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1.
Indian Journal of Forensic Medicine and Toxicology ; 16(2):326-333, 2022.
Article in English | EMBASE | ID: covidwho-1957671

ABSTRACT

Coronavirus disease 2019 discovered in December 2019, Wuhan, China. It was transmitted globally producing the present COVID-19 pandemic. Concerns have been raised about the potential impact of COVID-19 on male reproductive organs and male fertility as the number of infections in the male community has increased. The objectives of current study are studying the relationship between the plasma levels of testosterone and the markers of immune reaction with the severity and mortality in a sample of COVID-19 patients. A cross section study included NO= 103 male patients affected by SARS-CoV-2 pneumonia, diagnosed by PCR and chest CT scan, (≥ 18 years old), and recovered in the respiratory intensive care unit (RICU). Several biochemical risk factors were determined Free Testosterone, sex hormone binding globulin (SHBG) were measured by Enzyme-Linked Immunosorbent Assay(ELISA), D-dimer, Ferritin, CRP, Urea, Creatinine were measured by automated method by using Abbott Architect c4000 and Complete Blood Count(CBC). The results show that the serum free testosterone and SHBG levels a significant lower in non-survivor patients than survivor patients with COVID-19. While the other biomarkers (D-dimer, Ferritin, Urea, Creatinine) were significant higher in non-survivor patients than survivor patients. The CRP, WBC and lymphocyte showed that no significant between the both group of patients. In conclusion the study showed that lower free testosterone and SHBG levels enable significant role in increasing risk of COVID-19 mortality amongst adult male patients.

2.
Journal of Clinical Periodontology ; 49:84, 2022.
Article in English | EMBASE | ID: covidwho-1956753

ABSTRACT

The aim is to determine oral manifestations in patients with COVID-19 disease and in the postcovid period. Methods: A special survey (questionnaire) was made in 424 people who had COVID-19 confirmed by RT-PCR, ELISA for specific IgM and IgG antibodies and Chest CT scan (168 people). 123 people had complaints and clinical symptoms in the oral cavity 2-6 months after the illness and they came to the University dental clinic. Laboratory tests have been performed (clinical blood test, blood immunogram, virus and fungal identification). Results: Survey results showed that 16,0% participants had asymptomatic COVID-19, 23,6% - mild and 48,1% moderate disease. 12,3% with severe COVID-19 were treated in a hospital with oxygen support. In the first 2 weeks 44,3% indicated xerostomia, dysgeusia (21,7%), muscle pain during chewing (11,3%), pain during swallowing (30,2%), burning and painful tongue (1,9%), tongue swelling (30,2%), catharal stomatitis (16,0%), gingival bleeding (22,6%), painful ulcers (aphthae) (8,5%) and signs of candidiasis - white plaque in the tongue (12,3%). After illness (3-6 months), patients indicated dry mouth (12,3%), progressing of gingivitis (20,7%) and periodontitis (11,3%). In patients who applied to the clinic we identified such diagnoses: desquamative glossitis - 16 cases, glossodynia (11), herpes labialis and recurrent herpetic gingivostomatitis (27), hairy leukoplakia (1), recurrent aphthous stomatitis (22), aphthosis Sutton (4), necrotising ulcerative gingivitis (13), oral candidiasis (14), erythema multiforme (8), Stevens-Johnson syndrome (2), oral squamous cell papillomas on the gingiva (4) and the lower lip (1). According to laboratory studies, virus reactivation (HSV, VZV, EBV, CMV, Papilloma viruces) was noted in 52 patients (42,3%), immunodeficiency in 96 people (78,0%), immunoregulation disorders (allergic and autoimmune reactions) in 24 people (19,5%). Conclusions: Lack of oral hygiene, hyposalivation, vascular compromise, stress, immunodeficiency and reactivation of persistent viral and fungal infections in patients with COVID-19 disease are risk factors for progression of periodontal and oral mucosal diseases.

3.
IHJ Cardiovascular Case Reports (CVCR) ; 6(2):83-85, 2022.
Article in English | EMBASE | ID: covidwho-1956162
4.
American Journal of Stem Cells ; 11(3):37-55, 2022.
Article in English | EMBASE | ID: covidwho-1955743

ABSTRACT

Objective: Mesenchymal stem cells can serve as a therapeutic option for COVID-19. Their immunomodula-tory and anti-inflammatory properties can regulate the exaggerated inflammatory response and promote recovery of lung damage. Method: Phase-1, single-centre open-label, prospective clinical trial was conducted to evaluate the safety and efficacy of intravenous administration of mesenchymal stem cells derived from umbilical cord and placenta in moderate COVID-19. The study was done in 2 stages with total 20 patients. Herein, the results of stage 1 including first 10 patients receiving 100 million cells on day 1 and 4 with a follow up of 6 months have been discussed. Results: No adverse events were recorded immediately after the administration of MSCs or on follow up. There was no deterioration observed in clinical, laboratory and radiological parameters. All symptoms of the study group resolved within 10 days. Levels of inflammatory biomarkers such as NLR, CRP, IL6, ferritin and D-dimer improved in all patients after intervention along with improved oxygenation demonstrated by improvement in the SpO2/FiO2 ratio and PaO2/FiO2 ratio. None of the patients progressed to severe stage. 9 out of 10 patients were discharged within 9 days of their admission. Improvements were noted in chest x-ray and chest CT scan scores at day 7 in most patients. No post-covid fibrosis was observed on chest CT 28 days after intervention and Chest X ray after 6 months of the intervention. Conclusion: Administration of 100 million mesenchymal stem cells in combina-tion with standard treatment was found to be safe and resulted in prevention of the cytokine storm, halting of the disease progression and acceleration of recovery in moderate COVID-19. This clinical trial has been registered with the Clinical Trial Registry-India (CTRI) as CTRI/2020/08/027043. http://www.ctri.nic.in/Clinicaltrials/pmaindet2. php?trialid=43175.

5.
International Journal of Drug Delivery Technology ; 12(2):873-877, 2022.
Article in English | EMBASE | ID: covidwho-1939655

ABSTRACT

Background: It has been documented that the mortality rate in diabetic persons can reach 10%. In addition, it has been shown that the rate of mortality and the need for respiratory support are higher among newly diagnosed cases of diabetes mellitus compared with patients known to have diabetes mellitus for a relatively long duration. In the setting of the pandemic of COVID-19, glycemic control for the patients admitted to hospitals is critical, as is diabetes screening to uncover undiagnosed cases. Aim of the study: To explore the possible link between diabetes mellitus and COVID-19 in Iraq Patients and methods: The current research was carried out in Al-Diwaniyah Province, Iraq, in Al-Diwaniyah Teaching Hospital, including the word of medicine, respiratory unit, and intensive care unit. The study started on Sept 15, 2021 and ended on Apr 15, 2022. The study was cross-sectional and included 100 patients with a diagnosis of COVID-19 evidenced by polymerase chain reaction (PCR) test and CT-scan “computed tomography scan of the chest. Those patients were chosen randomly from the pool of patients visiting the teaching hospital. The age range of patients was between 18 and 94 years, with 45 males and 55 females. Laboratory investigation results were retrieved from patients’ records and included random blood sugar, lactate dehydrogenase, d-dimer, HbA1c%, and “C-reactive protein (CRP).” Results: The mean values of age, random blood sugar (RBS), lactate dehydrogenase (LDH), d-dimer, HbA1c, and HS-CRP were comparable between males and females (p > 0.05). Patients with high HbA1c levels (HbA1c ≥ 6.5%) were older and had significantly higher levels of random blood sugar and d-dimer than patients with HbA1c < 6.5%. The d-dimer level showed a significant positive correlation to RBS, LDH, HbA1c, and HS-CRP (p < 0.05). Conclusion: Higher levels of markers of inflammation were associated with HbA1c levels in the diabetic range, indicating a bi-directional relation between diabetes mellitus and the severity of COVID-19.

6.
Caspian Journal of Internal Medicine ; 13:221-227, 2022.
Article in English | EMBASE | ID: covidwho-1939558

ABSTRACT

Background: Frequent waves of corona virus disease (COVID-19) and lack of specific drugs against that, warrant studies to reduce the morbidity and mortality of this pandemic disease. In this study, we investigated the association between influenza vaccination and the severity and outcome of COVID-19 disease in Iranian patients living in the North. Methods: This retrospective case-control study was performed on186 patients with COVID-19 infection between March and April, 2020. Patients with positive PCR were divided into two groups of case and control;Patients with moderate to severe and normal to mild lung involvement, respectively. The lung opacities in all of the 5 lobes were evaluated on chest CT images using a CT severity scoring system. The history of influenza vaccination during the fall of 2019-2020 was determined by a phone call. Statistical analysis was done using the chi-square test, student’s t-test, and logistic regression. The significance level was p<0.05. Results: The mean age of patients was 54.67±15.05years. Most patients had pulmonary manifestations including ground-glass opacity (57%), consolidation (80%) and pleural effusion (3.2%). Adjusting for age, gender, and history of underlying disease, vaccination is an effective factor in the severity of pulmonary involvement (AOR=0.39;95%CI: (0.21, 0.73);P=0.003). Furthermore, the chance of ICU admission decreased via influenza vaccination (OR=0.21, P=0.001). Conclusion: The results showed that the severity of COVID-19 pulmonary involvement and outcome as ICU admission, and severe symptoms in patients with history of influenza vaccination were significantly lower than those without history of vaccination. This strategy can be used to prevent and reduce the complications of COVID-19.

7.
Journal of Hypertension ; 40:e170-e171, 2022.
Article in English | EMBASE | ID: covidwho-1937713

ABSTRACT

Objective: The patient was a 61-year-old woman who typically underwent mitral valve replacement and tricuspid valve repair in 2011. During these years, she underwent an annual checkup and experienced no particular problems. The potential patient contracted Covid 19 a month ago and underwent conservative treatment. The patient displayed no specific symptoms, no fever, and her Covid 19 disease was mild. In the accompanying echocardiography, we notice a lump on the atrial surface of the Tricuspid valve that we instantly suspect of local vegetation or heart mass. As a result, we admitted the patient to resume the examination. Design and method: Multi-slice (16) spiral thoracic CT scan: Sternotomy and MVR are seen. Cardiomegaly is evident. Patchy peripheral ground-glass opacities are seen bilaterally, suggesting covid-19 pneumonia;correlation with clinical and paraclinical data is recommended. Degenerative changes are perceived in the thoracic spine. There is no pleural effusion. Blood cultures and urinary trachea were requested to diagnose endocarditis, and she was also asked to have an esophageal echocardiogram. The antibiotic Meropenem 500 was started three times a day with vancomycin 1 gram twice a day for prophylaxis. After these examinations, the mass diagnosis was rejected as the image of vegetation on echocardiography did not found echogenicity similar to cardiac tissue and was denser. Consequently, we diagnosed vegetation. According to the negative culture results, and the patient had no symptoms (chills, heart pain), this patient's diagnosis of an immunological reaction caused by Covid disease was made. Libman -sacks endocarditis is a type of sterile nonbacterial thrombotic endocarditis (NBTE) secondary to inflammation. Results: In this rare case, the vital point is that immunological reaction after covid can give rise to vegetation on the heart artificial valve and can be typically established with endocarditis. Covid can cause libman sac endocarditis, then we consider patients with heart disease maybe get limban sac or other forms of immunological reaction after covid virus. Conclusions: Concerning the explicit rejection of all the causes, the patient was diagnosed correctly with limb sac endocarditis. She underwent anticoagulant therapy and corticosteroid therapy accordingly and was recovered fully.

8.
Journal of Hypertension ; 40:e170, 2022.
Article in English | EMBASE | ID: covidwho-1937712

ABSTRACT

Objective: The patient was a 59-year-old man who was referred to the hospital due to shortness of breath due to increased activity, accompanied by cough, weakness, and lethargy. The patient also had a history of diabetes, hypertension, hyperlipidemia, and asthma. The patient also underwent cardiac stenting last year. LCX and LAD stenting Design and method: He had a continuous pan-systolic murmur on cardiac examination diagnosed with valvular dysfunction. Severe aortic regurgitation was reported on echo. The patient underwent a CT scan of the lungs and a PCR test to rule out Covid-19, which was negative. Finally, the patient was diagnosed with severe aortic regurgitation and underwent aortic valve replacement surgery. Echocardiography was performed before the operation, and the diagnosis was confirmed. Results: Echocardiography was performed postoperatively, which showed good valve function and no valve leakage. From the 5th day after the operation, the patient developed fever and increased leukocytosis. Suspected of having Covid19 and accordingly underwent PCR test, the test result was positive;the patient underwent a CT scan of the lungs. After that, he was transferred to the corona ICU. The patient was treated with Remdesivir, and after two weeks, his PCR was negative, and he was almost ready to be discharged. The patient had completed the entire course of treatment and developed pulmonary fibrosis due to Covid disease, but suddenly, after two weeks from the onset of the illness, she developed severe shortness of breath, which led to intubation. We find severe pulmonary fibrosis in the re-CT scan, especially in the left lung, where the entire left lung had fibrosis. Prednisolone was started at a dose of 50 mg three times a day. The patient was intubated for ten days, then gradually removed from the device. Now the patient is extubated and ready for discharge. Conclusions: Risk factors such as Past cardiac surgery and present cardiac intervention with diabetes mellitus increase the risk of developing lung failure in these Covid19 patients. Elective intubation is better than emergency intubation in patients with comorbidities. Corticosteroids can be effective in treating pulmonary insufficiency.

9.
European Stroke Journal ; 7(1 SUPPL):295, 2022.
Article in English | EMBASE | ID: covidwho-1928071

ABSTRACT

Background and aims: The initiation of a global mass vaccination against COVID-19 seems to decrease mortality and hospitalization for vaccinated people. However, side effects may occur. This short review illustrates some cases of vascular complications following the COVID-19 vaccination, affecting young people with ischemic, embolic complications or a combination of the two. Patients and methods: Observation 1: a 46 years old woman consulted for a sudden left sided hemiparesis seven days following the second dose of covid-19 vaccine. The initial brain scan was normal and she received thrombolytic treatment. Control scan showed signs of ischemic stroke of right superficial cerebral artery with haemorrhagic transformation. Supra-aortic ultrasound was performed showing a fresh mobile thrombus with complete obstruction of the right internal carotid artery. Observation 2: a 52 year old patient admitted for accute dyspnea, three days after receiving the third dose of covid-19 vaccine. CT angiography revealed a thrombosis of left pulmonary artery. Five days later, an ischemic vascular accident occurs confirmed by CT scan, so we made a supra-aortic ultrasound revealing a thrombosis of right proximal internal carotid artery. Discussion and results: Incidence of vascular complications due to the covid 19 vaccination is discussed with possible hypotheses. Conclusions: COVID-19 vaccines are considered safe since the proven benefits of vaccination in protecting against COVID-19. Nonetheless, health professionals must be aware of all possible complications, early diagnosis and quick initiation of the appropriate treatment may enhance the outcome. (Figure Presented).

10.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927930

ABSTRACT

RATIONALE The COVID-19 pandemic led to rapid changes in care-delivery for intensive care unit (ICU) patients, due to factors including high ICU strain, shifting team member roles, and changes in care locations. As these changes may have not only impacted patients with COVID-19 but also critically ill patients without COVID-19, we assessed changes in common ICU practices for mechanically ventilated patients without COVID before and after the start of the COVID-19 pandemic. METHODS We used the Premier Healthcare Database to identify mechanical ventilated ICU patients in the US from January 1, 2016 - December 31, 2020. Patients were excluded if they had an ICD-10 diagnosis of COVID-19 (U07.1) or if they were admitted to a hospital that did not contribute data for all five years. We assessed annual rates of common ICU imaging studies (chest CT scan, chest x-ray, lower extremity doppler ultrasound), bedside diagnostics (electrocardiogram, electroencephalogram), and bedside procedures (arterial line, central venous catheterization, bronchoscopy) and annual mortality rates. We used interrupted time series analysis, adjusted for seasonality and autocorrelation where present, to evaluate trends in ICU practices prior to the pandemic (March 2016 - February 2020), at the onset of the pandemic (April 2020) and as the pandemic progressed (April 2020 - December 2020). March 2020, as the US transitioned into the pandemic, was excluded from the analysis. RESULTS We identified 584,393 mechanically ventilated patients without COVID- 19 at 509 hospitals. Trends in ICU procedures and mortality are illustrated in Figure 1. At the onset of the pandemic, use of chest x-ray (-35.6% [-53.5 to -17.8%, p<0.001]), electrocardiogram (-14.8% [-21.9 to -7.6%, p<0.001]), and bronchoscopy (-1.2% [-1.8 to -0.6%, p<0.001]) decreased;rates of lower extremity doppler (-1.8% [-4.1 to -0.5%, p=0.12]), electroencephalogram (-0.8% [- 1.7 to 0.1%, p=0.09]), arterial lines (-0.09 [-1.0 to 0.9%, p=0.85]) and central venous catheters (+0.2 [-1.3 to 1.7%, p=0.77]) did not significantly change;use of chest CT increased 2.6% (0.9 to 4.3%, p=0.001). With the exception of chest CT, arterial lines, and central venous catheters, trends in all other measured procedures increased as the pandemic progressed, compared with pre-pandemic trends. There was no significant trend change in mortality at the onset of the pandemic or during the pandemic. CONCLUSIONS Multiple practice patterns changed among patients without COVID-19 early during the pandemic. However, no change in mortality was seen during this time. These findings warrant further investigation to determine their impact on patientcentered outcomes.

11.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927835

ABSTRACT

Invasive aspergillosis is a rapidly progressive, fatal infection that usually occurs in immunocompromised patients. The spectrum of clinical presentation ranges from non-invasive, invasive, destructive and allergic aspergillosis. It is rare to see overwhelming aspergillosis in an immunocompetent host. Nevertheless, certain risk factors such as underlying fibrotic lung disease, suppurative infection, long-term corticosteroid use and uncontrolled diabetes mellitus (DM) have been described. We hereby present a case of invasive pulmonary aspergillosis in a patient with uncontrolled DM. A 60-year-old man with a history of heavy smoking (50- pack-year), poorly controlled DM presented to the hospital with a large area of erythema with eschar over his left posterior thigh. Clinical examination and CT abdomen pelvis confirmed necrotizing fasciitis involving his perineum and left thigh. Admission CT abdomen showed a small left lower lobe infiltrate (Day 1, Panel A). He underwent urgent debridement and intraoperative tissue cultures grew coagulase-negative staphylococcus, Proteus Vulgaris and anaerobic gram-positive rods. He received piperacillintazobactam, vancomycin, and clindamycin for 16 days which was subsequently narrowed to ceftriaxone and metronidazole. He had worsening leukocytosis but all his blood cultures have been negative. Tracheal aspirate gram stain on day 5 showed moderate yeast, and cultures grew Candida albicans and Aspergillus fumigatus. CT scan of his chest showed bilateral reticulonodular opacities with a new loculated right pleural effusion (Day 16, Panel B). Trans-esophageal echocardiogram did not show any right-sided heart valve vegetation. He received intravenous voriconazole for disseminated aspergillosis. Despite of new prophylactic antifungal strategies, more sensitive and rapid diagnostic tests, as well as various efficacious treatments, survival of invasive disseminated aspergillosis remains poor. High clinical suspicion with a proactive investigation approach is the key to minimizing mortality. Various risk factors such as hematopoietic-cell transplantation, neutropenia, solid-organ transplantation, chemotherapy, prolonged ICU stay, structural lung disease, impaired mucociliary clearance after a recent pulmonary infection (including SARS-CoV-2) have been well described. Our case highlights the importance of recognizing uncontrolled DM as a crucial risk factor for disseminated aspergillosis. (Figure Presented).

12.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927787

ABSTRACT

Introduction: Pulmonary Epithelioid hemangioendothelioma (EHE) is a rare vascular tumor;with approximately 248 cases of reported in the literature, making diagnosis and management challenging. Case: A 57-year-old female with past history of hypertension, hyperthyroidism and scoliosis was admitted with worsening chronic right flank pain. Initial lab workup was unremarkable. revealed COVID-19 PCR test was negative. CT chest revealed bilateral pleural effusions and CT abdomen showed 2.8 x2.0cm vague hypo-attenuating lesion in the right hepatic lobe. A repeat CT scan following thoracentesis demonstrated multiple bilateral pulmonary nodules, with the largest located in the right lower lobe (RLL) measuring 2.1cm (Image). Flowcytometry on bronchoalveolar lavage fluid was significant for a CD4/CD8 ratio of 5;however, the transbronchial biopsy was unremarkable. Differential diagnosis included sarcoidosis and hence patient was discharged on prednisone with Bactrim prophylaxis. She underwent VATS lung biopsy. RLL and pleural biopsies revealed EHE. Following the prednisone taper, patient was placed on pazopanib 800mg. The dose of medication subsequently reduced to 300-600mg due to adverse events. Repeat CT scans at 3 months demonstrated minimal change in size of the nodules. Patient continues to be followed on regular basis with a stable clinical status. Discussion: EHE is a low-intermediate grade malignancy which affects mostly liver, lungs and bones;although it can be found in any bodily tissue. Up to 50- 76% of patients are asymptomatic at diagnosis, with the most common symptomatic being local pain. Radiologically, Pulmonary EHE consists of bilateral perivascular nodularity. Our case describes the clinical course of a rare and poorly understood disease. Clinicians must be aware of the characteristics of unusual diseases and pursue robust diagnostic approach. In our case, biopsy led to the definitive diagnosis of EHE. Because of its rarity, there is no standard therapy for metastatic disease. Pazopanib has demonstrated prolonged long-term disease control in observational studies. Some other reports have shown response to cytotoxic chemotherapy such as doxorubicin-containing regimens, however, long-term survival is compromised. Lenalidomide, sorafenib and sunitinib have also been used, but the experience is limited. Our patient is currently on her 4th month of treatment with pazopanib, with 3-month follow-up showing no progression of disease. (Figure Presented).

13.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927774

ABSTRACT

Introduction: Electronic vaping-associated lung injury (EVALI), attributed to inhalation through E-cigarettes and other devices was first characterized in the US in July 2019. By February 2020, 2807 cases were reported. Patients often present with respiratory, gastrointestinal, and constitutional symptoms. The presence of EVALI without respiratory complaints is under-recognized, only reported three times in the literature thus far. Case: A 22-year-old female student presented with five days of fever, watery, nonmucoid, non-bloody diarrhea, nausea, 3-4 episodes of vomiting, and generalized weakness, without cough, dyspnea, chest or abdominal pain. Social history revealed vaping e-cigarettes containing nicotine and tetrahydrocannabinol for the past 3-4 years with increased use recently due to upcoming exams. She denied smoking traditional cigarettes, marijuana, or illicit drugs. A temperature of 101oF and 98% SaO2 were recorded. Physical examination was notable for bilateral diffuse crackles with a normal abdominal examination. Initial labs demonstrated a WBC of 14,600 without a shift and the remaining labs were within normal limits. Despite the absence of respiratory symptoms, her chest radiograph revealed bilateral multifocal airspace disease. Further investigation with Chest CT showed extensive multifocal bilateral infiltrates and predominantly peripheral ground-glass opacities. COVID-19 PCR was negative three times. Influenza A and B, RSV, mycoplasma, and legionella testing were negative. She was unable to provide sputum for culture. Stool cultures were negative and an abdominal and pelvic CT was normal. She denied any history of dietary intolerances, prior diarrhea, or chronic colitis. Empiric treatment for atypical community-acquired pneumonia with intravenous ceftriaxone and azithromycin was initiated, with little improvement over the subsequent 4 days. Lack of clinical effect with antibiotics prompted a suspicion for EVALI and intravenous methylprednisolone 1mg/kg every 8 hours was initiated. There was a significant improvement of her gastrointestinal and constitutional symptoms within 24 hours. After three days of IV steroids, she was discharged on an enteral taper. A repeat Chest CT scan 2 weeks later demonstrated complete resolution of the previously identified ground-glass opacities. Discussion: The use of E-cigarettes has grown by 900% between 2011 and 2019 among young adults but used by older individuals as well. This has contributed to the burgeoning EVALI epidemic. Although COVID has taken the centre stage while identifying diffuse interstitial lung abnormalities, there must be a high index of suspicion regarding the incidence of EVALI, especially in young patients, considering the varied presentations and the potential absence of respiratory symptoms.

14.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927727

ABSTRACT

Introduction: Daptomycin is an antibiotic approved by FDA in 2003 with an excellent coverage for Gram positive cocci including methicillin resistant Staph. Aureus and vancomycin resistant Enterococci.Acute Eosinophilic Pneumonia(AEP) is a rare but potentially fatal complication of daptomycin is characterized by febrile illness, Hypoxemia,Diffuse Bilateral pulmonary infiltrates and BAL with >25% eosinophils. Case Report: 79 Y/O M with the CKD stage 4 and hypertension presented to the hospital with fever, dry cough and worsening shortness of breath after a recent hospital admission for MRSA bacteremia.Patient was admitted 1 week before presentation for symptoms of pyelonephritis and was found to have MRSA bacteremia for which he was discharged on IV daptomycin for 6 weeks. On admission,patient was febrile with hypoxic to 81%. Labs did show leukocytosis with mild peripheral eosinophilia.PCR for respiratory viruses including covid was negative.Chest X ray was done, which was consistent with multifocal Pneumonia which was followed by Chest CT scan which demonstrated new bilateral dense ground-glass and consolidative opacities.Given concerns for aspiration pneumonia, fungal infections or eosinophilic pneumonitis,pulmonology was consulted for possible bronchoscopy.Bronchoscopy with BAL was done the next day.BAL revealed a WBC of 260/μL with 45% eosinophilic predominance. Given the bronchoscopy results,his symptoms were attributed to Daptomycin related eosinophilic pneumonia.Patient was started on 40mg oral prednisone for a total of 4 weeks with rapid taper.Over the hospital course, his symptoms completely resolved. Discussion: The prosed mechanism involves presentation of drug or drug-hapten combination by the macrophages to the T helper cell results in interleukin-5 release which along with macrophage released eotaxin, results in eosinophilic migration to lungs.The criteria for to diagnose AEP due to daptomycin consist of 4 components which includes febrile illness,hypoxemia,diffuse bilateral pulmonary infiltrates and BAL with >25% eosinophils.Peripheral eosinophilia may not be present in all cases. It is also possible that daptomycin, a renally excreted drug, persists in the lungs of patients with renal dysfunction as seen in our patient and as such may lead to higher incidence of daptomycin induced AEP.In most cases, a short course of steroids(2-3 weeks)is sufficient for complete resolution of symptoms. Conclusion: Daptomycin induced AEP is increasingly seen in patients with high doses of drug and underlying renal dysfunction,and not related to therapy duration as it can occur as early as day 3 of treatment and as late as week 6 of treatment course. Bronchoscopy with BAL should be considered in all cases suspected. (Figure Presented).

15.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927723

ABSTRACT

Introduction: Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a newly emergent coronavirus, that was first recognized in Wuhan, Hubei province, China, in December 2019. SARS-CoV-2 is a positive-sense singlestranded RNA virus that is contagious in humans. E-cigarette or vaping product use-associated lung injury (EVALI) is a type of acute lung injury of unclear pathogenesis. The two pathologies present with overlapping clinical symptoms, and imaging, making them difficult to distinguish, especially in global COVID-19 pandemic. Case report: 27-year-old female with past medical history of IBS, Diverticulitis, and anxiety presented with cough, shortness of breath, fever and fatigue. She also reported headaches and abdominal pain, she denies sick contact and recent travel but admit that she uses E cigarette more than usual due to anxiety attack. Patients initially discharge from ED but subsequently admit to hospital for worsening of symptoms possible COVID pneumonia vs community acquired pneumonia. She was persistently hypoxic and transfer to ICU for acute hypoxic respiratory failure. Labs was significant for elevated WBC while serum chemistries were unremarkable, Chest x-ray was not significant for any acute pathology. CT scan show revealed parenchymal changes consistent with bilateral upper and lower lobe ground-glass opacities. No septal change was noted, helping us rule out causes such as organizing pneumonia, lipoid pneumonia, and diffuse alveolar damage. Extensive testing for viral and bacterial infections was all negative. she has Covid19 PCR negative twice. Bronchoalveolar lavage testing was not done as patient refuse for invasive intervention. Patient started on steroids. Discussion: EVALI is thought to be a type of acute lung injury with an unknown pathogenesis. E-cigarette use, especially those containing THC and/or vitamin E acetate, is a key risk factor for developing the disease process. COVID 19 pneumonitis and EVALI have same clinical presentation, laboratory studies and images, and make challenge for physician to differentiate both pathologies. Both disease present with similar initial symptoms, including cough, shortness of breath, fevers, vomiting, diarrhea and headache. Similarly, laboratory studies may be unremarkable or elevated in both presentations and do not help distinguish between them. Furthermore, Chest X-ray and CT have very similar findings in both presentations, including diffuse hazy or consolidative opacities and ground-glass opacities, respectively. As well, both COVID-19 and EVALI are associated with worse outcomes in older adults or those with underlying chronic conditions, including cardiac and pulmonary disease.

16.
American Journal of Respiratory and Critical Care Medicine ; 205(1), 2022.
Article in English | EMBASE | ID: covidwho-1927722

ABSTRACT

Palbociclib, abemaciclib and ribociclib are cyclin-dependent kinase 4/6 (CDK 4/6) inhibitors used in the current treatment of HR-positive, HER2-negative metastatic breast cancer.1.2 As CDK 4/6 inhibitors are becoming more common it is important to be aware of some potentially fatal side effects. A 54-year-old woman with stage III breast cancer with prior mastectomy currently on hormonal and immunotherapy with anastrozole, ribociclib and goserelin presented with fever and shortness of breath. The patient became febrile with a negative COVID-19 test, and was treated for community acquired pneumonia. The fevers persisted despite antibiotics. CBC notable for leukopenia and uptrending absolute eosinophil count of 280 cells per microlitre. A chest CT scan revealed scattered, predominantly peripheral ground glass opacities in the bilateral upper, bilateral lower, and right middle lobes not present on prior imaging. A diagnostic bronchoscopy with BAL revealed 140 white-blood cells, 4 polys, 60 lymphocytes, 30 monocytes and 6 eosinophils. Flow cytometry yielded predominantly T-cells, abundant macrophages and inflammatory Infectious work up including PCP PCR, gram stain, fungal and AFB culture were negative. Ribociclib was discontinued and the patient improved symptomatically with return to baseline level of function. Reports of CDK 4/6 inhibitor drug-associated lung injury are limited There has been only one case report outside of clinical trials of Ribociclib pneumonitis.7 As these drugs become more commonly used, it is important for clinicians to be aware of this potentially fatal drug associated lung injury. Treatment with drug cessation has varying responses from recovery like in our patient to death.

17.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925464

ABSTRACT

Objective: NA Background: Due to the COVID-19 pandemic, Thailand has started its vaccination program since February 2021. After the launch of the mass vaccination with CoronaVac, there were reports of patients who suffer unusual hemiparesis across the country. We report the first case of a patient who suffered transient focal neurological deficit mimicking stroke following CoronaVac vaccination. However, instead of an ischemic stroke, motor aura was suspected. Design/Methods: A 24 year-old Thai female presented with left hemiparesis fifteen minutes after receiving CoronaVac. She also had numbness of her left arm and legs, flashing lights, and headaches. On physical examination, her BMI was 32.8. Her vital signs were normal. She had moderate left hemiparesis (MRC grade III), numbness on her left face, arms, and legs. Her weakness continued for 5 days. Results: A brain CT scan was done showing no evidence of acute infarction. Acute treatment with aspirin was given. MRI in conjunction with MRA was performed in which no restricted diffusion was seen. A SPECT was performed to evaluate the function of the brain showing significant hypoperfusion of the right hemisphere. The patient gradually improved and was discharged. Conclusions: In this study, we present the first case of stroke mimic after CoronaVac vaccination. After negative imaging studies, stroke is unlikely to be the cause. Asymmetrical abnormal functional imaging study showing multifocal hypoperfusion on the right could represent the ongoing neurological deficits. Therefore, we believed that it might be due to cortical spreading depression, in which motor aura could be responsible. The uniqueness in our case is the prolongation of weakness that we think might be due reverberating spreading depression wave. The cause is unknown, but we proposed that aluminum found to enhance the vaccine that could disrupt the Glutamate - Nitric oxide - cGMP pathway leading to the prolongation of motor aura.

18.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925183

ABSTRACT

Objective: N/A Background: The full scope of the mid- and long-term effects of SARS-CoV2 infection is currently being reported. The immune response might contribute not only to the development of ARDS, but also to other systemic complications after the acute setting. Some disorders, including those of autoimmune or presumed autoimmune etiology, have been reported to be triggered, exacerbated, or unmasked during the COVID-19 pandemic. Sarcoidosis is a multi-systemic inflammatory disorder believed to occur due to an exaggerated immune response to unknown antigens in the setting of genetic susceptibility. We present a case of neuro-sarcoidosis after COVID-19. Design/Methods: Descriptive study, case report. Results: A 51-year-old right-handed female presented with multiple cranial neuropathies and paresthesia after a mild case of COVID-19. Her symptoms included vertigo, hypoacusis, balance issues, left facial palsy, and paresthesia in her upper extremities. Her brain MRI with contrast showed bilateral enhancement of the VII and VIII cranial nerves. CSF analysis showed mild protein elevation and elevated CD4:CD8 ratio. Serum sIL-2R was also elevated. Her chest CT scan was abnormal, prompting a lymph node biopsy that was consistent with non-caseating granulomas. A diagnosis of probable neuro-sarcoidosis was made and she showed improvement with steroids. She was later started on methotrexate as a steroid sparing agent in the outpatient setting. Conclusions: To our knowledge, neuro-sarcoidosis has not been previously described in temporal association with COVID-19. It might be that this infection acts as one of the triggers for sarcoidosis. Some common pathways shared by these conditions could explain the possibility of such a trigger. These pathways include the ACE2 receptor, the TMRPPS gene, and certain cytokines. When aberrant, causing incomplete clearance of an antigen, these pathways might lead to the formation of granulomas. Further research surrounding the non-immediate effects of the novel coronavirus is needed to better delineate possible autoimmune consequences of this serious infection.

19.
Pakistan Journal of Medical and Health Sciences ; 16(5):359-362, 2022.
Article in English | EMBASE | ID: covidwho-1918400

ABSTRACT

COVID-19 is a virus that can cause disease. Phylogenetic analysis Bats have been discovered to have a full genome sequence, according to research done with available entire genome sequences. The COVID-19 virus reservoir has been identified, however the intermediate host(s) has yet to be identified. now. This study was conducted in Marjan Teaching Hospital in Babylon for all patients infected with Covid 19 disease during January of 2022 and their ages were between 30-55, where the diagnosis was made by CT-scan. the reports that I will mention that the new mutation from Corona does not cause severe damage to the lung, and the infection rate is less than 45% in the lung. She also indicated that all patients were exposed to severe diarrhea without losing the sense of smell and taste. From this, we conclude that the new mutations in Covid -19 are Less severe and less severe, and the vaccine reduces a high rate of infection, as most of the vaccinated people had a very weak rate. And here are pictures of the reports of the new mutant from Covid -19 (OMICRON).

20.
Journal of SAFOG ; 14(2):136-143, 2022.
Article in English | EMBASE | ID: covidwho-1917986

ABSTRACT

Aim: We have witnessed diverse presentations of coronavirus disease-2019 (COVID-19) in pregnant females during first and second waves. The aim of this study was to evaluate the usefulness of chest X-ray and its correlation of severity scoring with clinical, laboratory parameters and maternal-fetal outcome during management of COVID-19 pregnant women in low resource settings. Methodology: This was a retrospective observational study conducted at the Government Institute of Medical Sciences, Greater Noida, from May 2020 to May 2021. The study included 185 pregnant women in second and third trimesters with reverse transcription-polymerase chain reaction (RT-PCR)-confirmed COVID-19 disease. The chest radiographs of all patients were analyzed and severity scoring was done using modified radiographic assessment of lung edema (RALE) criteria. The correlation of severity index with clinical and biochemical profile of patients with normal and abnormal X-ray findings was compared. Two-tailed p-value of <0.05 was considered significant in our study. Results: Out of 185 patients, 38 had abnormal X-ray findings, whereas 147 had normal X-ray. A significant difference was observed in mean values of lactate dehydrogenase (LDH), ferritin, C-reactive protein (CRP), D-dimer, total leukocyte count (TLC), and interleukin 6 (IL-6) levels across both X-ray groups. The proportion of pregnant mothers with live birth, high-risk pregnancy, steroid treatment, oxygen supplementation, invasive ventilation, and number of presenting symptoms varied statistically across both the X-ray groups (p-value <0.05). Receiver-operating characteristic (ROC) analysis revealed that an X-ray score of “5.5” has the best prognostic significance of maternal death with sensitivity of 87.5 and 96.6% specificity. Conclusion: Chest radiography for the assessment of disease status in COVID-19 pregnancies is an effective and affordable alternative to CT scan in low resource settings.

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