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1.
Russian Journal of Forensic Medicine ; 7(4):39-44, 2021.
Article in Russian | Scopus | ID: covidwho-1811664

ABSTRACT

BACKGROUND: Helium, being an inert substance, does not have a significant effect on the human body, but sometimes at very high concentrations in the air, it can cause suffocation and a state of oxygen deficiency. Oxygen-helium therapy has proven to be the most effective recovery, rehabilitation, and treatment for all types of lung damage and reduced saturation. It is even included in the recommendations for preventing, diagnosing, and treating COVID-19. Deaths due to inhalation of inert gases, especially helium, are sporadic in forensic practice. As a rule, the probability of death in such cases is most often associated with man-made accidents or violations of safety regulations when performing technological processes and operations related to the use of gas. Safety instructions for handling helium warn of possible damage to the mucous membrane of the eyes and frostbite of the skin, as well as mechanical injury when a heavy gas cylinder falls. CASE PRESENTATION: Inert gases do not interact with other chemicals. However, we encountered a suicide case where an inert gas was chosen as a means. Inhalation of helium caused macro- and micromorphological changes in the human body, which led to a fatal outcome. The case is illustrated by photographs of microscopic preparations, which demonstrate the absence of specific signs of toxic effects on the organs and tissues of the deceased. CONCLUSION: Despite the substance's extreme volatility, the compressed gas's pressure and low temperature can cause various injuries and even death. The study of general pathomorphology can be helpful in the conduct of a forensic medical examination. © Authors, 2021

2.
Embase; 2021.
Preprint in English | EMBASE | ID: ppcovidwho-331121

ABSTRACT

Directional clinical evaluation and management of coronavirus disease (Covid-19) was initially presumptive based on the Wuhan data set as reported by World Health Organization (WHO). The current recommendations emanate primarily from the Chinese experience and subsequent Centers for Disease Control and Prevention (CDC) guidelines. Here we report a case with an “atypical” patient risk profile and variant longitudinal disease progression contrasting from existing recommendations. Our case report suggests that a universal 14-day quarantine timeline may not be sufficient;that correlation is needed between viral presence as determined by RT-PCR and a patient’s humoral response tested by serologic immunoassay of IgM & IgG. Hence, a clinical decision-making algorithm that can help clinicians clear a patient from “active infection” status would require testing that is sufficiently reliable, and should include serological testing for immunity

3.
Cardiopulmonary Physical Therapy Journal ; 33(1):e14-e15, 2022.
Article in English | EMBASE | ID: covidwho-1677324

ABSTRACT

BACKGROUND AND PURPOSE: Respiratory muscle training (RMT) may be beneficial for patients with COVID-19. A variety of devices exist but none provide combined inspiratory and expiratory muscle training (IMT and EMT, respectively) with expiratory vibration from water filling the Triburter device (TD) which may facilitate the removal of pulmonary secretions as well as strengthening of the respiratory muscles. The purpose of this case study was to examine the effects of RMT with the TD in a patient recovering from COVID-19 complications. CASE DESCRIPTION: The case study subject was a 57-year-old female who was diagnosed with COVID-19 in July 2020 and again in December 2020. The subject's past medical history includes gastroesophageal reflux, pneumonia, hypertension, interstitial lung disease, hypoxemic respiratory failure and the use of supplemental O2 (2 L/min via nasal cannula at rest and with exercise and 24% FiO2 via ventimask adapter with IMT). At the start of cardiopulmonary rehabilitation (CPR) in March 2021, the subject showed signs of paradoxical breathing and extensive use of accessory muscles, decreased endurance, and dyspnea at rest with bronchospasms following full inhalations and exercise that resulted in coughing and prolonged dyspnea. The subject was given a Threshold IMT device to use during CPR sessions and as part of her home exercise program, but she was not compliant with Threshold IMT. In July 2021 the patient used the TD in CPR and performed 30 repetitions with 4 cm of water in the TD representing a resistance of approximately 30% of her current maximal inspiratory pressure. OUTCOMES: While performing RMT with the Triburter in CPR the patient's heart rate, oxygen saturation, modified BORG dyspnea and blood pressure ranged from 90-93 bpm, 96-97% on room air, 3-4/10 and approximately 120/80 mmHg, respectively. The patient reported greater adherence as well as less coughing and dyspnea with the TD vs Threshold device, but reported difficulty closing the TD after adding water. Also, the resistance during IMT with the TD may have been less than that with the Threshold device since the IMT and EMT resistance parameters are not clearly defined with the TD. Compared to the initial evaluation in March 2021, the number of 6-minute walk test (6MWT) rests and rest durations as well as total distance walked in late July 2021 improved (2 rests for a total of 46 seconds and distance of 370 m vs 4 rests for a total of 132 seconds and distance of 229 m). DISCUSSION: The improvement in 6MWT performance in a post-COVID-19 patient is noteworthy highlighting the important role of RMT and CPR in this patient population. The TD device appeared to elicit greater compliance and more tolerable RMT than that from the Threshold device due possibly to combined IMT and EMT and vibration with exhalation. Patients recovering from COVID19 with retained pulmonary secretions and weak respiratory muscles may benefit from the TD, but further investigation of it is needed.

4.
Anaesthesia ; 77(SUPPL 2):44, 2022.
Article in English | EMBASE | ID: covidwho-1666279

ABSTRACT

Allergy to excipients used in drug formulations is an often overlooked issue, recently highlighted by cases of severe reaction to the Pfizer-Biontech COVID-19 vaccination. Sulphites, including metabisulphites, are antioxidant preservatives found in many foods but also in certain drugs used by anaesthetists, including metaraminol, catecholamines, metoclopramide and some forms of propofol. Patients may present with a variety of intolerances to sulphites. Anaesthetists need to know how to counsel them, which drugs to avoid, and whether to administer sulphite-containing adrenaline in an emergency scenario. Description A patient with reported sulphite allergy following previous reactions to metabisulphite-containing local anaesthetic presented for an elective operation. The hospital pharmacist took several weeks to confirm the sulphite content of key anaesthetic drugs and to find alternatives. In particular, sulphite-free adrenaline had to be sourced from France. General anaesthesia proceeded uneventfully, and a 'green bag' of safe emergency drugs stayed with the patient until her discharge. The patient was referred for further allergy testing, but as the allergy centre could not provide sulphite-free adrenaline, she declined challenge with metabisulphites and with preparations of adrenaline available in the UK. This will clearly pose a challenge in the future should she present with anaphylaxis or for emergency surgery or critical care. Discussion Documented reactions to parenteral sulphites are uncommon, varied and cover a variety of suggested pathophysiologies, of which IgE-mediated allergy is rare [1]. Additionally, asthmatics may report bronchospasm related to sulphite containing foodstuffs, but this results from direct irritation from sulphur dioxide and is not immune mediated. Establishing the diagnosis is difficult, requiring challenge testing in specialist allergy centres;skin prick testing can be unreliable. Challenge with sulphite-containing adrenaline, thus establishing safety of use in case of anaphylaxis, is one pragmatic option. Sensible precautions include close liaison with the hospital pharmacist, an easily accessible list of sulphite-free alternatives and a policy on adrenaline use in anaphylaxis. Although evidence is scant, expert opinion suggests that in anaphylaxis the benefit of administering sulphite-containing adrenaline outweighs the risks [2].

5.
Cogent Medicine ; 8, 2021.
Article in English | EMBASE | ID: covidwho-1617059

ABSTRACT

Background: Coronavirus disease 19 (COVID-19) tends to be milder in children, but severe cases have been reported. We described a case report of a toddler admitted to our department with additional findings, highlighting the importance of assessing the patient as a whole. Case Presentation: A previously healthy, 15-month-year-old girl presented with fever and dry cough for 10 days, respiratory distress and PCR SARS-CoV-2 was positive. At admission, she presented with hypoxemia (SpO2 89-90% in room air), global retraction and bilateral bronchospasm. She was treated with bronchodilators, methylprednisolone, remdesivir and also amoxicillin/clavulanic acid. Her complete blood count revealed leucocytosis 16,160x109/L, 41% lymphocytes, C-reactive protein 57,9 mg/L, procalcitonin 0,13 ng/mL, sedimentation rate 44 mm/h, ferritin 218,4 ng/mL. Chest computed tomography (CT) scan revealed bilateral peripheral areas of ground glass, coexisting consolidation areas at inferior lobes but also revealed a 6 cm supra-renal mass. Abdominal ultrasound and CT confirmed an heterogeneous right supra-renal gland mass of 5,5cm along the greatest diameter with diffuse calcifications, evolving the inferior vena cava and the renal vascular pedicle, no signs of liver, bone, cutaneous or ganglionic metastization. These features were suggestive of neuroblastoma in stage L2. Vanillylmandelic acid, normetanephrine/creatinine ratio and metanephrine/creatinine ratio were elevated. The metaiodobenzylguanidine (Mibg) scan showed a localized disease. The total excision of the tumour mass was performed, and the histology confirmed neuroblastoma with no N-myc oncogene amplification, nor other bad prognosis chromosomal abnormalities. She is currently under oncological surveillance, with no signs of recurrence. Learning Points Discussion: Neuroblastoma is the most common extracranial solid tumour of childhood. It is known for its broad spectrum of clinical behaviour and outcome. In this case, although this toddler was admitted due to COVID-19 pneumonia, it allowed to identify a localized tumour, perform excision and due to the favourable biology tumour, she has a very good chances of being cured and free of disease.

6.
Reproductive Endocrinology ; - (61):8-14, 2021.
Article in Ukrainian | EMBASE | ID: covidwho-1614416

ABSTRACT

Research objective: to determine the risk factors for the spread of coronavirus infection among women of fertile age. Materials and methods. Authors analyzed the medical records (case histories and questionnaires) of 60 women of fertile age who were treated for coronavirus disease. After analysis of medical and social factors women were divided into age groups. Analysis of risk factors for coronavirus disease was determined by calculating the odds ratio according to Wald at p < 0.05. Results. Evaluation of the odds ratio of the COVID-19 chances depending on the nature of work of women of different ages showed that with intense work the risk of disease increases 2.5 times in the age group up to 30 years, which also confirms the analysis of previous indicators, that younger women with moderate workloads have more opportunities to attend mass events and crowds. In the structure of extragenital diseases in women with coronavirus disease, the chances of disease increased 2.6 times in those women who had a history of chronic tonsillitis. Among the history of infectious diseases, the chance ratio of coronavirus disease was increased in women over 30 years of age who had pertussis. Such data may indicate a similar mechanism of development of these diseases, because the causative agent of pertussis also penetrates the upper respiratory tract and may be accompanied by neurological symptoms – the appearance of seizures and bronchospasm. Conclusions. The data obtained in this way allow us to separate a narrower cohort of women of fertile age who may develop coronavirus disease. This will further allow developing proposals for a more efficient distribution of vaccines among the female population of Ukraine and reduce the prevalence of coronavirus infection.

7.
Allergy: European Journal of Allergy and Clinical Immunology ; 76(SUPPL 110):50-51, 2021.
Article in English | EMBASE | ID: covidwho-1570357

ABSTRACT

Case Report Background: The pediatric population represents 35% of all atopics (Chad et al. 2001). SCIT has been shown to be effective in pediatrics in the management of Allergic Rhino-Conjuncitvitis (ARC), (Kim et al. 2013). Debate continues in dosing regimes (Arasi et al. 2018) and the true reporting of pediatric SCIT induced Systemic Reactions (SR). As SR's, mild to severe bronchospasm ranges from 1-30% and unspecified systemic reactions between 3-34% (Kim et al. 2013). This retrospective study aimed at illustrating the frequency of aeroallergen SCIT induced adverse reactions in a pediatric population. Method: Data was obtained from pediatric patients (PP) attending a community allergy clinic for aeroallergen SCIT. Recorded data included the following: demographics, diagnosis, allergen, administered dose and occurrence of adverse reactions over the last 5 years. SCIT doses were administered in accordance with Canadian Society of Allergy and Clinical Immunology guidelines and SR were graded as per World Allergy Organization guidelines (Cox et al. 2010). Patients on Vespid immunotherapy were excluded. Results: SCIT data was reviewed over 5 years. Out of a total of 97 SCIT patients, 23 were pediatric (mean age of 11.2 years 95% CI, 10.12 to 12.28). Of all pediatric patients, 9% received single allergen immunotherapy, 91% received multi-allergen immunotherapy. Ten of the 23 PP sustained adverse reactions to SCIT. Clinically significant large local reactions requiring dose reduction were reported in 3 PP (13%), while SR were noted in 7 PP (30%), 4 classified as Grade 1 and 3 as Grade 2. SR occurred in 4/7 (57%) PP on a build-up regime and 3/7 (43%) on maintenance dosing. Six PP with SR continued on SCIT with modified dosing regimes, 1 discontinued therapy because of current COVID-19 concerns. Two of the 23 PP completed the duration of therapy with no reactions and were discharged from follow up care. During the same time period, SR occurred in 6/74 (8.1%) adult patients. In comparison to adults undergoing SCIT, the rate of SCIT induced SR in the pediatric population was three times higher. Conclusion: In general, the rate of SCIT-associated SR of varying severity is low (James et al. 2017). However, in PP, our study reported a significantly higher occurrence of SR compared to adults on SCIT over the same time period. Additional research is required to tailor conventional build-up and dosing to a pediatric population to address higher rates of SR in this population.

8.
Allergy: European Journal of Allergy and Clinical Immunology ; 76(SUPPL 110):169-170, 2021.
Article in English | EMBASE | ID: covidwho-1570344

ABSTRACT

Background: Vasospasm due to eosinophilic coronary periarteritis (VECP) can cause not only vasospastic angina but also myocardial infarction and sudden cardiac death. It is usually resistant to conventional treatment of coronary disease and responds to systemic corticosteroids. The role that may have the monoclonal antibodies reducers eosinophils is unknown. Method: A 52-year-old female with chronic rhinosinusitis with nasal polyposis, moderate persistent bronchial asthma and Aspirinexacerbated respiratory disease(AERD), without atopy, had been treated with inhaled and intranasal fluticasone, oral montelukast and inhaled formoterol. In July 2019, she arrived at the emergency room with an acute coronary syndrome. Results: The procedures performed revealed high levels of troponin 16717ng/L(0- 47ng/L), and abnormal electrocardiogram (alteration of repolarization in II, III and aVF). Marked eosinophilia of 750cells/ mm3 was noticed. She was treated with oral vasodilators and aspirin, which due to her AERD required rapid desensitization, being effective. However, she continued with recurrent chest pain and electrocardiographic abnormalities. Diagnostic coronary angiography revealed vasospasm in the right coronary artery without atheromatous lesions. Type 2 myocardial infarction secondary to VECP was suspected and prednisone 30mg/day was started with complete resolution of chest pain. She developed a Cushing syndrome and prednisone dose was reduced, but chest pain and eosinophilia(1000/mm3) reappeared, and prednisone 20mg/day was reintroduced. It was decided to discontinue corticosteroids and treatment was begun with anti-IL-5(benralizumab) in May 2020, reducing eosinophilia( 0/mm3) from the first dose. At 6 months we suspended prednisone without new episodes of pain. In August 2020, she was visited due to SARS-CoV-2 infection without symptoms of bronchospasm or pneumonia and received the 4th dose of benralizumab without complications. Conclusion: An acute coronary syndrome refractory to conventional medications with normal coronary arteries and eosinophilia, with a history of chronic rhinosinusitis/polyposis, asthma and/or AERD, VECP should be considered and early treatment with corticosteroids could save lives. This is the first case to our knowledge in which anti IL 5 has been used for VECP to control of the eosinophilic disorder. Likewise, it was administrated during the SARS-CoV-2 infection without complications.

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