Larva currens secondary to corticotherapy. Case report.

The infection by the new coronavirus (SARS-CoV-2) had in its beginnings a debated treatment, due to the unknown about its pathogenesis, which with the passage of time was clarified evidencing an inflammatory component. Corticosteroid therapy showed as a therapeutic option. In patients with corticosteroids it is essential to know the possible side reactions due to their immunosuppressive effect. We present the case of a 48-year-old male from Ecuador, who after infection by SARSCoV- 2 treated with corticosteroids, suffering as a complication the appearance of a serpiginous rash in the lumbar region. Due to its migratory history, serology for Strongyloides stercoralis, the diagnosis of currens larva was confirmed.Copyright © 2023 Sociedad Madrinela de Neumologia y Cirugia Toracica. All rights reserved.

Risk of in-Hospital Mortality Due to Covid19 in Patients with Bronchial Asthma: Application of 4c Mortality Scale

Role of asthma as a risk factor in severity and mortality in COVID-19 varies in literature. In 2020, 4CMortality score was published, which through 8 parameters in the initial evaluation (age, sex, comorbidity index Charlson, respiratory rate, peripheral oxygen saturation, renal function, Glasgow scale and C-reactive protein) stratified risk of in-hospital mortality from COVID-19 into low(0-3 points), intermediate(4-8), high(9-14) and very high(from 15). Our objective is to assess usefulness of 4CMortality in asthmatic patients admitted for COVID-19 and to verify the degree of correlation between the score and the mortality data and hospital stay. Observational retrospective study of asthmatic patients admitted for COVID-19 between March 2020 and March 2021. Statistical analysis is performed using Fisher's exact test(risk scale-death), ANOVA(risk scale-days hospitalization), and Kaplan Meier curve, considering statistically significant those results with a p<0.05. Sample of 99 patients, 18 in low risk group, 35 intermediate risk, 44 high risk and 2 very high risk. In terms of mortality, 7 deaths(high risk, 15.9%) and 2(very high risk, 100%), statistically significant (Fisher 17.07, p<0.0001). In terms of hospitalization days, median 7 days(low risk), 10(intermediate risk), 17 (high risk) and 5 (very high risk);statistically significant(F 6.37, p 0.001). In the survival analysis, median survival of 7 days(low-risk), 10(intermediate risk) and 19(high risk)(Log Rank 32.887, p<0.0001)(Fig 1). In conclusion, 4CMortality score is a good tool to establish the probability of poor evolution in asthmatic patients admitted for COVID-19 due to increased mortality and hospital stay.

PLATYPNEA-ORTHODEOXIA SYNDROME AS A CAUSE OF DYSPNEA IN A PATIENT WITH COVID-19 PNEUMONIA

Platypnea-Orthodeoxia Syndrome (SPO) is a poorly described entity, mainly caused by alterations at the cardiac and/or pulmonary level, characterized by dyspnea and hypoxemia in the upright position that improves with supine position. Because of the subtle and positional nature of the symptoms, it constitutes a diagnostic challenge and its multi-causality must be considered. The treatment can control the symptoms and even be potentially curative. We present a clinical case of persistent dyspnea in a patient with COVID-19 pneumonia which debuts with platypnea-orthodeoxia syndrome of a cardio-respiratory origin.

Risk factors of COVID-19. Role of chronic respiratory diseases

COVID-19 disease, caused by the SARS-CoV-2 coronavirus, has spread throughout the world. It can manifest from an asymptomatic form to the development of acute respiratory distress syndrome (ARDS). This article addresses aspects related to risk factors and comorbidities in patients with COVID-19, as well as the role of the main chronic respiratory diseases in their development and evolution, including chronic obstructive pulmonary disease (COPD), asthma and diffuse interstitial lung diseases (ILD). The most prevalent comorbidities in patients with COVID-19 are arterial hypertension (HTN), diabetes mellitus (DM) and cardiovascular diseases. In addition, it has been shown that both overweight and obesity predispose to the severity of the COVID-19 disease. With regard to chronic respiratory diseases, it seems that their prevalence in patients with COVID-19 is lower than expected.

Incidence of asymptomatic deep vein thrombosis in patients with COVID-19 pneumonia and elevated D-dimer levels.

AIM: An increased risk of venous thromboembolism (VTE) in patients with COVID-19 pneumonia admitted to intensive care unit (ICU) has been reported. Whether COVID-19 increases the risk of VTE in non-ICU wards remains unknown. We aimed to evaluate the burden of asymptomatic deep vein thrombosis (DVT) in COVID-19 patients with elevated D-dimer levels. METHOD: In this prospective study consecutive patients hospitalized in non-intensive care units with diagnosis of COVID-19 pneumonia and D-dimer > 1000 ng/ml were screened for asymptomatic DVT with complete compression doppler ultrasound (CCUS). The study was approved by the Institutional Ethics Committee. RESULTS: The study comprised 156 patients (65.4% male). All but three patients received standard doses of thromboprophylaxis. Median days of hospitalization until CCUS was 9 (IQR 5-17). CCUS was positive for DVT in 23 patients (14.7%), of whom only one was proximal DVT. Seven patients (4.5%) had bilateral distal DVT. Patients with DVT had higher median D-dimer levels: 4527 (IQR 1925-9144) ng/ml vs 2050 (IQR 1428-3235) ng/ml; p < 0.001. D-dimer levels > 1570 ng/ml were associated with asymptomatic DVT (OR 9.1; CI 95% 1.1-70.1). D-dimer showed an acceptable discriminative capacity (area under the ROC curve 0.72, 95% CI 0.61-0.84). CONCLUSION: In patients admitted with COVID-19 pneumonia and elevated D-dimer levels, the incidence of asymptomatic DVT is similar to that described in other series. Higher cut-off levels for D-dimer might be necessary for the diagnosis of DVT in COVID-19 patients.