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Background and Aims: The Nutrition Risk in Critically ill (NUTRIC) score is an appropriate nutritional assessment tool in mechanically ventilated patients. We retrospectively observed the applicability of the NUTRIC score for predicting outcomes in coronavirus disease (COVID)-19 acute respiratory distress syndrome (ARDS) patients. Methods: All adult COVID-19 ARDS patients admitted to the intensive care unit and requiring various forms of oxygen therapy were included in the study. The demographic characteristics and clinical information about the patients were obtained from the hospital's medical records department. The nutritional risk for each patient was assessed using the NUTRIC score at 72 hours of ICU admission. The discriminating power and ability of NUTRIC score, Sequential Organ Failure Assessment (SOFA) score, age and Acute Physiology and Chronic Health Evaluation (APACHE) II to predict the 28-day mortality and need for mechanical ventilation (MV) was calculated using receiver operating characteristic curves and area under this curve. Results: A total of 80 COVID-19 ARDS patients fitted into the inclusion criteria. Among non-survivors, the median Glasgow Coma Score, APACHE II score, NUTRIC score and SOFA score were 10, 16, 6 and 4, respectively. The cut-off values for NUTRIC score, SOFA, and APACHE II to predict 28-day mortality and need for MV was obtained as 3.5, 3.5 and 11.5, respectively. These cut-off values of NUTRIC score, SOFA score, and APACHE II have a sensitivity of 62%, 72.5% and 75.5%, respectively, and specificity of 95%, 72% and 83% for predicting mortality. Conclusions: Most COVID-19 ARDS patients requiring MV in the ICU are at nutritional risk, and a high NUTRIC score is associated with higher mortality. [ABSTRACT FROM AUTHOR]

Sir, A high-flow nasal cannula (HFNC) has become to be widely used in intensive care units (ICUs) treating patients suffering from COVID-19. Nebulizer aerosol drug delivery through high flow nasal cannula in adult patients. To mitigate this difficult challenge, we made an assembly using HFNC circuit and T-piece jet nebulizer interface so that we can give the aerosolized drug through HFNC only instead of face mask interface which is not being accepted by the patient. [Extracted from the article]

During this swab testing, it produces symptoms such as mild discomfort, sneezing, and coughing of COVID19 patients, which not only produces droplets and aerosol but also directly cause respiratory tract infections in health-care professionals.[[2]] This can lead to an increased risk of patient cross-infection and environmental contamination.[[3]] All health-care professionals before nasopharyngeal sampling must wear personal protective equipment. The gold standard method for diagnosing COVID-19 is real-time fluorescence-based real-time polymerase chain reaction of the upper respiratory tract samples, which includes throat swab, nasal swab, and lower respiratory tract samples like bronchoalveolar lavage.[[1]] The nucleic acid testing of COVID-19 mainly involves the nasopharyngeal swabs. [Extracted from the article]

Indian data regarding serious neurological and psychiatric adverse events, following coronavirus disease 2019 (COVID‑19) vaccination, are lacking. We, therefore, systematically evaluated cases of post‑vaccinal serious neurological and psychiatric adverse reactions published from India. A systematic review of cases published from India, which were archived in PubMed, Scopus, and Google Scholar databases, was performed; pre‑print databases along with ahead‑of‑print contents were searched in addition. Retrieved articles, as on June 27, 2022, were evaluated following PRISMA guidelines. EndNote 20 web tool was used to make a PRISMA flow chart. Individual patients’ data were compiled in a tabular form. The protocol of the systematic review was registered with PROSPERO (CRD42022324183). A total of 64 records describing 136 instances of serious neurological and psychiatric adverse events were identified. More than 50% (36/64) reports were from the following four states, namely, Kerala, Uttar Pradesh, New Delhi, and West Bengal. The mean age of persons developing these complications was 44.89 ± 15.77 years. In the majority, adverse events occurred within 2 weeks of administration of the first dose of COVISHIELD vaccine. Immune‑mediated central nervous system (CNS) disorders were identified in 54 instances. Guillain‑Barre syndrome and other immune‑mediated peripheral neuropathies were reported in 21 cases. Post‑vaccinal herpes zoster was recorded in 31 vaccine recipients. Psychiatric adverse events were recorded in six patients. In Indian recipients of COVID‑19 vaccine, a variety of serious neurological complications were reported. The overall risk appears minuscule. Immune‑mediated central and peripheral neuronal demyelinations were the most frequently reported post‑vaccinal adverse events. A large number of cases of herpes zoster have also been reported. Immune‑mediated disorders responded well to immunotherapy. [ABSTRACT FROM AUTHOR]

Severe coronavirus disease-2019 (COVID-19) is a distinct entity that rapidly evolves and may abruptly culminate in to a critical illness. As per Chinese experience, approximately, 15% of patients of COVID-19 progress to severe disease and 5% become critically ill. The incidence of severe and critical illness is higher among men, patients older than 65 years of age and in persons with other medical comorbidities. Cytokine storm cause pronounced lung damage and multiorgan failure. Coagulopathy is a key component of severe COVID-19. Critically ill patients are generally predisposed to a high risk of thromboembolism as well. Lymphopenia predisposes to severe disease. None of the antiviral or immunomodulators has proven efficacy in severe COVID-19. Supplemental oxygen need be administered in patients with hypoxemia. Excessive breathing effort, acute respiratory distress syndrome (ARDS), encephalopathy, and multiorgan failure are indications for mechanical ventilation. In a large number of patients, the overall outcome is poor. Health care workers in intensive care units are exposed to the enormous risk of acquiring hospital acquired SARS-COV-2 infection. [ABSTRACT FROM AUTHOR]