High Plasma Osteopontin Levels Are Associated with Serious Post-Acute-COVID-19-Related Dyspnea.

COVID-19 survivors commonly report persistent symptoms. In this observational study, we investigated the link between osteopontin (OPN) and post-acute COVID-19 symptoms and lung functional/imaging abnormalities. We recorded symptoms and lung imaging/functional data from previously hospitalized COVID-19 patients, who were followed for 4-84 weeks (122 patients/181 visits) post-symptom onset at our outpatient clinic. Circulating OPN was determined using ELISA. Plasma OPN levels were higher in symptomatic patients (compared with the asymptomatic ones); those with dyspnea (compared with those without dyspnea);those with a combination of serious symptoms, i.e., the presence of at least one of the following: dyspnea, fatigue and muscular weakness (compared with those with none of these symptoms); and those with dyspnea and m-MRC > 1 (compared with those with m-MRC = 0-1). Plasma OPN levels were inversely correlated with EQ-VAS (visual analog scale of the EQ-5D-5L health-related quality-of-life questionnaire) values. High-resolution CT or diffusion lung capacity (DLCO) findings were not related to circulating OPN. In the multiple logistic regression, the presence of symptoms, dyspnea, or the combination of serious symptoms were linked to female gender, increased BMI and pre-existing dyspnea (before the acute disease), while increased plasma OPN levels, female gender and pre-existing dyspnea with m-MRC > 1 were independently associated with severe post-COVID-19 dyspnea (m-MRC > 1). Using a correlation matrix to investigate multiple correlations between EQ-VAS, OPN and epidemiological data, we observed an inverse correlation between the OPN and EQ-VAS values. Increased circulating OPN was linked to the persistence of severe exertional dyspnea and impaired quality of life in previously hospitalized COVID-19 patients.

Scanographic comparison of high frequency oscillation with versus without tracheal gas insufflation in acute respiratory distress syndrome.

PURPOSE: In acute respiratory distress syndrome (ARDS), combined high frequency oscillation (HFO) and tracheal gas insufflation (TGI) improves oxygenation versus standard HFO, likely through TGI-induced lung recruitment. Experimental data suggest that steady flows such as TGI favor the filling of the lower (i.e., subcarinal) lung. We used whole-lung computerized tomography (CT) to determine whether HFO-TGI versus HFO improves the recruitment of the lower lung, and especially of its dependent region, where loss of aeration is maximized in ARDS. METHODS: We enrolled 15 patients who had ARDS for 96 h or less, and pulmonary infiltrates in at least three chest X-ray quadrants. Patients were subjected to whole-lung CT after lung-protective conventional mechanical ventilation (CMV) and after 45 min of HFO and 45 min of HFO-TGI. HFO/HFO-TGI were employed in random order. CT scans were obtained at a continuous positive airways pressure equal to the mean tracheal pressure (P (tr)) of CMV. During HFO/HFO-TGI, mean airway pressure was titrated to the CMV P (tr) level. Gas exchange and intra-arterial pressure/heart rate were determined for each ventilatory technique. RESULTS: Regarding total lung parenchyma, HFO-TGI versus HFO and CMV resulted in a lower percentage of nonaerated lung tissue (mean ± SD, 51.4 ± 5.1% vs. 60.0 ± 2.5%, and 62.1 ± 9.0%, respectively; P≤0.04); this was due to HFO-TGI-induced recruitment of nonaerated tissue in the dependent and nondependent lower lung. HFO-TGI increased normally aerated tissue versus CMV (P=0.04) and poorly aerated tissue versus HFO and CMV (P≤0.04), and improved oxygenation versus HFO and CMV (P≤0.04). CONCLUSIONS: HFO-TGI improves oxygenation versus HFO and CMV through the recruitment of previously nonaerated lower lung units.

Primary right atrium angiosarcoma mimicking pericarditis.

BACKGROUND: Primary cardiac neoplasms occur rarely and most of them are benign. Malignant tumors including angiosarcoma are extremely rare and have a non specific clinical presentation and a poor prognosis. CASE PRESENTATION: We present a case of a young male who was transferred to our hospital because of shock and multiple organ failure after a complicated pericardial biopsy. During the previous seven months he presented with recurrent episodes of pericardial effusions and tamponade. Chest computed tomography revealed a mass in the right atrium, infiltrating the myocardium and pericardium. During emergency surgery that followed, the patient died because of uncontrolled hemorrhage. Autopsy revealed the mass of the right atrium, which was identified on histological examination as primary cardiac angiosarcoma. CONCLUSION: This case highlights the difficulties both in early diagnosis and in the management of patients with cardiac angiosarcoma.