Chest Symptoms Research Articles

Assessment of cardiopulmonary exercise capacity in suspected heart failure with preserved ejection fraction: impact of coronary flow velocity reserve and body fat

Abstract Background and objectives Heart failure with preserved ejection fraction (HFpEF) has various pathophysiology including coronary microvascular dysfunction (CMD), obesity, and frailty. In the present study, we aimed to assess the cardiopulmonary exercise capacity according to coronary microvascular function and body composition in patients with suspected HFpEF. Methods Patients with chest symptoms with non-obstructive coronary artery disease (<50% stenosis) and preserved left ventricle (LV) ejection fraction (≥50%) were enrolled. LV end-diastolic pressure was measured during coronary angiography. All patients underwent body composition analysis, adenosine stress echocardiography with the evaluation of coronary blood flow, and cardiopulmonary exercise test assessing maximal oxygen consumption (VO2max). Coronary flow velocity reserve (CFvR) was defined as the ratio of peak to baseline mean diastolic velocity of coronary blood flow. Association between VO2max and CFvR as well as body composition was assessed. Results Of the 106 patients (mean age 63.5), 54 (50.9%) were women, 52.4% had hypertension, and 28.6% had diabetes. Baseline LV end-diastolic pressure was 15.3 ± 5.5 mmHg. Median Heart Failure Association-PEFF score was 3, while medial e’ velocity was 6.7 ± 2.0 cm/s and E/e’ was 9.6 (7.6 – 12.0). Mean diastolic velocity of coronary blood flow was 0.17 [interquartile range (IQR) 0.13 – 0.23] m/sec at baseline, while it increased to 0.46 [IQR 0.38 – 0.57] m/sec at peak, resulting in CFvR of 2.75 [IQR 2.10 – 3.67]. Eighteen (17.1%) patients had CMD (CFvR <2.0). VO2max was 23.1 ± 5.4 mL/kg/min with lower value in women (21.7 ± 4.8 vs. 24.5 ± 5.6 mL/kg/min, p = 0.007). CFvR was directly related to VO2max (r = 0.350, p <0.001). In body composition, skeletal muscle mass index, percent body fat, and visceral fat area were associated with VO2max. In multivariable analysis, age, visceral fat area or percent body fat, and CFvR were linearly correlated with VO2max, and estimated VO2max was well correlated with measured VO2max. Conclusions Cardiopulmonary exercise capacity represented by VO2max was correlated with CFvR and body composition including skeletal muscle mass index, percent body fat, and visceral fat area in patients with suspected HFpEF. VO2max could be estimated by CFvR and fat component in the body.

Clinical Features and Risk Factors for Outcome in Hemodialysis Patients with COVID-19 after Complete Liberalization of Epidemic Control in China

Introduction: Patients undergoing hemodialysis (HD) are highly vulnerable during the COVID-19 pandemic. We aimed to investigate the risk factors associated with the severity of COVID-19 and death after the complete liberalization of epidemic control in China. Methods: We followed the outcomes of the HD patients of Central Hospital of Dalian University of Technology, from December 6, 2022, to January 8, 2023. The non-contrast-enhanced chest computed tomography (CT) was performed on all COVID-19-infected hospitalized patients. We recorded the patient’s clinical characteristics, demographic features, vaccination history, treatments, and lung lesions. Odds ratios and 95% confidence intervals were calculated using logistic regression models to identify independent risk factors for COVID-19-related severity and mortality. Results: This study included a total of 858 HD patients, of which 660 were infected with COVID-19. The mean age was (55.61 ± 14.61) years, with a median (interquartile range) dialysis duration of 44.5 (69.5) months. Over half (60%) of the study participants were male, and the majority had hypertension as a comorbidity. Multivariable analysis revealed that age, pre-dialysis diastolic pressure, fever, white blood cell (WBC) count, potassium, β2-microglobulin level, and calcium were independent risk factors for disease severity, while platelets, urea nitrogen, serum chlorine and creatinine were identified as independent protective factors. Furthermore, total iron-binding capacity and vaccination were found to be independent protective factors against mortality, and WBC count was an independent risk factor for in-hospital mortality (p < 0.05). The most frequent CT finding among hospitalized patients with chest symptoms was patchy shadow or pleural effusion, observed in 64.8% of cases. More than half of the patients exhibited bilateral lung lesions, and over 60% involved two or more lobes. Conclusion: The majority of HD patients are susceptible to COVID-19. Demographic, clinical features, and laboratory indicators can be used to predict the severity and mortality associated with COVID-19. Our findings will assist clinicians in identifying markers for the early detection of high mortality risk in HD patients with COVID-19.

Pericardial cyst unveiling: a case of unusual chest symptoms in a young woman with a family history of cancer: a case report and review of literature

BackgroundPericardial cysts, though rare and benign, can present with various clinical symptoms depending on their size and location in the body. The detection of these cysts typically relies on imaging studies for a conclusive diagnosis, with surgical removal being the definitive treatment.Case presentationThis case report details the clinical journey of a 32-year-old Iranian woman with a family history of breast and lung cancer, who experienced left-sided chest pain. Utilizing a combination of clinical history review, mammography, echocardiography, and computed tomography, a precise diagnosis of a 10 cm × 3.5 cm pericardial cyst was achieved. The patient underwent median sternotomy for complete cyst excision.ConclusionsWhile pericardial cysts are often asymptomatic and benign, they can lead to life-threatening complications. Hence, regular follow-up is advised, and in certain instances, minimally invasive interventions or surgery may be necessary.

The Effect of COVID-19 Vaccines (Available in Egypt) on D-Dimer and Platelets Count in Kafr El-Sheikh Governorate

Abstract Background The COVID-19 pandemic, caused by the SARS-CoV-2 virus, led to the development of various vaccines, including mRNA (Pfizer, Moderna), vector (AstraZeneca, Johnson &amp; Johnson), and inactivated virus (Sinopharm, Sinovac) types. Although generally safe, rare cases of thromboembolic events associated with vector vaccines have been reported. Governments, like Egypt, prioritize vaccine distribution. Common side effects include mild reactions, and overall, vaccines play a crucial role in mitigating the pandemic. Aim of the Work This study in Kafr El Sheikh, Egypt, investigates the effects of COVID-19 vaccines on D-dimer levels, platelet counts, and various short-term complications, including general, local, and chest-related issues. Patients and Methods A cross-sectional study at Kafr El Sheikh Chest Hospital involving 88 participants above 18 years assessed the impact of AstraZeneca and Pfizer COVID-19 vaccines. It included medical history, clinical examination, and laboratory investigations, with ethical approval and minimal risks. Statistical analysis utilized SPSS version 20, presenting qualitative and quantitative data. The study found significance at p &amp;lt; 0.05. Results This Kafr El Sheikh study on 88 individuals receiving AstraZeneca and Pfizer COVID-19 vaccines found no significant differences in D-dimer, platelet counts, or chest symptoms between the two groups. AstraZeneca was associated with higher constitutional symptoms, while Pfizer resulted in more pain at the injection site. Overall, both vaccines demonstrated safety. Conclusion This study concludes that the second doses of AstraZeneca and Pfizer COVID- 19 vaccines show similar safety profiles regarding D-dimer, platelet counts, and symptoms. Both vaccines demonstrate overall safety and efficacy, supporting their continued use in mitigating the impact of the pandemic.

The Role of Screening of Patient Proved to have Gastroesophageal Reflux Disease by Upper Gastrointestinal Endoscope for Early Detection of Interstitial Lung Diseases

Abstract Background Gastroesophageal reflux disease (GERD) is a common digestive disorder in North America, causing symptoms and complications. It affects 18.1-27.28% of people and is associated with decreased quality of life. Treatment improves quality of life, but treatment costs are higher. Aim and Objectives The study aims to assess the role of screening of patient proved to have gastroesophageal reflux disease by upper gastrointestinal endoscope for early detection of interstitial lung diseases. Subjects and Methods this study was Cross sectional study. The study will be conducted at Chest diseases Department of Ain Shams university hospitals. This prospective cross-sectional study will be conducted on 90 randomly selected patients diagnosed with GERD by upper gastrointestinal endoscopy. For one year. Result the findings of chest HRCT for enrolled patients is 15 patients (16.7%) showed positive CT findings suggestive of interstitial lung disease, whereas 75 patients (83.3%) had normal CT scan. The most common CT finding was atelectasis reported in nine patients (10%). a statistically significant correlation between age and fibrosis and reticular infiltration, female gender &amp; reticular infiltration. no statistically significant correlation between CT findings and each of chest symptoms and GERD symptoms. Conclusion The study found that gastrointestinal endoscopes are effective in early detection of interstitial lung diseases, with 16.7% of patients showing positive CT findings. Age, gender, hiatal hernia presence, cough, dyspnea, and wheezes were significant factors in fibrosis. and reticular infiltration

Plasma Fibrinogen as a Biomarker for Mortality and Hospitalized Exacerbations in People with COPD

Abstract Background Chronic obstructive pulmonary disease (COPD), predominantly prevalent in smokers, is a chronic inflammatory disorder of the airway and lungs. COPD is one of the most prevalent diseases and the third leading cause of death globally. COPD is a common, preventable, treatable disease that characterize by persistent chest symptoms and airflow limitation due to air way or, and alveolar abnormalities. Fibrinogen is a soluble protein that is produced in the liver and released into the bloodstream, with normal ranges of 200-400 mg/dL or 2-4 g/L. COPD and fibrinogen are associated with frequency of hospitalizatied exacerbations of COPD, and related to the severity of the disease and mortality. Objective To explore whether the fibrinogen level affects the mortality and hospitalized excerbations in COPD patients. Methods The present study was conducted upon 50 subjects during the period from August 2022 to January 2023 who were admitted to our chest department at Ain Sham University Hospitals. Results We made our study on 50 smoker patients, spirometric assessment for all patients was done to confirm COPD diagnosis. The mean age was 59.0± 8.83 years. There were 47 (94%) males and 3 (6%) females with male to female ratio was 16.7:1. Fibrinogen test was done during exacerbation with mean fibrinogen level was 3.64± 1.01 g/L. According to cutoff of fibrinogen level, most of excerbated patients had high fibrinogen level (&amp;gt;3.2). The mean FEV1 was 41.06± 18.75 there was a significant negative correlation between fibrinogen level and FEV1 shows that high fibrinogen level was significantly higher in cases with severe and very severe conditions. Most cases (94%) were discharged while three cases (6%) died shows that there was no significant relation between fibrinogen level and mortality. Conclusion Aecopd associated with high fibrinogen level and that the plasma fibrinogen level was increased with decreasing value of FEV1 showing significant negative correlation between plasma fibrinogen level and FEV1% predicated value. this suggests that high plasma fibrinogen level could be a diagnosis of severity of copd and a poor prognostic factor. but no significant relation between fibrinogen level and mortality. the results of the present study, combined with the fact that plasma fibrinogen is a widely and rapidly available, easy to interpret, low-cost biomarker, suggest a possible role for plasma fibrinogen in the identification of copd patients at an increased risk of adverse outcomes.

Prevalence of Non-ST-Segment Elevation Myocardial Infarction in Acute Coronary Syndrome With Unremarkable Electrocardiogram: A Cross-Sectional Study From Lady Reading Hospital, Medical Teaching Institute, Peshawar.

Introduction Patients admitted to the cardiac care unit with non-ST-segment elevation myocardial infarction frequently have inconclusive electrocardiogram results. In individuals presenting with sudden central chest discomfort, non-ST-segment elevation myocardial infarction should be suspected until confirmed or ruled out by a cardiac biomarker analysis. This study aims to determine the prevalence of non-ST-elevation myocardial infarction among acute coronary syndrome patients who present with normal electrocardiogram findings. Materials and methods This study was conducted from October 24, 2022, to April 24, 2023, and involved 120 patients who came to the cardiac emergency department at Lady Reading Hospital, Peshawar. These patients experienced chest pain and symptoms of acute coronary syndrome, all within 24 hours of the onset of their symptoms. Demographic data and clinical histories were recorded for each patient. Electrocardiograms were performed, and non-ST-segment elevation was observed. The diagnosis of non-ST-segment elevation myocardial infarction was confirmed by measuring cardiac troponin T levels. A threshold value greater than 0.5 ng/mL was considered diagnostic. Data analysis was performed using the Statistical Package for the Social Sciences (SPSS) (IBM SPSS Statistics for Windows, Version 23, Armonk, NY), and grammar was checked using the Grammarly software (Grammarly, Inc., San Francisco, CA). Results The study participants had an average age of 53.96 years, with a standard deviation of 8.57. Most participants were male, comprising 65.83% of the total population, while 34.17% were female. Among the participants, 26.66% were diagnosed with non-ST-segment elevation myocardial infarction, affecting 32 individuals. The results showed a significant correlation between the occurrence of non-ST-segment elevation myocardial infarction and male gender, as well as with individuals who had pre-existing comorbidities. The p-values for these associations were 0.032 and 0.043, respectively, indicating statistically significant relationships. Conclusion In conclusion, a significant proportion of patients who presented to the emergency department with acute coronary syndrome symptoms and a normal electrocardiogram were diagnosed with non-ST-segment elevation myocardial infarction. This highlights the need for special attention to male patients and those with comorbidities.

Applying Clinical Practice Guidelines on Chronic Headaches, Neck Pain, and Chest Symptoms: A Single Case Report

BACKGROUND: Neck pain and headaches are common conditions in physical therapy practice. Clinical practice guidelines (CPGs) are forms of evidence designed to decrease practice variability and guide care. CPG recommendations are general, with few specific tactics recommended, which could be a factor in their limited adoption and poor application. This case report demonstrates an example of implementing the Academy of Orthopedic Physical Therapy Neck Pain Revision CPG while also highlighting limitations and areas lacking specificity. CASE PRESENTATION: The patient was a 37-year-old female with neck pain, chest pain, and headaches. She was treated following the recommendations within the Academy of Orthopedic Physical Therapy CPG along with psychologically informed practice. The Neck Disability Index (NDI), Patient-Specific Functional Scale, Fear-Avoidance Beliefs Questionnaire, symptoms, and impairments were measured at evaluation, discharge, and 2 months post discharge. OUTCOMES: Clinically meaningful improvements in NDI and Patient-Specific Functional Scale scores, improved cervical endurance, scapular strength, and cervical motor control were observed at discharge. Additional improvements in NDI scores were seen at 2 months post discharge. DISCUSSION: While the CPG promotes the use of manual therapy, exercise, and general screening, the authors demonstrate specific techniques for identifying and managing fear-avoidance behavior with cognitive and graded exposure techniques. JOSPT Cases 2024;4(4):159-166. Epub 18 September 2024. doi:10.2519/josptcases.2024.0025

The role of screening of patients proved to have gastroesophageal reflux disease by upper gastrointestinal endoscope for early detection of interstitial lung diseases

BackgroundGastroesophageal reflux disease (GERD) is a frequent digestive illness in North America, causing symptoms and complications. It affects 18.1–27.28% of people and is associated with decreased quality of life. Treatment improves quality of life, but treatment costs are higher. The study aims to assess the role of screening of patients proven to have GERD by upper gastrointestinal endoscope for early detection of interstitial lung diseases.Subjects and methodsThis research was cross-sectional research. The study will be conducted at the Chest Diseases Department of Ain Shams University hospitals. This prospective cross-sectional research will be performed on 90 randomly selected cases diagnosed with GERD by upper gastrointestinal endoscopy. For 1 year.ResultThe findings of chest HRCT for enrolled patients are 15 patients (16.7%) showed positive CT findings suggestive of interstitial lung disease, whereas 75 patients (83.3%) had normal CT scans. The most common CT finding was atelectasis reported in nine patients (10%). a statistically significant correlation between age and fibrosis and reticular infiltration, female gender, and reticular infiltration. no statistically significant association between CT findings and each of the chest symptoms and GERD symptoms.ConclusionCT chest screen of patients diagnosed with GERD by upper gastrointestinal endoscopy plays a favorable role in the early detection of ILD to help in early management and treatment them. In patients diagnosed with GERD by upper gastrointestinal endoscopy, we revealed that: reticular infiltration is more prevalent in female gender. Reticular infiltration and fibrosis increase with older age. Reticular infiltration and atelectasis increase in patients who have a hiatus hernia. Cough, dyspnea, and wheezes increase in older age.

Type I Kounis syndrome in a young woman without chest pain: a case report

BackgroundKounis syndrome is defined as the concurrence of acute coronary syndromes in the setting of allergic or anaphylactic reactions. It primarily affects men aged 40–70 years and is often associated with chest pain. This syndrome is often unrecognized and undiagnosed in clinical practice due to a low level of awareness. Herein, we present a case of type I Kounis syndrome in a young woman without chest pain.Case presentationA 28-year-old Japanese woman with a history of atopic dermatitis received a glycyrrhizin, glutathione, and neurotropin preparation (a preparation of inflamed skin extract from rabbits inoculated with vaccinia virus) at a dermatology clinic to treat pruritus caused by atopic dermatitis. Immediately after the administration, the patient developed abdominal pain and generalized body wheals. The patient was diagnosed with anaphylaxis and was transported to our hospital. She had no chest pain on arrival at our hospital; however, a 12-lead electrocardiogram showed ST elevation in leads I, aVL, V2, and V3, and an echocardiogram showed decreased wall motion in the anterior and lateral walls of the left ventricle. Sublingual nitroglycerin administration improved ST-segment elevation and left ventricular wall motion abnormalities. The patient underwent emergency coronary angiography, which revealed no significant stenosis, and was diagnosed with type I Kounis syndrome.ConclusionKounis syndrome without chest pain is rare in young women. Since it can be fatal in cases with severe allergic symptoms such as anaphylaxis, the possibility of concurrent acute coronary syndrome should be considered when treating systemic allergic reactions, regardless of age, sex, or the presence or absence of chest symptoms.

427. THE ROLE OF CROSS-SECTIONAL IMAGING IN PATIENTS WITH PULMONARY MICRO ASPIRATION

Abstract Background There is increasing evidence of a strong relationship between pulmonary microaspiration of refluxate and pulmonary diseases such as bronchiectasis and lung fibrosis. This group has demonstrated the presence of co-location of pulmonary aspiration on modified reflux scintigraphy with lobar parenchymal lung changes on high resolution computed tomographic imaging of the lung (HRCT-L) in patients with typical and atypical reflux symptoms. There is, however, a cohort of patients who demonstrate evidence of reflux aspiration without evidence of parenchymal changes on HRCT-L. This study aims to demonstrate a group of patients with confirmed reflux micro-aspiration without corresponding changes in lung parenchyma on HRCT. Methods Data were obtained from a prospectively populated database of patients with treatment resistant typical and atypical GORD and suspected reflux pulmonary microaspiration. Modified novel digital technique of reflux pulmonary microaspiration scintigraphy using a previously validated technique was performed to evaluate the possibility of significant GORD or extra-oesophageal symptoms, including typical symptoms such as heartburn and reflux and atypical symptoms such as throat symptoms, cough, globus, mucous, throat clearing, dysphonia and recurrent respiratory infections. Patients who underwent microaspiration studies and had normal HRCT-L for chest symptoms were included. The group was compared to patients with lung changes on HRCT-L corresponding with micro-aspiration studies. Results Inclusion criteria were met by 14 patients (86% female, 14% male). The mean age was 54 years (range: 36 – 81 years). All patients demonstrated reflux microaspiration on scintigraphy in the supine delayed phase and all had intermittent or continuous full column gastro-oesophageal reflux. Lung parenchymal changes on HRCT-L corresponding to site of reflux micro-aspiration on scitigraphy were demonstrated in 66 out of 80 patients listed in the database. Amongst patients with normal HRCT-L typical reflux symptoms were reported in 1 patient, atypical symptoms in 6 patients, both in 5 patients and 2 did not report symptoms. Most common presenting symptom was cough. There was no difference in symptomatology of patients with or without HRCT-L pulmonary parenchymal changes. Patients with pulmonary changes on HRCT were on average 13 years older than patients without CT changes (mean age 67, range 31-91). Conclusion HRCT-L is an important additional investigation in patient with reflux micro-aspiration detected on scintigraphy to identify patients with reflux related lung parenchymal changes. Younger age of patients with normal HRCT-L suggests that parenchymal changes may be developing as a result of prolonged exposure to reflux micro-aspiration over time.

Anticipated prehospital decision delay in response to different symptom clusters in acute coronary syndrome: Results from the Spanish Cardiobarometer study

Background and objectiveReducing patient decision delay – the time elapsed between symptom onset and the moment the patient decides to seek medical attention – can help improve acute coronary syndrome survival. Patient decision delay is typically investigated in retrospective studies of acute coronary syndrome survivors that are prone to several biases. To offer an alternative approach, the goal of this research was to investigate anticipated patient decision delay in the general population in response to different symptom clusters. MethodsWe developed scenarios representing four commonly experienced symptom clusters: classic (chest symptoms only), heavy (a large number of very intense symptoms including chest pain), diffuse (mild symptoms including chest pain), and weary (mild symptoms without clear chest involvement). The scenarios were administered in random order in a representative survey of 1002 adults ≥55 years old from the non-institutionalized general population in Spain. We measured help-seeking intentions, anticipated patient decision delay (waiting >30 min to seek help), and symptom attribution. ResultsPatient decision delay was most common in the diffuse scenario (55%), followed by the weary (34%), classic (22%), and heavy (11%) scenarios. Attributing the symptoms to a cardiovascular cause and intentions to call emergency services were least frequent in the weary and diffuse scenarios. Women were less likely to intend to seek help than men in the classic (OR = 0.48, [0.27, 0.85], diffuse (OR = 0.67, [0.48, 0.92]), and weary (OR = 0.66, [0.44, 0.98]) scenarios, despite being more likely to attribute symptoms to cardiovascular causes. Participants with traditional cardiovascular risk factors (e.g., diabetes, hypercholesterolemia, hypertension) reported faster help-seeking, whereas participants with obesity and history of depression were more likely to delay. DiscussionThe diverse manifestations of acute coronary syndrome generate fundamentally different appraisals. Anticipated patient decision delay varies as a function of socio-demographic characteristics and medical history, supporting findings from studies with patients who experienced ACS. Measuring anticipated patient decision delay in the general population can help reveal potential barriers to help-seeking and capture effects of population interventions.

Health outcomes of COVID-19 patients from Wuhan, China 3-year after hospital discharge: a cohort study

ObjectivesTo evaluate changes in health outcomes between years 2 and 3 after discharge following COVID-19 and to identify risk factors for poor health 3-year post-discharge.DesignThis is a multicentre observational cohort...

Clinical and Imaging Features of Pulmonary Nodular Lymphoid Hyperplasia.

To investigate the clinical and radiographic features of PNLH and the relationship with pathologic features. A total of 11 patients in whom PNLH was confirmed in our department were retrospectively studied. The clinical and radiographic features were extracted and analyzed, and we also discussed the relationship between radiologic and pathologic features. Of the 11 patients with PNLH, 5 were discovered incidentally, while 4 presented with chest symptoms. Laboratory tests showed no specificity and the lesions were located under the pleura with an adjacent pleural indentation. Most lesions were solid, with some showing signs of spiculation or spiculate protuberance. In some cases, hypodense areas and vocules were visible. The enhanced scan showed marked enhancement, but most had no lymph node enlargement, and there was no pleural effusion. The clinical manifestations of PNLH are nonspecific and the imaging features overlap with those of malignant lung tumors, and the diagnosis depends on pathologic examination.

Burden of respiratory syncytial virus infections in older adults with acute respiratory infection in Japan: An epidemiological study among outpatients

BackgroundRespiratory syncytial virus (RSV) is a leading cause of acute respiratory illness, with severe outcomes in older adults. Information on the prevalence, hospitalization rate, and impact on the health-related quality of life (HRQoL) of RSV in older adults with acute respiratory infections (ARI) in outpatient settings in Japan is limited. MethodsThis multi-center epidemiological study included outpatients aged ≥60 years presenting with ARI between August 2021 and February 2023. Nasal and throat swabs were collected and tested by reverse transcription polymerase chain reaction (RT-PCR). The prevalence of RT-PCR-confirmed RSV (cRSV)-ARI, cRSV-lower respiratory tract disease (LRTD), and other respiratory viruses was calculated by season, region, age group, and RSV subtype. HRQoL was assessed via patient-reported outcomes. ResultsThe study included 923 ARI episodes (cRSV-ARI: N = 24; non-cRSV-ARI: N = 899). In years 1 and 2 (August 2021–July 2022 and August 2022–February 2023), the prevalence of cRSV-ARI was 2.5% and 2.8%, respectively. There was a predominance of RSV-B and RSV-A subtypes in years 1 and 2, respectively. In years 1 and 2 combined, 37.5% of cRSV-ARI cases had lower respiratory tract infection; all cRSV-LRTD cases occurred in those aged 60–74 years. RSV-ARI cases reported throat, chest, and respiratory symptoms, leading to impaired functioning and HRQoL. ConclusionsDuring the observed study period, RSV was circulating among older adults in Japan. RSV was a leading cause of ARI and LRTD. More data are needed to fully clarify the burden of RSV among older adults in Japan.

Assessment of Hepatocellular Carcinoma Patients Infected with Covid-19 Infection during the Pandemic

Hepatocellular carcinoma (HCC) patients are more susceptible to decompensation if they get Coronavirus disease 2019 (COVID-19) infection that leads to significant reduction in HCC related health services, reduction in surveillance activities and progression of HCC. On the other hand, symptoms of covid-19 infection are usually severe in HCC patients. Assessment of severity of covid-19 infection in HCC patients. And assessment of clinical course and outcome of HCC patients when they get infected by Covid-19. This is a retrospective case control study including 100 HCC patients (50 of them were infected by covid-19 while the other 50 were not infected). All patients were Egyptians presented to HCC clinic in national hepatology &amp; tropical research institute (NHTMRI) from 1/2022 to 1/2023 assessed for covid-19 infection (by typical CT chest, covid swab and covid symptoms) and assessed for HCC staging (by Barcelona clinic liver cancer BCLC), clinical course over six months (by Child Pugh score) and mortality rates. Most of Covid-19 infected HCC patients had severe covid symptoms and progressive HCC course with mortality 72%, while low percentage of covid-19 HCC infected group were mild with stationary course. On the other hand, high percentage of non-infected HCC group have stationary HCC course with low mortality 24%. COVID-19 infection seems to have a significant effect on clinical course and outcome of HCC. Also, HCC patients are vulnerable to have more severe COVID-19 symptoms.

Chest Computerized Tomography Findings in COVID-19 Patients Presenting to the ER with Gastrointestinal Symptoms

Abstract Background The world continues to face a life-threatening viral pandemic. SARS-CoV-2 has caused over 98 million cases and 2.2 million deaths since January 2020. Chest Computerized tomography is one of the main modalities in the screening and diagnosis of corona virus disease; yet it must correlate with the clinical and laboratory findings. Among available modalities for detecting COVID19, Chest Computerized tomography was done mainly in symptomatic and in high risk patients showing a sensitivity of 94.6% and specificity of 46.0%. Purpose of the Study Detecting COVID19 patients presenting initially or mainly with Gastrointestinal manifestations and to help preventing misdiagnosis and overlooking these patients. In addition to estimating the prevalence of these COVID19 patients presenting with gastrointestinal symptoms only versus those presenting with combined gastrointestinal and respiratory manifestations. Results This study included 95 patients recruited from the Ain-shams and Souad Kafafi University Hospitals from August 2021 till March 2022. These patients presented with gastrointestinal symptoms as their initial or main symptoms with positive PCR test. They were investigated by Chest CT and were interpreted by experienced radiologists in reading CT chest. From such patients, (32%) presented with gastrointestinal manifestations only. The rest of the patients were presenting mainly with gastrointestinal symptoms and associated with chest symptoms. A recurrently observed pattern of bilateral peripheral Ground glass opacities with basal predominance was found in gastrointestinal only group CT scans. Bilateral involvement, consolidation, crazy paving and multi lobar affection were statistically significantly higher in combined group in comparison to GIT only group. Conclusions Commonest Chest CT pattern was bilateral, peripheral GGO with basal predominance among Gastrointestinal only group. These findings indicate high possibility of COVID 19 even in the absence of chest symptoms. Consequently, a rapid diagnosis and earlier quarantine will assist in better treatment and prognosis.

Chest Symptoms and Long-Term Risk of Incident Cardiovascular Disease

BackgroundWe sought to evaluate the associations of chest pain and dyspnea with the long-term risk of cardiovascular disease including coronary disease, heart failure, atrial fibrillation, and stroke. MethodsIn 13,200 participants without cardiovascular disease in the Atherosclerosis Risk in Communities study (1987-1989), chest pain was categorized into definite angina, possible angina, non-anginal chest pain, and no chest pain using the Rose questionnaire. Dyspnea was categorized into grades 3-4, 2, 1, and 0 by the modified Medical Research Council scale. The associations of chest pain and dyspnea with incident myocardial infarction, heart failure, atrial fibrillation, and stroke over a median follow-up of ∼27 years were quantified with multivariable Cox models. ResultsDefinite angina and possible angina were associated with myocardial infarction (adjusted hazard ratios [HR] 1.80 [95%CI 1.45-2.13] and 1.65 [1.27-2.15]). Although lesser magnitude than myocardial infarction, both definite and possible angina were associated with heart failure. For atrial fibrillation, possible angina showed higher HR than definite angina. Dyspnea showed similar HRs for myocardial infarction and heart failure in grades 3-4 (2.00 [1.61-2.49] and 1.94 [1.62-2.32]). Stroke was least associated with chest symptoms. Chest pain and dyspnea significantly improved the discrimination of cardiovascular disease except stroke, beyond traditional risk factors. ConclusionsIn individuals without cardiovascular disease, chest pain and dyspnea were independently associated with incident cardiovascular disease for about 3 decades, suggesting the need for evaluating chest pain from a broader perspective of cardiovascular disease beyond coronary disease and the importance of dyspnea for cardiovascular risk assessment including myocardial infarction.

A clinical study to monitor prescription patterns, clinical outcomes, and adverse drug reactions among patients of various interstitial lung diseases attending respiratory medicine outpatient department at tertiary care hospital in Northern India.

The aim of this study was to monitor prescription patterns, clinical outcomes, and adverse drug reactions (ADR) among patients of various interstitial lung diseases (ILDs). This prospective study was conducted in the Department of Pharmacology and Therapeutics in collaboration with the Department of Respiratory Medicine, King George's Medical University, Lucknow, for a period of 12 months (October 2020-September 2021). A total of 77 patients were enrolled after satisfying the inclusion and exclusion criteria. The prescriptions were collected, and necessary details were noted on the case report form. After completion of the study, the data were analyzed for prescription patterns, clinical outcomes, and quality of life with the help of a validated questionnaire-King's Brief ILD (KBILD) questionnaire. At the same time, ADRs, if any, were assessed using Hartwig's Severity Assessment Scale and Naranjo Causality Assessment Scale. The most common ILD was acute/chronic hypersensitivity pneumonitis (HP). Average number of drugs per encounter was 4.45. Crepitations were the most common clinical signs. Clubbing and rhonchi were reported maximum in idiopathic pulmonary fibrosis. It was found that psychological, breathlessness and activities, chest symptoms, and total KBILD reduced significantly after 3 months as compared to baseline with a statistically significant difference as P < 0.01. ADRs were found in 23.38% (18) of the subjects. Maximum ADR reported was gastritis (9.09%), followed by hepatitis (3.90%). The high proportion of patients clinically diagnosed with HP in our study highlights the importance of a detailed environmental exposure history in the diagnostic evaluation of patients with ILD to avoid inaccurate diagnoses. ADR-related hospital admissions are a significant problem in the health-care system.

Importance of provoked spasms at the sites of nonobstructive stenosis as well as at the sites of obstructive stenosis in patients with obstructive coronary arteries and coronary spasm.

There are few reports regarding the prognosis in patients with obstructive coronary artery disease (OCAD) and vasospastic angina (VSA). This study investigated the clinical characteristics and clinical outcomes in patients with VSA and OCAD, especially regarding provoked spasm phenotypes and sites. This was a retrospective, observational, single-center study of 403 patients with typical or atypical angina-like chest pain undergoing acetylcholine (ACH) spasm provocation testing and OCAD. An obstructed coronary artery was defined as ≥50% luminal narrowing. We defined positive epicardial spasm as ≥90% transient stenosis and usual chest symptoms or ischemic ECG changes. Among these 403 patients with OCAD, positive spasm by intracoronary ACH testing was observed in 196 patients (49%), whereas negative spasm was found in the remaining 207 patients (51%). The clinical outcomes in the patients with OCAD and provoked spasm were not different according to the provoked-spasm phenotypes. Furthermore, the clinical outcomes were unsatisfactory in the patients with spasm at the site of nonobstructive lesion alone compared with those with spasm at the site of obstructive and nonobstructive lesions. We should precisely diagnose patients with OCAD who have provoked spasm by using intracoronary ACH testing and medicate the nonobstructive vessels in patients with OCAD and VSA under optimal coronary vasodilators.