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Severe progression of autoimmune hepatitis in a young COVID-19 adult patient: A case report

Journal of Acute Disease 2022年第4期11卷 161-164页

作者： Neeraj Kumar Sushant Satyapriya Shaik Mohammad Tahaseen Kunal Singh Abhyuday Kumar department of trauma&emergency AIIMS PatnaBiharIndia801505 department of Anaesthesiology AIIMS PatnaBiharIndia801505 department of Medicine AIIMS PatnaBiharIndia801505

Rationale:The impact of COVID-19 in patients with autoimmune liver disease treated with immunosuppressive therapy has not been described so *** case report describes the clinical course of a patient with autoimmune hepatitis(AIH)who developed COVID-19 and the features of cytokine syndrome leading to its deterioration in our intensive care ***’s Concern:A 28-year-old male presented with generalized anasarca for two weeks and chronic liver disease for 8 ***:AIH and Covid-19 with features of cytokine storm ***:Intravenous furosemide,mannitol,syrup lactulose,steroids(prednisolone 40 mg),azathioprine 1 mg/kg body weight,rifaximin,vitamin K,and blood ***:The patient had hepatic encephalopathy and AIH and died on the 10th day after admission despite ventilatory support,sustained low-efficiency hemodialysis,and ***:The dramatic release of cytokines and the inflammatory‐immune responses not only alter the pathophysiology but also affects the onset and severity of disease progression in patients with AIH.

关键词： COVID-19 Autoimmune hepatitis Cytokine storm syndrome Immunosuppressant drugs Liver dysfunction

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COVID-19 presentation as acute pancreatitis:A case report

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Journal of Acute Disease 2022年第5期11卷 199-201页

作者： Abhyuday Kumar A.Valiyaparambath Neeraj Kumar Amarjeet Kumar Ajeet Kumar department of Anaesthesiology AIIMS PatnaBiharIndia801505 departments of trauma&emergency AIIMS PatnaBiharIndia801505

Rationale:The gastrointestinal manifestations of COVID-19 include anorexia,nausea,vomiting,abdominal pain,and ***,pancreatitis as the presentation of COVID-19 is rarely ***’s Concern:A 63-year-old COVID-19 patient presented with complaints of abdominal pain and difficulty breathing for 5 ***:Contrast-enhanced computed tomography of the abdomen suggested acute interstitial pancreatitis without any biliary tract ***:The patient was resuscitated with intravenous fluids based on dynamic parameters of fluid *** patient was started on enteral feeding,analgesics,antibiotics,dexamethasone,low molecular weight heparin,and supportive ***:The patient developed severe acute respiratory distress syndrome and died 6 days after ***:Management of COVID-19 in the presence of pancreatitis is *** early fluid resuscitation is an important aspect of medical management for COVID-19 patients with pancreatitis and restrictive strategies must be *** liver enzymes and renal dysfunction in acute pancreatitis can also limit the use of specific therapies like ***,even though it has shown a beneficial effect in treating COVID-19,can have an additive effect in causing hyperglycemia in these *** should be aware of this atypical presentation of COVID-19 with pancreatitis and adjust their management strategies,keeping in mind the considerations for both diseases.

关键词： Pancreatitis COVID-19 APACHE II Remdesivir Fluid

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Prognostic value of elevated cardiac and inflammatory biomarkers in patients with severe COVID-19:a single-center,retrospective study

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emergency and Critical Care Medicine 2022年第3期2卷 122-127页

作者： Neeraj Kumar Sarfaraz Ahmad Mala Mahto Abhyuday Kumar Prabhat K.Singh department of trauma and emergency All India Institute of Medical Sciences PatnaBiharIndia department of Anaesthesiology All India Institute of Medical Sciences PatnaBiharIndia department of Biochemistry All India Institute of Medical Sciences PatnaBiharIndia Director All India Institute of Medical Sciences PatnaBiharIndia

Background:The outbreak of coronavirus disease 2019(COVID-19)caused by severe acute respiratory syndrome coronavirus 2 in India has been declared a public health *** patients with COVID-19 experience cardiac *** with COVID-19 admitted to the intensive care unit(ICU)with acute myocardial injury showed increased high-sensitivity troponin *** troponin levels may indicate myocardial injury and are commonly associated with ***:We conducted a retrospective observational study of 44 patients with severe COVID-19 in ICU during the second *** primary end point of our retrospective study was 28-day mortality,and the time of ICU admission was designated as day *** extracted and analyzed cardiac biomarkers,such as creatine kinase(CK),creatine kinase-MB(CK-MB),B-type natriuretic peptide(BNP),and high-sensitivity cardiac troponin I(hs-cTnI),and various inflammatory markers such as C-reactive protein(CRP)level,interleukin 6(IL-6),D-dimer,ferritin,lactate dehydrogenase,IL-6,and procalcitonin in patients with severe COVID-19 at ICU admission and 72 hours after ICU admission from our electronic medical record ***:The best cutoff of BNP were 326.8 and 398.5 pg/mL,CK were 195.95 and 180.12 U/L,CK-MB were 112.10 and 108.5 U/L,and hs-cTnI were 0.035 and 0.025 ng/mL,at ICU admission and 72 hours after ICU admission for predicting 28-day mortality among ***:In patients with severe COVID-19,CK and hs-cTnI may be considered effective and valuable predictive cardiac biomarkers among nonsurvivors and predict poor prognosis.

关键词： Cardiac biomarkers COVID-19 Intensive care unit Mortality Prognosis Retrospective study

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Cope's sign and complete heart block secondary to acute cholecystitis: A case report

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Journal of Acute Disease 2020年第4期9卷 176-178页

作者： Neeraj Kumar Pankaj Kumar Prakash K Dubey Abhyuday Kumar Amarjeet Kumar department of trauma and emergency aiims patna bihar India department of emergency Medicine Paras Global HospitalDarbhangaBiharIndia department of Anaesthesiology&Critical Care IGIMS patna bihar India department of Anesthesiology aiims patna bihar India

Rationale: Cope's sign is reflex bradycardia seen in the patient presenting with symptoms of acute cholecystitis. This bradycardia may be due to vagally mediated cardio-biliary reflex. Many of these reflexes due to acute cholecystitis have similar clinical features (some electrocardiographic changes like bradycardia, complete heart block, and asystole) mimicking that of acute coronary syndrome. Patient's concern: A 60-year old male presented with symptoms of acute cholecystitis and referred to the emergency department with complete heart block and abdominal pain with hypotension requiring an emergency temporary pacemaker. Diagnosis: Cope's sign and complete heart block. Intervention: emergency temporary cardiac pacemaker insertion. Outcomes: The patient was discharged after three days with regular follow-up and advice for laparoscopic cholecystectomy. Lessons: Complete heart block or any symptomatic bradycardia associated with abdominal pain should be under consideration of cholecystitis that may be associated with either presence or absence of gall stones due to cardio biliary reflex.

关键词： Cope sign Complete heart block Temporary pacemaker insertion

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