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1.
Chest ; 161(2): e91-e96, 2022 02.
Article in English | MEDLINE | ID: covidwho-1664780

ABSTRACT

CASE PRESENTATION: A 54-year-old South African man with a medical history of type 2 diabetes mellitus, seizure disorder, OSA, and latent TB presented to the ER with gradually progressive dyspnea over months. He also reported occasional dry cough and fatigue at presentation but denied fever, chills, chest pain, leg swelling, palpitations, or lightheadedness. He was treated with a course of levofloxacin for presumed community-acquired pneumonia as an outpatient without improvement and had tested negative for COVID-19. He denied occupational or environmental exposures or sick contacts, though he had traveled back to South Africa 1 year before presentation. He had complex partial seizures for the past 22 years, which had been well controlled on phenytoin (300 mg daily). His other home medications included dulaglutide, sertraline, and atorvastatin and had no recent changes. He quit smoking 30 years ago after smoking one pack per day for 10 years.


Subject(s)
COVID-19/diagnosis , Drug Substitution/methods , Lacosamide/administration & dosage , Lung Diseases, Interstitial , Lung , Phenytoin , Seizures/drug therapy , Biopsy/methods , COVID-19/epidemiology , Diagnosis, Differential , Dyspnea/diagnosis , Dyspnea/etiology , Humans , Lung/diagnostic imaging , Lung/pathology , Lung Diseases, Interstitial/diagnosis , Lung Diseases, Interstitial/etiology , Lung Diseases, Interstitial/physiopathology , Lung Diseases, Interstitial/therapy , Male , Middle Aged , Phenytoin/administration & dosage , Phenytoin/adverse effects , SARS-CoV-2 , Seizures/complications , Seizures/diagnosis , Tomography, X-Ray Computed/methods , Treatment Outcome , Voltage-Gated Sodium Channel Blockers/administration & dosage , Voltage-Gated Sodium Channel Blockers/adverse effects
2.
BMJ Open Respir Res ; 8(1)2021 03.
Article in English | MEDLINE | ID: covidwho-1388518

ABSTRACT

INTRODUCTION: SARS-CoV-2 has restricted access to face-to-face delivery of pulmonary rehabilitation (PR). Evidence suggests that telehealth-PR is non-inferior to outpatient PR. However, it is unknown whether patients who have been referred to face-to-face programmes can feasibly complete an online-PR programme. METHODS: This service evaluation used a mixed-methods approach to investigate a rapid PR service remodelling using the University of Gloucestershire eLearn Moodle platform. Quantitative baseline demographic and PR outcome data were collected from online-PR participants, and semistructured interviews were completed with PR staff and participants. RESULTS: Twenty-five individuals were eligible from a PR waiting list. Thirteen declined participation and 14 completed PR. Significant pre-post online PR improvements were achieved in 1 min sit-to-stand (CI 2.1 to 9 (p=0.004)), Generalised Anxiety Disorder (CI -0.3 to -2.6 (p=0.023)), Primary Health Questionnaire-9 (CI -0.3 to -5.1 (p=0.029)), Chronic Respiratory Questionnaire dyspnoea (CI 0.5 to 1.3 (p=0.001)), fatigue (CI 0.7 to 2 (p=0.0004)), emotion (CI 0.7 to 1.7 (p=0.0002)), mastery (CI 0.4 to 1.3 (p=0.001)). Interviews indicated that patient PR inclusion was made possible with digital support and a PR introduction session improved participant engagement and safety. Incremental progression of exercise was perceived as more successful online compared with face-to-face PR. However, perceptions were that education sessions were less successful. Online-PR required significant staff time resource. DISCUSSION: Online-PR improves patient outcomes and is feasible and acceptable for individuals referred for face-to-face PR in the context of a requirement for social distancing. Face-to-face programmes can be adapted in a rapid fashion with both staff and participants perceiving benefit. Future pragmatic trials are now warranted comparing online-PR including remote assessments to centre-based PR with suitably matched outcomes, and patient and staff perceptions sought regarding barriers and facilitators of online delivery.


Subject(s)
Internet , Physical Therapy Modalities , Pulmonary Disease, Chronic Obstructive/rehabilitation , Telerehabilitation/methods , Aged , Aged, 80 and over , Anxiety/psychology , Asthma/physiopathology , Asthma/psychology , Asthma/rehabilitation , COVID-19 , Depression/psychology , Exercise Tolerance , Feasibility Studies , Female , Humans , Lung Diseases, Interstitial/physiopathology , Lung Diseases, Interstitial/psychology , Lung Diseases, Interstitial/rehabilitation , Male , Middle Aged , Pulmonary Disease, Chronic Obstructive/physiopathology , Pulmonary Disease, Chronic Obstructive/psychology , Quality of Life , SARS-CoV-2 , Treatment Outcome
3.
Chron Respir Dis ; 18: 14799731211035822, 2021.
Article in English | MEDLINE | ID: covidwho-1354699

ABSTRACT

In people with advanced respiratory disease, we examined (i) the impact of COVID-19-related physical and social isolation on physical activity and (ii) relationships between time spent in isolation and disability in activities of daily living. Cross-sectional analysis was conducted in adults with advanced non-small cell lung cancer, chronic obstructive lung disease or interstitial lung disease. Measures included change in physical activity since physically and socially isolating (Likert scale) and disability (Barthel Index and Lawton-Brody IADL scale) or difficulty (World Health Organisation Disability Assessment Schedule-2.0) in daily activities. Multiple logistic regression was used to examine factors associated with disability in daily activities. 194/201 participants were isolating for a median [IQR] 5 [3-8]-month period, often leading to lower levels of physical activity at home (n = 94, 47%), and outside home (n = 129, 65%). 104 (52%) and 142 (71%) were not fully independent in basic and instrumental activities of daily living, respectively. 96% reported some degree of difficulty in undertaking daily activities. Prolonged physical and social isolation related to increased disability in basic (r = -0.28, p < 0.001) and instrumental (r = -0.24, p < 0.001) activities of daily living, and greater difficulty in daily activities (r = 0.22, p = 0.002). Each month spent in physical or social isolation was independently related to disability in basic activities of daily living (odds ratio [OR], 1.17 [95% CI: 1.03-1.33], p = 0.013). These findings suggest disability in daily activities is associated with prolonged physical or social isolation, which may present as difficulty in people who are fully independent. Post-isolation recovery and rehabilitation needs should be considered for all people deemed extremely clinically vulnerable.


Subject(s)
Activities of Daily Living , COVID-19/prevention & control , Carcinoma, Non-Small-Cell Lung/physiopathology , Exercise , Lung Diseases, Interstitial/physiopathology , Lung Neoplasms/physiopathology , Pulmonary Disease, Chronic Obstructive/physiopathology , Aged , Communicable Disease Control , Female , Humans , Logistic Models , Male , Middle Aged , Odds Ratio , Physical Distancing , SARS-CoV-2 , Social Isolation
4.
Ann Am Thorac Soc ; 18(5): 799-806, 2021 05.
Article in English | MEDLINE | ID: covidwho-1219727

ABSTRACT

Rationale: The natural history of recovery from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains unknown. Because fibrosis with persistent physiological deficit is a previously described feature of patients recovering from similar coronaviruses, treatment represents an early opportunity to modify the disease course, potentially preventing irreversible impairment.Objectives: Determine the incidence of and describe the progression of persistent inflammatory interstitial lung disease (ILD) following SARS-CoV-2 when treated with prednisolone.Methods: A structured assessment protocol screened for sequelae of SARS-CoV-2 pneumonitis. Eight hundred thirty-seven patients were assessed by telephone 4 weeks after discharge. Those with ongoing symptoms had outpatient assessment at 6 weeks. Thirty patients diagnosed with persistent interstitial lung changes at a multidisciplinary team meeting were reviewed in the interstitial lung disease service and offered treatment. These patients had persistent, nonimproving symptoms.Results: At 4 weeks after discharge, 39% of patients reported ongoing symptoms (325/837) and were assessed. Interstitial lung disease, predominantly organizing pneumonia, with significant functional deficit was observed in 35/837 survivors (4.8%). Thirty of these patients received steroid treatment, resulting in a mean relative increase in transfer factor following treatment of 31.6% (standard deviation [SD] ± 27.6, P < 0.001), and forced vital capacity of 9.6% (SD ± 13.0, P = 0.014), with significant symptomatic and radiological improvement.Conclusions: Following SARS-CoV-2 pneumonitis, a cohort of patients are left with both radiological inflammatory lung disease and persistent physiological and functional deficit. Early treatment with corticosteroids was well tolerated and associated with rapid and significant improvement. These preliminary data should inform further study into the natural history and potential treatment for patients with persistent inflammatory ILD following SARS-CoV-2 infection.


Subject(s)
Aftercare/methods , COVID-19/complications , Glucocorticoids/therapeutic use , Lung Diseases, Interstitial , Lung , Respiratory Function Tests/methods , COVID-19/mortality , COVID-19/therapy , Female , Hospitalization/statistics & numerical data , Humans , Lung/diagnostic imaging , Lung/physiopathology , Lung/virology , Lung Diseases, Interstitial/diagnosis , Lung Diseases, Interstitial/etiology , Lung Diseases, Interstitial/physiopathology , Lung Diseases, Interstitial/therapy , Male , Middle Aged , Patient Discharge/statistics & numerical data , SARS-CoV-2/isolation & purification , Survivors/statistics & numerical data , Symptom Assessment/methods , Symptom Assessment/statistics & numerical data , Tomography, X-Ray Computed/methods , Treatment Outcome , United Kingdom/epidemiology
5.
High Blood Press Cardiovasc Prev ; 28(4): 373-381, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1205023

ABSTRACT

The aim of the study was to assess the short-term consequences of SARS-CoV-2-related pneumonia, also in relation to radiologic/laboratory/clinical indices of risk at baseline. This prospective follow-up cohort study included 94 patients with confirmed COVID-19 admitted to a medical ward at the Montichiari Hospital, Brescia, Italy from February 28th to April 30th, 2020. Patients had COVID-19 related pneumonia with respiratory failure. Ninety-four patients out of 193 survivors accepted to be re-evaluated after discharge, on average after 4 months. In » of the patients an evidence of pulmonary fibrosis was detected, as indicated by an altered diffusing capacity of the lung for carbon monoxide (DLCO); in 6-7% of patients the alteration was classified as of moderate/severe degree. We also evaluated quality of life thorough a structured questionnaire: 52% of the patients still lamented fatigue, 36% effort dyspnea, 10% anorexia, 14% dysgeusia or anosmia, 31% insomnia and 21% anxiety. Finally, we evaluated three prognostic indices (the Brixia radiologic score, the Charlson Comorbidity Index and the 4C mortality score) in terms of prediction of the clinical consequences of the disease. All of them significantly predicted the extent of short-term lung involvement. In conclusion, our study demonstrated that SARS-CoV-2-related pneumonia is associated to relevant short-term clinical consequences, both in terms of persistence of symptoms and in terms of impairment of DLCO (indicator of a possible development of pulmonary fibrosis); some severity indices of the disease may predict short-term clinical outcome. Further studies are needed to ascertain whether such manifestations may persist long-term.


Subject(s)
COVID-19/virology , Lung Diseases, Interstitial/virology , Lung/virology , Pulmonary Fibrosis/virology , SARS-CoV-2/pathogenicity , COVID-19/complications , COVID-19/diagnosis , Follow-Up Studies , Host-Pathogen Interactions , Humans , Italy , Lung/pathology , Lung/physiopathology , Lung Diseases, Interstitial/diagnosis , Lung Diseases, Interstitial/physiopathology , Prognosis , Prospective Studies , Pulmonary Diffusing Capacity , Pulmonary Fibrosis/diagnosis , Pulmonary Fibrosis/physiopathology , Quality of Life , Time Factors
6.
Respiration ; 100(7): 594-599, 2021.
Article in English | MEDLINE | ID: covidwho-1194385

ABSTRACT

BACKGROUND AND OBJECTIVES: The 6-minute walk test (6MWT), as a clinical assessment tool for functional exercise capacity, is an integral component of lung allocation scores (LASs). In times of the coronavirus disease (COVID-19) pandemic, patients underwent 6MWTs wearing a surgical mask in ambulatory care. We investigated the impact of wearing a mask on 6-minute walk distances (6MWDs). METHOD: 6MWDs of 64 patients with end-stage lung diseases wearing an oronasal surgical mask were retrospectively compared to previously investigated 6MWDs of the same cohort, in a pre-COVID-19 pandemic era, without wearing a mask. Four patients were excluded due to a primary vascular disease, 29 patients due to clinically unstable pulmonary functions, and 1 patient due to a psychiatric disorder. RESULTS: The median age of the patients included was 55 (46-58) years; 15 (48%) were male. Ten (32.2%) were on the Eurotransplant lung transplant waiting list with a median LAS of 34.3 (31.9-36.2). Twenty (64.5%) patients had chronic obstructive pulmonary diseases, 7 (22.6%) had interstitial lung diseases, and 4 (12.9%) had other end-stage lung diseases. The mean 6MWD without versus with wearing a mask was 306.9 (101.9) versus 305.7 (103.8) m, with a mean difference of -1.19 m (95% confidence interval -13.4 to 11.03). The observed difference is statistically equivalent to zero (p < 0.001). No significant differences in 6MWDs were observed between the clinical groups. CONCLUSION: Wearing an oronasal surgical mask did not affect the 6MWDs of patients with advanced lung diseases. Therefore, a masked 6MWT appears to provide a reliable examination of functional exercise capacity in this cohort.


Subject(s)
COVID-19/prevention & control , Lung Diseases, Interstitial/physiopathology , Masks , Pulmonary Disease, Chronic Obstructive/physiopathology , Respiratory Insufficiency/physiopathology , Walk Test/methods , Blood Gas Analysis , Chronic Disease , Exercise Tolerance , Female , Forced Expiratory Volume , Humans , Lung Diseases/physiopathology , Lung Diseases/surgery , Lung Diseases, Interstitial/surgery , Lung Transplantation , Male , Middle Aged , Minimal Clinically Important Difference , Plethysmography, Whole Body , Pulmonary Disease, Chronic Obstructive/surgery , Reproducibility of Results , Respiratory Insufficiency/surgery , Retrospective Studies , SARS-CoV-2 , Vital Capacity
7.
BMC Pulm Med ; 21(1): 126, 2021 Apr 19.
Article in English | MEDLINE | ID: covidwho-1191325

ABSTRACT

BACKGROUND: Platypnea-orthodeoxia syndrome (POS) is a rare condition characterized by dyspnoea (platypnea) and arterial desaturation in the upright position resolved in the supine position (orthodeoxia). Intracardiac shunt, pulmonary ventilation-perfusion mismatch and others intrapulmonary abnormalities are involved. CASE PRESENTATION: We report a case of POS associated with two pathophysiological issues: one, cardiac POS caused by a patent foramen ovale (PFO) and second, pulmonary POS due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) interstitial pneumonia. POS has resolved after recovery of coronavirus disease 2019 (COVID-19) pneumonia. CONCLUSIONS: Right-to-left interatrial shunt and intrapulmonary shunt caused by SARS-CoV-2 pneumonia contributed to refractory hypoxemia and POS. Therefore, in case of COVID-19 patient with unexplained POS, the existence of PFO must be investigated.


Subject(s)
COVID-19 , Dyspnea , Foramen Ovale, Patent , Hypoxia , Lung/diagnostic imaging , Pneumonia, Viral , COVID-19/diagnosis , COVID-19/physiopathology , Dyspnea/diagnosis , Dyspnea/etiology , Dyspnea/physiopathology , Echocardiography/methods , Foramen Ovale, Patent/complications , Foramen Ovale, Patent/diagnosis , Foramen Ovale, Patent/physiopathology , Hemodynamics , Humans , Hypoxia/diagnosis , Hypoxia/etiology , Hypoxia/physiopathology , Lung Diseases, Interstitial/complications , Lung Diseases, Interstitial/physiopathology , Lung Diseases, Interstitial/virology , Male , Middle Aged , Oxygen/analysis , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Pneumonia, Viral/physiopathology , Posture/physiology , SARS-CoV-2/isolation & purification , Syndrome , Treatment Outcome
8.
Medicina (Kaunas) ; 57(3)2021 Mar 18.
Article in English | MEDLINE | ID: covidwho-1167652

ABSTRACT

The COVID-19 pandemic dramatically changed medical care. Healthcare professionals are faced with new issues. Patients who survived COVID-19 have plenty of different continuing symptoms, of which the most common are fatigue and breathlessness. It is not well known how to care for patients with persistent or worsening respiratory symptoms and changes on chest X-ray following COVID-19 pneumonia. In this article, we talk about a subgroup of patients with organizing pneumonia following COVID-19 pneumonia that could be effectively treated with systemic glucocorticoids. It is important that patients with COVID-19 pneumonia be followed-up at least three weeks after diagnosis, in order to recognize early lung damage. We are providing a management algorithm for early diagnosis of lung diseases after COVID-19 pneumonia.


Subject(s)
COVID-19/complications , Lung Diseases, Interstitial/diagnosis , Algorithms , Biopsy , COVID-19/diagnosis , COVID-19/drug therapy , COVID-19/physiopathology , Computed Tomography Angiography , Disease Management , Early Diagnosis , Glucocorticoids/therapeutic use , Humans , Lung/diagnostic imaging , Lung/pathology , Lung/physiopathology , Lung Diseases, Interstitial/drug therapy , Lung Diseases, Interstitial/etiology , Lung Diseases, Interstitial/physiopathology , Pulmonary Diffusing Capacity , SARS-CoV-2 , Spirometry , Tomography, X-Ray Computed , Walk Test
9.
Chest ; 159(3): e151-e154, 2021 03.
Article in English | MEDLINE | ID: covidwho-1108122

ABSTRACT

CASE PRESENTATION: A 64-year-old previously healthy man presented with 8 weeks of progressive dyspnea on exertion and cough. Prior to presentation, the patient was able to bicycle > 60 miles per week and work full-time in a home improvement store. He was up-to-date with age-appropriate cancer screening and immunizations, and home medications included famotidine for reflux and nonsteroidal antiinflammatories for osteoarthritis, both as-needed. He had no significant respiratory exposure, aside from previous work as an electrician. His symptoms began in mid-February 2020 amid the coronavirus disease 2019 pandemic, although he had no known exposure to the virus.


Subject(s)
COVID-19/diagnosis , Fructose-Bisphosphate Aldolase/blood , Glucocorticoids/administration & dosage , Lung/diagnostic imaging , Myositis , Plasma Exchange/methods , Rituximab/administration & dosage , Threonine-tRNA Ligase/immunology , Autoantibodies/blood , Diagnosis, Differential , Disease Progression , Humans , Immunosuppressive Agents/administration & dosage , Lung Diseases, Interstitial/diagnosis , Lung Diseases, Interstitial/physiopathology , Male , Middle Aged , Muscle Weakness/diagnosis , Muscle Weakness/etiology , Myositis/blood , Myositis/diagnosis , Myositis/physiopathology , Myositis/therapy , Oxygen Inhalation Therapy/methods , Prognosis , Treatment Outcome
10.
Rev Alerg Mex ; 67(4): 350-369, 2020.
Article in Spanish | MEDLINE | ID: covidwho-1106728

ABSTRACT

Coronavirus disease 2019 (COVID-19) is an infection caused by SARS-CoV-2 that has caused an unprecedented pandemic with a high rate of morbidity and mortality worldwide. Although most cases are mild, there are a considerable number of patients who develop pneumonia or even acute respiratory distress syndrome (ARDS). After having recovered from the initial disease, many patients continue with various symptoms (fatigue, dry cough, fever, dyspnea, anosmia, and chest pain, among others.), which has led to consider the possible existence of "post-COVID-19 syndrome". Although the definition and validity of this syndrome are not clear yet, several studies report that individuals who have recovered from COVID-19 may have persistent symptoms, radiological abnormalities, and compromised respiratory function. Current evidence suggests that there is a large number of pulmonary sequelae after COVID-19 pneumonia (interstitial thickening, ground glass opacities, crazy paving pattern, and bronchiectasis, among others.). Likewise, it seems that pulmonary function tests (spirometry, DLCO, 6MWT, and measurement of maximum respiratory pressures), in addition to high-resolution computed axial tomographies (CAT scan), are useful for the assessment of these post-COVID-19 pulmonary sequelae. This review aims to describe the possible pulmonary sequelae after COVID-19 pneumonia, as well as to suggest diagnostic procedures for their correct assessment and follow-up; thus, allowing proper management by a multidisciplinary medical team.


COVID-19 es la enfermedad causada por el virus SARS-CoV-2, la cual ha ocasionado una pandemia sin precedentes, con gran cantidad de infectados y muertos en el mundo. Aunque la mayoría de los casos son leves, existe una cantidad considerable de pacientes que desarrollan neumonía o, incluso, síndrome de distrés respiratorio agudo (SDRA). Luego de recuperarse del cuadro inicial, muchos pacientes continúan con diversos síntomas (fatiga, tos seca, fiebre, disnea, anosmia, dolor torácico, entre otras), lo que ha llevado a considerar la posible existencia del "síndrome pos-COVID-19". Aunque la definición y validez de este síndrome aún no son claras, varios estudios reportan que los individuos recuperados de la COVID-19 pueden tener persistencia de síntomas, anormalidades radiológicas y compromiso en la función respiratoria. La evidencia actual sugiere que existe gran cantidad de secuelas pulmonares despues de una neumonía por COVID-19 (engrosamiento intersticial, infiltrado en vidrio esmerilado, patrón en empedrado, bronquiectasias, entre otras.). De igual forma, parece ser que las pruebas de función pulmonar (espirometría, prueba de difusión pulmonar de monóxido de carbono, prueba de caminata de seis minutos y la medición de las presiones respiratorias máximas), además de la tomografía axial computarizada de alta resolución, son útiles para evaluar las secuelas pulmonares pos-COVID-19. En esta revisión se pretende describir las posibles secuelas a nivel pulmonar posteriores a neumonía por COVID-19, así como sugerir procedimientos diagnósticos para su correcta evaluación y seguimiento, que permitan el manejo adecuado por parte de un equipo médico multidisciplinario.


Subject(s)
COVID-19/complications , Convalescence , Lung Diseases/etiology , Respiratory Distress Syndrome/etiology , Bronchiectasis/diagnostic imaging , Bronchiectasis/etiology , Bronchiectasis/physiopathology , Disease Progression , Follow-Up Studies , Humans , Hypoxia/blood , Hypoxia/etiology , Hypoxia/physiopathology , Lung Diseases/diagnostic imaging , Lung Diseases, Interstitial/diagnostic imaging , Lung Diseases, Interstitial/etiology , Lung Diseases, Interstitial/physiopathology , Mental Disorders/etiology , Mental Disorders/physiopathology , Oxygen/blood , Pulmonary Embolism/diagnostic imaging , Pulmonary Embolism/etiology , Pulmonary Embolism/physiopathology , Respiratory Distress Syndrome/physiopathology , Respiratory Function Tests , Spirometry , Tomography, X-Ray Computed
11.
BMJ Open Respir Res ; 7(1)2020 09.
Article in English | MEDLINE | ID: covidwho-788168

ABSTRACT

Reviews of COVID-19 CT imaging along with postmortem lung biopsies and autopsies indicate that the majority of patients with COVID-19 pulmonary involvement have secondary organising pneumonia (OP) or its histological variant, acute fibrinous and organising pneumonia, both well-known complications of viral infections. Further, many publications on COVID-19 have debated the puzzling clinical characteristics of 'silent hypoxemia', 'happy hypoxemics' and 'atypical ARDS', all features consistent with OP. The recent announcement that RECOVERY, a randomised controlled trial comparing dexamethasone to placebo in COVID-19, was terminated early due to excess deaths in the control group further suggests patients present with OP given that corticosteroid therapy is the first-line treatment. Although RECOVERY along with other cohort studies report positive effects with corticosteroids on morbidity and mortality of COVID-19, treatment approaches could be made more effective given that secondary OP often requires prolonged duration and/or careful and monitored tapering of corticosteroid dose, with 'pulse' doses needed for the well-described fulminant subtype. Increasing recognition of this diagnosis will thus lead to more appropriate and effective treatment strategies in COVID-19, which may lead to a further reduction of need for ventilatory support and improved survival.


Subject(s)
Coronavirus Infections/physiopathology , Cryptogenic Organizing Pneumonia/diagnosis , Diagnostic Errors , Hypoxia/physiopathology , Lung/diagnostic imaging , Pneumonia, Viral/physiopathology , Betacoronavirus , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/drug therapy , Cryptogenic Organizing Pneumonia/drug therapy , Cryptogenic Organizing Pneumonia/etiology , Cryptogenic Organizing Pneumonia/physiopathology , Dexamethasone/therapeutic use , Glucocorticoids/therapeutic use , Humans , Hypoxia/etiology , Lung/pathology , Lung/physiopathology , Lung Diseases, Interstitial/diagnosis , Lung Diseases, Interstitial/drug therapy , Lung Diseases, Interstitial/etiology , Lung Diseases, Interstitial/physiopathology , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/drug therapy , SARS-CoV-2 , Tomography, X-Ray Computed
12.
Pediatr Pulmonol ; 55(12): 3579-3586, 2020 12.
Article in English | MEDLINE | ID: covidwho-777654

ABSTRACT

BACKGROUND: We aim to assess the anxiety and depressive symptoms related to the COVID-19 pandemic in children with chronic lung disease and their parents and also to evaluate parents' coping strategies. METHODS: Parents of children aged 4-18 years, with chronic lung disease (study group n = 113) and healthy control (n = 108) were enrolled in the study. General Health Questionnaire-12, specific COVID-19 related anxiety questions, The Coping Orientation to Problems Experienced inventory, coronavirus-related psychiatric symptom scale in children-parental form were used to analyze the psychiatric effects of COVID-19. Parents were also asked about how online education affected their family life and children. All data were compared between children/parents in the study and control groups. Risk factors related with anxiety scores of children were also analyzed. RESULTS: Talking about the pandemic, concern about coronavirus transmission, taking precaution to prevent coronavirus transmission, making pressure to protect from COVID-19 were significantly higher in parents within the study group (p < .05). Parents in the study group used more problem-focused coping than parents in the control group (p = .003). Anxiety symptoms score was higher in children of the study group (p = .007). Parents in the study group found online education more useful than parents in the control group. CONCLUSION: Children with chronic lung diseases and their parents have more anxiety due to COVID-19 pandemic and these parents use more mature coping strategies to manage the stress of the pandemic. Longitudinal and larger studies should be done in all aspects of online education in children with chronic lung diseases.


Subject(s)
Anxiety/psychology , Ciliary Motility Disorders/psychology , Coronavirus Infections , Cystic Fibrosis/psychology , Lung Diseases, Interstitial/psychology , Pandemics , Parents/psychology , Pneumonia, Viral , Stress, Psychological/psychology , Adaptation, Psychological , Adolescent , Adult , Betacoronavirus , COVID-19 , Case-Control Studies , Child , Child, Preschool , Ciliary Motility Disorders/physiopathology , Cystic Fibrosis/physiopathology , Female , Health Status , Humans , Lung Diseases, Interstitial/physiopathology , Male , Middle Aged , Risk Factors , SARS-CoV-2
14.
G Ital Cardiol (Rome) ; 21(8): 575-583, 2020 Aug.
Article in Italian | MEDLINE | ID: covidwho-680054

ABSTRACT

The new coronavirus disease 2019 (COVID-19), which is causing hundreds of thousands of deaths worldwide, is complex and can present with a multi-organ localization. One of its worst complications is an interstitial pneumonia with acute respiratory failure also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which requires non-invasive or invasive ventilation. A severe coagulopathy with poor prognosis is found in 5-10% of cases. SARS-CoV-2 is manifesting as a multi-dimensional disease and, recently, unique co-existing pathophysiological and clinical aspects are being defined: (i) an increased immune and inflammatory response with the activation of a cytokine storm and consequent coagulopathy, which promote both venous thromboembolic events and in situ thrombosis localized in small arterioles and pulmonary alveolar capillaries; (ii) a high intrapulmonary shunt, which often accounts for the severity of respiratory failure, due to reduced hypoxic pulmonary vasoconstriction with pulmonary neo-angiogenetic phenomena. Furthermore, the high incidence of venous thromboembolism in COVID-19 patients admitted to the intensive care unit and the autoptic findings of in situ micro-thrombosis at the pulmonary vascular level, suggest that in this disease coagulopathy, unlike septic disseminated intravascular coagulation, is driven towards a hyper-thrombogenic state, giving rise to a debate (with ongoing studies) about the preventive use of anticoagulant doses of heparin to reduce mortality. The aim of this position paper from the Italian Association of Hospital Cardiologists (ANMCO) is to highlight the main implications that COVID-19 infection has on the pulmonary circulation from a pathophysiological, clinical and management point of view.


Subject(s)
Cause of Death , Coronavirus Infections/epidemiology , Lung Diseases, Interstitial/mortality , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Severe Acute Respiratory Syndrome/epidemiology , Venous Thromboembolism/etiology , COVID-19 , Cardiology , Communicable Diseases, Emerging/epidemiology , Coronavirus Infections/diagnosis , Disease Progression , Female , Humans , Incidence , Italy/epidemiology , Lung Diseases, Interstitial/etiology , Lung Diseases, Interstitial/physiopathology , Male , Pneumonia, Viral/diagnosis , Pulmonary Circulation/physiology , Risk Assessment , Severe Acute Respiratory Syndrome/diagnosis , Societies, Medical , Survival Analysis , Venous Thromboembolism/mortality , Venous Thromboembolism/physiopathology
15.
Telemed J E Health ; 26(10): 1304-1307, 2020 10.
Article in English | MEDLINE | ID: covidwho-639940

ABSTRACT

Purpose: Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and is an acute respiratory illness. Although most infected persons are asymptomatic or have only mild symptoms, some patients progress to devastating disease; such progression is difficult to predict or identify in a timely manner. COVID-19 patients who do not require hospitalization can self-isolate at home. Calls from one disease epicenter identify the need for homebased isolation with telemedicine surveillance to monitor for impending deterioration. Methodology: Although the dominant approach for these asymptomatic/paucisymptomatic patients is to monitor oxygen saturation, we suggest additionally considering the potential merits and utility of home-based imaging. Chest computed tomography is clearly impractical, but ultrasound has shown comparable sensitivity for lung involvement, with major advantages of short and simple procedures, low cost, and excellent repeatability. Thoracic ultrasound may thus allow remotely identifying the development of pneumonitis at an early stage of illness and potentially averting the risk of insidious deterioration to severe pneumonia and critical illness while in home isolation. Conclusions: Lung sonography can be easily performed by motivated nonmedical caregivers when directed and supervised in real time by experts. Remote mentors could thus efficiently monitor, counsel, and triage multiple home-based patients from their "control center." Authors believe that this approach deserves further attention and study to reduce delays and failures in timely hospitalization of home-isolated patients.


Subject(s)
Coronavirus Infections/diagnostic imaging , Lung Diseases, Interstitial/diagnostic imaging , Monitoring, Physiologic/methods , Occupational Health , Pneumonia, Viral/diagnostic imaging , Remote Consultation/methods , Ultrasonography, Doppler/methods , COVID-19 , Coronavirus Infections/epidemiology , Disease Transmission, Infectious/prevention & control , Female , Hospitalization/statistics & numerical data , Humans , Infection Control/methods , Lung Diseases, Interstitial/physiopathology , Lung Diseases, Interstitial/virology , Male , Mentoring/methods , Pandemics , Patient Safety , Pneumonia, Viral/epidemiology , Quality Improvement , Severe Acute Respiratory Syndrome/diagnostic imaging
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