How to cite this article: Sabharwal P, Chakraborty S, Tyagi N, Kumar A. Acute Flaccid Quadriparesis in a Recovering COVID-19 Patient: A Clinical Dilemma. Indian J Crit Care Med 2021;25(2):238–239.
A bstract Spontaneous air-leak syndromes have emerged as rare but significant complication of Coronavirus disease-2019 (COVID-19) pneumonia in the last few months. This complication has been documented in both spontaneous and mechanically ventilated patients. Although few studies have used computed tomographic scans to confirm the diagnosis, this could be challenging in resource-limited setup. We present a series of 15 cases that highlight the clinical heterogeneity with respect to stage of illness, ventilatory status, and varied clinical scenarios at the time of development of these syndromes. All cases in our series were diagnosed clinically and confirmed by bedside chest X-ray and were managed promptly. Though mortality was not so infrequent in our experience, these air-leak syndromes were not directly attributed as cause of death in these patients. Therefore, high level of clinical suspicion and vigilance is necessary to identify and manage cases of air-leak syndrome. How to cite this article: Sabharwal P, Chakraborty S, Tyagi N, Kumar R, Taneja A. Spontaneous Air-leak Syndrome and COVID-19: A Multifaceted Challenge. Indian J Crit Care Med 2021;25(5):584–587.
Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM Background and objective Coronavirus disease-19 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus-2 (SARS-COV-2) virus has been associated with increased secondary bacterial and fungal infections. A few centers from India have reported a high number of cases of COVID-associated mucormycosis (CAM). Depending on the anatomical site of infection, mucromycosis is classified as rhino-orbito-cerebral, pulmonary, gastrointestinal, cutaneous, renal, and disseminated mucromycosis. Several risk factors such as uncontrolled diabetes mellitus, hematologic malignancies, renal disease, organ transplant, and corticosteroid therapy administered for COVID-19 are implicated in CAM. In this study, we report a case series of CAM, presenting its prevalence, clinical features, risk factors, etiological agents, site of infection, and outcomes in a single center. Methods A retrospective data analysis of all proven mucormycosis cases among COVID-19 infected patients from September 1, 2020 to December 31, 2020, was carried out after approval from the institutional ethics committee. All proven cases of mucormycosis (either by culture from sterile site or histopathology), along with compatible clinical and radiological findings, in patients with positive real-time-polymerase chain reaction (RT-PCR) for SARS-CoV-2 within 2 months of the diagnosis of mucormycosis were included in the study. All patients received treatment for COVID-19 and mucormycosis as per the institutional protocol. Data was collected in a predefined case-record form developed for the study which included demographic characteristics, risk factors, days to the diagnosis of mucormycosis after COVID-19, site of involvement by mucormycosis along with microscopy, culture and histopathology, treatment details and outcome at 6 and 12 weeks. Results During the study period, a total of 19 patients were diagnosed with CAM. The major risk factors of the patients were type 2 diabetes mellitus (DM) (n = 15, 78.9%) and steroid therapy (n = 18, 94.7%), The other co-morbidities included hypertension (n = 7, 38.8), chronic kidney disease (CKD) (n = 4, 22.2%) and chronic liver disease (n = 1, 5.2%). Rhino orbital mucromycosis (ROM) was the most common form (n = 9, 47.3%). The prevalence of CAM (as calculated by the total number of cases of CAM divided by the number of COVID-19 cases treated) was 5.47/1000 COVID patients during the study period. Majority (15, 73.6%) of the patients were successfully treated and discharged whereas three patients succumbed to infection and one left against medical advice. The mortality in this cohort (n = 4) was 21.05% as compared with 13.9% among all COVID patients (n = 9) admitted during the same time period in 2020. Conclusion Though sample size is small, the findings in our study suggest that the fatality from COVID-associated mucormycosis is high, though the risk factors remain the same. The incidence of mucormycosis was twice that in non-pandemic period. Early diagnosis is crucial as despite aggressive surgical medical therapy, mortality continues to be high.
The novel coronavirus disease (COVID-19) pandemic, caused by SARS-CoV-2, has affected people's health in more than one way with catastrophic impacts on primary healthcare systems across the globe. However, the rapid expansion of knowledge over the last few months, supported by rigorous scientific research, has enabled our understanding of the mechanism(s) of COVID-19 and potential therapeutics. Initial infection of the upper respiratory tract by SARS-CoV-2 is mediated by binding of the virus to host expressed angiotensin-converting enzyme 2 receptor (ACE2). While viral pneumonia is one of the predominant manifestations of COVID-19, current evidence shows that the virus also affects multiple organs, especially the cardiovascular system. Comorbidities such as hypertension, diabetes, and coronary heart disease, not only result in worsening outcomes but also account for high death counts among infected patients. Serious cardiovascular complications such as cardiac injury, heart failure, and arrhythmias are often seen in the severe hospitalized cases of COVID-19; such cases predominantly feature hyper inflammation, cytokine storm along with elevated cardiac injury biomarkers. Whether viral invasion through ACE2-expressed in heart cells-is responsible for the development of new cardiovascular dysfunction in COVID-19 patients without any history of heart disease, remains under investigation. Other concerns have also surfaced regarding the use of renin-angiotensin system (RAS) inhibitors like angiotensin receptor blockers (ARBs) and ACE inhibitors (ACEIs), potentially increasing the severity of COVID-19. Here, we review current research and epidemiological data on SAR-CoV-2 infection and its clinical manifestations with a focus on cardiovascular complications and mechanisms of injury. Current guidelines over the use of RAS inhibitors in the context of the speculated role of ACE2 in COVID-19 patients are also discussed.
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