Pulmonary manifestations and management of COVID-19 pediatric patients admitted in a tertiary government hospital

@#Background. Coronavirus Disease 2019 (COVID-19) presents with respiratory signs and symptoms in children. Presently, there are no local studies on the pulmonary manifestations and management of COVID-19 among children. Objective. Our study aimed to identify and describe the presenting respiratory signs and symptoms, oxygenation status, radiologic findings, blood gas analysis, and pulmonary interventions among children admitted for COVID-19. We also analyzed the clinical and radiologic variables associated with mortality. Methodology. This is a retrospective study using data obtained from a review of medical records from April 1, 2020, to June 30, 2020, at a tertiary government institution in the Philippines. All pediatric patients (0-18 years) hospitalized for probable or confirmed COVID-19 during the said time period were included in this study. Univariate and multivariate logistic regression was applied to determine factors affecting mortality. Results. A total of 25 pediatric patients with a mean age of 7 years old (age range: 11 days to 18 years) were admitted for COVID-19. Cough (44%) and dyspnea (24%) were the most common presenting respiratory symptoms, while tachypnea (68%), crackles (36%), and peripheral oxygen desaturation (36%) were the most common respiratory signs. Indeterminate findings for COVID-19 such as multifocal or diffuse ground-glass opacities and/or consolidations were the most common radiographic abnormalities. Invasive ventilatory support was administered to 6 cases of severe COVID-19 and 4 critical cases. There were no variables that correlated significantly with mortality. Conclusion. Respiratory signs and symptoms were prominent in our cohort of children admitted due to COVID-19. Mechanical ventilation was required in more severe cases. Larger prospective studies may help identify variables that significantly correlate with poor outcomes among children with COVID-19.

Pulmonary Manifestations in HIV Seropositive Patients and Their Correlation with CD4 Counts in a Tertiary Care Centre of North India.

The prolonged course of human immunodeficiency virus (HIV) infection is marked by a decrease in the number of circulating CD4+ T helper cells and persistent viral replication, resulting in immunologic decline and death from opportunistic infections. The study was conducted in HIV Seropositive Patients admitted in our hospital. Demographic profile of the patient was recorded along with history, examination, investigations and evaluated for pulmonary manifestations and correlated with the CD4 counts. Age of HIV positive cases ranged from 21 to 74 years, male: female ratio was 3:1. Commonest mode of transmission was heterosexual sex (77%) followed by IV drug abusers (13.3%). Commonest X- ray finding was Infiltrates (33.3%) followed by pleural effusion (8%) and miliary mottling (5.3%). Commonest pulmonary diagnosis was pulmonary tuberculosis in 22.6% cases, followed by pyogenic pneumonia in 14.67% and pneumocystis carinii pneumonia (PCP) in 5.3% cases. Extrapulmonary tuberculosis was present in 16% of the cases. Pulmonary tuberculosis and pyogenic pneumonia was present in over wide range of CD4 count but their incidence has increased as the CD4 count declined. The knowledge of the CD4 count level in HIV patients is extremely useful in making differential diagnosis and suggesting a diagnostic and therapeutic plan.

Manifestations of pulmonary disease in adults with congenital heart disease.

Children with congenital heart disease (CHD) are more frequently living into adulthood as their survival has improved due to availability of better medical and surgical management in recent times. Management of adults with CHD is emerging as new challenge in the field of medical science. Adults surviving with CHD for longer duration have been observed to develop more complications as compared to children. It is important to recognise and treat these complications early to reduce the morbidity. Pulmonary diseases are the most common systemic complications associated with adults having CHD. These individuals are presenting to clinics or emergency for pulmonary complaints, hence, pulmonologist must be aware about the pulmonary manifestations of CHD and their management.

Pulmonary manifestations in connective tissue disorders: Hospital-based study at a Tertiary Care Hospital.

Background. The pleuro-pulmonary manifestations frequently occur in patients with the connective tissue disorders (CTDs), and limited data are available on this topic from India. Methods. Between January 2002 and December 2006, 195 patients with various CTDs having respiratory symptoms were evaluated for respiratory system involvement. Results. Interstitial lung disease (ILD) was the commonest (38.5%) presentation of CTDs. It was observed in nearly threefourth of the cases with scleroderma followed by rheumatoid arthritis (RA) cases (44.5%). Pulmonary arterial hypertension was observed in 53.8% and 60% of cases with scleroderma and mixed connective tissue disorder (MCTD), respectively. In RA and systemic lupus erythematosus (SLE), pulmonary hypertension was a rare presentation. Pulmonary function tests were abnormal in all the patients with MCTD, 89.9% patients with RA, 84.6% patients with scleroderma and nearly one-third patients with SLE. Restrictive defect was the most common abnormality [RA (88.7%), scleroderma (72.7%), SLE (66%)]. High resolution computed tomography revealed reticulonodular lesions (n=78); pleural effusion (n=15, mainly in patients with RA and SLE); honeycomb appearance (n=14; mainly in patients with RA and scleroderma); and bronchiectasis (n=9, mainly in patients with RA). Conclusions. Pulmonary manifestations are common in patients with CTDs, ILD being the most common pulmonary involvement. All patients with CTDs should be systematically evaluated and monitored for pulmonary involvement.

Clinical feature of pulmonary manifestation in mixed connective tissue disease:analysis of 112 patients / 中国实用内科杂志

Objective To study the clinical manifestations,diagnosis,treatments and prognosis of the pulmonary change in mixed connective tissue disease(MCTD).Methods From January 1996 to June 2008,112 patients with definite MCTD in Second Affiliated Hospital of Harbin Medical University were retrospectively studied,and the clinical feature about pulmanary manifestations,echocardiography feature,radiology features and treatments were reviewed and analyzed.44 patients were followed up.Results 48(5 male)had pulmonary manifestation.The median age of onset of symptoms was 39 years and the median duration of disease was three years.The most common manifestation was pleural effusion and(or)pachynsis pleurae(21 cases,18.8%).16 patients(14.3%) had interstitial lung disease,and 8 cases(7.1%)had pulmonary hypertension.The cardinal symptom was short breath.Thirteen patients(11.6%)had dyspnea,4 cases(3.6%)had chest pain,and 4 cases(3.6%)had cough.Reductions of pulmonary function or abnormalities of ultrasonographic image were noted in 25(52.1%)of 48 patients with pulmonary involvement of MCTD who had not any complaint of respiratory symptoms.Six patients had reductions in diffusing capacity of the lung for carbon monoxide(DLCO),17 patients had pulmonary abnormality on chest X ray or CT,and two patients had pulmonary hypertension on doppler echocardiography.Conclusion Pulmonary involment of MCTD may contribute to prognosis seriously.DLCO was the most sensitive parameter.Pulmonary hypertension was the most common cause of death.