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1.
Hpb ; 24(Supplement 1):S41, 2022.
Article in English | EMBASE | ID: covidwho-2061209

ABSTRACT

Introduction: National guidance issued in response to COVID-19 resulted in adoption of non-surgical modes of treatment in emergency surgery, including acute cholecystitis (AC). The CHOLECOVID Study is the definitive global audit of the management and outcomes of AC during COVID19. Method(s): Patients >18 years with acute cholecystitis during two predefined 8-week time periods, pre-pandemic (P1, 12/09/19- 12/11/19) and during the pandemic (P2, 12/03/20-12/05/20), were included. The primary outcome was 30-day all-cause mortality. Secondary outcomes included severity of AC, radiological diagnostic modalities implemented, definitive management and pulmonary complications. Result(s): 9,783 patients were included from 40 countries. 30-day mortality was higher in P2 (1.7%vs2.4%;p<0.015). Higher rates of moderate and severe AC were seen in P2 (30.1%vs35.1%, p<0.001;3.7%vs4.1%, p<0.001). First-line CT imaging was more common in P2 (36.3%vs46.3%;p<0.001). Cholecystostomy rates were higher in P2 (5.8%vs8.8%;p<0.001), with a reduction in cholecystectomy (23.4% vs 44.2%, p<0.001). Overall 4.6% (n=193) of P2 patients were COVID-19 positive, with overall mortality of 0.7% (n=30). Following adjustment using a natural effects mediation analysis, a diagnosis of acute cholecystitis during the pandemic was associated with almost 30% higher odds of death compared to the pre-pandemic. Conclusion(s): During the COVID-19 pandemic, a small increase in mortality among AC patients was noted, when compared to the pre-pandemic cohort. Patients during the COVID-19 pandemic presented with more severe AC, resulting in altered trends in diagnosis and management. Clear pathways are required to prevent disruption of services and safely manage AC moving forward, in the face of the ongoing COVID-19 pandemic. Copyright © 2022

2.
Chest ; 162(4):A2637, 2022.
Article in English | EMBASE | ID: covidwho-2060976

ABSTRACT

SESSION TITLE: Late Breaking Chest Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: (1) Assess the characteristics of COVID-19 patients who developed pulmonary cysts, bullae, blebs, and pneumatoceles. (2) Investigate outcomes of patients who developed cystic lung disease from COVID-19. METHODS: A literature search using Pubmed, Cochrane, and Embase was performed for case reports from 2020 to 2022 describing COVID-19 patients who developed lung cysts, bullae, blebs and pneumatoceles. The following data were extracted: patient demographics, presence of underlying lung disease, history of smoking, maximum oxygen requirements during acute illness, imaging findings, complications, and patient mortality. RESULTS: 65 publications (11 case series and 54 case reports) with a total sample size of 76 patients were analyzed. The mean age of patients was 52.2 ± 15.8 years. A majority of the cases were males (n=67, 88.2%). Twelve (15.8%) cases had an underlying lung disease, such as COPD or asthma, and 16 (21.1%) cases had a history of smoking tobacco. We categorized severity of illness based on the levels of oxygen requirement defined as: (1) mild - 0 to 2 liters of oxygen, (2) moderate - greater than 2 liters of oxygen to face mask/venturi mask and (3) severe - high flow nasal cannula, non-invasive ventilation, or mechanical ventilation. The majority of patients (n=40, 52.6%) had severe illness while 7 (9.2%) and 17 (22.4%) presented with mild and moderate disease, respectively. Of the 25 (32.9%) patients who required invasive mechanical ventilation, duration of ventilator days was provided for 14 patients, with a median of 40 days (interquartile range=54). Twenty-one (27.6%) patients were found to have cysts on imaging, 26 (34.2%) were found to have bullae, 3 (3.9%) were found to have blebs, 15 (19.7%) were found to have pneumatoceles, and 11 (14.5%) were found to have more than one of the aforementioned findings. A total of 53 (69.7%) patients developed pneumothorax and 12 (15.8%) developed pneumomediastinum. Seventeen (22.4%) patients were on the mechanical ventilator while pulmonary complications occurred. Additionally, 41 (53.9%) required chest tube placement, 16 (21.1%) required surgical intervention including open thoracotomy or video assisted thoracoscopy. A total of 47 (61.8%) cases reported either resolution of symptoms and complications, or improved imaging findings following interventions. The rate of inpatient mortality was 11.8%. CONCLUSIONS: Patients with severe COVID-19 may have a higher risk for developing cystic lung disease, hence, increasing the risk for complications such as pneumothorax and pneumomediastinum. CLINICAL IMPLICATIONS: Patients who had severe COVID-19 may benefit from closer follow up and serial imaging for early detection of cystic lung disease. DISCLOSURES: No relevant relationships by Kavita Batra No relevant relationships by Rajany Dy No relevant relationships by Christina Fanous No relevant relationships by Wilbur Ji No relevant relationships by Max Nguyen No relevant relationships by Omar Sanyurah

3.
Chest ; 162(4):A2486, 2022.
Article in English | EMBASE | ID: covidwho-2060952

ABSTRACT

SESSION TITLE: What Lessons Will We Take From the Pandemic? SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Post COVID pulmonary complications can be attributed to severe inflammatory response that can result in pulmonary fibrosis. It is somewhat predictable in patients with severe illness, advanced age and comorbidities. However, a little is known about pulmonary complications in younger patients with mild illness followed up at outpatient clinics. We aim to shed light on post COVID pulmonary complications in patients who did not require hospitalization but had significant outpatient visits. METHODS: This study is based upon a retrospective chart review of patients who presented to Pulmonology Clinic at Cayuga Medical Associates with respiratory symptoms associated with COVID-19 disease. Mild illness was defined as symptoms of dyspnea on exertion or fatigue or shortness of breath that have not required oxygen and lasted for less than or equal to two months. Moderate illness was defined as symptoms of mild illness lasting for more than two months without oxygen supplementation. Severe illness was defined as hypoxia requiring home oxygen. We have excluded the patients who were hospitalized for COVID pneumonia. RESULTS: Of 23 patients (56.52% female) with COVID illness seen at Pulmonology Clinic in one-year duration, 13.04% had COPD, 26.09% had asthma and 21.74% had OSA. Median age was 33 with mean BMI 27.61.13.04% were current smokers. 39.13% required a PFT among which 77.78% had normal results. 21.74% of the total patients who never had OSA as an underlying diagnosis, required sleep study, among which 60% had mild OSA and 20% had severe OSA. 13.04% were already on oral steroids for other diseases. Majority of the patients had normal chest x-ray findings. 39.13% had CT chest, majority of which showed normal findings and few with diffuse ground glass opacities. 8.70% developed palpitations along with respiratory symptoms. At six months follow up, 43.48% had mild illness who were managed with conservative management such as incentive spirometry, deep breathing techniques, prone positioning and as needed short acting bronchodilator treatments. 43.48% had moderate illness who were treated with short course of oral steroids in addition to conservative management. 13.04% had severe illness who required home oxygen up to 2 L for two months maximum. Most common pulmonary complaint was dyspnea on exertion, seen in 43.48%. 17.39% had fatigue. 21.74% had sleep apnea symptoms. Median duration of symptoms was two months. CONCLUSIONS: Our study outlines the incidence of post COVID pulmonary complications in patient group where these complications are least expected. CLINICAL IMPLICATIONS: Post COVID pulmonary complications appear to be of significant concern in patients visiting outpatient clinics. The heterogeneity in management of those complications needs a serious attention. The feasibility and implementation strategy of post COVID-19-care-clinic with proper management guidelines should be brought to streamline practice. DISCLOSURES: No relevant relationships by Sameer Acharya No relevant relationships by Ali AKRAM No relevant relationships by Samjhauta Bhattarai No relevant relationships by Lavanya Kodali

4.
Chest ; 162(4):A2165, 2022.
Article in English | EMBASE | ID: covidwho-2060905

ABSTRACT

SESSION TITLE: Systemic Disease with Diffuse Lung Symptoms Case Posters SESSION TYPE: Case Report Posters PRESENTED ON: 10/17/2022 12:15 pm - 01:15 pm INTRODUCTION: Since its first detection at Wuhan, China, SARS-CoV-2 (novel coronavirus 2019) has engulfed the world with more than 100 million cases and manifestations of COVID19 have been evolving over time. Various post COVID19 syndromes are being recognized. Reactive arthritis, connective tissue disorders such as myositis and pulmonary complications have been correlated with exposure to COVID infection. We describe the case of antisynthetase syndrome in a patient correlated with exposure to COVID infection or vaccine. CASE PRESENTATION: A 68 year old female with history of hypertension and exposure to COVID infection in the family member, presented with 2-3 months worsening generalized body ache/pain started 2 weeks after receiving second dose of mRNA vaccine. Patient also reported dyspnea and leg swelling for 1 month. Upon presentation, she was placed on 4 liter oxygen via nasal cannula. Chest x-ray concerning for infiltrates, possibly COVID. CT chest no pulmonary embolism but evidence of pneumonia superimposed on chronic appearing bronchiectasis. Flu and Covid testing were negative. Patient was started on IV antibiotics for community acquired pneumonia. Labs showed elevated ESR, CRP and CK level. No fever, weakness, mechanics hands, rash or Raynaud's phenomenon. Infectious work up remained negative. No lymphadenopathy on CT chest to suggest sarcoid. ACE level normal. ANA and anti aminoacyl-tRNA synthetase antibody positive but other ENA were negative. HMG-COA ab negative. MPO/PR3 neg. Echocardiogram was unremarkable. Work up was suggestive of Anti synthetase syndrome with interstitial lung disease(ILD), a form of dermatomyositis. Patient was started on intravenous steroid with good improvement in symptoms and later transitioned to oral prednisone. Patient was discharged on minimal home oxygen with plan to start immunosuppressive medications. DISCUSSION: We are unsure if our patient had COVID19 infection since COVID testings were negative (antigen, antibody and nucleic acid detection ). The likelihood of autoimmune and rheumatic diseases in COVID19 survivors is a big issue. COVID19 infection may unmask previously undiagnosed rheumatic conditions and precipitate de novo disease, both of which may persist after resolution of the initial infection. Corticosteroids remain the cornerstone of early treatment with initial doses at 1mg/kg of the ideal body weight. In an effort to reduce steroid related side effects, other immunosuppressive agents should be considered at the outset of therapy, particularly when treating anti-synthetase syndrome with manifestations of ILD. CONCLUSIONS: Patients with anti-synthetase syndrome with ILD could have correlation with exposure to COVID infection or vaccination, and are steroid responsive. It is likely that clinical improvement may result from prompt suppression of inflammatory systemic response by corticosteroid. Reference #1: 1. Ahmed S, Zimba O, Gasparyan AY. COVID-19 and the clinical course of rheumatic manifestations. Clin Rheumatol. 2021;40(7):2611-2619. doi:10.1007/s10067-021-05691-x Reference #2: 2. Witt LJ, Curran JJ, Strek ME. The Diagnosis and Treatment of Antisynthetase Syndrome. Clin Pulm Med. 2016;23(5):218-226. doi:10.1097/CPM.0000000000000171 DISCLOSURES: No relevant relationships by ELINA MOMIN No relevant relationships by Mohammedumer Nagori

5.
Chest ; 162(4):A843, 2022.
Article in English | EMBASE | ID: covidwho-2060706

ABSTRACT

SESSION TITLE: COVID-19 Case Report Posters 3 SESSION TYPE: Case Report Posters PRESENTED ON: 10/19/2022 12:45 pm - 01:45 pm INTRODUCTION: One of the greatest challenges of the coronavirus (COVID-19) pandemic has been deciphering its unique properties, such as the propensity to infect and damage lung epithelium, thereby increasing susceptibility to pulmonary complications.(1, 2) A 2020 cohort study comparing patients with acute respiratory distress syndrome (ARDS) from COVID-19 and ARDS from other causes showed a significantly higher rate of subcutaneous emphysema and pneumomediastinum in the COVID-19 group, suggesting these diagnoses may be due to direct viral damage rather than exposure to positive pressure alone.(3) Presented here is a patient with no underlying lung pathology who was diagnosed with COVID-19 and developed severe subcutaneous emphysema, pneumomediastinum, and pneumothorax. CASE PRESENTATION: A 74 year old male with a history of hypertension presented to the emergency room with a 5-day history of difficulty breathing, cough, fever, chills, and weakness. He tested positive for COVID-19, required non-invasive positive pressure ventilation (NIPPV), and was started on ceftriaxone, doxycycline, and daily dexamethasone. He received a five-day course of remdesivir and one dose of convalescent plasma. By day 9, a chest x-ray revealed a left apical pneumothorax, bilateral subcutaneous emphysema, and pneumomediastinum. On day 12, his respiratory status deteriorated, necessitating invasive mechanical ventilation. A chest CT showed extensive subcutaneous emphysema involving the chest, supraclavicular and axillary regions, and abdominal wall, as well as extensive pneumomediastinum and a moderate left pneumothorax. A left-sided thoracostomy tube was placed and he was proned per ICU protocol. He required placement of a second left-sided chest tube due to persistent worsening pneumothorax. On day 28, despite all aggressive measures, he expired from acute hypoxemia. DISCUSSION: Although this patient was exposed to NIPPV, the severe degree of lung pathology was inconsistent with the amount of positive pressure administered. Furthermore, he lacked underlying pulmonary disease that would compromise his lung compliance to this magnitude. Combining evidence that COVID-19 can cause epithelial lung damage, the patient's absence of pulmonary risk factors, and his severe degree of lung damage incongruent with his exposure to positive pressure, is reasonable to extrapolate that a significant portion of his lung pathology was a result of direct damage from COVID-19. CONCLUSIONS: Patients with COVID-19 may be at higher risk for the development of subcutaneous emphysema, pneumomediastinum, and pneumothorax, likely due to direct viral effect. Lung damage seen may be disproportionate to exposure of positive pressure and may also be seen in the absence of any underlying pulmonary comorbidities. Awareness of this observed pathophysiology may help guide clinicians to optimize ventilator management as well as anticipate potential complications. Reference #1: Hu B, Guo H, Zhou P, Shi ZL. Characteristics of SARS-CoV-2 and COVID-19 [published correction appears in Nat Rev Microbiol. 2022 Feb 23;:]. Nat Rev Microbiol. 2021;19(3):141-154. doi:10.1038/s41579-020-00459-7 Reference #2: Miró Ò, Llorens P, Jiménez S, et al. Frequency, Risk Factors, Clinical Characteristics, and Outcomes of Spontaneous Pneumothorax in Patients With Coronavirus Disease 2019: A Case-Control, Emergency Medicine-Based Multicenter Study. Chest. 2021;159(3):1241-1255. doi:10.1016/j.chest.2020.11.013 Reference #3: Lemmers DHL, Abu Hilal M, Bnà C, et al. Pneumomediastinum and subcutaneous emphysema in COVID-19: barotrauma or lung frailty?. ERJ Open Res. 2020;6(4):00385-2020. Published 2020 Nov 16. doi:10.1183/23120541.00385-2020 DISCLOSURES: No relevant relationships by Shanaz Azad No relevant relationships by Sarah Monaghan No relevant relationships by Brandon Nance No relevant relationships by Samantha Peterson

6.
Chest ; 162(4):A546-A547, 2022.
Article in English | EMBASE | ID: covidwho-2060624

ABSTRACT

SESSION TITLE: Lung Transplantation: New Issues in 2022 SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Immunosuppressed patients are more susceptible to severe infection due to COVID-19. Management of lung transplant recipients is especially difficult due to constant exposure of the graft to the environment, leading to increased risk of rejection and requiring higher levels of maintenance immunosuppressive regimens. Mortality rates for lung transplant recipients with COVID-19 infection have ranged from 15% to 40% in published case series. We report our centers experience in managing lung transplant recipients with COVID-19 infections in a moderate-volume lung transplant center in Grand Rapids, Michigan. METHODS: This is a single center review of all lung transplant recipients with a COVID-19 diagnosis from March 2020 to December 2021. Recipients’ demographics and baseline characteristic, as well as their management, post infectious complications, and mortality data, were reviewed. RESULTS: In 2019, our center performed 48 lung transplants. During the study period, 42 of the 219 (19%) lung transplant recipients followed at our center had COVID-19 infections diagnosed by nasal or nasopharyngeal PCR testing. Twenty-four (57%) were male, mean age of 60.5 (range 25-77). Thirty-six (86%) patients had bilateral lung transplants. The diagnosis leading to their transplantation were COPD (N=18, 43%), idiopathic pulmonary fibrosis (N=12, 29%), cystic fibrosis (N=5, 12%), other pulmonary fibrosis (N=3, 7%), alpha-1 antitrypsin deficiency (N=2, 5%), Sarcoidosis (N=1, 2%), and ARDS (N=1, 2%). Almost all patients were on standard three drug immunosuppressive regimens which included a steroid, calcineurin inhibitor, and nucleotide-blocking agent, at the time of diagnosis. Mean time from transplant to diagnosis of COVID-19 was 34.6 months (range 1 to 104 months). Fifteen (36%) of the patients were unvaccinated. Once diagnosed, patients were advised to monitor their home spirometry and vitals at least daily. They were evaluated weekly via telemedicine by a physician or advanced practice provider. They received the following treatments: monoclonal antibody (N=31, 74%), increased steroids (N=5, 12%), remdesivir (N=2, 5%), Tocilizumab (N=1, 2%). Eleven (26.2%) patients required hospitalization, 4 (10%) required ICU admission and intubation. Mean length of stay was 7.5 days (median of 3 days). Three (7%) patients required oxygen at discharge. Of the 42 infected patients, 3 (7.1%) died on day 3, 16 and 326 days from the date of infection. CONCLUSIONS: Our center reports a lower mortality rate than previously published data in lung transplant recipients infected with COVID-19. We attribute this to availability of the vaccine, early detection and treatment, as well as close monitoring of the patients. CLINICAL IMPLICATIONS: Though COVID-19 infection can have devastating complications in lung transplant recipients, vaccinations and monoclonal antibody treatment reduce morbidity and mortality in this population. DISCLOSURES: No relevant relationships by Phillip Camp research relationship with United Therapeutics Please note: 2016- ongoing by Reda Girgis, value=Grant/Research research relationship with Pfizer Please note: 2014-2020 by Reda Girgis, value=Grant/Research Speaker/Speaker's Bureau relationship with Boehringher Ingelheim Please note: 2016-ongoing by Reda Girgis, value=Honoraria Speaker/Speaker's Bureau relationship with Genentech Please note: 2016-ongoing by Reda Girgis, value=Honoraria no disclosure on file for Ryan Hadley;No relevant relationships by Sheila Krishnan No relevant relationships by Edward Murphy No relevant relationships by Gayathri Sathiyamoorthy

7.
Chest ; 162(4):A402-A403, 2022.
Article in English | EMBASE | ID: covidwho-2060586

ABSTRACT

SESSION TITLE: Complicated Chest Infections SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 12:25 pm - 01:25 pm INTRODUCTION: Fusarium species (FS) are large filamentous fungi widely distributed in soil and plants that are well-known to cause human infections ranging from superficial to disseminated predominantly depending on the host's immune system. Histoplasma capsulatum (HC), on the other hand, is a dimorphic fungus found in soil contaminated with bird or bat droppings, such as caves, where most infections are asymptomatic or self-limited. We present a case of an immunocompetent patient who developed long-term pulmonary sequelae after a co-infection pneumonia with FS and HC. CASE PRESENTATION: 47-year-old man, non-smoker with history of Myasthenia Gravis presents to the emergency department with worsening shortness of breath and sporadic episodes of fever over the course of 3 weeks. The patient claimed to have gone cave-exploring and worked as an air-condition technician. During the previous three years, he reports progressive dyspnea on exertion, fatigue, and a constant dry cough that required multiple hospitalizations which was treated as Myasthenic Crisis. Clinical exam was remarkable for diffuse rales on bilateral lungs with a resting hypoxia of 82-84%. Laboratories showed elevated inflammatory markers with no leukocytosis or neutropenia. Chest-x-ray revealed increased pulmonary markings and chest CT demonstrated diffuse bilateral ground-glass opacities with septal thickening and innumerable millimetric pulmonary nodules of unclear distribution. Extensive infectious, immunologic, and rheumatologic workup were negative. He underwent a bronchoscopy with broncho-alveolar lavage (BAL) which showed FS and HC on cytology. Therefore, intravenous liposomal Amphotericin B was given for 2 weeks followed by a long-course of oral Voriconazole resulting in marked improvement of symptoms, yet he remained with limited physical activity due to exertional hypoxia of less than 80%. Pulmonary function tests revealed mixed obstructive-restrictive disease. DISCUSSION: To our knowledge, this case represents a novel and rare presentation of invasive pulmonary fusariosis with superimposed histoplasmosis in an immunocompetent host. Our patient had environmental exposure for years with subsequent chronic and progressive respiratory symptoms, however, with no evidence of immunosuppression. Imaging findings were non-specific which difficulted the diagnosis. Nonetheless, the patient was given directed antifungal therapy as a result of the BAL's histopathologic findings with improvement of symptoms. CONCLUSIONS: Regardless of the immunologic status, invasive fungal pneumonia should be considered in patients with prolonged environmental exposure and non-specific chest imaging abnormalities. Reference #1: Chae, S. Y., Park, H. M., Oh, T. H., Lee, J. E., Lee, H., Jeong, W. G., & Kim, Y.-H. (2020). Fusarium species causing invasive fungal pneumonia in an immunocompetent patient: a case report. Journal of International Medical Research. https://doi.org/10.1177/0300060520976475. Retrieved March 18, 2022. Reference #2: Kauffman, C. A. (2022). Diagnosis and treatment of pulmonary histoplasmosis. In Bogorodskaya, M. (Ed.), UpToDate. Retrieved March 18, 2022, from https://www.uptodate.com/contents/diagnosis-and-treatment-of-pulmonary-histoplasmosis. Reference #3: Poignon, C., Blaize, M., Vezinet, C., Lampros, A., Monsel, A., & Fekkar, A. (2020). Invasive pulmonary fusariosis in an immunocompetent critically ill patient with severe COVID-19. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases, 26(11), 1582–1584. https://doi.org/10.1016/j.cmi.2020.06.026. Retrieved March 18, 2022. DISCLOSURES: No relevant relationships by Juan Adams-Chahin No relevant relationships by Jorge Barletta Farias No relevant relationships by Gabriel Galindez De Jesus No relevant relationships by Camille Gonzalez Morales No relevant relationships by manuel hernandez No rele ant relationships by Enrique Leal No relevant relationships by Arelis Morales Malavé No relevant relationships by Ruth Santos Rodriguez

8.
Journal of Thoracic Oncology ; 17(9):S213-S214, 2022.
Article in English | EMBASE | ID: covidwho-2031514

ABSTRACT

Introduction: It was aimed to evaluate the efficacy, local control and survival in patients with inoperable primary or metastatic lung cancer who underwent stereotactic body radiotherapy (SBRT) using the Cyberknife-M6 (CK-M6) with lung optimized treatment (LOT) module. Methods: Ethics committee (no: 2018-7/6) and scientific research project (OUAP (T) 2019/1) approval were obtained. 23 lesions of 21 patients were treated between April 2019 to December 2020 at our department. The patients were immobilized in the supine position by wearing a Synchrony vest, with the hands at their sides. A planning 4D-CT was obtained in a free breathing modality. The gross target volumes was created both on the full-inhale and full-exhale phases and internal target volume (ITV) was created. By taking an image of patients on the treatment device, tracking modality was selected according to the visibility of the target. Zero-View tracking was applied in 10 patients, 1-View in 10 patients, 2-View in 1 patients. 3 to 5 mm margin added for planning target volume (PTV) according to tracking method. Median ITV and PTV was 9,38 (2-52,34) and 20,27 (9,25-82,7) cc, respectively. An InCise2 multileaf collimator optimized by the Monte Carlo algoritm was used in all patients. A pair of the orthogonal kV X-ray imaging systems were used for simultaneous target tracking. Median prescribed dose was 48 Gy in 4 fractions (30-54 Gy in 3-6 fractions) administered consecutively or every other day. Prescription isodose covering 95% of PTV was 82,5% (77,4-99,3). Median conformity and homogeneity index was 1,17 (1,02-1,77) and 1,22 (1,09-1,29), respectively. Median BED10 was 100 Gy (53,62-151,2) and median beam on time was 26 minutes (12-42). Results: Patients were evaluated on January 2022. The median follow-up was 21 months (2-33). The median age was 68 (53-80) and 40% of the cases were adenocarcinoma. Two patients diagnosed with radiologically. Median lesion size was 13 mm (9-27). SBRT was applied to 13 primary tumors, 3 lung metastases and 7 lymph nodes. At initial evaluation, complete, partial and stable response was found 30%, 65% and 5%, respectively. During the follow-up, 3 patients locally recurred at a median of 11 months (9-14). The median and one-year local recurrence free survival was 22 months, and 89%. Acute and late grade 1-2 pulmonary complications was seen in 10 patients in a median of 7 months (2-13). While the cause of death in 6 cases was existent cardiac morbidity, covid19 pneumonia, lung infection (2) and progression (2), it was unknown in 1 patient. The median and one-year survival was 23 months and 95%. Conclusions: LOT module of the CK-M6 Xsight lung tracking system allows for the application of fiducial-free motion management strategies. The advantage of our study is that the most appropriate tracking modality can be selected prospectively before treatment. In our study, excellent local control with a median survival of 23 months for primary and metastatic lung cancer. With a median treatment time 26 minutes, noninvasive CK-M6 based SBRT was efficient, safe and comfortable treatment in lung cancer. Keywords: lung cancer, Cyberknife-M6, stereotactic body radiotherapy

9.
International Journal of Pharmaceutical and Clinical Research ; 14(8):245-252, 2022.
Article in English | EMBASE | ID: covidwho-2003129

ABSTRACT

Background: Following covid 19, most patients have variety of neurological symtoms (headache, dizziness, tinnitus, paraesthesia, sleep disorders, loss of taste and smell, mental fog, concentration issues, anxiety, depression) persisting even after resolution of fever, cough. Fatigue is the most frequently described and globally recognized as a disabling symptom following covid. Fatigue reflects subjective state, decreased capacity to perform, decrement in vigilance. General psychophysiological phenomenon in which motivational decrement, diminished ability to perform tasks with alertness, vigilance is reduced. Several weeks after COVID 19, some patients are still dealing with lung complications and crushing fatigue. The long-term consequences of covid 19 are being studied. The aim of the study is to understand persisting fatigue, investigate associated risk factors, disease severity. Materials and methods: COVID 19 post-acute outpatient clinic. Outpatients who met WHO criteria for discontinuation of quarantine i.e., no fever for 3 consecutive days, improvement in other symptoms, RT PCR negative. Results: 19 of 53 patients reported of chronic fatigue syndrome. No association between severity of illness, inflammatory markers and fatigue. Persistent fatigue following SARS-CoV-2 is common and independent of severity of initial infection. Conclusion: Fatigue persists after COVID 19. Identifying the type of fatigue, early interventions could reduce socio economic burden. Frequent follow up is required to identify long term consequences of covid 19.

10.
Russian Journal of Infection and Immunity ; 12(3):511-518, 2022.
Article in English | EMBASE | ID: covidwho-1969864

ABSTRACT

Background. The SARS-CoV-2 pandemic has prompted researchers around the world to identify risk factors associated with disease severity and mortality. Results suggest that COVID-19 mortality might be due to a ‘cytokine storm’ involving IL-6, and that obesity can be considered a risk factor for COVID-19 prevalence, severity, and mortality. The current study aimed to evaluate the serum levels of IL-6 and adiponectin in patients and their relationship with disease progression. Materials and methods. ELISA was used to assess the levels of IL-6 and adiponectin in serum samples from a control group and from patients with COVID-19 at the time of admission to ICU or non-ICU wards. The results were analyzed using the Mann–Whitney and Spearman tests. Results. Mean serum levels of adiponectin in patients admitted to ICU (10.18±15.4 ng/ml) were significantly higher than patients admitted to non-ICU wards (3.14±3 ng/ml, p = 0.001). Mean serum IL-6 levels showed a similar pattern, however the difference was not statistically significant (p = 0.18). In addition, a significant direct correlation was observed between adiponectin expression and IL-6 (R = 0.2, p = 0.03). Conclusion. The results of this study show that serum levels of adiponectin in COVID-19 patients with severe lung involvement were significantly higher than those with less lung involvement. This finding is of high importance mainly due to the critical role of the lungs in adiponectin signaling, and as a result, adiponectin disorders may be associated with pulmonary complications in COVID-19 patients.

11.
Polish Annals of Medicine ; 28(2):244-249, 2021.
Article in English | EMBASE | ID: covidwho-1957648

ABSTRACT

I nt r o duc t i o n: First cases of a disease called coronavirus disease 2019 (CO-VID-19), caused by a novel virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) of the coronavirus family, were detected in December 2019. The disease is manifested by a variety of symptoms and can run a different course: from oligosymptomatic or asymptomatic to the development of acute respiratory failure and even death. Ai m: The aim of this paper is to provide critical analysis of the potential pulmonary complications after COVID-19 infection. Ma t e r i a l a nd me t ho ds: We have provided the systematic literature review based on which we have discussed the pathophysiology of COVID-19, its outco-mes, risk factors and pulmonary complications. R e s u l t s a n d d i s c u s s i o n: The organs that are most often affected by a SARS--CoV-2 infection are the lungs. An infection with this virus can lead to a severe respiratory tract illness, both in the acute phase and as a complication after a rela-tively mild case. There are numerous observations of patients convalescing from COVID-19 who suffer from the interstitial pulmonary disease with fibrosis. There are also reported cases of spontaneous pneumothorax after COVID-19. Co nc l us i o ns: It should be borne in mind that other late complications may appear with time.

12.
Pakistan Journal of Medical and Health Sciences ; 16(6):355-356, 2022.
Article in English | EMBASE | ID: covidwho-1939796

ABSTRACT

Objective: To analyze multisystem imaging techniques for diagnosis of Covid-19 viral pathogenesis and pulmonary complications. Study Design: Retrospective study. Place and Duration of Study: Department of Pulmonology, Ghulam Muhammad Mahar Medical College, Sukkur from 1st June 2021 to 31st December 2021. Methodology: Two hundred patients admitted due to Covid-19 positive results were enrolled. Pulmonary consolidations and pneumonia related alterations were observed due to these images. Changes which were related with acute respiratory distress syndrome in complicate Covid-19 cases were also observed. Patients with serious illness were further underwent chest computer topographic imaging scan. Pulmonary-US scan was also performed on the bedside of severe ill Covid-19 patients. In patients with acute respiratory decline and acute dyspnea were also further diagnosed through computed tomography angiography. Results: The mean age of the patients was 41.2±6.5 years. Chest radiograph presented bilateral pneumonia opacities. In a typical progressive pneumonia could be seen through non-contrast enhanced computed tomography imaging in covid-19 patients with glass opacities and bilateral ground glass opacities. In many cases multifocal, patchy as well as distribution findings which were confluent and organizing as pneumonia were also observed. Pulmonary embolism was also identified through computed tomography imaging in Covid-19 patients. Conclusion: Multisystem imaging techniques are significantly important and efficient in diagnosis of various manifestations of Covid-19.

13.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927923

ABSTRACT

Rationale: LAU-7b is developed as a broadly effective oral COVID-19 therapeutic targeting membrane lipids to exert dual antiviral and inflammation-controlling activity. SARS-CoV-2 reprograms host cellular lipid metabolism to favor entry and replication, a mechanism shared by all lipid-enveloped viruses. LAU-7b decreases host cell membrane lipids fluidity, inhibits de-novo cell lipogenesis, and modulates phospholipid signaling promoting resolution of inflammation. Due to its host-directed mutation-agnostic mechanism, LAU-7b utility could span across future variants, as demonstrated in-vitro against multiple SARS-CoV-2 strains and MERS-CoV. RESOLUTION, a large Phase 2/3 study evaluating LAU-7b in hospitalized COVID-19 patients, is ongoing in the US and Canada, and preliminary Phase 2 results are presented. Methods: RESOLUTION is a placebocontrolled study of oral LAU-7b, once-a-day for 14 days on top of standard of care, in hospitalized COVID-19 patients at risk of developing pulmonary complications. The Phase 2 portion of the study randomized 148 patients with moderate-to-severe COVID-19 and 84 patients in critical condition, but not on invasive ventilation. Key endpoints included proportion of patients alive and free of respiratory failure at Day 29, rates of progression to mechanical ventilation and all-causes death by Day 60, time to recovery and length of hospitalization. Results: Both study arms were highly comparable in terms of mean age, number of comorbidities and concomitant medications. LAU-7b demonstrated a 100% reduction in the risk of progressing to mechanical ventilation or death by Day 60 in moderate-to-severe COVID-19 patients. None of the 76 patients on LAU-7b required mechanical ventilation and none died, while 5 out of 72 patients on placebo progressed to mechanical ventilation (6.9% difference, p=0.025), and 4 patients died (5.6% difference, p=0.053). LAU-7b group also showed an increase of 6.9% (p=0.055) in the proportion of patients alive and free of respiratory failure at Day 29, versus placebo. Patients on LAU-7b tended to recover more rapidly and leave hospital faster. LAU-7b was well-tolerated, with safety comparable to placebo. Critically ill patients treated with LAU-7b did not show improvement over placebo, suggesting that COVID-19 patients in respiratory failure at baseline are too severely affected to benefit. Conclusion: LAU-7b showed positive results in the trial's Phase 2 portion on both survival and avoidance of mechanical ventilation in moderate-to-severe COVID-19. The confirmatory Phase 3 portion was triggered and received approval from the FDA and Health Canada, focusing on moderate-to-severe COVID-19 and using the “Proportion of patients requiring mechanical ventilation and/or death by Day 60” as primary efficacy endpoint.

14.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927915

ABSTRACT

Introduction: In our study, we are reporting pulmonary function testing (PFT) changes post recovery from SARS-CoV-2 infection in the pediatric and adolescents. This is a unique paper which may shed light on a matter of utter importance that has been poorly reported in the literature. Studies reviewing SARS-CoV-2 infection PFT, mostly from adult, had shown obstructive and restrictive impairment, small airway dysfunction, and decreased diffusion capacity for carbon monoxide (DLCO), which gives an overall assessment of the lung's ability of gas exchange likely due to SARS-CoV-2 triggered pulmonary vasculopathy. Restrictive pattern and decreased DLCO were the most frequently impaired PFT parameter. Method: This is a single-site retrospective charts review of children and adolescents, ages 6 to 22 years old, who presented to pediatric pulmonology outpatient after having a SARS-CoV-2 infection. They were either managed in the hospital and had at least one pulmonary symptom or they were managed as outpatient. Results: In our case series of 33 patients, mean age was 16.8 years, the majority were seen as an outpatient (78.7%, 26/33). PFT results were interpreted using ATS standard, 4 PFT were suboptimal, mean time from SARSCoV- 2 infection and PFT was 4.3 months. Among patients with optimal PFT, 72.4% (21/29) had abnormal PFT (table 1). Subjects with PFT changes, 9 previously healthy subjects had PFT changes post- SARS-CoV-2, compared to 12 patients who had history of asthma. All hospitalized patients had measured DLCO except one whom DLCO wasn't measured. Among all hospitalized patients, whose pulmonary imaging exhibited ground glass opacities, 2 patients had normal DLCO (42.8%, 2/6). The rate of low DLCO was higher inpatient than outpatient cases (42.9% vs. 4.5%, p<0.0369) with mean DLCO 71.2% predicted. All hospitalized patients with decreased DLCO had elevated lactate dehydrogenase (LDH) and D-dimer.The most common co-morbid conditions noted to have were asthma (55%, 16/29) and obesity/overweight (51.7%, 15/29). Subjects who were hospitalized, 71% (5/7) required supplemental oxygen;most common chest imaging findings were bilateral ground-glass opacity, or patchy infiltrates. LDH was elevated in 71% (5/7) whereas D-dimer was elevated in 85.7% (6/7). All received steroids, and 85.7% (6/7) received remdesivir. Conclusion: SARS-CoV-2 related pulmonary complications remains a topic of research and is poorly studied in pediatric population. Impaired DLCO could correlate imaging findings However;we didn't find that association in our report, which is limited by low sample size. PFT may be useful as an objective measure for post-COVID infection follow up. (Figure Presented).

15.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927721

ABSTRACT

Introduction: First synthesized in 1869, Hydroxyurea is known for its efficacy in treating myeloproliferative disorders, cervical cancer, and sickle cell disease. Usually well-tolerated, Hydroxyurea has numerous documented adverse effects, including bone marrow suppression, fevers, gastrointestinal upset, anorexia, and maculopapular rash. In addition, one rare side effect is interstitial pneumonitis, a potentially devastating complication if overlooked. We present one such case of Hydroxyurea-induced interstitial pneumonitis. Case Description: A 65-year-old man with a six-month diagnosis of Chronic Granulocytic Leukemia (CGL) on Hydroxyurea developed acute hypoxemic respiratory failure saturating 80% on room air with HR 102, RR 24, and increasing oxygen requirements (10 Lpm) after being admitted with complaints of worsening dyspnea, fatigue, and productive cough with yellow/green sputum. Physical examination was notable for cachexia, ill appearance, generalized weakness, hoarse voice, tachycardia, tachypnea, diffusely diminished breath sounds, and scattered rales on auscultation of lung fields. Initial imaging was notable for bilateral airspace disease and pulmonary opacities on chest radiography and bilateral pneumonia (concerning for COVID-19 pneumonia), mediastinal adenopathy, and splenomegaly on chest computed tomography. Initial laboratory results were notable for leukocytosis 62.5 th/uL, lactic acidosis 2.5 mmol/L, procalcitonin level 4.95 ng/mL, and negative COVID-19 PCR test. Prompt initiation of Vancomycin/Cefepime therapy ensued upon collection of blood cultures in light of possible sepsis. Flagyl, Valacyclovir, and Posaconazole were added to antimicrobial coverage, along with steroid therapy, due to minimal clinical improvement. Tachycardia with significant oxygen requirements alternating between BiPAP and heated high flow nasal cannula with FiO2 ranging from 70-85% persisted. Daily imaging also showed worsening airspace disease. Negative viral, bacterial, and fungal cultures led to subsequent discontinuation of Hydroxyurea therapy due to suspicion of medicationinduced pneumonitis. Three days after cessation of Hydroxyurea, the patient's oxygen requirements began to decrease and imaging revealed interval resolution of pneumonitic changes in the absence of antimicrobial therapy. The patient was later transitioned to Ruxolitinib for his underlying CGL prior to his discharge home without the need for home oxygen therapy. Discussion: Thought to be caused by hypersensitivity pneumonitis, pulmonary toxicity from Hydroxyurea can easily be misdiagnosed. Unfortunately, while much is known about the pancytopenic, gastrointestinal, and cutaneous side effects of Hydroxyurea, few cases in the literature highlight the potentially fatal interstitial pneumopathy caused by Hydroxyurea, first reported in 1999. Thus, this case serves as an additional contribution to the minutiae of literature detailing Hydroxyurea's adverse pulmonary side effect profile. (Figure Presented).

16.
Diseases of the Colon and Rectum ; 65(5):185, 2022.
Article in English | EMBASE | ID: covidwho-1893948

ABSTRACT

Purpose/Background: Identify barriers for compliance with orders for incentive spirometer (IS) to be at postoperative patients' bedside on POD 0/1 with patient education on use. Hypothesis/Aim: There are barriers to order compliance that are not readily identifiable. Methods/Interventions: Many of our elective post-colectomy patients were not receiving incentive spirometers (IS) to the bedside on postoperative day (POD) 0/1 as ordered. This is important since our patient population is older than ever before, with comorbidities that elevate risk for pulmonary complications. We collected baseline data on the frequency of successful order completion. We focused intervention on the unit caring for the vast majority of our postoperative patients. Head nurses of both the preanesthesia unit and the postoperative unit were interviewed to clarify how orders for IS and teaching were fulfilled. A plan was enacted to improve the rate of IS being at the patient bedside on POD 0/1. Data was then collected over a four month period after the plan's implementation. This took place in a single center tertiary care center. Results/Outcome(s): Baseline data revealed an overall rate of IS to patient bedside on POD 0/1 of 31%. Process was that IS and teaching are provided to patient in pre-anesthesia setting. IS then may go to postop area with patient belongings, or family may inadvertently take the IS home. This often requires an additional IS to be provided after the lack is noted by surgical caregivers, and often includes a 24+ hour lag time. Intervention was enacted of placing IS in clear plastic bag, separate from other belongings, and family educated to allow IS to accompany patient to postoperative unit. After intervention was instituted, overall success rate of IS to patients on POD 0/1 rose to 46%, and on the unit caring for most CRS patients success rate was 62.5%. Limitations: Short time frame for data collection and education of nursing and support staff. High rate of nursing turn-over during the COVID-19 pandemic. Conclusions/Discussion: There can be many reasons that a written order is not executed as planned. When the number of individuals and units involved in the order execution increases and is elastic or variable, there are many possible points at which the expected execution can fail. Identification of the simplest pathway can aid in all the stakeholders being more motivated to help the pathway succeed.

17.
Egyptian Journal of Radiology and Nuclear Medicine ; 53(1), 2022.
Article in English | EMBASE | ID: covidwho-1869114

ABSTRACT

Background: Coronavirus disease COVID-19 is a viral illness, currently affecting millions of people worldwide. Pneumonia is the most common extreme presentation of COVID-19 infection, manifesting by fever, dry cough, difficulty of breathing or shortness of breath and mainly ground-glass infiltrates in radiological images. Chest computed tomography (CT) has a potential role in the diagnosis, detection of complications and prognostication of coronavirus disease COVID-19. In addition to severe respiratory manifestations, there are a wide range of neurological manifestations ranging from nonspecific symptoms to necrotizing encephalopathies and stroke. Our study aimed to review lung and neurological manifestations in recent and post-COVID-19 Egyptian patients and to be familiar with magnetic resonance imaging (MRI) findings of Neuro-COVID patients. Results: The present study included eighty COVID-19 patients with age ranged from 28 to 78 years (mean age 57.84 + 12.58 years) who were 54 males (mean age 56.64 + 12.50) and 26 females (mean age 48.65 + 14.24). All our patients were with recent or previous history of COVID-19 infection and subjected to careful history taking, thorough clinical examination, routine laboratory investigations and CT examination. The reported lung manifestations included normal lung shadows, ground-glass opacifications (GGOs), consolidations, reticulation, reticulation and GGOs (crazy paving) and fibrotic-like changes. Out of eighty COVID-19 patients, twenty showed neurological manifestations ranging from nonspecific symptoms to necrotizing encephalopathies and stroke. Patients with neurological manifestation were in addition to CT submitted to magnetic resonance imaging (MRI) as appropriate. MRI done to neuro-COVID patients showed that 8/20 (40%) had no abnormalities and 12/20 (60%) had abnormalities. The most common abnormalities are infarction, major or lacunar infarction, followed by acute disseminated encephalomyelitis (ADEM), posterior reversible encephalopathy syndrome (PRES) and meningoencephalitis. Conclusion: Old age patients, especially males, were more affected than females. Lung manifestations are common in COVID-19 patients than neurological manifestations. The presence of fibrotic changes in the lung could predict severe COVID-19 affection and bad prognosis. There might be an association between appearance of neurological manifestations and poor outcome in COVID-19 patients.

18.
Lung India ; 39(SUPPL 1):S153-S154, 2022.
Article in English | EMBASE | ID: covidwho-1857762

ABSTRACT

Background: SARS-COV-2 has caused morbidity and mortality at an unprecedented scale globally. During recovery, several patients are found to have functional impairment and radiological abnormalities. Case Study: An observational study done on 54 post-covid patients attending our center during July to November. A detailed history, radiology and clinical data during acute and post-covid visit were analyzed. Aims: To document various post-covid complications, assessing risk factors for complications Discussion: Mean age group of presentation 49.2years, mean time of follow-up presentation is 66.4 days. Incidence is higher in males (64.8%) than females (35%),83.3% are having one or more existing comorbidities during acute covid mainly diabetes 61%, hypertension 38%, Both in 25%, copdin 7.4%, tuberculosis in 3.7%, HIV in 1.85 %. About 79.6% had more than 3 weeks of hospital stay,46.2% are on NIV support during acute covid. Majority of post-covid patients came with dyspnea -75.9%, cough -74%, fatigue -31.4%, productive cough -14%, fever -9%, chest pain -7%. Resting hypoxia is seen in 29.6% of patients. Of post-covid patients,88% presented with pulmonary fibrosis,12.9% with pnemothorax,12.9%with lung cavity,3.6%with necrotizing pneumonia and 1.8%with lung abscess. Both pneumothorax and fibrosis are seen in 9.25%, both cavity and fibrosis in 5.5%. post-covid pulmonary cavities (7) were due to tuberculosis, klebsiella, pseudomonas, E. coli, fungal itology.Comparativelyradiological improvement is seen in 86% of the patients Conclusion: Diabetes,nonvaccinating, severe covid at admission, mechanical ventilation, older age contributes to severe post-covid complications.Regularfollow up,rehabilitation therapy, screening for tuberculosis is to be considered.

19.
Lung India ; 39(SUPPL 1):S1, 2022.
Article in English | EMBASE | ID: covidwho-1857487

ABSTRACT

Background: Coronavirus disease 2019 (COVID-19) is a communicable disease caused by SARS-CoV-2. Ranging from atypical pneumonia to respiratory failure & ARDS. The complications are pulm fibrosis, pneumothorax / pneumomediastinum, pleural effusion & TB. Development of a pneumothorax is emerging complications. Potential cause is structural changes include cystic & fibrotic changes leading to alveolar tears. Also Increase in intrathoracic pressure from prolonged coughing or respiratory support. However, pneumothorax was rare complication all patients required placement of chest tube. The reactivation of tb due to decreased in built immunity or due to steroids. Materials and Methods: We performed a retrospective review. Cases were collected from Govt medical college Kota. Clinical, radiological, demographic and laboratory data were collected. Also Diagnosed with pulm complications. Results: 50 cases were included. Study done btw November 2020 to August 2021. 34 patients covid RT PCR positive, 16 patients were negative (positive in CT). 40 patients were hospitalized, 10 were home isolated during covid infection. Hydropneumo/pneumothorax develop in 12 (24%), with associated pneumomediastinum in 3 (6%) patients, primary tb or reactivation tb in 8 (16%), pleural effusion 1 (2%) patient. post covid fibrosis was found in most of cases 41 (82%). Conclusion: COVID 19 affect the whole body, the post covid fibrosis is main complications. both pneumothorax or pneumomediastinum may be present during or after SARS COVID 19 pneumonia even in non-intubated patients.

20.
Lung India ; 39(SUPPL 1):S152, 2022.
Article in English | EMBASE | ID: covidwho-1857378

ABSTRACT

Background: There is a need for a unified pathway & structure for the respiratory follow-up of patients with COVID-19 pneumonia. Introduction: The long- term complications of COVID-19 pneumonia-Pulmonary Fibrosis, Pulmonary vascular disease, Bronchial Hyper-reactivity, Pleural effusion are real. Aims and Objectives: 1. To estimate the prevalence of post covid-19 pulmonary complications 2. To study the risk factors& long-term outcome of post covid pulmonary fibrosis. Methods: Prospective study;Study Period: November 2020-January 2021;All patients with history of COVID-19 attending post covid clinic of MES Medical College during the study period. RESULTS • Out of the 300 patients studied,most common outcome was post covid pulmonary fibrosis- 10.7%;followed by death 9%, Pleural effusion (2%), Bronchial hyperreactivity (1.3%), Pulmonary embolism (.3%), Anosmia (.3%), Pneumothorax (.3%) and Organizing Pneumonia (.3%) • Follow up study of patients with post covid pulmonary fibrosis, showed clearance in serial chest-xray. Conclusion: Most of the complications were seen among Cat-C patients, the most common being post covid pulmonary fibrosis which showed a serial decrement in the chest-xray scores suggesting favourable outcome.

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