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Introduction: Severe and threatening complications of Corona Virus Disease-2019 (COVID-19) are caused by direct viral injury as well as excessive and aberrant host immune response induced by the virus. In this context, use of Methylprednisolone (MP) to prevent cytokine storm and Remdesivir to prevent viral replication seems prudent. Aim: To assess the clinical outcome of combination therapy of Remdesivir and MP pulse therapy in patients with severe COVID-19 in Intensive Care Unit (ICU). Materials and Methods: The retrospective study was conducted in the COVID-19 Intensive Care Unit (ICU), dealing exclusively with severe illness cases, of Safdarjung Hospital, New Delhi from June to July 2020. They were given MP pulse therapy (500 mg/day for three days, followed by 1 mg/kg orally once daily, tapered by 10 or 20 mg/day and finishing with 10 mg) along with intravenous Remdesivir. Pre and post-therapy examination of the patients included clinical features, inflammatory markers (Interleukin-6, ferritin and D-dimer), gas parameters like ratio of arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) and changes in chest radiograph. Values of PaO2/FiO2, inflammatory markers on day 1 and day 3 were expressed as mean±SD and their difference compared using student t-test. Statistical significance was defined as p<0.05. Results: This treatment regimen was associated with significant improvement in PaO2/FiO2 (p<0.001), significant decrease in inflammatory markers (p<0.001) and reversal of radiological changes. Ten patients were discharged with-in two weeks of treatment while six patients were shifted to high dependency unit for further oxygen requirement. They were all successfully discharged from hospital without oxygen requirement within next two weeks. Five patients developed opportunistic infections and succumbed to death. Side-effects of therapy included hyperglycaemia in nine patients, which was managed by insulin infusion. Conclusion: Combination therapy of MP pulse and Remdesivir in patients with severe COVID-19 resulted in significant clinical improvement. Given the high efficacy, it could be one of the promising approaches to the management of patients with severe COVID-19. [ABSTRACT FROM AUTHOR]

Identification of neurological manifestations associated with SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2) in patients with no or mild pulmonary infection proves to be a challenge. The incidence of neurological associations of COVID-19 may be small as compared with respiratory disease; however, in the present scenario with an increasing number of cases each day, the overall incidence of patients with neurological manifestations and their health-related socioeconomic impact might be large. Hence it is important to report such cases so that healthcare providers and concerned authorities are aware of and may prepare for the growing burden. The literature on primary neurological manifestations of COVID-19 is limited, and hence our case series is relevant in the current scenario. The most commonly reported neurological complications are cerebrovascular accidents, encephalopathy, encephalitis, meningitis, and Guillain-Barré syndrome (GBS). We present a series of seven cases with various neurological presentations and possible complications from this novel virus infection. [ABSTRACT FROM AUTHOR]

Background and Objective: COVID-19 has been associated with more than 770 million cases and 6.9 million deaths worldwide, since the first case was reported in 2019 in Wuhan, China. Various demographic and clinical factors have been associated with high mortality. We retrospectively analyzed data of patients admitted to our Intensive Care Unit (ICU) with moderate to severe disease for association of mortality with baseline clinical parameters and lab values. Methodology: Retrospectively, data was collected for patients admitted to ICU of our hospital from March 2021 to August 2021, with moderate to severe covid infection. A total of 399 patients were included in the analysis after exclusion of patients with incomplete outcome data. Analysis was initially performed to find association of baseline parameters with ICU mortality; stratified analysis was further performed for association with various age groups. Results: There was significant association of increased mortality with higher baseline heart rate (> 100 bpm), respiratory rate (> 30 bpm), low PaO2/FiO2 (< 100), Low oxygen saturation (< 80%), high neutrophil/lymphocyte ratio (> 10) and high baseline proBNP (> 500); however, subgroup analysis in the study showed that increased respiratory rate and increased neutrophil/lymphocyte ratio were not associated with increased mortality in patients with ages less than 50 y. Conclusion: Baseline higher baseline heart rate, respiratory rate, low PaO2/FiO2, Low oxygen saturation, high neutrophil/lymphocyte ratio and high baseline proBNP were found to be associated with higher mortality in COVID patients. However, higher respiratory rate and higher neutrophil/lymphocyte ratio were not associated with increased mortality in patients with age less than 50 y. [ABSTRACT FROM AUTHOR]