Comparative outcomes between COVID-19 and influenza patients placed on veno-venous extracorporeal membrane oxygenation for severe ARDS

Background ECMO is an established supportive adjunct for patients with severe, refractory ARDS from viral pneumonia. However, the exact role and timing of ECMO for COVID-19 patients remains unclear. Methods We conducted a retrospective comparison of the first 32 patients with COVID-19-associated ARDS to the last 28 patients with influenza-associated ARDS placed on V-V ECMO. We compared patient factors between the two cohorts and used survival analysis to compare the hazard of mortality over sixty days post-cannulation.Results COVID-19 patients were older (mean 47.8 vs. 41.2 years, p = 0.033), had more ventilator days before cannulation (mean 4.5 vs. 1.5 days, p < 0.001). Crude in-hospital mortality was significantly higher in the COVID-19 cohort at 65.6% (n = 21/32) versus 36.3% (n = 11/28, p = 0.041). The adjusted hazard ratio over sixty days for COVID-19 patients was 2.81 (95% CI 1.07, 7.35) after adjusting for age, race, ECMO-associated organ failure, and Charlson Comorbidity Index. Conclusion ECMO has a role in severe ARDS associated with COVID-19 but providers should carefully weigh patient factors when utilizing this scarce resource in favor of influenza pneumonia

Effects of telmisartan and ramipril on adiponectin and blood pressure in patients with type 2 diabetes

&lt;b&gt;Background:&lt;/b&gt; Adiponectin is secreted by adipose tissue and may play a role in cardiovascular disease. We examined adiponectin levels in patients with type 2 diabetes who participated in the Telmisartan vs. Ramipril in Renal Endothelial Dysfunction (TRENDY) study. &lt;b&gt;Methods&lt;/b&gt; A total of 87 patients were assessed at baseline and following 9 weeks treatment with the angiotensin-receptor blocker telmisartan (final dose, 80 mg; n = 45) or the angiotensin-converting enzyme inhibitor ramipril (final dose, 10 mg; n = 42). Adiponectin levels were measured in plasma by radioimmunoassay. &lt;b&gt;Results:&lt;/b&gt; Adiponectin levels were inversely correlated with systolic (SBP; r = -0.240, P &#60; 0.05) and diastolic (DBP; r = -0.227, P &#60; 0.05) blood pressure at baseline and following treatment with telmisartan or ramipril (SBP: r = -0.228, P &#60; 0.05; DBP: r = -0.286, P &#60; 0.05). Changes in adiponectin levels were related to changes in SBP (r = -0.357, P &#60; 0.01) and DBP (r = -0.286, P &#60; 0.01). There was a significant increase in adiponectin levels in the telmisartan (0.68 (95% confidence interval (CI), 0.27 to 1.10) &lt;sup&gt;&#181;&lt;/sup&gt;g/ml, P &#60; 0.01) but not in the ramipril group (0.17 (95% CI, -0.56 to 0.90) &lt;sup&gt;&#181;&lt;/sup&gt;g/ml, P = 0.67). Blood pressure reduction in the telmisartan group (DeltaSBP: -13.5 (95% CI, -17.0 to -10.0) mm Hg; &#916;DBP: -7.6 (95% CI, -9.8 to -5.3) mm Hg, each P &#60; 0.001) was significantly (P less than or equal to 0.01 for SBP and P &#60; 0.01 for DBP) greater than in the ramipril group (&#916;SBP: -6.1 (95% CI, -6.2 to -2.0) mm Hg; &#916;DBP: -2.7 (95% CI, -5.0 to -0.5) mm Hg; P &#60; 0.01 and P &#60; 0.05, respectively). &lt;b&gt;Conclusion:&lt;/b&gt; Adiponectin is correlated with blood pressure in patients with type 2 diabetes. Whether increased adiponectin contributes to the blood pressure–lowering effect of telmisartan needs further study

Post-Partum Pituitary Insufficiency and Livedo Reticularis Presenting a Diagnostic Challenge in a Resource Limited Setting in Tanzania: A Case Report, Clinical Discussion and Brief Review of Existing Literature.

Pituitary disorders following pregnancy are an important yet under reported clinical entity in the developing world. Conversely, post partum panhypopituitarism has a more devastating impact on women in such settings due to high fertility rates, poor obstetric care and scarcity of diagnostic and therapeutic resources available. A 37 year old African female presented ten years post partum with features of multiple endocrine deficiencies including hypothyroidism, hypoadrenalism, lactation failure and secondary amenorrhea. In addition she had clinical features of an underlying autoimmune condition. These included a history of post-partum thyroiditis, alopecia areata, livedo reticularis and deranged coagulation indices. A remarkable clinical response followed appropriate hormone replacement therapy including steroids. This constellation has never been reported before; we therefore present an interesting clinical discussion including a brief review of existing literature. Post partum pituitary insufficiency is an under-reported condition of immense clinical importance especially in the developing world. A high clinical index of suspicion is vital to ensure an early and correct diagnosis which will have a direct bearing on management and patient outcome

Time to Cannulation after ICU Admission Increases Mortality for Patients Requiring Veno-Venous ECMO for COVID-19 Associated Acute Respiratory Distress Syndrome

Objective: COVID-19 can cause acute respiratory distress syndrome (ARDS) that is rapidly progressive, severe, and refractory to conventional therapies. Extracorporeal membrane oxygenation (ECMO) can be used as a supportive therapy to improve outcomes but evidence-based guidelines have not been defined. Summary Background Data: Initial mortality rates associated with ECMO for ARDS in COVID-19 were high, leading some to believe that there was no role for ECMO in this viral illness. With more experience, outcomes have improved. The ideal candidate, timing of cannulation, and best post-cannulation management strategy, however, has not yet been defined. Methods: We conducted a retrospective review from April 1 to July 31 2020 of the first 25 patients with COVID-19 associated ARDS placed on V-V ECMO at our institution. We analyzed the differences between survivors to hospital discharge and those who died. Modified Poisson regression was used to model adjusted risk factors for mortality. Results: 44% of patients (11/25) survived to hospital discharge. Survivors were significantly younger (40.5 years vs. 53.1 years; p < 0.001) with no differences between cohorts in mean body mass index, diabetes, or PaO2:FiO2 at cannulation. Survivors had shorter duration from symptom onset to cannulation (12.5 days vs. 19.9 days, p = 0.028) and shorter duration of intensive care unit (ICU) length of stay (LOS) prior to cannulation (5.6 days vs. 11.7 days, p = 0.045). Each day from ICU admission to cannulation increased the adjusted risk of death by 4% and each year increase in age increased the adjusted risk 6%. Conclusions: ECMO has a role in severe, refractory ARDS associated with COVID-19. Increasing age and time from ICU admission were risk factors for mortality and should be considered in patient selection. Further studies are needed to define best practices for V-V ECMO use in COVID-19

Phase equilibrium data for development of correlations for coal fluids

The overall objective of the authors' work is to develop accurate predictive methods for representations of vapor-liquid equilibria in systems encountered in coal-conversion processes. The objectives pursued in the present project include: (1) Measurements of binary vapor-liquid phase behavior data for selected solute gases (e.g., C{sub 2}H{sub 6}, CH{sub 4}) in a series of paraffinic, naphthenic, and aromatic hydrocarbon solvents to permit evaluations of interaction parameters in models for phase behavior. Solubilities of the gases in the liquid phase have been determined. (2) Evaluation of existing equations of state and other models for representations of phase behavior in systems of the type studied experimentally; development of new correlation frameworks as needed. (3) Generalization of the interaction parameters for the solutes studied to a wide spectrum of heavy solvents; presentation of final results in formats useful in the design/optimization of coal liquefaction processes