Purpose Hyperinflammation in severe COVID-19 infection increases the risk of respiratory failure and one of the cogent reasons of mortality associated with COVID-19. Baricitinib, a janus kinases inhibitor, can potentially suppress inflammatory cascades in severe COVID-19 pneumonia. Methods The objective of this study was to compare the clinical outcomes of high dose of baricitinib with its usual dose in patients with severe COVID-19 pneumonia. This prospective cohort study was conducted on 238 adult patients with severe COVID-19 pneumonia. Eight milligram and 4 mg of baricitinib was given orally to 122 patients in the high dose (HD) group and 116 patients the usual dose (UD) group, respectively daily for 14 days, and clinical outcomes were compared among the groups. Results Blood oxygen saturation level was stabilized (≥94% on room air) earlier in the HD group compared to the UD group [5 (IQR: 4–5)/8 (IQR: 6–9), P < 0.05]. Patients in the HD group required intensive care unit (ICU) and intubation supports more in the UD group than that in patients of the HD group [17.2%/9%, P < 0.05; 11.2%/4.1%, P > 0.05; N = 116/122, respectively]. The 30-day mortality and 60-day rehospitalization rate were higher in the UD group than the HD group [6%/3.3%, P < 0.01; 11.9%/7.6%, P > 0.05; N = 116/122, respectively]. Conclusion The daily high dose of baricitinib in severe COVID-19 results in early stabilization of the respiratory functions, declined requirements of critical care supports, reduced rehospitalization with mortality rate compared to its daily usual dose.
Background: Ventilator-associated pneumonia (VAP) caused by methicillin-resistant Staphylococcus aureus (MRSA) is a serious infection in an intensive care unit (ICU). Ventilator-associated MRSA pneumonia (VAMP) in critically ill patients causes a high rate of mortality. Objectives: This study mainly aimed to compare the clinical outcomes and associated drug safety perspective of linezolid and teicoplanin in VAMP treatment. Methods: This retrospective study included 98 adult ICU patients with VAMP, where 42 patients (LZD group) and 56 patients (TPN group) received a standard dose of linezolid and teicoplanin, respectively, for their VAMP treatment. Adverse reactions associated with linezolid and teicoplanin were considered. Clinical outcomes and 30-day mortality rates were compared in both groups. Results: The LZD group showed a higher MRSA eradication rate (97%, n = 34) than the TPN group (94.3%, n = 53) (P = 0.034). The linezolid and teicoplanin therapy was suddenly discontinued in 19% and 5.3% of the patients in the LZD and TPN groups, respectively, before completing the full duration of antibiotic therapy due to developed adverse drug reactions (ADRs), including thrombocytopenia (LZD/TPN groups: 7/1 event), tachycardia (LZD group: 1 event), and nephrotoxicity (TPN group: 2 events). This discontinuation increased the total duration of antibiotic therapy in 19% (n = 42) and 5.3% (n = 56) of the patients (P = 0.034) in the LZD and TPN groups, respectively. Conclusions: VAMP is a life-threatening event in critically ill ICU patients worldwide. In this study, teicoplanin showed better clinical outcomes with a certain higher level of drug safety compared to linezolid in the treatment of ventilator-associated MRSA pneumonia.
Posterior reversible encephalopathy syndrome (PRES) refers to a clinicoradiologic entity with characteristic features on neuroimaging and nonspecific symptoms comprising headache, confusion, visual disturbances and seizures. The radiological findings in PRES are thought to be due to vasogenic edema, predominantly in the posterior cerebral hemispheres and are reversible with appropriate management.We report 4 cases of PRES diagnosed by MRI scan following uneventful caesarean section in previously normotensive patients who were succesfully treated with antihypertensives, anticonvulsants and supportive treatment. DOI: http://dx.doi.org/10.3329/bccj.v1i2.17205 Bangladesh Crit Care J September 2013; 1 (2): 104-106
NIV is a method of ventilatory support which is delivered to the patient without using an invasive airway. For the last two decades it is increasingly used as an accepted method of mechanical ventilatory support as it is proved to have many positive outcomes as it can prevent invasive ventilation & its complication. In a tertiary care hospital of Bangladesh we are using this method in all patients meeting the NIV criteria & not having absolute contraindication irrespective of diagnosis. Our study aimed to access the out come of the NIV trial using our local resource & to compare it with others. This is an ongoing prospective study and till this report data from 82 patients were analyzed here of which 50% patient ended with positive outcome & 50% ended as negative outcome. As the result of this method varies significantly by diagnosis & severity of disease we are generating specific recommendations according to the likely outcome according to the diagnosis. DOI: http://dx.doi.org/10.3329/bccj.v1i1.14358 Bangladesh Crit Care J March 2013; 1: 3-7
:In the spectrum of patient with severe pre-eclampsia,
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