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Ghabally M, Shebli B, Yahaya H, Al Ali Y, Alhames S. An abrupt fatal hemothorax in a stable COVID-19 patient: a case report with literature review. Ann Med Surg (Lond) 2024; 86:3123-3126. [PMID: 38694276 PMCID: PMC11060195 DOI: 10.1097/ms9.0000000000001965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 03/06/2024] [Indexed: 05/04/2024] Open
Abstract
Introduction and importance COVID-19 has been widely spread in the last 2 years. Hemothorax is considered one of the rarest complications of COVID-19. Case presentation The authors herein report a case of a 52-year-old patient of COVID-19 that was complicated with abrupt massive hemothorax with hemodynamic instability. Emergent thoracostomy drained almost 4500 ml of blood within 48 h. Thoracoscopy was also performed draining an additional 2000 ml of blood and clots. No further bleeding occurred. Unfortunately, the patient died of septic shock and multiorgan dysfunction. Clinical discussion Hemothorax has been reported in seven patients with COVID-19 in the medical literature. Six patients had severe infection with veno-venous extra-corporeal membranous oxygenation (VV-ECMO), and the seventh patient had necrotizing pneumonia. To our knowledge, this represents the first patient of an abrupt massive hemothorax in a COVID-19 patient just before recovery. Conclusion Post-COVID-19 hemothorax should be suspected in severe cases with sudden clinical deterioration and evidence of pleural effusion.
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Affiliation(s)
- Mike Ghabally
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, University of Aleppo
| | - Baraa Shebli
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, University of Aleppo
| | | | - Yasin Al Ali
- Department of Thoracic Surgery, Aleppo Private Hospital
| | - Samer Alhames
- French College of Vascular and Cardiothoracic Surgery; Chief of Thoracic Surgery Department at Saint Louis Hospital, Aleppo, Syria
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Post-COVID-19 Necrotizing Pneumonia in Patients on Invasive Mechanical Ventilation. Infect Dis Rep 2021; 13:835-842. [PMID: 34563000 PMCID: PMC8482120 DOI: 10.3390/idr13030075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/03/2021] [Accepted: 09/03/2021] [Indexed: 12/14/2022] Open
Abstract
(1) Background: Few reports of necrotizing pneumonia in patients with COVID-19 have been published. We have observed an elevated incidence at two hospitals in our city, suggesting this complication is not uncommon, and may have been overlooked. (2) Methods: This article presents a retrospective, descriptive cohort study that was undertaken from 22 March 2020 to 15 June 2021 in two tertiary care hospitals in Medellín, Colombia. All adult patients admitted to the intensive care unit (ICU) for respiratory failure related to confirmed COVID-19, on invasive mechanical ventilation (IMV), with imaging or surgical findings documenting necrotizing pneumonia (NP) were included. (3) Results: Of 936 patients with COVID-19 that required IMV, 42 (4.5%) developed NP. Overall mortality was 57% and in-hospital mortality was 71%, occurring 15–79 days after COVID-19 diagnosis. NP was diagnosed at a median of 27 days after COVID-19 symptom onset and 15.5 days after initiation of IMV. Infections were polymicrobial in 52.4% of patients. Klebsiella pneumoniae (57%) and Pseudomonas aeruginosa (33%) were the most common etiologic agents. Pulmonary embolism (PE) was documented in 13 patients overall (31%), and in 50% of patients who underwent an angioCT. Drainage and/or surgical procedures were performed on 19 patients (45.2%) with a 75% mortality rate. (4) Conclusions: In our experience, NP is a relatively common, albeit neglected, complication in mechanically ventilated COVID-19 patients, possibly originating in poorly vascularized areas of lung parenchyma. Associated mortality is high. Although drainage procedures did not seem to favorably impact patient outcomes, diagnosis and treatment were late events in the overall disease course, suggesting that early recognition and timely treatment could have a positive impact on prognosis.
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Jung C, Gillmann HJ, Stueber T, Hinken L. Spontaneous massive hemothorax as a complication of necrotizing pneumonia in a patient with severe acute respiratory syndrome coronavirus 2 induced acute respiratory distress syndrome: a case report. J Med Case Rep 2021; 15:444. [PMID: 34479651 PMCID: PMC8415192 DOI: 10.1186/s13256-021-03032-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 07/28/2021] [Indexed: 01/02/2023] Open
Abstract
Background We present an unusual bleeding complication in a patient with severe acute respiratory distress syndrome in coronavirus disease 2019. Case presentation The patient, a 63-year-old Caucasian man, received venovenous extracorporeal membrane oxygenation support after rapid deterioration of lung function on day 6 after admission to hospital. After initial stabilization on lung protective ventilation and prone positioning, he started to develop mild bleeding complications until he went into occult profound hemorrhagic shock. Causative was a massive hemothorax of the right hemithorax with mediastinal shifting due to spontaneous bleeding from a pulmonal artery in a heavily remodeled right inferior lobe. Histopathological examination of the resected tissue showed signs of an organizing fibrinous pneumonia with focal parenchyma necrosis. After surviving a massive bleeding event caused by necrotizing pneumonia, the patient made a swift recovery and was discharged to rehabilitation 31 days after initial hospital admission. Conclusions The combination of severely elevated inflammatory markers and pulmonary hemorrhage should arouse suspicion of necrotizing pneumonia. In necrotizing pneumonia, the possibility of severe intrathoracic bleeding complications should be kept in mind if it comes to sudden deterioration of the patient. Supplementary Information The online version contains supplementary material available at 10.1186/s13256-021-03032-9.
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Affiliation(s)
- Carolin Jung
- Department of Anaesthesiology and Intensive Care Medicine, Medical School Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Hans-Joerg Gillmann
- Department of Anaesthesiology and Intensive Care Medicine, Medical School Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Thomas Stueber
- Department of Anaesthesiology and Intensive Care Medicine, Medical School Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Lukas Hinken
- Department of Anaesthesiology and Intensive Care Medicine, Medical School Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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Paley EL. Towards Understanding COVID-19: Molecular Insights, Co-infections, Associated Disorders, and Aging. J Alzheimers Dis Rep 2021; 5:571-600. [PMID: 34514341 PMCID: PMC8385430 DOI: 10.3233/adr-210010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND COVID-19 can be related to any diseases caused by microbial infection(s) because 1) co-infection with COVID-19-related virus and other microorganism(s) and 2) because metabolites produced by microorganisms such as bacteria, fungi, and protozoan can be involved in necrotizing pneumonia and other necrotizing medical conditions observed in COVID-19. OBJECTIVE By way of illustration, the microbial metabolite of aromatic amino acid tryptophan, a biogenic amine tryptamine inducing neurodegeneration in cell and animal models, also induces necrosis. METHODS This report includes analysis of COVID-19 positivity by zip codes in Florida and relation of the positivity to population density, possible effect of ecological and social factors on spread of COVID-19, autopsy analysis of COVID-19 cases from around the world, serum metabolomics analysis, and evaluation of autoantigenome related to COVID-19. RESULTS In the present estimations, COVID-19 positivity percent per zip code population varied in Florida from 4.65% to 44.3% (February 2021 data). COVID-19 analysis is partially included in my book Microbial Metabolism and Disease (2021). The autoantigenome related to COVID-19 is characterized by alterations in protein biosynthesis proteins including aminoacyl-tRNA synthetases. Protein biosynthesis alteration is a feature of Alzheimer's disease. Serum metabolomics of COVID-19 positive patients show alteration in shikimate pathway metabolism, which is associated with the presence of Alzheimer's disease-associated human gut bacteria. CONCLUSION Such alterations in microbial metabolism and protein biosynthesis can lead to toxicity and neurodegeneration as described earlier in my book Protein Biosynthesis Interference in Disease (2020).
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Affiliation(s)
- Elena L. Paley
- Expert BioMed, Inc. and Nonprofit Public Charity Stop Alzheimers Corp., Miami-Dade, FL, USA
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Nizami M, Grieco C, Hogan J, Aresu G. Surgical management of a COVID-19-associated necrotic pneumonia. BMJ Case Rep 2021; 14:14/6/e240766. [PMID: 34083188 DOI: 10.1136/bcr-2020-240766] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
At the outset of the pandemic, SARS-CoV-2 was thought to present simply as persistent cough and fever. However, with time, the medical community noted a myriad of associated symptoms well-described in the literature. Medical complications were particularly common in elderly populations and many early publications described pneumonia, organ failure, acute respiratory distress syndrome, hypercoagulability/microthrombosis and superimposed bacterial/viral infections. There is, however, a lack of literature describing surgical complications of COVID-19 and as such little knowledge regarding safe surgical interventions. This case describes the presentation/management of a patient who developed COVID-19-associated necrotising pneumonia. Video-assisted thoracoscopy lobectomy was performed following CT demonstration of necrotising pneumonia. Pathological evaluation of the surgical resection specimen demonstrated the microarchitecture of a severely diseased COVID-19 lung-fibrosis. This case demonstrates the safe management of a necrotic lung using a minimal access approach in the context of COVID-19 infection.
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Affiliation(s)
- Maria Nizami
- Cardiothoracic Surgery, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Charlotte Grieco
- Cardiothoracic Surgery, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - John Hogan
- Cardiothoracic Surgery, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Giuseppe Aresu
- Cardiothoracic Surgery, Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
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Han T, Xu H, Liu J, Zhou L, Li X, Dong J, Ge H. One-Pass Conversion of Benzene and Syngas to Alkylbenzenes by Cu-ZnO-Al 2O 3 and ZSM-5 Relay. Catal Letters 2021; 152:467-479. [PMID: 34002107 PMCID: PMC8116197 DOI: 10.1007/s10562-021-03617-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 03/28/2021] [Indexed: 02/03/2023]
Abstract
Alkylbenzenes have a wide range of uses and are the most demanded aromatic chemicals. The finite petroleum resources compels the development of production of alkylbenzenes by non-petroleum routes. One-pass selective conversion of benzene and syngas to alkylbenzenes is a promising alternative coal chemical engineering route, yet it still faces challenge to industrialized applications owing to low conversion of benzene and syngas. Here we presented a Cu-ZnO-Al2O3/ZSM-5 bifunctional catalyst which realizes one-pass conversion of benzene and syngas to alkylbenzenes with high efficiency. This bifunctional catalyst exhibited high benzene conversion (benzene conversion of 50.7%), CO conversion (CO conversion of 55.0%) and C7&C8 aromatics total yield (C7&C8 total yield of 45.0%). Characterizations and catalytic performance evaluations revealed that ZSM-5 with well-regulated acidity, as a vital part of this Cu-ZnO-Al2O3/ZSM-5 bifunctional catalyst, substantially contributed to its performance for the alkylbenzenes one-pass synthesis from benzene and syngas due to depress methanol-to-olefins (MTO) reaction. Furthermore, matching of the mass ratio of two active components in the dual-function catalyst and the temperature of methanol synthesis with benzene alkylation reactions can effectively depress the formation of unwanted by-products and guarantee the high performance of tandem reactions. GRAPHIC ABSTRACT SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s10562-021-03617-5.
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Affiliation(s)
- Tengfei Han
- College of Chemistry and Chemical Engineering, Taiyuan University of Technology, Taiyuan, 030024 Shanxi Province China
| | - Hong Xu
- College of Chemistry and Chemical Engineering, Taiyuan University of Technology, Taiyuan, 030024 Shanxi Province China
| | - Jianchao Liu
- College of Chemistry and Chemical Engineering, Taiyuan University of Technology, Taiyuan, 030024 Shanxi Province China
| | - Ligong Zhou
- Institute of Coal Chemistry, Chinese Academy of Sciences, Taiyuan, 030001 Shanxi Province China
| | - Xuekuan Li
- Institute of Coal Chemistry, Chinese Academy of Sciences, Taiyuan, 030001 Shanxi Province China
| | - Jinxiang Dong
- College of Chemistry and Chemical Engineering, Taiyuan University of Technology, Taiyuan, 030024 Shanxi Province China
| | - Hui Ge
- Institute of Coal Chemistry, Chinese Academy of Sciences, Taiyuan, 030001 Shanxi Province China
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Zhang D, Liu X, Shao M, Sun Y, Lian Q, Zhang H. The value of artificial intelligence and imaging diagnosis in the fight against COVID-19. PERSONAL AND UBIQUITOUS COMPUTING 2021; 27:783-792. [PMID: 33564287 PMCID: PMC7861001 DOI: 10.1007/s00779-021-01522-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 01/07/2021] [Indexed: 05/27/2023]
Abstract
The outbreak of the new type of coronavirus pneumonia (COVID-19) has caused a huge impact on the world. In this case, only by adhering to the prevention and control methods of early diagnosis, early isolation, and early treatment, can the spread of the virus be prevented to the greatest extent. This article uses artificial intelligence-assisted medical imaging diagnosis as the research object, combines artificial intelligence and CT medical imaging diagnosis, introduces an intelligent COVID-19 detection system, and uses it to achieve COVID-19 disease screening and lesion evaluation. CT examination has the advantages of fast speed and high accuracy, which can provide a favorable basis for clinical diagnosis. This article collected 32 lung CT scan images of patients with confirmed COVID-19. Two professional radiologists analyzed the CT images using traditional imaging diagnostic methods and artificial intelligence-assisted imaging diagnostic methods, and the comparison showed the gap between the two methods. According to experiments, CT imaging diagnosis assisted by artificial intelligence only takes 0.744 min on average, which can save a lot of time and cost compared with the average time of 3.623 min for conventional diagnosis. In terms of comprehensive test accuracy, it can be concluded that the combination of artificial intelligence and imaging diagnosis has extremely high application value in COVID-19 diagnosis.
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Affiliation(s)
- Dandan Zhang
- Department of Medical Imaging, Henan Provincial People’s Hospital, Zhengzhou, 450003 Henan China
| | - Xiaoya Liu
- Department of Cerebrovascular Surgery, Henan Provincial People’s Hospital, Zhengzhou, 450003 Henan China
| | - Mingyue Shao
- Department of Medical Imaging, Henan Provincial People’s Hospital, Zhengzhou, 450003 Henan China
| | - Yaping Sun
- Department of Medical Imaging, Henan Provincial People’s Hospital, Zhengzhou, 450003 Henan China
| | - Qingyuan Lian
- Department of Medical Imaging, Henan Provincial People’s Hospital, Zhengzhou, 450003 Henan China
| | - Hongmei Zhang
- Department of Nursing, Henan Provincial People’s Hospital, Zhengzhou, 450003 Henan China
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Peeters K, Mesotten D, Willaert X, Deraedt K, Nauwelaers S, Lauwers G. Salvage Lobectomy to Treat Necrotizing SARS-CoV-2 Pneumonia Complicated by a Bronchopleural Fistula. Ann Thorac Surg 2020; 111:e241-e243. [PMID: 33279555 PMCID: PMC7713638 DOI: 10.1016/j.athoracsur.2020.10.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/28/2020] [Accepted: 10/18/2020] [Indexed: 01/05/2023]
Abstract
We report a case of necrotizing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia complicated by a bronchopleural fistula and treated by decortication and salvage lobectomy. Owing to the unknown characteristics of the underlying SARS-CoV-2 infection, treatment of the abscess and bronchopleural fistula was delayed. This may have resulted in further deterioration of the patient, with ensuing multiple organ dysfunction. Complications of SARS-CoV-2 pneumonia, such as a bacterial abscess and a bronchopleural fistula, should be treated as if the patient were not infected with SARS-CoV-2.
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Affiliation(s)
- Karen Peeters
- Department of Thoracovascular Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium.
| | - Dieter Mesotten
- Department of Anesthesiology, Ziekenhuis Oost-Limburg, Genk, Belgium; Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Xavier Willaert
- Department of Anesthesiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Karen Deraedt
- Department of Pathology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Sigi Nauwelaers
- Department of Thoracovascular Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Geert Lauwers
- Department of Thoracovascular Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium
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