ABSTRACT
BACKGROUND: One-third of pregnant women will experience worsening asthma requiring emergency hospitalization. However, no report comprehensively discussed the management of asthma attacks in pregnant women in impoverished settings. We attempt to illuminate what general practitioners can do to stabilize and improve the outcome of severe acute asthma exacerbations in primary care with resource limitations. CASE REPORT: A nulliparous 29-year-old woman in her 21st week of pregnancy presented severe acute asthma exacerbation in moderate persistent asthma with uncontrolled asthma status along with gestational hypertension, uncompensated metabolic acidosis with a high anion gap, anemia, respiratory infection, and asymptomatic bacteriuria, all of which influenced her exacerbations. This patient was admitted to our resource-limited subdistrict hospital in Indonesia during the COVID-19 pandemic for optimal stabilization. Crystalloid infusions, oxygen supplementation, nebulized beta-agonist with anticholinergic agents, inhaled corticosteroids, intravenous methylprednisolone, broad-spectrum antibiotics, subcutaneous terbutaline, mucolytics, magnesium sulphate, oral antihypertensives, and continuous positive airway pressure were used to treat her life-threatening asthma. After she was stabilized, we referred the patient to a higher-level hospital with more advanced pulmonary management under the supervision of a multidisciplinary team to anticipate the worst scenario of pregnancy termination. CONCLUSION(S): Limitations in primary care, including the lack of sophisticated intensive care units and laboratory panels, may complicate challenges in managing severe acute asthma exacerbation during pregnancy. To enhance maternal-fetal outcomes, all multidisciplinary team members should be well-informed about key asthma management strategies during pregnancy using evidence-based guidelines regarding the drug, rationale, and safety profile.Copyright © 2023 Muhammad Habiburrahman, Triya Damayanti, Mohammad Adya Firmansha Dilmy, Hariyono Winarto.
ABSTRACT
Objective To analyze the clinical features of patients with coronavirus disease 2019COVID-19in Wuhan, and we provide reference for further prevention and control of the disease. Methods We collected the clinical data of patients with COVID-19 in Dongxihu Shelter Hospital of Wuhan from February 7 to March 6, 2020. The main symptoms, blood test results, lung CT results, and nucleic acid negative conversion were analyzed. Results A total of 654 patients were included, 17526.76%were mild, and 47973.24%were general. There were 344 males (52.60%), and 310 females (47.40%). The patients were with a mean age of49.36+/-10.30years, and 97 patients (14.83%) with a history of hypertension, 51 patients (7.80%) had a history of diabetes. The main clinical symptoms were fever with 547(83.64%) patients, 186 cases (28.44%) had chills, 15 cases (2.29%) had shiver, 342(52.29%) had fatigue symptoms, 413(63.15%) had cough, 137(20.95%) had chest tightness, and 109(16.67%) had diarrhea during the course of the disease. Blood routine tests of 395 patients, the white blood cell count (WBC) was (4.12+/-1.46)x109/L. The total white blood cell count was normal in 378 cases(95.70%), increased in 7(1.77%), and decreased in 10(2.53%). The lymphocyte percentage was (23.10+/-10.02)%, lymphocyte1.06+/-0.37x109/L. The percentage and count of lymphocyte were low. All the 654 cases were examined by CT, 175 cases (26.76%) showed normal lung CT, 422 cases (64.52%) showed patchy or segmental ground-glass opacity, and 57 cases (8.72%) showed multilobar consolidation, ground-glass shadow coexisted with consolidation or streak shadow. The interval between positive nucleic acid test before admission and negative test after admission was as short as 5 days and as long as 24 days, the average was (12.35+/-3.73) days. Conclusion Fever, coughing, and fatigue are the main symptoms in patients with COVID-19. The typical lung CT findings can be used as the basis for clinical diagnosis and disease evaluation. Patients with mild and common type had better prognosis.Copyright © 2021 Editorial Office of Chinese Journal of Schistosomiasis Control. All rights reserved.
ABSTRACT
Employees of medical organizations are one of the risk groups for infection with a new coronavirus infection (COVID-19), including with the development of severe clinical forms. The aim of the study was to analyze the clinical manifestations of a new coronavirus infection in medical workers with the determination of laboratory markers for the development of severe COVID-19. Material and methods. The study included 186 medical workers who had COVID-19 in 2020. In 67 people (observation group), the disease occurred in the form of pneumonia, in 119 people (comparison group) - acute respiratory infection caused by SARS-CoV-2. In the acute period of the disease, a laboratory examination was carried out: a general clinical blood test, CD-typing of lymphocyte subpopulations, assessment of biochemical parameters, determination of parameters of the hemostasis system and cytokine levels. Using the binary logistic regression method, we have built multifactor models. To determine the threshold values of the indicators, we used ROC analysis. Statistical processing of materials was carried out using Microsoft Office 2016 and IBM SPSS Statistics (version 26). The differences were considered statistically significant at p<0.05. Results and discussion. The most frequent clinical manifestations of COVID-19 were: weakness, fever, myalgia, arthralgia, difficulty in nasal breathing, serous-mucous discharge from the nose, sore throat, cough, feeling of "tightness" in the chest, shortness of breath, headache, pain in the eyeballs, dizziness, anosmia, ageusia and dyspeptic manifestations in the form of diarrhea, nausea or vomiting. Markers associated with the development of severe pneumonia associated with COVID-19 have been identified. Threshold values of laboratory parameters for predicting the severe course of COVID-19 were determined: the number of platelets (less than 239x109/l), lymphocytes (less than 1.955x109/l), cytotoxic T-lymphocytes (less than 0.455x109/l), T-helper cells (less than 0.855x109/l), NK-cells (less than 0.205x109/l), ESR (more than 11.5 mm/h), LDH (more than 196 units/l), total protein (less than 71.55 g/l), D-dimer (more than 0.325 mcg/ml), CRP (more than 4.17 mg/l), IL-6 (more than 3.63 pg/l). Conclusion. The data obtained make it possible to predict the possibility of developing a severe variant of the COVID-19 course.Copyright © 2022 Infectious Diseases: News, Opinions, Training. All rights reserved.
ABSTRACT
Background: With the introduction of new cystic fibrosis transmembrane conductance regulator (CFTR) modulator therapy (elexacaftor/tezacaftor/ ivacaftor), peoplewith CF experiencing severe lung disease can experience significant improvements in clinical symptoms. Method(s): This single-center institutional review board-approved retrospective chart review identified patients with advanced lung disease who met criteria for a compassionate use or expanded access program because of high risk of death or transplant need within 2 years. Clinical data collection for all patients began at baseline, 2 to 4 weeks after therapy initiation, and continued every 3 months for 2 years. Datawere collected on demographic characteristics, clinic progress notes, clinical labs, forced expiratory volume in 1 minute (FEV1),weight, body mass index, respiratory colonization, and hospitalizations after drug initiation. Patients also completed sinus and chest computed tomography (CT) to track clinical changes. Result(s): Eighteen people with CF (aged 15-49, 56% male) from a large midwestern CF center who initiated drug therapy between July and September 2019 in an inpatient hospital or clinic setting were identified. Clinical markers (Table 1) indicated that modulator therapy was well tolerated and not discontinued by any participant;safety lab values did not indicate medical concern or discontinuation. There were 90 admissions for the group in the 2 years before therapy and 17 admissions during the 2 years after, although seven of the posttherapy admissions were for nonrespiratory indications. Monitoring results indicated the safety of modulator therapy because there were no adverse clinical occurrences or laboratory events, and all patients presented with universal stabilization. There have been no deaths and no transplants. Unlike lumacaftor/ivacaftor, therewere no problems with chest tightness or any difficulty with troublesome increases in expectoration burden or choking during initiation of therapy. Most had significant reduction in or loss of spontaneous cough and sputum production. The impact on microbial colonization is unclear, because even in this severe group, inability to produce sputum on command led to considerable missing data in follow-up, leaving colonization status at follow-up unclear. Conclusion(s): This study focused on people with CF who qualified for modulator therapy based on advanced lung disease. Initiation of modulator therapy was deemed safe and resulted in objective positive changes in nutrition;cough;FEV1);and subjective reports of clinical status, level of activity, and reduction in burden of treatment. No evidence was found of difficulty managing the increased expectoration during initial therapy. Limitations were noted in missing data during the COVID-19 pandemic, small sample size, and delayed follow-up for drug monitoring.(Table Presented) Clinical indicators before and after modulator therapy *Completed post-drug initiation (earlier than 12 months), **24 months before and after therapy initiationCopyright © 2022, European Cystic Fibrosis Society. All rights reserved
ABSTRACT
Case report The Food and Drug Administration (FDA) provided emergency use authorization (EUA) for the Pfizer/BioNTech (BNT162b2) COVID-19 vaccine in December 2020. Implementation of COVID-19 mass vaccination efforts were implemented soon after. However, following the FDAs EUA, COVID-19 vaccine allergic reactions were reported. These findings led to concerns about vaccine hesitancy and the possible avoidance of future doses. The Texas Children's Hospital COVID-19 Vaccine Hypersensitivity Clinic was established in December 2020 to help address these concerns and to evaluate both pediatric and adult patients with immediate allergic reactions to the COVID-19 vaccines, as well as evaluating patients with polyethylene glycol (PEG) or polysorbate (PS) allergy. We present the case of an 18yo female who experienced anaphylaxis following her second Pfizer mRNA COVID-19 vaccine. The patient developed symptoms of generalized hives, chest tightness and dyspnea 17 minutes after receiving the Pfizer mRNA COVID-19 vaccine. She was treated in the emergency department with IM prednisone and PO diphenhydramine. Of note, in 2018, she had a similar response to her HPV9 vaccine (containing PS 80). Tryptase wasn't obtained at the time of her COVID-19 or HPV9 vaccine reactions, but she did have a baseline that was normal around 4ng/mL. Skin testing was performed to the following: PEG 3350, PS 20 and PS 80. Skin testing (skin prick and intradermal) were negative for PS20 and PS80. PEG 3350 skin prick was negative but methylprednisone acetate (PEG 3350) was positive at the 4mg/mL intradermal testing strength. She underwent a Miralax (PEG 3350) oral challenge. Within 20 minutes of ingesting 0.17grams PEG 3350 she developed an itchy macular rash on neck and upper chest, nausea and a globus throat sensation. She was treated with PO cetirizine and symptoms improved. Tryptase level was obtained 30 min after the start of her reaction and was 4ng/mL. Given the patient's reaction, she was advised to avoid PEG containing products and will return to undergo a graded-step challenge to the Janssen (J&J) COVID-19 vaccine. The prevalence of COVID-19 mRNA vaccine anaphylaxis and PEG allergies is rare. However, allergy referral is warranted in cases of immediate reactions to the COVID-19 vaccine or history of PEG or polysorbate allergies.
ABSTRACT
Since the introduction of COVID-19 vaccine, various adverse events have been reported including injection site pain, fatigue, headaches, and myocarditis. Cranial neuropathies and optic neuritis, have been also rarely reported, however, the significance of these autoimmune manifestations after the administration of COVID-19 vaccine remain controversial. In this report we present a case of myocarditis and bilateral optic neuritis that occurred in a young healthy male patient after the administration of first dose of mRNA-1273 vaccine (Moderna).Copyright © 2022 The Author(s)
ABSTRACT
Background: Since the outbreak of COVID-19, vaccination has been considered as an important measure against it. Side effects have always been an inseparable component of vaccination, which in this study, Sinopharm vaccine, its side effects and the differences of their manifestation amongst men and women have been investigated. Objective(s): This study aimed to compare the side effects of the Sinopharm vaccine among men and women working in some medical centers in Tehran, Iran. Method(s): This cross-sectional descriptive-analytical study on 890 healthcare workers of 7 medical centers in Tehran within 2 months, from late June to late August 2021. The samples were selected by the complete enumeration method, and the required data were collected using a questionnaire. Only those who received the Sinopharm vaccine at least 10 days before the study were included. Result(s): Of 890 participants, 22.96% and 77.30% were women and men, respectively, and 65.8% of women and 78.1% of men were in the age range of 20-29 years. It was revealed that 74.75% of women and 26.16% of men had at least one side effect. The incidence of at least one side effect was significantly higher in women than in men (P<0.001). It was also found that 12 side effects were significantly higher in women than in men. Most men and women had side effects within the first 24 h after vaccination. There was no significant difference in taking therapeutic measures to reduce or minimize the post-vaccination complications between men and women;however, 9.4% of men and 27.2% of women reported a decline in their ability to perform daily activities as they were unable to do their everyday tasks the day after vaccination which was significantly different between the two groups (P<0.001). Conclusion(s): The results showed that the occurrence rate of side effects after receiving the Sinopharm vaccine was significantly higher in women than in men. Moreover, women were significantly less able to perform daily routines than men.Copyright © 2022, Author(s).
ABSTRACT
Limited evidence exists regarding adverse effects on cardiovascular and pulmonary function in adults affected by covid 19 infection. We describe the cardiopulmonary functions in a cohort of national level athletes with recent covid infection. 42 healthy athletes were evaluated after at least a 10-day period of quarantine after mild covid infection.44% females [n=19] and 56% males [n=23]. The age range was 15 - 38 years. The commonest persistent symptoms were difficulty in breathing (4.8%), cough (7%) and chest tightness (4.8%). PCFS (post covid functional score) was 0 in 93%. The CXR and 6-minute walk test were normal in all. The spirometry was normal in 83% (n=35). The mean FEV1 were 2.68l and 3.75l;mean FVC were 3.09l and 4.6l in females and males respectively. The mid expiratory flow rate (FEF 25-75) was less than the predicted lower limit of normal in 52.4%(mean=2.8L). Cardiac abnormalities were detected in 7%;moderate interventricular septal dyssynchrony, global hypokinesia with mild LV dysfunction and mild pulmonary hypertension. 13 players with persistent difficulty in breathing and chest tightness who had otherwise normal spirometry and echo were referred for CPET. Only 6 players had CPET due to limited resources: evidence of deconditioning (n=3) and cardiac limitation with poor O2 pulse (n=3). 78% (n=33) had normal cardiopulmonary assessment and were referred for graduated return to practice. Abnormalities were identified in 21% (n=9). Mid expiratory flow was reduced in 53% indicating possible effect on peripheral airways post covid. Evaluation of athletes and guidelines on return to practice after covid infection are an important and timely need.
ABSTRACT
Objective: To explore the value of low-dose CT in pregnancy with COVID-19. Method(s): A retrospective analysis was performed on the clinical characteristics, laboratory tests, and chest CT findings of 12 pregnant women with COVID-19 diagnosed by nucleic acid testing in the Renmin Hospital of Wuhan University from January 20, 2020 to February 16, 2020. Two radiologists blinded to the reconstruction algorithm independently scored subjective image quality on a 5-point Likert scale. Image quality score >= 3 was acceptable in clinics. The CT radiation doses were recorded, including CT volume dose index (CTDIvol), dose length product (DLP), and effective radiation dose (E). Two radiologists observed the distribution, shape, density, and other characteristics of lung lesions, and they also decided whether hilar, mediastinal lymphadenopathy, and pleural changed. Result(s): A total of 12 pregnant women with COVID-19, 8 had cough, 4 had fever, 2 had chest tightness, and 1 had dyspnea and diarrhea each. The CT image quality score of all patients was 3-4, with an average of 3.46, which fully met the clinical diagnosis requirements. The CTDIvol value was 1.13-4.31 mGy, with an average of 3.02 mGy. The DLP value was 34.48-75.29 mGy*cm, with an average of 55.48 mGy*cm. The Evalue was 0.48-1.05 mSv, with an average of 0.78 mSv. In all cases, chest CT examination showed abnormal manifestations after clinical symptoms, including unilateral lung lesions in 5 cases and bilateral lung lesions in 7 cases, 1 case of ground-glass opacity, 1 case of solidification, 7 cases of ground-glass and consolidation, 1 case of strip opacity, ground-glass, and consolidation and strip cable shadow coexisted in 2 cases. Conclusion(s): The application of low-dose CT scan in pregnant women with COVID-19 is completely feasible. CT mainly manifested as bilateral lung patchy and flaky ground-glass opacity with consolidation. Active and effective treatment can help recover and improve prognosis.Copyright © 2020 by the Chinese Medical Association.
ABSTRACT
Background: Currently, the present world is facing a new deadly challenge from a pandemic disease called COVID-19, which is caused by a coronavirus named SARS-CoV-2. To date, no drug or vaccine can treat COVID-19 completely, but some drugs have been used primarily, and they are in different stages of clinical trials. This review article discussed and compared those drugs which are running ahead in COVID-19 treatments. Method(s): We have explored PUBMED, SCOPUS, WEB OF SCIENCE, as well as press releases of WHO, NIH and FDA for articles related to COVID-19 and reviewed them. Result(s): Drugs like favipiravir, remdesivir, lopinavir/ritonavir, hydroxychloroquine, azithromycin, ivermectin, corticosteroids and interferons have been found effective to some extent, and partially approved by FDA and WHO to treat COVID-19 at different levels. However, some of these drugs have been disapproved later, although clinical trials are going on. In parallel, plasma therapy has been found fruitful to some extent too, and a number of vaccine trials are going on. Conclusion(s): This review article discussed the epidemiologic and mechanistic characteristics of SARS-CoV-2, and how drugs could act on this virus with the comparative discussion on progress and drawbacks of major drugs used till date, which might be beneficial for choosing therapies against COVID-19 in different countries.Copyright © 2022 Bentham Science Publishers.
ABSTRACT
Background: Although vaccines have been launched, COVID-19 has not been effectively curbed, and the number of infections is increasing. Compared with western medicine, Traditional Chinese Medicine has made some achievements in the treatment of COVID-19, which should be paid attention to and play a greater role. As a classical Chinese medicine prescription for treating pestilence, Lianhuaqingwen (LHQW) has gone to many countries with the Chinese medical team to participate in the local fight against the epidemic, which has been widely recognized. Method(s): We searched MEDLINE, EMBASE, AMED, Chchrane Central Register of Controlled Trials (CENTRAL), PubMed, Web of Science, Chinese National Knowledge Infrastructure (CNKI), VIP Information Database (VIP), Chinese Biomedical Literature Database (CBM), and Wanfang Database from inception up to November 24, 2021, which formed the basis for evidence used to formulate recommendations. Sixteen randomized controlled trials (RCTs) involving 1896 patients were enrolled. LHQW is a traditional Chinese medicine compound preparation, which contains 13 traditional Chinese medicine (TCM) components. Two dosage formulations of LHQW were included: granule and capsule. The most commonly used dosage formulation was granule (15/17, 88.24%), followed by capsule (2/17, 11.76%). Conclusion(s): This systematic review and Meta analysis suggested that, in the treatment of COVID-19, LHQW Capsule (Granule) could not only significantly improve the fever symptoms, shorten the fever time, but also reduce the cough and fatigue symptoms, improve the clinical efficiency, improve the lung CT, significantly reduce the number of patients with mild to severe diseases, and have certain anti-inflammatory effect. And there is no server adverse events which support the safety of LHQW Capsule (Granule) for the treatment of COVID-19. As a classic formula of TCM, LHQW Capsule (Granule) could be used as potential candidates for COVID-19 in this battle.Copyright © 2022
ABSTRACT
Aim: In this study, we aimed to assess the COVID-19 clinical manifestations after recovery from illness among healthcare professionals. Material(s) and Method(s): After ethical approval, a structured questionnaire has been distributed among healthcare professionals who were willing to participate in the study. The questionnaire contained forty questions, which were divided into four sections. Result(s): A total of 126 participants completely filled the questionnaire, including 65 (51.6%) females and 61(48.4%) males. Fatigability is the most common (38.1%) post-COVID clinical manifestation in healthcare professionals. Other common post-COVID clinical manifestations are numbness in the face/ arms/ legs (34.2%), cough (23%), muscle pain (20.6%) and anxiety/depression (20.6%) in order of frequency. Discussion(s): The presence of fatigue, anxiety, cough and hair fall was observed in women healthcare workers up to 2 months even after recovery from mild to moderate disease.Copyright © 2022, Derman Medical Publishing. All rights reserved.
ABSTRACT
Background: Novel coronavirus disease (SARS-COV-2 infection or COVID-19) is a respiratory tract infection that has been linked to severe acute respiratory syndrome transmitted particularly through touching and respiration. The purpose of this study is to understand the epidemiological characteristics of COVID-19 cases in a typical tourist-related outbreak and explore the possible route for its transmission. Method(s): All data and epidemiological survey reports of COVID-19 cases in the outbreak were reported by provincial and urban (county) Centers for Disease Control and Prevention and Health Commissions nationwide from October 16th to November 5th, 2021. The epidemiological survey reports included information on gender, age, source of infection (imported from other provinces or locally acquired), daily life track and itinerary, date of symptom onset, and date of diagnosis. The data were analyzed using descriptive statistical methods, one-way analysis of variance, independent t-test, and Chi-square tests. Histograms and percentage stacked area plots were used to describe the epidemiological characteristics of the outbreaks. Result(s): The COVID-19 outbreak associated with the tourist groups has involved 551 COVID-19 cases, with a median age of 44 years (interquartile range: 30-59 years), gradually spreading from the northwestern region to the national level across 15 provinces of China. One-fifth of the cases (16.0%) had traveled to Ejin Banner, resulting in 68 second-generation cases. We estimated an outbreak on 11 flights and 19 trains, accounting for a total of 27 confirmed cases. In addition, 42 clusters of outbreak cases were also reported to occur, 21 (50.0%) in households and 10 (23.81%) in restaurants. About 106 confirmed cases were related to the gatherings in restaurants. The median incubation period for this COVID-19 outbreak was 7 days (inter-quartile range: 5-10 days). Conclusion(s): The survey results indicated that this COVID-19 outbreak originated in Ejin Banner and was spread by tourist groups, which was a typical infection outbreak promoted by travel. Our results further confirmed that travel needs to be more strictly weighed in pandemics like COVID-19, and people need to pay more attention to the prevention against infectious diseases, particularly when traveling in a tourist group.Copyright © 2022 Zheng et al.
ABSTRACT
Bronchial asthma is one of the most important diseases of our time in terms of its medical and social conse-quences. The view of asthma and its treatment is changing considerably. There are several very effective drugs available, the correct administration of which can have a highly beneficial effect on the disease. Asthma is a common chronic disease that affects people of all ages. It is a condition in which the airways narrow and swell and produce extra mucus. This can make it hard to breathe. Asthma can be triggered by allergies, exercise, cold air, emotional stress, or other factors. People with asthma may have shortness of breath, chest tightness, wheezing, and coughing. Asthma can be mild, moderate, or severe. It is a serious condition that can be deadly. There is no cure for asthma, but it can be controlled with medication. This review will discuss our perception of bronchial asthma based on theoretical characteristics such as its triggers, risk factors, symptoms, diagnostic tests, and genetic predisposition. This review will discuss our perception of bronchial asthma based on theoretical characteristics such as its triggers, risk factors, symptoms, diagnostic tests, and genetic predisposition. Copyright © 2022, Termedia Publishing House Ltd.. All rights reserved.
ABSTRACT
INTRODUCTION: Granulomatosis with polyangiitis (GPA) is a rare rheumatologic disease in pediatric patients but with a similar presentation and organ involvement as an adult patient. We present a case of a patient with pulmonary hemorrhage due to GPA who was managed without extracorporeal life support. DESCRIPTION: A 14 year-old female with no medical history presented with migratory polyarthritis, sore throat, chest tightness, fatigue, and positive rheumatoid factor. Found to be hypoxic on presentation. Her respiratory failure progressed, requiring intubation and inhaled nitric oxide, with minimal improvement. A chest CT showed nonspecific bilateral multifocal, patchy airspace opacification. Her C-ANCA and proteinase 3 antibody were positive, making GPA the most likely diagnosis for which she was started on methylprednisolone and rituximab. Her hypoxemia continued to worsen despite maximal mechanical ventilator support and neuromuscular blockade infusion. She had bloody secretions from her endotracheal tube, concerning for pulmonary hemorrhage, despite high positive end-expiratory pressure. A chest radiograph at that time was consistent with worsening bilateral infiltrates. Echocardiogram showed normal biventricular function, pulmonary hypertension, and a 1.8 cm by 1.5 cm thrombus at the cavoatrial junction. A multidisciplinary team determined that the location of the clot precluded placement of ECMO cannulas without risking clot mobilization. Plasmapheresis was emergently initiated followed by further rituximab and cyclophosphamide. Her respiratory status stabilized after being placed in the prone position. She was ultimately discharged home after a prolonged period of intubation and hospitalization, on a steroid taper, oral anticoagulation for her cavoatrial thrombus, and maintenance rituximab therapy. DISCUSSION: This case highlights a rare case of GPA with multiorgan involvement in a pediatric patient resulting in refractory hypoxemia treated with aggressive rheumatologic therapy and proning. There is limited evidence for the efficacy of plasmapheresis in patients with GPA, although this patient may have benefited from it since she was not safe for extracorporeal life support. Furthermore, as highlighted through the COVID-19 pandemic, proning proved crucial in managing her severe hypoxemia.
ABSTRACT
Case Diagnosis: 23-year-old female with past medical history significant for morbid obesity and prior oral contraceptive use diagnosed with right sigmoid and transverse sinus thrombosis resulting in visual impairment nineteen days after testing positive for COVID-19 infection. Case Description or Program Description: Patient initially presented to the emergency department for evaluation of worsening dyspnea and chest tightness eight days after diagnosis of COVID-19 infection. At that time a diagnosis of right lower lobe pulmonary embolism was established. She was discharged home with warfarin for anticoagulation. Prior to discharge, the patient did not have visual disturbance or focal neurological deficits. Five days after discharge and nineteen days after COVID-19 diagnosis patient returned to the emergency department for evaluation of new onset blurry vision and tinnitus. Setting(s): Tertiary care hospital Assessment/Results: Physical examination revealed bilateral mydriasis, abducens palsy, and papilledema. Patient with a therapeutic INR at time of admission. Full neurological workup was performed including MRI/MRV of brain which revealed extensive venous sinus thrombosis involving the right transverse and sigmoid sinuses and significant bilateral optic nerve head edema. Patient underwent left optic nerve sheath fenestration followed by thrombectomy of right sigmoid sinus with angioplasty. Serial lumbar punctures were performed for cerebrospinal fluid pressure reduction. Despite treatment the patient was left with permanent vision loss and was admitted to an inpatient rehabilitation facility (IRF) for three weeks prior to discharge home. Discussion (relevance): The inflammatory response related to COVID-19 infection places patients in a hypercoagulable state and those who have pre-existing risk factors for venous thrombosis should be monitored closely for complications related to acute thrombosis. Conclusion(s): This case brings awareness to possible neurological deficits seen following the acute phase of a COVID-19 infection. It is important for physiatrists to be mindful of these complications as they may present following acute phase of infection within an IRF to assist with early detection and improved outcomes.
ABSTRACT
Introduction: Nephrogenic diabetes insipidus (NDI) is caused by reduced renal response to vasopressin. NDI affects up to 40% of patients on lithium. We present a case of partial NDI secondary to lithium use. Case Description: A 66 year old male with bipolar disorder on lithium presented with shortness of breath, chest tightness and cough. On exam he was cachectic, lethargic, tremulous with decreased skin turgor and dry mucous membranes found to have COVID-19 with initial unremarkable blood work. Received treatment for COVID and subsequently developed worsening encephalopathy, follow up blood work revealed elevated serum sodium of 168 mg/dl, with urine osmolality of 382 and lithium level was elevated at 1.6 mEq/L. He received adequate IV fluid hydration with hypotonic fluids and free water. Serum sodium remained elevated with polyuria. Follow up labs showed urine osmolality decrease to 94 mosml/L therefore nephrogenic diabetes insipidus was suspected. A desmopressin stimulation test was performed and hourly urine osmolality was obtained [Table 1] confirming the diagnosis of nephrogenic diabetes insipidus with a partial response to desmopressin compatible with lithium-induced partial diabetes insipidus. Treatment was started initially with chlorthalidone with inappropriate response, then dose increased to 100mg daily with further addition of amiloride 10mg twice daily with subsequent response and decrease of sodium level from 167 to 147 mEq/L. Discussion(s): Lithium-induced NDI is explained by downregulation of aquaporin 2 channel expression in the principal cells due to accumulation of toxic concentrations of lithium and reduction of the kidneys' ability to preserve water in response to vasopressin. NDI usually presents with polyuria, polydipsia, severe dehydration, and electrolyte imbalance. A less than 50% increase in urine osmolality following desmopressin administration proves NDI. Treatment options include high doses of desmopressin, low sodium diet, thiazide diuretics, amiloride, and NSAIDs. (Table Presented).
ABSTRACT
Aim: To evaluate the potential use of ivermectin with standard therapy among mild to moderate covid-19 illness. Methods: This is a single-centered, prospective observational, randomized, parallel group (1:1 ratio), standard versus controlled ivermectin study recruited 210 confirmed COVID-19 positive patients who were admitted in COVID treatment center of Dr Ruth Kum Pafu Civil hospital Karachi, Pakistan from 1st November 2020 to 30th May 2021. Data were analyzed using SPSS version Results: Total of 210 patients were enrolled in the study and aged matched patients were divided in two groups 105 patients received ivermectin 6 mg twice a day for five days along with standard therapy while remaining 105 patients received standard therapy as per local and international guidelines. Male were 140(66.7%) and female 70(33.3%);age ranges between 26 to 77 years and majority 140( 66.7%) were more than 50 years of age. Fever, dry cough and dyspnea were the major symptoms seen;112(53.3%) patients had DM as a comorbid illness . Total of 21(20%) of 105 patients of ivermectin group had negative PCR for COVID 19 on day seven while the other group had positive covid test in all of 105 patients . On day 10 total of 49 more patients from ivermectin group found COVID negative along with 21 previously negative had second PCR was found negative in this way total of 70( 66.7%) of ivermectin group had negative PCR for COVID 19 while 21(20%) patients from non ivermectin got negative PCR for COVID 19 on day 10 . Conclusion: Use of ivermectin with standard therapy clear the virus earlier than standard therapy in mild to moderate COVID-19 infected patients admitted in COVID treatment center of Dr Ruth Kum Pafu Civil Hospital Karachi.
ABSTRACT
SESSION TITLE: Unique Uses of Pulmonary Function Tests SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Breathlessness, fatigue, and exertional intolerance can persist for several months in up to 50% people after recovery from SARS-CoV-2 infection. The physiological underpinning(s) of the reduced exercise capacity associated with post-acute sequelae of SARS-CoV-2 infection (PASC) requires further investigation. We characterized pulmonary function relative to normative values and determined the relationship between measures of pulmonary function and peak pulmonary O2 uptake (V̇O2peak) in people with PASC. METHODS: Pulmonary function [including lung diffusing capacity for carbon monoxide (DLCO), and maximal inspiratory pressure (MIP)] and the cardiopulmonary responses to maximal incremental treadmill exercise (CPET) were assessed in ten adults (five females;age 41 ± 11 y;BMI 21 ± 5 kg/m2) with PASC. Time from initial SARS-CoV-2 infection to study enrollment was 6 ± 4 months. At the time of study, participants (n) reported persistent fatigue (9), breathlessness (9), headache (6), chest tightness (4), cough (2), muscle pain (4), palpitations (4), dizziness (5), and nausea (1). RESULTS: There was inter-individual heterogeneity in total lung capacity (TLC;range 68 to 117% predicted), forced vital capacity (FVC;range 73 to 123% predicted), forced expiratory volume in 1 s (FEV1;92 to 109% predicted), and maximal voluntary ventilation (MVV;range 75 to 122% predicted);however, no group mean measure of spirometric function or lung volume was different relative to normative values. Conversely, group mean DLCO (21 ± 9 vs. 27 ± 5 ml/min/mmHg, P = 0.017) and MIP (75 ± 43 vs. 102 ± 18 cmH2O, P = 0.049) were reduced relative to normative values. During the CPET, peak RER and heart rate were 1.16 ± 0.12 and 174 ± 16 beats/min (97 ± 8% predicted), respectively. V̇O2peak was 27.3 ± 6.8 ml/kg/min (90 ± 20% predicted, range 49-122% predicted, V̇O2peak <85% predicted in 4 of 10 participants), and there was no clear evidence of ventilatory or gas exchange impairment to exercise (breathing reserve 49 ± 31 L;minimum SpO2 96 ± 2%;V̇E/V̇CO2 nadir 27 ± 2;∆PETCO2 7.4 ± 2.8 mmHg). There was no relationship between percent predicted V̇O2peak and percent predicted TLC (r2 = 0.061, P = 0.492), FVC (r2 = 0.196, P = 0.200), FEV1 (r2 = 0.173, P = 0.232), MVV (r2 = 0.037, P = 0.595), DLCO (r2 = 0.007, P = 0.836), and MIP (r2 = 0.007, P = 0.820). CONCLUSIONS: Impaired pulmonary function and decreased exercise capacity are present in some but not all people with PASC who report persistent fatigue and breathlessness. Presently, we find no relationship between pulmonary function and V̇O2peak in people with PASC. CLINICAL IMPLICATIONS: Some but not all people with PASC have normal exercise capacity within ~2-12 months after recovery from SARS-CoV-2 infection. CPET may be considered when evaluating the presence and mechanistic underpinning(s) of impaired exercise capacity in such individuals. DISCLOSURES: No relevant relationships by Natalie Bonvie-Hill No relevant relationships by Igor Fernandes No relevant relationships by Augustine Lee No relevant relationships by Amy Lockwood No relevant relationships by Bala Munipalli No relevant relationships by Tathagat Narula No relevant relationships by Brian Shapiro Competitive research grant recipient relationship with Gilead Sciences Inc. Please note: 1 year Added 03/30/2022 by Bryan Taylor, value=Grant/Research Support
ABSTRACT
SESSION TITLE: Post-COVID-19 Outcomes SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Short- and long-term postacute sequelae of SARS-CoV-2 infection (PASC) includes a constellation of clinical symptoms that persist following recovery from COVID-19. The precise pathophysiology of PASC is unknown but likely multifactorial, and intervention strategies to combat PASC are lacking. Our aim was to investigate whether homebased exercise training (HBExT) enhances recovery of and/or improves exercise capacity, pulmonary function, symptoms, and overall health-related quality of life (HRQoL) in people with PASC. METHODS: Pulmonary function [including lung diffusing capacity for carbon monoxide (DLCO) and maximal inspiratory pressure (MIP)] and the cardiopulmonary responses to maximal incremental treadmill exercise (CPET) were assessed before and after 8-weeks of HBExT in three adults (2 males, 48 and 40 years old;1 female, 37 years old) with PASC. Symptoms (via standard questionnaire) and HRQoL (via EQ-5D-3L questionnaire) were also assessed before and after HBExT. HBExT consisted of 3-to-4 aerobic (duration 25-40 min, intensity 60-80% heart rate reserve) and 2-to-3 resistance (7 exercises, 8-12 repetitions, 2-3 sets) sessions per week, and was prescribed and tracked in each participant using a mobile application (Connected mHealth) integrated with a heart rate monitor (Polar H7). RESULTS: Time from initial SARS-CoV-2 infection to enrollment in the study (in months) and adherence rate to HBExT was 8 and 66%, 4 and 71%, and 3 and 100% for the three participants. Before to after HBExT, there was a 13 ± 7% increase in exercise time (12.6 ± 2.0 vs. 14.1 ± 1.3 min) and a 14 ± 9% increase in peak O2 uptake (V̇O2peak;27.6 ± 2.8 vs. 31.5 ± 2.5 ml/kg/min) during the CPET. Neither the heart rate nor the pulmonary gas exchange (V̇E/V̇CO2, PETCO2, SpO2) response to CPET was different before vs. after HBExT. Conversely, peak-exercise breathing reserve was lower (13 ± 16 vs. 30 ± 11 L/min) and O2pulse was greater (16.3 ± 1.2 vs. 13.8 ± 0.2 ml/beat) following HBExT. No remarkable changes in pulmonary function or DLCO were noted after HBExT;however, there was a 16 ± 12% increase in MIP from before to after HBExT (74 ± 21 vs. 85 ± 18 cmH2O). After HBExT, a fraction of the participants reported resolution of persistent fatigue (n = 1), breathlessness (n = 2), chest tightness (n = 1), palpitations (n = 1), and dizziness (n = 2), and overall health score (via EQ-5D-3L) was increased (42 ± 34 vs. 81 ± 6;100 = ‘best health imaginable’). CONCLUSIONS: Prescribed exercise training may increase exercise capacity and inspiratory muscle strength, alleviate persistent symptoms of fatigue and breathlessness, and improve overall HRQoL in people with PASC. CLINICAL IMPLICATIONS: Exercise-based therapy may improve functional capacity and partially alleviate persistent symptoms in people with PASC, strengthening calls for cardiopulmonary rehabilitation as a potential therapeutic intervention in such individuals. DISCLOSURES: No relevant relationships by Natalie Bonvie-Hill No relevant relationships by Isabel Cortopassi No relevant relationships by Igor Fernandes No relevant relationships by Scott Helgeson No relevant relationships by Elizabeth Johnson No relevant relationships by Augustine Lee No relevant relationships by Amy Lockwood No relevant relationships by Patricia Mergo No relevant relationships by Bala Munipalli No relevant relationships by Tathagat Narula No relevant relationships by Brian Shapiro Competitive research grant recipient relationship with Gilead Sciences Inc. Please note: 1 year Added 03/30/2022 by Bryan Taylor, value=Grant/Research Support