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This study examines clinical outcomes in patients with cytomegalovirus (CMV) and SARS-CoV-2 coinfection. Between June and November 2020, previously immunocompetent patients with SARS-CoV-2 and CMV coinfection were identified at Houston Methodist Hospital as part of routine clinical correlation by a molecular pathologist. SARS-CoV-2 nasopharyngeal specimens were analyzed by real time reverse-transcriptase polymerase chain reaction (RT-PCR). All CMV tests were performed on plasma or bronchoalveolar lavage (BAL) specimens and analyzed by competitive polymerase chain reaction. 65 previously immunocompetent patients with CMV and SARS-CoV-2 coinfection were identified. Patient demographics include 41 male patients (63%) and 24 female patients (37%) ranging in age from 34 to 86 years (mean: 66.04, median 68). Documented pre-existing conditions include 27 patients with hypertension 41.5%), 19 patients with diabetes mellitus (29.2%), 9 patients with coronary artery disease (13.8%), and 3 patients with asthma (4.6%). Eight patients (12.3%) had no documented pre-existing conditions. The plasma CMV viral load ranged from <300 to 21,566 IU/mL. The CMV PCR results from bronchoalveolar lavage and bronchial wash specimens ranged from <300 to 59,127 IU/mL. CMV PCR was initially negative in 10 patients then positive on serial testing. 60 patients were critically ill requiring ventilator support (92.3%). 47 patients (72.3%) expired, 7 patients (10.8%) were transferred to a long term acute care facility, 3 patients (4.6%) were discharged to a rehabilitation facility, 3 patients (4.6%) were discharged home, and 1 patient (1.5%) remained in-patient at the time of analysis. The prevalence of CMV seropositivity and medical comorbidities increases with age. Reactivation of latent CMV is a known occurrence in critically ill patients that is associated with poor outcomes. The majority of the patients in our cohort were 50 years old, and all were severely to critically ill with a mortality rate of 72.3% These findings suggest CMV portends a worse prognosis in patients with COVID-19. These findings also demonstrate the importance of clinical correlation in molecular testing.
ABSTRACT
Smoking is a significant social problem threatening the population's health, especially during the coronavirus pandemic. Due to the problem's urgency, we present a clinical case of SARS-CoV-2 infection in a patient with 10 years of smoking and concomitant chronic obstructive pulmonary disease (chronic bronchitis and peribronchial pneumosclerosis). Patient L.K., 42 years old, on 13.10.2022, was hospitalized for several hours at the Emergency Hospital of the Ministry of Health of Chuvashia (Cheboksary) with a severe new coronavirus infection. Secondary diagnosis: Chronic obstructive pulmonary disease Case history: for about two to three weeks, the patient noted an increase in body temperature to 37.2-37.4 degreeC and a cough. He has smoked for about 10 years, 1 pack per day. Computed tomography showed signs of bilateral COVID-associated pneumonitis, alveolitis with 85% involvement and consolidation sites, signs of chronic bronchitis, and peribronchial pneumosclerosis. The diagnosis of COVID-19 was confirmed by a polymerase chain reaction in a nasopharyngeal smear. The NEWS2 score was 9. After the treatment started, the patient died. Histological examination showed perivascular sclerosis, peribronchial pneumosclerosis, atrophic changes in the ciliated epithelium, and structural and functional alteration of the bronchial mucosa. In addition, areas of hemorrhage and inflammatory infiltrate in the bronchial wall were found. Coronavirus is known not to cause bronchitis but bronchiolitis. In the presented case, the patient showed signs of transition of bronchitis to the acute stage. Therefore, it can be assumed that the coronavirus acts as a complicating factor. In addition to the described changes, signs of viral interstitial pneumonia, pulmonary edema, and early development of acute respiratory distress syndrome were identified.Copyright © 2023, Media Sphera Publishing Group. All rights reserved.
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Objective: Although the neurological and olfactory symptoms of coronavirus disease 2019 have been identified, the neurotropic properties of the causative virus, severe acute respiratory syndrome-associated coronavirus 2 (SARS-CoV-2), remain unknown. We sought to identify the susceptible cell types and potential routes of SARS-CoV-2 entry into the central nervous system, olfactory system, and respiratory system. Method(s): We collected single-cell RNA data from normal brain and nasal epithelium specimens, along with bronchial, tracheal, and lung specimens in public datasets. The susceptible cell types that express SARS-CoV-2 entry genes were identified using single-cell RNA sequencing and the expression of the key genes at protein levels was verified by immunohistochemistry. We compared the coexpression patterns of the entry receptor angiotensin-converting enzyme 2 (ACE2) and the spike protein priming enzyme transmembrane serine protease (TMPRSS)/cathepsin L among the specimens. Result(s): The SARS-CoV-2 entry receptor ACE2 and the spike protein priming enzyme TMPRSS/cathepsin L were coexpressed by pericytes in brain tissue;this coexpression was confirmed by immunohistochemistry. In the nasal epithelium, ciliated cells and sustentacular cells exhibited strong coexpression of ACE2 and TMPRSS. Neurons and glia in the brain and nasal epithelium did not exhibit coexpression of ACE2 and TMPRSS. However, coexpression was present in ciliated cells, vascular smooth muscle cells, and fibroblasts in tracheal tissue;ciliated cells and goblet cells in bronchial tissue;and alveolar epithelium type 1 cells, AT2 cells, and ciliated cells in lung tissue. Conclusion(s): Neurological symptoms in patients with coronavirus disease 2019 could be associated with SARS-CoV-2 invasion across the blood-brain barrier via pericytes. Additionally, SARS-CoV-2-induced olfactory disorders could be the result of localized cell damage in the nasal epithelium.Copyright © Wolters Kluwer Health, Inc. All rights reserved.
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The purpose of this study is to evaluate changes in the trachea and bronchi using 3-dimensional reconstruction images obtained from the initial and follow-up computed tomography (CT) scans of COVID-19 patients. A hundred COVID-19 patients over the age of 18 were included in our study. CT images were transferred to Mimics software, and a 3-dimensional reconstruction of the trachea and bronchi was performed. The initial and follow-up CT images of COVID-19 patients were graded as none (grade 0), mild (grade 1), moderate (grade 2), and severe (grade 3) according to the total lung severity score. The patients were divided into progression and regression groups according to the grade increase/decrease between the initial and follow-up CTs. Moreover, the patients were divided into groups as 0-2 weeks, 2-4 weeks, 4-12 weeks, and over 12 weeks according to the duration between the initial and follow-up CTs. The mean cross-sectional area, circumference, and diameter measurements of the right upper lobar bronchus, intermediate bronchus, middle lobar bronchus, and left lower lobar bronchus decreased in the follow-up CTs of the progression group. This decrease was not found to be statistically significant. In the follow-up CTs of the regression group, the left upper lobar bronchus and left lower lobar bronchus measurements increased but not statistically significant. Upon comparing the onset of the disease and the follow-up period, statistically significant changes did not occur in the trachea, main bronchus, and lobar bronchus of COVID-19 patients.Copyright © 2023, Universidad de la Frontera. All rights reserved.
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Objectives: Extracorporeal membrane oxygenation (ECMO) is well established in cardiorespiratory failure. Here we report the use of ECMO in an airway emergency to provide respiratory support. Method(s): Informed consent was obtained from patient at the time of admission. Result(s): A 48-year-old with COVID-19 requiring venovenous ECMO (VVECMO) for 32 days and tracheostomy for 47 days had developed tracheal stenosis three months after tracheostomy removal, and undergone tracheal resection and reconstruction. He presented two weeks later with acute dyspnea, bloody drainage and a bulge in his neck with coughing. A computerized tomography (CT) of the cervical spine and chest showed dehiscence of the tracheal wound and a gap in the trachea. He was managed with High Flow Nasal Canula and supported on VVECMO support using 25 Fr. right femoral drainage cannula and 23 Fr. left IJ return cannula. A covered stent was placed, neck wound was irrigated and debrided. Patient was decannulated after 10 days on ECMO. Future therapeutic considerations include mediastinal tracheostomy, aortic homograft interposition of the disrupted segment of trachea with stent placement and permanent self-expandable stent with internal silicone stent. Conclusion(s): ECMO is increasingly used in complex thoracic surgery as well as in the perioperative period as salvage support. One of the areas where it has shown promising results is traumatic main bronchial rupture, airway tumor leading to severe airway stenosis, and other complex airway problems. The ease of cannulation, the technological advances and growing confidence in the management of ECMO patients are the main reasons for the expansion of ECMO use beyond conventional indications. The case described above is an example of the use of ECMO in the perioperative management of impending respiratory failure due to airway obstruction or disconnection. (Figure Presented).
ABSTRACT
Anaplastic large-cell lymphoma (ALCL) is an aggressive subtype of non-Hodgkin lymphoma. There are two forms of ALCL: primary and secondary. Primary can be systemic, affecting multiple organs, or cutaneous, affecting mainly the skin. A secondary form occurs when another lymphoma undergoes an anaplastic transformation. ALCL rarely presents as initial symptoms of respiratory failure. In most of these situations, the trachea or bronchial involved with an obstruction was present. We present an unusual case of ALCL where the patient rapidly progressed to acute hypoxic respiratory failure with a patent bronchus and trachea. Unfortunately, the patient rapidly deteriorated and died before diagnosis. Only upon at autopsy, it was found that his lung parenchyma was diffusely involved with ALCL. The autopsy report showed that the patient had CD-30 anaplastic lymphoma kinase (ALK)-negative ALCL diffusely involving all lung fields.
ABSTRACT
Smoking is a significant social problem threatening the population's health, especially during the coronavirus pandemic. Due to the problem's urgency, we present a clinical case of SARS-CoV-2 infection in a patient with 10 years of smoking and concomitant chronic obstructive pulmonary disease (chronic bronchitis and peribronchial pneumosclerosis). Patient L.K., 42 years old, on 13.10.2022, was hospitalized for several hours at the Emergency Hospital of the Ministry of Health of Chuvashia (Cheboksary) with a severe new coronavirus infection. Secondary diagnosis: Chronic obstructive pulmonary disease Case history: for about two to three weeks, the patient noted an increase in body temperature to 37.2-37.4 degreeC and a cough. He has smoked for about 10 years, 1 pack per day. Computed tomography showed signs of bilateral COVID-associated pneumonitis, alveolitis with 85% involvement and consolidation sites, signs of chronic bronchitis, and peribronchial pneumosclerosis. The diagnosis of COVID-19 was confirmed by a polymerase chain reaction in a nasopharyngeal smear. The NEWS2 score was 9. After the treatment started, the patient died. Histological examination showed perivascular sclerosis, peribronchial pneumosclerosis, atrophic changes in the ciliated epithelium, and structural and functional alteration of the bronchial mucosa. In addition, areas of hemorrhage and inflammatory infiltrate in the bronchial wall were found. Coronavirus is known not to cause bronchitis but bronchiolitis. In the presented case, the patient showed signs of transition of bronchitis to the acute stage. Therefore, it can be assumed that the coronavirus acts as a complicating factor. In addition to the described changes, signs of viral interstitial pneumonia, pulmonary edema, and early development of acute respiratory distress syndrome were identified.Copyright © 2023, Media Sphera Publishing Group. All rights reserved.
ABSTRACT
Background: The COVID-19 pandemic is considered as a major challenge of the 21st century medicine around the world. Prolonged post-COVID symptoms of the respiratory system remain a topical issue: dry annoying cough, respiratory failure, and discomfort in the lung projection area. Thus, in COVID-infected patients, the assessment of respiratory system functional state with postcoid respiratory symptoms is undoubtedly important that is the aim of our study. Method(s): To achieve this aim, 56 patients (18 to 65 years of age, 33-females, 23-males) with post-COVID respiratory symptoms who referred to the Scientific Research Institute of Allergology, Asthma and Clinical Immunology (Tskaltubo, Georgia) for further diagnosis and treatment were involved in the study. Result(s): Respiratory status: external respiratory functioning status and spirometry features were assessed using computer spirometry -Spirolab 3. Analysis of the results showed that in the above patients, defects in forced expiratory time (FET < 6 min) were observed. According to the basic parameters of spirometry, the slight changes in FEV1;FVC FEV1/VC (Tiffeneau-Pinelli index) were revealed;Only 6 (10%) patients showed a mild obstruction, 4 of irreversible type and only 2 patients had reversible broncho-obstruction. In addition, mild restriction was determined in only 5 (9%) patients. Restrictive changes were detected in patients with a history of severe course of COVID infection and CT severity scores 12-21. Significant changes were observed in the PEF-peak expiratory flow rate in 35 (61%) patients the PEF index was reliably lower, by 70% or more, compared to the norm. Conclusion(s): Obstruction of medium and small bronchus was also reported in the majority of patients. MEF50%, MEF25% indicators were reliably reduced, undoubtedly indicating the importance of COVID 19 infection in the development and course of respiratory symptoms. The study reaffirmed the need for spirometry in the management and monitoring of COVID infection. Information on changes in spirometry parameters in COVID patients and patients with post-COVID respiratory symptoms is still scarce, however, the study in this area is undoubtedly promising.
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Background In the UK it is estimated that 10-15% of lung cancer cases occur in never-smokers. This study demonstrates the changes of the demographic characteristics, including the smoking status, of all the patients referred to the thoracic malignancy unit at Guy's Cancer Centre, South East London, between 2010 and 2021. Methods We included patients with a documented ICD10 diagnosis of bronchus and lung malignancy who were referred to Guy's thoracic malignancy unit from 2010 until 2021. A total of 6861 patients with a diagnosis of lung cancer were identified. We collected baseline demographic and clinical characteristics, including smoking status and socio-economic status for all the patients. Descriptive statistics were utilised to highlight the dynamic changes over the years of the referred patients. Results The number of referrals per year remained overall stable from 2010 until 2019, with a decrease in the number of referrals in 2020 and 2021, most likely due to the COVID-19 pandemic. We observed a gradual increase in the percentage of never smokers among the lung cancer patients: 5%, 8%, 10% and 13% of the referred patients were never smokers in the years 2010, 2015, 2018 and 2021 respectively. Median age remained stable across the years (range 68-71 years). Male percentage was 56%, 55%, 53% and 53% in 2010, 2015, 2018 and 2021 respectively. From the patients that we had a documented ethnic background the proportion of White/Black/Asian/Other or Mixed ethnicity remained stable across the years with a median 87%, 7%, 3%, and 3% respectively. The most common histological diagnosis was adenocarcinoma, followed by squamous cell carcinoma and small cell lung carcinoma. Conclusions The proportion of never-smoking to smoking related lung cancer has gradually increased between 2010 and 2021. There was little variability in age, sex and ethnic background. Never-smoking lung cancer is a distinct biological entity, therefore, further research should focus on the understanding of the aetiology and the risk factors leading to the development of lung cancer, in the absence of a history of tobacco exposure. Legal entity responsible for the study The authors. Funding Has not received any funding. Disclosure All authors have declared no conflicts of interest.Copyright © 2023 International Association for the Study of Lung Cancer. Published by Elsevier Inc.
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Aim of this study is to evaluate the incidence of fungal infections in COVID-19 intensive care unit (ICU) patients, to identify potential risk factors and to investigate whether differences in patients' outcomes are depicted. Material-Methods: This prospective observational study included critically ill patients diagnosed with COVID-19 that were admitted from 1/9/2020 to 1/11/2021 in ICU of the 1st Respiratory Department of Sotiria Chest Diseases Hospital. Epidemiologic characteristics, severity of disease, medication, outcome and complications were recorded. Result(s): Out of 300 patients included (213 men, 60,4+/-13,23 (mean+/-SD) years-old), 22 (7,3%) developed fungal infections (16 COVID-19 Associated Pulmonary Aspergillosis, 5 COVID-19 Associated Candidemia and 1 both). They were 6 female & 16 male, 55,73+/-13,28 years-old. Most patients had co-infections with multi-drug resistant bacteria. Patients with fungal infections were statistifically more on high dose of corticosteroids, invasive mechanical ventilation and renal replacement treatment (p<0.05). They had statistically more positive blood and bronchial secretion cultures, as well as more incidents of septic shock, venous thromboembolism and varotrauma (p<0.05). Their PaO2/FiO2 ratio on admission was statistically lower (p<0.05). Finally, after adjustment for confounfing factors and ICU days, they were at higher risk of dying (50% mortality). Conclusion(s): Fungal infections are a significant co-infection in critically ill COVID-19 patients. Those patients seem to have more severe respiratory failure on admission, be on higher doses of corticosteroids and in need of organ failure support. They also seem to develop more complications of COVID-19 and be at a higher risk of dying.
ABSTRACT
Introduction: We report a case of a 67 year old lady with an acute drop in conscious level whilst on a transatlantic flight. She had a background history of TII DM and recent mild COVID. Past surgical history of a gastric bypass, at which time a CXR had incidentally shown a bulla, with no underlying respiratory symptoms, or history of COPD. Method(s): On arrival in the emergency department, her GCS was 7/15, and she required immediate intubation. Non-contrast CT head showed multiple tiny gas locules in keeping with air emboli. CT Chest, Abdo, Pelvis showed an 88mm bulla within the left lung lingula with a bronchus and many large pulmonary vessels running on its edge. Result(s): It was thought the change in air pressure during the flight caused a communication to open between the bulla and the pulmonary circulation resulting in the release of air emboli. Conclusion(s): She required ITU admission for 8 days. After initial stabilisation she was stepped down to HASU. Neurologically she was dysphagic, dysarthric, quadriplegic and GCS 14 due to confusion. MRI whole spine ruled out spinal cord pathology. Repeat CT head showed air initially present had completely resorbed leaving multifocal, small areas of cortical and subcortical ischaemia in both cerebral hemispheres. MRI head confirmed innumerable small early subacute embolic ischaemic infarcts across multiple vascular distributions.
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Introduction: One of the major challenges of the SARS-CoV2 pandemic is to identify people most at risk of developing severe COVID-19. Patients with cystic fibrosis (CF) and COPD are at higher risk as alteration of their bronchial epithelium is a major target of SARS-CoV2 in triggering excessive inflammation. Aims and objectives: We aim to know whether the pathophysiological status of bronchial epithelium from CF and COPD patients could lead to specific responses to SARS-CoV2 infection. Method(s): Differentiated bronchial epithelium from controls, CF and COPD patients (N=4/group) were infected with SARS-CoV2 (24, 48 and 72h) as we previously described (Pizzorno, A. et al. Cell Rep Med, 2020). We compared its effect on epithelial integrity (transepithelial resistance), global gene expression (RNA sequencing) and inflammation (multiplex analysis). Result(s): SARS-CoV2 induces a stronger impairment of bronchial epithelial integrity and a greater number of deregulated genes in controls, compared to CF or COPD subjects. We identified specific transcriptomic signatures for each group, further characterized using in silico functional enrichment approaches. Although the magnitude of the responses differed, we identified common genes induced 72h post infection, including SOCS1, ZBP1 and CXCL10 (IP-10). Differential induction of CXCL10 was further validated at the protein level. Conclusion(s): We defined a common core signature of the bronchial epithelium response to SARS-CoV2, as well as specific differences according to the pathological context. This study may allow a better understanding of the underlying mechanisms related to COVID-19 severity and for identifying potential markers of interest.
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The article provided the information about the results of clinical-morphological analysis of the practical observation with pulmonary aspergillosis associated with COVID-19 and undiagnosed when the patient was alive. The pulmonary aspergillosis associated with COVID-19 is one of the widespread complications. However, in numerous cases, the pulmonary aspergillosis associated with COVID-19 is not diagnosed due to its unclear signs and lack of information about it. An infiltrate with signs of destruction was noted during X-ray examination of the lower part of the right lung of the observed patient. It was evaluated as destructive pneumonia associated with bacterial infection. However, despite the patient had type II diabetes, no additional examination methods were applied to exclude aspergillosis. Disruption of the protective properties of the bronchial epithelium and the effect of oseltamivir type drugs may also contribute to the entry of aspergillus fungi into the lung tissue. According to the authors, during the development of diagnosis, treatment and prevention strategy of COVID-19in the patients with pulmonary aspergillosis it is important to study the interaction of these diseases.Copyright © 2022 Authors. All rights reserved.
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Rationale: The incidence of SARS-CoV-2 infection and the impact of corticosteroid treatment in patients with symptomatic airway disease has been a concern. We examined airway expression of SARS-CoV-2 receptors following allergen challenge and steroid intervention in asthmatic patients. Method(s): From steroid-naive mild allergic asthmatic (AA n=23) we collected endobronchial biopsies pre and 24hr post allergen inhalation challenge (AIC). In a subset of AA with allergic rhinitis (AR n=8) we collected inferior nasal turbinate biopsies pre and 24hr post-nasal allergen challenges (NAC) after placebo treatment or after 21 days of 22 mg BID triamcinolone nasal spray. FEV1 and PNIF expressed as % fall from baseline quantified the early (ER, 0-2h) and late (LR, 3-7h) airway responses post challenge. Epithelium and laminae propria were immunostained for ACE2 and TMPRSS2 and expressed as # cells/mm2. Result(s): AIC reduced FEV1 (31% ER, 19% LR) and the number of bronchial cells immunopositive for ACE2, TMPRSS2 and double positive for ACE2/TMPRSS2 (P=0.0002, P=0.04, P=0.02, respectively). The PNIF reduction by NAC (69% ER, 49% LR) was attenuated by triamcinolone (31% ER, 18% LR), but without changes in ACE2 or TMPRSS2 in nasal tissue after NAC or steroid treatment (all P>0.05). In the nasal tissue, significantly fewer cells expressed ACE2 compared to bronchi (P=0.007). Conclusion(s): ACE2 and TMPRSS2 expression in bronchial tissue is reduced in the T2 microenvironment post allergen challenge, however it is unknown if this protects lower airways from SARS-CoV-2 infection. Low expression of ACE2 and TMPRSS2 in nasal tissue made it difficult to determine the effects of NAC or steroid.
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The COVID-19 pandemic is a worldwide problem. The clinical spectrum of SARS-CoV-2 infection varies from asymptomatic or paucity-symptomatic forms to conditions such as pneumonia, acute respiratory distress syndrome and multiple organ failure. Objective was to describe a clinical case of SARS-CoV-2 infection in the patient with sarcoidosis and cardiovascular pathology developing acute respiratory syndrome and lung edema. Material and methods. There were analyzed accompanying medical documentation (outpatient chart, medical history), clinical and morphological histology data (description of macro- and micro-preparations) using hematoxylin and eosin staining. Results. Lung histological examination revealed signs of diffuse alveolar damage such as hyaline membranes lining and following the contours of the alveolar walls. Areas of necrosis and desquamation of the alveolar epithelium in the form of scattered cells or layers, areas of hemorrhages and hemosiderophages are detected in the alveolar walls. In the lumen of the alveoli, a sloughed epithelium with a hemorrhagic component, few multinucleated cells, macrophages, protein masses, and accumulated edematous fluid were determined. Pulmonary vessels are moderately full-blooded, surrounded by perivascular infiltrates. Signs of lung sarcoidosis were revealed. Histological examination found epithelioid cell granulomas consisting of mononuclear phagocytes and lymphocytes, without signs of necrosis. Granulomas with a proliferative component and hemorrhage sites were determined. Giant cells with cytoplasmic inclusions were detected — asteroid corpuscles and Schauman corpuscles. Non-caseous granulomas consisting of clusters of epithelioid histiocytes and giant Langhans cells surrounded by lymphocytes were detected in the lymph nodes of the lung roots. Hamazaki–Wesenberg corpuscles inside giant cells were found in the zones of peripheral sinuses of lymph nodes. In the lumen of the bronchi, there was found fully exfoliated epithelium, mucus. Granulomas are mainly observed subendothelially on the mucous membrane, without caseous necrosis. Histological examination of the cardiovascular system revealed fragmentation of some cardiomyocytes, cardiomyocyte focal hypertrophy along with moderate interstitial edema, erythrocyte sludge. Zones of small focal sclerosis were determined. The vessels of the microcirculatory bed are anemic, with hypertrophy of the walls in small arteries and arterioles. Virological examination of the sectional material in the lungs revealed SARS-CoV-2 RNA. Conclusion. Based on the data of medical documentation and the results of a post-mortem examination, it follows that the cause of death of the patient R.A., 50 years old, was a new coronavirus infection COVID-19 that resulted in bilateral total viral pneumonia. Сo-morbidity with competing diseases such as lung sarcoidosis and cardiovascular diseases aggravated the disease course, led to the development of early ARDS and affected the lethal outcome. © 2022 Saint Petersburg Pasteur Institute. All rights reserved.
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Background: A typical patient complaint in patients with a history of Covid-19 infection is dyspnoea with or without exercise. One of the causes of shortness of breath could be bronchial obstruction due to bronchial hyperreactivity (BHR), a characteristic asthma prerequisite. Therefore, we tried to find out if one of the consequences of Covid-19 could be the development of BHR. The objective: of the study was to find out whether Covid-19 infection causes bronchial hyperreactivity. Materials: The study was conducted between 25.01.2021 and 07.10.2021, when the Covid-19 delta variant predominated. During this period, 447 bronchial challenge tests with methacholine (BCT) were performed in patients who complained of dyspnoea. The 96 patients studied had a history of Covid-19 infection. We also identified factors (gender, pneumonia, BMI, smoking, allergy, lung function parameters) that may be associated with positive BPT in patients with a history of Covid-19 infection. Result(s): The study revealed that 43% of patients with a history of Covid-19 had a positive BCT, but uninfected patients had a significantly higher number (56%) of positive BCT (p = 0.02). Factors associated with a positive BCT in patients with a history of Covid-19 infection included allergy (n = 78, p = 0.002) and FEV1/FVC ratio below 0.7 (n = 55, p = 0.04). Other factors were not associated with a positive BCT in patients with a history of Covid-19. Conclusion(s): The cause of dyspnoea in patients with a history of Covid-19 is not associated with bronchial hyperreactivity. Bronchial hyperresponsiveness in infected people is likely to be caused by an underlying allergy, which may be exacerbated by the disease.
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Background: Severe covid-19 disease has led to many death. Some post mortem study has investigated the cause. The autopsy revealed occurrence of DVT and postmortem lung CT showed reticular infiltration, dense consolidation, while histologically showed diffuse alveolar damage. Through FOB conducted In mechanically ventilated COVID-19 patient, airway obstruction was seen due to hypersecretion and mucus plug in the bronchi. Inhaled budesonide in COVID-19 patient has showed faster recovery and the research focus in the administration of ICS is limited. Objective(s): This study aims to investigate the benefit of LABACS treatment in LONG COVID-19 patients in Pringsewu Indonesia. Method(s): The method of this research was cross sectional. Total subjects included in this study were 276 patients. 168 subjects were treated with Beclomethasone-Formoterol (61%), 49 subjects were treated with FluticasoneSalmeterol (17%), 59 subjects were treated with Budesonide-Formoterol (22%) during 3 months period. We assessed symptoms improvement, mMRC score and chest X-ray imaging. Spirometry of 34 subjects were measured. Result(s): There was a significant correlation between the incidence of lung obstruction and persistent symptom of long covid patients according to spirometry measurement (P value = 0.000). There was a significant correlation between symptoms improvement, mMRC score and chest X-ray imaging after treatment with Beclomethasoneformoterol (p-value = <0.05) Fluticasone-Salmeterol (P value = <0.05) Budesonide-Formoterol (P value = 0.002, P value = 0.007, P value = 0.049). Conclusion(s): LABACS treatment improved lung function and clinically benefit in managing obstruction due to COVID-19.
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Aim. The study is aimed at investigating the incidence of lung cancer (LC) at the population level with the analysis of key analytical indicators in the context of coronavirus. Materials and methods. We have used data from the IARC, statistical reference books of P.A. Herzen Moscow Research Oncological Institute, data from N.N. Petrov NMRC of Oncol¬ogy, and the database of the Population Cancer Registry of St. Petersburg (DB PCR St. Petersburg) for the current study. Results. The study has established a steady decline in the incidence of LC among the male population in the worldwide, in Russia and in St. Petersburg. Among the female population, a significant increase in the incidence has been revealed. On the basis of the database PCR St. Petersburg, the patterns of age-sex indicators of the incidence of LC have been analyzed. It has been established that the largest number of cases is registered in the age group of patients over 70 years old, here the largest losses due to coronavirus have also been identified. An increase in the proportion of early stages of the disease has been noted. The accounting reliability index decreased from 2000 to 2019, with the exception of 2017. Comparison of yearly lethality in the DB PCR St. Petersburg showed a signifi¬cant difference in the data. The detailed localization structure of LC has been studied, where it has been found out that the first place is occupied by cancer of the upper lobe, bronchi or lung, although over 19 years of observation, a decrease in the proportion of this localization in the total volume of C34 has been noted. The proportion of patients with LC without histological verification has decreased. The influence of the smoking factor on the increased risk of LC has been studied.
ABSTRACT
The COVID-19 pandemic is a worldwide problem. The clinical spectrum of SARS-CoV-2 infection varies from asymptomatic or paucity-symptomatic forms to conditions such as pneumonia, acute respiratory distress syndrome and multiple organ failure. Objective was to describe a clinical case of SARS-CoV-2 infection in the patient with sarcoidosis and cardiovascular pathology developing acute respiratory syndrome and lung edema. Material and methods. There were analyzed accompanying medical documentation (outpatient chart, medical history), clinical and morphological histology data (description of macro- and micro-preparations) using hematoxylin and eosin staining. Results. Lung histological examination revealed signs of diffuse alveolar damage such as hyaline membranes lining and following the contours of the alveolar walls. Areas of necrosis and desquamation of the alveolar epithelium in the form of scattered cells or layers, areas of hemorrhages and hemosiderophages are detected in the alveolar walls. In the lumen of the alveoli, a sloughed epithelium with a hemorrhagic component, few multinucleated cells, macrophages, protein masses, and accumulated edematous fluid were determined. Pulmonary vessels are moderately full-blooded, surrounded by perivascular infiltrates. Signs of lung sarcoidosis were revealed. Histological examination found epithelioid cell granulomas consisting of mononuclear phagocytes and lymphocytes, without signs of necrosis. Granulomas with a proliferative component and hemorrhage sites were determined. Giant cells with cytoplasmic inclusions were detected — asteroid corpuscles and Schauman corpuscles. Non-caseous granulomas consisting of clusters of epithelioid histiocytes and giant Langhans cells surrounded by lymphocytes were detected in the lymph nodes of the lung roots. Hamazaki–Wesenberg corpuscles inside giant cells were found in the zones of peripheral sinuses of lymph nodes. In the lumen of the bronchi, there was found fully exfoliated epithelium, mucus. Granulomas are mainly observed subendothelially on the mucous membrane, without caseous necrosis. Histological examination of the cardiovascular system revealed fragmentation of some cardiomyocytes, cardiomyocyte focal hypertrophy along with moderate interstitial edema, erythrocyte sludge. Zones of small focal sclerosis were determined. The vessels of the microcirculatory bed are anemic, with hypertrophy of the walls in small arteries and arterioles. Virological examination of the sectional material in the lungs revealed SARS-CoV-2 RNA. Conclusion. Based on the data of medical documentation and the results of a post-mortem examination, it follows that the cause of death of the patient R.A., 50 years old, was a new coronavirus infection COVID-19 that resulted in bilateral total viral pneumonia. Сo-morbidity with competing diseases such as lung sarcoidosis and cardiovascular diseases aggravated the disease course, led to the development of early ARDS and affected the lethal outcome.
ABSTRACT
Background: Isolated tracheobronchial mucormycosis (ITBM) is an uncommonly reported entity. Herein, we report a case of ITBM following coronavirus disease 2019 (COVID-19) and perform a systematic review of the literature. Case description and systematic review: A 45-year-old gentleman with poorly controlled diabetes mellitus presented with cough, streaky haemoptysis, and hoarseness of voice 2 weeks after mild COVID-19 illness. Computed tomography and flexible bronchoscopy suggested the presence of a tracheal mass, which was spontaneously expectorated. Histopathological examination of the mass confirmed invasive ITBM. The patient had complete clinical and radiological resolution with glycaemic control, posaconazole, and inhaled amphotericin B (8 weeks). Our systematic review of the literature identified 25 additional cases of isolated airway invasive mucormycosis. The median age of the 26 subjects (58.3% men) was 46 years. Diabetes mellitus (79.2%) was the most common risk factor. Uncommon conditions such as anastomosis site mucormycosis (in two lung transplant recipients), post-viral illness (post-COVID-19 [n = 3], and influenza [n = 1]), and post-intubation mucormycosis (n = 1) were noted in a few. Three patients died before treatment initiation. Systemic antifungals were used in most patients (commonly amphotericin B). Inhalation (5/26;19.2%) or bronchoscopic instillation (1/26;3.8%) of amphotericin B and surgery (6/26;23.1%) were performed in some patients. The case-fatality rate was 50%, primarily attributed to massive haemoptysis. Conclusion: Isolated tracheobronchial mucormycosis is a rare disease. Bronchoscopy helps in early diagnosis. Management with antifungals and control of risk factors is required since surgery may not be feasible. © 2022 Wiley-VCH GmbH.