Introduction: Corona virus disease 2019 (COVID-2019) disease caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2, is having propensity of pulmonary and extrapulmonary involvement. Although dengue virus has a predominant extrapulmonary effect, pulmonary involvement is less common. COVID-19–dengue overlap is a mixture of both diseases sharing few similarities. Methods: A multicentric observational study conducted from May 2021 to October 2021, in MIMSR Medical College and Venkatesh Hospital, Latur, India, included 300 COVID-19 cases with dengue NS1 or dengue immunoglobulin M (IgM) positive, with lung involvement documented and categorized on high-resolution computerized tomography (CT) thorax at the entry point. We have recorded demographic parameters as age, gender, comorbidity, and laboratory parameters such as total white blood cell count, platelet count, lactate dehydrogenase (LDH), C-reactive protein (CRP), interleukin-6 (IL-6), dengue serology, and use of BIPAP/NIV in COVID-19 cases in critical care settings in all study cases. CT severity scoring was done as per universally accepted standard mild if score < 7, moderated if score 8–15, and severe if score > 15. The final radiological outcome as presence or absence of fibrosis with clinical recovery was documented. All cases were subjected to dengue immunoglobulin G (IgG) antibody titers and dengue IgM/IgG antibody titer analysis after 12 weeks of discharge from the hospital after clinical recovery. Statistical analysis is done by using Chi-square test. Results: In a study of 300 COVID-19 pneumonia cases, COVID-19–dengue overlap was documented in 16.3% (49/300) of cases. Predominant age groups between 18–95 years and age ≥ 50 years were 60% (180/300), age < 50 were 40% (120/300). In the gender distribution in the study group, male population was 70.3% (211/300) and females were 29.7% (89/300). The main symptoms in the study group were shortness of breath in 79% of cases, fever in 71%, cough especially dry in 48%, and fatigability in 79%, tachycardia in 72%, tachypnea in 24%, and oxygen desaturation on 6 minutes walk in 29%. Positive dengue serology was documented as per CT severity scoring in 26/42 mild CT severity cases, 16/92 in moderate CT severity cases, and 7/166 in severe CT severity cases (P < 0.00001). Hematological parameters were having a significant association in COVID-19 cases with and without dengue overlap such as abnormal white blood cell count (P < 0.0076) and abnormal platelet count (P < 0.00001). Clinical parameters like hypoxia have a significant association in COVID-19 cases with and without dengue overlap (P < 0.00001). “Inflammatory markers” analysis such as interleukin 6 (IL-6) (P < 0.00001), CRP (P < 0.00001), and LDH (P < 0.00001) has documented significant association in COVID-19 cases with and without dengue overlap. In a study of 49 cases of COVID-19–dengue overlap, post-COVID lung fibrosis was documented in 1 case while 251 COVID-19 patients with negative dengue serology documented post-COVID lung fibrosis in 45 cases (P < 0.004). In a study of 49 cases of COVID-19–dengue overlap, actual serological assessment in dengue IgM/IgG and COVID-19 antibody titers was documented in significant association (P < 0.00001). Conclusion: COVID-19–dengue overlap is very frequently documented in tropical settings and disease of concern in critical care settings as the natural trend of this entity is different and has an impact on clinical outcome if diagnosis is delayed. COVID-19 pneumonia with dengue fever behaves like “two sides of the same coin” or the “polyhedron” nature of COVID-19 due to antigenic cross reactivity. Rationality for coexistent pathology is still undetermined.

Introduction: The current study is to identify the performance of urinary tissue inhibitors of metalloproteinase-2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7) for predicting renal replacement therapy (RRT) initiation and mortality in postoperative acute kidney injury (AKI) patients. Methods: Postoperative AKI patients were prospectively and consecutively enrolled. The biomarkers of urinary TIMP-2 and IGFBP7 were detected at the time AKI diagnosed (day 0) and 24 h later (day 1). The primary endpoint was the initiation of RRT, and the secondary endpoint was 30-day mortality. The receiver operating characteristic (ROC) curve was used to assess the performance of biomarkers for the prediction of RRT requirement. Results: There were 220 AKI patients enrolled in this study. Among the 220 patients, 33 (15.0%) initiated RRT during intensive care units period. Urinary (TIMP-2) × (IGFBP7), TIMP-2 and IGFBP7 on day 1 had fair performance for predict RRT initiation, the predictive area under the ROC curve (AUC) were 0.792 (0.732, 0.843), 0.784 (0.724, 0.837), and 0.770 (0.709, 0.824), respectively, with no significant difference. When they combined with clinically independent risk factors (nonrenal sequential organ failure assessment score, duration of surgery procedure, and serum creatinine at the time of AKI diagnosed) to construct predictive models for predicting RRT. The AUCs were greatly improved to be good. The best AUC was achieved by TIMP-2, which was 0.866 (0.814, 0.908). All of the biomarkers performed poor predictive values for predicting 30-day mortality. Conclusion: Urine concentrations of (TIMP-2) × (IGFBP7), TIMP-2 alone, and IGFBP7 alone on AKI day 1 show fair value for prediction of RRT initiation. However, they fail to predict 30-day mortality.

Objective: To evaluate the effect of online objective structured clinical examination (OSCE) in critical care teaching. Methods: This is a self-controlled prospective study performed in Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from 2020 to 2021. Consecutive students came from various surgical departments. Online tests were conducted for each student pre-and post-ICU round. There were three spots in online OSCE including clinical case, electrocardiography and chest X-ray. Results: Twenty-four students completed the tests. The median age is 27 years (24–28) in the cohort. There are 18 males and 6 females. Of twenty-four students, 7 came from department of neurologic or head-neck surgery, 3 from department of thoracic surgery, 12 from department of abdominal surgery, and 2 from others. There was significant difference in scores between pre-round and post-round ICU test in the chest X-ray spot, which was 3.33±4.81 and 6.67±4.81 respectively (P = 0.029). Scores in the postround ICU test in the electrocardiography spot was higher than that in the pre-round test (5.85±5.05 vs. 8.33±3.80)however no significance was reached (P = 0.056). There was no significant difference in the scores between pre-round and post-round ICU test in the clinical case spot (63.33±18.33 vs 71.67 ± 13.07, P = 0.116). Lastly, there were significant differences in total scores between pre-round and post-round ICU test (72.50±19.83 vs 86.67±13.40, P = 0.019). Conclusions: Online OSCE was feasible in the teaching evaluation of surgical rotation residents in ICU. Surgery rotation residents in ICU should receive more training in electrocardiography and chest X-ray.

Background: Vasopressin receptor antagonists increase serum sodium through increased aquaresis via inhibition of V2 receptors. The purpose of this study was to compare the efficacy and safety of conivaptan versus tolvaptan for the treatment of hyponatremia. Subject and Methods: This was a retrospective study of patients who received conivaptan or tolvaptan for hyponatremia admitted to the neurocritical care unit. Serum sodium values were collected at baseline and daily up to 4 days after the last dose. The primary efficacy outcome was an increase in serum sodium ≥4 mEq/L in 24 h after the first vaptan dose. The primary safety outcome was overcorrection defined by an increase in serum sodium >12 mEq/L in 24 h. Results: Thirty-four encounters (14 conivaptan and 20 tolvaptan) were included. Baseline serum sodium was similar between groups (conivaptan 126 mEq/L and tolvaptan 125 mEq/L). Each group received a median of one vaptan dose received on days 5 and 7 of hospitalization for conivaptan and tolvaptan, respectively. The primary efficacy outcome was similar between conivaptan (9 of 14, 64.3%) and tolvaptan (14 of 20, 70%) groups, P = 1.0, and the median change in serum sodium 24 h after the first vaptan dose was 5 versus 7 mEq/L (P = 0.377), respectively. The rate of overcorrection was similar between conivaptan and tolvaptan patients (7.1% vs. 15% P = 0.627). Conclusion: In this study, conivaptan compared to tolvaptan for the treatment of hyponatremia in patients admitted with a primary neurological diagnosis appears efficacious and safe. Further studies are warranted given the sample size of this cohort.

Background: There are controversies regarding corticosteroids using in coronavirus disease-2019 (COVID-19) pneumonia in the current pandemic. Objectives: This study investigates the efficacy and safety profiles of corticosteroids therapy in COVID-19 patients. Methods: Retrospective, multicenter study case series of consecutive patients with confirmed COVID-19 infection at the whole hospital from January 1 to March 1, 2020, were enrolled. Demographic, clinical, radiological, laboratory, and treatment data were collected and analyzed. The effect of corticosteroids therapy on death and organ-failure complications of pneumonia were analyzed by logistic regression. Results: A total of 470 COVID-19 patients at the whole hospital were enrolled. According to the time of corticosteroids initiation and severity of illness, there were 159 patients stratified into critical ill group and 64% (102 of 159) patients received corticosteroids treatments. Ninety-four percent (166 of 176) of corticosteroids were methylprednisolone. The median cumulative corticosteroids dosage was 300 mg equivalent of methylprednisolone over a median duration of 6 days. Multivariate regression analysis showed that corticosteroids use did not affect the mortality. However, corticosteroids therapy at moderate cumulative doses (total exposure 480 mg to 1200 mg) was associated with deceased occurrence of organ-failure complications in critically ill COVID-19. Conclusions: Corticosteroids have no effect to mortality in COVID-19 patients. The moderate cumulative doses of corticosteroids might decrease organ-failure complications in critically ill COVID-19. Further large-scale randomized controlled trials are warranted to confirm our findings, until then use of corticosteroids should be used with caution COVID-19 patients.