Respiratory Tract Involvement Research Articles

Respiratory manifestations of pediatric granulomatosis with polyangiitis: A 12-year experience from a tertiary care facility.

Pediatric granulomatosis with polyangiitis (GPA) is associated with several pulmonary manifestations. This study aims to describe these manifestations at time of diagnosis and longitudinally at a tertiary-care pediatric hospital. We performed a retrospective chart review of patients with GPA treated at our facility between 1 January 2010 through 31 December 2021. We collected baseline demographics, reported symptoms, imaging findings, pulmonary function tests (PFTs), and laboratory data at time of diagnosis. Data were collected using 6-month observation intervals to follow recurrence of respiratory manifestations, testing during recurrence, and resultant treatment modifications. Of 13 patients treated for GPA during the study period, 12 developed respiratory tract involvement. A total of 87 6-month observation periods were analyzed. At time of diagnosis, 83% (10/12) of subjects reported respiratory symptoms, 92% (11/12) had abnormal chest computed tomography (CT) imaging, and 42% (5/12) had abnormal PFTs. Fewer than half of the patients were seen by pulmonology within 6 months of diagnosis. Eight subjects (75%) had respiratory manifestations during subsequent observation periods. Chest CT or PFTs were obtained in 23/44 (52%) of observations periods with respiratory symptoms, with pulmonary consultation in only 9/44 (20%). This is the first US study to describe respiratory manifestations in pediatric GPA patients longitudinally, finding they are common and frequently recurrent. Our cohort had almost universally abnormal imaging at diagnosis regardless of respiratory symptoms. Early collaboration with pediatric pulmonology in the care of GPA patients may allow rheumatology teams to efficiently evaluate recurrent symptoms and address concomitant lung disease.

Clinical Significance of Respiratory Involvement in Cryptosporidiosis: Cross-Sectional Study of Children with Diarrhea and Respiratory Symptoms in Uganda.

Respiratory cryptosporidiosis is considered an occasional, late-stage complication of HIV/AIDS. This study aimed to assess the clinical importance of respiratory cryptosporidiosis in children with diarrhea and respiratory symptoms at Mulago Hospital, Kampala, Uganda. Children aged 9 to 36 months presenting with diarrhea and cough or unexplained tachypnea (N = 1,918) were screened for fecal Cryptosporidium using polymerase chain reaction (PCR). Children with positive stool samples were eligible for further diagnostic tests, including sputum induction. Sputum samples were subjected to PCR for Cryptosporidium, as well as routine microbiology (culture and gram stain) and auramine stain for tuberculosis. Regression analyses were used to investigate 1) factors associated with respiratory cryptosporidiosis and 2) whether respiratory cryptosporidiosis was independently associated with hospitalization. Prevalence of enteric cryptosporidiosis was 260/1,918 (13.6%) (>80% Cryptosporidium hominis). Of the 236 children who had sputum available for analysis, 62 (26.3%) had Cryptosporidium in the sputum, only two of whom had HIV infection. Children with Cryptosporidium in the sputum were more likely to have abnormal oxygen saturation at presentation (SpO2 <96%; P = 0.053); no other differences in frequency or severity of respiratory signs were noted. No alternative bacterial cause of respiratory symptoms was identified in 37.7% of children with respiratory cryptosporidiosis, compared with 23.6% of children without (P = 0.04). Sputum-positive children had twice the odds of hospitalization compared with children without Cryptosporidium infection at this site (adjusted odds ratio = 2.08, 95% confidence interval: 1.02-4.22; P = 0.043). Respiratory tract involvement is common in children with intestinal cryptosporidiosis who are experiencing respiratory symptoms. Such children may experience some degree of respiratory compromise and may be at increased risk for hospitalization.

Air pollution and health in Eastern India: Findings from a primary survey conducted in West Bengal and Jharkhand

Introduction: Exposure to air pollution has long been associated with mortality and shortened life expectancy and has been acknowledged as one of the growing risk factors that affect human health. Although air pollution is considered a global problem affecting rural and urban equally, it is still observed that the people of developing countries are disproportionately affected by it. Objectives of the Study: The present study aims to (1) understand the prevalence of upper respiratory symptoms, lower respiratory symptoms, and cardiometabolic and psychological health issues; (2) analyze the dichotomy in the degree of upper and lower respiratory symptoms based on the type of residence (rural/urban), age group, job profile (indoor/outdoor), and degree of pollution exposure; and (3) map the extent of reported health issues in the city of Kolkata. Methodology: A primary questionnaire survey was conducted in West Bengal and Jharkhand, where respondents were enquired about their health symptoms and their level of awareness of air pollution. An attempt was made to conduct a census survey in all of the target health camps, and only those who gave their consent were surveyed. Sample Description: The total sample (N) size was 2784 respondents (Jharkhand and West Bengal), with 1456 respondents from West Bengal and 1328 from Jharkhand. The total rural sample size was 417 respondents. The total urban sample size was 2367 respondents. Among the samples, 1369 were involved in indoor jobs (49%), 1415 were involved in outdoor jobs (51%), 2404 were exposed to both indoor and outdoor air, and 380 were exposed to only outdoor air pollution. Results and Discussion: More than 40% of the respondents reported sneezing, coughing, nasal congestion, or mood-related problems. More than 30% of the respondents reported sore throat or sleep-related problems, 14% had hypertension and 6% had diabetes. Among the various symptoms, cough was the predominant symptom in both rural and urban areas. Other than cough, all other symptoms suggestive of lower respiratory tract involvement were marginally higher in the urban areas in comparison to the rural areas. The urban population had higher numbers of symptoms per respondent than the rural counterparts. Lower respiratory symptoms (cough, chest discomfort, breathlessness) primarily increase with age and were the highest in the old age group (61 years and above). Lower respiratory symptoms were observed to be higher among outdoor workers, in comparison to indoor workers. Upper respiratory symptoms (sore throat, nasal congestion, and sneezing) except sinusitis were higher among outdoor workers in comparison to indoor workers. Except for cough and wheezing, most other lower respiratory symptoms (chest discomfort and tightening/degree of breathlessness) were observed to be higher among respondents who were exposed to both indoor and outdoor air pollution. Nasal congestion and sneezing were comparatively higher among people exposed to only outdoor air pollution. Sore throat and sinusitis were seen to be higher among respondents who were exposed to both indoor and outdoor air pollution. Population with both indoor and outdoor pollution exposure was more likely to have a higher number of symptoms per respondent than population with only outdoor pollution exposure. More than half of the respondents used liquified petroleum gas as their primary cooking fuel. At least 12% of the respondents use cooking fuel, which is attributed to the generation of unhealthy smoke. People of Kolkata also associated lifestyle diseases and psychological issues related to air pollution. Conclusion: Exposure to air pollution was associated with various upper and lower respiratory tract symptoms in more than half of exposed individuals. Symptoms suggestive of lower respiratory tract involvement were marginally higher in the urban areas in comparison to the rural areas. The urban population had higher numbers of symptoms per respondent than the rural counterparts. Symptoms suggestive of lower respiratory tract involvement increased with age and were highest after 61 years of age. Both upper and respiratory symptoms were more common in outdoor workers. Overall symptoms burden was more in Kolkata as compared to the overall study.

Upper respiratory tract involvement in granulomatosis with polyangiitis – single center experience

Upper respiratory tract involvement in granulomatosis with polyangiitis – single center experience

New medical technologies in cough therapy: results of a double-blind randomized placebo-controlled multicenter clinical trial

To study the efficacy and safety of Eladis® in comparison with placebo in patients with non-productive cough. A phase III clinical trial enrolled 250 patients aged 18-65 years with acute respiratory viral infection with upper respiratory tract involvement or acute bronchitis. Patients were randomized into 2 groups of 125 subjects: group 1 received Eladis® (40 mg tablets), group 2 received a matching placebo. The patients received the study drugs 1 tablet BID for 7-14 days. After the treatment, patients were followed up (day 7±2) to assess the effect of therapy on the frequency of coughing attacks, the frequency and severity of daytime and nocturnal cough, the severity of cough, the duration of clinical cough cure, and the effect on the severity of the main acute respiratory viral infection symptoms. The results of the study demonstrate the overall efficacy and statistically significant superiority of Eladis® over placebo: there were significant differences between the study groups in the proportion of patients who decreased the coughing attack frequency by ≥50% by day 5 (p<0.0001). In addition, the clinical cure of cough in the Eladis® group occurred 2 days earlier: the median time was 6 days, vs 8 days in placebo group. There was a decrease in the frequency of cough attacks and a decrease in its severity by more than 3.5 points by day 5 of treatment. All the effects were associated with high safety of the drug.

Orthomolecular Therapy for Management &amp; Prevention of SARS-CoV-2 Disease

The renowned coronavirus spread throughout the entire world within a short duration of time and in the process it destroyed everything it encountered in its path, like an invisible fire. This article is to review some of the key features of the coronavirus pandemic and also the virus that causes it. That is, to review the covid-19 virus, which is also known as SARS-CoV-2 (Severe Acute Respiratory Syndrome – Corona Virus – 2). Several vaccines have been developed worldwide for the prevention and treatment of this virus, but due to the limitation of their distribution and manufacturing capacities, the targeted global “herd immunity” has not been achieved. Meanwhile, SARS-CoV-2 is constantly mutating and that unfortunately limits the effectiveness of various vaccination campaigns, notwithstanding the speed of the campaigns. Meanwhile, the current antiviral drugs being used including ivermectin, hydroxychloroquine, ritonavir and lopinavir have not resulted into any conclusive benefits to those infected. Therefore, more effective treatments that are affordable, safe and available globally are urgently needed for targeting the SARS-CoV-2 infections. Covid-19 infections affects the upper respiratory tract and also the lower respiratory tract. However, about 80% of the patients with the disease will not require any hospitalization because their symptoms are relatively mild. But, for the remaining 20% patients, the disease deteriorates to the lower respiratory tract and results into pneumonia. Unfortunately, about 6% of the covid-19 patients with pneumonia (out of the 20% patients with lower respiratory tract involvement) eventually develop respiratory failure which usually require urgent admission to an Intensive Care Unit (ICU) for adequate support. The most frequent and commonly reported symptoms of covid-19 infections are cough, shortness of breath, and fever. The clinical diagnosis for covid-19 infections can be made using the symptoms, chest imaging, and exposures history. In addition to that, an individual that is suspected to have covid-19 can be evaluated and thereafter confirmed for SARS-CoV-2 based on quantitative Real Time – Polymerase Chain Reaction (qRT-PCR), which is a viral nucleic acid test. So far, covid-19 has proven to be a serious global health threat and it has strained the global healthcare capacity. Therefore, it is very important and necessary to really study it and develop more effective pharmacological treatments which are effective for the treatment and prevention of the disease. In this article, we will review an anti-viral therapy made up of quercetin, zinc and ascorbic acid (vitamin C) combination. This combination has proven to be quite effective and safe. Also, various clinical studies and anecdotal evidence supports its efficacy in the management and prevention of covid-19 infections. The evidence includes a study done at Liaquat University of Medical and Health Sciences (LUMHS), Jamshoro, Pakistan and another study at the Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, China.

Characteristics, clinical manifestations and management of leprosy in KwaZulu-Natal, South Africa: A 20-year retrospective study.

Although leprosy, a neglected tropical disease, has been eliminated (<1 case per 10 000 population) in South Africa (SA) since 1926, according to the World Health Organization, new cases continue to be reported. The management of leprosy poses several challenges, including patient adherence, education and insufficient training of healthcare practitioners. To describe the biographical profile, clinical manifestations and treatment outcomes in patients with leprosy in KwaZulu-Natal Province. This retrospective study aimed to analyse the clinical data of leprosy patients in SA from 2002 to 2022. Data collected included patient demographics, comorbidities, cutaneous and neurological manifestations of leprosy, complications, treatment and adverse reactions. Descriptive statistics were used to summarise the data. The study analysed the clinical data of 194 leprosy patients from 2002 to 2022. The majority of patients were male and middle aged, with a disproportionate representation of black South Africans. Regarding socioeconomic status, 80% were unemployed and 40% were social grant recipients. Most cases were clustered in urban centres and diagnosed at secondary care facilities, with 15% being HIV positive. The majority of patients (90%) were classified as having multibacillary leprosy. Common symptoms included upper respiratory tract involvement, hair loss and painful nerves, with the face and limbs being most frequently affected. Cutaneous morphology predominantly included plaques and hypopigmented patches, while neurological signs included ulnar nerve tenderness, muscle weakness and sensory deficits. Debilitating neurological complications were found in one-fifth of patients. Despite initiation of multidrug therapy in most patients, a significant proportion (27.3%) did not complete the full course of treatment, and treatment reactions were noted in 33.5% of patients. These findings emphasise the urgent need for enhanced patient and healthcare worker education, particularly in primary healthcare settings, to improve adherence to treatment, advocate for prophylactic measures and prevent new cases. Achieving leprosy-free status in SA requires the collaboration of many role-players to address these challenges and improve healthcare practices.

Is SARS-CoV-2 Now More Like the Seasonal Coronaviruses Following Its Evolution?

SARS-CoV-2 has evolved significantly since the beginning of the COVID-19 pandemic. COVID-19 mortality has decreased due to increased population immunity and possibly the reduced intrinsic severity of the new variants. SARS-CoV-2 is now considered an endemic virus, but the extent to which its clinical findings resemble those of seasonal coronaviruses (sCoV) is not fully understood. Pediatric patients under 18 years of age who were sent for SARS-CoV-2 polymerase chain reaction real-time reverse transcription polymerase chain reaction between January 1, 2022 and January 14, 2023 and whose results were positive were included in this study. To include only symptomatic COVID-19 patients in the study, asymptomatic patients who were positive in their screening tests were excluded. For the sCoV patients' group, patients who had a respiratory viral polymerase chain reaction assay between January 10, 2022 and January 11, 2023 and were positive for any type of sCoV were included in the study. The 2 groups were compared for clinical and laboratory characteristics. The study included 213 patients with COVID-19 and 194 patients with sCoV infection. Fever was a more common symptom in patients with COVID-19. sCoV was associated with lower respiratory involvement while increasing age was protective. The likelihood of hospitalization was decreased by increasing age but increased by the presence of comorbid conditions and lower respiratory tract involvement. The type of virus had no effect on the likelihood of hospitalization. In conclusion, sCoV infections carry a higher risk for lower respiratory involvement than COVID-19, and COVID-19 has a milder course than sCoV infections in children.

ANCA-associated Vasculitis: The Focus is on Eosinophilic Granulomatosis With Polyangiitis (Eosinophilic Vasculitis of Charge-Strauss)

Eosinophilic granulomatosis with polyangiitis (Charge-Strauss syndrome) is an eosinophilic granulomatous disease characterized by small caliber vascular lesions and is autoimmune in nature. Patients with this syndrome experience weight loss, fever, arthralgias, and myalgias. The disease most often begins with respiratory tract involvement, including infectious allergic rhinitis, bronchial asthma, symmetric eosinophilic pulmonary infiltrates, and eosinophilic pneumonia. In older individuals, the syndrome manifests with multiple mononeuritis, asymmetric polyneuropathy, anemia, and muscle weakness. This scientific review presents the main aspects of the prevalence, mechanisms of development, spectrum of clinical manifestations, diagnosis and differential diagnosis of eosinophilic granulomatosis with polyangiitis.

Fluid management strategy in dengue acute respiratory distress syndrome with chronic kidney disease: A case report

Abstract Pulmonary manifestation in dengue is due to the involvement of both the upper and lower airways. Severe forms of dengue infection (pleural effusion, dengue hemorrhagic shock syndrome, and acute respiratory distress syndrome [ARDS]) are mainly due to the involvement of the lower respiratory tract. ARDS is a well-known respiratory complication following dengue infection. Patients with chronic kidney disease (CKD) diagnosed with dengue had a higher risk of unfavorable outcomes. Pulmonary involvement is one of the life-threatening complications in patients having CKD that contributes to increasing the mortality rate. Dysregulation of cytokines and apoptotic signaling pathway is a nonclassical mechanism of the kidney–lung crosstalk that results in the development of acute kidney injury in patients having ARDS. Severe worsening of renal function is common in CKD patients with dengue. Here, we discuss fluid management strategy in a patient having CKD who developed ARDS following dengue infection. The difficulty in the therapeutic dilemma is attributable to ambiguity in liberal versus conservative fluid therapy, contributing to a high risk of mortality. The narrow window of fluid tolerance in CKD patients further complicates the resuscitation strategy in patients with dengue ARDS.

Granulomatosis with polyangiitis: The wily masquerader of cavitary pulmonary lesions

Background: Granulomatosis with Polyangiitis (GPA) is a small and medium vessel vasculitis with predominant respiratory and renal involvement that causes florid presentation of the disease entity with varying spectrum of illness at different time intervals. Case: We report the case of a 42-years-old female patient with symptoms of low-grade fever, productive cough and significant loss of weight with multiple cavitary lesions on Chest radiograph. The patient was initially suspected to have tuberculosis which was eventually ruled out. A diagnosis of vasculitis was suspected as patient gave history of repeated hospitalisations with symptoms of upper respiratory tract involvement, left facial nerve palsy and sensorineural hearing loss, A diagnosis of limited GPA was made when the cytoplasmic Antineutrophil Cytoplasmic Antibodies, (c-ANCA) and antiproteinase-3 antibodies (anti-PR3) was elevated. The patient was treated with combination immunosuppressive therapy of prednisolone and methotrexate which induced clinical remission within one month and complete radiological remission within 4 months. Conclusion: GPA is an important non infective cause of cavitary pulmonary lesions that presents with extrapulmonary clinical spectrum (recurrent sinusitis, ear infections, renal dysfunction and neurological disease). Multifocal presentation of the disease at different time intervals results in considerable delay in diagnosis and adds to the morbidity of the disease entity.

A difficult to diagnose case of respiratory tract injury in granulomatosis with polyangiitis

Granulomatosis with polyangiitis (GPA, Wegener's granulomatosis) is a rare autoimmune disease, characterized by vasculitis of small and medium-sized vessels, as well as the formation of granulomas and the most frequent involvement of the upper respiratory tract, lungs, kidneys and eyes in the pathological process. In the absence of treatment, the disease progresses rapidly and is fatal. The onset of the disease is possible at any age. Pharmacotherapy is aimed at suppressing the immunopathological reactions underlying the disease in order to achieve complete remission associated with anti-neutrophil cytoplasmic antibodies of systemic vasculitis (ANCA-SV). The article deals with a difficult case for diagnosis of respiratory tract damage in GPA in a 60-year-old woman.

Management Practices for Standard-Risk and High-Risk Patients With Bronchiolitis.

Management guidelines for bronchiolitis advocate for supportive care and exclude those with high-risk conditions. We aim to describe and compare the management of standard-risk and high-risk patients with bronchiolitis. This retrospective study examined patients <2 years of age admitted to the general pediatric ward with an International Classification of Diseases, 10th Revision discharge diagnosis code of bronchiolitis or viral syndrome with evidence of lower respiratory tract involvement. Patients were defined as either standard- or high-risk on the basis of previously published criteria. The frequencies of diagnostic and therapeutic interventions were compared. We included 265 patients in this study (122 standard-risk [46.0%], 143 high-risk [54.0%]). Increased bronchodilator use was observed in the standard-risk group (any albuterol dosing, standard-risk 65.6%, high-risk 44.1%, P = .003). Increased steroid use was observed in the standard-risk group (any steroid dosing, standard-risk 19.7%, high-risk 14.7%, P = .018). Multiple logistic regression revealed >3 doses of albuterol, hypertonic saline, and chest physiotherapy use to be associated with rapid response team activation (odds ratio [OR] >3 doses albuterol: 8.36 [95% confidence interval (CI): 1.99-35.10], P = .048; OR >3 doses hypertonic saline: 13.94 [95% CI: 4.32-44.92], P = .001); OR percussion and postural drainage: 5.06 [95% CI: 1.88-13.63], P = .017). A varied approach to the management of bronchiolitis in both standard-risk and high-risk children occurred institutionally. Bronchodilators and steroids continue to be used frequently despite practice recommendations and regardless of risk status. More research is needed on management strategies in patients at high-risk for severe disease.

General infectious and neurological manifestations of new coronavirus infection COVID-19

Introduction. The most important problems of clinical characterization and timely diagnosis of a new coronavirus infection COVID- 19 have been identified. The detection and treatment of patients with COVID-1 9 in the domestic health care system are carried out according to the Provisional Methodical Recommendations “Prevention, Diagnostics and Treatment of New Coronavirus Infection”. Its basic clinical manifestations are characterized by typical symptoms of acute respiratory viral disease: fever, dry cough, stuffy nose, headache, etc.Objective. To study the nature of clinical manifestations of new coronavirus infection COVID-1 9, associated with delta strain of SARS-CoV-2 coronavirus with moderate and severe course.Materials and methods. We analyzed the course of the disease in 50 patients treated as inpatients at Saransk Covid Hospital. Questionnaires to analyze complaints and anamnesis of diseases, data of medical records of in-patients were used. We used visual analog scale (VAS) to estimate the intensity of non-specific neurological disturbances, decreased sense of smell, taste and hearing, where 0 point means no neurological disturbance, 10 points – expressed disturbance. The presented data allowed to analyze the general, nonspecific and specific neurological manifestations of the new coronavirus infection COVID- 19 in the acute period in patients with moderate and severe course and to reveal their peculiarities.Results. At a moderately severe course of the disease, the characteristic symptoms of respiratory infection in combination with depressed mood and anxiety predominated. Of nonspecific neurological disorders, sleep disturbances, dizziness, and of specific manifestations, impaired sense of smell and taste prevailed. At a severe course the above symptoms were joined by myalgia, headache, dyspnea and shortness of breath, gastrointestinal disorders.Conclusions. The severity of the course of COVID-1 9 coronavirus infection, associated with the delta strain of SARS-CoV-2 coronavirus, is determined by the severity of the generalized manifestations, involvement of the lower respiratory tract, gastrointestinal disorders.

Obliterative bronchiolitis in rheumatoid arthritis (clinical case)

Obliterative (constrictive) bronchiolitis (OB) is a rare disease characterized by destruction of the bronchiolar epithelium and subsequent progressive airway obstruction. OB is most common in rheumatoid arthritis (RA) compared to other systemic rheumatic diseases. Clinical manifestations of OB are found mainly with a long duration of RA and the absence of adequate therapy for articular manifestations. We present a clinical observation, demonstrating the distal respiratory tract involvement in a patient with RA during the first year of the disease, which is observed in no more than 10–20% of cases. The nonspecificity of respiratory symptoms on the background of immunosuppressive therapy led to a diverse differential diagnostic spectrum of pulmonary pathology. For timely diagnosis and optimization of therapeutic approaches, clinical suspicion for respiratory lesions in patients with RA and interdisciplinary cooperation are necessary.

Global expert views on the diagnosis, classification and pharmacotherapy of allergic rhinitis in clinical practice using a modified Delphi panel technique

BackgroundDiagnosis, classification, and treatment of allergic rhinitis (AR) varies considerably despite the availability of treatment guidelines. ObjectivesWe aimed to carry out a two-part modified Delphi panel study to elucidate global expert management of AR in real life. MethodsThe modified Delphi panel study was composed of two ten-minute online questionnaires sent to global AR experts, aiming to identify areas of consensus (defined as >75% respondent agreement) on aspects of their real-world daily practice related to AR diagnosis, classification, and pharmacotherapy. A workshop discussion with respondents held after the first-round questionnaire informed the development of the second-round questionnaire. ResultsEighteen experts (from 7 countries across 3 continents) completed both questionnaires in September–October 2021 and January 2022, respectively. The majority of respondents agreed that diagnosis of AR is best confirmed using a mixture of observation and testing (n = 15) and collaborating with colleagues across other specialties (n = 14). Experts agreed that severity (n = 18), upper/lower respiratory tract involvement (n = 15) and symptom frequency (n = 14) are important factors when classifying AR, however consensus was not reached on which classification tool should be used. Although there were mixed opinions on the preferred pharmacotherapy treatment in the presented case studies, respondents largely agreed on which treatments require less monitoring (intranasal corticosteroid therapies [INCS]) and when treatments should be stepped down (≤3 months). Although opinions varied across respondents, some respondents considered as-needed INCS treatment and surgery to be viable treatment options. ConclusionWe identified clear differences between real-world practice and treatment guidelines related to the management of AR. Furthermore, we recognized differences among physicians concerning their clinical practice in the pharmacological treatment of AR. These findings highlight the need for greater research into the management of AR and further indicate there is still a major gap between treatment guidelines and daily practice, even among specialists, suggesting a need for local guideline adaptation and implementation plans.

COVID-19-Triggered Acute Liver Failure and Rhabdomyolysis: A Case Report and Review of the Literature

COVID-19 is primarily known for its respiratory tract involvement, often leading to severe pneumonia and exacerbation of underlying diseases. However, emerging evidence suggests that COVID-19 can result in multiorgan failure, affecting organs beyond the respiratory system. We present the case of a 62-year-old male with COVID-19 who developed acute liver failure (ALF) and rhabdomyolysis in the absence of respiratory failure. Initially, the patient presented with significantly elevated aspartate transaminase (5398 U/L) and alanine transaminase (2197 U/L) levels. Furthermore, a prolonged prothrombin time international normalized ratio (INR) of 2.33 indicated the diagnosis of ALF without hepatic coma, according to Japanese diagnostic criteria. The patient also exhibited elevated creatine kinase (9498 U/L) and a mild increase in creatinine (1.25 mg/dL) levels, but both values improved with intravenous fluid support and molnupiravir administration. To our knowledge, this is the first reported case presenting with both ALF and rhabdomyolysis associated with COVID-19. In addition, we review the existing literature to summarize previously reported cases of ALF triggered by SARS-CoV-2. This case report underscores the significance of recognizing COVID-19 as a significant contributing factor in the development of multiorgan failure. Furthermore, it suggests that COVID-19 can lead to severe illness, irrespective of the absence of respiratory failure.

Leprosy mimicking ANCA-associated vasculitis

Vasculitis represents a large group of diseases, classified between primary and secondary. Diagnosis of primary vasculitis is a challenge in medical practice, since there are wide and heterogeneous clinical manifestations, with diagnostic criteria still scarce. Some clinical manifestations are common: constitutional status, myalgia, arthralgia, arthritis, papules, nodules and ulcers. One of the clinical forms is the limited one in which patients with upper respiratory tract involvement often evolve with systemic disease. Most patients have nasal, sinus or ear involvement that may be present weeks or months before other symptoms. Secondary vasculitis can be related to infections, drugs, toxic substances and neoplasms. The virchowian and dimorphic form of leprosy has similar clinical and serological characteristics with rheumatological diseases. As it is an endemic disease in Brazil, there is a description of a wide variety of clinical presentations, so making a differential diagnosis is essential.

Analysis of related factors for postoperative recurrence of antrochoanal polyps in children

Objective:To analyze the correlation between nasal resistance and lung function in children with allergic rhinitis（AR）, and explore whether AR children with increased nasal resistance are accompanied by potential lower respiratory tract involvement. Methods:A total of 88 children diagnosed with AR from December 2021 to December 2022 were selected as the study group, while 20 normal children were selected as the control group during the same period. Both the study group and the control group children underwent lung function tests, bronchodilator tests, and nasal resistance measurements. Spearman correlation analysis and multiple linear regression analysis were performed on the results of nasal resistance and lung function tests to explore the relationship and influencing factors between the two groups.According to the results of nasal resistance measurement, children with increased nasal resistance and abnormal lung function were divided into a mild increase in nasal resistance with abnormal lung function group and a moderate to severe increase in nasal resistance with abnormal lung function group. The degree of increased nasal resistance was analyzed to determine whether it would affect lung function. Results:The FEF25, FEF50, and FEF75 levels in the study group were significantly lower than those in the control group（P<0.05）. The FEV1of children with moderate to severe increase in AR nasal resistance was significantly lower than that of children with mild increase in AR nasal resistance（P<0.05）. There was a correlation between nasal resistance and FEV1/FVC, R20 in AR children, and FEV1/FVC, R20 were the influencing factors of nasal resistance in AR children（P<0.05）. There was no correlation between total serum IgE, lung function, and bronchodilation test in AR patients（P>0.05）. Conclusion:The nasal ventilation function of AR patients has changed, and there is a downward trend in small airway function. Children with moderate to severe increase in AR nasal resistance have a more significant decrease in lung ventilation function than those with mild increase. The nasal resistance of AR children is influenced by FEV1/FVC and R20, and FEV1/FVC and R20 decrease as the nasal resistance value increases. The improvement rate of lung function and FEV1 are not influencing factors for the elevation of total serum IgE.

Peripheral T-cell lymphoma mimicking granulomatosis with polyangiitis.

Upper respiratory tract involvement is common in patients with granulomatosis with polyangiitis (GPA), but malignancies should be kept in mind in the differential diagnosis. A68-year-old man was referred to rheumatology to investigate for GPA after nasal excisional biopsy. After careful radiologic and pathologic assessment, he was diagnosed with peripheral T‑cell lymphoma, nasal type. This is arare case of T‑cell lymphoma in apatient who was referred as GPA.