Outcome of tracheostomy among COVID-19 patients in a tertiary hospital setting: Our experience

INTRODUCTION

The COVID-19 pandemic is unprecedented. Amongst those who contracted COVID-19, a number required intubation and prolonged ventilation. This increased the number of ventilated patients in the hospital and increased the requirement for tracheostomy of severe COVID-19 patients. Our objective is to study the outcome of patients with COVID-19 who underwent tracheostomy.

MATERIALS AND METHODS

This study is a novel retrospective study in a tertiary centre in Malaysia. Case notes of COVID- 19 patients who underwent tracheostomy in Hospital Ampang were collected using the electronic Hospital Information System. Data were analysed using the SPSS system.

RESULTS

From a total of 30 patients, 15 patients survived. All patients underwent either open or percutaneous tracheostomy. The median age is 53 (range: 28-69) with a significant p-value of 0.02. Amongst comorbidities, it was noted that diabetes mellitus was significant with a p-value of 0.014. The median time from the onset of COVID-19 to tracheostomy is 30 days. The median duration of intensive care unit (ICU) stay is 30.5 days, with the median duration of hospital length of stay of 44 days (p = 0.009 and <0.001, respectively). No complications that contributed to patient death were found. Survivors had a median of 29.5 days from tracheostomy to oxygen liberation.

CONCLUSION

Tracheostomy in COVID-19 patients that requires prolonged ventilation is unavoidable. It is a safe procedure and mortality is not related to the procedure. Mortality is primarily associated with COVID-19.

P1708Therapeutic hypothermia in cardiac arrest survivors with pre-existing heart failure is nephroprotective

Introduction

The impact of therapeutic hypothermia on kidneys in cardiac arrest survivors with known congestive heart failure (CHF) is not known. Weak evidence suggests higher risk of acute kidney injury with hypothermia.

Purpose

The effect of hypothermia on organ function in cardiac arrest patients with preexisting CHF

Methods

This analysis includes 1417 comatose cardiac arrest survivors that achieved achieved return of spontaneous circulation on hospitalization and had a previous left ventricular ejection fraction (LVEF) assessment within last 1 year. Detailed chart review of these patients was performed. CHF was defined as either prior episode of congestive heart failure or presence of LVEF <50%. Odds ratio (OR) and 95% confidence intervals (CI) for association of hypothermia and acute kidney injury as well as hemodialysis at discharge among patients with and without CHF were computed using multivariable adjusted logistic regression.

Results

Overall, 1417 cardiac arrest patients (mean age 62.5±14.6 years, 60.2% males, 67.2% white and 29.7% black) were included in this analysis, out of which 467 (33.0%) were treated with therapeutic hypothermia and known CHF was present in 624 (44%). AKI developed in 25.2% of CHF patients that were not treated with hypothermia while, only in 18.0% among CHF patients treated with hypothermia (OR 0.56; 95% CI 0.32–0.96, p=0.03). There was an decrease in trend of requiring hemodialysis at discharge among CHF patients treated with hypothermia compared with CHF patients that were not treated with hypothermia (8.1% vs. 19.62%, p=0.019) among CHF patients not treated with hypothermia. However, there was no significant result.

Conclusions

Hypothermia is associated with nephroprotective effects among patients with cardiac survivors with pre-existing CHF. Future research is needed to identify subgroups that derive benefit from therapeutic hypothermia after cardiac arrest.

P1710Risk of Mortality associated with use of mechanical support devices among comatose cardiac arrest patients

Background

The impact of mechanical circulatory assist devices (MCS) has not been well studied in cardiac arrest survivors. We examined that association of MCS with risk of mortality among comatose cardiac arrest survivors

Purpose

Compare the survival between different MCS and non MCS groups

Methods

This is a retrospective cohort study of 1417 comatose adult cardiac arrest survivors that survived for at least 1 day post cardiopulmonary resuscitation. Cox proportional hazard models adjusted for demographics, resuscitation parameters, comorbidities and medications were used to compute hazard ratios for extracorporeal membrane oxygenation (ECMO), ECMO + Impella/intraaortic balloon pump (IABP), IABP and Impella associated with risk of short term 60 day mortality. Kaplan meier's curves were used to demonstrate cumulative survival rate.

Results

Among 1417 cardiac arrest survivors, MCS was used among 553 (39.1%) patients. After 60 days of follow up, mortality rate was 49.4% in non MCS group, 58.6% in IABP group, 22.9% in Impella group, 40.0% in ECMO only group, 50.0% in ECMO + Impella/IABP group. When compared with no MCS use, only Impella use was associated with decrease risk of short term mortality (HR 0.37; 95% CI 0.16–0.83, p=0.02) while there was no significant association of other forms of MCS with short term mortality. There was no significant association of any MCS with long term mortality. Kaplan-Meier curves demonstrate early benefit of Impella and very early benefit of ECMO (figure 1).

Conclusions

This is the first large study to report various types of MCS use among comatose cardiac arrest survivors and has shown an indication of benefit with Impella use only in first 60 days post cardiac arrest. Future prospective study may be needed to validate this association

Acknowledgement/Funding

None

In vivo interactions of entomopathogenic fungi, Beauveria spp. and Metarhizium anisopliae with selected opportunistic soil fungi of sugarcane ecosystem

In the present study, the interactions of entomopathogenic fungi viz., Beauveria bassiana, Beauveria brongniartii and Metarhizium anisopliae among themselves and three other opportunistic soil fungi from the sugarcane ecosystem namely, Fusarium saachari, Aspergillus sp. and Penecillium sp. were assayed in vivo against Galleria mellonella larvae. The tested fungi were co-applied on IV instar G. mellonella @ 1 x 10(7) ml(-1), in combinations of two, at the interval of 24 hrs either preceding or succeeding each otherto assess their efficacy and sporulation rates. Results showed that often mortality rates did not correspond to the spore harvest of the mortality agent and presence of other fungus may be antagonistic. The efficacy of B. bassiana (90%) and B. brongniartii (100%) was not enhanced further but was negatively affected in most combinations with other fungi. In case of M. anisopliae compatibility was higher, resulting in higher mortality by application of B. bassiana before (100%) or after (83.3%) M. anisopliae than when it was applied alone (70%). During sporulation, B. bassiana faced the most intense competition from M. anisopliae (2.75 x 10(6) larva(-1)) and enhancement due to F sacchari irrespective of sequence of application. In case of B. brongniartii, sporulation was lowest in the combination of B. brongniartiipreceding M. anisopliae (1.83 x10(6) larva(-1)) and B. brongniartii succeeding B. bassiana (1.58 x 10(6) larva(-1)). Of all fungi tested, except F sacchari (65.33 x 10(6) larva(-1)) all the other species affected sporulation of M. ansiopliae with the least in treatment of B. bassiana application following M. anisopliae. Similar kind of interaction was observed during sporulation of soil fungi when combined with entomopathogenic fungi, though individually they could not cause mortality of larvae.

Non-traumatic myelopathy at the Chris Hani Baragwanath Hospital, South Africa--the influence of HIV

BACKGROUND

Non-traumatic myelopathy from developing regions has been described widely. In these regions infections, mainly tuberculosis, followed by acute transverse myelitis and neoplasms, dominate. These are also regions of high HIV prevalence. In developed regions, the most prominent reported spinal cord disease in HIV/AIDS is vacuolar myelopathy (VM). Other myelopathy causes in HIV/AIDS include opportunistic infections, neoplasms, vascular lesions and metabolic disease. In developing regions, opportunistic infections are more commonly encountered with VM occurring less frequently.

AIM

To determine the influence of HIV on the myelopathy spectrum in an HIV endemic region.

DESIGN

Prospective case series.

METHODS

Hundred unselected consecutive in-patients admitted with myelopathy were studied. Myelopathy aetiologies were established by collating information obtained from magnetic resonance imaging (MRI) scans, CSF and blood studies, CXR findings, non-neurological illness and response to treatment. Data were analysed in terms of two cohorts, HIV positive and HIV negative.

RESULTS

Approximately 50% of the patients presenting and admitted to our hospital with non-traumatic myelopathy are HIV positive. The HIV positive myelopathy patients were younger (20-40 years) and had infectious aetiologies. Tuberculosis was the most frequently identified cause of myelopathy. The majority of HIV-positive patients had advanced HIV infection. Anti-retroviral treatment did not influence myelopathy aetiologies. The HIV-negative patients were older and had neoplasms, followed by degenerative spondylosis as the main myelopathy causes.

CONCLUSION

HIV influences the non-traumatic myelopathy spectrum in regions with high HIV prevalence. Empiric treatment of HIV-myelopathy patients with anti-tuberculous medications where resources are severely limited has merit.

Occurrence of Gluconacetobacter diazotrophicus in tropical and subtropical plants of Western Ghats, India

Endophytic bacteria were isolated from the tissues of surface sterilized roots, stems, and leaves of fifty different crop plants. Phenotypic, biochemical tests and species-specific PCR assay permitted identification of four isolates of Gluconacetobacter diazotrophicus from root tissues of carrot (Daucus carota L.), raddish (Raphanus sativus L.), beetroot (Beta vulgaris L.) and coffee (Coffea arabica L.). Further the plant growth promoting traits such as nitrogenase activity, production of phytohormone indole acetic acid (IAA), phosphorus and zinc solubilization were assessed. Significant nitrogenase activity was recorded among the isolates and all the isolates produced IAA in the presence of tryptophan. Though all the four isolates efficiently solubilized phosphorus, the zinc solubilizing ability differed among the isolates.

Identification of the catalytic subunit of cAMP-dependent protein kinase from the photosynthetic flagellate, Euglena gracilis Z

A gene named epk2 that encodes the amino acid sequence of a protein kinase was identified from the photosynthetic flagellate, Euglena gracilis Z. Homology search and phylogenetic analysis revealed that the deduced amino acid sequence of epk2 is most similar to that of the catalytic subunit of cAMP-dependent protein kinase (PKA). Northern blot analysis showed that Euglena cells express a 1.4-kb transcript of this gene. When the EPK2 protein was coexpressed with the rat regulatory subunit of PKA in cultured mammalian cells, these two proteins were coimmunoprecipitated. The association of EPK2 and the rat regulatory subunit of PKA was not detected in the cell lysate incubated with cAMP. EPK2 immunoprecipitated from the transfected cells phosphorylated Kemptide, a synthetic peptide substrate for PKA, and the phosphorylation was inhibited by PKI, a PKA-selective protein kinase inhibitor. These results indicate that EPK2 is a PKA homologue in the photosynthetic flagellate, and this is the first evidence for the occurrence of the PKA catalytic subunit in photosynthetic organisms.