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Background/Aims We report the features of chronic chilblain-like digital lesions newly presenting since the start of the covid-19 pandemic. Comparison with primary perniosis and acrocyanosis, reveals a unique phenotype which appears to be a long-covid phenomenon. Methods The case records of 26 patients with new onset persistent chilblain-like lesions presenting to the Rheumatology service of St George's University Hospital, London between Autumn 2020 and Spring 2022 were reviewed. Demographic and clinical features, serology, imaging, treatment response and outcome up to Summer 2022 were collated retrospectively. Results Chilblain-like lesions first occurred between September and March;2019/ 2020 6 cases, 2020/2021 18 cases and 2021/2022 2 cases. Mean age 35.4 (17-60) years, 88% female, 85% white, all non-smokers. Median body mass index (BMI) 20.2, range 17.0 - 33.2. BMI underweight (<18.5) in 27%. All cases reported new red-purple-blue colour changes of the fingers, some with pain, swelling and pruritis, affecting both hands in 12, one hand in 6, and both hands and feet in 8 cases. There was a past history of cold sensitivity or primary Raynaud's in 54%. Covid was confirmed in 3 cases, 2 - 8 months prior to onset of chilblain-like symptoms. Possible covid, unconfirmed, was suspected in 5 cases, 1 - 11 months earlier. Affected digits appeared diffusely erythro-cyanotic in 81%, with blotchy discrete maculo-papular erythematous lesions in 42%, some with both features. Involvement was asymmetric in 54%, thumbs spared in 69%. Complement was low in 50% (8/16), ANA positive in 26% (6/23). MRI of hands showed phalangeal bone marrow oedema in keeping with osteitis in 4 of 7 cases. More severe signs and symptoms were associated with low BMI, low C3/4 and a past history of cold sensitivity or Raynauds. Cold avoidance strategies were sufficient for 58%. Pain prompted a trial of NSAIDs, aspirin, nitrates, calcium channel blockers, hydroxychloroquine, oral or topical corticosteroid or topical tacrolimus in 42%. In general, these were minimally effective or not tolerated. 4 severe cases received sildenafil or tadalafil, effective in 2. In 27% complete remission occurred during the first summer season after symptoms commenced, median duration 6 (range 2 - 10) months. In the remaining 19 cases, chilblain-like symptoms returned or worsened in the subsequent second winter period, with 6 of 19 entering remission the following summer. For the remaining 13 persistent cases the total duration of symptoms spans more than a year, and in four cases more than 2 years. Conclusion This series illustrates a distinct chronic chilblain-like condition. Features similar to primary perniosis include female predominance, middle age, pruritic painful blotchy lesions, asymmetry and low BMI. Features in keeping with acrocyanosis include chronicity, extensive diffuse erythro-cyanotic discoloration, relative improvement in warm weather and lack of association with smoking.
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Intro: Tuberculosis (TB) is an ancient disease in Malaysia and the arrival of COVID-19 has driven TB into an unknown that possibly creates hidden threats to public health. Recently, TB is identified as a socially influenced disease transmitted through people that are easily mobile and dynamically connected. It is critical to develop a data-driven geospatial-based modelling to map tuberculosis (TB) cases in Malaysia for boosting early detection. Method(s): We conducted a retrospective review of TB notified cases in Kuala Lumpur, Malaysia, between the years 2020 and 2021. The data was retrieved from the MyTB database and TB cases trends were examined against the five main series of 2020-2021 Malaysia Movement Control Order (MCO). The examination was extended to the study of social demographic and disease profiles. Locality, sub-locality, and housing type were investigated to measure hotspots in Kuala Lumpur. Finding(s): The number of patients with pulmonary TB (PTB) was high where 51% of them are smear positive and contributed majorly by male dominants. Cases with diabetes tend to be dominated by positive smear PTB that is close to 80%. There is a relatively strong trend that cases diagnosed with diabetes are in the non-smokers group and almost equally distributed between men and women, although the remaining cases are succeeded by men at the rate of 98% as opposed to women. Conclusion(s): The review of Kuala Lumpur TB notification between 2020 and 2021 is presented in this study providing a glance at a retrospective view of TB case notification in the era of the pandemic COVID-19. There are 188 cases per 100,000 population within the area of Kuala Lumpur and several important examinations were conducted to understand the underlying insights of notified TB cases. Several areas have been identified as hotspots according to geospatial modelling to allow targeted TB prevention activities at the community level.Copyright © 2023
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INTRODUCTION: Hispanic patients such as those with Moyamoya disease are less likely to receive surgical revascularization therapy due to inequities in access (1). Our institution is a located in the Southern Texas- Mexico border region serving a largely Hispanic population. We previously referred patients for EC-IC bypass to other quaternary-care centers in Texas. While referrals were already challenging due to distance, mixed immigration status, and poor socioeconomic background of many patients;COVID-19 further exacerbated this problem with restriction of elective surgical volume. METHOD(S): A consecutive series of EC-IC bypasses performed by authors (SKD and MDLG) were retrospectively reviewed. Baseline clinical, perioperative radiographic, and post-operative outcomes were studied. All patients were offered option of a referral to a quaternary-care centers and also given local option for performing bypass surgery. Further, patients met preoperatively with both the plastic and neurological surgeon. Ultimately, decision was made by patient. RESULT(S): A total of 6 craniotomies for EC-IC bypass were performed during the study period. The diagnoses included Moyamoya in 5 cases and symptomatic intracranial atherosclerosis in one. All patients were Hispanic, female, and nonsmokers with mean age of 35.6 years. Mean preoperative HBa1c was 7.9, preoperative LDL was 82, and mean preoperative hemoglobin was 11.3. Direct bypass was performed in 40% of cases. Mean OR time was 3 hours and 7 minutes. CONCLUSION(S): We have found collaboration between plastic and neurological surgery for surgical revascularization is feasible and improved access to care for Hispanic Moyamoya disease patients residing in a border community.
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Purpose of Study: COVID-19 caused by the SARS-CoV-2 virus has led to a worldwide pandemic with cytokine storm as the leading cause of morbidity and mortality. It is known that pregnant women are at higher risk of viral infections given an alteration in immune response. Mothers who smoke cigarettes during pregnancy are even at higher risk. The infection varies from asymptomatic to severe disease in pregnant women depending upon the degree of inflammation and cytokine storm. At present, limited data are available to show the effects of simultaneous maternal smoking and SARS-CoV-2 infection on the biologic efficacy of human umbilical cord derived mesenchymal stem cells (MSCs). We hypothesized that SARS-CoV-2 infection in combination with smoking of the pregnant mother at the time of delivery will lead to an alteration in the growth and differential potential of cord-derived MSCs. Our aims included collection, isolation and growth of human umbilical cord derived MSCs followed by assessment of their differentiation potential. Methods Used: The study was approved by the Institutional IRB. The umbilical cords were collected from the following groups of pregnant mothers at the time of delivery: Normal (non-smoking and negative SARS-CoV-2 infection), Smoker (smoking with negative SARS-CoV-2), Covid Smoker (smoking with positive SARS-CoV-2 infection) and Covid non-smoker (non-smoking with positive SARS-CoV-2 infection). Plastic adherent cells were harvested from 3 pooled human umbilical cords from each group. These cells were cultured and underwent immunodepletion per International Society for cellular therapy guidelines to isolate MSCs. MSCs were cultured in MSC-culture media to assess the duplication time. Similarly, MSCs were cultured in differentiation media (adipocytes and osteocytes) to assess differentiation time. Summary of Results: Picture shows the duplication and differentiation time from each group. Smoker group showed the longest duplication and differentiation time. Covid non-smoker group showed the shortest duplication and differentiation time. Covid Smoker group showed similar duplication and differentiation time as normal controls. All these results were statistically significant (T-test). Conclusion(s): Maternal smoking and active SARS-CoV-2 infection at the time of delivery alters the growth and differentiation potential of cord-derived MSCs. Further in vitro and in vivo studies are currently in progress to determine how this change effects the biological potential of these cells.
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Case report Introduction: PM is a rare, but potentially life-threatening complication during COVID 19 pandemic, being reported in patients affected by COVID-19 pneumonia, even in the absence of mechanical ventilation-related barotrauma. Case details: We reported the clinical data of 4 cases affected by COVID-19 pneumonia complicated with PM. Chest CT scan showed multiple confluent areas of ground-glass opacities, crazy paving pattern, PM, cervical subcutaneous emphysema, and pneumothorax in one case. Management included pharmacological treatment, oxygen supplementation and no acute intervention recommended by cardiothoracic surgery. Case 1: 50-year- old male without past medical history, non-smoker, hypoxic on the day of admission. During the hospital stay, he continued to require increasing levels of oxygen and was subsequently flown to a tertiary care center for higher level of care. Case 2: 38-year- old male admitted with a 7-day history of fever, dyspnea and cought. He continues to be symptomatic with neurological manifestations (COVID19 Encephalopathy). Finally whose dyspnea regressed during hospitalization, he was discharged at his own request to come for control. Case 3: 73-year- old male with a history of hypertension, non-smoker, presented with complaints of shortness of breath for 1 week. He did not receive non invasive positive pressure ventilation. The pneumothorax and PM were managed conservatively. Case 4: 53-year- old lady with no significant past medical history, presented with fever and cough for 10 days and worsening shortness of breath for two days. Progressive deterioration of respiratory function transferred her to the intensive care unit. In view of worsening hypoxia and increased work of breathing, she was intubated on the same day and was started on volume control ventilator support. Despite the support measures she developed multiple organ failure and passed 35 days after the symptoms initiated. Conclusion(s): PM is usually self-limiting and is managed conservatively. Treatment of the underlying causes and least damaging ventilator settings possible to achieve adequate oxygenation are the mainstays in managing PM. COVID-19 patients with PM seem to have a more complicated clinical course and poor outcome.
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Previous studies comparing treatment outcomes and the recovery of smokers after COVID 19 infection have yielded contradictory results. The aim of this retrospective study was to compare recovery and the rate of posthospital complications of former long-term smokers (FS) with non-smoking (NS) controls observed in PostCovid out-clinic hospital. We compared 88 FS and 96 NS, who had suffered from moderate to severe Covid-19 pneumonia, and were observed during 1-year follow-up period. The inclusion criteria were positive PCR test for SARS-CoV-2 infection and hospitalization due to acute respiratory failure. We compared lung function tests, blood gas analyses, onset of new symptoms and incidence of thrombotic incidents. Mean age of participants was 64.8+/-11.4 years for NS and 63.8+/-8.8 years for FS. At the beginning of follow-up FS group had significantly lower pulmonary function tests vs NS, including FEV1 (89.9% vs 94.6%, p<0.01);FVC (87.5% vs 94.3%, p< 0.01);DLco (62.3% vs 72.7%, p< 0.01), with a tendency for slower recovery during subsequent examinations. There was no significant difference between two groups regarding blood gas levels, number of reported symptoms and incidence of pulmonary embolism (7 vs 7). According to the results we can conclude that former smokers initially had worse lung function scores and prolonged recovery course. However, there was no significant difference in the number of symptoms and the frequency of thrombotic complications.
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Introduction: Long-COVID patients are individuals that have ongoing symptoms persisting for weeks to months after SARS-CoV-2 infection. The incidence is increasing and more studies are necessary to deepen the knowledge of these patients. Objective(s): To investigate the clinical profile, symptomatology and sequelae of long-COVID patients. Method(s): In this observational study, long-COVID patients were included and evaluated by an internet survey. Sociodemographic data were obtained from the patient together with the COVID-19 Yorkshire Rehabilitation Screening Tool (C19-YRS). Consent of the patient was sought at the beginning of the survey. Result(s): Finally, 89 patients were included in the study. The main age was 43,34 +/-7,85 years, they were overweight, and non-smokers (84%), the 85,4% were females and the median time of infection was 8,18 +/-3,93 months. The results have shown significant impairments in dyspnea at rest or under exercise, personal care, pain, fatigue, psychological distress, and quality of life after COVID infection. Additionally, patients have referred sensitivity of the throat, voice and swallowing impairment, gastrointestinal disorders, and attention and memory problems. Conclusion(s): Patients with long- COVID present multiple sequelae that affect their health status, being necessary more future studies.
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Introduction: The occurrence of the late effects of covid-19(long-covid)is a hot issue. Detailed data on its forms within the population are still lacking. Aim(s): We want to describe the long-covid in the population of the Czech Republic(CR)in relation to the covid severity. Method(s): Prospective collection of data on consecutive patients(pts)sent by GPs to pulmonologists started since June,21. The interim analysis concerns pts enrolled by February,22. The analysis was based on data collected in Information System of Infectious Diseases of the CR, especially its long-covid module. The 44 outpatient centers cover all 14regions of the CR and represent 13% of all(343)outpatient clinics of pulmonologists, they are responsible for the care of long-covid pts in the CR. Result(s): 3.489pts have been included in the study so far. After the removal of 40%pts with significant comorbidities,1.895"healthy"post-covid individuals (50%men,69%non-smokers)remained. Only a minority of these pts with long-covid 874(46%)were hospitalized due to covid severity. Inpatients were older, more often males/obese, less likely smokers. Inpatients had more severe post-covid residual CTchanges, more frequent diffusion capacity impairment, more restrictive ventilation pattern, and more oxygen desaturation during walking. Contrary nonhospitalized pts had more cough, and obstructive ventilation pattern. Hospitalized and non-hospitalized pts did not differ in incidence of resting desaturation, dyspnea, fatigue, expectoration, and chest pain. Despite the fact that 64%of the CR population is fully vaccinated, only 25(1.3%)were vaccinated among long-covid cohort. Conclusion(s): Previously hospitalized have more severe long-covid, however, most pts had only a mild acute COVID.
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Introduction: COVID-19, as of 9 June 2020, had been responsible for 404,396 deaths worldwide. Throughout the pandemic, IRCU and ICU directly cared for patients with severe or very severe respiratory failure due to COVID19 pneumonia. Objective(s): To determine if N-acetyl-cysteine (NAC) could be associated with lower mortality risk. Methodology: 1141 patients from March to May 2020 admitted to the ICU and IRCU of the Fundacion Jimenez Diaz were analysed. Patients with <3 days of hospital admission and those with CURB-65 equal to or <0 were excluded. A multivariate regression logistics models have been used to respond to our hypothesis and investigate the relationship between each variable and the mortality. Result(s): Of all patients analyzed, 44% received treatment with NAC associated with other drugs according to established protocols. Of these, 55% were male, most non-smokers with a mean age of 74.43 years. In table 2 we describe statistically significant predictive parameters associated with a decreased risk of mortality in severe or very severe patients with an area AUC of 0.80 Conclusion(s): Adjuvant treatment with NAC in severe or very severe COVID-19 pneumonia is associated with a significantly lower risk of mortality by 30% in elderly patients, principally males, and with associated co-morbidities.
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Introduction: Data on the short, medium and long term after covid-19 in adults is lacking and is sometimes discordant. The aim of our study was to describe the clinical profile of patients with symptoms lasting for more than 4 weeks after covid-19 and to determine the frequency of each symptom according to the time of infection. Method(s): Cross-sectional study including 1124 NH patients who reported having had covid-19 at least 1 month ago or more and who self-reported their symptoms prospectively in an online questionnaire. Result(s): A total of 861(76.6%) patients reported persistent symptoms, of which 728(84.5%) for>=3 months, 649(75.3%) for>=6 months, 268(31.1%) for>=12 months. The mean age was 30.5+/-9.4 years with a sex ratio at 0.12. Most of them was non-smokers (83.5 %), did not drink alcohol (87.4%) and had no medical history (81.3%). Overweight or obesity was found in 33.6% of them. Covid-19 was virologically confirmed in 75.3% of cases. Long covid was characterized by cognitive disorders, asthenia, psychological troubles, dysosmia, dysgeusia and sleeping disorders (Table 1). Conclusion(s): Symptoms can last for several months and even more than 1 year after covid-19 in NH patients with an improvement over time. Cognitive disorders and asthenia are main patients' complaint. Dyspnea and chest pain are less common. (Figure Presented).
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Aim: The aim of the study was to outline the longitudinal outcomes of olfactory dysfunction amongst patients with coronavirus disease 2019 (COVID-19) in a single tertiary centre in Malaysia. Material(s) and Method(s): Adults patients who tested positive for COVID-19 via reverse transcription-polymerase chain reaction and were admitted to Hospital Sungai Buloh, Malaysia, were recruited in this study. The patients completed a questionnaire via telephone interview comprising the following details: age, sex, ethnicity, comorbidities, general and otorhinolaryngological symptoms, and onset and duration of olfactory and gustatory dysfunction. The patients with persistent olfactory and gustatory dysfunction at the time of the initial interview were followed up every 3 to 5 days until resolution. Result(s): A total 185 patients were included in this study out of 378 patients contacted. Ninety patients reported olfactory dysfunction symptoms, with 59 of them complaining of anosmia. The mean age of the participants was 39.52 years (age range: 18-66 years). More than half of the patients with olfactory dysfunction had no comorbidities (55.56%). Of the 90 patients with olfactory dysfunction, 66 patients (73.3%), including 40 males and 26 females, regained their olfactory function completely within 2 weeks. The remaining 24 patients were contacted after 4, 8, and 12 weeks. Ten patients (11.1%) were found to have recovered their sense of smell after one month, while 5 patients (5.56%) recovered within 2 months, and 1 patient (1.11%) recovered in 3 months. Conclusion(s): Complete recovery was noted in 73% of the patients within a period of 2 weeks, whereas persistence of symptoms was noted in 6 patients (6.67%) after 3 months.Copyright © Pediatr Med Rodz 2022.
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Introduction: Smokers are at increased risk of developing viral infections and more severe outcomes than are nonsmokers. Objectif: To evaluate the effect of current smoking on the prognostic of COVID19 infection. Method(s): This is a retrospective observational study including all patients admitted for COVID-19 pneumonia between February and August 2021 in the pulmonary department at Habib Bourguiba Hospital. We compared the demographic, clinical, biological, radiological characteristics and outcomes of 2 groups: G1: current smokers;G2: non-smokers. Result(s): Three hundred patients were included in this study (G1: n =95;G2: n =205). All the smokers were male. The mean number of daily cigarettes consumption was 17.0 cigarettes. No differences were found between the two groups regarding the age, biological inflammatory markers (D-dimer, Creactive protein, neutrophil-to-lymphocyte ratio) and extend of radiological damage. Hypertension was more prevalent in G2 (46,1% versus 27,3%, p= 0,01), however, chronic obstructive pulmonary disease was more frequent in G1(8,4 % versus 3,9 %, p= 0,034). Troponin level was significantly higher in G1 (p=0,004). The average length of hospital stay was 10 [7-16] days in G1 versus 9 [5-14] days in G2 (p=0,293). No Significant difference were found between the two groups regarding in-hospital mortality (p=0, 75) and need for mechanical ventilation (p=0, 79). Conclusion(s): Our study shows that the severity of the COVID 19 infection among smoker and non-smoker patients is similar, and smokers are not more prone than others to develop severe outcomes.
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Background COVID19 has emerged in the last 3 years thus different types of vaccines are massively administered globally which exhibit systemic and cardiac side effects mostly myocarditis and pericarditis. We present a case of a 29 YO completely healthy male, non-smoker with negative FHX of cardiac diseases, who developed acute pericarditis after the first dose of the "viral-vector" vaccine and evolved rapidly into constrictive pericarditis in 3 weeks duration. The patient started to complain of dyspnea III-IV and central chest pain relieved by bending forward day 3 post-vaccine, labeled at EMD with acute pericarditis. NSAID and colchicine were started & by 3rd-week outpatient follow-up. Despite a full adequate medx course, we found him to have persistent Dyspnea NYHA II with evidence of constrictive pericarditis on echocardiography, cCT and cMRI after 1 month. He refused myocardial biopsy. Methods we used the serial TTE studies showed small pericardial effusion <1cm and then signs of septal bounce, tran MV/TV respiratory variation and thickned pericardium, same features seen on cCT scan. In addition to a positive LGE on cMRI with 18 months follow-up. Results post vaccine constrictive pericarditis is not uncommon, early detection and appropriate management is the mainstay to avoid unwanted consequences. Conclusion Although there are many reports and registries of post-vaccine myo/pericarditis, the exact association is still unclear and requires further investigation. [Formula presented]Copyright © 2023 American College of Cardiology Foundation
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Background: Few studies have shown that smokers are more likely than nonsmokers to contract COVID-19, while some reports indicate that smokers are underrepresented among that requiring hospital treatment for this illness. This study was designed and implemented for investigating the severity and outcome of COVID-19 based on underlying smoking status. Material(s) and Method(s): This was a cross sectional study which implemented in Tehran and Ahvaz with all COVID19 hospitalization patients from February to June 2021. 18200 patients with positive PCR test were observed. A check list of demographic data and smoking history was completed and analyzed. Result(s): 11112 patients were male (61.1%) and the mean age was 47.9+/-11.3. 1508 smokers (8.3%) were seen with any type of tobacco consumption. The frequency of ICU admission in the smokers is significantly higher than nonsmokers (23.9% vs. 18.8%). Using of more than 3 medications in the smokers were significantly higher (70.6% vs. 52%). A comparison between patients based on smoking indicates that the death rate was significantly higher in smokers (31.6% vs. 25.6%). Conclusion(s): Smokers with COVID-19 had more severe and worse consequences.
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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.
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Case report - Introduction: This case highlights the dilemma of keeping rheumatoid arthritis disease under control in active cancer cases and establishing a consistent multidisciplinary dialogue during a pandemic and staffing crises. During chemotherapy and active cancer treatment, disease-modifying therapies (conventional and biologic) are often stopped. In some cases, the potential benefits versus risks of restarting usual therapies have to be balanced against risks of suppressing disease activity with highdose steroids. Risks of infection (common and atypical) need to be considered. Case report - Case description: A is a 67-year-old female nonsmoker diagnosed with seropositive rheumatoid arthritis (RF, anti - CCP positive) in 2008. Other conditions include type 2 diabetes, atrial fibrillation (on warfarin), hypothyroidism and obstructive sleep apnoea. Due to active disease, despite triple therapy (methotrexate, sulphasalazine and hydroxychloroquine), anti-TNF therapy (etanercept) commenced in 2009 with primary non-response. However, she responded well to B-cell therapy (rituximab) in conjunction with oral methotrexate (25mg weekly) receiving annual infusions from 2010 to 2016. In 2017, an elective sleeve gastrectomy procedure for high BMI was abandoned after peritoneal deposits of concern were noted. Histology and CT imaging were consistent with a primary peritoneal malignancy (Stage 3c low-grade serous adenocarcinoma). Treatment involved debulking surgery (total abdominal hysterectomy, bilateral salpinoophorectomy, omentectomy) and tamoxifen. Treatment for rheumatoid arthritis stalled during this period but as frequent steroids were required for active joint inflammation, in agreement with the oncologists, she had a rituximab cycle in 2018. Unfortunately, in 2019 she had signs of cancer progression (elevated tumour markers, CT imaging) and has subsequently started carboplatin chemotherapy. She has been unable to continue methotrexate or rituximab pending completion of the chemotherapy cycles (ongoing). However, her arthritis is now uncontrolled without increased steroids. Due to recurrent flares, her maintenance dose has been increased from 5mg to 7.5-10mg prednisolone daily until we can establish if it is safe and appropriate to recommence her usual arthritis regime. Even without disease-modifying therapy like methotrexate and rituximab, risk of infection (including atypical ones) is still significant with the combination of chemotherapy and steroids. Risk of progressive joint damage and adverse quality of life with active arthritis also needs to be considered. Staffing crises, exacerbated by COVID pandemic issues, have added to complexity of decision making and coordination of regular multidisciplinary discussions regarding treatment. Case report - Discussion: Cancer is a known association in rheumatoid arthritis patients with a twofold higher risk of lymphoma compared to the general population. Whether condition or treatment affects risk remains unclear as immune dysregulation is relevant in both autoimmunity and cancer. Paraneoplastic, recent onset arthritis, chemotherapy- or immunotherapy-induced arthralgia/arthritis are also well documented. This case had a seropositive rheumatoid arthritis phenotype quite a few years prior to cancer diagnosis. Primary peritoneal cancer is uncommon, often presenting as in this case as an incidental finding. It is usually treated like ovarian cancer Whilst methotrexate has been implicated in lung cancer, melanoma and non-Hodgkin lymphoma, overall safety data suggest any risk is quite low (e.g., EBV-associated lymphoproliferative disorders usually resolve with drug discontinuation). It is also a known chemotherapeutic agent. Anti-TNF treatment algorithms generally exclude patients with recent cancer. Rituximab, originally developed as a cancer drug, is not thought to affect risk of cancer development or progression. Treatment with disease-modifying therapy (conventional and biologics) is often withheld in patients with active malignancy undergoing chemotherapy due to a theo etical risk of potentiated immunosuppression and toxicity, particularly cytopaenias. However, maintaining arthritis control with glucocorticoids also has short- and long-term risks. Combining chemotherapy agents like carboplatin with methotrexate has been used for urothelial carcinoma and can be well tolerated with close monitoring of haematological parameters. Thus, it could be argued this patient is at risk of infections whichever treatment approach is taken and regaining control of arthritis with recommencement of methotrexate and rituximab is much better for her quality of life. Regular multidisciplinary discussions are important to outline risks versus benefits of combined treatment. This may be difficult in practice during staffing crises. Covid risk in patients receiving rituximab and/or chemotherapy, timing and response to COVID vaccination are also important considerations. Case report - Key learning points: . Primary peritoneal cancer is uncommon and can present as an incidental finding . Whilst treatment for progressive cancer is important, withholding rheumatoid arthritis treatment can have a significant adverse impact on quality of life . Morbidity and mortality risks of stopping treatment versus combined treatment (cancer therapy and disease-modifying therapy) ideally needs to be fully discussed and agreed with the patient and all care providers - lack of "named" providers, restructuring, redeployment, multi-specialty care and a global pandemic can make coordination of this difficult.
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Since the start of the pandemic of COVID-19, it was clear that vaccination was the best way to combat it. A few vaccines were produced and approved in the last year. Many questions about the vaccinations' efficacy and safety arose due to this unprecedented vaccine development effort. This study aimed to evaluate the short-term side effects after receiving the available COVID-19 vaccines by the students of the Kut university college. This research was conducted as a cross-sectional, retrospective study using an online questionnaire distributed among COVID-19 vaccine recipients. The number of students who are enrolled in this study is 804, nearly (81%) of our study subjects were symptomatic after receiving the vaccination. Participants with a history of SARS-CoV-2 infection, comorbid diseases, females, non-smokers, and AstraZeneca vaccine receivers showed significantly (p<0.05) more severe side effects. In conclusion, the side effects described by our undergraduate students after receiving vaccinations from Pfizer BioNTech, Oxford AstraZeneca, and Sinopharm are similar to those reported in clinical trials, showing that these vaccines have safe profiles. More research is needed to assess the efficiency of current vaccinations in preventing SARS-CoV-2 reinfections. Copyright © 2022 Marmara University Press.
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Objective: To investigate the attitudes of health care professionals involved within the coronavirus disease-2019 (COVID-19) pandemic process towards the COVID-19 vaccine in line with their demographic characteristics. Material(s) and Method(s): A questionnaire consisting of 16 questions was conducted to 510 healthcare professionals working in Inegol State Hospital between December 2021-January 2022 and who agreed to participate in the study, to determine their approach to the COVID-19 vaccine. The data were collected with Student's t-test and Mann-Whitney U Test. Chi-square test was used in comparison of categorical variables. Result(s): While 54.3% of the respondents said that they don't want to have the COVID-19 vaccine, 69% answered that "Since there is not any adequate research on the vaccine, the vaccine is not reliable". Were observed that vaccine rejection was most common in the 20-29 age group (72.7%) and pregnant women (100%). In addition, as the education level increased, the number of people considering vaccination increased. The desire to be vaccinated was seen more in married, and it was noted that non-smokers had more COVID-19 (80.3%). Conclusion(s): Healthcare professionals who participated in study were found to have a negative attitude towards COVID-19 vaccine. Although healthcare professionals have hesitations about vaccine, in fact, noteworthy that they're afraid of the disease (43.8%). Despite of the pandemic, more than half (54.3%) of healthcare professionals working in Inegol State Hospital stated that they didn't think about getting a COVID-19 vaccine. Providing hospital staff with more education about the safety, efficacy, and value of currently available COVID-19 vaccines is critical to vaccine acceptance in this population. Copyright © 2022 by Turkiye Klinikleri.
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SESSION TITLE: Occupational and Environmental Lung Disease Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: We describe a case of acute progression of chronic hypersensitivity pneumonitis (HP) in an adult, previously misdiagnosed as COPD for 13 years due to severe emphysematous changes seen on imaging. He was also found to have acutely worsened disease as a result of Covid-19. CASE PRESENTATION: A 64-year-old male presented to the pulmonary clinic with dyspnea on minimal exertion. He reported respiratory complaints for 13 years, treated with 2 L/min of oxygen overnight, and budesonide-formoterol and tiotropium inhalers. These complaints were previously associated with brief occupational mold exposure and possible COPD. His respiratory distress worsened one year ago when he was hospitalized for Covid-19. On discharge, his oxygen requirement had increased to 6 L/min. CT chest showed air-trapping in the mid-zones bilaterally, mosaic attenuation, and peri-bronchial thickening. PFTs showed an FEV1 33% and FVC 55% of predicted, consistent with severe obstruction and reduction in lung volume. As the patient was a lifetime non-smoker, alternative diagnoses were pursued. Alpha-1 antitrypsin levels and immunologic testing, including scleroderma and myositis panels, were within normal limits. Positive findings included CCP IgG/IgA antibodies at 96 units and HP panel positive for pigeon serum antibodies. Prompted by this testing, the patient revealed that he had parakeets in his home for the past 15 years. He also reported significant symptom improvement on occasions that he took a course of steroids. Based on these findings, a diagnosis of chronic fibrotic hypersensitivity pneumonitis with bronchiolitis obliterans was considered. The patient's severe airflow obstruction and respiratory failure precluded surgical lung biopsy. Empiric management was initiated with 30 mg of prednisone daily with a slow taper and instruction to eliminate exposure to exotic birds. DISCUSSION: HP is commonly caused by inhalation of and sensitization to an aerosolized environmental antigen;a common subtype is bird fancier's lung due to repetitive exposure of avian antigen. Continuous antigen exposure increases the risk for development of fibrosis, which was also seen in our patient. The most commonly described radiologic findings in HP are ground-glass opacities, ill-defined centrilobular nodules, and focal areas of air trapping resulting in mosaic attenuation and fibrosis. More than 20% lymphocytosis on bronchoalveolar lavage is also a sensitive tool in detecting alveolitis. The relationship between Covid-19 and disease progression in HP is not well studied. CONCLUSIONS: Chronic hypersensitivity pneumonitis from avian antigens, or Bird fancier's lung, can present with severe emphysematous changes on CT imaging, along with obstructive pattern of PFTs. This should be an important differential, especially in patients who are non-smokers. Covid-19 causes disease progression in HP, this relationship needs to be further explored. Reference #1: Funke M., Fellrath J.-M. Hypersensitivity pneumonitis secondary to lovebirds: a new cause of bird fancier's disease. Eur. Respir. J. 2008;32:517–521. DOI: 10.1183/09031936.00108507 Reference #2: Pereira C., Gimenez A., Kuranishi L., Storrer K. Chronic hypersensitivity pneumonitis. J. Asthma Allergy. 2016;9:171–181. DOI: 10.2147/JAA.S81540 Reference #3: C.S. Glazer, C.S. Rose, D.A. Lynch Clinical and radiologic manifestations of hypersensitivity pneumonitis J. Thorac. Imag., 17 (4) (2002), pp. 261-272. DOI: 10.1097/00005382-200210000-00003 Morell F, Roger A, Reyes L, Cruz MJ, Murio C, Muñoz X Bird fancier's lung: a series of 86 patients. Medicine (Baltimore). 2008;87(2):110-130. DOI: 10.1097/MD.0b013e31816d1dda DISCLOSURES: No relevant relationships by Momina Amjad No relevant relationships by Amit Chopra No relevant relationships by Rafeh Safdar
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SESSION TITLE: Lung Cancer Case Report Posters 3 SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Tracheal tumor accounts for 0.4% of all tumors and only 10% of them are benign (1). We present, to our knowledge, the first case of a primary benign tracheal tumor with features of chondroid metaplasia arising from the posterior wall of the trachea. CASE PRESENTATION: 58-year-old male non—smoker with non-significant past medical history, presented to the Emergency department for COVID-19 pneumonia. CTA chest was done showing bilateral pulmonary embolism and a 12 mm polypoid tracheal mass arising from the posterior wall of the trachea extending into the lumen (Figure#1). The patient was asymptomatic prior to his COVID 19 infection;he denied any chest pain, hemoptysis, trauma, or prior intubation. After recovering from COVID-19, the patient was scheduled for an outpatient rigid bronchoscopy which revealed a tracheal polyp arising from the mid-distal posterior membranous trachea. (Figure#2). An electrocautery snare was used to simultaneously cut and cauterize the stalk using a lasso technique. The polyp was removed in its entirety without complication. Histopathology examination demonstrated a respiratory epithelium lined cyst with cartilaginous tissue, favoring chondroid metaplasia. DISCUSSION: Primary benign tracheal tumors with cartilaginous features are uncommon, especially in the posterior membrane of the trachea, which lacks cartilaginous support. Diagnosis of any benign tracheal tumor is usually delayed since most patients are asymptomatic. The majority of such tumors are found incidentally, as in this case. One of the most common benign tracheal tumors is hamartoma, which can have respiratory epithelium and cartilaginous tissue, however they do not have features of chondroid metaplasia, and are generally found in the lateral or anterior wall of the trachea. Furthermore, endobronchial lesions only account for 3% of all pulmonary hamartomas. (2) Reports of airway chondroid metaplasia are usually described in the larynx and are commonly associated with prior trauma or inflammation in the area which is not known to have occurred in this case (3). The histopathologic findings and unusual location of this tumor makes this case unique. CONCLUSIONS: The tracheal origin of this benign tumor, arising from the posterior membrane with cartilaginous features is extremely rare, and has not previously been described in the literature. Reference #1: Park CM, Goo JM, Lee HJ, Kim MA, Lee CH, Kang MJ. Tumors in the tracheobronchial tree: CT and FDG PET features. Radiographics. 2009 Jan-Feb;29(1):55-71. doi: 10.1148/rg.291085126. PMID: 19168836. Reference #2: Hurst IJ Jr, Nelson KG. Tracheal hamartoma. Chest. 1977 Nov;72(5):661-2. doi: 10.1378/chest.72.5.661. PMID: 913152. Reference #3: Orlandi A, Fratoni S, Hermann I, Spagnoli LG. Symptomatic laryngeal nodular chondrometaplasia: a clinicopathological study. J Clin Pathol. 2003 Dec;56(12):976-7. doi: 10.1136/jcp.56.12.976. PMID: 14645364;PMCID: PMC1770148. DISCLOSURES: No relevant relationships by Jorge Cedano Consultant relationship with Olympus America Please note: 8/1/21-present Added 04/18/2022 by Lucas Pitts, value=Consulting fee