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Stern R, Bibi M, Keltz MD. Premature Ovarian Insufficiency After Coronavirus Disease 2019 (COVID-19): Autoimmune Follicle-Stimulating Hormone (FSH) and FSH Receptor Blockade. Obstet Gynecol 2024; 143:e149-e152. [PMID: 38574363 DOI: 10.1097/aog.0000000000005574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 02/29/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Since the onset of the coronavirus disease (COVID-19) pandemic, a variety of long-COVID-19 symptoms and autoimmune complications have been recognized. CASES We report three cases of autoimmune premature poor ovarian response in patients aged 30-37 years after mild to asymptomatic COVID-19 before vaccination, with nucleotide antibody confirmation. Two patients failed to respond to maximum-dose gonadotropins for more than 4 weeks, despite a recent history of response before having COVID-19. After a month of prednisone 30 mg, these two patients had normal follicle-stimulating hormone (FSH) levels, high oocyte yield, and blastocyst formation in successful in vitro fertilization cycles. All three patients have above-average anti-müllerian hormone levels that persisted throughout their clinical ovarian insufficiency. Two patients had elevated FSH levels, perhaps resulting from FSH receptor blockade. One patient, with a history of high response to gonadotropins 75 international units per day and below-normal FSH levels, had no ovarian response to more than a month of gonadotropins (525 international units daily), suggesting autoimmune block of the FSH glycoprotein and possible FSH receptor blockade. CONCLUSION Auto-antibody production in response to COVID-19 before vaccination may be a rare cause of autoimmune poor ovarian response. Although vaccination is likely protective, further study will be required to evaluate the effect of vaccination and duration of autoimmune FSH or FSH receptor blockade.
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Affiliation(s)
- Rachel Stern
- New York Medical College, the Department of Obstetrics and Gynecology, New York Medical College, and Reproductive Endocrinology, Westchester Medical Center, Valhalla, and Westmed Reproductive Services, Purchase, New York
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Haber R, Ghezzawi M, Puzantian H, Haber M, Saad S, Ghandour Y, El Bachour J, Yazbeck A, Hassanieh G, Mehdi C, Ismail D, Abi-Kharma E, El-Zein O, Khamis A, Chakhtoura M, Mantzoros C. Mortality risk in patients with obesity and COVID-19 infection: a systematic review and meta-analysis. Metabolism 2024; 155:155812. [PMID: 38360130 DOI: 10.1016/j.metabol.2024.155812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 01/13/2024] [Accepted: 01/29/2024] [Indexed: 02/17/2024]
Abstract
Obesity is a risk factor for severe respiratory diseases, including COVID-19 infection. Meta-analyses on mortality risk were inconsistent. We systematically searched 3 databases (Medline, Embase, CINAHL) and assessed the quality of studies using the Newcastle-Ottawa tool (CRD42020220140). We included 199 studies from US and Europe, with a mean age of participants 41.8-78.2 years, and a variable prevalence of metabolic co-morbidities of 20-80 %. Exceptionally, one third of the studies had a low prevalence of obesity of <20 %. Compared to patients with normal weight, those with obesity had a 34 % relative increase in the odds of mortality (p-value 0.002), with a dose-dependent relationship. Subgroup analyses showed an interaction with the country income. There was a high heterogeneity in the results, explained by clinical and methodologic variability across studies. We identified one trial only comparing mortality rate in vaccinated compared to unvaccinated patients with obesity; there was a trend for a lower mortality in the former group. Mortality risk in COVID-19 infection increases in parallel to an increase in BMI. BMI should be included in the predictive models and stratification scores used when considering mortality as an outcome in patients with COVID-19 infections. Furthermore, patients with obesity might need to be prioritized for COVID-19 vaccination.
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Affiliation(s)
- Rachelle Haber
- Department of Internal Medicine, Division of Endocrinology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Malak Ghezzawi
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Houry Puzantian
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon; Hariri School of Nursing, American University of Beirut, Beirut, Lebanon.
| | - Marc Haber
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Sacha Saad
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Yara Ghandour
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | | | - Anthony Yazbeck
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | | | - Celine Mehdi
- Faculty of Arts and Sciences, American University of Beirut, Beirut, Lebanon
| | - Dima Ismail
- Faculty of Arts and Sciences, American University of Beirut, Beirut, Lebanon
| | - Elias Abi-Kharma
- Department of Internal Medicine, Division of Endocrinology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ola El-Zein
- Saab Medical Library, American University of Beirut, Beirut, Lebanon
| | - Assem Khamis
- Hull York Medical School, University of Hull, York, United Kingdom
| | - Marlene Chakhtoura
- Department of Internal Medicine, Division of Endocrinology, American University of Beirut Medical Center, Beirut, Lebanon.
| | - Christos Mantzoros
- Beth Israel Deaconess Medical Center and Boston VA Healthcare System, Harvard Medical School, Boston, MA, USA
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Pannu S, Exline MC, Bednash JS, Englert JA, Diaz P, Bartlett A, Brock G, Wu Q, Davis IC, Crouser ED. SCARLET (Supplemental Citicoline Administration to Reduce Lung injury Efficacy Trial): study protocol for a single-site, double-blinded, placebo-controlled, and randomized Phase 1/2 trial of i.v. citicoline (CDP-choline) in hospitalized SARS CoV-2-infected patients with hypoxemic acute respiratory failure. Trials 2024; 25:328. [PMID: 38760804 DOI: 10.1186/s13063-024-08155-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 05/07/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND The SARS CoV-2 pandemic has resulted in more than 1.1 million deaths in the USA alone. Therapeutic options for critically ill patients with COVID-19 are limited. Prior studies showed that post-infection treatment of influenza A virus-infected mice with the liponucleotide CDP-choline, which is an essential precursor for de novo phosphatidylcholine synthesis, improved gas exchange and reduced pulmonary inflammation without altering viral replication. In unpublished studies, we found that treatment of SARS CoV-2-infected K18-hACE2-transgenic mice with CDP-choline prevented development of hypoxemia. We hypothesize that administration of citicoline (the pharmaceutical form of CDP-choline) will be safe in hospitalized SARS CoV-2-infected patients with hypoxemic acute respiratory failure (HARF) and that we will obtain preliminary evidence of clinical benefit to support a larger Phase 3 trial using one or more citicoline doses. METHODS We will conduct a single-site, double-blinded, placebo-controlled, and randomized Phase 1/2 dose-ranging and safety study of Somazina® citicoline solution for injection in consented adults of any sex, gender, age, or ethnicity hospitalized for SARS CoV-2-associated HARF. The trial is named "SCARLET" (Supplemental Citicoline Administration to Reduce Lung injury Efficacy Trial). We hypothesize that SCARLET will show that i.v. citicoline is safe at one or more of three doses (0.5, 2.5, or 5 mg/kg, every 12 h for 5 days) in hospitalized SARS CoV-2-infected patients with HARF (20 per dose) and provide preliminary evidence that i.v. citicoline improves pulmonary outcomes in this population. The primary efficacy outcome will be the SpO2:FiO2 ratio on study day 3. Exploratory outcomes include Sequential Organ Failure Assessment (SOFA) scores, dead space ventilation index, and lung compliance. Citicoline effects on a panel of COVID-relevant lung and blood biomarkers will also be determined. DISCUSSION Citicoline has many characteristics that would be advantageous to any candidate COVID-19 therapeutic, including safety, low-cost, favorable chemical characteristics, and potentially pathogen-agnostic efficacy. Successful demonstration that citicoline is beneficial in severely ill patients with SARS CoV-2-induced HARF could transform management of severely ill COVID patients. TRIAL REGISTRATION The trial was registered at www. CLINICALTRIALS gov on 5/31/2023 (NCT05881135). TRIAL STATUS Currently enrolling.
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Affiliation(s)
- Sonal Pannu
- Division of Pulmonary, Critical Care and Sleep Medicine of the Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Matthew C Exline
- Division of Pulmonary, Critical Care and Sleep Medicine of the Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Joseph S Bednash
- Division of Pulmonary, Critical Care and Sleep Medicine of the Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Joshua A Englert
- Division of Pulmonary, Critical Care and Sleep Medicine of the Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Philip Diaz
- Division of Pulmonary, Critical Care and Sleep Medicine of the Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Amy Bartlett
- Center for Clinical and Translational Sciences, The Ohio State University, Columbus, OH, USA
| | - Guy Brock
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
| | - Qing Wu
- Department of Biomedical Informatics, The Ohio State University, Columbus, OH, USA
| | - Ian C Davis
- Department of Veterinary Biosciences, The Ohio State University, Columbus, OH, USA.
| | - Elliott D Crouser
- Division of Pulmonary, Critical Care and Sleep Medicine of the Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
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4
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Li M, Zhu G, Guo Y, Ye Q. Association between emphysema and other pulmonary computed tomography patterns in primary varicella pneumonia: A retrospective cohort study. Medicine (Baltimore) 2024; 103:e38185. [PMID: 38758910 PMCID: PMC11098192 DOI: 10.1097/md.0000000000038185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 04/18/2024] [Indexed: 05/19/2024] Open
Abstract
This study aims to evaluate chest computed tomography (CT) findings in hospital patients with primary varicella pneumonia (PVP). We retrospectively analyzed CT images of 77 PVP patients using 3D Slicer, an open-source software, to model lesions and lungs. This retrospective cohort study was approved by the Institutional Review Board (Ethical Committee, Renmin Hospital, Hubei University of Medicine, Shiyan, China) and waived the requirement for written informed consent. The left lung was more frequently and severely affected in PVP, with significant differences between the 2 groups in CT involvement percentage of each lung region, except for total lung inflation. Group A showed higher median percentages of lung collapse compared to Group B. The extent of left lung involvement is a critical predictor of emphysema in PVP patients, highlighting the importance of also monitoring the right lung for more severe cases. Lower emphysema levels correspond to more collapsed and infiltrated lung segments, suggesting a more severe clinical presentation.
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Affiliation(s)
- Meng Li
- Department of Pulmonary & Critical Care Medicine, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, PR China
| | - Guijuan Zhu
- Department of Gynecology, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, PR China
| | - Yajun Guo
- Department of Pulmonary & Critical Care Medicine, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, PR China
| | - Qing Ye
- Department of Pulmonary & Critical Care Medicine, Renmin Hospital, Hubei University of Medicine, Shiyan, Hubei, PR China
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Lai SHF, Kuok MCI, Ho PPK, Yau YS. Mycoplasma pneumoniae and Viral Pneumonia Coinfection: Something NOT to be Overlooked. Pediatr Infect Dis J 2024; 43:e191. [PMID: 38363143 DOI: 10.1097/inf.0000000000004249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Affiliation(s)
- Stephanie Hui Fung Lai
- Department of Paediatrics, Queen Elizabeth Hospital, Hong Kong SAR, People's Republic of China
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6
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Alsaqobi AK, Miskin BA, Gopinath B, Elgohary G. More than what meets the eye in COVID-19 critical illness: A case report of bilateral femoral neuropathy due to psoas hematomas. Neurosciences (Riyadh) 2024; 29:133-138. [PMID: 38740405 DOI: 10.17712/nsj.2024.2.20230072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Bilateral femoral neuropathy is rare, especially that caused by bilateral compressive iliopsoas, psoas, or iliacus muscle hematomas. We present a case of bilateral femoral neuropathy due to spontaneous psoas hematomas developed during COVID-19 critical illness. A 41-year-old patient developed COVID-19 pneumonia, and his condition deteriorated rapidly. A decrease in the hemoglobin level prompted imaging studies during his intensive care unit (ICU) stay. Bilateral psoas hematomas were identified as the source of bleeding. Thereafter, the patient complained of weakness in both upper and lower limbs and numbness in the lower limb. He was considered to have critical illness neuropathy and was referred to rehabilitation. Electrodiagnostic testing suggested bilateral femoral neuropathy because of compression due to hematomas developed during the course of his ICU stay. The consequences of iliopsoas hematomas occurring in the critically ill can be catastrophic, ranging from hemorrhagic shock to severe weakness, highlighting the importance of recognizing this entity.
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Affiliation(s)
- Ameerah K Alsaqobi
- From the Department of Physical Medicine and Rehab (Alsaqobi, Gopinath, Elgohary), Physical Medicine and Rehabilitation Hospital, from the Department of Internal Medicine (Miskin), Jaber Alahmad Hospital, Kuwait
| | - Brouj A Miskin
- From the Department of Physical Medicine and Rehab (Alsaqobi, Gopinath, Elgohary), Physical Medicine and Rehabilitation Hospital, from the Department of Internal Medicine (Miskin), Jaber Alahmad Hospital, Kuwait
| | - Biju Gopinath
- From the Department of Physical Medicine and Rehab (Alsaqobi, Gopinath, Elgohary), Physical Medicine and Rehabilitation Hospital, from the Department of Internal Medicine (Miskin), Jaber Alahmad Hospital, Kuwait
| | - Ghada Elgohary
- From the Department of Physical Medicine and Rehab (Alsaqobi, Gopinath, Elgohary), Physical Medicine and Rehabilitation Hospital, from the Department of Internal Medicine (Miskin), Jaber Alahmad Hospital, Kuwait
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7
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Florin TA, Freedman SB, Xie J, Funk AL, Tancredi DJ, Kim K, Neuman MI, Yock-Corrales A, Bergmann KR, Breslin KA, Finkelstein Y, Ahmad FA, Avva UR, Lunoe MM, Chaudhari PP, Shah NP, Plint AC, Sabhaney VJ, Sethuraman U, Gardiner MA, Sartori LF, Wright B, Navanandan N, Mintegi S, Gangoiti I, Borland ML, Chong SL, Kwok MY, Eckerle M, Poonai N, Romero CMA, Waseem M, Nebhrajani JR, Bhatt M, Caperell K, Campos C, Becker SM, Morris CR, Rogers AJ, Kam AJ, Pavlicich V, Palumbo L, Dalziel SR, Morrison AK, Rino PB, Cherry JC, Salvadori MI, Ambroggio L, Klassen TP, Payne DC, Malley R, Simon NJ, Kuppermann N. Features Associated With Radiographic Pneumonia in Children with SARS-CoV-2. J Pediatric Infect Dis Soc 2024; 13:257-259. [PMID: 38391389 DOI: 10.1093/jpids/piae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Indexed: 02/24/2024]
Abstract
14% of children with SARS-CoV-2 infections had radiographic pneumonia. Hypoxemia, cough, higher temperature, and older age were associated with pneumonias. In children tested, SARS-CoV-2 test results were not associated with radiographic pneumonia.
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Affiliation(s)
- Todd A Florin
- Division of Emergency Medicine, Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University, Chicago, USA
| | - Stephen B Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Jianling Xie
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Anna L Funk
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | | | - Kelly Kim
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Mark I Neuman
- Division of Emergency Medicine, Department of Pediatrics, Harvard Medical School, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Adriana Yock-Corrales
- Department of Emergency Medicine, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", CCSS, San José, Costa Rica
| | - Kelly R Bergmann
- Department of Emergency Medicine, Children's Minnesota, Minneapolis, USA
| | - Kristen A Breslin
- Division of Emergency Medicine, Children's National Hospital, Washington, District of Columbia, USA
| | - Yaron Finkelstein
- Divisions of Emergency Medicine, and Clinical Pharmacology and Toxicology, Department of Pediatrics Hospital for Sick Children, Toronto, Canada
| | - Fahd A Ahmad
- Department of Pediatrics, Washington University School of Medicine, St. Louis, USA
| | - Usha R Avva
- Department of Emergency Medicine, Montefiore-Nyack Hospital, Nyack, New York, USA
| | - Maren M Lunoe
- Department of Pediatrics, UPMC Children's Hospital of Pittsburgh, Pittsburgh, USA
| | - Pradip P Chaudhari
- Division of Emergency and Transport Medicine, Children's Hospital Los Angeles and Keck School of Medicine of the University of Southern California, Los Angeles, USA
| | - Nipam P Shah
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, USA
| | - Amy C Plint
- Division of Emergency Medicine, Children's Hospital of Eastern Ontario, Department of Pediatrics, University of Ottawa, Ottawa, Canada
| | - Vikram J Sabhaney
- Department of Paediatrics, University of British Columbia, Vancouver, Canada
| | - Usha Sethuraman
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Michigan, Central Michigan University, Detroit, USA
| | - Michael A Gardiner
- Department of Pediatrics, Rady Children's Hospital, University of California San Diego, San Diego, USA
| | - Laura F Sartori
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, USA
| | - Bruce Wright
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alberta, Stollery Children's Hospital, Women's and Children's Health Research Institute, Edmonton, Canada
| | - Nidhya Navanandan
- Section of Emergency Medicine, Department of Pediatrics, Children's Hospital Colorado, University of Colorado, Aurora, USA
| | - Santiago Mintegi
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU, Bilbao, Basque Country, Spain
| | - Iker Gangoiti
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU, Bilbao, Basque Country, Spain
| | - Meredith L Borland
- Divisions of Emergency Medicine and Paediatrics, School of Medicine, Perth Children's Hospital, University of Western Australia, Perth, Australia
| | - Shu-Ling Chong
- Department of Emergency Medicine, KK Women's and Children's Hospital, Pediatrics Academic Clinical Programme, Emergency Medicine Academic Clinical Programme, Duke-NUS Medical School, Singapore
| | - Maria Y Kwok
- Department of Emergency Medicine, New York Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, NY, New York, USA
| | - Michelle Eckerle
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital, Cincinnati, USA
| | - Naveen Poonai
- Department of Pediatrics, Schulich School of Medicine & Dentistry, London, Canada
| | | | - Muhammad Waseem
- Department of Pediatrics, Lincoln Medical Center, New York City, Bronx, New York, USA
| | | | - Maala Bhatt
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - Kerry Caperell
- Division of Emergency Medicine, Department of Pediatrics, University of Louisville, Norton Children's Hospital, Louisville, USA
| | - Carmen Campos
- Pediatric Emergency Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Sarah M Becker
- Department of Pediatrics, Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, USA
| | - Claudia R Morris
- Division of Emergency Medicine, Department of Pediatrics, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, USA
| | - Alexander J Rogers
- Departments of Emergency Medicine and Pediatrics, University of Michigan School of Medicine, Ann Arbor, USA
| | - April J Kam
- Division of Emergency Medicine, Department of Pediatrics, McMaster Children's Hospital, Hamilton, Canada
| | - Viviana Pavlicich
- Departamento de Emergencia Pediátrica, Facultad de Medicina, Hospital General Pediátrico Niños de Acosta Ñu, Universidad Privada del Pacífico, San Lorenzo, Paraguay
| | - Laura Palumbo
- Department of Pediatrics, ASST Spedali Civili di Brescia - Pronto soccorso pediatrico, Brescia, Italy
| | - Stuart R Dalziel
- Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand
- Departments of Surgery and Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Andrea K Morrison
- Division of Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, USA
| | - Pedro B Rino
- Department of Pediatrics, Hospital de Pediatría "Prof. Dr. Juan P. Garrahan", RIDEPLA, Buenos Aires, Argentina
| | - Jonathan C Cherry
- Department of Pediatric Emergency Medicine, IWK Health Centre, Dalhousie University, Halifax, Canada
| | | | - Lilliam Ambroggio
- Section of Emergency Medicine, Department of Pediatrics, Children's Hospital Colorado, University of Colorado, Aurora, USA
| | - Terry P Klassen
- Department of Pediatrics and Child Health, Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Canada
| | - Daniel C Payne
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Richard Malley
- Division of Infectious Diseases, Boston Children's Hospital and Harvard Medical School, Boston, USA
| | - Norma-Jean Simon
- Data Analytics and Reporting and Division of Emergency Medicine, Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
| | - Nathan Kuppermann
- Departments of Emergency Medicine and Pediatrics, University of California, Davis School of Medicine, Sacramento, USA
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8
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Carvalho RLR, Aguiar GG, Moreira JFB, Pereira DN, Augusto VM, Schwarzbold AV, Matos CC, Rios DRA, Costa FR, Anschau F, Chatkin JM, Ruschel KB, Carneiro M, Oliveira NRDE, Paraíso PG, Aguiar RLO, Grizende GMS, Marcolino MS. Patients hospitalized with active tuberculosis and Covid-19 coinfection: A matched case-control from the Brazilian Covid-19 Registry. AN ACAD BRAS CIENC 2024; 96:e20230791. [PMID: 38656058 DOI: 10.1590/0001-3765202420230791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 12/04/2023] [Indexed: 04/26/2024] Open
Abstract
Although control of Covid-19 has improved, the virus continues to cause infections, such as tuberculosis, that is still endemic in many countries, representing a scenario of coinfection. To compare Covid-19 clinical manifestations and outcomes between patients with active tuberculosis infection and matched controls. This is a matched case-control study based on data from the Brazilian Covid-19 Registry, in hospitalized patients aged 18 or over with laboratory confirmed Covid-19 from March 1, 2020, to March 31, 2022. Cases were patients with tuberculosis and controls were Covid-19 patients without tuberculosis. From 13,636 Covid-19, 36 also had active tuberculosis (0.0026%). Pulmonary fibrosis (5.6% vs 0.0%), illicit drug abuse (30.6% vs 3.0%), alcoholism (33.3% vs 11.9%) and smoking (50.0% vs 9.7%) were more common among patients with tuberculosis. They also had a higher frequency of nausea and vomiting (25.0% vs 10.4%). There were no significant differences in in-hospital mortality, mechanical ventilation, need for dialysis and ICU stay. Patients with TB infection presented a higher frequency of pulmonary fibrosis, abuse of illicit drugs, alcoholism, current smoking, symptoms of nausea and vomiting. The outcomes were similar between them.
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Affiliation(s)
- Rafael L R Carvalho
- Universidade Federal da Bahia, Escola de Enfermagem, Rua Basílio da Gama, 241, 40110-040 Salvador, BA, Brazil
- IATS - Instituto de Avaliação de Tecnologias em Saúde(CNPq), Rua Ramiro Barcelos, 2350, 90035-003 Porto Alegre, RS, Brazil
| | - Gabriella G Aguiar
- UNIFENAS, Faculdade de Medicina, Rua Líbano, 66, 31710-030 Belo Horizonte, MG, Brazil
| | - Jessica F B Moreira
- Universidade Federal da Bahia, Escola de Enfermagem, Rua Basílio da Gama, 241, 40110-040 Salvador, BA, Brazil
| | - Daniella N Pereira
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Av. Professor Alfredo Balena, 190, 30130-100 Belo Horizonte, MG, Brazil
| | - Valéria Maria Augusto
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Av. Professor Alfredo Balena, 190, 30130-100 Belo Horizonte, MG, Brazil
| | - Alexandre V Schwarzbold
- Hospital Universitário de Santa Maria, Av. Roraima, 1000, Prédio 22, 95015-900 Santa Maria, RS, Brazil
| | - Carolina C Matos
- Faculdade de Ciências Médicas de Minas Gerais, Faculdade de Medicina, Al. Ezequiel Dias, 275, 30130-110 Belo Horizonte, MG, Brazil
| | - Danyelle R A Rios
- Hospital São João de Deus, Rua do Cobre, 800, 35500-227 Divinópolis, MG, Brasil
| | - Felício R Costa
- Hospital Metropolitano Odilon Behrens, Rua Formiga, 50, 31210-780 Belo Horizonte, MG, Brazil
| | - Fernando Anschau
- Hospital Nossa Senhora da Conceição, Av. Francisco Trein, 596, 91350-200 Porto Alegre, RS, Brazil
| | | | - Karen B Ruschel
- IATS - Instituto de Avaliação de Tecnologias em Saúde(CNPq), Rua Ramiro Barcelos, 2350, 90035-003 Porto Alegre, RS, Brazil
- Hospital Universitário de Canoas, Av. Farroupilha, 8001, São José, 92425-900 Canoas, RS, Brazil
| | - Marcelo Carneiro
- Hospital Santa Cruz, Rua Fernando Abott, 174, 96810-072 Santa Cruz do Sul, RS, Brazil
| | - Neimy R DE Oliveira
- Hospital Eduardo de Menezes, Rua Dr. Cristiano Rezende, 2213, 30622-020 Belo Horizonte, MG, Brazil
| | - Pedro G Paraíso
- Orizonti - Instituto de Saúde e Longevidade, Av. José do Patrocínio Pontes, 1355, 30210-090 Belo Horizonte, MG, Brazil
| | - Rubia Laura O Aguiar
- Hospital Metropolitano, Doutor Célio de Castro, Rua Dona Luiza, 311, 30620-090 Belo Horizonte, MG, Brazil
| | - Genna Maira S Grizende
- Santa Casa de Belo Horizonte, Av. Francisco Salles, 1111, 41905-535 Belo Horizonte, MG, Brazil
| | - Milena S Marcolino
- IATS - Instituto de Avaliação de Tecnologias em Saúde(CNPq), Rua Ramiro Barcelos, 2350, 90035-003 Porto Alegre, RS, Brazil
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Av. Professor Alfredo Balena, 190, 30130-100 Belo Horizonte, MG, Brazil
- Universidade Federal de Minas Gerais, Telehealth Center, Hospital das Clínicas da UFMG, Av. Professor Alfredo Balena, 190, sala 246, 30130-100 Belo Horizonte, MG, Brazil
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9
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Atramont A, Martin GL, Singer M, Tajahmady A, Agamaliyev E, Harhay MO, Leone M, Legrand M. One-Year Survival and Hospital-free Days in Critical Illness After Viral Pneumonia. Am J Respir Crit Care Med 2024; 209:1019-1022. [PMID: 38285911 DOI: 10.1164/rccm.202310-1771le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/29/2024] [Indexed: 01/31/2024] Open
Affiliation(s)
| | | | - Mervyn Singer
- Bloomsbury Institute for Intensive Care Medicine, Division of Medicine, University College London, London, United Kingdom
| | | | | | - Michael O Harhay
- Clinical Trials Methods and Outcomes Lab, PAIR (Palliative and Advanced Illness Research) Center & Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine University of Pennsylvania, Philadelphia, Pennsylvania
| | - Marc Leone
- Department of Anesthesia and Intensive Care Unit, Assistance Publique Hôpitaux de Marseille, Hospital Nord, Aix-Marseille University, Marseille, France
| | - Matthieu Legrand
- Division of Critical Care Medicine, Department of Anesthesia and Perioperative Care, University of California, San Francisco, San Francisco, California; and
- INI-CRCT Network, Nancy, France
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10
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Garg D, Bhalla K, Nanda S, Gupta A, Mehra S. Vitamin D status in children with community acquired pneumonia and its association with severity: a hospital-based study. Minerva Pediatr (Torino) 2024; 76:227-235. [PMID: 33845559 DOI: 10.23736/s2724-5276.21.06036-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND International and observational epidemiological studies provide evidence that vitamin D deficiency may confer increased risk of influenza and respiratory tract infection. This study was undertaken to evaluate the prevalence of vitamin D deficiency in pneumonia in children, and to assess its relationship with the severity. METHODS Study group included children aged between 2 months to 5 years of age admitted as inpatients who presented with clinical features of pneumonia as per WHO Classification. Detailed clinical assessment and physical examination was done at the time of admission and patients were enrolled and relevant findings were noted in prestructured proforma. Vitamin D levels <30 nmol/L (<12 ng/mL) were defined as deficient, 30-50 nmol/L (12-20 ng/mL) as insufficient, and >125 nmol/L (>50 ng/mL) as sufficient. Outcomes of the patients admitted were recorded in terms of duration of hospitalization, Intensive Care Unit (ICU) stay, oxygen requirement, antibiotic need and duration, need for upgradation of antibiotics, nebulization need with drugs used, ventilator need and other parameters. Statistical analysis was performed using statistical package for social sciences software (SPSS Inc., Chicago, IL, USA). A P value of <0.05 was considered statistically significant. RESULTS Out of 101 patients, 100% presented with fever, cough and fast breathing, 42.6% with grunting, 41 (40.5%) with noisy breathing, 5.7% with bluish discoloration, and 4.3% with apnea. Forty-one (40.5%) patients had crepitation, 53 (52.4%) patients had rhonchi, while 7 (6%) presented with bronchial breathing. Chest radiography features at admission helped to differentiate between presumed viral and presumed bacterial infection. Vitamin D deficient patients had significantly longer duration of hospital stay as compared to vitamin D sufficient group (P<0.001). The need for upgradation of antibiotics between the three groups were found to be significant (P<0.001). This showed that vitamin D deficiency is directly proportional to the need of upgradation of antibiotics. Bacterial pneumonia presents mostly as alveolar infiltrates and/or pleural effusion while viral pneumonia presents as interstitial infiltrates and/or hyperinflation. Cases with presumed bacterial pneumonia (based on X-ray, 38 out of 48, 79.1%) were more often vitamin D deficient as compared to case with presumed viral pneumonia (32 out of 52, 61.5%, P=0.05). CONCLUSIONS Vitamin D is widely prevalent in Indian children with pneumonia. Vitamin D deficient patients needed a longer duration of hospitalization, more upgradation of antibiotics, and PICU admissions; moreover, it had more CPAP requirement, longer duration of PICU stay and longer duration of CPAP requirements as compared to vitamin D sufficient group.
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Affiliation(s)
- Deepali Garg
- Department of Pediatrics, Pandit Bhagwat Dayal Sharma Post-Graduate Institute of Medical Sciences, Rohtak, India
| | - Kapil Bhalla
- Department of Pediatrics, Pandit Bhagwat Dayal Sharma Post-Graduate Institute of Medical Sciences, Rohtak, India -
| | - Sanjiv Nanda
- Department of Pediatrics, Pandit Bhagwat Dayal Sharma Post-Graduate Institute of Medical Sciences, Rohtak, India
| | - Ashish Gupta
- Department of Anesthesiology, Paras Hospital, Gurgaon, India
| | - Shuchi Mehra
- Department of Microbiology, Pandit Bhagwat Dayal Sharma Post-Graduate Institute of Medical Sciences, Rohtak, India
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11
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Sharetts R, Moein ST, Khan R, Doty RL. Long-Term Taste and Smell Outcomes After COVID-19. JAMA Netw Open 2024; 7:e247818. [PMID: 38652477 DOI: 10.1001/jamanetworkopen.2024.7818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
Importance Self-report surveys suggest that long-lasting taste deficits may occur after SARS-CoV-2 infection, influencing nutrition, safety, and quality of life. However, self-reports of taste dysfunction are inaccurate, commonly reflecting deficits due to olfactory not taste system pathology; hence, quantitative testing is needed to verify the association of post-COVID-19 condition with taste function. Objective To use well-validated self-administered psychophysical tests to investigate the association of COVID-19 with long-term outcomes in taste and smell function. Design, Setting, and Participants This nationwide cross-sectional study included individuals with and without a prior history of COVID-19 recruited from February 2020 to August 2023 from a social media website (Reddit) and bulletin board advertisements. In the COVID-19 cohort, there was a mean of 395 days (95% CI, 363-425 days) between diagnosis and testing. Exposure History of COVID-19. Main Outcomes and Measures The 53-item Waterless Empirical Taste Test (WETT) and 40-item University of Pennsylvania Smell Identification Test (UPSIT) were used to assess taste and smell function. Total WETT and UPSIT scores and WETT subtest scores of sucrose, citric acid, sodium chloride, caffeine, and monosodium glutamate were assessed for groups with and without a COVID-19 history. The association of COVID-19 with taste and smell outcomes was assessed using analysis of covariance, χ2, and Fisher exact probability tests. Results Tests were completed by 340 individuals with prior COVID-19 (128 males [37.6%] and 212 females [62.4%]; mean [SD] age, 39.04 [14.35] years) and 434 individuals with no such history (154 males [35.5%] and 280 females [64.5%]; mean (SD) age, 39.99 [15.61] years). Taste scores did not differ between individuals with and without previous COVID-19 (total WETT age- and sex-adjusted mean score, 33.41 [95% CI, 32.37-34.45] vs 33.46 [95% CI, 32.54-34.38]; P = .94). In contrast, UPSIT scores were lower in the group with previous COVID-19 than the group without previous COVID-19 (mean score, 34.39 [95% CI, 33.86-34.92] vs 35.86 [95% CI, 35.39-36.33]; P < .001]); 103 individuals with prior COVID-19 (30.3%) and 91 individuals without prior COVID-19 (21.0%) had some degree of dysfunction (odds ratio, 1.64 [95% CI, 1.18-2.27]). The SARS-CoV-2 variant present at the time of infection was associated with smell outcomes; individuals with original untyped and Alpha variant infections exhibited more loss than those with other variant infections; for example, total to severe loss occurred in 10 of 42 individuals with Alpha variant infections (23.8%) and 7 of 52 individuals with original variant infections (13.5%) compared with 12 of 434 individuals with no COVID-19 history (2.8%) (P < .001 for all). Conclusions and Relevance In this study, taste dysfunction as measured objectively was absent 1 year after exposure to COVID-19 while some smell loss remained in nearly one-third of individuals with this exposure, likely explaining taste complaints of many individuals with post-COVID-19 condition. Infection with earlier untyped and Alpha variants was associated with the greatest degree of smell loss.
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Affiliation(s)
- Ryan Sharetts
- Smell and Taste Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Research and Development Division, Sensonics International, Haddon Heights, New Jersey
| | - Shima T Moein
- Smell and Taste Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Research and Development Division, Sensonics International, Haddon Heights, New Jersey
| | - Rafa Khan
- Smell and Taste Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Richard L Doty
- Smell and Taste Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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12
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Wen S, Xu M, Jin W, Zeng L, Lin Z, Yu G, Lv F, Zhu L, Xu C, Zheng Y, Dong L, Lin L, Zhang H. Risk factors and prediction models for bronchiolitis obliterans after severe adenoviral pneumonia. Eur J Pediatr 2024; 183:1315-1323. [PMID: 38117354 DOI: 10.1007/s00431-023-05379-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/07/2023] [Accepted: 12/09/2023] [Indexed: 12/21/2023]
Abstract
Severe adenoviral pneumonia (SAP) can cause post-infectious bronchiolitis obliterans (PIBO) in children. We aimed to investigate the relevant risk factors for PIBO and develop a predictive nomogram for PIBO in children with SAP. This prospective study analysed the clinical data of hospitalised children with SAP and categorised them into the PIBO and non-PIBO groups. Least absolute shrinkage and selection operator (LASSO) regressions were applied to variables that exhibited significant intergroup differences. Logistic regression was adopted to analyse the risk factors for PIBO. Additionally, a nomogram was constructed, and its effectiveness was assessed using calibration curves, C-index, and decision curve analysis. A total of 148 hospitalised children with SAP were collected in this study. Among them, 112 achieved favourable recovery, whereas 36 developed PIBO. Multivariable regression after variable selection via LASSO revealed that aged < 1 year (OR, 2.38, 95% CI, 0.82-6.77), admission to PICU (OR, 24.40, 95% CI, 7.16-105.00), long duration of fever (OR, 1.16, 95% CI, 1.04-1.31), and bilateral lung infection (OR, 8.78, 95% CI, 1.32-195.00) were major risk factors for PIBO. The nomogram model included the four risk factors: The C-index of the model was 0.85 (95% CI, 0.71-0.99), and the area under the curve was 0.85 (95% CI, 0.78-0.92). The model showed good calibration with the Hosmer-Lemeshow test (χ2 = 8.52, P = 0.38) and was useful in clinical settings with decision curve analysis. CONCLUSION Age < 1 year, PICU admission, long fever duration, and bilateral lung infection are independent risk factors for PIBO in children with SAP. The nomogram model may aid clinicians in the early diagnosis and intervention of PIBO. WHAT IS KNOWN • Adenoviruses are the most common pathogens associated with PIBO. • Wheezing, tachypnoea, hypoxemia, and mechanical ventilation are the risk factors for PIBO. WHAT IS NEW • Age < 1 year, admission to PICU, long duration of fever days, and bilateral lung infection are independent risk factors for PIBO in children with SAP. • A prediction model presented as a nomogram may help clinicians in the early diagnosis and intervention of PIBO.
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Affiliation(s)
- Shunhang Wen
- Department of Children's Respiration Disease, the Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, 109 West Xueyuan Road, Lucheng District, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Ming Xu
- Department of Children's Respiration Disease, the Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, 109 West Xueyuan Road, Lucheng District, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Weigang Jin
- Department of Children's Respiration Disease, the Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, 109 West Xueyuan Road, Lucheng District, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Luyao Zeng
- Department of Children's Respiration Disease, the Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, 109 West Xueyuan Road, Lucheng District, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Zupan Lin
- Department of Pediatrics, Jinhua Maternal and Child Health Care Hospital, Jinhua, 321000, Zhejiang, People's Republic of China
| | - Gang Yu
- Department of Children's Respiration Disease, the Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, 109 West Xueyuan Road, Lucheng District, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Fangfang Lv
- Department of Children's Respiration Disease, the Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, 109 West Xueyuan Road, Lucheng District, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Lili Zhu
- Department of Children's Respiration Disease, the Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, 109 West Xueyuan Road, Lucheng District, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Changfu Xu
- Department of Children's Respiration Disease, the Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, 109 West Xueyuan Road, Lucheng District, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Yangming Zheng
- Department of Children's Respiration Disease, the Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, 109 West Xueyuan Road, Lucheng District, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Lin Dong
- Department of Children's Respiration Disease, the Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, 109 West Xueyuan Road, Lucheng District, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Li Lin
- Department of Children's Respiration Disease, the Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, 109 West Xueyuan Road, Lucheng District, Wenzhou, 325000, Zhejiang, People's Republic of China
| | - Hailin Zhang
- Department of Children's Respiration Disease, the Second Affiliated Hospital and Yuying Children's Hospital, Wenzhou Medical University, 109 West Xueyuan Road, Lucheng District, Wenzhou, 325000, Zhejiang, People's Republic of China.
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13
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Kang VJW, Huang YS, Chen MC, Chiang PY, Sheng WH, Wang HC, Wang TC, Chang YC. CT findings of 144 in-hospital patients with influenza pneumonia: A retrospective analysis. J Formos Med Assoc 2024; 123:381-389. [PMID: 37640653 DOI: 10.1016/j.jfma.2023.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/08/2023] [Accepted: 08/17/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND/PURPOSE Patients with influenza infection during their period of admission may have worse computed tomography (CT) manifestation according to the clinical status. This study aimed to evaluate the CT findings of in-hospital patients due to clinically significant influenza pneumonia with correlation of clinical presentations. METHODS In this retrospective, single center case series, 144 patients were included. All in-hospital patients were confirmed influenza infection and underwent CT scan. These patients were divided into three groups according to the clinical status of the most significant management: (1) without endotracheal tube and mechanical ventilator (ETTMV) or extracorporeal membrane oxygenation (ECMO); (2) with ETTMV; (3) with ETTMV and ECMO. Pulmonary opacities were scored according to extent. Spearman rank correlation analysis was used to evaluate the correlation between clinical parameters and CT scores. RESULTS The predominant CT manifestation of influenza infection was mixed ground-glass opacity (GGO) and consolidation with both lung involvement. The CT scores were all reach significant difference among all three groups (8.73 ± 6.29 vs 12.49 ± 6.69 vs 18.94 ± 4.57, p < 0.05). The chest CT score was correlated with age, mortality, and intensive care unit (ICU) days (all p values were less than 0.05). In addition, the CT score was correlated with peak lactate dehydrogenase (LDH) level and peak C-reactive protein (CRP) level (all p values were less than 0.05). Concomitant bacterial infection had higher CT score than primary influenza pneumonia (13.02 ± 7.27 vs 8.95 ± 5.99, p < 0.05). CONCLUSION Thin-section chest CT scores correlated with clinical and laboratory parameters in in-hospital patients with influenza pneumonia.
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Affiliation(s)
| | - Yu-Sen Huang
- Department of Medical Imaging, National Taiwan University, Taipei, Taiwan.
| | - Mei-Chi Chen
- Department of Medical Imaging, National Taiwan University, Taipei, Taiwan.
| | - Pin-Yi Chiang
- Department of Medical Imaging, National Taiwan University, Taipei, Taiwan.
| | - Wang-Huei Sheng
- Division of Infectious Diseases, Department of Internal Medicine, National Taiwan University, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University College of Medicine, Taiwan.
| | - Hao-Chien Wang
- Department of Internal Medicine, National Taiwan University College of Medicine, Taiwan; Division of Chest Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Teh-Chen Wang
- Department Medical Imaging, Taipei City Hospital Yang-Ming Branch, Taipei, Taiwan.
| | - Yeun-Chung Chang
- Department of Medical Imaging, National Taiwan University, Taipei, Taiwan; Department of Radiology, National Taiwan University College of Medicine, Taipei, Taiwan.
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14
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Valga F, Monzón T, Vega-Diaz N, Ruiz-Santana S, Aladro S, Diallo-Saavedra R, De la Flor JC, Rodriguez-Perez JC. Hypochloremia associated with a greater incidence of pneumonia in chronic hemodialysis patients with COVID-19: a center's experience. Nefrologia 2024; 44:290-292. [PMID: 38631966 DOI: 10.1016/j.nefroe.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Affiliation(s)
- Francisco Valga
- Servicio de Nefrología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain; Doctorado en Investigación en Biomedicina, Facultad de Ciencias de la Salud, Departamento de Ciencias Clínicas, Universidad de Las Palmas de Gran Canaria, Spain.
| | - Tania Monzón
- Servicio de Nefrología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain.
| | - Nicanor Vega-Diaz
- Servicio de Nefrología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain; Doctorado en Investigación en Biomedicina, Facultad de Ciencias de la Salud, Departamento de Ciencias Clínicas, Universidad de Las Palmas de Gran Canaria, Spain.
| | - Sergio Ruiz-Santana
- Doctorado en Investigación en Biomedicina, Facultad de Ciencias de la Salud, Departamento de Ciencias Clínicas, Universidad de Las Palmas de Gran Canaria, Spain; Unidad de Cuidados Intensivos, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain.
| | - Sara Aladro
- Servicio de Nefrología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain.
| | - Rassoul Diallo-Saavedra
- Servicio de Anestesiología. Hospital Universitario de Gran Canaria Doctor Negrín. Las Palmas de Gran Canaria, Spain.
| | | | - José Carlos Rodriguez-Perez
- Servicio de Nefrología, Hospital Universitario de Gran Canaria Doctor Negrín, Las Palmas de Gran Canaria, Spain; Doctorado en Investigación en Biomedicina, Facultad de Ciencias de la Salud, Departamento de Ciencias Clínicas, Universidad de Las Palmas de Gran Canaria, Spain.
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15
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Cheng R, Lin F, Deng Z, Liang J, Li X, Lu M, Li L. Prevalence and progression of pneumonia in immunocompetent adults with varicella. Virol J 2024; 21:39. [PMID: 38336670 PMCID: PMC10858607 DOI: 10.1186/s12985-024-02303-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
Pneumonia is the most common complication of varicella infections. Although previous studies have tended to focus mainly on immunocompromised patients, varicella pneumonia can also occur in healthy adults. Therefore, in this study, we aimed to assess the progression of varicella pneumonia in immunocompetent hosts. This retrospective study involved immunocompetent adult outpatients with varicella who attended the adult Fever Emergency facility of Peking University Third Hospital from April 1, 2020, to October 31, 2022. Varicella pneumonia was defined as a classic chickenpox-type rash in patients with infiltrates on chest computed tomography. The study included 186 patients, 57 of whom had a contact history of chickenpox exposure. Antiviral pneumonia therapy was administered to 175 patients by treating physicians. Computed tomography identified pneumonia in 132 patients, although no deaths from respiratory failure occurred. Seventy of the discharged patients were subsequently contacted, all of whom reported being well. Follow-up information, including computed tomography findings, was available for 37 patients with pneumonia, among whom 24 reported complete resolution whereas the remaining 13 developed persistent calcifications. Notably, we established that the true incidence of varicella pneumonia is higher than that previously reported, although the prognosis for immunocompetent hosts is generally good.
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Affiliation(s)
- Ran Cheng
- Department of Infectious Diseases, Peking University Third Hospital, Beijing, China
| | - Fei Lin
- Department of Infectious Diseases, Peking University Third Hospital, Beijing, China
| | - Zhonghua Deng
- Department of Infectious Diseases, Peking University Third Hospital, Beijing, China
| | - Jingjin Liang
- Department of Infectious Diseases, Peking University Third Hospital, Beijing, China
| | - Xiaoguang Li
- Department of Infectious Diseases, Peking University Third Hospital, Beijing, China
| | - Ming Lu
- Department of Respiratory and Critical Care Medicine, Peking University Third Hospital, Beijing, China.
| | - Lu Li
- Department of Infectious Diseases, Peking University Third Hospital, Beijing, China.
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16
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Sellarès-Nadal J, Burgos J, Velasquez F, Martin-Gómez MT, Antón A, Romero-Herrera D, Eremiev S, Bosch-Nicolau P, Rodriguez-Pardo D, Len O, Falcó V. Impact of viral detection in patients with community-acquired pneumonia: An observational cohort study. Med Clin (Barc) 2023; 161:523-529. [PMID: 37598051 DOI: 10.1016/j.medcli.2023.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE The presence of a respiratory virus in patients with community-acquired pneumonia (CAP) may have an impact on the bacterial etiology and clinical presentation. In this study we aimed to assess the role of viral infection in the bacterial etiology and outcomes of patients with CAP. METHODS We performed a retrospective study of all adults hospitalized with CAP between November 2017 and October 2018. Patients were classified according to the presence of viral infection. An unvaried and a multivaried analysis were performed to identify variables associated with viral infection and clinical outcomes. RESULTS Overall 590 patients were included. A microorganism was documented in 375 cases (63.5%). A viral infection was demonstrated in 118 (20%). The main pathogens were Streptococcus pneumoniae (35.8%), Staphylococcus aureus (2.9%) and influenza virus (10.8%). A trend to a higher rate of S. aureus (p=0.06) in patients with viral infection was observed. Patients with viral infection had more often bilateral consolidation patterns (17.8% vs 10.8%, p=0.04), respiratory failure (59.3% vs 42.8%, p=0.001), ICU admission (17.8% vs 7%, p=0.001) and invasive mechanical ventilation (9.3% vs 2.8%, p=0.003). Risk factors for respiratory failure were chronic lung disease, age >65 years, positive blood cultures and viral infection. Influenza, virus but no other respiratory viruses, was associated with respiratory failure (OR, 3.72; 95% CI, 2.06-6.73). CONCLUSIONS Our study reinforces the idea that co-viral infection has an impact in the clinical presentation of CAP causing a more severe clinical picture. This impact seems to be mainly due to influenza virus infection.
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Affiliation(s)
- Julia Sellarès-Nadal
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain; Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona, Spain; Malalties Infeccioses Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Joaquin Burgos
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain; Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona, Spain.
| | - Fernando Velasquez
- Microbiology Department, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | | | - Andrés Antón
- Microbiology Department, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Dani Romero-Herrera
- Microbiology Department, Vall d'Hebron Hospital Universitari, Barcelona, Spain
| | - Simeón Eremiev
- Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona, Spain
| | - Pau Bosch-Nicolau
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain; Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona, Spain
| | - Dolors Rodriguez-Pardo
- Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona, Spain
| | - Oscar Len
- Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona, Spain
| | - Vicenç Falcó
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Barcelona, Spain; Infectious Diseases Department, Vall d'Hebron Hospital Universitari, Vall d'Hebron Barcelona, Spain
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17
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Wang SY, Wang YM, Liu M, Zhao L, Cao B. [Migratory pulmonary ground glass opacities caused by SARS-CoV-2 infection in a patient on B-cell depletion therapy]. Zhonghua Jie He He Hu Xi Za Zhi 2023; 46:1233-1239. [PMID: 38044051 DOI: 10.3760/cma.j.cn112147-20230809-00061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
In immunosuppressed individuals, the manifestation of viral pneumonia due to SARS-CoV-2 infection differs from that in healthy individuals. We reported a unique case of a 58-year-old male patient with B-cell depletion following treatment with the anti-CD20 monoclonal antibody. He presented to the Department of Pulmonary and Critical Care Medicine with complaints of intermittent fever and cough for three months, aggravated by shortness of breath for one month. He was previously diagnosed with stage IVA follicular lymphoma in April 2022 and underwent chemotherapy with Obinutuzumab (anti-CD20 monoclonal antibody). His last treatment was on November 3, 2022. On December 20, 2022, after contact with a SARS-CoV-2-infected person, he exhibited symptoms of fever peaking at 39.0 ℃, cough, and sputum production. A positive SARS-CoV-2 nucleic acid result was confirmed from a pharyngeal swab. Nine days later (December 29, 2022), the patient still had a fever. Chest CT showed multiple small pieces of ground glass opacities (GGOs) in both lower lungs. The diagnosis of viral pneumonia due to SARS-CoV-2 infection was confirmed. After five days of treatment with nirmatrelvir/ritonavir (Paxlovid) and intravenous dexamethasone (5 mg/d), his fever subsided. However, a subsequent chest CT on January 9, 2023 showed partial resorption of multiple GGOs in both lungs, accompanied by novel focal lesions. The patient developed a fever again on January 29, 2023, after which he had recurrent symptoms of fever, cough, and sputum, with intermittent short courses of antibiotics and dexamethasone, which never completely resolved. Multiple chest CTs during this period showed recurrent GGOs and consolidations in both lungs, demonstrating a migratory pattern. The patient was admitted to our hospital on March 7, 2023, with a peripheral blood test suggesting lymphocytopenia, a CD19+B lymphocyte count of zero, and negative IgG and IgM for SARS-CoV-2. A bronchoscopy and bronchoalveolar lavage fluid (BALF) analysis indicated a significantly elevated lymphocyte percentage and the presence of SARS-CoV-2 nucleic acid. Given the three-month history of chronic fever and respiratory symptoms, changing bilateral pulmonary infiltrates, and lack of SARS-CoV-2 humoral immunity, a diagnosis of persistent SARS-CoV-2 infection was considered. Subsequent treatment with Paxlovid for 15 days resulted in the resolution of all symptoms. A follow-up chest CT one month later showed almost complete normalization.
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Affiliation(s)
- S Y Wang
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - Y M Wang
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing 100029, China
| | - M Liu
- Department of Radiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - L Zhao
- Department of Pathology, China-Japan Friendship Hospital, Beijing 100029, China
| | - B Cao
- National Center for Respiratory Medicine, State Key Laboratory of Respiratory Health and Multimorbidity, National Clinical Research Center for Respiratory Diseases, Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, Beijing 100029, China
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18
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Lin F, Zhou Q, Li W, Xiao W, Li S, Liu B, Li H, Cui Y, Lu R, Li Y, Zhang Y, Pan P. A prediction model for acute respiratory distress syndrome in immunocompetent adults with adenovirus-associated Pneumonia: a multicenter retrospective analysis. BMC Pulm Med 2023; 23:431. [PMID: 37932725 PMCID: PMC10629070 DOI: 10.1186/s12890-023-02742-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 10/30/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND In recent years, the number of human adenovirus (HAdV)-related pneumonia cases has increased in immunocompetent adults. Acute respiratory distress syndrome (ARDS) in these patients is the predominant cause of HADV-associated fatality rates. This study aimed to identify early risk factors to predict early HAdV-related ARDS. METHODS Data from immunocompetent adults with HAdV pneumonia between June 2018 and May 2022 in ten tertiary general hospitals in central China was analyzed retrospectively. Patients were categorized into the ARDS group based on the Berlin definition. The prediction model of HAdV-related ARDS was developed using multivariate stepwise logistic regression and visualized using a nomogram. RESULTS Of 102 patients with adenovirus pneumonia, 41 (40.2%) developed ARDS. Overall, most patients were male (94.1%), the median age was 38.0 years. Multivariate logistic regression showed that dyspnea, SOFA (Sequential Organ Failure Assessment) score, lactate dehydrogenase (LDH) and mechanical ventilation status were independent risk factors for this development, which has a high mortality rate (41.5%). Incorporating these factors, we established a nomogram with good concordance statistics of 0.904 (95% CI 0.844-0.963) which may help to predict early HAdV-related ARDS. CONCLUSION A nomogram with good accuracy in the early prediction of ARDS in patients with HAdV-associated pneumonia may could contribute to the early management and effective treatment of severe HAdV infection.
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Affiliation(s)
- Fengyu Lin
- Department of Respiratory Medicine, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, National Key Clinical Specialty, Central South University, Changsha, China
- Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
- Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
- Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, China
| | - Qianhui Zhou
- Department of Respiratory Medicine, Zhuzhou Central Hospital, Zhuzhou, China
| | - Wen Li
- Department of Respiratory Medicine, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, National Key Clinical Specialty, Central South University, Changsha, China
- Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
- Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
- Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, China
| | - Wenchao Xiao
- Department of Cardiology, Yiyang Central Hospital, Yiyang, China
| | - Sha Li
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, China
| | - Ben Liu
- Department of Emergency Medicine, Xiangya Hospital, Central South University, Changsha, China
| | - Haitao Li
- First Department of Thoracic Medicine, The Affiliated Cancer Hospital of Xiangya School of Medicine, Hunan Cancer Hospital, Central South University, Changsha, China
| | - Yanhui Cui
- Department of Respiratory Medicine, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, National Key Clinical Specialty, Central South University, Changsha, China
- Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China
- Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China
- Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, China
| | - Rongli Lu
- Department of Respiratory Medicine, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, National Key Clinical Specialty, Central South University, Changsha, China.
- Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China.
- Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China.
- Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, China.
- Furong Laboratory, Changsha, China.
| | - Yi Li
- Department of Respiratory Medicine, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, National Key Clinical Specialty, Central South University, Changsha, China.
- Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China.
- Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China.
- Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, China.
- Furong Laboratory, Changsha, China.
| | - Yan Zhang
- Department of Respiratory Medicine, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, National Key Clinical Specialty, Central South University, Changsha, China.
- Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China.
- Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China.
- Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, China.
- Furong Laboratory, Changsha, China.
| | - Pinhua Pan
- Department of Respiratory Medicine, Branch of National Clinical Research Center for Respiratory Disease, Xiangya Hospital, National Key Clinical Specialty, Central South University, Changsha, China.
- Center of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, China.
- Hunan Engineering Research Center for Intelligent Diagnosis and Treatment of Respiratory Disease, Changsha, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, China.
- Clinical Research Center for Respiratory Diseases in Hunan Province, Changsha, China.
- Furong Laboratory, Changsha, China.
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19
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Fukihara J, Kondoh Y. COVID-19 and interstitial lung diseases: A multifaceted look at the relationship between the two diseases. Respir Investig 2023; 61:601-617. [PMID: 37429073 PMCID: PMC10281233 DOI: 10.1016/j.resinv.2023.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 04/09/2023] [Accepted: 05/22/2023] [Indexed: 07/12/2023]
Abstract
Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although it has been a fatal disease for many patients, the development of treatment strategies and vaccines have progressed over the past 3 years, and our society has become able to accept COVID-19 as a manageable common disease. However, as COVID-19 sometimes causes pneumonia, post-COVID pulmonary fibrosis (PCPF), and worsening of preexisting interstitial lung diseases (ILDs), it is still a concern for pulmonary physicians. In this review, we have selected several topics regarding the relationships between ILDs and COVID-19. The pathogenesis of COVID-19-induced ILD is currently assumed based mainly on the evidence of other ILDs and has not been well elucidated specifically in the context of COVID-19. We have summarized what has been clarified to date and constructed a coherent story about the establishment and progress of the disease. We have also reviewed clinical information regarding ILDs newly induced or worsened by COVID-19 or anti-SARS-CoV-2 vaccines. Inflammatory and profibrotic responses induced by COVID-19 or vaccines have been thought to be a risk for de novo induction or worsening of ILDs, and this has been supported by the evidence obtained through clinical experience over the past 3 years. Although COVID-19 has become a mild disease in most cases, it is still worth looking back on the above-reviewed information to broaden our perspectives regarding the relationship between viral infection and ILD. As a representative etiology for severe viral pneumonia, further studies in this area are expected.
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Affiliation(s)
- Jun Fukihara
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, 160 Nishioiwake-cho, Seto, Aichi, 489-8642, Japan
| | - Yasuhiro Kondoh
- Department of Respiratory Medicine and Allergy, Tosei General Hospital, 160 Nishioiwake-cho, Seto, Aichi, 489-8642, Japan.
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20
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Poteshkina NG, Krylova NS, Karasev AA, Nikitina TA, Beloglazova IP, Kovalevskaya EA, Parshin VV, Lysenko MA, Ibragimova AM, Smorshchok VN. Condition of the Right Heart in Patients With COVID-19‑Associated Pneumonia: Follow-Up During Hospitalization. Kardiologiia 2023; 63:26-32. [PMID: 37691502 DOI: 10.18087/cardio.2023.8.n2092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Accepted: 05/27/2022] [Indexed: 09/12/2023]
Abstract
Aim Dynamic assessment of the right heart in patients with COVID-19-associated pneumonia of different severity during regression of the systemic inflammatory response (SIR).Material an methods This single-center prospective study included 46 patients with the novel coronavirus infection COVID-19 and viral pneumonia according to chest multispiral computed tomography (CT). Laboratory and echocardiographic examinations of patients were performed.Results Based on the results of evaluation with the Clinical Condition Scale (CCS-COVID), patients were divided into two groups: group A, patients with a score from 6 to 9 and group B, patients with a score from 10 to 14. The study results of both groups were evaluated twice: on day 10±2.5 from the onset of symptoms (groups A10 and B10, respectively) and again on day 17±1.8 (groups A17 and B17, respectively). Patients of group B10 had more pronounced SIR (C-reactive protein, 111.38±52.5 mg / l) and a larger volume of ground-glass opacity (38.3±9.6 %). At the first stage, higher values of right ventricular global longitudinal strain (RV GLS) were detected in group B10 compared to group A10 (23.2±4.8 % vs. 19.9±3.5 %, р=0.048). During the regression of SIR intensity and the positive dynamics of CT, lower values of Е / А were observed in group B17 (1.0 [0.98; 1.2]) vs. group А17 (1.4 [1.18; 1.5, p=0.015), and е' / a' in group B17 (0.66 [0.58; 0.85]) vs. 0.95 [0.79; 1.12] in group B17 (p=0.010). Е / А and е' / a' ratios were correlated with total lactate dehydrogenase fraction (r= -0.452 and p=0.006; r= -0.334 and p=0.050, respectively).Conclusion In patients with severe COVID-19-associated pneumonia during regression of SIR intensity, changes in the parameters that reflected RV diastolic dysfunction were observed.
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Affiliation(s)
- N G Poteshkina
- Pirogov Russian National Research Medical University, Moscow; Municipal Clinical Hospital #52, Moscow
| | - N S Krylova
- Pirogov Russian National Research Medical University, Moscow; Municipal Clinical Hospital #52, Moscow
| | - A A Karasev
- Pirogov Russian National Research Medical University, Moscow
| | | | - I P Beloglazova
- Pirogov Russian National Research Medical University, Moscow; Municipal Clinical Hospital #52, Moscow
| | - E A Kovalevskaya
- Pirogov Russian National Research Medical University, Moscow; Municipal Clinical Hospital #52, Moscow
| | | | - M A Lysenko
- Pirogov Russian National Research Medical University, Moscow; Municipal Clinical Hospital #52, Moscow
| | - A M Ibragimova
- Pirogov Russian National Research Medical University, Moscow
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21
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Gottlieb J, Torres F, Haddad T, Dhillon G, Dilling DF, Knoop C, Rampolla R, Walia R, Ahya V, Kessler R, Budev M, Neurohr C, Glanville AR, Jordan R, Porter D, McKevitt M, German P, Guo Y, Chien JW, Watkins TR, Zamora MR. A randomized controlled trial of presatovir for respiratory syncytial virus after lung transplant. J Heart Lung Transplant 2023; 42:908-916. [PMID: 36964084 DOI: 10.1016/j.healun.2023.01.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 01/06/2023] [Accepted: 01/30/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Respiratory syncytial virus (RSV) infection in lung transplant recipients is associated with high morbidity. This study evaluated the RSV fusion inhibitor presatovir in RSV-infected lung transplant recipients. METHODS In this international Phase 2b, randomized, double-blind, placebo-controlled trial (NCT02534350), adult lung transplant recipients with symptomatic confirmed RSV infection for ≤7 days received oral presatovir 200 mg on day 1 and 100 mg daily on days 2 to 14, or placebo (2:1), with follow-up through day 28. There were 2 coprimary endpoints: time-weighted average change in nasal RSV load from day 1 to 7, calculated from nasal swabs, in the full analysis set ([FAS]; all patients who received study drug and had quantifiable baseline nasal RSV load) and time-weighted average change in nasal RSV load from day 1 to 7 in the subset of patients with pretreatment symptom duration at the median or shorter of the FAS. Secondary endpoints were changes in respiratory infection symptoms assessed using the Influenza Patient-Reported Outcomes questionnaire and lung function measured by spirometry. RESULTS Sixty-one patients were randomized, 40 received presatovir, 20 placebo, and 54 were included in efficacy analyses. Presatovir did not significantly improve the primary endpoint in the FAS (treatment difference [95% CI], 0.10 [-0.43, 0.63] log10 copies/ml; p = 0.72) or the shorter symptom-duration subgroup (-0.12 [-0.94, 0.69] log10 copies/ml; p = 0.76). Secondary endpoints were not different between presatovir and placebo groups. Presatovir was generally well tolerated. CONCLUSIONS Presatovir treatment did not significantly improve change in nasal RSV load, symptoms, or lung function in lung transplant recipients.
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Affiliation(s)
- Jens Gottlieb
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany
| | - Fernando Torres
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Tarik Haddad
- Pulmonary Disease and Critical Care, Tampa General Hospital, Tampa, Florida
| | - Gundeep Dhillon
- Department of Medicine, Stanford University Medical Center, Stanford, California
| | - Daniel F Dilling
- Division of Pulmonary and Critical Care, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois
| | - Christiane Knoop
- Department of Chest Medicine, Erasme University Hospital, Brussels, Belgium
| | | | - Rajat Walia
- Pulmonary and Critical Care Section, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Vivek Ahya
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Romain Kessler
- Department of Respiratory Medicine and INSERM-UMR 1260 Regenerative NanoMedicine, University of Strasbourg, Strasbourg, France
| | - Marie Budev
- Department of Pulmonary Medicine, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Claus Neurohr
- Department of Internal Medicine, University of Munich, Munich, Germany
| | - Allan R Glanville
- Department of Thoracic Medicine, St. Vincent's Hospital, Darlinghurst, New South Wales, Australia
| | | | | | | | | | - Ying Guo
- Gilead Sciences, Inc., Foster City, California
| | | | | | - Martin R Zamora
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado at Denver Anschutz Medical Center, Aurora, Colorado.
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22
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Li L, Wang C, Ren Y, Liu J, Liu F, Zhang X. Clinical features and risk factors for viral pneumonia complicated with invasive pulmonary aspergillosis in adult patients. Chin Med J (Engl) 2023; 136:1361-1363. [PMID: 37106526 PMCID: PMC10309498 DOI: 10.1097/cm9.0000000000002354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Indexed: 04/29/2023] Open
Affiliation(s)
- Lijuan Li
- Department of Pulmonary and Critical Care Medicine, National Centre for Clinical Research on Respiratory Diseases, China-Japan Friendship Hospital, Beijing 100029, China
| | - Chuan Wang
- Department of Pulmonary and Critical Care Medicine, First Hospital of Shijiazhuang, Shijiazhuang, Hebei 050011, China
| | - Yali Ren
- Department of Pulmonary and Critical Care Medicine, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China
| | - Jiangbo Liu
- Department of Pulmonary and Critical Care Medicine, Tianjin First Central Hospital, Tianjin 300192, China
| | - Feifei Liu
- Department of Respiratory and Critical Care Medicine, First Hospital of Qin Huang Dao, Qinhuangdao, Hebei 066000, China
| | - Xiaoqi Zhang
- Department of Pulmonary and Critical Care Medicine, Second People's Hospital of Weifang, Weifang, Shandong 261041, China
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23
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Sedighi F, Zarghami M, Alizadeh Arimi F, Moosazadeh M, Ala S, Ghasemian R, Mehravaran H, Elyasi F. Efficacy and safety of adding fluoxetine to the treatment regimen of hospitalized patients with non-critical COVID-19 pneumonia: A double-blind randomized, placebo-controlled clinical trial. Neuropsychopharmacol Rep 2023; 43:202-212. [PMID: 36941089 PMCID: PMC10275279 DOI: 10.1002/npr2.12327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/27/2023] [Accepted: 02/21/2023] [Indexed: 03/22/2023] Open
Abstract
INTRODUCTION Selective serotonin reuptake inhibitors are considered the drugs, whose effectiveness in viral pandemics has been studied. The aim of this study was to evaluate of adding fluoxetine to the treatment regimen of patients with COVID-19 pneumonia. METHODS This study was a double-blind randomized placebo controlled clinical trial .36 patients in the fluoxetine and 36 patients in the placebo group were enrolled. Patients in the intervention group were first treated with fluoxetine 10 mg for 4 days and then the dose of 20 mg was continued for 4 weeks. Data analysis was conducted using SPSS V. 22.0. RESULTS There was no statistically significant difference between the two groups in terms of clinical symptoms at the beginning of the study and also the score of anxiety and depression, oxygen saturation at the time of hospitalization, mid-hospitalization and discharge periods. The need for mechanical ventilator support (p = 1.00), the need for admission in the intensive care unit (ICU) (p = 1.00), rate for mortality (p = 1.00), and discharge with relative recovery (p = 1.00) were not significantly different between the two groups. The distribution of CRP within the study groups showed a significant decrease during different time periods (p = 0.001), and although there was no statistically significant difference between the two groups on the first day (p = 1.00) and at discharge (p = 0.585), mid-hospital CRP showed a significant decrease in the fluoxetine group (p = 0.032). CONCLUSION Fluoxetine resulted in a faster reduction of patients' inflammation without association with depression and anxiety.
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Affiliation(s)
- Faranak Sedighi
- Psychiatry and Behavioral Sciences Research CenterAddiction InstituteMazandaran University of Medical SciencesSariIran
| | - Mehran Zarghami
- Psychiatry and Behavioral Sciences Research CenterAddiction InstituteMazandaran University of Medical SciencesSariIran
- Department of PsychiatryFaculty of MedicineMazandaran University of Medical SciencesSariIran
| | - Fatemeh Alizadeh Arimi
- Psychiatry and Behavioral Sciences Research CenterAddiction InstituteMazandaran University of Medical SciencesSariIran
| | - Mahmood Moosazadeh
- Gastrointestinal Cancer Research CenterNon‐communicable Diseases InstituteMazandaran University of Medical SciencesSariIran
| | - Shahram Ala
- Department of Clinical PharmacyPharmaceutical Sciences Research CenterHemoglobinopathy Institute, Faculty of PharmacyMazandaran University of Medical SciencesSariIran
| | - Roya Ghasemian
- Antimicrobial Resistance Research CenterDepartment of Infectious DiseasesMazandaran University of Medical SciencesSariIran
| | - Hossein Mehravaran
- Department of Internal MedicinePulmonary and Critical Care DivisionFaculty of MedicineMazandaran University of Medical SciencesSariIran
| | - Forouzan Elyasi
- Psychiatry and Behavioral Sciences Research CenterAddiction InstituteMazandaran University of Medical SciencesSariIran
- Department of PsychiatryFaculty of MedicineMazandaran University of Medical SciencesSariIran
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24
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Beliavsky A, Johnston B, Li Q, Tomlinson G, Kaul R, Granton J. Secondary infections in critically ill patients with viral pneumonia due to COVID-19 and influenza: a historical cohort study. Can J Anaesth 2023; 70:374-383. [PMID: 36918454 PMCID: PMC10013978 DOI: 10.1007/s12630-022-02376-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 08/22/2022] [Accepted: 09/20/2022] [Indexed: 03/15/2023] Open
Abstract
PURPOSE To compare the incidence and nature of secondary infections (SI) between critically ill patients with viral pneumonia due to COVID-19 and seasonal influenza and explore the association between SI and clinical outcomes. METHODS We conducted a historical cohort study of patients admitted to the intensive care unit (ICU) at two tertiary care centers during the first wave of the COVID-19 pandemic and patients admitted with influenza during the 2018-2019 season. The primary outcome was the rate of SI. Secondary outcomes included rates of ICU and in-hospital mortality, organ-support-dependent disease, and length of ICU and hospital stay. RESULTS Secondary infections developed in 55% of 95 COVID-19 patients and 51% of 47 influenza patients (unadjusted odds ratio [OR], 1.16; 95% confidence interval [CI], 0.57 to 2.33). After adjusting for baseline differences between cohorts, there were no significant differences between the COVID-19 cohort and the influenza cohort (adjusted OR, 1.00; 95% CI, 0.41 to 2.44). COVID-19 patients with SI had longer ICU and hospital stays and duration of mechanical ventilation. The SI incidence was higher in COVID-19 patients treated with steroids than in those not treated with steroids (15/20, 75% vs 37/75, 49%). CONCLUSION Secondary infections were common among critically ill patients with viral pneumonia including COVID-19. We found no difference in the incidence of SI between COVID-19 and influenza in our cohort study, but SI in patients with COVID-19 were associated with worse clinical outcomes and increased healthcare resource use. The small cohort size precludes any causal inferences but may provide a basis for future research.
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Affiliation(s)
- Alina Beliavsky
- Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada.
| | - Barry Johnston
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Qixuan Li
- Biostatistics Research Unit, University Health Network, Toronto, ON, Canada
| | - George Tomlinson
- Biostatistics Research Unit, University Health Network, Toronto, ON, Canada
- Department of Medicine, University Health Network, Toronto, ON, Canada
- Sinai Health System, Toronto, ON, Canada
| | - Rupert Kaul
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - John Granton
- Department of Critical Care Medicine, Queen's University, Kingston, ON, Canada
- Division of Respirology, University of Toronto, University Health Network, Toronto, ON, Canada
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25
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Fabbri L, Moss S, Khan FA, Chi W, Xia J, Robinson K, Smyth AR, Jenkins G, Stewart I. Parenchymal lung abnormalities following hospitalisation for COVID-19 and viral pneumonitis: a systematic review and meta-analysis. Thorax 2023; 78:191-201. [PMID: 35338102 PMCID: PMC8977456 DOI: 10.1136/thoraxjnl-2021-218275] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 02/03/2022] [Indexed: 01/17/2023]
Abstract
INTRODUCTION Persisting respiratory symptoms in COVID-19 survivors may be related to development of pulmonary fibrosis. We assessed the proportion of chest CT scans and pulmonary function tests consistent with parenchymal lung disease in the follow-up of people hospitalised with COVID-19 and viral pneumonitis. METHODS Systematic review and random effects meta-analysis of proportions using studies of adults hospitalised with SARS-CoV-2, SARS-CoV, MERS-CoV or influenza pneumonia and followed up within 12 months. Searches performed in MEDLINE and Embase. Primary outcomes were proportion of radiological sequelae on CT scans; restrictive impairment; impaired gas transfer. Heterogeneity was explored in meta-regression. RESULTS Ninety-five studies (98.9% observational) were included in qualitative synthesis, 70 were suitable for meta-analysis including 60 SARS-CoV-2 studies with a median follow-up of 3 months. In SARS-CoV-2, the overall estimated proportion of inflammatory sequelae was 50% during follow-up (0.50; 95% CI 0.41 to 0.58; I2=95%), fibrotic sequelae were estimated in 29% (0.29; 95% CI 0.22 to 0.37; I2=94.1%). Follow-up time was significantly associated with estimates of inflammatory sequelae (-0.036; 95% CI -0.068 to -0.004; p=0.029), associations with fibrotic sequelae did not reach significance (-0.021; 95% CI -0.051 to 0.009; p=0.176). Impaired gas transfer was estimated at 38% of lung function tests (0.38 95% CI 0.32 to 0.44; I2=92.1%), which was greater than restrictive impairment (0.17; 95% CI 0.13 to 0.23; I2=92.5%), neither were associated with follow-up time (p=0.207; p=0.864). DISCUSSION Sequelae consistent with parenchymal lung disease were observed following COVID-19 and other viral pneumonitis. Estimates should be interpreted with caution due to high heterogeneity, differences in study casemix and initial severity. PROSPERO REGISTRATION NUMBER CRD42020183139.
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Affiliation(s)
- Laura Fabbri
- National Heart & Lung Institute, Imperial College London, London, UK
- Nottingham NIHR Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Samuel Moss
- National Heart & Lung Institute, Imperial College London, London, UK
- Nottingham NIHR Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Fasihul A Khan
- Nottingham NIHR Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Wenjie Chi
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Jun Xia
- Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Karen Robinson
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Alan Robert Smyth
- Nottingham NIHR Biomedical Research Centre, University of Nottingham, Nottingham, UK
- Division of Child Health, Obstetrics & Gynaecology, University of Nottingham, Nottingham, UK
| | - Gisli Jenkins
- National Heart & Lung Institute, Imperial College London, London, UK
- Nottingham NIHR Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - Iain Stewart
- National Heart & Lung Institute, Imperial College London, London, UK
- Nottingham NIHR Biomedical Research Centre, University of Nottingham, Nottingham, UK
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Çelik T, Doğan D, Parlak ÇF. The prevalence and prognostic effect of hyponatremia in children with COVID-19 pneumonia: a retrospective study. Turk J Pediatr 2023; 65:572-582. [PMID: 37661672 DOI: 10.24953/turkjped.2022.1027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
BACKGROUND The aim of the study was to examine the effect of hyponatremia at admission as a negative prognostic factor in children hospitalized with COVID-19 pneumonia. METHODS The data of patients aged 1 month-18 years, who were followed with the diagnosis of pneumonia at Çanakkale Onsekiz Mart University Hospital, Department of Pediatrics, between January 2018 and May 2021 were examined, retrospectively. Patients (n=661) were divided into two main groups; COVID-19 pneumonia (n=158) and the other pneumonias [other viral pneumonia (n=161) and pneumonia of unknown etiology (n=342)]. RESULTS Six hundred and twenty-three patients with a median (Q1-Q3) age of 4 (1.5-8) years, 59.4% of whom were male were included in the study. The overall prevalence of hyponatremia at admission was 11.2% and was lower in those with COVID-19 pneumonia than in those with other viral pneumonia (6.4% vs. 15.2%, p=0.013). When evaluated irrespective of their COVID-19 status, hyponatremic patients had a higher supplemental oxygen requirement (OR 2.5 [1.4-4.3], p < 0.001), higher need for intensive care unit (ICU) admission (OR 3.7 [1.3-10.2], p=0.009) and longer duration of hospitalization (p=0.016) than the normonatremic patients. In patients with COVID-19 pneumonia, being hyponatremic had no effect on supplemental oxygen requirements or the duration of hospitalization. When hyponatremic patients were evaluated, the supplemental oxygen requirements and duration of hospitalization of those with COVID-19 pneumonia were similar to the other pneumonias (p > 0.05 for all comparisons). However, normonatremic COVID-19 pneumonias had higher supplemental oxygen requirements than other viral pneumonias and pneumonia of unknown etiology (OR 4.7 [2.2-10.3], p < 0.001; OR 1.6 [1 -2.7], p=0.043, respectively). CONCLUSION This study found that hyponatremia at admission is rarer in children with COVID-19 pneumonia than other viral pneumonias and has no effect on supplemental oxygen requirements or the duration of hospitalization.
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Affiliation(s)
- Taylan Çelik
- Divisions of Pediatric Infectious Disease, Department of Pediatrics, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale
| | - Durmuş Doğan
- Department of Pediatric Endocrinology, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale, Türkiye
| | - Çağrı Furkan Parlak
- Divisions of Pediatric Infectious Disease, Department of Pediatrics, Çanakkale Onsekiz Mart University Faculty of Medicine, Çanakkale
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Chen LL, Weng H, Li HY, Wang XH. Noninvasive Mechanical Ventilation in Patients with Viral Pneumonia-Associated Acute Respiratory Distress Syndrome: An Observational Retrospective Study. Int J Clin Pract 2023; 2023:1819087. [PMID: 36793926 PMCID: PMC9908335 DOI: 10.1155/2023/1819087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 12/02/2022] [Accepted: 12/08/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES Appropriate mechanical ventilation may change the prognosis of patients with viral pneumonia-associated acute respiratory distress syndrome (ARDS). This study aimed to identify the factors associated with the success of noninvasive ventilation in the management of patients with ARDS secondary to respiratory viral infection. METHODS In this retrospective cohort study, all patients with viral pneumonia-associated ARDS were divided into the noninvasive mechanical ventilation (NIV) success group and the NIV failure group. The demographic and clinical data of all patients were collected. The factors associated with the success of noninvasive ventilation were identified by the logistic regression analysis. RESULTS Among this cohort, 24 patients with an average age of 57.9 ± 17.0 years received successful NIVs, and NIV failure occurred in 21 patients with an average age of 54.1 ± 14.0 years. The independent influencing factors for the success of the NIV were the acute physiology and chronic health evaluation (APACHE) II score (odds ratio (OR): 1.83, 95% confidence interval (CI): 1.10-3.03) and lactate dehydrogenase (LDH) (OR: 1.011, 95% CI: 1.00-1.02). When the oxygenation index (OI) is <95 mmHg, APACHE II > 19, and LDH > 498 U/L, the sensitivity and specificity of predicting a failed NIV were (66.6% (95% CI: 43.0%-85.4%) and 87.5% (95% CI: 67.6%-97.3%)); (85.7% (95% CI: 63.7%-97.0%) and 79.1% (95% CI: 57.8%-92.9%)); (90.4% (95% CI: 69.6%-98.8%) and 62.5% (95% CI: 40.6%-81.2%)), respectively. The areas under the receiver operating characteristic curve (AUC) of the OI, APACHE II scores, and LDH were 0.85, which was lower than the AUC of the OI combined with LDH and the APACHE II score (OLA) of 0.97 (P=0.0247). CONCLUSIONS Overall, patients with viral pneumonia-associated ARDS receiving successful NIV have lower mortality rates than those for whom NIV failed. In patients with influenza A-associated ARDS, the OI may not be the only indicator of whether NIV can be used; a new indicator of NIV success may be the OLA.
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Affiliation(s)
- Lu-lu Chen
- Department of Respiratory Diseases, People' Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou 350009, China
| | - Heng Weng
- Department of Respiratory Diseases, People' Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou 350009, China
| | - Hong-yan Li
- Department of Critical Care Medicine, People' Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuzhou 350009, China
| | - Xin-hang Wang
- Department of Respiratory Diseases, Fuzhou Pulmonary Hospital of Fujian, Fuzhou 350008, China
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Anstett S, Gravenstein KS, Finn A, Salloum I. Diffuse Alveolar Hemorrhage Secondary to Human Metapneumovirus Pulmonary Infection. R I Med J (2013) 2022; 105:31-33. [PMID: 36300961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
A 67-year-old man presented with a week of flu-like symptoms, hypoxia, and fever. Respiratory viral panel was positive for human metapneumovirus. Initial chest imaging showed left lower lobe opacification, suggesting a bacterial superimposed on viral pneumonia. Despite antibiotics, the patient became tachycardic and increasingly hypoxic, requiring 40 L high-flow nasal cannula. Repeat imaging demonstrated worsening of a left lower lobe process. Elective bronchoscopy with bronchoalveolar lavage revealed hemorrhage. Subsequent autoimmune, bacterial, and fungal workup was negative. The patient was diagnosed with diffuse alveolar hemorrhage (DAH) secondary to human metapneumovirus pneumonia. DAH is defined as bleeding into the alveolar spaces of the lungs, a process which carries high rates of morbidity and mortality.1 While dramatic in name and often associated with hemoptysis, DAH may only present with clinically subtle and nonspecific features with a variety of alternative etiologies to consider. We present this case of DAH secondary to human metapneumovirus (hMPV) to promote discussion of etiologies of DAH aside from systemic vasculitis.
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Affiliation(s)
- Sarah Anstett
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | | | - Arkadiy Finn
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Ibrahem Salloum
- The Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Liakina V, Stundiene I, Milaknyte G, Bytautiene R, Reivytyte R, Puronaite R, Urbanoviciute G, Kazenaite E. Effects of COVID-19 on the liver: The experience of a single center. World J Gastroenterol 2022; 28:5735-5749. [PMID: 36338891 PMCID: PMC9627423 DOI: 10.3748/wjg.v28.i39.5735] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/12/2022] [Accepted: 09/21/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) was perhaps the most severe global health crisis in living memory. Alongside respiratory symptoms, elevated liver enzymes, abnormal liver function, and even acute liver failure were reported in patients suffering from severe acute respiratory disease coronavirus 2 pneumonia. However, the precise triggers of these forms of liver damage and how they affect the course and outcomes of COVID-19 itself remain unclear.
AIM To analyze the impact of liver enzyme abnormalities on the severity and outcomes of COVID-19 in hospitalized patients.
METHODS In this study, 684 depersonalized medical records from patients hospitalized with COVID-19 during the 2020-2021 period were analyzed. COVID-19 was diagnosed according to the guidelines of the National Institutes of Health (2021). Patients were assigned to two groups: those with elevated liver enzymes (Group 1: 603 patients), where at least one out of four liver enzymes were elevated (following the norm of hospital laboratory tests: alanine aminotransferase (ALT) ≥ 40, aspartate aminotransferase (AST) ≥ 40, gamma-glutamyl transferase ≥ 36, or alkaline phosphatase ≥ 150) at any point of hospitalization, from admission to discharge; and the control group (Group 2: 81 patients), with normal liver enzymes during hospitalization. COVID-19 severity was assessed according to the interim World Health Organization guidance (2022). Data on viral pneumonia complications, laboratory tests, and underlying diseases were also collected and analyzed.
RESULTS In total, 603 (88.2%) patients produced abnormal liver test results. ALT and AST levels were elevated by a factor of less than 3 in 54.9% and 74.8% of cases with increased enzyme levels, respectively. Patients in Group 1 had almost double the chance of bacterial viral pneumonia complications [odds ratio (OR) = 1.73, P = 0.0217], required oxygen supply more often, and displayed higher biochemical inflammation indices than those in Group 2. No differences in other COVID-19 complications or underlying diseases were observed between groups. Preexisting hepatitis of a different etiology was rarely documented (in only 3.5% of patients), and had no impact on the severity of COVID-19. Only 5 (0.73%) patients experienced acute liver failure, 4 of whom died. Overall, the majority of the deceased patients (17 out of 20) had elevated liver enzymes, and most were male. All deceased patients had at least one underlying disease or combination thereof, and the deceased suffered significantly more often from heart diseases, hypertension, and urinary tract infections than those who made recoveries. Alongside male gender (OR = 1.72, P = 0.0161) and older age (OR = 1.02, P = 0.0234), diabetes (OR = 3.22, P = 0.0016) and hyperlipidemia (OR = 2.67, P = 0.0238), but not obesity, were confirmed as independent factors associated with more a severe COVID-19 infection in our cohort.
CONCLUSION In our study, the presence of liver impairment allows us to predict a more severe inflammation with a higher risk of bacterial complication and worse outcomes of COVID-19. Therefore, patients with severe disease forms should have their liver tests monitored regularly and their results should be considered when selecting treatment to avoid further liver damage or even insufficiency.
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Affiliation(s)
- Valentina Liakina
- Centre of Hepatology, Gastroenterology and Dietetics, Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
- Department of Chemistry and Bioengineering, Faculty of Fundamental Sciences, VILNIUS TECH, Vilnius 10223, Lithuania
| | - Ieva Stundiene
- Centre of Hepatology, Gastroenterology and Dietetics, Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
| | - Gabriele Milaknyte
- Centre of Hepatology, Gastroenterology and Dietetics, Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
| | - Ramune Bytautiene
- Centre of Hepatology, Gastroenterology and Dietetics, Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
| | - Rosita Reivytyte
- Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
| | - Roma Puronaite
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
- Institute of Data Science and Digital Technologies, Faculty of Mathematics and Informatics, Vilnius University, Vilnius 01513, Lithuania
| | | | - Edita Kazenaite
- Centre of Hepatology, Gastroenterology and Dietetics, Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
- Department of Pathology, Forensic Medicine and Pharmacology, Institute of Biomedical Sciences, Faculty of Medicine, Vilnius University, Vilnius 01513, Lithuania
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Hussen WM. Post COVID-19 pulmonary mass: Case report and review of literatures. Saudi Med J 2022; 43:1165-1167. [PMID: 36261211 PMCID: PMC9994499 DOI: 10.15537/smj.2022.43.10.20220294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 08/21/2022] [Indexed: 06/16/2023] Open
Abstract
To present an unusual and a rare pulmonary affection by coronavirus disease-19 (COVID-19), in which only one lung is affected. Coronavirus disease-19 attacks the lungs and interferes seriously with their functions. The attack is usually bilaterally, while a uni lateral pulmonary affection is unusual. The presentation, both clinical and radiological findings, bronchoscopy appearance, the strange operative findings of the resected mass, the uneventful post-operative course, in addition to the histopathological report, will be presented.In conclusion, unilateral lung affection is unusual and post-viral pneumonia COVID-19 should be considered as a possible aftermath, which may not be uncommon in Iraq.
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Affiliation(s)
- Waleed M. Hussen
- From the Department of Surgery, College of Medicine, University of Baghdad, Baghdad, Iraq.
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31
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Nedel W, da Silveira F, da Silva CF, Lisboa T. Bacterial infection in coronavirus disease 2019 patients: co-infection, super-infection and how it impacts on antimicrobial use. Curr Opin Crit Care 2022; 28:463-469. [PMID: 36017559 PMCID: PMC9593329 DOI: 10.1097/mcc.0000000000000975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW Since the beginning of the severe acute respiratory syndrome coronavirus 2 pandemic, there has been a large increase in the consumption of antimicrobials, both as a form of treatment for viral pneumonia, which has been shown to be ineffective, and in the treatment of secondary infections that arise over the course of the severe presentation of coronavirus disease 2019 (COVID-19). This increase in consumption, often empirical, ends up causing an increase in the incidence of colonization and secondary infections by multi and pan-resistant germs. RECENT FINDINGS The presence of a hyperinflammatory condition induced by the primary infection, associated with the structural damage caused by viral pneumonia and by the greater colonization by bacteria, generally multiresistant, are important risk factors for the acquisition of secondary infections in COVID-19. Consequently, there is an increased prevalence of secondary infections, associated with a higher consumption of antimicrobials and a significant increase in the incidence of infections by multi and pan-resistant bacteria. SUMMARY Antimicrobial stewardship and improvement in diagnostic techniques, improving the accuracy of bacterial infection diagnosis, may impact the antibiotic consumption and the incidence of infections by resistant pathogens.
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Affiliation(s)
- Wagner Nedel
- Hospital de Clinicas de Porto Alegre
- Hospital Nossa Senhora Conceição
| | - Fernando da Silveira
- Hospital Nossa Senhora Conceição
- Programa de Pos-Graduação Ciencias Pneumológicas, UFRGS, Porto Alegre
| | - Cristofer Farias da Silva
- Hospital de Clinicas de Porto Alegre
- Programa de Pos-Graduação Ciencias Pneumológicas, UFRGS, Porto Alegre
| | - Thiago Lisboa
- Hospital de Clinicas de Porto Alegre
- Programa de Pos-Graduação Ciencias Pneumológicas, UFRGS, Porto Alegre
- Universidade LaSalle, Canoas
- Instituto de Pesquisa HCOR, São Paulo, Brazil
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Nakajo K, Nishiura H. Age-specific hospitalization risk of primary and secondary respiratory syncytial virus infection among young children. Int J Infect Dis 2022; 124:14-20. [PMID: 36100066 DOI: 10.1016/j.ijid.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/31/2022] [Accepted: 09/05/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Elucidating the infection dynamics that lead to severe respiratory syncytial virus (RSV) pneumonia and hospitalization among young children are critical. We explored the role of infection parity as well as age in months for RSV-associated hospitalization among young children in Japan. METHODS We used a sequential transmission catalytic model to capture the transmission mechanisms of RSV among infants in an endemic state. We investigated data on the age-dependent seroprevalence and incidence rate of hospitalization in Japan, and jointly estimated the age-specific risk of hospitalization during primary RSV infection and relative risk of hospitalization during secondary infection in children aged <5 years. RESULTS The estimated risk of hospitalization with primary infection was 0.08 (95% CI: 0.05-0.14) in infants aged 0-2 months. The estimated relative risk of hospitalization owing to secondary infection was 0.18 (95% CI: 0.01-2.04). CONCLUSION Our simple models successfully captured the infection dynamics of RSV among young children in Japan. The age group of early infancy may be most vulnerable to infection and hospitalization, offering key insights into future vaccinations. The burden of hospitalization from secondary infection may be less important in young children.
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Affiliation(s)
- Ko Nakajo
- Kyoto University School of Public Health, Kyoto, Japan; Sanofi K.K. Tokyo Opera City Tower, 3-20-2, Nishi Shinjuku, Shinjuku-ku, Tokyo, Japan
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Conway Morris A, Kohler K, De Corte T, Ercole A, De Grooth HJ, Elbers PWG, Povoa P, Morais R, Koulenti D, Jog S, Nielsen N, Jubb A, Cecconi M, De Waele J. Co-infection and ICU-acquired infection in COIVD-19 ICU patients: a secondary analysis of the UNITE-COVID data set. Crit Care 2022; 26:236. [PMID: 35922860 PMCID: PMC9347163 DOI: 10.1186/s13054-022-04108-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 07/26/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic presented major challenges for critical care facilities worldwide. Infections which develop alongside or subsequent to viral pneumonitis are a challenge under sporadic and pandemic conditions; however, data have suggested that patterns of these differ between COVID-19 and other viral pneumonitides. This secondary analysis aimed to explore patterns of co-infection and intensive care unit-acquired infections (ICU-AI) and the relationship to use of corticosteroids in a large, international cohort of critically ill COVID-19 patients. METHODS This is a multicenter, international, observational study, including adult patients with PCR-confirmed COVID-19 diagnosis admitted to ICUs at the peak of wave one of COVID-19 (February 15th to May 15th, 2020). Data collected included investigator-assessed co-infection at ICU admission, infection acquired in ICU, infection with multi-drug resistant organisms (MDRO) and antibiotic use. Frequencies were compared by Pearson's Chi-squared and continuous variables by Mann-Whitney U test. Propensity score matching for variables associated with ICU-acquired infection was undertaken using R library MatchIT using the "full" matching method. RESULTS Data were available from 4994 patients. Bacterial co-infection at admission was detected in 716 patients (14%), whilst 85% of patients received antibiotics at that stage. ICU-AI developed in 2715 (54%). The most common ICU-AI was bacterial pneumonia (44% of infections), whilst 9% of patients developed fungal pneumonia; 25% of infections involved MDRO. Patients developing infections in ICU had greater antimicrobial exposure than those without such infections. Incident density (ICU-AI per 1000 ICU days) was in considerable excess of reports from pre-pandemic surveillance. Corticosteroid use was heterogenous between ICUs. In univariate analysis, 58% of patients receiving corticosteroids and 43% of those not receiving steroids developed ICU-AI. Adjusting for potential confounders in the propensity-matched cohort, 71% of patients receiving corticosteroids developed ICU-AI vs 52% of those not receiving corticosteroids. Duration of corticosteroid therapy was also associated with development of ICU-AI and infection with an MDRO. CONCLUSIONS In patients with severe COVID-19 in the first wave, co-infection at admission to ICU was relatively rare but antibiotic use was in substantial excess to that indication. ICU-AI were common and were significantly associated with use of corticosteroids. Trial registration ClinicalTrials.gov: NCT04836065 (retrospectively registered April 8th 2021).
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Affiliation(s)
- Andrew Conway Morris
- Division of Anaesthesia, Department of Medicine, Level 4 Addenbrooke's Hospital, University of Cambridge, Hills Road, Cambridge, UK.
- Division of Immunology, Department of Pathology, University of Cambridge, Cambridge, UK.
- JVF Intensive Care Unit, Addenbrooke's Hospital, Cambridge, UK.
| | - Katharina Kohler
- Division of Anaesthesia, Department of Medicine, Level 4 Addenbrooke's Hospital, University of Cambridge, Hills Road, Cambridge, UK
| | - Thomas De Corte
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
- Dept of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Ari Ercole
- Division of Anaesthesia, Department of Medicine, Level 4 Addenbrooke's Hospital, University of Cambridge, Hills Road, Cambridge, UK
- Neurocritical Care Unit, Addenbrooke's Hospital, Cambridge, UK
| | - Harm-Jan De Grooth
- Department of Intensive Care, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Laboratory for Critical Care Computational Intelligence, Amsterdam Medical Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
| | - Paul W G Elbers
- Department of Intensive Care, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pedro Povoa
- Nova Medical School, New University, Lisbon, Portugal
- Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, OUH Odense University Hospital, Odense, Denmark
- Polyvalent Intensive Care Unit, Hospital de São Francisco Xavier, CHLO, Lisbon, Portugal
| | - Rui Morais
- Polyvalent Intensive Care Unit, Hospital de São Francisco Xavier, CHLO, Lisbon, Portugal
| | - Despoina Koulenti
- 2Nd Critical Care Department, Attikon University Hospital, University of Athens, Athens, Greece
- UQ Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Sameer Jog
- Deenanath Mangeshkar Hospital and Research Center, Pune, India
| | - Nathan Nielsen
- Divisions of Pulmonary, Critical Care and Sleep Medicine and Transfusion Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Alasdair Jubb
- Division of Anaesthesia, Department of Medicine, Level 4 Addenbrooke's Hospital, University of Cambridge, Hills Road, Cambridge, UK
- Neurocritical Care Unit, Addenbrooke's Hospital, Cambridge, UK
| | | | - Jan De Waele
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
- Dept of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Weir-McCall JR, Galea G, Mun Mak S, Joshi K, Agrawal B, Screaton N, Toshner M, Ruggiero A, Benedetti G, Brozik J, Machin R, Das I, Kotnik M, Sun J, Mackay M, Jacob J, Rodrigues JCL, Camporota L, Vuylsteke A. Vascular Thrombosis in Severe COVID-19 Requiring Extracorporeal Membrane Oxygenation: A Multicenter Study. Crit Care Med 2022; 50:624-632. [PMID: 34582412 PMCID: PMC8923278 DOI: 10.1097/ccm.0000000000005322] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Coronavirus disease 2019 has been reported to be a prothrombotic condition; however, multicenter data comparing this with other viral pneumonias in those requiring extracorporeal membrane oxygenation are lacking. We conducted a multicenter study using whole-body CT to examine the prevalence, severity, and nature of vascular complications in coronavirus disease 2019 in comparison with patients with other viral pneumonias. DESIGN We analyzed whole-body CT scans for the presence of vascular thrombosis (defined as pulmonary artery thrombus, venous thrombus, systemic arterial thrombus, or end-organ infarct). The severity, distribution, and morphology of pulmonary artery thrombus were characterized. Competing risk cumulative incidence analysis was used to compare survival with discharge. SETTING Three centers of the English national extracorporeal membrane oxygenation service. PATIENTS Consecutive patients admitted with either coronavirus disease 2019 or noncoronavirus disease 2019 viral pneumonia admitted from January 2019. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS One-hundred thirty-six patients (45.2 ± 10.6 yr old, 39/146 [27%] female) requiring extracorporeal membrane oxygenation support underwent whole-body CT scans at admission. Of these, 86 had coronavirus disease 2019 pneumonia, and 50 had noncoronavirus disease 2019 viral pneumonia. Vascular thrombosis was seen more often in patients with coronavirus disease 2019 (odds ratio, 12.9 [95% CI 4.5-36.8]). In those with coronavirus disease 2019, 57 (73%) demonstrated pulmonary artery thrombus or pulmonary perfusion defects. Eighty-two percent of thrombus exhibited emboli-like morphology. The location of pulmonary artery thrombus and parenchymal perfusion defects was only concordant in 30% of cases. The risk of mortality was higher in those with coronavirus disease 2019 compared with noncoronavirus disease 2019 pneumonia (χ2 = 3.94; p = 0.047). Mortality was no different in coronavirus disease 2019 patients with or without vascular thrombosis (χ2 = 0.44; p = 0.51). CONCLUSIONS In patients who received extracorporeal membrane oxygenation, coronavirus disease 2019 is associated with a higher prevalence of vascular thrombosis compared with noncoronavirus disease viral pneumonias. The pattern of pulmonary vascular changes suggests concurrent embolic disease and small vessel disease. Despite this, vascular thrombosis was not linked to poorer short-term prognosis in those with coronavirus disease 2019.
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Affiliation(s)
- Jonathan R Weir-McCall
- Royal Papworth Hospital, Cambridge, United Kingdom
- University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
| | | | - Sze Mun Mak
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Kushal Joshi
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | | | | | - Mark Toshner
- Royal Papworth Hospital, Cambridge, United Kingdom
| | | | - Giulia Benedetti
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Jan Brozik
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Ruth Machin
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Indrajeet Das
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | | | - Julia Sun
- Royal Papworth Hospital, Cambridge, United Kingdom
| | | | - Joseph Jacob
- Centre for Medical Image Computing, University College London, London, United Kingdom
- UCL Respiratory, University College London, London, United Kingdom
| | - Jonathan C L Rodrigues
- Royal United Hospital Bath NHS Foundation Trust, Bath, United Kingdom
- Department of Health, University of Bath, Bath, United Kingdom
| | - Luigi Camporota
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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Affiliation(s)
- David W Louis
- Lifespan Cardiovascular Institute, 593 Eddy Street, RIH APC 730, Providence, RI 02903, USA; Department of Medicine, Division of Cardiology, Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, USA
| | - Marwan Saad
- Lifespan Cardiovascular Institute, 593 Eddy Street, RIH APC 730, Providence, RI 02903, USA; Department of Medicine, Division of Cardiology, Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, USA
| | - Shilpa Vijayakumar
- Lifespan Cardiovascular Institute, 593 Eddy Street, RIH APC 730, Providence, RI 02903, USA; Department of Medicine, Division of Cardiology, Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, USA
| | - Suleman Ilyas
- Department of Medicine, Division of Cardiology, Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, USA
| | - Aravind Kokkirala
- United States Department of Veterans Affairs Providence VA Medical Center, 830 Chalkstone Avenue, Providence, RI 02908, USA
| | - Herbert D Aronow
- Lifespan Cardiovascular Institute, 593 Eddy Street, RIH APC 730, Providence, RI 02903, USA; Department of Medicine, Division of Cardiology, Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903, USA.
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Chan WY, Ramli Hamid MT, Lim YT, Ng CC, Gowdh NF, Rahmat K. Pulmonary Complications of COVID-19. Sultan Qaboos Univ Med J 2022; 22:138-143. [PMID: 35299811 PMCID: PMC8904102 DOI: 10.18295/squmj.4.2021.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/16/2021] [Accepted: 02/10/2021] [Indexed: 11/16/2022] Open
Abstract
Rapid evolution of pulmonary complications associated with severe COVID-19 pneumonia often pose a management challenge to clinicians especially in the critical care setting. Serial chest imaging enable clinicians to better monitor disease progression and identify potential complications early which may decrease the mortality and morbidity associated with COVID-19. We report a 69-year-old male patient with severe COVID-19 pneumonia who presented to a tertiary referral centre in Kuala Lumpur, Malaysia, in 2020 with multiple pulmonary complications including lung cavitation, bronchopleural fistula, pneumothorax, pneumomediastinum, subcutaneous emphysema and acute pulmonary embolism. Unfortunately, the patient died one month after admission. COVID-19 patients may develop pulmonary complications due to a combination of direct viral lung damage, hypoxaemia and high stress ventilation. Awareness of COVID-19 complications can prompt early diagnosis and timely management to reduce morbidity and mortality.
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Affiliation(s)
- Wai Y. Chan
- Department of Biomedical Imaging, University Malaya, Kuala Lumpur, Malaysia
| | - Marlina T. Ramli Hamid
- Department of Radiology; University Teknologi Mara, Selangor, Malaysia
- Corresponding Author’s e-mails: and
| | - Yi T. Lim
- Department of Biomedical Imaging, University Malaya, Kuala Lumpur, Malaysia
| | - Ching C. Ng
- Department of Anaesthesiology, University Malaya, Kuala Lumpur, Malaysia
| | - Nadia F.M. Gowdh
- Department of Biomedical Imaging, University Malaya, Kuala Lumpur, Malaysia
| | - Kartini Rahmat
- Department of Biomedical Imaging, University Malaya, Kuala Lumpur, Malaysia
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Vorobeva OV. [A rare case of multifocal leukoencephalopathy and cerebral stroke after SARS-CoV-2 infection]. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:133-137. [PMID: 36279240 DOI: 10.17116/jnevro2022122101133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
A case of the development of multifocal leukoencephalopathy and hemorrhage after infection with SARS-CoV-2 in a female patient with Alzheimer's disease, aged 67 years, is described. The patient was hospitalized by an ambulance. Computed tomography (CT) of the brain showed the signs of cerebral infarction in the basin of the left middle cerebral artery with hemorrhagic transformation, multiple low-density foci that do not accumulate contrast in the white matter of the brain, the presence of sickle-shaped lesions in the cerebellum. CT of the chest revealed bilateral diffuse COVID-associated pneumonitis, alveolitis. The percentage of lesion was 75%. A smear express test for a new coronavirus infection was positive. Treatment was started, and a sudden death occurred. A sectional study in the brain revealed signs of ischemic cerebral infarction and multifocal leukoencephalomalacia - foci of demyelination (from 1 mm to 1 cm) had a multifocal lesion located in different parts of the white matter. Fibrinoid necrosis of vessel walls, destructive-productive vasculitis, ischemic small-focal perivascular necrosis, ischemic lesions of neurons and glial cells, neuronal and glial spongiosis were noted. In conclusion, the cause of death of the patient was a new coronavirus infection COVID-19, which caused diffuse viral COVID-associated pneumonitis, alveolitis with the development of acute respiratory distress syndrome in adults, respiratory failure and COVID-associated ischemic infarction, multifocal leukoencephalopathy (or malacia), cerebral edema complicated by neuromorphological changes in the brain.
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Affiliation(s)
- O V Vorobeva
- Ulyanov Chuvash State University, Cheboksary, Russia
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Malyutin DS, Koneva ES, Achkasov EE, Kostenko AB, Tsvetkova AV, Elfimov MA, Eremenko AA, Bazarov DV, Shestakov AV, Korchazhkina NB. [Influence of therapeutic exercises and hardware massage in electrostatic field on lung damage in patients with novel coronavirus pneumonia]. Vopr Kurortol Fizioter Lech Fiz Kult 2022; 99:43-50. [PMID: 36083817 DOI: 10.17116/kurort20229904243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To analyze the efficacy and safety of therapeutic exercises and chest hardware massage in electrostatic field in patients with COVID-associated viral pneumonia. MATERIAL AND METHODS We retrospectively analyzed 1551 patients admitted to the Clinical Hospital No. 1 (MEDSI Group JSC) with COVID-associated pneumonia between April 01, 2020 and June 15, 2021 (ICD-10 U07.1 and U07.2). Considering inclusion and exclusion criteria, we enrolled 153 patients. All patients were divided into comparable groups and subgroups depending on the methods of rehabilitation treatment and CT stage of viral pneumonia. Lung damage was assessed semi-automatically using Philips Portal v11 COPD software. Rehabilitation measures included therapeutic exercises and chest hardware massage in electrostatic field. therapeutic exercises. RESULTS Therapeutic exercises significantly reduced severity of lung damage in patients with viral pneumonia CT-2 and no oxygen support (from 28.05% [28; 29.5] at admission to 15.3% [14.2; 19.3] at discharge). It was not observed in patients without rehabilitation treatment and in patients undergoing therapeutic exercises and massage in electrostatic field. CONCLUSION Therapeutic exercises in patients with COVID-19 and baseline lung damage > 25% and < 50% (CT-2 stage) significantly reduce severity of lung damage at discharge compared to the control group.
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Affiliation(s)
- D S Malyutin
- Group of companies MEDSI, Otradnoe, Russia
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - E S Koneva
- Group of companies MEDSI, Otradnoe, Russia
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - E E Achkasov
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - A B Kostenko
- Group of companies MEDSI, Otradnoe, Russia
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - A V Tsvetkova
- Group of companies MEDSI, Otradnoe, Russia
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - M A Elfimov
- Petrovsky National Research Center of Surgery, Moscow, Russia
| | - A A Eremenko
- Petrovsky National Research Center of Surgery, Moscow, Russia
| | - D V Bazarov
- Petrovsky National Research Center of Surgery, Moscow, Russia
| | - A V Shestakov
- Petrovsky National Research Center of Surgery, Moscow, Russia
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Mendy A, Salo PM, Wilkerson J, Feinstein L, Fessler MB, Thorne PS, Zeldin DC. Albuminuria as a Predictor of Mortality from Chronic Lower Respiratory Disease and from Influenza and Pneumonia. Ann Am Thorac Soc 2021; 18:2093-2095. [PMID: 33979561 PMCID: PMC8641818 DOI: 10.1513/annalsats.202009-1226rl] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Angelico Mendy
- National Institute of Environmental Health SciencesResearch Triangle Park, North Carolina
- University of Cincinnati College of Medicine,Cincinnati, Ohio
| | - Päivi M. Salo
- National Institute of Environmental Health SciencesResearch Triangle Park, North Carolina
| | | | | | - Michael B. Fessler
- National Institute of Environmental Health SciencesResearch Triangle Park, North Carolina
| | | | - Darryl C. Zeldin
- National Institute of Environmental Health SciencesResearch Triangle Park, North Carolina
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Carrasco-Sánchez FJ, López-Carmona MD, Martínez-Marcos FJ, Pérez-Belmonte LM, Hidalgo-Jiménez A, Buonaiuto V, Suárez Fernández C, Freire Castro SJ, Luordo D, Pesqueira Fontan PM, Blázquez Encinar JC, Magallanes Gamboa JO, de la Peña Fernández A, Torres Peña JD, Fernández Solà J, Napal Lecumberri JJ, Amorós Martínez F, Guisado Espartero ME, Jorge Ripper C, Gómez Méndez R, Vicente López N, Román Bernal B, Rojano Rivero MG, Ramos Rincón JM, Gómez Huelgas R. Admission hyperglycaemia as a predictor of mortality in patients hospitalized with COVID-19 regardless of diabetes status: data from the Spanish SEMI-COVID-19 Registry. Ann Med 2021; 53:103-116. [PMID: 33063540 PMCID: PMC7651248 DOI: 10.1080/07853890.2020.1836566] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/08/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Hyperglycaemia has emerged as an important risk factor for death in coronavirus disease 2019 (COVID-19). The aim of this study was to evaluate the association between blood glucose (BG) levels and in-hospital mortality in non-critically patients hospitalized with COVID-19. METHODS This is a retrospective multi-centre study involving patients hospitalized in Spain. Patients were categorized into three groups according to admission BG levels: <140 mg/dL, 140-180 mg/dL and >180 mg/dL. The primary endpoint was all-cause in-hospital mortality. RESULTS Of the 11,312 patients, only 2128 (18.9%) had diabetes and 2289 (20.4%) died during hospitalization. The in-hospital mortality rates were 15.7% (<140 mg/dL), 33.7% (140-180 mg) and 41.1% (>180 mg/dL), p<.001. The cumulative probability of mortality was significantly higher in patients with hyperglycaemia compared to patients with normoglycaemia (log rank, p<.001), independently of pre-existing diabetes. Hyperglycaemia (after adjusting for age, diabetes, hypertension and other confounding factors) was an independent risk factor of mortality (BG >180 mg/dL: HR 1.50; 95% confidence interval (CI): 1.31-1.73) (BG 140-180 mg/dL; HR 1.48; 95%CI: 1.29-1.70). Hyperglycaemia was also associated with requirement for mechanical ventilation, intensive care unit (ICU) admission and mortality. CONCLUSIONS Admission hyperglycaemia is a strong predictor of all-cause mortality in non-critically hospitalized COVID-19 patients regardless of prior history of diabetes. KEY MESSAGE Admission hyperglycaemia is a stronger and independent risk factor for mortality in COVID-19. Screening for hyperglycaemia, in patients without diabetes, and early treatment of hyperglycaemia should be mandatory in the management of patients hospitalized with COVID-19. Admission hyperglycaemia should not be overlooked in all patients regardless prior history of diabetes.
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Affiliation(s)
| | | | | | | | | | - Verónica Buonaiuto
- Internal Medicine Department, Málaga Regional University Hospital, Málaga, Spain
| | | | | | - Davide Luordo
- Internal Medicine Department, Infanta Cristina University Hospital, Parla, Spain
| | | | | | | | | | - José David Torres Peña
- Lipis and Atherosclerosis Unit, Department of Interna Medicine, Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Reina Sofia University Hospital, University of Córdoba, Spain
- CIBER Fisiopatologia de la Obesidad y Nutrición (CIBEROBN), Insituto de Salud Carlos III, Córdoba, Spain
| | | | | | | | | | - Carlos Jorge Ripper
- Internal Medicine Department, Insular de Gran Canaria Hospital, Las Palmas de Gran Canaria, Spain
| | - Raquel Gómez Méndez
- Internal Medicine Department, Lucus Augusti University Hospital, Lugo, Spain
| | | | - Berta Román Bernal
- Internal Medicine Department, Doctor José Molina Orosa Hospital, Arrecife, Spain
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Affiliation(s)
- Neha Rastogi
- Pediatric Hematology Oncology and Bone Marrow Transplant Unit, Medanta The Medicity, Gurgaon, Haryana, India
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Abstract
Smoking, TB and Covid-19 are high prevalence entities with public health consequences. All three of them have a possible complex interaction at cellular level. Smoking behavior makes it difficult to maintain infection control measures. Smoking is known to increase TB infection and also adversely affect treatment outcomes in TB. There is also upcoming evidence which suggests that smoking and TB increase the risk of severe Covid-19 symptoms. Simple infection control measures like, social distancing, cough etiquette, isolation, hand hygiene, quarantine, use of masks etc. play a pivotal role in prevention of these diseases. There is need of strengthening of the public health policies and incorporation of the Covid-19 safety awareness measures into the various national programmes.
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Affiliation(s)
- Parul Mrigpuri
- Department of Pulmonary Medicine, Vallabhbhai Patel Chest Institute, University of Delhi, New Delhi, 110007, India
| | - Amitesh Gupta
- Department of Tuberculosis and Chest Diseases, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, 110030, India
| | - Ritika Jha
- Department of Tuberculosis and Chest Diseases, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, 110030, India
| | - Pranjal Singla
- iDEFEAT TB Project, International Union Against Tuberculosis and Lung Diseases, India
| | - Rupak Singla
- Department of Tuberculosis and Chest Diseases, National Institute of Tuberculosis and Respiratory Diseases, New Delhi, 110030, India.
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Lombardi F, Calabrese A, Iovene B, Pierandrei C, Lerede M, Varone F, Richeldi L, Sgalla G. Residual respiratory impairment after COVID-19 pneumonia. BMC Pulm Med 2021; 21:241. [PMID: 34273962 PMCID: PMC8286033 DOI: 10.1186/s12890-021-01594-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 06/25/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION The novel coronavirus SARS-Cov-2 can infect the respiratory tract causing a spectrum of disease varying from mild to fatal pneumonia, and known as COVID-19. Ongoing clinical research is assessing the potential for long-term respiratory sequelae in these patients. We assessed the respiratory function in a cohort of patients after recovering from SARS-Cov-2 infection, stratified according to PaO2/FiO2 (p/F) values. METHOD Approximately one month after hospital discharge, 86 COVID-19 patients underwent physical examination, arterial blood gas (ABG) analysis, pulmonary function tests (PFTs), and six-minute walk test (6MWT). Patients were also asked to quantify the severity of dyspnoea and cough before, during, and after hospitalization using a visual analogic scale (VAS). Seventy-six subjects with ABG during hospitalization were stratified in three groups according to their worst p/F values: above 300 (n = 38), between 200 and 300 (n = 30) and below 200 (n = 20). RESULTS On PFTs, lung volumes were overall preserved yet, mean percent predicted residual volume was slightly reduced (74.8 ± 18.1%). Percent predicted diffusing capacity for carbon monoxide (DLCO) was also mildly reduced (77.2 ± 16.5%). Patients reported residual breathlessness at the time of the visit (VAS 19.8, p < 0.001). Patients with p/F below 200 during hospitalization had lower percent predicted forced vital capacity (p = 0.005), lower percent predicted total lung capacity (p = 0.012), lower DLCO (p < 0.001) and shorter 6MWT distance (p = 0.004) than patients with higher p/F. CONCLUSION Approximately one month after hospital discharge, patients with COVID-19 can have residual respiratory impairment, including lower exercise tolerance. The extent of this impairment seems to correlate with the severity of respiratory failure during hospitalization.
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Affiliation(s)
- Francesco Lombardi
- Division of Pulmonary Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Angelo Calabrese
- Division of Pulmonary Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Bruno Iovene
- Division of Pulmonary Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | | | | | - Francesco Varone
- Division of Pulmonary Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
| | - Luca Richeldi
- Division of Pulmonary Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giacomo Sgalla
- Division of Pulmonary Medicine, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Largo Agostino Gemelli 8, 00168, Rome, Italy.
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Tilliridou V, Kirkbride R, Dickinson R, Tiernan J, Yong GL, van Beek EJR, Murchison JT, Williams MC. Pulmonary embolism severity before and during the COVID-19 pandemic. Br J Radiol 2021; 94:20210264. [PMID: 34106780 PMCID: PMC8248223 DOI: 10.1259/bjr.20210264] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/23/2021] [Accepted: 05/01/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Early in the coronavirus 2019 (COVID-19) pandemic, a high frequency of pulmonary embolism was identified. This audit aims to assess the frequency and severity of pulmonary embolism in 2020 compared to 2019. METHODS In this retrospective audit, we compared computed tomography pulmonary angiography (CTPA) frequency and pulmonary embolism severity in April and May 2020, compared to 2019. Pulmonary embolism severity was assessed with the Modified Miller score and the presence of right heart strain was assessed. Demographic information and 30-day mortality was identified from electronic health records. RESULTS In April 2020, there was a 17% reduction in the number of CTPA performed and an increase in the proportion identifying pulmonary embolism (26%, n = 68/265 vs 15%, n = 47/320, p < 0.001), compared to April 2019. Patients with pulmonary embolism in 2020 had more comorbidities (p = 0.026), but similar age and sex compared to 2019. There was no difference in pulmonary embolism severity in 2020 compared to 2019, but there was an increased frequency of right heart strain in May 2020 (29 vs 12%, p = 0.029). Amongst 18 patients with COVID-19 and pulmonary embolism, there was a larger proportion of males and an increased 30 day mortality (28% vs 6%, p = 0.008). CONCLUSION During the COVID-19 pandemic, there was a reduction in the number of CTPA scans performed and an increase in the frequency of CTPA scans positive for pulmonary embolism. Patients with both COVID-19 and pulmonary embolism had an increased risk of 30-day mortality compared to those without COVID-19. ADVANCES IN KNOWLEDGE During the COVID-19 pandemic, the number of CTPA performed decreased and the proportion of positive CTPA increased. Patients with both pulmonary embolism and COVID-19 had worse outcomes compared to those with pulmonary embolism alone.
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Affiliation(s)
- Vicky Tilliridou
- Department of Radiology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Rachael Kirkbride
- Department of Radiology, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Rebecca Dickinson
- Department of Respiratory Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - James Tiernan
- Department of Respiratory Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Guo Liang Yong
- Department of Radiology, Royal Infirmary of Edinburgh, Edinburgh, UK
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Bamgboye EL, Omiye JA, Afolaranmi OJ, Davids MR, Tannor EK, Wadee S, Niang A, Were A, Naicker S. COVID-19 Pandemic: Is Africa Different? J Natl Med Assoc 2021; 113:324-335. [PMID: 33153755 PMCID: PMC7607238 DOI: 10.1016/j.jnma.2020.10.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 09/24/2020] [Accepted: 10/05/2020] [Indexed: 12/29/2022]
Abstract
COVID-19 has now spread to all the continents of the world with the possible exception of Antarctica. However, Africa appears different when compared with all the other continents. The absence of exponential growth and the low mortality rates contrary to that experienced in other continents, and contrary to the projections for Africa by various agencies, including the World Health Organization (WHO) has been a puzzle to many. Although Africa is the second most populous continent with an estimated 17.2% of the world's population, the continent accounts for only 5% of the total cases and 3% of the mortality. Mortality for the whole of Africa remains at a reported 19,726 as at August 01, 2020. The onset of the pandemic was later, the rate of rise has been slower and the severity of illness and case fatality rates have been lower in comparison to other continents. In addition, contrary to what had been documented in other continents, the occurrence of the renal complications in these patients also appeared to be much lower. This report documents the striking differences between the continents and within the continent of Africa itself and then attempts to explain the reasons for these differences. It is hoped that information presented in this review will help policymakers in the fight to contain the pandemic, particularly within Africa with its resource-constrained health care systems.
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Affiliation(s)
| | | | | | - Mogamat Razeen Davids
- Division of Nephrology, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | | | - Shoyab Wadee
- Wits Donald Gordon Medical Centre, University of the Witwatersrand, Johannesburg, South Africa
| | - Abdou Niang
- Dalal Jamm Hospital, Dakar Cheikh A. Diop University, Senegal
| | - Anthony Were
- Department of Medicine, East African Kidney Institute, College of Health Sciences, University of Nairobi, Kenya
| | - Saraladevi Naicker
- Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Dewi IM, Janssen NA, Rosati D, Bruno M, Netea MG, Brüggemann RJ, Verweij PE, van de Veerdonk FL. Invasive pulmonary aspergillosis associated with viral pneumonitis. Curr Opin Microbiol 2021; 62:21-27. [PMID: 34034082 DOI: 10.1016/j.mib.2021.04.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/20/2021] [Accepted: 04/30/2021] [Indexed: 12/12/2022]
Abstract
The occurrence of invasive pulmonary aspergillosis (IPA) in critically ill patients with viral pneumonitis has increasingly been reported in recent years. Influenza-associated pulmonary aspergillosis (IAPA) and COVID-19-associated pulmonary aspergillosis (CAPA) are the two most common forms of this fungal infection. These diseases cause high mortality in patients, most of whom were previously immunocompetent. The pathogenesis of IAPA and CAPA is still not fully understood, but involves viral, fungal and host factors. In this article, we discuss several aspects regarding IAPA and CAPA, including their possible pathogenesis, the use of immunotherapy, and future challenges.
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Affiliation(s)
- Intan Mw Dewi
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands; Microbiology Division, Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia; Radboudumc - CWZ Center of Expertise for Mycology, Nijmegen, the Netherlands
| | - Nico Af Janssen
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands; Radboudumc - CWZ Center of Expertise for Mycology, Nijmegen, the Netherlands
| | - Diletta Rosati
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands; Radboudumc - CWZ Center of Expertise for Mycology, Nijmegen, the Netherlands
| | - Mariolina Bruno
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands; Radboudumc - CWZ Center of Expertise for Mycology, Nijmegen, the Netherlands
| | - Mihai G Netea
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Immunology and Metabolism, Life and Medical Sciences Institute, University of Bonn, Germany; Radboudumc - CWZ Center of Expertise for Mycology, Nijmegen, the Netherlands
| | - Roger Jm Brüggemann
- Department of Pharmacy, Radboud University Medical Center, Nijmegen, the Netherlands; Radboudumc - CWZ Center of Expertise for Mycology, Nijmegen, the Netherlands
| | - Paul E Verweij
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands; Radboudumc - CWZ Center of Expertise for Mycology, Nijmegen, the Netherlands
| | - Frank L van de Veerdonk
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands; Radboudumc - CWZ Center of Expertise for Mycology, Nijmegen, the Netherlands.
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Kim DH, Park HC, Cho A, Kim J, Yun KS, Kim J, Lee YK. Age-adjusted Charlson comorbidity index score is the best predictor for severe clinical outcome in the hospitalized patients with COVID-19 infection. Medicine (Baltimore) 2021; 100:e25900. [PMID: 33951004 PMCID: PMC8104192 DOI: 10.1097/md.0000000000025900] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 04/23/2021] [Indexed: 01/08/2023] Open
Abstract
Aged population with comorbidities demonstrated high mortality rate and severe clinical outcome in the patients with coronavirus disease 2019 (COVID-19). However, whether age-adjusted Charlson comorbidity index score (CCIS) predict fatal outcomes remains uncertain.This retrospective, nationwide cohort study was performed to evaluate patient mortality and clinical outcome according to CCIS among the hospitalized patients with COVID-19 infection. We included 5621 patients who had been discharged from isolation or had died from COVID-19 by April 30, 2020. The primary outcome was composites of death, admission to intensive care unit, use of mechanical ventilator or extracorporeal membrane oxygenation. The secondary outcome was mortality. Multivariate Cox proportional hazard model was used to evaluate CCIS as the independent risk factor for death.Among 5621 patients, the high CCIS (≥ 3) group showed higher proportion of elderly population and lower plasma hemoglobin and lower lymphocyte and platelet counts. The high CCIS group was an independent risk factor for composite outcome (HR 3.63, 95% CI 2.45-5.37, P < .001) and patient mortality (HR 22.96, 95% CI 7.20-73.24, P < .001). The nomogram showed that CCIS was the most important factor contributing to the prognosis followed by the presence of dyspnea (hazard ratio [HR] 2.88, 95% confidence interval [CI] 2.16-3.83), low body mass index < 18.5 kg/m2 (HR 2.36, CI 1.49-3.75), lymphopenia (<0.8 x109/L) (HR 2.15, CI 1.59-2.91), thrombocytopenia (<150.0 x109/L) (HR 1.29, CI 0.94-1.78), anemia (<12.0 g/dL) (HR 1.80, CI 1.33-2.43), and male sex (HR 1.76, CI 1.32-2.34). The nomogram demonstrated that the CCIS was the most potent predictive factor for patient mortality.The predictive nomogram using CCIS for the hospitalized patients with COVID-19 may help clinicians to triage the high-risk population and to concentrate limited resources to manage them.
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Affiliation(s)
- Do Hyoung Kim
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine
- Hallym University Kidney Research Institute, Seoul
| | - Hayne Cho Park
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine
- Hallym University Kidney Research Institute, Seoul
| | - Ajin Cho
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine
- Hallym University Kidney Research Institute, Seoul
| | - Juhee Kim
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine
| | - Kyu-sang Yun
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine
| | - Jinseog Kim
- Department of Bigdata and Applied Statistics, Dongguk University, Gyeongju, Korea
| | - Young-Ki Lee
- Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine
- Hallym University Kidney Research Institute, Seoul
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Patel S, Thompson MD, Slaven JE, Sanders DB, Ren CL. Reduction of pulmonary exacerbations in young children with cystic fibrosis during the COVID-19 pandemic. Pediatr Pulmonol 2021; 56:1271-1273. [PMID: 33434352 PMCID: PMC8014497 DOI: 10.1002/ppul.25250] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 12/20/2020] [Accepted: 12/25/2020] [Indexed: 11/05/2022]
Abstract
To assess the impact of COVID-19 restrictions on cystic fibrosis (CF) pulmonary exacerbations (PEx) we performed a retrospective review of PEx events at our CF Center and compared the rate of PEx in 2019 versus 2020. Restrictions on social interaction due to the COVID-19 pandemic were associated with a lower number of PEx events at our pediatric CF Center, suggesting that these restrictions also reduced exposure to other respiratory viral infection in children with CF.
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Affiliation(s)
- Shreya Patel
- Indiana University School of MedicineIndianapolisIndianaUSA
| | - Misty D. Thompson
- Division of Pediatric Pulmonology, Allergy, and Sleep MedicineRiley Hospital for ChildrenIndianapolisIndianaUSA
- Department of PediatricsIndiana University School of MedicineIndianapolisIndianaUSA
| | - James E. Slaven
- Department of BiostatisticsIndiana University/Purdue University at IndianapolisIndianaUSA
| | - Don B. Sanders
- Division of Pediatric Pulmonology, Allergy, and Sleep MedicineRiley Hospital for ChildrenIndianapolisIndianaUSA
- Department of PediatricsIndiana University School of MedicineIndianapolisIndianaUSA
| | - Clement L. Ren
- Division of Pediatric Pulmonology, Allergy, and Sleep MedicineRiley Hospital for ChildrenIndianapolisIndianaUSA
- Department of PediatricsIndiana University School of MedicineIndianapolisIndianaUSA
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Abstract
BACKGROUND Hearing loss is a relatively newly reported symptom of novel strain of coronavirus (COVID-19). Cochlear implant is an effective therapeutic method for patients with severe to profound hearing loss. CASE REPORT We describe two cochlear implanted children with the sole presenting symptom of a sudden speech perception problem. They not suspected to have COVID-19 until they showed respiratory symptoms on the first week of admission. CONCLUSION The current report indicates the importance of COVID-19 screening in hearing impaired patients (including cochlear implanted recipients) presented with sudden or gradual deterioration of speech intelligibility during the pandemic.
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Affiliation(s)
- Nader Saki
- Hearing Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Otolaryngology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Arash Bayat
- Hearing Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran; Department of Audiology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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Abstract
Objective The current study showed the relation between otitis externa and COVID-19 infection and compared otitis externa with other symptoms of COVID-19 as anosmia. Methods 257 cases who were confirmed positive for COVID-19, were examined otoscopic and endoscopic for otitis externa, onset of starting symptoms of otitis externa and its relation to days of infection with COVID-19 were documented and the prevalence of otitis externa with anosmia in the study group were estimated. Results Increased incidence of otitis externa in COVID-19 patients (18% of study group) and symptoms starting mainly between the 5th to 8th day of COVID-19 infection. Combined otitis externa and anosmia occurred in 13% of study group. Conclusions Otitis externa has a relation to COVID-19 infection. Further research needed to study its pathogenesis and mechanisms.
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Affiliation(s)
- Ossama M Mady
- Otorhinolaryngology, Faculty of Medicine, Ain Shams University, Abassia, Cairo, Egypt.
| | - Hala S El-Ozairy
- ICU and Pain Management, Faculty of Medicine, Ain Shams University, Abassia, Cairo, Egypt
| | - Eman M Wady
- Otorhinolaryngology, Faculty of Medicine, Ain Shams University, Abassia, Cairo, Egypt; Ain Shams General Hospital, Cairo, Egypt
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