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Introduction: Spontaneous pneumothorax is a rare complication of coronavirus disease 2019 (COVID-19), primarily reported in adults. Pediatric cases with bilateral pneumothorax are much less reported. Case Presentation: We presented the case of a five-year-old previously healthy boy who developed persistent fever, abdominal pain, generalized maculopapular rash, and dyspnea before admission. His chest computed tomography (CT) showed a viral involvement pattern of pneumonia suggestive of COVID-19. Subsequently, he was confirmed with multisystem inflammatory syndrome in children (MIS-C). While he responded well to the therapies, on the fifth day of admission, he developed respiratory distress again. A chest roentgenogram showed bilateral spontaneous pneumothorax. Bilateral chest tubes were inserted, and his condition improved sig-nificantly after five days of admission to the intensive care unit. Two weeks later, he was discharged in good condition. Conclusion(s): Children with MIS-C associated with COVID-19 may develop primary spontaneous pneumothorax. Owing to the clinical picture overlapping with MIS-C associated with COVID-19, the timely diagnosis of pneumothorax may be challenging in such patients.Copyright © 2022, Author(s).
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BACKGROUND: According to the results of the ESSE-RF study, the frequency of obesity in the population reached 29.7%. Obesity is one of the main risk factors for the development of cardiovascular diseases. Features of the course of COVID-19 in patients with obesity is a very urgent problem. AIM: The aim of the study was a comparative investigation of clinical and laboratory-instrumental parameters in AH patients with or without obesity who had COVID-19 associated pneumonia, to identify the role of obesity as a potential predictor of post-COVID cardiovascular complications 3 months after discharge from the hospital. MATERIALS AND METHODS: Materials and methods. The study included 174 patients with COVID-19-associated pneumonia. Group 1 included 78 patients with AH without obesity, group 2 - 96 patients with AH and obesity. All patients were tested with a blood sample at the time of admission and 3 months after discharge from the hospital. We assessed parameters of general blood test, biochemistry, hemostasis, inflammation biomarkers - concentration of C-reactive protein (CRP), highly sensitive CRP (hs-CRP), homocysteine, IL-6, etc. All patients initially underwent computed tomography of the chest. In both groups, 24-hour blood pressure monitoring was performed using BPLaB device, according to the standard protocol;echocardiography using an expert class ultrasound diagnostic system Vivid S70. The study is registered with the Clinical Trials.gov database Identifier: NCT04501822. RESULT(S): Results. The biomarker that significantly distinguished the both groups of patients, as well as subgroups according to the degree of obesity was the concentration of maxCRP and hs-CRP, which was significantly higher in group 2. In addition, the registered maximum values of MPO, NT-proBNP, IL-1,6, TNA-alpha and NRL parameters in group 2 of patients with 2-3 degrees of obesity, may indicate the highest probability of developing delayed adverse cardiovascular complications in this group of patients. Mean systolic blood pressure, variability of systolic and diastolic blood pressure, and heart rate at night were significantly higher in AH patients with obesity. Numerous correlations of obesity with laboratory and instrumental parameters have been registered, which may indicate an increased likelihood of delayed unwanted cardiovascular complications in this particular group of patients. Multiple regression showed that obesity is an independent predictor of an increase in LDH, hs-CRP and right atrium. CONCLUSION(S): Dynamic control of the studied parameters in patients with AH and OB registered an increased concentration of CRP at the initial stage and 3 months after treatment, with a general trend towards a decrease in the increased initial structural parameters of ECHO CG. The logistic regression method showed that the presence of OB in patients with AH is an independent factor causing increased levels of immune inflammation (CRP), a marker of tissue destruction (LDH), and load on the right atrium.Copyright © Endocrinology Research Centre, 2022.
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Background: At our hospital, people with COVID-19 (coronavirus disease 2019) had a high rate of pulmonary barotrauma. Therefore, the current study looked at barotrauma in COVID-19 patients getting invasive and non-invasive positive pressure ventilation to assess its prevalence, clinical results, and features. Methodology: Our retrospective cohort study comprised of adult COVID-19 pneumonia patients who visited our tertiary care hospital between April 2020 and September 2021 and developed barotrauma. Result(s): Sixty-eight patients were included in this study. Subcutaneous emphysema was the most frequent type of barotrauma, reported at 67.6%;pneumomediastinum, reported at 61.8%;pneumothorax, reported at 47.1%. The most frequent device associated with barotrauma was CPAP (51.5%). Among the 68 patients, 27.9% were discharged without supplemental oxygen, while 4.4% were discharged on oxygen. 76.5% of the patients expired because of COVID pneumonia and its complications. In addition, 38.2% of the patients required invasive mechanical breathing, and 77.9% of the patients were admitted to the ICU. Conclusion(s): Barotrauma in COVID-19 can pose a serious risk factor leading to mortality. Also, using CPAP was linked to a higher risk of barotrauma.Copyright © 2021 Muslim OT et al.
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BACKGROUND: While the type and the number of treatments for Coronavirus Disease 2019 (COVID-19) have substantially evolved since the start of the pandemic a significant number of hospitalized patients continue to succumb. This requires ongoing research in the development and improvement of early risk stratification tools. METHOD(S): We developed a prognostic score using epidemiological, clinical, laboratory, and treatment variables collected on admission in 130 adult COVID-19 patients followed until in-hospital death (N.=38) or discharge (N.=92). Potential variables were selected via multivariable logistic regression modelling conducted using a logistic regression univariate analysis to create a combined index. RESULT(S): Age, Charlson Comorbidity Index, P/F ratio, prothrombin time, C-reactive protein and troponin were the selected variables. AUROC indicated that the model had an excellent AUC value (0.971, 95% CI 0.926 to 0.993) with 100% sensitivity and 83% specificity for in-hospital mortality. The Hosmer-Lemeshow calibration test yielded non-significant P values (chi2=1.79, P=0.99) indicates good calibration. CONCLUSION(S): This newly developed combined index could be useful to predict mortality of hospitalized COVID-19 patients on admission.Copyright © 2022 EDIZIONI MINERVA MEDICA.
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Background: According to data from the World Health Organization updated to September 30, 2022, SARS-CoV-2 is a viral disease, that infected six hundred million people and claimed six and a half million victims in all over the world. Some authors describe the alteration of blood parameters in pediatric age following COVID-19 such as: anomalies of the leukocyte formula, CK-MB and LDH enzymes, C reactive protein (PCR) and procalcitonin (PCT). Based on these studies we wanted to focus on two cardiac biomarkers: type B natriuretic peptide (BNP) and high sensitivity cardiac troponin (cTnT-hs). In order to suggest a strategy aimed at preventing the possible occurrence of cardiovascular complications in children we monitored them in patients with specific anti-SARS-CoV-2 immunoglobulins (IgG). Method(s): From November 2020 to December 2021, 53 children with positive IgG to SARS-CoV-2 by immunochromatographic method were tested for BNP and cTnT-hs. Samples collected in potassium EDTA tubes were tested for BNP by a fluorescence immunoassay. cTnT-hs was determined with an electrochemiluminescence sandwich test, which employs two specific monoclonal antibodies directed against cardiac troponin. The BNP cutoff is 100 pg/mL for patients aged 1 to 14 years, while that of cTnT-hs is 14 ng/L. All patients were monitored from hospitalization to discharge. Result(s): At least one of the two biomarkers resulted pathologic in 35 (66%) patients, while 18 (34%) were negative. The 35 pathologic cases were distributed as follows: 12 were simultaneously positive for cTnT-hs and BNP;13 were only positive for BNP, and 10 only positive for cTnT-hs. Sick children had a BNP mean value of 634 pg/mL at hospitalization, and of 94 pg/mL at discharge. For cTnT-hs, the initial mean value was 46 ng/l and the final was 17 ng/L. Twelve children with both altered values were monitored for a longer time, as they returned negative more slowly. Repeated dosages of the two analytes from hospitalization to discharge, showed a constant decrease over the time. After about ten days from the first dosage, both parameters returned to values near to the relative cutoffs. Conclusion(s): Measuring BNP and cTnt-hs can be useful for screening and monitoring pediatric patients positive for anti-SARSCoV-2 IgG.Copyright © 2022 EDIZIONI MINERVA MEDICA.
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Objectives: The prognostic nutrition index (PNI), as an indicator of inflammation and immunity, is calculated by "serum albumin (g/L)+5xlymphocyte count (109/L)."A lower PNI could determine a poor prognosis. Recent publications showed that lower albumin levels are correlated with an increased mortality to the coronavirus disease 2019 (COVID-19). This research aimed to determine the PNIs predictive value of mortality at intensive care units (ICUs) in patients with COVID-19. Method(s): In this retrospective one-centered research, 391 patients with COVID-19 followed up at ICU included in the study. Demographic data, comorbidities, thorax computed tomography, polymerase chain reaction results, length of stay, and laboratory results were collected and statistically analyzed. Result(s): Data from 306 patients were analyzed. Older age (>65-yearsold), hypertension, and cardiac diseases were found to be risk factors. Higher Acute Physiologic Assessment and Chronic Health Evaluation II scores were associated with increased mortality. Increased procalcitonin, creatinine, aspartate aminotransferases, lactate dehydrogenases, white blood cell count, D-dimer, fibrinogen, ferritin, brain-natriuretic peptide, and calcitonin-related peptide were related to mortality. Lower PNI scores were noted as indicators of mortality and prognosis. Conclusion(s): Lower PNI scores indicate increased mortality and the length of stay in patients in the ICU. PNI scores could be useful in predicting the prognosis of patients with COVID-19.Copyright © 2022 by The Cardiovascular Thoracic Anaesthesia and Intensive Care.
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Aim. To establish risk factors for heart failure (HF) in patients with coronavirus disease 2019 (COVID-19). Material and methods. Medical records of 151 patients treated in an infectious disease hospital from November 3, 2020 to February 2, 2021 with a confirmed diagnosis of COVID-19 were retrospectively selected. The collection of clinical, history and laboratory data were carried out by analyzing electronic medical records. We analyzed information on age, sex, body mass index, smoking, and comorbidities. Following laboratory studies were analyzed: complete blood count, biochemical blood tests, coagulation profile, acute phase proteins (C-reactive protein (CRP), ferritin, lactate dehydrogenase (LDH)), procalcitonin. The diagnosis of HF was confirmed by clinical performance, echocardiography, and elevated levels of the N-terminal pro-brain natriuretic peptide (NT-proBNP). The risk of HF was taken as the endpoint of the study. Results. The studied sample of patients was divided into two groups depending on HF: the 1st group included 46 patients with HF, the 2nd group - 105 patients without HF. The median age was 66,2 (50-92) years (women, 91 (60,3%)). Laboratory indicators, such as the levels of CRP, LDH, procalcitonin, creatinine, bilirubin, differed significantly from each other, and the median values were higher in patients with HF. The neutrophil-to-lymphocyte ratio (NLR) showed significant intergroup differences: in the group of patients with HF, the median was 4,97% vs 3,62% (p=0,011) in the group of patients without HF. There were following most significant predictors increasing the HF risk: age >=66 years (odds ratio, 8,038, p<0,001), procalcitonin level, which increases the HF risk in patients by 3,8 times (p<0,001), NLR >=4,11% (p=0,010), thrombocytopenia <=220x109/l (p=0,010), history of chronic kidney disease (CKD) (p=0,018). Conclusion. The following predictors of HF were established: age >=66 years, procalcitonin >=0,09 ng/ml, NLR >=4,11%, thrombocytopenia <=220x109/l, history of CKD, LDH >=685 U/l and creatinine >=102 micromol/l, international normalized ratio >=1,19, QTc interval >=407,5 ms, bilirubin <=10,7 micromol/l. It is worth noting that the best accuracy values are demonstrated by the Random Forest algorithm (88,5% on the validation set), but the mathematical model of the neural network turned out to be the most sensitive (90,0% on the validation set).Copyright © 2023, Silicea-Poligraf. All rights reserved.
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Objective: To invetigate the influencing factors and clinical significance of liver function damage (LFD) in patients diagnosed with Corona Virus Disease 2019 (COVID-19). Method(s): The retrospective case-control study was conducted. The clinicopathological data of 51 patients with COVID-19 who were admitted to the Sino-French New City Branch of Tongji Hospital Affiliated to Huazhong University of Science and Technology by the 5th group assisting team from the First Hospital of Jilin University from February 9th to 27th in 2020 were collected. There were 27 males and 24 females, aged from 36 to 86 years, with an average age of 68 years. The treatment modality was according to the diagnostic and therapeutic guideline for COVID-19 (Trial 6th edition) issued by National Health Commission. Observation indicators: (1) clinical data of patients;(2) analysis of liver function index and treatment of LFD;(3) analysis of influencing factors for LFD. Measurement data with normal distribution were represented as Mean+/-SD, and measurement data with skewed distribution were described as M (range). Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. The Logistic regression method was used for univariate analysis. Result(s): (1) Clinical data of patients: of the 51 patients, 21 were classified as ordinary type of COVID-19, 19 as severe type and 11 as critical type. In terms of medical history, 31 patients suffered from more than or equal to one kind of chronic disease, 20 had no history of chronic disease. Thirteen patients had the drinking history and 38 had no drinking history. Seven patients were hepatitis positive and 44 were hepatitis negative. Five patients had septic shock at admission, 5 had systemic inflammatory response syndrome (SIRS), and 41 had neither shock nor SIRS. The body mass index (BMI), time from onset to admission, temperature, heart rate, respiratory rate of the 51 patients were (24+/-3)kg/m2, (13+/-5)days, 36.5 (range, 36.0-38.1 ), 82 times/minutes (range, 50-133 times/minutes), 20 times/minutes (range, 12-40 times/minutes). The white blood cell count, level of creatinine, and level of b-type natriuretic peptide within 24 hours after admission were 6.3x109/L [range, (2.2-21.7)x109/L], 75 mumol/L (range, 44-342 mumol/L), 214 ng/L (range, 5-32 407 ng/L). (2) Analysis of liver function index and treatment of LFD: the level of alanine aminotransferase (ALT), aspartate aminotransferase (AST), glutamyl transpeptidase (GGT), alkaline phosphatase (ALP), direct bilirubin (DBil), indirect bilirubin (IBil), activated partial thromboplastin time (APTT) and prothrombin time (PT) were 31 U/L (range, 7-421 U/L), 29 U/L (range, 15-783 U/L), 36 U/L (range, 13-936 U/L), 76 U/L (range, 41-321 U/L), 4.9 mumol/L (range, 2.6-14.3 mumol/L), 5.8 mumol/L (range, 2.6-23.9 mumol/L), 37.2 s (range, 30.9-77.1 s), 13.9 s (range, 12.5-26.7 s), respectively. The percentages of cases with abnormal ALT, AST, GGT, ALP, DBil, IBil, APTT and PT were 47.1%(24/51), 47.1%(24/51), 35.3%(18/51), 13.7%(7/51), 7.8%(4/51), 2.0%(1/51), 21.6%(11/51), and 19.6%(10/51), respectively. Of the 51 patients, LFD was detected in 10 patients classified as ordinary type, in 9 patients as severe type, and in 10 as critical type, respectively. In the 51 patients, 1 of 22 patients with normal liver function developed respiratory failure and received mechanical ventilation within 24 hours after admission, while 9 of 29 patients with abnormal liver function developed respiratory failure and received mechanical ventilation, showing a significant difference between the two groups (chi2=5.57, P<0.05). (3) Analysis of influencing factors for LFD. Results of univariate analysis showed that clinical classification of COVID-19 as critical type was a related factor for LFD of patients (odds ratio=10.000, 95% confidence interval: 1.050-95.231, P<0.05). Conclusion(s): COVID-19 patients with LFD are more susceptible to develop respiratory failure. The clinical classification of COVID-19 as critic l type is a related factor for LFD of patients.Copyright © 2020 by the Chinese Medical Association.
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Coronavirus disease 2019 (COVID-19) has been reported to cause cardiovascular complications such as myocardial injury, thromboembolic events, arrhythmia, and heart failure. Multiple mechanisms-some overlapping, notably the role of inflammation and IL-6-potentially underlie these complications. The reported cardiac injury may be a result of direct viral invasion of cardiomyocytes with consequent unopposed effects of angiotensin II, increased metabolic demand, immune activation, or microvascular dysfunction. Thromboembolic events have been widely reported in both the venous and arterial systems that have attracted intense interest in the underlying mechanisms. These could potentially be due to endothelial dysfunction secondary to direct viral invasion or inflammation. Additionally, thromboembolic events may also be a consequence of an attempt by the immune system to contain the infection through immunothrombosis and neutrophil extracellular traps. Cardiac arrhythmias have also been reported with a wide range of implicated contributory factors, ranging from direct viral myocardial injury, as well as other factors, including at-risk individuals with underlying inherited arrhythmia syndromes. Heart failure may also occur as a progression from cardiac injury, precipitation secondary to the initiation or withdrawal of certain drugs, or the accumulation of des-Arg9-bradykinin (DABK) with excessive induction of pro-inflammatory G protein coupled receptor B1 (BK1). The presenting cardiovascular symptoms include chest pain, dyspnoea, and palpitations. There is currently intense interest in vaccine-induced thrombosis and in the treatment of Long COVID since many patients who have survived COVID-19 describe persisting health problems. This review will summarise the proposed physiological mechanisms of COVID-19-associated cardiovascular complications. Copyright © 2022, Anka Publishers. All rights reserved.
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Periorbital swelling is a clinical presentation with a broad differential and potentially deleterious consequence. Causes range from benign, including allergic reaction, to vision-and life-threatening, including orbital cellulitis and orbital infarction. The recent climate of SARS-CoV-2 has further complicated this differential, as the virus poses broad clinical presentations with new manifestations reported frequently. Rapid identification of the underlying etiology is crucial, as treatment approaches diverge greatly. Here, we report the case of an African American adolescent male with a history of homozygous sickle cell anemia presenting to an inner city hospital with bilateral periorbital swelling amid the coronavirus pandemic. Differentials including orbital cellulitis, COVID-MIS-C, orbital inflammatory syndrome, Hoagland sign, and orbital infarction secondary to sickle cell crisis are contrasted. We contrast our case with 12 case reports of orbital infarction in the setting of sickle cell crisis within the past 10 years, highlighting how these presentations, along with commonly reported findings of orbital infarction, compare with our patient. Copyright © 2022 Tehran University of Medical Sciences.