equipment. Material and Methods: This prospective, observational study was performed in 1647 adult patients undergoing surgery under spinal anesthesia. Patient characteristics, anatomical landmarks, spinal bony deformity, provider experience, technique, skin punctures, needle redirections, subarachnoid space depth, and complications, if any, were noted. Difficult dural puncture was assessed by first puncture success and number of attempts (skin punctures plus needle redirections) required for successful needle placement. Results: First puncture success was obtained in 872 (52.9%) patients. Failed dural puncture occurred in 4 (0.2%) of 1647 patients. Multivariate logistic regression analysis revealed that longer distance from C7 vertebral spine to tip of coccyx ( P = 0.04), lower subarachnoid space depth ( P = 0.001), good quality of bony landmarks ( P = 0.001) and absence of crowded spine ( P = 0.02) were associated with first puncture success. Male gender, poor or no spinal landmarks, presence of bony deformity and lower level of provider's experience predicted increased number of attempts for successful dural puncture. Conclusion: First puncture success of spinal block was influenced only by patient's anatomical factors, whereas the number of attempts required for successful block were predicted by both provider and patient factors.
H ighlights There is no dearth of literature on pulmonary involvement in COVID-19 infection. However, extra-pulmonary manifestations are rare and can be easily missed during this pandemic. Our case series hopes to highlight the fact that neurological manifestations of COVID-19 infection are likely to be overlooked. Hence, a low threshold of clinical suspicion and testing for COVID-19 infection is needed in cases presenting with primary neurological symptoms. This will facilitate quicker detection, isolation of cases to prevent further transmission, and provision of early treatment.
There are numerous publications describing the epidemiology and clinical outcome of patients infected with COVID-19. However, limited studies solely describing the fatalities, especially in India. In this retrospective, single-centre analysis of patients’ case records, we aim to describe and discuss the demographics, clinical, laboratory findings in 201 patients who expired as a result of SARS CoV-2 infection. Electronic medical files of all confirmed COVID-19 patients, admitted to the ICU between 1st February 2020 and 15th July 2020, were scanned retrospectively and data was collected from files of the fatalities only, without revealing patient identity at any point. The data, including demographics (age, sex, comorbidities), clinical presentation, baseline laboratory parameters, SOFA score and duration of illness was recorded and analyzed statistically. A total of 201 deceased patients were included in the study, out of which 58.2% were males. The median age was 59 years (IQR: 47.5 – 65 years) which appears to be less than a lot of studies conducted outside India. Majority of patients had classical influenza-like symptoms at presentation (74.1%), but a sizable number also had extra-pulmonary manifestations (24.9%). Eight patients had isolated neurological presentation. It was found that number of comorbidities increased, and duration of illness decreased with increasing age, and this was statistically significant (p 0.03 and 0.01, respectively). SOFA score was found to be an important marker of severity of illness in COVID patients. ARDS remained the primary cause of death in 87.1% patients, although septic shock was observed in 34.8%. Six patients expired due to a high suspicion of pulmonary thromboembolism.
The year 2020 saw the rise of an influenza-like illness from SARS-nCoV2 (Severe Acute Respiratory Illness by novel Coronavirus 2), which causes myriad of symptoms in patients, ranging from mild upper respiratory symptoms to severe ARDS (Acute Respiratory Distress Syndrome). It is, however, known to cause high morbidity and mortality in patients with underlying comorbidities like diabetes, hypertension, kidney disease, obesity and malignancies. Amongst these, the subset with haematological malignancies has an especially poor prognosis possibly as a result of immune suppression, due to underlying bone marrow depression as well as effects of chemotherapeutic agents. These patients need frequent visits and admissions to the hospital for treatment, thus exposing them to the risk of acquiring the infection. Also, a high index of suspicion, with low threshold for testing is needed in view of possible atypical presentation and symptoms. These patients may also warrant an early ICU admission, as they tend to develop severe disease with ARDS more frequently, with an overall poor prognosis and high mortality rate. We hereby present a series of six patients with underlying haematological malignancies who were admitted in our ICU with a serious COVID-19 illness and a grave outcome.
INTRODUCTION COVID-19 started in November 2019 as an infection with a new strain of Corona virus and spread across all geographic regions. It has been observed that various coagulation abnormalities are not infrequent in COVID-19. Bleeding and coagulation abnormalities have surfaced as one of the mechanisms that could be related to increased mortality associated with it. Through our work, we look forward to discovering more on this association & we believe our study could provide new insight that could save additional lives. AIMS & OBJECTIVES - To study coagulation abnormalities in Covid-19 Positive patients. - To correlate these coagulation abnormalities with severity of disease and outcome of Covid-19 Positive patients. Material & Methods:This is a prospective study being carried out on the Intensive Care Unit (ICU) admitted Covid 19 positive patients, in a tertiary care hospital. Fifty cases have been studied so far, to look for coagulation abnormalities. Covid 19 positive patients by RNA detection by RT PCR method, admitted in ICU of hospital have been investigated for Prothrombin Time (PT), Activated Partial Thromboplastin Time (APTT), Thrombin Time (TT), Fibrinogen levels and D-Dimer levels.The results of these investigations were correlated with clinical condition of these ICU patients, to assess the prognosisand outcome, of Covid-19 Positive patients. Results: Fifty COVID positive patients admitted in ICU have been studied & out of these 19 patients eventually expired (Non-survivors group) and 31 recovered from their illness (Survivors group). These fifty patients were investigated,at the time of presentation in ICU. Prothrombin time (PT)was prolonged in Covid 19 positive patients. Prothrombin time (PT) values in theSurvivors group ranged from 13.47 to 15.36 seconds(Mean 14.42 seconds). Prothrombin time (PT) values in theNon-survivors group ranged from 13.63 to 15.43 seconds (Mean 14.53 seconds).Normal control of Prothrombin time (PT) was 13 seconds. Prothrombin time (PT) values in the Survivors group were compared with Non-survivors group with ap value = 0.865(statistically not significant). Activated partial thromboplastin time (APTT)values in theSurvivors group ranged from 33.44 to 36.38 seconds(Mean 34.91 seconds). Activated partial thromboplastin time (APTT) values in theNon-survivors group ranged from 33.68 to 38.32 seconds(Mean 36.00 seconds). Normal control of activated partial thromboplastin time (APTT) was 34 seconds. Activated partial thromboplastin time (APTT) values in the Survivors group were compared with Non-survivors group with ap value = 0.397(statistically not significant). Thrombin time (TT)values in theSurvivors group ranged from 17.61 to 19.81 seconds(Mean 18.71 seconds). Thrombin time (TT) values in theNon-survivors group ranged from 18.68 to 22.32 seconds(Mean 20.50 seconds). Normal control of thrombin time (TT) was 18 seconds. Thrombin time (TT) values in the Survivors group were compared with Non-survivors group with ap value = 0.072(statistically not significant). Fibrinogen levelsin theSurvivors group ranged from 378 mgm/dl to 441mgm/dl(Mean 410mgm/dl). Fibrinogen levels in theNon-survivors group ranged from 331 mgm/dl to 419mgm/dl(Mean 375mgm/dl). Normal values for fibrinogen levels were 150 to 450 mgm/dl. Fibrinogen levels in the Survivors group were compared with Non-survivors group with ap value = 0.184(statistically not significant). D-Dimer levelswere increased in Covid 19 positive patients. D-Dimer levels in theSurvivors group ranged from 854 ngm/ml to 1847ngm/ml(Mean 1401ngm/ml). D-Dimer levels in theNon-survivors group ranged from 1308 ngm/ml to 2858 ngm/ml(Mean 2083ngm/ml). Normal values for D-Dimer levels were 135 to 250 ngm/ml. D-Dimer levels in the Survivors group were compared with Non-survivors group with ap value = 0.130(statistically not significant). Conclusion Ours is a small single centre study, however, shows coagulopathies in Covid 19 positive patients. Although, there is a difference between coagulation abnormalities in survivor & non-survivor group of ICU patients but this difference is statistically not significant. Disclosures No relevant conflicts of interest to declare.
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