Kolla Vinod

Abstract

Background:  To determine the value of coagulation indicators: D-dimer (DD), prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT), in predicting the severity and prognosis of COVID-19. Materials and Methods:  Around 150 patients with confirmed COVID-19 disease, who were admitted at Rajarajeswari Medical College and Hospital, Bangalore between April 15 2021 and July 15, 2021, were included in the study. The changes of D-Dimer, PT, APTT were tested, and the correlation with, clinical classifications, demographics, CT imaging, vaccination status against COVID-19 and prognosis were observed. Results:  Coagulation disorder occurred at the early stage of COVID-19 infection, in a total of 150 patients observed, 109 (72.66%, St. deviation of 4.26) patients having DD increased at time of admission and 148 patients (98.66%) having increased coagulation profile. The levels of DD and coagulation profile were correlated with clinical classification and also the CT severity and vaccination status. Among 41(27.33%) patients who died, 31(20.66%) patients had DD increased at the first lab test, 40 (26.66%) patients had DD increased on the fifth day of lab tests. The results shows that D-dimer is raised in severe category of COVID-19 infection. Also the CT severity is high (severe, with CT score>15) 71(47.33%) patients with increased D-dimer on admission. It was observed that 41(27.33%) patients who were vaccinated had increased D-dimer 70(46.66%) compared to unvaccinated patients. In addition, with the progression of the disease, the change of CT imaging was closely related to the increase of the DD value (P  Conclusions:  Coagulation dysfunction is more likely to occur in severe and critically ill patients. DD and PT could be used as the significant indicators in predicting the mortality of COVID-19 and measuring the level of D-dimer and coagulation parameters from the early stage of the disease can also be useful in controlling and managing of COVID-19 disease, also vaccinated patients had better outcome among the unvaccinated patients.   Keywords: DD­ D dimer, PT­ prothrombin time, aPTT­ activated partial thromboplastin time

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Abstract

Background: Non-resolving pneumonia (NRP) is a cause of concern among treating physicians due to its diagnostic dilemma. Bronchoalveolar lavage (BAL) is an important tool in diagnosing non resolving pneumonia. This study was undertaken to evaluate non resolving pneumonia by fiberoptic bronchoscopy and BAL to find the etiological diagnosis. Methodology: A prospective observational study was done at a tertiary care centre, Rajarajeshwari Medical College and Hospital Bangalore over the period of one and a half year. Total 64 cases of non-resolving pneumonia were included and patients were evaluated thoroughly by history, clinical examination, radiological tests like chest X-ray and CT-chest, laboratory investigations like white blood cell count, sputum culture and brochoscopic BAL culture were obtained in all patients. Results: 64 patients enrolled in the study out of which 46 (71.87%) male and 18(28.125%) female, mean age of the patients was 52.6 ±11.2. unilateral lung involvement was in 48(75%) of the patients and right lung was most commonly involved in 39(60.93%) patients. The bronchoscopic findings of mucosal inflammation and purulent secretion were most common findings in 36(56.25%). Bacterial culture was positive in 52(81.25%) in BAL analysis, among that Klebsiellae pneumoniae was most common organism in 23(35.93%). BAL AFB smear was positive in 7(10.93%) and 9(14.06%) positive for CBNAAT test. Conclusions: NRP is difficult to treat and diagnostic dilemma for physicians. Bronchoscopic interventions like BAL show significant results in etiological diagnosis of non-resolving pneumonia. Timely intervention of FOB BAL helps in treating patients of non-resolving pneumonia. Keywords: Fiberoptic bronchoscopy; Non resolving pneumonia.

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