COVID 19
As everybody knows that covid 19 pandemic had caused heavy toll of life and those who survived had very severe complications of pulmonary fibrosis, thrombotic events, neuritis, joints pain. Out of these complications most dreaded was pulmonary fibrosis which left people morbid and a hunger for air. In fibrosed lung exchange of gases is not proper which reduces the oxygen saturation of blood and this hypoxia affects the overall metabolism of the body as oxygen in the tissue enters the Krebs cycle and helps in production of ATP in the mitochondria which are the fuel of body. These pandemics were highly mismanaged by the countries, leaving the people at their own with all crossections of society suffering financially, socially and psychologically. There were few comments “eerie of funeral pyre are signature images of our country”. The ravages, devastation and catastrophic effect of this draconian disease is still haunting many families.
TREATMENT
There are many drugs under trial for pulmonary fibrosis with poor outcome and most of the patients are advised lung transplant which is a costly procedure, high rates of mortality and morbidity because of graft rejection, and long cues for graft match.
MODERN APPROACH FOR TREATMENT
With extensive research & development in the field of cell based therapy (like stem cell therapy), it has become a promising and safe technique for reducing the fibrosis and improving the transport of gases along the alveolar membrane and hence the oxygen saturation.
In present case the patient was suffering from post covid fibrosis with oxygen saturation of 90% at rest and 83-84% during walking which forced her to take rest in between. Patient was on oxygen for 12 hours a day @ 4 litres/minute.
LIPOSUCTION
Liposuction was done under local anesthesia and 100 ml of fat was aspirated and after thorough washing it was processed in tissue culture lab and 10 ml stromal vascular fraction prepared. Stromal vascular fraction is rich in mesenchymal cells which have a powerful anti-inflammatory effect and promotes the conversion of alveolar stem cells into alveolar cells which in turn reduces the fibrosis and improves transport of oxygen.
ROUTE OF AUTOLOGOUS MESENCHYMAL CELLS INFUSION
Stem cells were given by IV route diluted in normal saline in non plastic infusion bags as plastic bottles make the mesenchymal cells adhere to the walls of bottle. Infusion was given slowly over 6 hours and oxygen saturation was observed during the entire process.
OUTCOME & RESULT
Patient was followed up on day to day basis and from 4th day patient said that she is feeling better and then rate of oxygen flow was reduced from 4 liters /minute to 2 liters /minute. Patient tolerated well this reduction in @ of oxygen delivery and it was continued for 3 days. Then duration of oxygen therapy was reduced to 8 hours instead of 12 hours and patient tolerated well for 3 days. Then duration was further reduced to 6 hours for 3 days then 4 hours for 3 days then 2 hours for 3 days. Every day oxygen was give for 2 hours @ 1 litre/minute for 7 days. Then oxygen therapy was with drawn.
Patient is doing very well with 95% saturation at rest and 90% saturation during day to day activities (3 months follow up).
