scholarly journals Combined effects of Tocilizumab and Remdesivir in severe COVID- 19 patient with cytokine release syndrome: A case-report (Preprint)

2021 ◽  
Author(s):  
Sabahat Ali ◽  
Sundas Khalid ◽  
Maham Afridi ◽  
Samar Akhtar ◽  
Yousef S. Khader ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Severe Acute Respiratory Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Virus Disease ◽  
Cytokine Release ◽  
Cytokine Release Syndrome ◽  
Treatment Regimens ◽  
Corona Virus

BACKGROUND Novel corona virus (nCoV) or Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is known to cause severe bilateral pneumonia and acute respiratory distress syndrome (ARDS) or Corona virus disease-2019 (COVID-19) in patients that can be debilitating and even fatal. With no drugs or vaccines available yet, a wide range of treatment regimens used are being repurposed. The need of the hour is to analyze various regimens available and devise a treatment plan most effective against SARS-CoV-2. OBJECTIVE Patient concerns: A 68-year-old hypertensive, diabetic male, exhibiting symptoms of cough and shortness of breath presented at the emergency department of our hospital. Diagnosis: Chest CT revealed bilateral ground glass opacities indicative of COVID-19 and the CT score of 24 indicated severe pulmonary pneumonia. He tested positive for COVID-19. METHODS Interventions: The treatment regimen included use of convalescent plasma, oxygen therapy, steroids, high dose antibiotics, broad spectrum antiviral Remdesivir, and anti-interleukin-6 monoclonal antibody/Tocilizumab at various stages of the disease. RESULTS Outcomes: Oxygen support was required at the time of admission. The patient initially developed cytokine release storm and mechanical ventilation was used to manage his condition. Supportive care and multiple treatment regimens were used to successfully recover the patient’s health. CONCLUSIONS Lessons: With a rapid increase in number of confirmed cases worldwide, COVID-19 has become a major challenge to our healthcare system. With no available vaccines currently, finding a combination of therapeutic drugs which are effective in reducing progression of disease is of utmost importance. CLINICALTRIAL Abbreviations:COVID-19=Corona virus disease 2019, nCoV=Novel corona virus (nCoV), SARS-CoV-2=Severe acute respiratory syndrome coronavirus 2, ARDS=acute respiratory distress syndrome, RT PCR= real-time polymerase chain reaction, SPO2= oxygen saturation, ICU=Intensive Care Unit, GGO=ground glass opacities, TDS=thrice daily, OD=once daily, BD= twice daily, CRS= cytokine release syndrome, CPAP=continuous positive airway pressure,FiO2= fraction of inspired oxygen, PEEP=positive end-expiratory pressure, PSV= pressure support ventilation.

scholarly journals Penggunaan Heparin Dosis Tinggi pada Pasien COVID-19 dengan ARDS dan Hipertensi di Unit Perawatan Intensif (ICU)

2020 ◽  
Vol 12 (3) ◽  
pp. 1-8
Author(s):  
Taufik Eko Nugroho ◽  
Mochamat Mochamat ◽  
Famila Famila
Keyword(s):  
Intensive Care Unit ◽  
Acute Respiratory Distress Syndrome ◽  
Intensive Care ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Virus Disease ◽  
Corona Virus ◽  
D Dimer

Latar Belakang: Corona Virus Disease 2019 (COVID-19), pertama kali dilaporkan pada bulan Desember 2019 di Cina, merupakan penyakit yang disebabkan oleh virus SARS-CoV-2 yang menyebar lebih cepat pada populasi manusia dan dalam waktu singkat berkembang menjadi pandemi di seluruh dunia. Sebagian besar kasus yang berujung pada kematian dilaporkan terkomplikasi dengan koagulopati dan disseminated intravascular cogulation (DIC).Kasus: Seorang laki-laki terkonfirmasi positif COVID-19 berusia 50 tahun dengan sesak, batuk dan demam dan komorbiditas hipertensi dirujuk ke intensive care unit (ICU), selama di ICU pasien mendapat terapi heparin dengan dosis terapi dengan melihat kadar aPTT. Setelah perawatan intensif selama 14 hari, pasien mengalami perbaikan yang signifikan.Pembahasan: Pasien dengan infeksi COVID-19 yang progresif dan parah dengan acute respiratory distress syndrome (ARDS) seringkali ditemukan dengan kadar D-dimer dan fibrinogen yang sangat tinggi, yang berujung pada keadaan hiperkoagulasi. Penggunaan antikoagulan untuk pasien dengan COVID-19 yang parah telah. Banyak institusi telah menerapkan penggunaan antikoagulan dosis penuh secara empiris berdasarkan risiko venous thrombo embolism (VTE) dan insiden rendah perdarahan (3-5%).Kesimpulan: Penggunaan antikoagulan, khususnya unfractionatedheparin (UFH) dengan dosis lebih tinggi, direkomendasikan untuk pasien dengan COVID-19 yang parah, meskipun belum ada panduan yang mutlak. 

scholarly journals Ko-infeksi Jamur pada COVID-19 dengan Terapi Steroid

2020 ◽  
Vol 12 (3) ◽  
pp. 49-56
Author(s):  
Septian Adi Permana ◽  
Adhrie Sugiarto ◽  
Muhammad Husni Thamrin ◽  
Purwoko Purwoko ◽  
Arifin Arifin ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Virus Disease ◽  
High Sensitivity ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Corona Virus

Latar belakang: Ko-infeksi jamur pada pasien Corona Virus Disease 2019 (COVID-19) acapkali terjadi. Hal itu dikarenakan kegagalan sistem imun karena infeksi COVID-19 maupun karena pengobatan anti inflamasi yang diberikan.Kasus: Seorang laki-laki 39 tahun dengan acute respiratory distress syndrome (ARDS) berat akibat infeksi COVID-19 dan disertai dengan ko-infeksi jamur. Pasien ini mendapatkan pengobatan steroid dari awal masuk dan pada hari ke-6 hasil kultur sputumnya menunjukkan adanya ko-infeksi jamur. Pasien ini memiliki komorbid berupa riwayat diabetes mellitus. Dari pemeriksaan fisik ditemukan dispnea, takipnea, takikardia sejak hari pertama. Dari hasil laboratorium menunjukkan angka leukosit, high sensitivity c-reactive protein (HsCRP), serum glutamic oxaloacetic (SGOT), gula darah, d-dimmer, lactat dehydrogenase (LDH) dan limfosit netrophyl ratio (LNR) yang tinggi. Pada pasien ini didapatkan rasio PaO2 / FiO2 rendah dan procalcitonin (PCT) yang normal. Dari kultur sputum ditemukan adanya infeksi jamur dan dari hasil rontgen toraks (CXR) menunjukkan pneumonia bilateral. Pasien ini dirawat dengan terapi standar dan mendapatkan dexametason 5 mg / 8 jam, setelah kultur sputum menunjukkan infeksi jamur, pasien juga mendapat mycafungin untuk pengobatan jamurnya.Diskusi: Kecurigaan terhadap ko-infeksi jamur pada pasien COVID-19 yang mendapatkan terapi steroid dalam jangka waktu lama maupun adanya penyerta diabetes harus dipikirkan. Penggunaan terapi anti jamur empiris pun acapkali diperlukan untuk mengurangi morbiditas dan mortalitas.Kesimpulan: Infeksi COVID-19 memiliki risiko terjadinya ko-infeksi, salah satunya adalah infeksi jamur. Insiden koinfeksi jamur diperberat dengan pemberian pengobatan steroid dan riwayat diabetes mellitus. 

scholarly journals Early Cytokine Removal in Critical COVID-19 Patients with Extracorporeal Therapies (HA-380 plus High Volume Hemofiltration) May Prevent Progression of Acute Respiratory Distress Syndrome: Case Report

2020 ◽  
pp. 1-3
Author(s):  
Gonzalo Ramírez-Guerrero ◽  
Vicente Torres Cifuentes ◽  
Romyna Baghetti Hernández ◽  
Francisco Villagrán Cortés ◽  
Simón Rojas Doll ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Clinical Case ◽  
Distress Syndrome ◽  
High Volume ◽  
Cytokine Release ◽  
Cytokine Release Syndrome ◽  
Hemodynamic Deterioration ◽  
High Volume Hemofiltration

We present the case of a patient who suffered from acute respiratory distress syndrome caused by pneumonia associated with COVID-19 and cytokine release syndrome. This patient received a high-volume hemofiltration plus adsorption, solving the hemodynamic deterioration, pulmonary infiltrates, and gas exchange. Our clinical case proposes that the extracorporeal therapies can have a role in the management of severe COVID-19.

Cytokine storm syndrome in SARS-CoV-2: a review

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Braira Wahid ◽  
Noshaba Rani ◽  
Muhammad Idrees
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Failure ◽  
Severe Acute Respiratory Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Cytokine Storm ◽  
Global Level ◽  
Management Option ◽  
Human Contact

Abstract After wreaking havoc on a global level with a total of 5,488,825 confirmed cases and 349,095 deaths as of May 2020, severe acute respiratory syndrome coronavirus 2 is truly living up to the expectations of a 21st-century pandemic. Since the major cause of mortality is a respiratory failure from acute respiratory distress syndrome, the only present-day management option is supportive as the transmission relies solely on human-to-human contact. Patients suffering from coronavirus disease 2019 (COVID-19) should be tested for hyper inflammation to screen those for whom immunosuppression can increases chances of survival. As more and more clinical data surfaces, it suggests patients with mild or severe cytokine storms are at greater risk of failing fatally and hence these cytokine storms should be targets for treatment in salvaging COVID-19 patients.

COVID 19 and its management

2021 ◽  
pp. 117-121
Author(s):  
Subhashis Debnath ◽  
Runa Chakravorty ◽  
Donita Devi
Keyword(s):  
Public Health ◽  
Acute Respiratory Distress Syndrome ◽  
Middle East ◽  
Severe Acute Respiratory Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
The Elderly ◽  
Public Health Emergency ◽  
Novel Coronavirus

In December 2019, severe acute respiratory syndrome-coronavirus-2, a novel coronavirus, initiated an outbreak of pneumonia from Wuhan in China, which rapidly spread worldwide. The outbreak was declared as “a public health emergency of international concern” by the WHO on January 30, 2020, and as a pandemic on March 11, 2020. The disease is transmitted by inhalation or contact with infected droplets and the incubation period ranges from 2 to 14 d. The symptoms are usually fever, cough, sore throat, breathlessness, fatigue, malaise among others. The disease is mild in most people; in some (usually the elderly and those with comorbidities), it may progress to pneumonia, acute respiratory distress syndrome (ARDS) and multi organ dysfunction. Many people are asymptomatic. The virus spreads faster than its two ancestors the SARS-CoV and Middle East respiratory syndrome coronavirus (MERS-CoV), but has lower fatality.

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