A bstract Background Immune dysregulation is one of the main reasons for mortality and morbidity in coronavirus disease 2019 (COVID-19). Mycobacterium w (Mw) is recently approved for gram-negative sepsis. Moreover, it is also found effective in COVID-19 patients in previous studies. The traditional route of administration for Mw is intradermal, which has a limitation of administering 0.1 mL per injection and local injection site reaction. Intravenous (IV) administration of Mw has not been explored in COVID-19. We report the retrospective analysis of six critically ill COVID-19 patients who received Mw (IV). Patients and methods At baseline, all patients in this case series required O 2 supplementation, and their inflammatory biomarkers were elevated. All patients received 0.6 mL Mw (high-dose) in normal saline along with the standard-of-care treatment. Results After Mw administration, gradual improvement in O 2 requirement was observed and patients were discharged from the hospital with no mortality. A reduction in mean C-reactive protein (CRP) (51.48–18.52 mg/dL), interleukin-6 (IL-6) (260.22–14.47 pg/mL), and FiO 2 (81.67–43.33) was also observed. No side effects were observed with the use of Mw by IV route. Conclusion Use of 0.6 mL Mw by IV route in this case series was associated with decreased O 2 supplementation without any side effects in critically ill patients of COVID-19. How to cite this article Patel PS, Patel S, Shah V, Aswani V, Narwaria M. Early Experience of High-dose Intravenous Mycobacterium w in Critically Ill Patients of COVID-19. Indian J Crit Care Med 2021;25(9):1066–1068.
Background: COVID-19 is associated with huge morbidity and mortality in India. Identication of factors associated with mortality would make a difference in the management of COVID-19 infection-related illness. To eval Objective: uate the risk factors which can predict the outcome in covid 19 survivors and non survivors including patient characteristics, comorbidities, laboratory abnormalities and modes of oxygenation and ventilation among 200 patients with COVID-19 infection admitted to a tertiary care hospital fullling inclusion and exclusion criteria. All the data collected were coded and entered in Microsoft Excel sheet which was re-checked and analyzed using SPSS statistical software version 25. Results: Out of 200 cases, 126(63%) patients were male while 74(37%) patients were female. The overall case-fatality rate among admitted cases was 24(12%) [In non -survivors males (12.7%) and females (0.8%)]. The Univariate analysis showed that more patients in the deceased group had respiratory rate of >30 cycles/min(p<0.001) spo2 75 +/- 13 (p<0.001), Patient who had pulse rate 96+/-19 (p=0.003) found to be signicantly associated. The Mean ± SD of white blood cell count, NLR, SGOT, APTT, S.Bilirubin , Total protein ,Albumin, Creatinine ,RBS, Trop I. CRP, D dimer, LDH ,Ferritin, IL6 ,PCT were statistically signicant and affecting mortality. In non-survived patients needed higher mode of oxygenation .out of 13 patients who required NIV on admission ,15 patients survived and 8 patient non-survived(P=0.002). out of 13 patients who required invasive ventilation, 5 patients survived and 8 patients non survived (p=0.001). Those who received more days of oxygenation they are not survived (6.25±4.19 P=0.001) and those who had prolonged ventilatory days also not survived (4.46±3.50 P=<0.001). Those who had admitted in ICU for mean days of 5±3.60 (p= <0.001) also not survived. All above differences were found to be statistically signicant. There was no signicant difference in the age, gender, clinical features, preexisting comorbidities between the two groups (p>0.05). Multivariate analysis using binary logistic regression was done to nd out independent factors associated with mortality. Logistic regression performed for signicant variables found in the univariate analysis showed higher HRCT CT severity score associated higher odds of death. Conclusion: The higher HRCT CT severity score associated higher odds of death. Lab markers such as raised TLC, NLR, CRP, LDH, ferritin, Ddimer, SGOT, APTT, Sodium, Creatinine, IL6, PCT and low albumin were associated with worse outcomes in COVID-19 illness.
Background: Hyponatremia is the most common electrolyte abnormality in hospitalized patients and is frequently encountered in the intensive care setting. In the present study, we aim to assess the causes and clinical outcomes of patients admitted to our inpatient ward and intensive care unit (ICUs) with hyponatremia. Methods: This prospective observation study was conducted in the Department of Family Medicine at a tertiary care hospital in Ahmedabad. In this study, all the patients aged more than 18 years, irrespective of gender admitted to our department and diagnosed with hyponatremia (serum sodium < 135 mmol/L) were included. Results: The most common presenting complaint was abnormal behavior (41.3%), 21.7% were drowsy, Syndrome of inappropriate antidiuretic hormone (SIADH) was the most common cause, 44.1% had severe hyponatremia, 44.1% were hypervolemic, and 23.1% stayed in ICU for more than 5 days. Mortality rate was 20.2% and was not associated with severity of hyponatremia, though it was high in patients with severe hyponatremia. Older age group, female gender, past medical history of hypertension, unconscious state at presentation, presenting complaints of abnormal behavior, edema on examination and ICU stay more than 5 days was signicantly associated with mortality among hyponatremia patients. Conclusion: Careful history and physical examination should be conducted so as to determine the time of onset and severity of symptoms. Patients with severe hyponatremia should be monitored closely in ICU.
The pericardium is a fibroelastic sac made up of visceral and parietal layers separated by a (potential) space, the pericardial cavity.The most troublesome complication of acute pericarditis is the development of recurrent episodes of pericardial inflammation, occurring in 15% to 32% of cases. Therapeutic modalities are nonspecific and include non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroids. Here we present a case of a patient presenting with pericarditis due to COVID-19. He was successfully treated with colchicine. To our knowledge acute pericarditis due to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) might be an under diagnosed condition in this pandemic. We want to share our findings, given the urgent need for different diagnostic and therapeutic strategies in order to better manage COVID-19 patients, and diminish the SARS-CoV-2 complications.
Pulmonary involvement in Henoch‐Schonlein purpura (HSP) although rare is an important treatable cause of hospital admission in patients. Its diagnosis is difficult due to the vague symptoms and non-specific radiographic findings. We present one such case of a known case of HSP presenting with pulmonary involvement and treated successfully with steroids and immunosuppressant medications after ruling out all other causes. This particular case could also have an additional component of methotrexate induced lung involvement. Overall it is an interesting case with some much needed learning points.
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