Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 79
Filter
Add filters

Document Type
Year range
1.
Chest ; 162(4):A2065, 2022.
Article in English | EMBASE | ID: covidwho-2060893

ABSTRACT

SESSION TITLE: Etiologies of Cardiovascular Disease Case Report Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Troponin level (Tnl) is usually used as confirmation of acute myocardial infarction (AMI) and is a sensitive marker. It is usually increased within 2-3 hours after AMI. In most cases, increased in Tnl is associated with symptomatic chest pain, cardiac ischemia, chronic coronary syndromes, etc. It can also be elevated in other conditions without cardiac injuries, like critical illness: COVID infection, septic shock, acute stroke and burns. CASE PRESENTATION: A 72 y/o man with history of b/l internal carotid artery (ICA) stenosis (70% in R-ICA and 80-90% in L-ICA) underwent elective left trans-carotid artery revascularization (TCAR). He was transferred to ICU after an uneventful procedure, for monitoring. His history was significant for HTN, HLD, Meniere's disease, gout, prior CVA of L-frontal lacunar and R-PICA (posterior inferior cerebellar artery). Postop vitals: BP 114/60 mmHg, HR 65, RR 16, O2 sat 98%. Tnl increased to 1.95 and then declined (normal 0 - 0.4 ng/ml). He was AAOx4, and asymptomatic. Post-op serial EKGs: normal sinus rhythm with no ST/T wave changes. Echo: EF 60%, normal biventricular size and function. LDL <70, A1C 5.9, normal TSH, no CPK elevation. Other labs: normal, No new neurological deficits. He was continued on ASA, clopidogrel, metoprolol, amlodipine and lisinopril. His hospital stay was uneventful, and he was discharged on post-op day 3. DISCUSSION: Cardiac troponin complex has its distinct subunits according to their functions: highly conserved Ca2+ binding subunit (cTnC);actomyosin ATPase inhibitory subunit and tropomyosin binding subunit. They play the pivotal role in regulating myocardial muscle contraction and relaxation and demonstrate as sensitive biomarkers for the myocardial injuries. Interestingly, there are many other causes that lead to increased cardiac troponin level without remarkable myocardial injuries or ischemia. Elevated Tnl after TCAR procedure can also be due to its surgical complication of a chance of hypoperfusion during the procedure. Our patient's surgery was uneventful. In one randomized controlled trial, it is stated that the risk of having CVA and AMI is higher in carotid endarterectomy compared to revascularization in patients with carotid artery stenosis. Our patient did not have any post-op complication, and only had an idiopathic elevation of troponin. CONCLUSIONS: The role of Tnl plays an important role in confirmation of myocardial infarction or ischemia but it can be idiopathic. Unpublished data from our institution revealed no increase in troponin s/p TCAR after uneventful procedures. This is the first reported case presenting with elevated troponin level without any pertinent positive findings (EKG changes/symptoms). Maybe in uneventful TCAR procedure troponin should not be ordered? Reference #1: Defilippi, C.R., Tocchi, M., Parmar, R.J., Rosanio, S., Abreo, G., Potter, M.A., Runge, M.S., & Uretsky, B.F. (2000). Cardiac troponin T in chest pain unit patients without ischemic electrocardiographic changes: angiographic correlates and long-term clinical outcomes. Journal of the American College of Cardiology, 35 7, 1827-34. Reference #2: Gordon AM, Homsher E, Regnier M. Regulation of contraction in striated muscle. Physiol Rev. 2000 Apr;80(2):853-924. doi: 10.1152/physrev.2000.80.2.853. PMID: 10747208. Reference #3: Brott, T.G., Hobson, R.W., Howard, G., Roubin, G.S., Clark, W.M., Brooks, W., Mackey, A., Hill, M.D., Leimgruber, P.P., Sheffet, A.J., Howard, V.J., Moore, W.S., Voeks, J., Hopkins, L.N., Cutlip, D.E., Cohen, D.J., Popma, J.J., Ferguson, R.D., Cohen, S.N., Blackshear, J.L., Silver, F.L., Mohr, J.P., Lal, B.K., & Meschia, J.F. (2010). Stenting versus endarterectomy for treatment of carotid-artery stenosis. The New England journal of medicine, 363 1, 11-23. DISCLOSURES: No relevant relationships by Moses Bachan No relevant relationships by Zin Min Htet No relevant relationships by Z nobia Khan No relevant relationships by Zin Oo

2.
Chest ; 162(4):A1868, 2022.
Article in English | EMBASE | ID: covidwho-2060878

ABSTRACT

SESSION TITLE: Drug-Induced Lung Injury Pathology Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: Acute eosinophilic pneumonia (AEP) is an atypical cause of acute hypoxic respiratory failure in adults, however if not identified can prove to be fatal. It can all be a COVID19 mimic during the pandemic. AEP has several causes, such as inhalational drugs, infections and various pharmaceuticals. Often, patients will have an acute respiratory syndrome for less than one-month, pulmonary infiltrates on chest computed tomography (CT) or radiography (CXR), in addition to bronchoalveolar lavage (BAL) with more than 25% of eosinophils. CASE PRESENTATION: A 79 y/o man underwent an elective total knee replacement complicated by acute lower limb ischemia from an occluded bypass graft. He developed methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin-resistant Enterococcus (VRE) joint and soft tissue infection of the lower extremity. He was prescribed a 6-week course of Daptomycin. He presented about 3 weeks into treatment with shortness of breath. He was initially diagnosed with acute on chronic congestive heart failure (CHF) exacerbation and COVID negative. He was initially treated with diuretics. He developed acute renal failure requiring dialysis and acute hypoxic respiratory failure requiring intubation. CXR revealed bilateral lung infiltrates with BAL having 80% eosinophils, eosinophilia and urinalysis positive for eosinophils. Daptomycin was discontinued and he was started on systemic steroids for a two-week course. He was successfully extubated 5 days after diagnosis of AEP and was subsequently discharged to a rehabilitation facility on lifelong Doxycycline for MRSA prosthetic joint infection prophylaxis. DISCUSSION: AEP related to Daptomycin was first reported in 2007, in a patient that developed the condition after receiving treatment for endocarditis. Daptomycin caused an inflammatory reaction within the lungs, due to an accumulation of the drug within the pulmonary surfactant. Our case report patient met all components for AEP diagnosis, in addition to symptom onset being approximately 3 weeks into treatment. The ultimate treatment for AEP is to stop the reversible cause, if identifiable, along with glucocorticoids and symptomatic support. Prognosis for patients with AEP is excellent when diagnosis is prompt, and usually infiltrates are resolved within 1 month without long term adverse pulmonary effects. Our patient was discharged to an acute rehab facility without supplemental oxygen therapy and continues to improve from functional standpoint. This case a definite cause of AEP from Daptomycin presented as COVID19 pneumonia mimic. It highlights the importance of rapid diagnosis to prevent morbidity and mortality. CONCLUSIONS: The differential in a patient with acute hypoxic respiratory failure is numerous, especially during the COVID19 pandemic. During these challenging times, it is important to think of atypical causes, such as AEP to improve the patient's clinical status. Reference #1: Allen JN, Pacht ER, Gadek JE, Davis WB. Acute Eosinophilic Pneumonia as a Reversible Cause of Noninfectious Respiratory Failure. N Engl J Med. 1989;321:569-574 Reference #2: Hayes Jr. D, Anstead MI, Kuhn RJ. Eosinophilic pneumonia induced by daptomycin. J Infect. 2007;54(4):e211-213. Reference #3: Rachid M, Ahmad K, Saunders-Kurban M, Fatima A, Shah A, Nahhas A. Daptomycin-Induced Acute Eosinophilic Pneumonia: Late Onset and Quick Recovery. Case Reports in Pulmonology. 2017. DISCLOSURES: No relevant relationships by Moses Bachan No relevant relationships by Zinobia Khan No relevant relationships by Kaitlyn Mehern

3.
Chest ; 162(4):A918, 2022.
Article in English | EMBASE | ID: covidwho-2060728

ABSTRACT

SESSION TITLE: Critical Renal and Endocrine Disorders Case Report Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: About 7% of acute pancreatitis (AP) cases are caused by hypertriglyceridemia (HTG). In such cases bowel rest, IV fluids, symptomatic therapy, and triglyceride (TG) lowering interventions are initiated. Plasmapheresis is one of the treatment options, but it has specific indications. We present a case of severe hypertriglyceridemia-induced pancreatitis that required plasmapheresis. CASE PRESENTATION: A 30 y/o man with type 2 diabetes, hyperlipidemia, multiple previous admissions for HTG-AP, presented with severe abdominal pain, nausea, and vomiting x 1 day. On admission, he was tachycardic, hypotensive, afebrile, SpO2 > 96% on RA. Labs: Glu 491 mg/dL, TG > 1000 mg/dL, Cholesterol 509 mg/dL, Lipase 987 U/L, Cr/BUN 2.4 mg/dL /20 mg/dL, VBG pH 7.25/PCO2 36.2 mmHg/PO2 19.4 mmHg/Ca 0.8/lactate 5.6;WBC 13.07 K/cm;COVID PCR positive. CXR: diffuse patchy opacities. CTAP with contrast was deferred because of AKI. He was admitted to the ICU and started on insulin drip with no improvement over 24hrs. He was still acidotic, Ca persistently low, TG still >1000, and kidney function worsened. Plasmapheresis was initiated. After one session his TG lowered to 700. He was restarted on insulin drip and in the next 24hr TG decreased to < 500 and metabolic acidosis resolved. Once AKI resolved, CT abdomen/pelvis with contrast confirmed acute pancreatitis, with focal hypodensities within the uncinate process and the proximal body, concerning infarcts as well as large phlegmon surrounding the pancreas, but no evidence of necrotizing or hemorrhagic pancreatitis. His hospital course was complicated with sepsis and DVT, which resolved with therapy. He was discharged home with TG lowering agents, Apixaban, and his previous T2DM regimen. DISCUSSION: Plasmapheresis is indicated in patients with severe HTG (>1000- 2000 mg/dl), severe HTG-AP, and when standard treatment options are inadequate. It lowers the lipid levels and removes proinflammatory markers and cytokines stopping further inflammation and damage to the pancreas and other organs faster compared to conservative therapy. Most patients need only one session which lowers TG level by 50-80%, as seen in our patient. CONCLUSIONS: Plasmapheresis should be considered in cases of HTGP with worrisome features such as lactic acidosis, hypocalcemia, worsening inflammation, and multi organ failure. Reference #1: Rajat Garg, Tarun Rustagi, "Management of Hypertriglyceridemia Induced Acute Pancreatitis", BioMed Research International, vol. 2018, Article ID 4721357, 12 pages, 2018. https://doi.org/10.1155/2018/4721357 Reference #2: Pothoulakis I, Paragomi P, Tuft M, Lahooti A, Archibugi L, Capurso G, Papachristou GI. Association of Serum Triglyceride Levels with Severity in Acute Pancreatitis: Results from an International, Multicenter Cohort Study. Digestion. 2021;102(5):809-813. doi: 10.1159/000512682. Epub 2021 Jan 21. PMID: 33477149. Reference #3: Gavva C, Sarode R, Agrawal D, Burner J. Therapeutic plasma exchange for hypertriglyceridemia induced pancreatitis: A rapid and practical approach. Transfus Apher Sci. 2016 Feb;54(1):99-102. doi: 10.1016/j.transci.2016.02.001. Epub 2016 Feb 20. PMID: 26947356. DISCLOSURES: No relevant relationships by Adam Adam No relevant relationships by Moses Bachan No relevant relationships by Chen Chao No relevant relationships by Vaishali Geedigunta No relevant relationships by Zinobia Khan No relevant relationships by Jelena Stojsavljevic

4.
Chest ; 162(4):A365, 2022.
Article in English | EMBASE | ID: covidwho-2060575

ABSTRACT

SESSION TITLE: Critical Care Presentations of TB SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 12:25 pm - 01:25 pm INTRODUCTION: TNFα plays a pivotal role in inflammation and maintenance of immune response against tuberculosis. The use of TNF inhibitors (TNFi) is associated with a significant increase in the incidence of tuberculosis (TB). TNFi may cause drug-induced lupus (ATIL) presenting as constitutional symptoms, rashes, pericardial and pleural effusions with positive autoantibodies. We present a case of pleural TB masquerading as drug-induced lupus. CASE PRESENTATION: A 68y/o woman with a history of ulcerative colitis (on infliximab, mesalamine), hypertension, T2DM, CAD, complained of low-grade fever, rashes, left-sided chest pain, dyspnea, and arthralgias for two weeks. Chest pain- worse with inspiration and cough. She emigrated from India to the USA 40 years ago. Six months before infliximab therapy, Quantiferon gold was negative. Exam: faint hyperpigmentation over shins, minimal swelling of MCPs and ankles, dullness to percussion over the left chest with decreased breath sounds. Labs: CRP 101 mg/dL, Hb 10.8 iron deficient, rheumatoid factor and anti-CCP negative, ANA 1:40, dsDNA 1:640, a reminder of ENA negative, anti-histone negative, C3/C4 normal, UA bland, protein/Cr 0.4 mg/gm, negative blood cultures, SPEP and LDH normal. CXR: opacification of the left lung up to midfield. CT chest: moderate left and small right pleural effusions, enlarged mediastinal lymph nodes. COVID and Quantiferon: negative. Thoracentesis: 850 ml of exudative fluid (2 out of 3 Light's criteria), lymphocytic predominance (76% of 4148 nucleated cells), adenosine deaminase (ADA) 42 U/L, gram stain, culture, acid-fast and MTB PCR negative, cytology negative. Thoracoscopy with biopsy of the parietal pleura: necrotizing granulomatous pleuritis with acid-fast bacilli. Sensitivity: pan-sensitive M. tuberculosis. Sputum: negative for TB. She was discharged on RIPE treatment for reactivation of TB. DISCUSSION: The incidence of infliximab-induced lupus is approximately 0.19% and confirming the diagnosis is challenging. The immunogenicity of infliximab is high, 66% of patients develop positive ANA. Anti-histone antibodies are less commonly associated with ATIL as opposed to classic drug-induced lupus and dsDNA is positive in up to 90% of cases of ATIL. Renal involvement is rare. The diagnostic usefulness of ADA (over 40 U/L) in lymphocytic pleural effusions for the diagnosis of tuberculosis in an immunosuppressed individual is demonstrated here. In countries with low TB burden, such as the USA, the positive predictive value of ADA in pleural fluid declines but the negative predictive value remains high. CONCLUSIONS: Tuberculous pleuritis is not always easily diagnosed since AFB smears and sputum may remain negative. When ADA level in lymphocytic pleural fluid is not low thorough search for TB with thoracoscopy and biopsy is justified. Reference #1: Shovman O, Tamar S, Amital H, Watad A, Shoenfeld Y. Diverse patterns of anti-TNF-α-induced lupus: case series and review of the literature. Clin Rheumatol. 2018 Feb;37(2):563-568. Reference #2: Benucci, M., Gobbi, F. L., Fossi, F., Manfredi, M. & Del Rosso, A. (2005). Drug-Induced Lupus After Treatment With Infliximab in Rheumatoid Arthritis. JCR: Journal of Clinical Rheumatology, 11 (1), 47-49. Reference #3: Valdés L, San José ME, Pose A, Gude F, González-Barcala FJ, Alvarez-Dobaño JM, Sahn SA. Diagnosing tuberculous pleural effusion using clinical data and pleural fluid analysis A study of patients less than 40 years-old in an area with a high incidence of tuberculosis. Respir Med. 2010 Aug;104(8):1211-7. DISCLOSURES: No relevant relationships by Adam Adam No relevant relationships by Moses Bachan No relevant relationships by Chen Chao No relevant relationships by Zinobia Khan No relevant relationships by Milena Vukelic

5.
Frontline Workers and Women as Warriors in the Covid-19 Pandemic ; : 133-147, 2022.
Article in English | Scopus | ID: covidwho-2055938
6.
Vacunas (English Edition) ; 23:S26-S32, 2022.
Article in English | EuropePMC | ID: covidwho-2034076

ABSTRACT

Objective The objective of this study was to assess the attitude and hesitancy toward vaccine against COVID-19 in a Pakistani Population. Materials and methods A mix-method, prospective study was conducted and adults (aged ≥18 years) residing in Pakistan were invited to participate. The questionnaire was prepared, hosted in Google Forms and circulated through electronic platforms and was also available to be done in in-person. Data was compiled from 15th September to 30th November 2020. Results The response rate was 80%. A total of 1003 participants were included in the final analysis. Of them, 75% completed survey questionnaire online, while remaining 25% responded in-person. The mean age of the participants was 29.62 ± 10.47 years. The majority of participants were females;60.9% (n = 611). 57.02% (n = 572) of the participants were employed at the time of survey. Overall, 70.68% (n = 709) of the participants had previous experience of vaccines such as the flu vaccine Only 4.9% (n = 49) participants thought that they will be seriously ill from COVID-19 within six months and 39% (n = 392) participants were confident that they will get COVID-19. A total of 71.29% of the participants reported they would consider getting vaccinated once available. There was statistical association between gender and getting vaccinated (P < 0.001). Conclusion This study demonstrated that majority of the participants showed positive attitude toward considering COVID-19 vaccine. However awareness with informed knowledge of efficacy, possible adverse effects and cost would be of added great value to increase the real response of Pakistani population toward COVID-19 vaccination.

7.
International Journal of Learning, Teaching and Educational Research ; 21(7):82-106, 2022.
Article in English | Scopus | ID: covidwho-2026392

ABSTRACT

Research in second language learning has identified the absence of metacognition among learners as one of the major problems contributing to students’ inability to comprehend listening texts. Moreover, the shift to remote teaching due to COVID-19 has made it more crucial for teachers and learners to adapt to new modes of teaching and learning. This accentuates the need for effective listening strategy instruction. This study conducted at a university in Oman, is unique in two ways: first, it seeks out teachers’ perceptions of metacognitive strategy instruction in remote teaching;and second, the intervention in the form of explicit metacognitive strategy instruction is offered online. This paper presents the findings of the study, which focused on the following: teachers’ perception of students’ listening difficulties;teachers’ perceptions of metacognitive strategies and their explicit instruction;the role of metacognitive strategy awareness and instruction in improving student participation and skills in listening;challenges encountered in teaching listening during remote teaching;and overcoming challenges of teaching metacognitive strategies in remote teaching. This mixed-method study collected data through questionnaires and interviews with 10 faculty members and 75 students. The findings show that teachers face several challenges, such as time limitations, shortened semesters, unfamiliar coursebook contexts, and assessment practices. For strategy instruction, teachers utilized collaborative lesson planning and resources and virtual flipped classrooms, among others. We conclude that metacognitive strategy instruction can provide better scaffolding during listening instruction and recommends further exploration of students’ use of metacognitive strategies in other academic contexts. ©Authors This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND 4.0).

8.
Fractals-Complex Geometry Patterns and Scaling in Nature and Society ; 30(05), 2022.
Article in English | Web of Science | ID: covidwho-2020337

ABSTRACT

This paper deals with the global dynamics of deterministic-stochastic COVID-19 mathematical model with quarantine class and incorporating a preventive vaccination. Lyapunov functions are utilized for the global stability of disease free equilibrium point and the graph theoretic method is used for the construction of Lyapunov function for positive equilibrium point. The stability of model is discussed regarding the reproductive number. Utilizing the non-standard finite difference scheme for the numerical solution of the deterministic model, the obtained results are shown graphically. Further, environmental noises are added to the model for description of stochastic model. Then we take out the existence and uniqueness of positive solution with extinction for infection. Finally, we solve numerically the stochastic model using Newton Polynomial scheme and present the results graphically.

9.
2nd International Conference of Smart Systems and Emerging Technologies, SMARTTECH 2022 ; : 12-13, 2022.
Article in English | Scopus | ID: covidwho-2018983

ABSTRACT

The novel coronavirus disease (COVID-19) constitutes a public health emergency globally. It is a deadly disease which has infected more than 230 million people worldwide. Therefore, early and unswerving detection of COVID-19 is necessary. Evidence of this virus is most commonly being tested by RT-PCR test. This test is not 100% reliable as it is known to give false positives and false negatives. Other methods like X-Ray images or CT scans show the detailed imaging of lungs and have been proven more reliable. This paper compares different deep learning models used to detect COVID-19 through transfer learning technique on CT scan dataset. VGG-16 outperforms all the other models achieving an accuracy of 85.33 % on the dataset. © 2022 IEEE.

10.
MediaEval 2021 Workshop, MediaEval 2021 ; 3181, 2021.
Article in English | Scopus | ID: covidwho-2011734

ABSTRACT

The spread of the COVID-19 is a challenge for the health sector. This pandemic created health and financial issues for the whole world. The medical experts are working for the diagnostics and reasons behind the COVID-19 disease and its spread. Some conspiracies are being spread related to the COVID-19 disease and its spread. Such conspiracies can be seen on social media including Twitter. In this research, the conspiracies of the COVID-19 have been analyzed from the public tweets. The tweets of the conspiracies have been filtered from the tweets of the COVID-19 disease, symptoms, and other discussions related to the disease. The analysis of the COVID-19 related tweets resulted into three conspiracy classes, the COVID-19 tweets without any conspiracy and the conspiracies. A model is presented for the classification of tweets into three conspiracy classes with the Matthews Correlation Coefficient (MCC) of 0.294. Copyright 2021 for this paper by its authors.

11.
Letters in Drug Design and Discovery ; 19(8):741-756, 2022.
Article in English | EMBASE | ID: covidwho-1957133

ABSTRACT

Background: Coronavirus disease-2019 (COVID-19) has recently emerged as a pandemic respiratory disease with mild to severe pneumonia symptoms. No clinical antiviral agent is available so far. However, several repurposing drugs and vaccines are being given to individuals or in clinical trials against SARS-CoV-2 Objective: The aim of this study is to uncover the potential effects of Luteolin (Lut) as an inhibitor of SARS-CoV2 encoded proteins via utilizing computational tools. Methods: Molecular modelling to unfold the anti-SARS-CoV2 potential of Lut along with reference drugs namely remdesivir and nafamostat was performed by the use of molecular docking, molecular dynamic (MD) simulation, absorption, distribution, metabolism, excretion, toxicity (ADMET) and density functional theory (DFT) methods against the five different SARS-CoV-2 encoded key proteins and one human receptor protein. The chemical reactivity of Luteolin is done through prediction of HOMO-LUMO gap energy and other chemical descriptors analysis. Results: In the present study, Lut binds effectively in the binding pockets of spike glycoprotein (6VSB), ADP phosphatase of NSP3 (6W02), and RNA dependent RNA polymerase (7AAP) protein receptors with significant values of docking scores-7.00,-7.25, and-6.46 respectively as compared to reference drugs remdesivir and nafamostat. Conclusion: Thus, Lut can act as a therapeutic agent and is orally safe for human consumption as predicted by molecular modelling against SARS-CoV-2 in the treatment of COVID-19.

12.
Journal of Clinical Periodontology ; 49:227, 2022.
Article in English | EMBASE | ID: covidwho-1956762

ABSTRACT

Background and Aim: This study aims to audit the process of patient management with aerosol generating procedure (ultrasonic scaling) while adherence to the guidelines for healthcare workers during the COVID-19. Methods: Audits records at the Department of Periodontology at University College of Dentistry Hospital Lahore - Pakistan were collected (prospectively) over the period of 1 October to 30 November 2020 (1st cycle) and 14 December 2020 to 12 February 2021 (2nd cycle). The audit was divided into three components based on the guidelines: (i) Physical environment, (ii) patients/appointments and (iii) COVID SOPs related to HCWs. Results: The recommended physical layout and procedural factors, as suggested by the guidelines for dental clinics, were observed during the first cycle of audit, and discrepancy of ventilation system was fixed after the first cycle. Only one house officer got COVID positive (PCR) on 3rd day of house job. There were four procedural slots per day with three fallow time of half an hour each in the first cycle. Audit team reported the observance of fallow time three times daily, which revealed that 83.3% observance of fallow time. Later in the 2nd cycle when the extra oral high volume air evacuator was installed, the fallow time was reduced to 15 min and not only we did five procedural slots per day but our fallow time was also observed 100% of the time. There were few occasions in each cycle where the appointed patients had to wait more than 10 min before they were seated, and waiting time decreased in the cycle 2 when the dental staff were sensitized with its importance repeatedly as part of our weekly dissemination of knowledge. Conclusions: Following the standard guidelines resulted in more efficient working environment and lesser risk for health care workers while performing aerosol-generating procedures.

13.
INDIAN JOURNAL OF CRITICAL CARE MEDICINE ; 26(7):791-797, 2022.
Article in English | Web of Science | ID: covidwho-1939282

ABSTRACT

Objective: To determine whether high-flow nasal oxygen (HFNO) or noninvasive ventilator (NIV) can avoid invasive mechanical ventilation (IMV) in COVID-19-related acute respiratory distress syndrome (ADRS), and the outcome predictors of these modalities. Design: Multicenter retrospective study conducted in 12 ICUs in Pune, India. Patients: Patients with COVID-19 pneumonia who had PaO2/FiO(2) ratio <150 and were treated with HFNO and/or NIV. Intervention: HFNO and/or NIV. Measurements: The primary outcome was to assess the need of IMV. Secondary outcomes were death at Day 28 and mortality rates in different treatment groups. Main results: Among 1,201 patients who met the inclusion criteria, 35.9% (431/1,201) were treated successfully with HFNO and/or NIV and did not require IMV. About 59.5% (714/1,201) patients needed IMV for the failure of HFNO and/or NIV. About 48.3, 61.6, and 63.6% of patients who were treated with HFNO, NIV, or both, respectively, needed IMV. The need of IMV was significantly lower in the HFNO group (p <0.001). The 28-day mortality was 44.9, 59.9, and 59.6% in the patients treated with HFNO, NIV, or both, respectively (p <0.001). On multivariate regression analysis, presence of any comorbidity, SpO(2) <90%, and presence of nonrespiratory organ dysfunction were independent and significant determinants of mortality (p <0.05). Conclusions: During COVID-19 pandemic surge, HFNO and/or NIV could successfully avoid IMV in 35.5% individuals with PO2/FiO(2) ratio <150. Those who needed IMV due to failure of HFNO or NIV had (87.5%) mortality.

14.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927836

ABSTRACT

INTRODUCTION: Covid- 19 has been associated with various fungal infections in immunocompetent/immunocompromised patients. We report the second case of PCP pneumonia coinfection in a HIV- uninfected man with COVID-19. CASE: A 52 y/o man with PMH of hyperlipidemia, gout, viral myocarditis and no prior immunodeficient conditions was admitted to hospital for COVID-19 SARS (Severe Acute Respiratory Syndrome) CoV- 2 Pneumonia. He was initially treated with Dexamethasone 6mg/day, Remdesivir and Tocilizumab x 2doses and oxygen therapy. On day 4, he was transferred to ICU for acute hypoxemic respiratory failure requiring NIV eventually requiring intubation with Fio2-60-90%. His course was complicated by AKI, septic shock requiring pressor for BP support. He received empiric ceftriaxone and Hydrocortisone for suspected adrenal insufficiency. Despite antibiotics, labs showed increasing WBC count with decreasing procalcitonin. Blood/urine cultures: no growth. Tracheal cultures: Ceftriaxone-sensitive E.coli therefore was continued on ceftriaxone. On ICU day3, he was still febrile so was started on prophylactic Bactrim for PCP suspecting immunosuppression although he was never treated with long term high dose steroids. Fungal cultures, Aspergillus, HIV, Beta-D glucan - negative. He was afebrile after 7days of antibiotics and PCP testing was done to discontinue Bactrim. Tracheal aspirate culture reported positive for PCP diagnosed with IFA stain. LDH - 471 but is an unreliable marker in the setting of covid pneumonia. HRCT was not attained due to unstable hemodynamics. Prophylactic Bactrim was then switched to therapeutic dose and also started on Prednisone 40mg twice daily on tapered dose. DISCUSSION: PCP is an infection commonly seen in immunocompromised individuals but may colonize healthy individuals remaining asymptomatic and serving as a reservoir to transmit and affect immunocompromised hosts with immunodeficiency syndromes/malignancy/organ transplant. Diagnosis is made via identification of organism via staining/PCR. Based on previous case series reported by Mayo Clinic amongst HIV- uninfected individuals, an average dose of steroids was 30mg/ day (minimum-16mg/ day) for an average duration of 12 weeks (minimum-8weeks) to acquire PCP infection. Our subject was treated with Hydrocortisone dose equivalent to a prednisone dose ∼ 75mg/day x 1 week which may have induced immunosuppression or due to COVID-19 infection itself making him susceptible for PCP infection. First case of PCP pneumonia coinfection in COVID-19 (recovered) was reported in March 2021. CONCLUSION: Our case report is unique for two reasons, PCP diagnosis via tracheal aspirate and two, detected in COVID-19 infected patient post prophylaxis. PCP coinfection with COVID-19 should be identified and treated.

15.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927821

ABSTRACT

Introduction: Pulmonary Hamartomas are the most common benign tumors of lungs. Hamartomas are usually asymptomatic and are incidentally diagnosed on chest imaging. Symptomatic cases usually involve endobronchial mucosa. We describe a case of a symptomatic patient who was noted to have a right upper lobe collapse by an endobronchial lesion. This lesion was confirmed to be a cartilaginous hamartoma and was definitively treated by electrosurgical by Argon plasma (APC). Description: A 37 year old obese male active smoker presented to the ER for worsening Shortness of air (SOA) for two weeks. He had dry cough for similar duration without any fevers. On physical examination he was afebrile with normal vital signs but without hypoxia and otherwise normal physical examination. Labs revealed normal white cell count. A COVID test was negative. CT chest showed an endobronchial lesion obstructing the right upper lobe (RUL) with some internal fat density measuring at least 1.5cm causing complete collapse of RUL. No mediastinal or hilar adenopathy was noted. A flexible bronchoscopy showed a pedunculated smooth lesion arising from RUL bronchus anteriorly occluding the RUL bronchus. FNA of the lesion did not show any malignant cells. Using electrosurgery by APC the lesion was removed en bloc. A histopathology showed findings of cartilaginous hamartoma. A follow up Chest X-ray showed improvement in RUL atelectasis. Discussion: Pulmonary hamartomas are the most common benign pulmonary tumors and comprise 6% of solitary pulmonary nodules. Mostly detected on chest imaging as an incidental finding however CT chest has characteristic finding of pop corn shaped calcifications, fat density. Symptomatic cases are usually endobronchial and can be definitively treated with endoscopic techniques.

16.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927787

ABSTRACT

Introduction: Pulmonary Epithelioid hemangioendothelioma (EHE) is a rare vascular tumor;with approximately 248 cases of reported in the literature, making diagnosis and management challenging. Case: A 57-year-old female with past history of hypertension, hyperthyroidism and scoliosis was admitted with worsening chronic right flank pain. Initial lab workup was unremarkable. revealed COVID-19 PCR test was negative. CT chest revealed bilateral pleural effusions and CT abdomen showed 2.8 x2.0cm vague hypo-attenuating lesion in the right hepatic lobe. A repeat CT scan following thoracentesis demonstrated multiple bilateral pulmonary nodules, with the largest located in the right lower lobe (RLL) measuring 2.1cm (Image). Flowcytometry on bronchoalveolar lavage fluid was significant for a CD4/CD8 ratio of 5;however, the transbronchial biopsy was unremarkable. Differential diagnosis included sarcoidosis and hence patient was discharged on prednisone with Bactrim prophylaxis. She underwent VATS lung biopsy. RLL and pleural biopsies revealed EHE. Following the prednisone taper, patient was placed on pazopanib 800mg. The dose of medication subsequently reduced to 300-600mg due to adverse events. Repeat CT scans at 3 months demonstrated minimal change in size of the nodules. Patient continues to be followed on regular basis with a stable clinical status. Discussion: EHE is a low-intermediate grade malignancy which affects mostly liver, lungs and bones;although it can be found in any bodily tissue. Up to 50- 76% of patients are asymptomatic at diagnosis, with the most common symptomatic being local pain. Radiologically, Pulmonary EHE consists of bilateral perivascular nodularity. Our case describes the clinical course of a rare and poorly understood disease. Clinicians must be aware of the characteristics of unusual diseases and pursue robust diagnostic approach. In our case, biopsy led to the definitive diagnosis of EHE. Because of its rarity, there is no standard therapy for metastatic disease. Pazopanib has demonstrated prolonged long-term disease control in observational studies. Some other reports have shown response to cytotoxic chemotherapy such as doxorubicin-containing regimens, however, long-term survival is compromised. Lenalidomide, sorafenib and sunitinib have also been used, but the experience is limited. Our patient is currently on her 4th month of treatment with pazopanib, with 3-month follow-up showing no progression of disease. (Figure Presented).

17.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927777

ABSTRACT

INTRODUCTION: Dietary and herbal supplements can contain clinically significant amounts of exogenous thyroid stimulants and hormones, including T3 and T4, thus placing consumers at increased risk of thyrotoxicosis and other metabolic-related adverse effects. We present a case of thyrotoxicosis in a young man with no history of thyroid disease, who was found to be consuming an extensive variety of supplements. DESCRIPTION: A 31 year old man with hypertension presented with 1 week of intermittent palpitations. He was in his usual state of health until 1 week prior to admission, when he noticed intermittent, self-resolving episodes of tachycardia as high as the 160s on his smart watch, associated with palpitations, dyspnea, low grade fevers, and intermittent dry cough. He came to the ED for persistence of symptoms. In the ED: T 98.8 F, HR 129, BP 152/77, RR 18, SpO2 98% on RA. CBC, BMP, UA, UTox, blood alcohol content, troponin and COVID tests were unremarkable. TSH was < .007 [0.358-3.740 ulU/mL], with a free thyroxine of 0.54 [0.70-1.48 ng/dL];other thyroid studies later returned with TSI < 0.10 [0.00-0.55 IU/L], free T3 32.50 [1.80-4.60 pg/mL], and an unremarkable thyroid ultrasound. CXR showed no acute infiltrates. EKG revealed sinus tachycardia, no Wolff-Parkinson-White syndrome, and no Brugada waveforms. He was given 2L NS, ceftriaxone 1g IV, aspirin 81mg PO, and tylenol 650mg PO, and admitted to the telemetry unit. Exam revealed an anxious appearing man with tachycardia. On ROS, patient admitted to drinking 6-8 cups of coffee daily, and to taking at least a dozen different supplements. He was started on propranolol 30 mg every 6 hours with improvement in his heart rate, and was counseled to stop the supplements and wean his caffeine intake. He was discharged the following day with plan for endocrinology and primary care follow-up. DISCUSSION: Thyrotoxicosis in this young patient with no history of thyroid disease posed a diagnostic quandary. This prompted further investigation into a more detailed social history, which revealed the extensive variety of supplements he was taking, consistent with thyrotoxicosis factitia. In patients presenting with newonset tachycardia, our case highlights the importance of collecting a thorough social history and maintaining early suspicion for thyroid disease and thyrotoxicosis.

18.
Annals of Dental Specialty ; 10(1):69-77, 2022.
Article in English | English Web of Science | ID: covidwho-1885014

ABSTRACT

Recently, with the emergence of world pandemic called COVID-19 virus all over the world, dental practitioners have stood out as high risked front liners. The aim of this study is to analyse the knowledge and management of emergency and safety precautions implemented by dentists during the pandemic of COVID-19 in Saudi Arabia. An online survey was used for this cross-sectional study using google forms and was distributed to dental professionals who works in government hospitals, private clinics, and academic universities in Saudi Arabia. Statistical evaluation was done using the data that was obtained from 355 dentists (academicians, private practitioners, military and government employees), with the power of the sample being 0.85. Relevant awareness regarding the incubation period and symptoms of COVID-19 virus was observed among the dental professionals. Preparedness and perception among dental professionals seem to be satisfactory and statistically significant. Obligatory improvements should be provided through educational campaigns.

19.
American Journal of Respiratory and Critical Care Medicine ; 205:2, 2022.
Article in English | English Web of Science | ID: covidwho-1880695
20.
American Journal of Respiratory and Critical Care Medicine ; 205:1, 2022.
Article in English | English Web of Science | ID: covidwho-1880258
SELECTION OF CITATIONS
SEARCH DETAIL