Recurrent Hydropneumothorax After COVID-19.

A 60-year-old male with a past medical history of heart failure with reduced ejection fraction, obstructive sleep apnea, atrial flutter, and hypertension initially presented to the emergency department with a chief complaint of shortness of breath. He was diagnosed with COVID-19-induced acute hypoxic respiratory failure. Before his presentation to the emergency department, he was treated with a brief course of hydroxychloroquine, azithromycin, and prednisone. His initial hospitalization was relatively uncomplicated. He then presented back to the emergency department approximately five months later with chief complaints of continued dyspnea and increased work of breathing. On this presentation, he was noted to have a right-sided pneumothorax with a moderate right-sided pleural effusion. The effusion was drained through CT (computed tomography)-guided catheter insertion. Pleural fluid culture and sensitivity were negative, and a cartridge-based nucleic acid amplification test (CBNAAT) was not performed. He was discharged a few days later to home. Over the next several weeks, the patient had recurrent admissions and chest tube placements for unresolving hydropneumothorax. He eventually had a right-sided posterolateral thoracotomy performed. The tissue sample from the thoracotomy was noted to have positive gram staining for fungal hyphae consistent with aspergillosis. This was initially considered a contaminant and not treated with antifungal medication. Unfortunately, after the thoracotomy, the patient continued to have complications including subcutaneous emphysema and recurring hydropneumothoraces. He was taken for another procedure after a repeat CT showed intercostal herniation of the pleura between the fifth and sixth ribs. The herniation was excised, and the pleura was repaired. This pleural tissue was then sent to pathology and noted to have non-caseating granulomas consistent with aspergillosis. At this time, the patient was started on voriconazole. After initiating this medication, the patient's last chest x-ray showed stable findings of his chronic disease process with no new or worsening hydropneumothorax.

Epidemiological Review on Monkeypox.

The significant increase in monkeypox cases that was reported at the beginning of 2022 was notable. The resurgence of viral zoonosis is especially concerning, given the current and recent COVID-19 epidemic. There are worries that a new pandemic may be beginning due to the virus that causes monkeypox spreading so quickly. This article aimed to provide an overview of the epidemiology, pathogenesis, and clinical symptoms of monkeypox. It has been known that monkeypox was primarily prevalent in Central and West Africa, but in recent years, cases of monkeypox infections have been reported around the world. The transmission of the infection to humans has been connected to exposure to a diseased animal or person's excretions and secretions. Various studies indicate that monkeypox clinically manifests as fever, fatigue, and a rash of smallpox-like lesions and can cause various complications, including pneumonia, encephalitis, and sepsis, which, when not properly managed, can lead to death. Those living in remote and forested areas, taking care of individuals infected with monkeypox, and trading and taking care of exotic animals are some of the risk factors for monkeypox. Men having sex with men are also at higher risk of contracting monkeypox. When dealing with individuals who have high-risk factors and come with new-onset progressive rashes, it is necessary for clinicians to highly suspect monkeypox. This review will serve as reference material and a supplement to the existing literature that will assist in the proper management and prevention of monkeypox.

Invasive fungal sinusitis-A neglected but important association with COVID 19 infection and a ticking bomb.

A retrospective analysis of severe acute respiratory syndrome (SARS) and influenza data worldwide has concluded that fungal coinfections associated with global SARS-coronavirus 2 (CoV-2) are likely to be missed or misdiagnosed. The coronavirus disease-2019 (COVID)-19 patients, especially those who are severely ill or immunocompromised, are more likely to suffer from invasive mycoses which require early detection and treatment. We report two such cases, one of which is a case of aspergillosis of unilateral orbit and maxilla and another case is of mucormycosis infection of the paranasal sinuses and bilateral orbits.

Changes in physical activity and sedentary time in United States adults in response to COVID-19.

Physical activity is associated lower risk for a broad range of non-communicable diseases and early mortality, and even small changes in daily activity levels could have a profound effect on public health at the population level. The COVID-19 pandemic reshaped daily life for United States (US) adults resulting in reductions in physical activity early in the pandemic, but its longer-term effects on daily activities are unknown. To examine the longer-term impact of the pandemic on daily activity levels, we conducted a nationwide longitudinal study of 1,635 adults (20-75 years) in AmeriSpeak. Previous-day recalls of time-use, sedentary time, and physical activity were completed on randomly selected days in Fall 2019 (pre-pandemic) and Fall 2020. Overall, US adults reported less time in transportation (-0.47 hrs/d), more total discretionary time (0.40 hrs/d), but no changes in total sedentary time (0.10 hrs/d) or leisure-time physical activity (-0.06 hrs/d). Women reported significantly less total activity (-0.36 hrs/d) and participants with children < 13 yrs reported more sedentary time (0.60 to 0.82 hrs/d) and less moderate-to-vigorous intensity activity (-0.84 to -0.72 hrs/d). Adults without children reported no changes in sedentary time (0.02 hrs/d) or moderate-vigorous intensity activity (-0.06 hrs/d). Adults who started working from home reported no changes in physical activity, but they were among the most sedentary and least active population groups at both timepoints. Our findings describe the complex inter-play between competing behaviors as time-use demands have changed in response to the pandemic, particularly for adults with younger children. Many US adults are likely to continue working from home; therefore, implementation of evidence-based approaches to increase physical activity and reduce sedentary time in this growing population subgroup appears warranted.

In Vitro Nasal Tissue Model for the Validation of Nasopharyngeal and Midturbinate Swabs for SARS-CoV-2 Testing.

Large-scale population testing is a key tool to mitigate the spread of respiratory pathogens, such as the current COVID-19 pandemic, where swabs are used to collect samples in the upper airways (e.g., nasopharyngeal and midturbinate nasal cavities) for diagnostics. However, the high volume of supplies required to achieve large-scale population testing has posed unprecedented challenges for swab manufacturing and distribution, resulting in a global shortage that has heavily impacted testing capacity worldwide and prompted the development of new swabs suitable for large-scale production. Newly designed swabs require rigorous preclinical and clinical validation studies that are costly and time-consuming (i.e., months to years long); reducing the risks associated with swab validation is therefore paramount for their rapid deployment. To address these shortages, we developed a 3D-printed tissue model that mimics the nasopharyngeal and midturbinate nasal cavities, and we validated its use as a new tool to rapidly test swab performance. In addition to the nasal architecture, the tissue model mimics the soft nasal tissue with a silk-based sponge lining, and the physiological nasal fluid with asymptomatic and symptomatic viscosities of synthetic mucus. We performed several assays comparing standard flocked and injection-molded swabs. We quantified the swab pickup and release and determined the effect of viral load and mucus viscosity on swab efficacy by spiking the synthetic mucus with heat-inactivated SARS-CoV-2 virus. By molecular assay, we found that injected molded swabs performed similarly or superiorly in comparison to standard flocked swabs, and we underscored a viscosity-dependent difference in cycle threshold values between the asymptomatic and symptomatic mucuses for both swabs. To conclude, we developed an in vitro nasal tissue model that corroborated previous swab performance data from clinical studies; this model will provide to researchers a clinically relevant, reproducible, safe, and cost-effective validation tool for the rapid development of newly designed swabs.

Reduction of pulmonary exacerbations in young children with cystic fibrosis during the COVID-19 pandemic.

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.