Symptoms Of Respiratory Distress Research Articles

Direct Amoxicillin Challenge Without Preliminary Skin Testing for Pediatric Patients With Penicillin Allergy Labels

To study the safety of direct provocation testing (DPT) without a preceding penicillin skin test (PST) in individuals considered low risk for immunoglobulin E (IgE)-mediated or non-IgE–mediated hypersensitivity on the basis of clinical history.A total of 54 pediatric (age: 1–17 years) patients at an academic-affiliated pediatric outpatient allergy clinic.This was a retrospective observational study. Patients were selected to undergo DPT without PST if considered low risk on the basis of clinical history. DPT was offered to patients with a history of nonspecific rash or urticaria. Patients were excluded if they had a history of (1) severe symptoms of respiratory distress, (2) vomiting, (3) angioedema, (4) mucosal involvement, (5) skin desquamation or blister formation, (6) target lesions, (7) new onset fever, (8) joint, kidney, or liver problems, and (9) required emergent treatment during the index reaction. A single dose of oral amoxicillin (20 mg/kg up to 500 mg) was given, and patients were observed for 60 minutes. Physical examination and vital signs were performed at baseline and every 15 minutes. If no reaction was noted, the penicillin allergy label was removed from the chart.A total of 54 patients previously labeled as penicillin allergic but considered low risk received DPT. One patient was excluded from analysis because of a diagnosis of anaphylaxis during the index reaction. The median age at index reaction was 2 years; the median age at DPT was 7 years. Nonspecific rash was reported by 57.4%, hives was reported by 38.9%, and emesis was reported by 5.5% during the index reaction. A total of 9.3% reported reaction within 1 hour of exposure, 42.6% reported reaction onset >1 hour after exposure, and 48.1% were unable to recall timing of index reaction. All 53 patients passed the DPT and had penicillin allergy removed from their chart. No adverse reactions were reported during the DPT, and there were no reports of delayed reactions.In this cohort of pediatric patients with penicillin allergy labels who were determined to be at low risk for immediate IgE-mediated hypersensitivity reactions, DPT without PST was found to be safe and effective in testing for penicillin allergy.It has been well established that the majority of patients labeled as penicillin allergic (up to 10% of US population) are not truly allergic. There has been a push to delabel patients, but this can involve several steps, including prick skin testing, intradermal testing, and an oral challenge. The time, cost, and invasiveness of this process may make this less attractive to children and their parents. This study supports other similar studies that, in low-risk patients, a direct oral challenge with observation is adequate for delabeling low-risk patients.

Frequency of different symptoms in patients with COVID-19

Background: COVID-19 is a wide spreading disease starts from Wuhan a city of China in east. Earlier symptoms include fever, cough and fatigue later on patients may present with loss of smell and taste, sore throat, nasal congestion and muscle or joint pain. Its long term effects may include respiratory distress and neurological symptoms. Aim: To determine the frequency of different symptoms in patients with COVID-19 presenting at outpatients department of Nishtar Hospital Multan. Methodology: This cross sectional study was conducted at department of medicine, Nishtar Medical University, Multan, from September 2020 to September 2021. This study was carried out on 200 patients presenting with symptoms of COVID-19 and diagnosis was confirmed after admission. Main variables of study were symptoms of COVID-19 like cough, fever, running nose, breathlessness, headache and palpitations. SPSS version 22 was used for data analysis. Results: Majority of the patients were (60.0%) between age group 46-60 years. The most common symptoms were fever and cough, (79.0%) and (65.0%), respectively. The symptoms recorded between both male and female were almost equal, (standardized residuals<1.96 and p>0.05). But, fever and running nose were most common among the females, (p=0.028) and (p=0.050), respectively. Conclusion: COVID-19 presents with variety of symptoms and fever and cough were most common among these symptoms. COVID-19 positive patients can be present asymptomatically. All persons who come into contact with COVID19 patients should be go through the PCR lab test. Keywords: Novel COVID 19, Acute Respiratory Distress Syndrome, Contagious, Pandemic

Pulmonary Infantile Hemangioma: Clinical and Histopathological Review of Eight Cases

IntroductionInfantile hemangioma (IH) is the most common benign vascular tumor of childhood. It typically appears as a single cutaneous mass in the head, neck, and trunk area. IH that does not arise in the skin most commonly presents in the liver. The lesion emerges shortly after birth, rapidly enlarges within the first six months of life, and then spontaneously involutes by 5-10 years of age. Risk factors associated with IH complications include lesional size, location, and growth characteristics. Pulmonary IH is rare with limited reports of clinical presentations and outcomes.MethodsAn IRB-approved, retrospective review of pediatric patients with a diagnosis of pulmonary IH was conducted. Cases were identified within the Department of Pathology at Boston Children's Hospital from surgical or autoptic specimens evaluated between 1918 and 2021. Analysis of histopathological slides confirmed pulmonary IH in eight infants. We describe the diagnostic workup, radiological, and histopathological findings of these eight patients.ResultsAll patients presented with symptoms of respiratory distress, including tachypnea, subcostal retractions, and hypoxia. The median age at initial symptoms was 1.5 months (range, birth to 12 months). Five patients had a single pulmonary hemangioma ranging in size from 0.2 to 8.0 cm; three patients had multiple pulmonary hemangiomas. Four patients had co-occurrence of multifocal hepatic IH. The median age at histologic diagnosis of pulmonary IH was 6.5 months (range, 5 weeks to 16 months). Glucose transporter-1 (GLUT-1) immunostaining was positive in seven cases. Chest radiography demonstrated nonhomogeneous, mass-like consolidative opacities or rounded nodules. Treatment was primarily supportive. Three patients received medical therapy; two were treated with interferon, and one received propranolol. The infant treated with propranolol responded well with decreased lesional size and resolution of respiratory symptoms. Half of the patients in the cohort died; causes of death included cardiac failure from hepatic involvement, sepsis, hemorrhage, and liver failure.ConclusionsAlthough IH is a common childhood tumor, IH of the lung is rare. Most (80%) IHs are focal, with hepatic co-involvement in 50-60% cases (Zavras et al. Eur J Pediatr, 2020; Hinen et al. Front Pediatr, 2020). Given that all patients who had concomitant hepatic hemangiomas died-albeit before the widespread availability of medical therapy-the presence of hepatic hemangiomas may confer high risk of complications. Patients with hepatic hemangiomas presented with pulmonary symptoms. Biopsy may be necessary to confirm the diagnosis of pulmonary IH and inform treatment. In this series, only treatment with propranolol or surgical resection was curative. Pulmonary IH should be considered in the differential diagnosis of infants with unexplained pulmonary masses, especially when accompanied by hepatic IH. Early recognition is critical for patients to receive proper and potentially life-saving treatment. DisclosuresNo relevant conflicts of interest to declare.

An Interpretable Object Detection-Based Model For The Diagnosis Of Neonatal Lung Diseases Using Ultrasound Images.

Over the last few decades, Lung Ultrasound (LUS) has been increasingly used to diagnose and monitor different lung diseases in neonates. It is a noninvasive tool that allows a fast bedside examination while minimally handling the neonate. Acquiring a LUS scan is easy, but understanding the artifacts concerned with each respiratory disease is challenging. Mixed artifact patterns found in different respiratory diseases may limit LUS readability by the operator. While machine learning (ML), especially deep learning can assist in automated analysis, simply feeding the ultrasound images to an ML model for diagnosis is not enough to earn the trust of medical professionals. The algorithm should output LUS features that are familiar to the operator instead. Therefore, in this paper we present a unique approach for extracting seven meaningful LUS features that can be easily associated with a specific pathological lung condition: Normal pleura, irregular pleura, thick pleura, A- lines, Coalescent B-lines, Separate B-lines and Consolidations. These artifacts can lead to early prediction of infants developing later respiratory distress symptoms. A single multi-class region proposal-based object detection model faster-RCNN (fRCNN) was trained on lower posterior lung ultrasound videos to detect these LUS features which are further linked to four common neonatal diseases. Our results show that fRCNN surpasses single stage models such as RetinaNet and can successfully detect the aforementioned LUS features with a mean average precision of 86.4%. Instead of a fully automatic diagnosis from images without any interpretability, detection of such LUS features leave the ultimate control of diagnosis to the clinician, which can result in a more trustworthy intelligent system.

The Misattributed and Silent Causes of Poor COVID-19 Outcomes Among Pregnant Women.

Abundant evidence strongly suggests that the condition of pregnancy makes women and their fetuses highly vulnerable to severe Corona-virus 2019 (COVID-19) complications. Here, two novel hypoxia-related conditions are proposed to play a pivotal role in better understanding the relationship between COVID-19, pregnancy and poor health outcomes. The first condition, “misattributed dyspnea (shortness of breath)” refers to respiratory symptoms common to both advanced pregnancy and COVID-19, which are mistakenly perceived as related to the former rather than to the latter; as a result, pregnant women with this condition receive no medical attention until the disease is in an advanced stage. The second condition, “silent hypoxia”, refers to abnormally low blood oxygen saturation levels in COVID-19 patients, which occur in the absence of typical respiratory distress symptoms, such as dyspnea, thereby also leading to delayed diagnosis and treatment. The delay in diagnosis and referral to treatment, due to either “misattributed dypsnea” or “silent hypoxia”, may lead to rapid deterioration and poor health outcome to both the mothers and their fetuses. This is particularly valid among women during advanced stages of pregnancy as the altered respiratory features make the consequences of the disease more challenging to cope with. Studies have demonstrated the importance of monitoring blood oxygen saturation by pulse oximetry as a reliable predictor of disease severity and outcome among COVID-19 patients. We propose the use of home pulse oximetry during pregnancy as a diagnostic measure that, together with proper medical guidance, may allow early diagnosis of hypoxia and better health outcomes.

Inferring a causal relationship between ceramide levels and COVID-19 respiratory distress

A causal relationship between plasma ceramide concentration and respiratory distress symptoms in COVID-19 patients is inferred. In this study, plasma samples of 52 individuals infected with COVID-19 were utilized in a lipidomic analysis. Lipids belonging to the ceramide class exhibited a 400-fold increase in total plasma concentration in infected patients. Further analysis led to the demonstration of concentration dependency for severe COVID-19 respiratory symptoms in a subclass of ceramides. The subclasses Cer(d18:0/24:1), Cer(d18:1/24:1), and Cer(d18:1/22:0) were shown to be increased by 48-, 40-, and 33-fold, respectively, in infected plasma samples and to 116-, 91- and 50-fold, respectively, in plasma samples with respiratory distress. Hence, monitoring plasma ceramide concentration, can be a valuable tool for measuring effects of therapies on COVID-19 respiratory distress patients.

Clinical and Laboratory Characteristics of Patients infected by Listeria monocytogenes at a Tertiary Hospital in Hefei City, China.

BackgroundHuman listeriosis is a severe foodborne infection caused by Listeria monocytogenes and the data of patients with this infection are largely limited for the Hefei population.PurposeThis is a retrospective study that evaluated the clinical and laboratory data of patients with listeriosis at a tertiary hospital in Hefei City.Patients and MethodsA total of 24 listeriosis patients were admitted to the First Affiliated Hospital of Anhui Medical University from January 2003 to July 2021. Data from all patients were collected from the hospital’s electronic medical records.ResultsThe most common symptom of all patients was fever (91.7%), followed by altered consciousness (50.0%), rashes (45.8%), respiratory distress symptoms (37.5%), nuchal rigidity (29.2%), and headaches (20.8%). Laboratory results also indicated elevated C-reactive protein (CRP) (79.1%), hypoproteinemia (75.0%), anemia (62.5%), leukocytosis (45.8%), and neutrophilia (45.8%). The mean value of 5.1 μg/mL (SD, 3.8) for D‐dimer (D‐D) was significantly higher than the normal value ((0.00–0.50) μg/mL), while both altered consciousness (6 vs 4, P = 0.034) and headaches (4 vs 1, P = 0.036) occurred more frequently in the neurolisteriosis group compared with the bacteremia one. Additionally, the mean maximal body temperature (°C) (40.5 ± 0.7) as well as white blood cell (WBC) (15.3 vs 7.5 ×109/L, P = 0.014) and neutrophil (NEUT#) (13.2 vs 6.1 ×109/L, P = 0.026) counts of neurolisteriosis patients were higher than those of bacteremia (39.4 ± 0.4) (P = 0.001). Of all patients, four (50%) from the maternal-neonatal group remained uncured.ConclusionListeriosis is a rare disease with extremely variable clinical characteristics in Hefei City. Our data indicated that unexplained fever, altered consciousness, hypoproteinemia, anemia, elevated CRP and DD should be considered to assist diagnosis of listeriosis for early treatment interventions.

S2134 Pulmonary Artery Sling—An Extremely Rare Etiology of Dysphagia

Introduction: Pulmonary artery sling (PAS) is a rare anomaly created when the left pulmonary artery originates from the posterior aspect of the right pulmonary artery and courses over from right to left, posterior to the trachea or carina and anterior to the esophagus, to reach the hilum of the left lung. While coursing, it can compress the trachea or the esophagus resulting in airway or esophageal obstruction. Case Description/Methods: 43-year-old man with history of Down’s syndrome was evaluated for esophageal dysphagia for solid food of 2-month duration. EGD was unrevealing except for mild distal esophagitis. Mid and distal esophageal biopsies were negative for eosinophilic esophagitis. Barium esophagogram revealed extrinsic impression on the right side of esophagus just inferior to the aortic arch. CT thorax revealed showed presence of left pulmonary artery (PAS) corresponding to the above-mentioned extrinsic impression seen on esophagogram. Due to complexity and high mortality associated with the required corrective surgery it was decided to manage this condition conservatively with dietary modifications. Discussion: Vascular rings are congenital anomalies that can present with a variety of pulmonary and gastroesophageal symptoms. PAS is a rare vascular anomaly first described by Glaevecke and Doehle in 1897. PAS can be associated with congenital cardiac anomalies like ASD, VSD or PDA or airway anomalies like tracheal stenosis. Majority of patients are symptomatic and 2/3rd of patients presents within their first 2 months of life mainly with respiratory symptoms of stridor, respiratory distress, cyanosis, wheezing, and/or pneumonia. Presentation in adulthood is extremely rare as only one other case of adult-onset dysphagia caused by PAS has been reported in English literature in 1966 by Dumler. Arteriosclerotic dilatation of the anomalous pulmonary artery can account for late onset of dysphagia in previously asymptomatic individuals. Corrective surgery is mainstay of treatment for life-limiting symptoms after failure of conservative management.Figure 1.: Cartoon depiction of Pulmonary sling (A), Esophagram (B), CT (C, D) showing aberrant pulmonary artery.

The Bronchodilating herbs used in the treatment of COVID-19: A Review

Nowadays, covid_19(SARS_CoV_2) intimidating the world. This disease is spreading by contact with affected droplets. Some of the affected persons are asymptomatic, majority of people suffer from mild illness, meanwhile few were affected , some severe acute respiratory distress (pneumonia) and multi organs dysfunction like Pulmonary oedema, Cardiac failure, Renal failure. Currently doctors and peoples use some spices herb (basil, clove, black pepper, turmeric, garlic, ginger, ajwain , cumin) to prevent and reduce the corona virus infection. Most of these are Bronchodilator herbs. These drugs dilate the respiratory airway and allow more volume of atmospheric air to enter the lungs. Therefore a large amount of oxygen goes into the lungs and dissolves in the respiratory membrane. Furthur more, it’s transported through the blood and carried to main organs of the body. So this review article reveals Bronchodilator herbs can reduce the risk factors and prevent the respiratory distress symptoms in covid_19 (SARS_CoV_2) patients.

Silent hypoxaemia in COVID-19: Journey through ICU

Silent hypoxia is a well-known entity associated with SARSCoV-2 [1,2]. It is a condition where despite the patient being hypoxic, they do not show any signs and symptoms of respiratory distress [2]. Hypoxia can only be detected either by pulse oximetry reading or through blood gas analysis. These patients may have variable radiological appearances on presentation. Many studies have shown silent hypoxia has a high incidence of 20-40% with patients with SARS-CoV-2 pneumonia [2,3]. Some patients need intensive care support and some recover without any supports. Here we present a series of chest radiographs of a patient presented with silent hypoxia. A previously well 53 year old male presented to a COVID-19 treatment facility with a positive antigen testing. At the time of admission, the patient was well with a respiratory rate of 16/min and stable haemodynamics. There were no other signs and symptoms of respiratory distress. His routine pulse oximetry reading was 66% with an arterial oxygen partial pressure of 56 mmHg. The first chest radiograph showed an extensive air space opacification (Figure 1). The appearance was so severe and did not match with his clinical picture. An entity of silent hypoxia was diagnosed, and he was admitted to the Intensive care unit and started on face mask oxygen through 60% venturi.

The COVID-19 pandemic: the effect on airway Management in non-COVID emergency patients

BackgroundDuring the COVID-19 outbreak, healthcare providers might have avoided droplet/aerosol-generating procedures, such as non-invasive ventilation (NIV) and high-flow nasal cannula (HFNC) due to the concern of themselves being infected. We hypothesized that this change of practice could have also occurred to other non-COVID-infected patients in the Emergency Department (ED).MethodsA retrospective analytic study was conducted in the ED of Siriraj Hospital, Bangkok, Thailand, including adult patients presenting with signs and symptoms of respiratory distress between 1 March and 30 April 2020 (the COVID period). A comparison group using the same inclusion criteria was retrieved from 1 March to 30 April 2019 (the pre-COVID period). The primary outcome was rate of NIV and HFNC use. The secondary outcomes were rate of intubation, failure of NIV and HFNC, complications, and mortality.ResultsA total of 360 and 333 patients were included during the pre-COVID and COVID periods, respectively. After adjusting for baseline differences, patients in the COVID period were less likely to receive either NIV or HFNC than the pre-COVID period (adjusted OR 0.52 [95%CI 0.29–0.92]). Overall, intubation rate was similar between the two study periods. However, patients in respiratory distress with pulmonary edema had a relatively higher intubation rate in the COVID period. There were higher failure rates of NIV and HFNC, more infectious complications, and a higher rate of mortality in the pre-COVID period.ConclusionDuring the COVID-19 pandemic, the overall usage of NIV and HFNC in emergency non-COVID patients decreased. Although not affecting the overall intubation rate, this change of practice could have affected some groups of patients. Therefore, treatment decisions based on a balance between the benefits to the patients and the safety of healthcare providers should be made.

Clinical Characteristics of Confirmed Cases of COVID-19 Admitted at Al Nahdha Hospital, Oman: A Cross-Sectional Descriptive Study.

Background and objectiveCoronavirus disease 2019 (COVID-19) has become a public health emergency of international concern. Several characteristics of hospitalised cases, including variations in symptoms as well as radiological and laboratory findings, have been described. However, the exact clinical spectrum of hospitalised patients with COVID-19 in Oman is currently unclear. The objective of this paper was to describe the sociodemographic, clinical, laboratory, and radiological characteristics, as well as the treatment and clinical outcomes of the confirmed cases of COVID-19 at Al Nahdha Hospital, Oman. Additionally, factors associated with the severity of the disease were identified.MethodologyThis was a cross-sectional descriptive study of hospitalised COVID-19 patients. The required data were retrieved from the electronic health information system for the period from 3rd March to 9th May 2020. Information was recorded in a bespoke sheet and exported to SPSS Statistics (IBM, Armonk, NY) for analysis.ResultsA total of 102 admissions were included in this study. The mean age of the cohort was 49.9 (14.7) years. The majority were males (77.5%), and more than half were expatriates (56.9%). Diabetes and hypertension were found in 39.2% and 36.3% of the study population, respectively. Common symptoms encountered were dry cough (78.3%), fever (76.5%), and shortness of breath (SOB) (69.6%). Radiologically, bilateral infiltrations were present in 73.5% of the patients. Only 19 cases required critical care (18.6%), and those were mostly older [54.1 (13.4) years], males (89.5%), and non-nationals (63.2%). Significant factors associated with requiring critical care were symptoms of SOB (89.5% vs 65.1%, p=0.03), diabetes (68.4% vs 32.5%, OR=1.5, p=0.004), chronic artery disease (15.8% vs 3.6%, OR=1.7, p=0.04), and diagnosis of acute respiratory distress symptoms (63.2% vs 6.0%, p<0.001). Additionally, the mean ferritin levels were significantly higher in cases requiring critical care [2350.4 (423.8) vs 795.7 (554.3), p=0.005]. Depending on disease severity, the treatment included antibacterials, antivirals, heparin, and steroids. The utilisation of steroids was significantly higher in the cases requiring critical care (63.2% vs 26.5%, p=0.001). Among cases that required critical care (n=19), nine died (death rate=47.4%).ConclusionsThis study has provided fundamental information about the clinical characteristics of confirmed COVID-19 cases in Oman, including factors associated with the disease's severity. Results from this study can be utilised to update the COVID-19 management guidelines for hospitalised patients.

Nasopharyngeal Tube and Functional Treatment in Pierre Robin Sequence: A Tertiary Clinical Experience From 150 Cases.

To describe the initial care practices for children with Pierre Robin sequence (PRS) and analyze the factors predicting the severity of the obstruction breathing disorders. A retrospective single-center study of 150 children with PRS. Single tertiary care center, Regional Competence Center for the diagnosis and treatment of PRS. A total of 150 children with PRS consecutively followed between 1986 and 2017. Group 1 comprises children without specific respiratory management; group 2, children requiring prone positioning to alleviate their respiratory distress symptoms; and group 3, children requiring nasopharyngeal airway tube (NT) or nonconservative surgical treatment. Evolution and results of the initial treatment of PRS. Forty-two percent (n = 63) were attributed to group 1, 39% (n = 50) to group 2, and 19% (n = 29) to group 3. Preterm birth, birth weight, or associated congenital malformations were not significantly different between the groups. However, the age of exclusive oral feeding was significantly different: 1 day (quartiles: 0-3) for group 1; 11 days (quartiles: 1-28) for group 2; 39 days (quartiles: 19-111) for group 3 (P < .0001). Considering the NT, its use relieves the upper airway obstruction, assessed by a respiratory polygraphy, in 14 children. Nasopharyngeal airway tube has become our major first-line treatment, avoiding more complex procedures in most of the cases. The achievement of exclusive oral feeding seems to be a good predictor of the severity of respiratory symptoms in PRS.

Congenital cystic adenomatoid malformation: a case report

Congenital cystic adenomatoid malformation (CCAM) is a rare condition defined by multiple cysts produced in the lung that occur during the fetal period, with respiratory distress as presenting symptoms. Untreated CCAM may lead to repeated lung infection and pneumothorax. Many surgical techniques have been used to treat CCAM. However, those techniques showed various results. Moreover, less studies were performed to evaluate the effect of those surgical techniques in treating CCAM patients. We reported a management of a rare pediatric case of CCAM referred to the Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada/Dr. Sardjito General Hospital. The patient was a 29-day-old male baby who presented with pneumothorax on the right lung due to CCAM. The plan of treatment for the patient was lobectomy until pneumonectomy on the affected lung. During the thoracotomy procedure, we found that all lobes in the right lung were covered with fibrous tissue. Based on this finding, a decortication procedure to remove the fibrous tissue continued by a bullectomy procedure with the insertion of a chest tube were performed. The patient continuously showed improvement in breathing and wound healing, thus making the patient discharged from the hospital on the nineteenth postoperative day. The cause of CCAM is thought to be congenital abnormalities of the bronchiole epithelium that produce multiple cysts. Due to its rarity and lack of research on CCAM, many CCAM patients are misdiagnosed/ underdiagnosed. Common surgical methods used in this patient are lobectomy with continuation until pneumonectomy or bilobectomy, if necessary, to prevent recurrence. Parenchymal saving methods can be considered because they have the same outcome as lobectomy. As performed in this patient, thoracotomy decortication continued with bullectomy is adequately capable of alleviating respiratory distress symptoms and is thus described as successful.

COVID-19: Perspectives From Frontline Critical Care Nurses in New York.

New York City quickly became the epicenter of coronavirus disease-2019 (COVID-19) in early March of 2020. While hospitals were aware of the potential of COVID-19, the volume of critically ill patients that flooded the hospitals in the New York City area was clearly not anticipated. Hospital staff worked quickly to create COVID-19-free areas, but were overcome with the volume of COVID-positive critically ill patients. Many newly admitted patients required respiratory support with mechanical ventilation. As Governor Cuomo issued executive orders to stay at home in mid-March, some patients were afraid to go into hospitals despite symptoms of respiratory distress. Once these patients came to the hospital, they were often critically ill. Emergency departments and intensive care units filled rapidly, overwhelming staff and equipment needs with such things as pumps, dialysis machines, medications, and personal protective equipment. Plans for the day were disrupted with frequent rapid response calls and the need for additional beds. Key issues that confronted the COVID-19 response in critical care units at NYU Langone Health included communication, patient and staff safety.

Management of COVID-19: current status and future prospects

COVID-19, a highly transmissible pandemic disease, is affecting millions of lives around the world. Severely infected patients show acute respiratory distress symptoms. Sustainable management strategies are required to save lives of the infected people and further preventing spread of the virus. Diagnosis, treatment, and vaccination development initiatives are already exhibited from the scientific community to fight against this virus. In this review, we primarily discuss the management strategies including prevention of spread, prophylaxis, vaccinations, and treatment for COVID-19. Further, analysis of vaccine development status and performance are also briefly discussed. Global socioeconomic impact of COVID-19 is also analyzed as part of this review.

Çocuk Yoğun Bakım Ünitesinde Takip Edilen Guillain Barre Sendromu Olguları; 3 Yıllık Deneyim

Objective: After the poliomyelitis eradicated, Guillain-Barre Syndrome (GBS) is the most common cause of acute flaccid paralysis in healthy child. It is one of the neuromuscular disorders required treatment to pediatric intensive care unit. Aim of this study is to present the three-year’s experience of caring for patients with GBS admitted the PICU in the university hospital. Materials and Methods: Patients who were admitted to the PICU with diagnosed GBS between March 2016 and March 2019 were evaluated retrospectively. Results: Twenty-two patients were diagnosed with GBS during study period. Seven of them needed PICU in 8 admissions, and they formed the study group. Four of them were female and 3 of them were male. They were 3 to12 years old. All of them were admitted in the PICU because of respiratory distress symptoms. The paralysis followed a nonspecific respiratory or gastrointestinal infection by 3 to 7 days, and ascending progress was present. Intravenous immunoglobulin infusion was administered in all patients. Five of them need to plasmapheresis and mechanical ventilator support. Stay to PICU length was 2 to 87 days and hospitalization length was 14 to 98 days. All of them were discharged, and became able to walk unaided. Conclusion: Our results show that PICU follow-up is very important in children with GBS. Although duration of mechanical ventilation, and hospitalization length is long, prognosis is good with effective management strategies.

Mediastinal emphysema as a complication of posterior pharyngeal wall injury – a case report

Mediastinal emphysema is a pathological condition in which air is present in the mediastinum. Mediastinal emphysema may occur spontaneously or as a result of disease or trauma, including iatrogenic injury. Air into the mediastinum may pass from the lungs, trachea, bronchi, esophagus, peritoneal cavity, or come from outside the patient's body. It can also pass from the mediastinum into the neck or abdominal cavity. The mediastinum communicates with the submandibular space, the retropharyngeal space, and the vascular sheaths in the neck. Predisposing factors for mediastinal emphysema include the Valsalva test, physical exertion, increased respiratory effort, coughing, asthma, respiratory infections, vomiting, and drug use. A patient with mediastinal emphysema may present with no symptoms or may present with symptoms of respiratory distress. The most common symptoms observed are retrosternal pain radiating to the shoulder or back and increasing with changes in body position, dyspnea, cough, neck pain or discomfort, dysphagia, tachycardia, and subcutaneous emphysema. The diagnosis is made on the basis of clinical features including the underlying cause and radiological findings. A case of a patient with mediastinal emphysema due to trauma to the posterior pharyngeal wall is presented.

Concurrent bronchopulmonary foregut malformations: a rare case of right-sided extralobar pulmonary sequestration and bronchogenic cyst

BackgroundBronchopulmonary foregut malformations are rare congenital malformations. It is extremely rare to have malformations that occur simultaneously. There is literature to show that extralobar sequestration is associated with other congenital anomalies, most commonly diaphragmatic hernias, and also with other bronchopulmonary foregut malformations (e.g., extralobar sequestration and congenital pulmonary airway malformations). However, very few case reports were found that reported extralobar sequestration and foregut duplication cysts and only one report of a right-sided complex foregut malformation with pulmonary sequestration.Case presentationWe present a case of a 3-month-old male infant with a prenatal diagnosis of a cystic lung lesion who, after developing symptoms of respiratory distress, was found to have concurrent right-sided extralobar pulmonary sequestration and a mediastinal bronchogenic cyst.ConclusionsThe concurrent occurrence of these malformations in one patient could help support the theory that these malformations result from an early error in development during the time when both the lung buds and foregut are developing simultaneously.

Clinicoradiological Profile of Patients with Hydropneumothorax: A Prospective Study of a Hospital Population in Northern India

Background: Hydropneumothorax is defined as the presence of air and liquid (pus, fluid, or blood) in the pleural cavity, and it carries significant morbidity. Aim: The aim of the study was to explore the demographic and clinical-radiological characteristics of patients with hydropneumothorax. Patients and Methods: This study was conducted in the tertiary care center of northern India. Patients diagnosed with hydropneumothorax between January 2017 and December 2019 were included in the study. Sociodemographic characteristics, causes, symptoms and signs, and X-ray findings were collected and analyzed prospectively. Results: Fifty-two patients with hydropneumothorax were included in the study, 39 of whom were male. The mean age of patients was 34.17 ± 11.6 years. Dyspnea and cough were the most common findings in 50 (96.2%) and 49 (94.2%) patients, respectively. Fever was seen in 47 (90.3%), chest pain in 48 (92.3%), weight loss and loss of appetite in 30 (57.7%) patients, and hemoptysis in 11 (21.2%) patients. Cavitation was the most common chest X-ray finding seen in 34 (65.4%) cases. Tuberculosis (61.5%) was the most common cause of hydropneumothorax. For the management of hydropneumothorax, an underwater intercostal tube drain (ICD) was inserted in all the patients. The mean duration of intercostal drainage (ICD) in 51 patients was 21.3 ± 10.6 days. Conclusion: Patients of hydropneumothorax presenting with symptoms of respiratory distress required a prolonged period of chest tube drainage and usually showed a good response to the treatment.