Dyspnea Research Articles

Impact of SARS-CoV-2 viral load on restrictive spirometry patterns in mild COVID-19 recovered middle-aged individuals: a six-month prospective study

BackgroundLong term respiratory complications of Corona Virus Disease-2019 (COVID-19) are of great concern. Many studies have reported altered respiratory patterns in COVID-19 recovered individuals and most of them were from severe to critically ill patients. The association of viral load at the time of infection with symptoms of long COVID-19 specifically on pulmonary functions after months of recovery is still not known. This study was aimed to assess the impact of SARS-CoV-2 viral load during mild-moderate COVID-19 disease on pulmonary functions in middle-aged population after 6–8 months of acute infection.MethodsThis study included 300 (102 healthy controls and 198 COVID-19 recovered) individuals between age 30–60 of either gender. Mild-moderate COVID-19 recovered individuals were recruited between a period of 6–8 months post-acute infection. Spirometry was performed with MIR-Spirolab-III. The association of spirometry pattern was compared with SARS-CoV-2 viral loads during acute infection.ResultsWe observed up to 70% of the participants presented with either shortness of breath (11.5%), body aches (23.5%), recurrent cough (4.4%), recurrent respiratory infections (9.5%) and/or fatigue (33.3%) at follow up. In our study, 35.5% of COVID-19 recovered individuals had abnormal respiratory patterns (33.5% had restrictive and 2% had obstructive patterns). Viral load ≤ 20 CT value was associated with restrictive respiratory patterns (p = 0.004). No association was found between viral load and disease severity (p = 0.23).ConclusionIn this study, we found one third of mild-moderate COVID-19 recovered individuals have restrictive respiratory patterns after 6–8 months of recovery. These findings had a strong association with SARS-CoV-2 viral loads during acute infection which has been reported for the first time in our study. Studying the relationship between viral load and pulmonary functions can contribute to identifying potential risk factors for long COVID and developing preventive measures to mitigate the long-term impact on lung health.Clinical trial numberNot applicable.

Diagnosis and management of spontaneous coronary artery dissection: Two cases and a review of the literature

Introduction and importance: Spontaneous coronary artery dissection (SCAD) is a rare but potentially fatal condition, often underdiagnosed despite its significance in acute coronary syndrome (ACS). The true prevalence remains uncertain due to diagnostic challenges. Identifying SCAD cases is crucial for reducing mortality and morbidity, especially considering the recurrence risk. The authors present two cases highlighting the importance of multimodality imaging in diagnosing and managing SCAD. Case presentation: Case 1: A 53-year-old man with a history of brain aneurysm presented with chest pain and shortness of breath. Despite negative EKGs and stress tests, coronary computed tomography angiography (CCTA) revealed non-obstructive dissection flaps. Medical management improved his condition. Case 2: A 55-year-old woman with no significant medical history experienced recurrent chest pain. Initial tests were negative, but CCTA revealed SCAD. Further screening uncovered undiagnosed fibromuscular dysplasia. Clinical discussion: SCAD poses diagnostic challenges, often mimicking other cardiac conditions. Traditional tests may yield negative results, necessitating advanced imaging techniques like CCTA. Recognizing SCAD’s association with connective tissue disorders (CTD) is vital for comprehensive patient care. The authors’ cases emphasize the importance of a systematic approach to diagnosing chest pain, including noninvasive modalities and considering underlying etiologies. Conclusion: SCAD diagnosis requires a high index of suspicion, especially when traditional cardiac tests are inconclusive. Beyond treatment, patients should undergo further evaluation for CTDs, particularly in those with minimal risk factors for atherosclerosis. Increased awareness and a multimodal diagnostic approach are crucial for timely intervention and improved outcomes in SCAD patients. Learning objectives: The authors aim to increase awareness regarding different clinical presentations of SCAD to decrease the risk of missed or late diagnosis. The authors’ case series also signifies the multimodal imaging approach’s role in evaluating chest pain. Upon diagnosis of SCAD, it is imperative to go beyond treatment and implement a reverse algorithmic strategy to discover any underlying causes and risk factors for SCAD predisposition.

Associations of symptom burden with patient-reported outcomes (PROs) and clinical outcomes among early phase cancer clinical trial (EP-CT) participants.

244 Background: Individuals with cancer often endure a substantial physical and psychological symptom burden. However, little is known about the baseline symptom burden of patients with cancer participating in EP-CTs or the associations of this symptom burden with other PROs and clinical outcomes. Methods: We prospectively enrolled adults with cancer participating in EP-CTs at Massachusetts General Hospital from 4/2021-1/2023. Participants completed baseline surveys prior to EP-CT initiation that assessed symptoms (Edmonton Symptom Assessment System [ESAS]), quality of life (QOL; Functional Assessment of Cancer Therapy-General), hope (Herth Hope Index), depression/anxiety symptoms (Patient Health Questionnaire-4 [PHQ-4]), and financial wellbeing (COST tool, higher scores indicate greater financial wellbeing). We used regression models to explore associations of baseline symptom burden with other PROs (QOL, hope, depression/anxiety, financial wellbeing) and clinical outcomes (time on trial, hospitalizations, overall survival). Results: Among 205 participants (median age=63.3 [range: 31.8-88.6], 57.1% female), the most common cancer types were gastrointestinal (34.6%), breast (20.0%), and head and neck (10.2%). Based on the ESAS, approximately half of participants reported moderate/severe fatigue (50.2%) and poor wellbeing (49.5%). Under half reported moderate/severe drowsiness (35.7%), pain (25.9%), lack of appetite (25.4%), shortness of breath (20.0%), anxiety (18.0%), depression (15.4%), and nausea (9.2%). Higher baseline ESAS total, physical, and psychological scores were associated with worse QOL, lower hope, greater PHQ-4 depression/anxiety symptoms, and worse financial wellbeing (see Table). Higher baseline ESAS scores were associated with decreased time on trial and worse overall survival (see Table). Conclusions: In this study of EP-CT participants, we found associations of baseline symptom burden with other important PROs and clinical outcomes. Specifically, higher baseline symptom burden was associated with decreased QOL, lower hope, increased depression/anxiety symptoms, and diminished financial wellbeing as well as greater risk for shorter time on trial and worse survival. Interventions seeking to enhance care delivery and outcomes for EP-CT participants should strive to address the symptom burden of this population. Outcomes ESAS Total ESAS Physical ESAS Psychological PROs Beta P Beta P Beta P QOL -0.55 <0.001 -0.68 <0.001 -1.93 <0.001 Hope -0.10 <0.001 -0.09 <0.001 -0.53 <0.001 PHQ-4 Depression/Anxiety 0.06 <0.001 0.06 <0.001 0.39 <0.001 Financial Wellbeing -0.13 0.003 -0.16 0.009 -0.36 0.032 Clinical Outcomes HR P HR P HR P Hospitalizations 1.01 0.066 1.02 0.059 1.03 0.290 Time on Trial 1.01 0.069 1.01 0.208 1.04 0.046 Overall Survival 1.02 <0.001 1.03 <0.001 1.04 0.088

Cachexia in tuberculosis in South-East Asian and African regions: knowledge gaps and untapped opportunities.

Tuberculosis (TB) and cachexia are clinical entities that have a defined relationship, making them often found together. TB can lead to cachexia, while cachexia is a risk factor for TB. This article reviews cachexia in Tuberculosis patients in Southeast Asian and African regions by conducting a comprehensive literature search across electronic databases such as PubMed, Google Scholar, and Research Gate between 2013 and 2024 using keywords including 'Africa', 'cachexia', 'prevalence', 'implications', 'tuberculosis', and 'Southeast Asia. This article utilized only studies that satisfied the inclusion criteria, revealing knowledge gaps and untapped opportunities for cachexia in TB across Southeast Asian and African regions. Many Southeast Asian and Western Pacific patients initially receive a tuberculosis diagnosis. Sub-Saharan African countries are among the 30 high TB burden nations, according to the WHO. Food inadequacy and heightened energy expenditure can impair the immune system, leading to latent TB and subsequently, active infection. Symptoms needing attention: shortness of breath, productive cough, hyponatremia at 131mmol/l, hypoalbuminemia at 2.1g/dl, elevated aspartate transaminase at 75U/l, increased lactate dehydrogenase at 654, and normocytic anemia. Comorbidities, such as kidney disease, cardiovascular disease, and asthma, can influence the nutritional status of individuals with TB. While efforts like screening, contact tracing, and utilizing gene Xpert to detect TB cases were implemented, only a few proved effective. It is essential to conduct further studies, including RCTs, in Southeast Asia and Africa to evaluate and manage cachexia in TB patients.

A recurrent typical angina pectoris without any finding in coronary angiography: Microvascular angina.

Microvascular angina (MVA) can present with recurrent chest pain and normal coronary angiography. Recognizing MVA is crucial as it significantly impacts patient morbidity and mortality. Early diagnosis and management with antianginal medications are essential for improving outcomes and quality of life. Cardiovascular diseases are still the main cause of death in many parts of the world. Chest pain and dyspnea are always concerning due to the implications of cardiovascular disease. However, in patients with the involvement of the small coronary vessels (Microvascular Angina), symptoms might be recurrent and persistent despite the presence of normal coronary vessel evaluations. A 45-year-old man with a 25-year smoking history presented with recurrent chest pain, especially during physical activity, and mild shortness of breath. He was admitted, and a coronary angiography the next day appeared normal. However, a cardiac PET scan revealed the involvement of small coronary vessels not visible on angiography. The Patient was a 45-year-old man who presented with recurrent chest pain, more prominent during physical activity. He also had mild shortness of breath. The patient was admitted, and the next day, he underwent normal coronary angiography. The cardiac positron emission tomography (PET scan) showed the involvement of small coronary vessels that were not obvious on angiography.

Associations Between Acute COVID-19 Symptom Profiles and Long COVID Prevalence: Population-Based Cross-Sectional Study.

Growing evidence suggests that severe acute COVID-19 illness increases the risk of long COVID (also known as post-COVID-19 condition). However, few studies have examined associations between acute symptoms and long COVID onset. This study aimed to examine associations between acute COVID-19 symptom profiles and long COVID prevalence using a population-based sample. We used a dual mode (phone and web-based) population-based probability survey of adults with polymerase chain reaction-confirmed SARS-CoV-2 between June 2020 and May 2022 in the Michigan Disease Surveillance System to examine (1) how acute COVID-19 symptoms cluster together using latent class analysis, (2) sociodemographic and clinical predictors of symptom clusters using multinomial logistic regression accounting for classification uncertainties, and (3) associations between symptom clusters and long COVID prevalence using modified Poisson regression. In our sample (n=4169), 15.9% (n=693) had long COVID, defined as new or worsening symptoms at least 90 days post SARS-CoV-2 infection. We identified 6 acute COVID-19 symptom clusters resulting from the latent class analysis, with flu-like symptoms (24.7%) and fever (23.6%) being the most prevalent in our sample, followed by nasal congestion (16.4%), multi-symptomatic (14.5%), predominance of fatigue (10.8%), and predominance of shortness of breath (10%) clusters. Long COVID prevalence was highest in the multi-symptomatic (39.7%) and predominance of shortness of breath (22.4%) clusters, followed by the flu-like symptom (15.8%), predominance of fatigue (14.5%), fever (6.4%), and nasal congestion (5.6%) clusters. After adjustment, females (vs males) had greater odds of membership in the multi-symptomatic, flu-like symptom, and predominance of fatigue clusters, while adults who were Hispanic or another race or ethnicity (vs non-Hispanic White) had greater odds of membership in the multi-symptomatic cluster. Compared with the nasal congestion cluster, the multi-symptomatic cluster had the highest prevalence of long COVID (adjusted prevalence ratio [aPR] 6.1, 95% CI 4.3-8.7), followed by the predominance of shortness of breath (aPR 3.7, 95% CI 2.5-5.5), flu-like symptom (aPR 2.8, 95% CI 1.9-4.0), and predominance of fatigue (aPR 2.2, 95% CI 1.5-3.3) clusters. Researchers and clinicians should consider acute COVID-19 symptom profiles when evaluating subsequent risk of long COVID, including potential mechanistic pathways in a research context, and proactively screen high-risk patients during the provision of clinical care.

The impact of the COVID-19 pandemic on university students

Introduction/Objective. Our study aims to investigate the effects of COVID-19 pandemic on dyspnea, exercise capacity and mood in university students. Method. A total of 120 university students were included in this prospective study. The students' scores of desire to exercise, hopelessness (Beck Hopelessness Scale), fatigue severity (Fatigue Severity Scale), shortness of breath (Modified Medical Research Council (mMRC) Dyspnea Scale), and pain (Visual Analogue Scale) before and after the onset of the SARS-CoV-2 pandemic were determined using scales, face-to-face and online surveys. The Shapiro-Wilk, Mann-Whitney U, Wilcoxon Signed Rank test and the chi-square tests were used. In the data analysis, a p-value of less than .05 was considered statistically significant. Results. A total of 120 subjects were included in the study, 95 of whom (79.2%) identified as female. The mean age of the participants was 22.8±5.3 (18-45) years. It was observed that the scores for hopelessness, shortness of breath, pain, and fatigue in the group with a history of SARS-CoV-2 infection increased significantly (p<0.05) compared to the pre-pandemic period. Conversely, the desire to exercise exhibited a notable decline (p<0.05). Conclusion. In university students, increased hopelessness, fatigue, shortness of breath and decreased desire to exercise after the COVID-19 pandemic may have developed secondary to post-COVID syndrome and immobility due to lockdown.

Is LVH a must in an amyloid heart?

Abstract Background Transthyretin amyloidosis (ATTR), an infiltrative cardiomyopathy, is characterized by the infiltration of transthyretin-derived amyloid fibrils into the cardiac extracellular space, which causes morphological and functional heart damage. Because of the vast range of symptoms that can accompany ATTR cardiac amyloidosis, the illness remains unknown. However, misdiagnosis or delayed diagnosis due to inconsistencies between clinical findings and the severity of the underlying disease hampers treatment methods. Aim and objectives This article investigates the intricate relationship between ATTR amyloidosis pathogenesis and clinical signs to understand better the challenges and advancements in early discovery, treatment, and prognosis of this concealed sickness. Methods & Results Between November 2022 and April 2024, we conducted a prospective analysis on a cohort of 71 patients diagnosed with ATTR cardiac amyloidosis utilizing PYP imaging at our institution (Al Hada Armed Force Hospital, Taif, Saudi Arabia). The Medical Ethics Review Committee of the hospital accepted this project (2023-720). During our study, we faced two cases without LVH and both cases have grade II-III cardiac uptake. 1st case A 66-year-old male patient who is a known case of ischemic cardiomyopathy with EF 35% since 2018, he underwent PCI in 2018. The patient is following the cardio clinic since 2018 and on every visit he was asymptomatic, The Patient in 2021 experienced new shortness of breath within six minutes’ walk distance less than 400 meters. The patient experienced erectile dysfunction and underwent intervention for his carpal tunnel syndrome. ECG showed old Q in anterior leads. Echo showed the same EF 35% and old wall motion abnormalities. Diagnostic coronary angiography showed patent stents and no residual ischemia. When we revised his old echo study that was done in 2017, we found EF 55%, concentric LVH. PYP bone scintigraphy was decided and showed grade II-III cardiac uptake. 2nd case A 53-year-old hypothyroid female patient and she has metastatic left breast cancer. During her workup bone scan, grade III cardiac uptake was accidentally discovered using an HMDP isotope. The patient was referred to the cardio clinic where the patient denied any cardiac or non-cardiac symptoms. All her labs, ECG and Echo were within normal range. CMR showed diffuse subendocardial LGE suggestive of infiltrative disease. Conclusion Based on unique pathological features of CA that would present as morphological LVH with /without ECG evidence of LVH. We hypothesized that LVH would occur in the later stages of the disease or may be decreased due to other pathology as coronary artery disease. Clinical suspicion remains the cornerstone for early diagnosis and workup.

Chronic Respiratory Diseases: Innovations in Treatment and Management

Chronic Respiratory Diseases (CRDs) include diseases of the airways and the lung and are among the major causes of morbidity and mortality worldwide. The major CRDs include asthma, chronic obstructive pulmonary disease (COPD), pulmonary sarcoidosis, pneumoconiosis and interstitial lung diseases (ILDs). The common symptoms of CRDs include wheezing, chest tightness, shortness of breath and cough [1]. These diseases affect millions of people across the globe and have significant impacts on patients’ quality of life and healthcare. Over the past few decades, however, improvement in the pharmacotherapy has provided a considerable progress. For example, biologics have given a new insight in the management of severe asthma by modulating certain inflammatory processes. Medications like omalizumab, dupilumab, and Mepolizumab are aimed at adjusting the immune response and significantly decrease the frequency of exacerbations and increase overall lung function. In addition, innovations in the field of stem cell therapy and tissue engineering are targeted to repair or replace diseased lung tissue, thus, being aimed at treating the origin of the diseases rather than simply alleviating the symptoms. Furthermore, Nanoparticles can be orally given, intravenously injected or inhaled using nanoparticle aerosols. Nanoparticles can also be used in the molecular imaging of chronic lung diseases such as COPD. Advanced inhalers, developed with sensors, can monitor the usage of medication and provide feedback in real-time to ensure compliance to prescriptions and other salient treatment plans. COPD pulmonary rehabilitation programs of exercise and education together with psychological support for individuals have been documented to enhance quality of life. The use of AI and a machine learning system has now moved to the ability to forecast disease exacerbations and provide individualized recommendations for treatment of CRDs. As a result, people with COPD receive care through various healthcare professions like doctors, nurses, and physiotherapists, which may have diverse roles, such as prescribing medications, supporting their self‐management or patient education, or delivering exercise training. The aim of an Integrated Disease Management (IDM) programme is that various aspects of care through which healthcare providers are working in coordination to deliver improved and optimum care to patients. Similarly Advancements in the treatment of ILD are being conducted, and recently, some new FDA-approved drugs have been advised for the management of patients. Among these are Nintedanib is a tyrosine kinase inhibitor, Pirfenidone an anti-fibrotic and anti-thrombotic agent and Treprostinil is an analogue of prostacyclin. These drugs have opened a new path for the treatment of ILD and have improved the recovery outcomes of patients [2]. Rituximab has also been found to be effective in more than half of patients treated in a small prospective open-label trial of refractory pulmonary disease in sarcoidosis[3]. Overall, there is a renewed emphasis on CRD management as a burgeoning field. With the advancement in the research in the personalized, proactive and integrative strategy the efforts made will lay down new avenues of better health outcomes for millions of people suffering from the CRDs. The future of respiratory health is bright as it is a growing field that has no sign of discontinuing its steady development and pushing for the comforts and breakthroughs for many patients across the globe.

Utilizing the '5 in 1 Magic Touch' CCRTV method for early detection of severe dengue warning signs in pediatric patients: A case study from a Type C Hospital in Indonesia

Background: Dengue fever, prevalent in tropical and subtropical regions, is recognized by WHO as a significant global health threat. Early detection of severe dengue symptoms, especially in resource-limited settings, is critical for patient outcomes. The "5 in 1 Magic Touch - CCRTV" method, which evaluates Color, Capillary Refill Time, Temperature, Pulse Rate, and Pulse Volume, provides a simple yet effective approach to monitor hemodynamics and identify early warning signs of severe dengue. Case Description: In a case study, a 3-year-old boy was admitted with fever, shortness of breath, weakness, nausea, vomiting, and epigastric pain. On the third day, he entered a critical phase with symptoms of pale extremities, delayed capillary refill time, high fever, and a weak, rapid pulse. Thorax examination revealed severe plasma leakage, pulmonary edema, and right pleural effusion, indicating a pre-shock state. The patient required close clinical monitoring, regular fluid balance management, and frequent blood tests to guide treatment. Conclusion:The CCRTV assessment method allowed for the early identification of the pre-shock condition, facilitating timely and appropriate intervention. This case highlights the potential of the CCRTV method for improving prognosis in severe dengue cases. The effectiveness of this method warrants further research, particularly in its ability to predict outcomes and improve recovery rates in children with severe dengue.

Improving Asthma Management through Iot-Based Telemedicine Spirometry in The Post-COVID-19 Era in Sidoarjo Tofu Making Community, Indonesia

Asthma is a chronic inflammatory disease of the airways that causes recurrent episodes of wheezing, shortness of breath, chest tightness and coughing. The partners in this study face the problem that tofu factories in their area use plastic waste as fuel, which can aggravate respiratory conditions. In addition, the partners need more knowledge about the clear signs of asthma attacks, asthma symptom control and risk factors for asthma patients. The solution provided through the Community Service Programme with the PKM (Student Creativity Programme) scheme is to measure lung volumes using an IoT-based telemedicine device, specifically a spirometry tool that can be used with an Android mobile phone. In addition, partners will receive support to improve their knowledge, skills and attitudes in the management of asthma exacerbations. The implementation method includes providing health education on asthma, clear signs of asthma attacks, asthma symptom control and risk factors for asthma patients, as well as self-management skills for asthma patients and efforts to monitor asthma signs and symptoms. Lung capacity is measured using a spirometry device connected to an Android mobile phone for direct measurement by health workers. The results of the community service show an increase in respondents' knowledge about asthma after a lecture intervention. This was tested using the Wilcoxon signed rank test, which showed a statistically significant increase in scores from pre-test to post-test. All changes were positive, indicating the effectiveness of the learning methods used. Spirometry measurements showed that the respondents' lungs were functioning well without significant airway obstruction, indicating that the intervention was successful in increasing knowledge about asthma and asthma control

Investigating The Clinical Manifestations, Severity And Outcomes Of COVID-19 Among Inpatients With Rheumatic Diseases: A Retrospective Cross-Sectional Study In Iran

Introduction — Patients with rheumatic diseases (RD) may be at an increased risk of developing severe symptoms of COVID-19. They are likely to have a wide range of manifestations and outcomes that can make it difficult to control the disease. The goal of this study was to investigate the clinical manifestations, severity, and outcomes of adult patients with RD hospitalized for COVID-19. Methods — We conducted a retrospective cross-sectional study. Eligible rheumatology patients were confirmed by a rheumatologist in compliance with American College of Rheumatology (ACR) criteria and had COVID-19 confirmed by computed tomography (CT) scan or polymerase chain reaction (PCR) test. Information about their gender, age, and clinical manifestations of COVID-19, along with the variables pertaining to the outcomes of the patients, was collected. Descriptive statistics and Fisher’s exact test were performed using IBM SPSS Statistics software. Results — A total of 105 patients with RD and COVID-19 were included. Rheumatoid arthritis (RA) was the most common disease (86 patients). Most patients were female (75.2%). The mean age of the participants was 58.97±12.25 years. Myalgia/arthralgia was the predominant symptom of COVID-19 (77.1%), followed by shortness of breath, cough, and fever. Only platelet count exhibited a significant association with the type of RD (p = 0.004). Conclusion — Common adverse outcomes included moderate severity based on CT grading, anemia, oxygen saturation levels (SpO2) below 90%, and severe CT-based grade of severity. The mortality rate was relatively high.

Chronic Pulmonary Aspergillosis with Tracheobronchial Involvement

Introduction: Aspergillosis is a fungal infection commonly found in human lungs and takes several forms. Chronic pulmonary aspergillosis (CPA) commonly affects individuals with underlying disease, most usually lung tuberculosis (TB). Aspergillosis can cause the formation of a fungus ball in the lung cavity and can also manifest in the tracheobronchial area, although this is rarely seen in immunocompetent patients. Case: A 23-year-old woman came with persistent cough, hemoptysis, and shortness of breath for 4 months. The patient also had a significant weight loss and a history of lung TB 3 years ago. She had completed her lung TB medication. Physical examination showed increased respiratory rate and rhonchi on the left lung. GeneXpert showed no Mycobacterium tuberculosis (MTB) detected. The chest X-ray showed a cavity on the left superior lobe of the lung. Bronchoscopy showed multiple plaques along the trachea, carina, and left main bronchus. A chest computed tomography (CT) scan with contrast enhancement was performed, and a fungus ball was found inside the cavity in the left upper lobe of the lung. The patient was given intravenous fluconazole as therapy and continued with oral fluconazole when discharged. A second bronchoscopy was performed, and improvement was shown. Conclusion: Early detection and treatment should be applied to CPA patients since some studies showed poor prognosis and low five-year survival rates.

Pulmonary Embolism in the Post-partum Period: A Case Report

Background: One well-known hypercoagulable state that raises the risk of venous thromboembolism is pregnancy and it is more common in cesarean delivery. Pulmonary embolisms are difficult to identify based solely on postpartum symptoms. Most of the symptoms are non-specific, therefore they are typically underdiagnosed throughout pregnancy and the postpartum period. Objective: This work presented information on the treatment of high-risk pulmonary embolism in the postpartum phase. Case presentation: This paper reported the case of a 33-year-old female, admitted to the emergency room for shortness of breath. Her personal history showed that she had just given birth to her sixth child by caesarian section a month ago and had a history of hysterectomy due to severe infection. Result: She suffered a high-risk pulmonary embolism in the post-partum period. It takes a strong index of suspicion to diagnose and treat patients in a timely manner. Conclusion: Echocardiography and Multislice Computerized Tomography are the best diagnostic methods. Venous thromboembolism prophylaxis should be taken into account, particularly in patients who have risk factors.

CONGENITAL ABSENCE OF PULMONARY ARTERY

Isolated unilateral absence of a proximal pulmonary main artery is a rare congenital condition with a prevalence of 1 in 200,000 (1). The first case was reported in 1868, and to date, 350 cases have been reported (2). It usually occurs in conjunction with other cardiovascular anomalies such as tetralogy of Fallot, VSD, truncus arteriosus, etc. (2), and is typically diagnosed in childhood. Survival into adulthood is rare. Symptoms of this condition can include shortness of breath, chest pain, hemoptysis, reduced exercise tolerance, pleural effusion, and recurrent infections. We encountered a case of a 22-year-old female presenting with these symptoms. Initially, the symptoms suggested pulmonary embolism. However, further investigation through CTPA and Echocardiography revealed the absence of the left pulmonary artery. This case report emphasizes that patients showing signs and symptoms indicative of PAH should also be evaluated for the absence of a pulmonary artery." The pulmonary arteries originate from the sixth aortic arch during the sixteenth week of normal embryonic development. The proximal segment of the 6th aortic arch forms the initial portion of the right & left pulmonary arteries, respectively. The link on the arch's right side vanishes, whereas it establishes a connection through the ductus arteriosus on the left side. Pulmonary artery agenesis arises from the aberrant rotation of the afflicted segment's attachment to the aortic arch and dysfunctions during migration (3). Certain publications utilize the phrase “proximal blockage of the pulmonary artery” instead of “agenesis” to describe this anomaly. Although the intraparenchymal distal segment of the pulmonary artery is miniature, it is safeguarded (4). The prevalence of bronchopneumonia is ascribed to multiple causes, such as diminished lung tissue perfusion, impaired mucosal defense, and a possible unbalance of protease-antiprotease enzymes. Moreover, increased collateral blood flow may be associated with the onset of hemoptysis.

Prevalence, duration, and factors influencing post-COVID conditions among patients at several public hospitals, Alexandria governorate, Egypt 2022–2023

BackgroundPost-COVID conditions (PCC), characterized by persistent symptoms following acute infection, represent an emerging chronic illness that potentially affects millions of people worldwide. SARS-CoV-2 infection has resulted in a PCC incidence ranging from 10 to 30 % in non-hospitalized individuals to 50–70 % in hospitalized patients. Most PCC patients experience mild symptoms, while a minority report severe manifestations. We aimed to estimate the prevalence of PCC among COVID-19 patients who attended three public hospitals in Alexandria, Egypt between June 2022 and February 2023, and to investigate its risk factors. MethodsAll COVID-19-confirmed patients aged >18 years attended the selected hospitals, and their household contacts were contacted. Data were collected through telephone interviews using a questionnaire adapted from World Health Organization (WHO) and Penn Medicine tools, covering demographics, COVID-19 history, and PCC symptoms. PCC was defined as symptoms starting three months after the post-acute infection and lasting for at least two months beyond. Statistical analyses employed descriptive statistics, chi-square tests, and a logistic regression model, with a significance level of p < 0.05. ResultsA total of 1546 patients were enrolled. Their mean age was 39.7 ± 15.9 years, 46.0 % were males, and 13.9 % had comorbidities. Of them, 760 patients (49.2 %) reported PCC symptoms including, 52.6 % seen at outpatients, 26.7 % were admitted, and 0.5 % required admission to ICU. PCC symptoms included shortness of breath (94.2 %), mood changes (13.9 %), cough (13.0 %), and fatigue (8.8 %). PCC was associated with older age, hospitalization during acute COVID-19, comorbidities including asthma, hypertension, and diabetes, as well as treatment with different COVID-19 medications. Logistic regression shows that asthma, male gender, and treatment with medicines at the hospital remained significant in the model (ORs: 6.85, 0.36, and 0.88, p < 0.001). ConclusionThis study sheds light on PCC's prevalence and influencing factors following infection in Alexandria, Egypt. Common PCC symptoms included difficulty in breathing, fatigue, and psychological manifestations. The findings emphasize the critical need for early intervention and targeted management strategies, especially for high-risk groups such as asthma patients, to alleviate the long-term health consequences of COVID-19. Study results could guide the prevention of PCC e.g., through vaccination, management of long-term sequelae of PCC e.g., rehabilitation, and psychological support initiatives.

Whitaker syndrome: A case report of autoimmune polyendocrine syndrome type 1 with dilated cardiomyopathy.

This case report highlights dilated cardiomyopathy as a cardiovascular complication in autoimmune polyendocrine syndrome type 1 (APS-1), emphasizing the need for early recognition and a multidisciplinary approach. Comprehensive care and regular follow-up are crucial in managing these atypical presentations to optimize patient outcomes. APS-1, also known as Whitaker syndrome, is characterized by a triad of mucocutaneous candidiasis, adrenal insufficiency, and hypoparathyroidism. This rare autosomal recessive disorder results from mutations in the autoimmune regulator (AIRE) gene. Cardiovascular and pulmonary manifestations in APS-1 are infrequently reported in the literature. We present a case of a 28-year-old male who presented with shortness of breath and pedal edema. Physical examination revealed alopecia, absence of eyebrows, hyperpigmentation on joints, oral candidiasis, and nail dystrophy. Echocardiography demonstrated dilated cardiomyopathy (DCM) and pericardial effusion. Chest x-ray showed left-sided pleural effusion. Laboratory investigations revealed hypocalcemia, hyperphosphatemia, low parathyroid hormone (PTH), low cortisol, and high adrenocorticotropic hormone (ACTH) levels. The combination of chronic mucocutaneous candidiasis (CMC), hypoparathyroidism, and adrenal insufficiency confirmed the diagnosis of APS-1. To the best of our knowledge, this is the first Pakistani and second worldwide reported case of APS-1 presenting with such a combination of manifestations. Early recognition and multidisciplinary management are crucial for improving outcomes in these patients.

Prevalence of Asymptomatic Rise in Troponin I in Hemodialysis Patients at a tertiary care hospital

Objective: To determine frequency of asymptomatic rise in troponin-I among hemodialysis patients. To compare the mean of asymptomatic rise in troponin I between twice and thrice weekly hemodialysis patients. Methods: It is a Cross Sectional Study held in Sindh Institute of Urology and Transplantation outpatient dialysis department from June 25, 2020 to December 26, 2020 All patients of either gender age greater than 18-80 years undergoing hemodialysis via permanent angio-access without any history of shortness of breath and chest pain in preceding two weeks were consecutively enrolled. Information related to age, gender, causes of ESRD, duration of hemodialysis, date of last dialysis and date of sample collection was noted. Those whose troponin I was in cardiac range was admitted. Results: Of 127 patients, mean age was 38.17 ±14.75 years. There were 64 (50.4%) females and 63 (49.6%) males. Twice weekly hemodialysis was observed in 64 (50.4%) and thrice weekly in 63 (49.6%) patients. Mean troponin I level was 33.99 ±63.38 ng/ml. Raised troponin I level was found in 26 (20.50%) patients. The mean troponin I level among with twice weekly hemodialysis was 38.46 ±78.42 while among thrice weekly hemodialysis session was 29.45 ±43.27 (p-value 0.425). Conclusion: The frequency of asymptomatic rise in troponin-I was found to be 20.5% among hemodialysis patients. However, the mean difference of troponin I level with number of sessions showed insignificant difference.

Don't miss it as anxiety, ARDS!

Acute respiratory distress syndrome(ARDS) is a critical condition which compromises with the respiratory functions.Aim of this study is to present the management of ARDS case in the emergency department. This is a case report of a patient who was admitted to an emergency department.We did not apply any statistical methods. A 41-year-old female patient with no medical history was admitted to the emergency department as an outpatient with complaints of shortness of breath and palpitations. After a physical examination,it was first though that the patient was simply experiencing an anxiety episode.However oxygen saturation was measured as 35 % and further investigation of the patient revealed ARDS as the cause of these symptoms.Patient was admitted to the ICU unit. Even though anxiety can be common,it can be dangerous to dismiss other clinical and potentially lethal pathologies when searching for the cause of respiratory distress.Physical examination and vital signs should be evaluated together to reach a potential diagnosis.

Survival of hospitalised COVID-19 patients in Hawassa, Ethiopia: a cohort study

The COVID-19 pandemic, caused by SARS-CoV-2, led to 622,119,701 reported cases and 6,546,118 deaths. Most studies on COVID-19 patients in hospitals are from high-income countries, lacking data for developing countries such as Ethiopia.This study assesses clinical features, demographics, and risk factors for in-hospital mortality in Hawassa, Ethiopia. The research cohort comprises 804 cases exhibiting clinical diagnoses and/or radiological findings and indicative of symptoms consistent with COVID-19 at Hawassa University Comprehensive Specialized Hospital from September 24, 2020, to November 26, 2021. In-hospital mortality rate was predicted using Cox regression. The median age was 45 years, with males making up 64.1% of the population. 173 (21.5%) fatalities occurred, with 125 (72.3%) among males. Male patients had higher mortality rates than females. Severe and critical cases were 24% and 21%. 49.1% had at least one comorbidity, with 12.6% having multiple. Common comorbidities were diabetes (15.9%) and hypertension (15.2%). The Cox regression in Ethiopian COVID-19 patients found that factors like gender, advanced age group, disease severity, symptoms upon admission, shortness of breath, sore throat, body weakness, hypertension, diabetes, multiple comorbidities, and prior health facility visits increased the risk of COVID-19 death, similar to high-income nations. However, in Ethiopia, COVID-19 patients were young and economically active. Patients with at least one symptom had reduced death risk. As a conclusion, COVID-19 in Ethiopia mainly affected the younger demographic, particularly economically active individuals. Early detection can reduce the risk of mortality. Prompt medical attention is essential, especially for individuals with comorbidities. Further research needed on diabetes and hypertension management to reduce mortality risk. Risk factors identified at admission play a crucial role in guiding clinical decisions for intensive monitoring and treatment. Broader risk indicators help prioritize patients for allocation of hospital resources, especially in regions with limited medical facilities. Government’s focus on timely testing and strict adherence to regulations crucial for reducing economic impact.