Room Air Oxygen Saturation Research Articles

Multidrug-resistant Tuberculosis and COVID-19 Coinfection with Diabetes Mellitus in Medan, Indonesia: A Case Report

BACKGROUND: Coronavirus disease 2019 (COVID-19) has distracted the global health system due to significant morbidity and mortality. There are increasing mortality rates related to the existence of comorbidities. Due to immunologic conditions, other infectious diseases, such as multidrug-resistant tuberculosis (MDR-TB), might coinfect with COVID-19. We describe a case of MDR-TB with diabetes mellitus and critical COVID-19 patient with fatal outcome. CASE REPORT: A 60-year-old man was admitted to our hospital with shortness of breath for 2 days. A history of recurrent shortness of breath has had developed for about 7 months. Room air oxygen saturation was at 66%. RT-PCR SARS-CoV-2 nasopharynx swab result was positive. The chest X-ray series result showed destroyed left lung with increasing infiltrate in the lower right lung. The patient was diagnosed with pulmonary MDR-TB based on GeneXpert and LPA (Line Probe Assay) test 6 months prior and also has had history of diabetes mellitus for 7 years. Then, the patient was diagnosed with COVID-19, pulmonary MDR-TB, and diabetes mellitus. MDR-TB regimen, anti-diabetic medication, and management of COVID-19 were carried out. On the 6th day, the patient’s condition worsened to the point, where he needed intubation. The patient eventually passed away. CONCLUSION: The treatment outcome was highly related to the severity of COVID-19 symptoms and complications of comorbidities when patients are admitted to the hospital. The early screening and treatment of COVID-19 are important to prevent deteriorating clinical conditions caused by comorbidities.

Stridor After Tracheoesophageal Fistula Repair: Where Is the Lesion?

Stridor After Tracheoesophageal Fistula Repair: Where Is the Lesion?

Impact of Oral Corticosteroids on Respiratory Outcomes in Acute Preschool Wheeze: A Randomised Clinical Trial

To determine if oral prednisolones given to acutely wheezing preschool-aged children alter respiratory outcomes.A total of 3247 children (aged 24–59 months) with acute wheezing episodes between August 2014 and September 2016 in 3 New Zealand emergency departments (EDs) were potentially eligible. A total of 493 were randomly assigned, and 477 patients were included in the intention-to-treat analysis (238 in the prednisolone group and 239 in the placebo group). Primary outcome data were available on 393 patients (82% overall; 195 (79%) in the prednisolone group and 198 (83%) in the placebo group). Children <24 months of age were purposely excluded, ensuring that those with bronchiolitis were not included.In this double-blind placebo-controlled trial, preschool-aged children with viral-induced wheeze who presented to the ED were randomly assigned to receive 3 days of prednisolone (2 mg/kg) or a placebo. The primary outcome measure was a change in the validated Preschool Respiratory Assessment Measure (PRAM) score 24 hours after the intervention. Secondary outcomes included PRAM score at 4 hours, admission rate, length of ED and inpatient stay, amount of albuterol given in 48 hours, additional treatment with open-label prednisolone, time to return to normal activity, and adverse events, including the need for intravenous (IV) medication, ICU admission, and representation to the ED or primary care provider within 7 days. Pediatric Respiratory Assessment Measure (PRAM) scores (ranging from 0–12) were calculated on the basis of suprasternal retractions, scalene retractions, wheezing, and oxygen saturation in room air. The study was designed as an equivalence trial and powered (power: 95%) to detect the minimal difference in PRAM scores that would disprove the null hypothesis that corticosteroids and placebo are equivalent treatments. In a pilot study (n = 137), researchers determined a SD of 2.3 for change in PRAM score at 24 hours was significant. Therefore, analysis was by intention to treat.Between groups, there was no difference in the primary outcome, the change in PRAM score at 24 hours (difference between means: −0.39; 95% confidence interval [CI]: −0.84 to 0.06, P = .09). The median PRAM score at 24 hours for both groups was 0, with only approximately one-third in either group showing mild disease (PRAM score 1–4) and few with PRAM scores >4 (2.0% and 3.6% in treatment and control groups, respectively). Change in PRAM score at 4 hours was significantly different in the treatment group (−0.67; 95% CI: −1.18 to −0.16; P = .01). No difference in length of ED stay was observed (−0.57; 95% CI: −1.15 to 0.02; P = .06), although admission to the hospital occurred more often in the placebo group (0.67; 95% CI: 0.45 to 1.01; P = .05) as well as additional corticosteroid (0.22; 95% CI: 0.06 to 0.79; P = .01) and IV medication use (0.27; 95% CI: 0.07 to 0.96; P = .03). No difference was observed in representation to the hospital or the primary care provider within 7 days (P = .33 and P = .22, respectively) or ICU admission (undefined P value because only 2 total children went to the ICU) as well as the amount of albuterol given in 48 hours (P = .27).Oral prednisolone does not alter respiratory outcomes at 24 hours or beyond in preschool-aged children presenting with acute wheezing to the ED because most children improved after 24 hours regardless of initial treatment. Subgroup analyses revealed no evidence that the 24-hour treatment effect differed for albuterol responsive children, those with a positive Asthma Predictive Index, or more severe disease at presentation (higher PRAM score). However, those who received prednisolone had less respiratory distress 4 hours after medication administration and a reduced requirement for hospital admission, additional corticosteroid, or IV treatment. These findings suggest that early in-hospital administration of oral prednisolone to preschoolers with wheeze may prevent further deterioration and requirement for escalation of therapy. Additionally, considering the lack of significant difference at 24 hours, oral prednisolone may improve short-term respiratory outcomes for preschoolers presenting with wheeze. However, subsequent doses of oral prednisolone may provide no additional therapeutic benefit.With this robustly designed randomized controlled trial, we are reminded that wheezing preschoolers are a heterogeneous group with numerous factors contributing to a wheezy phenotype. We should consider that they should not be treated the same as older asthmatics, with regards to corticosteroids. With this study, the authors question oral steroid dosing dogma and demonstrate that oral prednisolone may improve short-term respiratory outcomes for wheezing preschoolers but subsequent doses of oral prednisolone may provide no additional therapeutic benefit. Further studies are needed in this population to understand the timing and dosing of corticosteroids.

PH-ILD: Identification, Evaluation, and Monitoring: A Diagnostic View From Both Sides

PH-ILD: Identification, Evaluation, and Monitoring: A Diagnostic View From Both Sides

SARS-COV-2 PNEUMONIA LEADING TO PROGRESSION OF PULMONARY SARCOIDOSIS

TOPIC: Pulmonary Manifestations of Systemic Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: The implication of COVID 19 pneumonia on chronic inflammatory disorders is not clearly known. Due to a lack of data, it is difficult to predict the disease course post-COVID 19 pneumonia. Here, we present a case of stable sarcoidosis that progressed rapidly after COVID 19 pneumonia. CASE PRESENTATION: A 43-year-old male, with a history of sarcoidosis, briefly treated with steroids at initial diagnosis and in remission for the last six years, was admitted for dyspnea and hypoxia (room air oxygen saturation 83%) secondary to COVID 19 pneumonia diagnosed a week prior to admission. Chest X-ray on admission showed diffuse bilateral interstitial and airspace opacities. He was treated with dexamethasone and remdesevir. The clinical status of the patient improved after a week, and he was discharged on prednisone taper (10 mg for 5 days). Four weeks later, the patient had a recurrence of dyspnea on exertion with occasional hemoptysis. Computed Tomography (CT) scan of the chest showed honeycombing and reticulations in bilateral upper lobes, interstitial thickening, and worsening hilar and mediastinal lymphadenopathy (sarcoidosis Scadding stage IV). Labs were significant for elevated serum soluble interleukin-2 (IL-2) receptor and calcitriol levels. Pulmonary function test showed a restrictive defect with reduced diffusion capacity. The patient was started on prednisone. Repeat CT scan after three months showed improvement in ground-glass opacities and stable scarring. Fine needle aspiration biopsy of subcarinal lymph node confirmed non-caseating granulomatous inflammation. The patient was started on mycophenolate mofetil, tapered off prednisone, and is being evaluated for a lung transplant. DISCUSSION: The main pathogenesis related to sarcoidosis is the formation of granulomas due to sustained host immune system stimulation from various known and unknown antigens. Activation of the immune system as evidenced by elevated inflammatory makers in viral infections may in turn precipitate the relapse and progression of inflammatory disorders such as sarcoidosis. It is difficult to distinguish between the sequela of COVID 19 pneumonia and sarcoidosis progression. CT scan findings in fibrotic sarcoidosis have upper lobe predilection. However, the distribution of ground-glass opacities and fibrosis in COVID 19 pneumonia is usually peripheral and may have lower lobe predilection. Close monitoring is important to look for activation of sarcoidosis post COVID 19 pneumonia. CONCLUSIONS: Implications of COVID 19 infection on pathogenesis and progression of sarcoid are important to understand, and more research is required so that clinicians can be vigilant about worsening pulmonary function and intervene in a timely manner. REFERENCE #1: Ramdani H, Benelhosni K, Moatassim Billah N, Nassar I. COVID-19 pneumonia in a patient with sarcoidosis: A case report. Clin Case Rep. 2020 Dec 23;9(2):910-913. REFERENCE #2: Tana C, Mantini C, Cipollone F, Giamberardino MA. Chest Imaging of Patients with Sarcoidosis and SARS-CoV-2 Infection. Current Evidence and Clinical Perspectives. Diagnostics (Basel). 2021 Jan 27;11(2):183. DISCLOSURES: No relevant relationships by Salim Daouk, source=Web Response No relevant relationships by Samiksha Gupta, source=Web Response No relevant relationships by Ahmad Hassan, source=Web Response No relevant relationships by SYED HUSSAIN, source=Web Response No relevant relationships by Miloni Parmar, source=Web Response

A RARE CASE OF PROGRESSIVE PULMONARY CAVITARY LESIONS

TOPIC: Chest Infections TYPE: Medical Student/Resident Case Reports INTRODUCTION: Recurrent respiratory papillomatosis (RRP) is a rare and often benign condition caused by a human papilloma virus (HPV) infection that results in papilloma growth throughout the respiratory tract. It is placed into 2 categories: juvenile (<18 years) and adult (>18 years) onset. The incidence of juvenile onset RRP (JORRP) is estimated to be 2 cases per 100,000 children. Here, we discuss a case of JORRP in a middle-aged male presenting with recurrent dyspnea and cough. CASE PRESENTATION: A 37-year-old male with a history of JORRP, diagnosed at age 2 with over 50 debulking procedures by the age of 28, presented to the pulmonary clinic with progressive dyspnea and cough. He was noted to be tachycardic with bilateral rales, room air oxygen saturation of 90% and other vital signs stable. Chest radiography revealed patchy ground-glass nodules, cavities and a mass-like opacification in the right lower lobe with air fluid levels. Flexible bronchoscopy revealed diffuse papillomas involving the laryngeal vestibule, glottis, subglottis and trachea down to carina as well as evidence of pus in his left mainstem bronchus. Treatment with antibiotics for post obstructive pneumonia resulted in symptomatic improvement. Weeks later, he represented with similar symptoms and was retreated for post obstructive pneumonia. Computed tomography (CT) chest revealed multiple bilateral peribronchovascular cavitary lesions, scattered solid nodules, dense airspace consolidation in the bilateral lower lobes and bulky bilateral subcarinal lymphadenopathy. Imaging was consistent with RRP but also concerning for infection or malignant transformation to squamous cell carcinoma (SCC). CT-guided lung biopsy showed squamous papilloma with areas of necrosis and rare foci suspicious for invasion. Given concern for malignant transformation, repeat biopsy revealed mild to moderate dysplasia but no evidence of invasion. PET-CT to evaluate for malignancy was recommended following completion of antibiotics. DISCUSSION: JORRP is an acquired infection that occurs during vaginal delivery with symptoms of respiratory obstruction starting in childhood. Dysphonia is commonly noted due to papilloma growth on the vocal cords disrupting normal vibration. It is primarily managed by surgical resection including micro-debridement and laser resection. Adjuvant therapies include interferon alpha, antivirals and bevacizumab. Malignant transformation of RRP into invasive SCC is reported to be 3-7% in adults and thought to be from a mutation in the HPV viral genome. CONCLUSIONS: JORRP is the most aggressive form of RRP with no curative therapy. Diagnosis is established by laryngoscopy and first seen in the vocal folds. Post-obstructive pneumonia and malignant transformation to SCC should always be considered given the nature of RRP. REFERENCE #1: Fortes, H. R et al.(2017).Recurrent respiratory papillomatosis:A state-of-the-art review. Resp. Medicine,126,116-121. REFERENCE #2: Ivancic, R. et al. (2018). Current and future management of recurrent respiratory papillomatosis. Laryngoscope Investigative Otolaryngology, 3(1), 22-34. REFERENCE #3: Karatayli-Ozgursoy, S. et al. (2015). Risk factors for dysplasia in recurrent respiratory papillomatosis in an adult and pediatric population. Annals of Otology, Rhinology & Laryngology, 125(3), 235-241. DISCLOSURES: No relevant relationships by Kathy Chan, source=Web Response No relevant relationships by George Moran, source=Web Response No relevant relationships by Sudhir Rajan, source=Web Response No relevant relationships by Eduardo Solbes, source=Web Response

Severity of COVID-19 Respiratory Complications during Pregnancy are Associated with Degree of Lymphopenia and Neutrophil to Lymphocyte Ratio on Presentation: A Multicenter Cohort Study.

This study aimed to determine if laboratory inflammatory markers can predict critical disease in symptomatic COVID-19 pregnant women. Multicenter, retrospective cohort study of all pregnant women presenting to New York City Health + Hospitals emergency departments from March 1 to May 30, 2020. We assessed all symptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive pregnant women with room air oxygen saturation <95% on presentation. Logistic regression modeled the relationship of inflammatory markers to outcomes. Area under receiver operating characteristic (ROC) curve and maximum Youden index determined prognostic ability and optimal predictive cut-off values. A total of 498 of 5,002 pregnant women were SARS-CoV-2 RT-PCR positive of which 77 presented with hypoxemia. The absolute lymphocyte count (ALC) and neutrophil to lymphocyte ratio (NLR) were highly sensitive for progression to severe illness. ROC curve analysis identified predictive cutoffs: ALC < 1.49 × 109/L (96% sensitivity, 52% specificity, area under the receiver operating characteristic curve [AUC] = 0.80 (95% confidence interval [CI]: 0.70-0.90) and NLR >8.1 (100% sensitivity, 70% specificity, AUC = 0.86 (95% CI: [0.76-0.96]). ALC and NLR on presentation are sensitive markers of progression to critical COVID-19 disease in symptomatic pregnant women. This finding provides a practical, rapid method for assessment and can assist clinicians with decision-making regarding triage, level of care, and patient management. · Few tools exist to gauge risk of severe COVID-19 disease in pregnancy.. · ALC and NLR are sensitive predictive markers of disease progression in symptomatic women.. · Cut-off values for ALC and NLR will help direct patient triage and management..

Recurrent Episodes of Abdominal Distention.

A 1-month-old nondysmorphic female infant presents with repeated episodes of abdominal distention and irregular stool patterns. Prenatal findings were significant for oligohydramnios at 34 weeks’ gestation. The infant was born at 36 weeks’ gestation with a birthweight of 2,250 g (10th percentile). She had abdominal distention and delayed passage of meconium, which occurred after a saline enema on the 3rd postnatal day and was discharged at 5 days of age. At 11 days of age, she had constipation with abdominal distention, for which she received simethicone drops that resolved her symptoms. At 26 days of age, she was admitted to a community hospital as a result of poor feeding, loose stools, and fever. She had poor perfusion and room air oxygen saturation of 88% at admission. She received intravenous fluid, antibiotics, and inotropes. Her laboratory testing showed a hemoglobin level of 13.9 g/dL (139 g/L), white blood cell count of 7,300/µL (7.3 × 109/L), platelet count of 415 × 103/µL (415 × 109/L), C-reactive protein of 0.6 mg/dL (6 mg/L), sodium of 136 mEq/L (136 mmol/L), potassium of 5 mEq/L (5 mmol/L), chloride of 103 mEq/L (103 mmol/L), and thyroid-stimulating hormone of 4.6 mIU/L. A blood culture was negative and she was presumed to have an infectious enterocolitis. Abdominal ultrasonography showed a fluid-filled distended bowel and a normal relationship of the …

May 2021 Imaging Case of the Month: A Growing Indeterminate Solitary Nodule

No abstract available. Article truncated after 150 words. A 58-year-old woman with a history of orthotopic heart transplant, performed for Adriamycin-induced cardiomyopathy, treated with mycophenolate and tacrolimus, presented for routine interval follow up. The patient’s past medical history was significant for follicular thyroid carcinoma treated with total thyroidectomy and bilateral breast carcinoma in remission as well as hypothyroidism and type II diabetes mellitus. In addition to tacrolimus and mycophenolate, the patient’s medications included aspirin, insulin, itraconazole (for anti-fungal prophylaxis), levothyroxine, prednisone (tapering since transplant), and valganciclovir. The patient recently complained of rhinorrhea and cough productive of brown-tinged sputum, improving over the previous 2 weeks; she denied fever, chills, shortness of breath, night sweats chest pain, or gastrointestinal symptoms. Physical examination showed the patient to be afebrile with normal heart and respiratory rates and blood pressure. Her room air oxygen saturation was 99%. The patient’s complete blood count and serum chemistries showed largely normal values, with the white blood …

POS-046 ACUTE KIDNEY INJURY IN AMPHETAMIN INTOXICATION

Nowadays, drug abusedisone ofthe major health concern in society. According to the clinical observations, the prevalence of addiction to a new psychoactive drug is increased among the adolescense and youth. Amphetamine (AMPs) is used as a recreational drug to bring the sense of energy and euphoria for its user. Amphetamine may cause hepatotoxicity, rhabdomyolysis, cardiotoxicity, nephrotoxicity, and neurotoxicity separately or sometimes together as multiorgan toxicity, mostly as a serious condition which is required hospitalization. In the beginning of end-stage renal disease, substance related renal disease has been involved in 5-6% patients. Case report. A 24-years-old man came to the hospital escorted by a security from a night club with unconsciousness, he reported that the patient consumed alcohol along with a green pill, while the name of the drug and the quantity remained unknown. Right after he took the drug, his reaction was jumping followed by vomitting then he fell unconscious before he had seizures for 5 minutes. Physical examination,we found the patient unconscious, fever presented at 40,50C, the blood pressure was 90/55 mmHg,and heart rate was 160 times per minutes, also respiratory rate was 26 times per minutes and room air oxygen saturation was 98%. From blood examination, we found Hb level 17 gr / dl, WBC 19.37 × 103sel / mm3, platelets183.000 cells / mm3, BUN 34 mg / dL, creatinine serum 3.86 mg / dL, sodium 137 mmol / L, potassium 3.11 mmol / L. total bilirubin 7.91 mg / dL, direct bilirubin 7.18 mg / dL, indirect bilirubin 0.73 mg / dL, AST 191,3 U / L, ALT 56.7 U / L, elevated prothrombine time 32 second, CKMB >40 ng/ml, T-troponin was high (732 ng/ml). Blood gas analysis revealed metabolic acidosis (pH 7.31, HCO3 17.7 mmol/L, BE -8.5 mmol/L, pCO2 36.1 mmHg). Urinalysis showed proteinuria (100 mg/dl), erythrocyturia (+3), urine amphetamin was positive, marijuana and morphine were negative. Urine output was 100 cc/24 hours. We diagnosed the patient with acute kidney injury (AKI) stage 3 due to AMPs intoxication with unstable haemodynamic. Initial management was fluid and electrolyte resuscitation, 8 sessions of daily SLED hemodialysis were performed,continue with alternate day HD. After 14 days hospitalization, blood result showed increase of BUN 50 mg/dl, serum creatinine was 7.1 mg/dl, a metabolic acidosisf rom blood gas analysis then death occured after mechanical ventilator was used to improve respiratory failure. Amphetamines represent a class of psychotropic compounds, widely abused for their stimulant, euphoric, anorectic, and in some cases, emphathogenic, entactogenic, and hallucinogenic properties. Renal complication as result of AMPs use are associated with hyperpyrexia and fibrinolysis (disseminated intravascular coagulation; DIC). Also, microvascular obstruction secondary to DIC, myoglobinuria, systemic hypotension or hyperpyrexia may lead to acute renal failure which is generally presents as AKI, hyponatremia, and hypertension Figure 1. Gross haematuriaView Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 2. Hypertermia patient A 24-years-old man came with AKI due to amphetamine intoxication. Initial management was fluid and electrolyte resuscitation, and 13 sessions of HD. Deterioration of conditions and death occured due to multiorgan failure.

Efficacy and safety of Levamisole treatment in clinical presentations of non-hospitalized patients with COVID-19: a double-blind, randomized, controlled trial

BackgroundLevamisole has shown clinical benefits in the management of COVID-19 via its immunomodulatory effect. However, the exact role of Levamisole effect in clinical status of COVID-19 patients is unknown. We aimed to evaluate the efficacy of Levamisole on clinical status of patients with COVID-19 during their course of the disease.MethodsThis prospective, double-blind, randomized controlled clinical trial was performed in adult patients with mild to moderate COVID-19 (room-air oxygen saturation > 94%) from late April 2020 to mid-August 2020. Patients were randomly assigned to receive a 3-day course of Levamisole or placebo in combination with routine standard of care.ResultsWith 25 patients in each arm, 50 patients with COVID-19 were enrolled in the study. Most of the study participants were men (60%). On days 3 and 14, patients in Levamisole group had significantly better cough status distribution when compared to the placebo group (P-value = 0.034 and 0.005, respectively). Moreover, there was significant differences between the two groups in dyspnea at follow-up intervals of 7 (P-value = 0.015) and 14 (P-value = 0.010) days after receiving the interventions. However, no significant difference in fever status was observed on days 1, 3, 7, and 14 in both groups (P-value > 0.05).ConclusionThe results of the current study suggest that Levamisole may improve most of clinical status of patients with COVID-19. The patients receiving Levamisole had significantly better chance of clinical status including cough and dyspnea on day 14 when compared to the placebo. However, the effect-size of this finding has uncertain clinical importance.Trial registrationThe trial was registered as IRCT20190810044500N7 (19/09/2020).

Nomogram for prediction of fatal outcome in patients with severe COVID-19: a multicenter study

BackgroundTo develop an effective model of predicting fatal outcomes in the severe coronavirus disease 2019 (COVID-19) patients.MethodsBetween February 20, 2020 and April 4, 2020, consecutive confirmed 2541 COVID-19 patients from three designated hospitals were enrolled in this study. All patients received chest computed tomography (CT) and serological examinations at admission. Laboratory tests included routine blood tests, liver function, renal function, coagulation profile, C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), and arterial blood gas. The SaO2 was measured using pulse oxygen saturation in room air at resting status. Independent high-risk factors associated with death were analyzed using Cox proportional hazard model. A prognostic nomogram was constructed to predict the survival of severe COVID-19 patients.ResultsThere were 124 severe patients in the training cohort, and there were 71 and 76 severe patients in the two independent validation cohorts, respectively. Multivariate Cox analysis indicated that age ≥ 70 years (HR = 1.184, 95% CI 1.061–1.321), panting (breathing rate ≥ 30/min) (HR = 3.300, 95% CI 2.509–6.286), lymphocyte count < 1.0 × 109/L (HR = 2.283, 95% CI 1.779–3.267), and interleukin-6 (IL-6) > 10 pg/ml (HR = 3.029, 95% CI 1.567–7.116) were independent high-risk factors associated with fatal outcome. We developed the nomogram for identifying survival of severe COVID-19 patients in the training cohort (AUC = 0.900, 95% CI 0.841–0.960, sensitivity 95.5%, specificity 77.5%); in validation cohort 1 (AUC = 0.811, 95% CI 0.763–0.961, sensitivity 77.3%, specificity 73.5%); in validation cohort 2 (AUC = 0.862, 95% CI 0.698–0.924, sensitivity 92.9%, specificity 64.5%). The calibration curve for probability of death indicated a good consistence between prediction by the nomogram and the actual observation. The prognosis of severe COVID-19 patients with high levels of IL-6 receiving tocilizumab were better than that of those patients without tocilizumab both in the training and validation cohorts, but without difference (P = 0.105 for training cohort, P = 0.133 for validation cohort 1, and P = 0.210 for validation cohort 2).ConclusionsThis nomogram could help clinicians to identify severe patients who have high risk of death, and to develop more appropriate treatment strategies to reduce the mortality of severe patients. Tocilizumab may improve the prognosis of severe COVID-19 patients with high levels of IL-6.

Covid-19 and Low Platelet Count-A Relationship

Background: Easily accessible, inexpensive, and widely used laboratory tests that demonstrate the severityof COVID-19 are important. Therefore, in this study, we aimed to investigate the relationship betweenmortality in COVID-19 and platelet count, Mean Platelet Volume (MPV), and platelet distribution width.Method: In total, 100 COVID-19 patients were included in this study. The patients were divided into twogroups. Patients with room air oxygen saturation &lt; 90% were considered as severe COVID-19, and patientswith ?90% were considered moderate COVID-19. Patient medical records and the electronic patient datamonitoring system were examined retrospectively. Analyses were performed using the SPSS statisticalsoftware. A p-value &lt;0.05 was considered significant.Results: The patients’ mean age was 64,32 ± 16,07 years. According to oxygen saturation, 38 patients hadmoderate and 62 had severe COVID-19. Our findings revealed that oxygen saturation at admission and theMPV difference between the first and third days of hospitalization were significant parameters in COVID-19patients for predicting mortality. While mortality was 8.4 times higher in patients who had oxygen saturationunder 90 % at hospital admission, 1 unit increase in MPV increased mortality 1.76 times.Conclusion: In addition to the lung capacity of patients, the mean platelet volume may be used as anauxiliary test in predicting the mortality in COVID-19 patients

COVID-19 and Low Platelet Count-A Relationship

Background: Easily accessible, inexpensive, and widely used laboratory tests that demonstrate theseverity of COVID-19 are important. Therefore, in this study, we aimed to investigate the relationshipbetween mortality in COVID-19 and platelet count, Mean Platelet Volume (MPV), and plateletdistribution width.Methods: In total, 100 COVID-19 patients were included in this study. The patients were divided intotwo groups. Patients with room air oxygen saturation &lt; 90% were considered as severe COVID-19, andpatients with ?90% were considered moderate COVID-19. Patient medical records and the electronicpatient data monitoring system were examined retrospectively. Analyses were performed using theSPSS statistical software. A p-value &lt;0.05 was considered significant.Results: The patients’ mean age was 64,32 ± 16,07 years. According to oxygen saturation, 38 patientshad moderate and 62 had severe COVID-19. Our findings revealed that oxygen saturation at admissionand the MPV difference between the first and third days of hospitalization were significant parametersin COVID-19 patients for predicting mortality. While mortality was 8.4 times higher in patients whohad oxygen saturation under 90 % at hospital admission, 1 unit increase in MPV increased mortality1.76 times.Conclusion: In addition to the lung capacity of patients, the mean platelet volume may be used as anauxiliary test in predicting the mortality in COVID-19 patients.

February 2021 Imaging Case of the Month: An Indeterminate Solitary Nodule

No abstract available. Article truncated after first page. Clinical History: A 43 -year-old woman with no past medical history presented to the Emergency Room with complaints of right chest wall pain extending into the right upper quadrant. The patient was a non-smoker, denied any allergies, and was not taking any prescription medications. Physical examination showed the patient to be afebrile with normal heart and respiratory rates and blood pressure = 110/75 mmHg. Her room air oxygen saturation was 99%. The patient’s complete blood count and serum chemistries showed normal values. Her liver function testing and renal function testing parameters were also within normal limits. Which of the following represents an appropriate next step for the patient’s management? 1. Perform abdominal ultrasound 2. Perform chest radiography 3. Perform unenhanced chest CT 4. More than one of the above 5. None of the above …

Incidence, risk factors, and thrombotic load of pulmonary embolism in patients hospitalized for COVID-19 infection

ObjectiveTo determine the incidence, characteristics, and risk factors of pulmonary embolism (PE) among patients hospitalized for COVID-19.Patients and MethodsWe performed a prospective observational study of a randomly selected cohort of consecutive patients hospitalized for COVID-19 infection between March 8, 2020 through April 25, 2020. All eligible patients underwent a computed tomography pulmonary angiography independently of their PE clinical suspicion and were pre-screened for a baseline elevated D-dimer level.Results119 patients were randomly selected from the 372 admitted to one tertiary hospital in Valencia (Spain) for COVID-19 infection during the period of study. Seventy-three patients fulfilled both the inclusion criteria and none of the exclusion criteria and were finally included in the study. Despite a high level of pharmacological thromboprophylaxis (89%), the incidence of PE was 35.6% (95% confidence interval [CI], 29.6 to 41.6%), mostly with a peripheral location and low thrombotic load (Qanadli score 18.5%). Multivariate analysis showed that heart rate (Hazard Ratio [HR], 1.04), room-air oxygen saturation (spO2) (HR, 0.87), D-dimer (HR, 1.02), and C-reactive protein (CRP) levels (HR, 1.01) at the time of admission were independent predictors of incident PE during hospitalization. A risk score was constructed with these four variables showing a high predictive value of incident PE (AUC-ROC: 0.86; 95% CI: 0.80 to 0.93).ConclusionsOur findings confirmed a high incidence of PE in hospitalized COVID-19 patients. Heart rate, spO2, D-dimer, and CRP levels at admission were associated with higher rates of PE during hospitalization.

Corticosteroids for COVID-19 patients requiring oxygen support? Yes, but not for everyone: Effect of corticosteroids on mortality and intensive care unit admission in patients with COVID-19 according to patients' oxygen requirements.

Corticosteroids reduce mortality in hospitalized patients with coronavirus disease 2019 (COVID-19), but the response seems to vary according to the level of respiratory support needed. This retrospective cohort study included COVID-19 patients with oxygen saturation (SatO2 ) in room air <92% admitted between March 3 and April 30, 2020. Following the interim protocol, patients could receive dexamethasone or methylprednisolone, and were classified according to oxygen requirements. The primary endpoint was admission to the intensive care unit (ICU) or mortality. Kaplan-Meier and Cox hazards analyses were used. Of the 115 patients included, 38 received corticosteroids. Among requiring high-flow, noninvasive ventilation (NIV) or fraction of inspired oxygen (FiO2 ) > 0.40, the hazard ratio (HR) for death or ICU admission, between the corticosteroids and non-corticosteroids group, was 0.07 (95% CI 0.01-0.4), p = .002, and for patients requiring low-flow oxygen, the HR was 0.70 (95% CI 0.13-3.8), p = .68. Significant differences were also observed when all patients were analyzed together. A significant reduction in mortality and ICU admission frequency was observed among patients requiring high-flow oxygen or NIV, but not among those requiring low-flow oxygen. Better targeting of COVID-19 patients is needed for thebeneficial use of corticosteroids.

Hypoxaemia during tracheal intubation in patients with hypertensive disorders of pregnancy: analysis of data from an obstetric airway management registry

BackgroundIn South Africa, hypertensive disorders of pregnancy are the leading cause of maternal mortality. More than 50% of anaesthesia-related maternal deaths are attributed to complications of airway management. We compared the prevalence and risk factors for hypoxaemia during induction of general anaesthesia in parturients with and without hypertensive disorders of pregnancy. We hypothesised that hypertensive disorders of pregnancy are associated with desaturation during tracheal intubation. MethodsData from 402 cases in a multicentre obstetric airway management registry were analysed. The prevalence of peri-induction hypoxaemia (SpO2 <90%) was compared in patients with and without hypertensive disorders of pregnancy. Quantile regression of SpO2 nadir was performed to identify confounding variables associated with, and mediators of, hypoxaemia. ResultsIn the cohort of 402 cases, hypoxaemia occurred in 19% with and 9% without hypertension (estimated risk difference, 10%; 95% CI 2% to 17%; P=0.005). Quantile regression demonstrated a lower SpO2 nadir associated with hypertensive disorders of pregnancy as body mass index increased. Room-air oxygen saturation, Mallampati grade, and number of intubation attempts were associated with the relationship. ConclusionsClinically significant oxygen desaturation during airway management occurred twice as often in patients with hypertensive disorders of pregnancy, compounded by increasing body mass index. Intermediary factors in the pathway from hypertension to hypoxaemia were also identified.

Compassionate Use of Remdesivir in Pregnant Women With Severe Coronavirus Disease 2019.

BackgroundRemdesivir is efficacious for severe coronavirus disease 2019 (COVID-19) in adults, but data in pregnant women are limited. We describe outcomes in the first 86 pregnant women with severe COVID-19 who were treated with remdesivir. MethodsThe reported data span 21 March to 16 June 2020 for hospitalized pregnant women with polymerase chain reaction–confirmed severe acute respiratory syndrome coronavirus 2 infection and room air oxygen saturation ≤94% whose clinicians requested remdesivir through the compassionate use program. The intended remdesivir treatment course was 10 days (200 mg on day 1, followed by 100 mg for days 2–10, given intravenously). ResultsNineteen of 86 women delivered before their first dose and were reclassified as immediate “postpartum” (median postpartum day 1 [range, 0–3]). At baseline, 40% of pregnant women (median gestational age, 28 weeks) required invasive ventilation, in contrast to 95% of postpartum women (median gestational age at delivery 30 weeks). By day 28 of follow-up, the level of oxygen requirement decreased in 96% and 89% of pregnant and postpartum women, respectively. Among pregnant women, 93% of those on mechanical ventilation were extubated, 93% recovered, and 90% were discharged. Among postpartum women, 89% were extubated, 89% recovered, and 84% were discharged. Remdesivir was well tolerated, with a low incidence of serious adverse events (AEs) (16%). Most AEs were related to pregnancy and underlying disease; most laboratory abnormalities were grade 1 or 2. There was 1 maternal death attributed to underlying disease and no neonatal deaths. ConclusionsAmong 86 pregnant and postpartum women with severe COVID-19 who received compassionate-use remdesivir, recovery rates were high, with a low rate of serious AEs.

Risk factors associated with hospital admission in COVID-19 patients initially admitted to an observation unit.

BackgroundNo set guidelines to guide disposition decisions from the emergency department (ED) in patients with COVID-19 exist. Our goal was to determine characteristics that identify patients at high risk for adverse outcomes who may need admission to the hospital instead of an observation unit.MethodsWe retrospectively enrolled 116 adult patients with COVID-19 admitted to an ED observation unit. We included patients with bilateral infiltrates on chest imaging, COVID-19 testing performed, and/or COVID-19 suspected as the primary diagnosis. The primary outcome was hospital admission. We assessed risk factors associated with this outcome using univariate and multivariable logistic regression.ResultsOf 116 patients, 33 or 28% (95% confidence interval [CI] 20–37%) required admission from the observation unit. On multivariable logistic regression analysis, we found that hypoxia defined as room-air oxygen saturation < 95% (OR 3.11, CI 1.23–7.88) and bilateral infiltrates on chest radiography (OR 5.57, CI 1.66–18.96) were independently associated with hospital admission, after adjusting for age. Two three-factor composite predictor models, age > 48 years, bilateral infiltrates, hypoxia, and Hispanic race, bilateral infiltrates, hypoxia yield an OR for admission of 4.99 (CI 1.50–16.65) with an AUC of 0.59 (CI 0.51–0.67) and 6.78 (CI 2.11–21.85) with an AUC of 0.62 (CI 0.54–0.71), respectively.ConclusionsOver 1/4 of suspected COVID-19 patients admitted to an ED observation unit ultimately required admission to the hospital. Risk factors associated with admission include hypoxia, bilateral infiltrates on chest radiography, or the combination of these two factors plus either age > 48 years or Hispanic race.