What you need to know about: organising pneumonia.

Organising pneumonia was first described in the context of respiratory infection, but over time has become established as its own entity. It is an area of diagnostic complexity because of the non-specific presenting symptoms and signs that can often mimic other respiratory pathology. Multidisciplinary review to correlate clinical, radiological and histopathological features can aid timely and effective diagnosis. This article discusses the epidemiology, aetiology, clinical, radiological and histopathological features, investigation and management of organising pneumonia.

Successful outcome using Tocilizumab in COVID-19 pneumonia with respiratory failure on a ward level.

We describe the case of a 40-year-old man of Asian ethnicity, who presented with one week history of shortness of breath, productive cough, intermittent hemoptysis, temperature, and systemic symptoms. He had a positive nasopharyngeal swab for SARS-CoV-2, standard COVID panel admission blood tests, a chest X-ray and a CT Pulmonary Angiogram. Significant bilateral infiltrates and no pulmonary embolism were identified. The patient received standard COVID-19 treatment. After 36 hours, he deteriorated requiring initiation of non-invasive ventilatory (NIV) support. In the context of worsening clinical status, the patient received Tocilizumab as a single dose with good clinical response. Early Tocilizumab intervention in appropriately selected patients should improve the outcome and length of hospitalization in COVID-19 pneumonia. It can be used as an intensive therapy unit sparing agent allowing management of critically ill patients on a ward-based level. This may further contribute to prevention of intensive therapy unit related complications and increased mortality.

A Short Course of Prednisolone in Patients With Moderate Covid 19 Respiratory Failure- Stop the Progression a Case Series.

Covid 19 positive patients requiring oxygen therapy to maintain saturations above 90% were given a trial of oral prednisolone between 15 and 30 mg until they were weaned to room air maintaining saturations >95%. This treatment resulted in the rapid resolution of worsening respiratory function of 4 Covid 19 positive patients within the High Dependency unit in a tertiary medical center. The cases are from the "first wave" in Trinidad, March 2020. The signs and symptoms of respiratory failure resolved after 72 hours of prednisolone treatment and none of these patients were escalated to non-invasive or invasive respiratory support. The patients were kept for a further 48 hours after the steroids were discontinued to monitor for relapse of symptoms, all patients were discharged home after quarantine. The initiation of a prednisolone steroid trial must be considered in Covid 19 positive patients needing supplementary oxygen therapy or developing worsening shortness of breath. Early Covid respiratory failure responds to a low dose for a short duration and prevents escalation to non-invasive/invasive respiratory support.

The effect of patient ethnicity on the accuracy of peripheral pulse oximetry in patients with COVID-19 pneumonitis: a single-centre, retrospective analysis.

Pulse oximetry is used widely to titrate oxygen therapy and for triage in patients who are critically ill. However, there are concerns regarding the accuracy of pulse oximetry in patients with COVID-19 pneumonitis and in patients who have a greater degree of skin pigmentation. We aimed to determine the impact of patient ethnicity on the accuracy of peripheral pulse oximetry in patients who were critically ill with COVID-19 pneumonitis by conducting a retrospective observational study comparing paired measurements of arterial oxygen saturation measured by co-oximetry on arterial blood gas analysis (SaO2 ) and the corresponding peripheral oxygenation saturation measured by pulse oximetry (Sp O2 ). Bias was calculated as the mean difference between SaO2 and Sp O2 measurements and limits of agreement were calculated as bias ±1.96 SD. Data from 194 patients (135 White ethnic origin, 34 Asian ethnic origin, 19 Black ethnic origin and 6 other ethnic origin) were analysed consisting of 6216 paired SaO2 and Sp O2 measurements. Bias (limits of agreement) between SaO2 and Sp O2 measurements was 0.05% (-2.21-2.30). Patient ethnicity did not alter this to a clinically significant degree: 0.28% (1.79-2.35), -0.33% (-2.47-2.35) and -0.75% (-3.47-1.97) for patients of White, Asian and Black ethnic origin, respectively. In patients with COVID-19 pneumonitis, Sp O2 measurements showed a level of agreement with SaO2 values that was in line with previous work, and this was not affected by patient ethnicity.

COVID-19 pneumonia treated with ultra-low doses of radiotherapy (ULTRA-COVID study): a single institution report of two cases.

INTRODUCTION: Since the outbreak of coronavirus disease 2019 (COVID-19) pandemic, healthcare systems have focused their efforts into finding a treatment to avoid the fatal outcomes of severe acute respiratory syndrome due to coronavirus­2 (SARS-CoV-2). Benefits and risks of systemic treatments remain unclear, with multiple clinical trials still ongoing. Radiotherapy could play a role in reducing the inflammatory response in the lungs and relieve life-threatening symptoms. METHODS: We designed a prospective study of Ultra-Low Doses of Therapy with Radiation Applied to COVID-19 (ULTRA-COVID) for patients who suffer pneumonia, are not candidates for invasive mechanical ventilation and show no improvement with medical therapy. RESULTS: We present the preliminary results of two patients diagnosed with COVID-19 pneumonia treated with ULTRA-COVID. After one radiotherapy session, significant clinical response and a good radiological response was observed in both cases, resulting in both patients being discharged from hospital in less than 2 weeks after radiation treatment. CONCLUSION: Preliminary clinical and radiological results suggest a potential benefit of treating COVID-19 pneumonia with ULTRA-COVID. ClinicalTrials.gov Identifier: NCT04394182.