Factors related to survival in Intensive Care Unit patients with Covid-19: a study from a single center in Brazil

Introduction: Analysis of the outcome of 268 ICU patients in a single-center, as well the impact of viral infection on patients with preexisting medical conditions and how these factors affected survival and hospital stay. Methodology: Patients admitted to the ICU from March-August, 2020 were retrospectively analyzed under the same protocol at Hospital Alemão Oswaldo Cruz, São Paulo, Brazil. Several factors were considered and the results were presented using 95% confidence intervals. For statistical significance, p <0.05 was adopted. Results: Patient median age was 72 years, 64,2 years for discharged patients and 79.9 years for those deceased (p<0.001). The most common comorbidities were: systemic arterial hypertension, diabetes, thyroid disease, cardiovascular and kidney disease. Predictors of survival through univariate analysis: myalgia (p=0.001), cerebrovascular disease (p=0.002), COPD (p=0.003), dementia (p=0.000), mechanical ventilation (p=0.000), dialysis (0.000), vasopressor use (0.000), SAPS3 (0.000), lymphopenia (p=0.004), elevated D-dimer (P=0.011), time in ICU before tracheostomy (p=0.002), and performing a tracheostomy (p=0.000). The independent predictors of mortality were: advanced age (p=0.003) and tracheostomy performed in ICU (p=0.002). Discussion: COVID-19 affects usually older adults, where there already is a higher fatality rate. Acute respiratory distress syndrome is the primary cause of death and <5% of patients were reported as experiencing co-infection at admission. Conclusion: age, vasopressor use in patients with tracheostomy, and systemic coronary disease, heart failure, neoplasia, and COPD, were found to be significantly associated with COVID-19 severity.

Idiopathic Chylopericardium in a Young Adult: Diagnosis and Management.

Primary idiopathic chylopericardium (PIC) is an uncommon cardiologic disorder; it is defined as accumulation of lymph in the pericardial sac without any know precipitating factor. A 25-year-old presented with dyspnea and chest pain for over two months. The patient underwent a chest X-ray, which revealed an enlargement of cardiac silhouette and signs of cardiac tamponade. Chest CT was performed, revealing large pericardial effusion and small pleural effusion on the right hemithorax. The patient was referred to the ICU and underwent a pericardial window through VATS, which revealed 500 ml of a milky fluid.

Thymic carcinoma and superior vena cava syndrome: Case report.

Tumor thrombus into the superior vena cava have been rarely reported in cases with mediastinal tumors. These tumors are frequently invasive and continuous from the main tumor that normally shows direct vessel wall invasion, but not in this case. In some cases, the tumor thrombus can be removed through a simple venotomy. To prevent superior vena cava and the left innominate vein stenosis, we used a pericardial patch to close the venotomy site. At this case we report a thymic carcinoma with superior vena cava syndrome, which was caused by a tumor thrombus in the superior vena cava without vessel wall invasion, an even more rare condition.

Recurrent pneumothorax in a COVID-19 patient: A case report.

An 88-year-old woman diagnosed with COVID-19 in Brazil presented with recurrent pneumothorax. She was under mechanical ventilation for 20 days because of acute respiratory distress syndrome (ARDS). Chest x-ray revealed right lung pneumothorax, which was treated with a pigtail chest tube leading to successful lung reexpansion. After 48 hours the patient developed an ipsilateral pneumothorax and a new tube thoracostomy under conventional chest tube under suction was performed and kept in place for 14 days. This brief report highlights that the conventional chest tube under suction procedures might be a good choice in Covid-19 patients.

Uniportal video assisted thoracic surgery right main sparing lung bronchial resection: live surgery in Sao Paulo.

We report the first uniportal right main sparing bronchial resection in Brazil. The procedure was performed live at Hospital Alemão Oswaldo Cruz, São Paulo during the II Brazil uniportal video assisted thoracic surgery (VATS) advanced masterclass. Another uniportal VATS right upper lobectomy with bronchoplasty, uniportal VATS S6 left segmentectomy and a subxiphoid uniportal VATS mediastinal tumor, were performed as well. This VATS program was conducted in São Paulo for the first time in 2016. We hope to extend the course to other centers around the country in the next year.

The lung adenocarcinoma guidelines: what to be considered by surgeons.

In 2011 the International Association for the Study of Lung Cancer (IASLC), the American Thoracic Society (ATS), and the European Respiratory Society (ERS), have proposed a new subclassification of lung adenocarcinomas. This new classification was founded on an evidence-based approach to a systematic review of 11,368 citations from the related literature. Validation has involved projects relating to histologic and cytologic analysis of small biopsy specimens, histologic subtyping, grading, and observer variation among expert pathologists. As enormous resources are being spent on trials involving molecular and therapeutic aspects of adenocarcinoma of the lung, the development of standardized criteria is of great importance and should help advance the field, increasing the impact of research, and improving patient care. This classification is needed to assist in determining patient therapy and predicting outcome. The 2011 IASLC/ATS/ERS adenocarcinoma classification can have an impact on TNM staging. It may help in comparing histologic characteristics of multiple lung adenocarcinomas to determine whether they are intrapulmonary metastases versus separate primaries. Use of comprehensive histologic subtyping along with other histologic characteristics has been shown to have good correlation with molecular analyses and clinical behavior. Also, it may be more meaningful clinically to measure tumor size in lung adenocarcinomas that have a lepidic component by using invasive size rather than total size to determine the size T factor.

Non-small cell lung cancer stage IV long-term survival with isolated spleen metastasis.

Splenic metastasis is rare and generally associated with disseminated disease, often seen in breast cancer, colorectal and ovarian carcinoma, and melanoma. Isolated metastasis to the spleen is rare, with only 93 cases from all sources having been reported up to 2007. Moreover, isolated splenic metastasis from primary lung cancer is extremely rare, with only 11 cases reported to date. We report a case of isolated splenic metastasis in a woman 8 months after lobectomy for an adenocarcinoma in the right lung completely resected. After 8 years of follow-up, the patient is still alive with no evidence of metastatic recurrence.