Diagnosis and treatment of a patient with pneumoconiosis and tuberculosis complicated with severe COVID-19

The removal and defense mechanisms of the respiratory system of patients with pneumoconiosis are impaired. Once patients with pneumoconiosis and other underlying lung diseases are infected with novel coronavirus, they are likely to progress to severe cases with COVID-19, a tough condition with a high mortality and poor prognosis. Herein we presented a case of pneumoconiosis and tuberculosis complicated with severe COVID-19. Active administration of anti-viral, anti-infection, phlegm-removing, anti-asthmatic, and high-flow oxygen therapies did not alleviate the patient's acute respiratory distress syndrome symptoms. Then tracheal intubation, ventilator assisted breathing, and lung protective ventilation were given but did not effectively treat the patient's respiratory failure. Finally, the patient died clinically despite use of extracorporeal membrane oxygenation (ECMO).Copyright © 2021, Shanghai Municipal Center for Disease Control and Prevention. All rights reserved.

Cerebellar syndrome as a complication of COVID-19 disease

COVID-19 disease is caused by the new coronavirus SARS-CoV-2. The disease first appeared in China in 2019 and quickly spread throughout the world. It primarily affects the respiratory tract, manifested by fever, cough and the devel-opment of dyspnoea, but the symptoms and complications can affect any organ system. Neurological symptoms include headaches, muscle and joint pain, taste and smell disorders. Complications include inflammatory diseases of the central nervous system, ataxia, peripheral nerve and muscle diseases, worsening of extra-pyramidal diseases, and neuropsychiatric disorders. This paper presents a case report of a 62-year-old man with cere bellar syndrome, ataxia, intentional tremor and hypermetria when dealing with COVID-19 disease.Copyright © 2021 Neuroendocrinology Letters.

Our evolving prescribing practice: inhaled medication prescription changes over 5 years at the West Midlands Adult Cystic Fibrosis Centre

Background: Highly effective modulator therapy (HEMT) is now available for ∼90% of adults with CF with Kaftrio® licenced for use in the UK from August 2020. Despite continuation of routine CF treatments in randomised controlled trials, real-world evidence suggests a reduction in prescribed inhaled medication for people with CF on HEMT.1 Alongside the introduction of Kaftrio®, additional factors have impacted upon our inhaled medication prescribing practice including the COVID-19 pandemic and the introduction of CFHealthHub, which allows us to monitor nebulised treatment adherence. Objective: To examine how and to what extent our inhaled medication prescribing practice has changed over the past 5 years. Method: A retrospective audit of our prescribed inhaled medication databases from 2016, 2019 and 2021. Results: See table 1. Table 1. Number of CF patients prescribed inhaled mucolytics and long term inhaled therapy for Pa. (Table Presented) Conclusion: Despite an increasing rate of Pa infection,we have observed an overall reduction in prescribing of inhaled antibiotics and mucolytics. HEMTs, particularly Kaftrio®, have improved the health of our patients and, despite our caution, many have requested a reduction of inhaled therapy in line with their improved well-being. Assessment of adherence via CFHealthHub has often led to rationalisation of inhaled treatments in order to support improved adherence. During the COVID-19 pandemic, drug response assessments, the gateway to accessing a change in inhaled medication, have frequently been delayed as we have had to redesign our service in response to changing circumstances.

A rare case of pulmonary mucormycosis apparent as difficult to extract mucus-plug per bronchoscopy

Background: Pulmonary mucormycosis, a rare pulmonary fungal disease, is difficult to diagnose and lacks effective treatment. Diabetes mellitus, systemic corticosteroid therapy, neutropenia, hematologic malignancies, stem cell transplant, Covid-19 infection and immunocompromised state are the predisposing situations for mucormycosis. There are no reliable serological, PCR-based, or skin tests. Bronchoscopy guided biopsy proved to be effective for early diagnosis. Case Study: A 47 years old female patient, known Diabetic, presented with complains of Dry Cough and fever. Patient had past history of COVID-19 pneumonia. HRCT showed mucus plugging with collapse of left lower lobe. During Bronchoscopy, mucus plug was difficult to extract despite using mucolytics;then biopsy was taken which turned out to be MUCORMYCOSIS. Patient was treated with injectable Amphotericin B for 4-weeks and then Tablet Posaconazole. Patient was improved on follow up. Discussion: Pulmonary Mucormycosis is a rapidly progressive infection that occurs after inhalation of spores. Most patients are presented with fever, cough and hemoptysis. After Covid-19 pandemic, cases of mucormycosis are on rise. Pulmonary Mucormycosis is rare entity than Rhino-orbito-cerebral mucormycosis. Biopsy remains mainstay for diagnosis. Conclusion: Pulmonary Mucormycosis being rare lifethreatening opportunistic infection;early diagnosis and treatment is necessary for better outcome and survival.