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1.
ARS Medica Tomitana ; 27(3):149-152, 2021.
Artigo em Inglês | EMBASE | ID: covidwho-2162839

RESUMO

SARS-COV2 translates as a highlycontagious viral strain, being part of thegenusBetacoronavirus, the Sarbecovirus subgroup, consisting of a single molecule of single-stranded RNA, withpositivepolarityandhavingdimensions of 27-32 kb. The timefromthetransposition of infectiontotheonset of symptomatology in order of frequency:cough,dysphagia, fever,breathlessness, anosmia, ageusia, headacheandfatiguabilityisbetween2-12days, with an average of 6days. The purpose of thisstudyisthestatisticalanalysis of thecases of SARS-COV2 infectionassociatedwith medical assistance in a family medicine office in Constanta in the period 2020-2022. The author notes thediscrepancybetweenthephases of exponentialgrowth, plateauandlatency, thankstothedemanding monitoring of theprovisions of Law no. 55/15 May 2020, whichregulatestheactivity of preventingandcombatingtheeffects of the COVID-19 pandemic. Copyright © 2022 Catana Emil et al., published by Sciendo.

3.
Rev Infirm ; 71(284):35-36, 2022.
Artigo em Francês | PubMed | ID: covidwho-2159774

RESUMO

In the front line, from the beginning of the pandemic, to take care of patients hospitalized for severe forms of Covid-19, health professionals have not failed, despite the precautions taken, to contract the virus and develop the disease, sometimes with severe forms. Two hospital caregivers testify about their respective experiences and the repercussions on their daily life due to a long Covid.

4.
SN Comprehensive Clinical Medicine ; 5(1) (no pagination), 2023.
Artigo em Inglês | EMBASE | ID: covidwho-2158266

RESUMO

We report a rare case of new-onset MDA-5-positive amyopathic dermatomyositis with rapidly progressive interstitial lung disease (RP-ILD) following the second dose of the COVID-19 mRNA vaccine. Our patient was a previously healthy Asian female in her 60 s who presented with fatigue, dyspnea on exertion, and typical dermatomyositis (DM) rashes without muscle involvement two weeks after receiving the second dose of the COVID-19 mRNA BNT162b2 vaccine. Workup revealed high titer MDA-5 antibodies, abnormal pulmonary function tests, and ground-glass opacities on chest imaging. She had good response to early aggressive therapy with high-dose steroids, intravenous (IV) rituximab, mycophenolate mofetil, and intravenous immunoglobulin (IVIG). This case highlights the potential immunogenicity of COVID-19 mRNA vaccines and the possibility of new-onset systemic rheumatic syndromes after vaccination. More studies are needed to understand a definitive causal relationship and improve surveillance of adverse immunological events following COVID-19 vaccinations. Copyright © 2022, This is a U.S. Government work and not under copyright protection in the US;foreign copyright protection may apply.

5.
Tehran University Medical Journal ; 80(8):584-589, 2022.
Artigo em Persa | EMBASE | ID: covidwho-2157229

RESUMO

Background: The incidence of adverse perinatal outcomes including increased risk of miscarriage, preeclampsia, preterm birth and stillbirth is higher in pregnant women with coronavirus. Pregnant women who are infected with the coronavirus have placentas that are abnormal compared to the placentas of healthy women. Examples of these adverse effects have been observed before and include reduced fetal growth, pre-eclampsia, premature birth and stillbirth. Scleroderma is an uncommon connective tissue disease and its most obvious manifestation is skin fibrosis. Patients may also have involvement of visceral organs, as a result, their digestive system, kidney and heart are affected. Scleroderma also exacerbates miscarriage, fetal growth retardation, intrauterine fetal death, and preterm delivery. Pregnant women with these problems need special measures, so this study was performed to report a successful cesarean section in a woman with coronavirus and scleroderma. Case presentation: The patient was a 31-year-old pregnant woman with a gestational age of 29 weeks who presented to Sanandaj Besat Hospital in November 2021 with symptoms of shortness of breath and dyspnea. HRCT-positive, PCR-positive, bilateral pleural effusion, and pulmonary dilatation corona were diagnosed. Due to 3 liters of vaginal bleeding and diagnosis of Decollement 60% and severe preeclampsia underwent emergency cesarean section. The live baby was born weighing 1300 g with Apgar 7. During surgery, he received 3 units of FFB and 3 units of Cryoprecipitate. Microcalcifications and fibrin thrombi were reported in the pathology of intermittent nodules. The diagnosis and treatment of this patient has significant points that are mentioned below. Conclusion(s): Complications of pregnancy and childbirth in pregnant women infected with Corona virus include an increase in premature birth and an increase in the rate of cesarean section. Pregnancy in women with scleroderma at the right time and careful delivery monitoring will increase the probability of successful pregnancy outcome and all patients need counseling. Copyright © 2022 Zare et al. Tehran University of Medical Sciences. Published by Tehran University of Medical Sciences.

6.
NeuroQuantology ; 20(16):1682-1693, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2156384

RESUMO

Mucormycosis in people with COVID-19 or who are immunocompromised in any other way has become a worldwide issue, resulting in severe morbidity and mortality. Infection is incapacitating. and deadly, resulting in organ loss and emotional anguish. Mucormycosis is a rare angioinvasive illness that primarily affects immunocompromised people and is caused by the prolife ration of Mucorales. There are no radiographic symptoms. However a diagnosis can be made by microscopically examining materials recovered from necrotizing lesions Because the fungus enters the body through the skin, treatment involves a multidisciplinary approach. The use of the several antifungal medicines available is restricted by resistance and toxicity factors. The lipid formulation of amphotericin-B (liposomal Am-B) is the first-line treatment for mucormycosis in COVID-19 patients. high cost and limited availability have prompted a shift toward surgery, so surgical debridement to remove all necrotic lesions remains the keystone of effective mucormycosis treatment in COVID-19. This study concentrates on the pathophysiology, clinical manifestations, and therapy of HyperglycemiaAndIts Contributing Factors In Patients With Post Covid - 19 Mucormycosis. Copyright © 2022, Anka Publishers. All rights reserved.

7.
Journal of Pharmaceutical Negative Results ; 13:1372-1377, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2156335

RESUMO

Ayurveda is the ancient medical system in India that uses nasal therapy. During COVID -19 pandemic, the ministry of AYUSH provided guidelines to boost immunity. The Nasya (nasal delivery) was one of the recommendations by the AYUSH ministry to boost immunity. Nasya has been still in practice for various ailments like chronic rhinitis, headache, cervical spondylosis, Dyspnea, etc., but the knowledge about how Nasya works is still unclear. This review article discusses the practice and current advances in nasal delivery in modern science. It also discusses the possible mechanism of how Nasya can act and boost immunity and what research can be done in the form of clinical and experimental studies to increase the knowledge and understanding of Nasya. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

8.
Journal of Biomedical Physics and Engineering ; 12(6):611-626, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2156137

RESUMO

Background: Since hospitalized patients with COVID-19 are considered at high risk of death, the patients with the sever clinical condition should be identified. De-spite the potential of machine learning (ML) techniques to predict the mortality of COVID-19 patients, high-dimensional data is considered a challenge, which can be addressed by metaheuristic and nature-inspired algorithms, such as genetic algorithm (GA). Objective(s): This paper aimed to compare the efficiency of the GA with several ML techniques to predict COVID-19 in-hospital mortality. Material(s) and Method(s): In this retrospective study, 1353 COVID-19 in-hospi-tal patients were examined from February 9 to December 20, 2020. The GA technique was applied to select the important features, then using selected features several ML algorithms such as K-nearest-neighbor (K-NN), Decision Tree (DT), Support Vector Machines (SVM), and Artificial Neural Network (ANN) were trained to design predictive models. Finally, some evaluation metrics were used for the comparison of devel-oped models. Result(s): A total of 10 features out of 56 were selected, including length of stay (LOS), age, cough, respiratory intubation, dyspnea, cardiovascular diseases, leukocy-tosis, blood urea nitrogen (BUN), C-reactive protein, and pleural effusion by 10-inde-pendent execution of GA. The GA-SVM had the best performance with the accuracy and specificity of 9.5147e+01 and 9.5112e+01, respectively. Conclusion(s): The hybrid ML models, especially the GA-SVM, can improve the treatment of COVID-19 patients, predict severe disease and mortality, and optimize the utilization of health resources based on the improvement of input features and the adaption of the structure of the models. Copyright © 2022, Shiraz University of Medical Sciences. All rights reserved.

9.
Cureus ; 14(11):e31009, 2022.
Artigo em Inglês | EuropePMC | ID: covidwho-2155770

RESUMO

Introduction Coronavirus disease 2019 (COVID-19) is a deadly virus affecting multiple organ systems, predominantly the respiratory system. Dyspnea along with the deterioration of health-related quality of life (HRQoL) is common in COVID-19 patients discharged from a dedicated Coronavirus disease (COVID) hospital. Very few studies in India used HRQoL for the assessment of COVID-19 patients after discharge. Our article aims to assess the factors associated with the persistence of dyspnea and HRQoL in discharged patients of COVID-19. Methods A total of 48 patients were included in this prospective observational study. Ethical approval from Institutional Ethics Committee was obtained before the enrolment of patients. Patients having dyspnea at exertion and during discharge were selected for this study. Modified Medical Research Council (mMRC) scale and modified Borg scale were used for assessing dyspnea on activity, and Saint George’s Respiratory Questionnaire (SGRQ) was used to assess HRQoL. Data were collected on the day of discharge (D0) and after 60 days (D60) post-discharge. The significance of changes in parameters from D0 to D60 was evaluated by paired t-test. Results The mean mMRC, modified Borg, and SGRQ scores at D0 were 2.38±0.98, 3.15±2.12, and 45.36±27.32, respectively, which were improved to 0.94±0.86, 0.94±1.27, and 19.22±18.96 at D60. Age showed significant positive correlations with initial modified Borg (r=0.292, p=0.044) and SGRQ (r=0.332, p=0.021) scores. Body mass index showed significant positive correlations with initial mMRC (r=0.352, p=0.014) and SGRQ (r=0.419, p=0.003) scores. Conclusion Our study showed that on discharge, many COVID patients have impaired HRQoL. Many of them also have dyspnea on exertion. With the early institution of standard pulmonary rehabilitation protocol, symptoms and HRQoL improves rapidly in a month. Different influencing factors were identified. Long-term follow-up with a bigger sample size is needed to formulate a management strategy for these patients.

10.
European Psychiatry ; 65(Supplement 1):S527, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2154068

RESUMO

Introduction: In addition to physical problems, patients with COVID-19 suffer fromconsiderable stress throughout the disease crisis and could present psychiatric consequences even after their remission. Objective(s): To assess anxiety, depression and post-traumatic stress symptoms among patients who had recovered from the acute COVID-19 infection in Tunisia. Method(s): A cross-sectional design included 50Tunisian adults who survived COVID-19 virus infection.Participants have been screened with a telephone interview 1 to 3months after a diagnosis of COVID- 19. We used a questionnaire including socio-psychological variables, presence of close relatives being infected, bereavement due to COVID-19 and post infection physical discomforts.The Impact of Event Scale-Revised (IES-R) was used to investigate post-traumatic stress disorder (PTSD). Depression and anxiety were measured using The Hospital Anxiety and Depression Scales (HADS). Result(s): The age of the participants ranged from 19 to 86 years.38% were female. Twelve percent (12%) of patients required hospitalization during COVID-19 infection. After a mean of 86.60 days (SD = 23) following the diagnosis, 28 % of patients reported clinically significant PTSD. The rates of depression and anxiety disorders in our population are 20% and 30%, respectively. Seventy percent of patients (70%) reported one or more post infection physical discomforts that the most common symptoms included Difficulty breathing and anosmia. Patients with PTSD, depression or anxiety had a more frequent history of a relative diagnosed positive for corona virus, a longer duration of infection, and more frequently post-infection physical discomfort Conclusion(s): Long-term psychological impact of COVID19 should not be ignored and mental health care could play an important role in rehabilitation.

11.
European Psychiatry ; 65(Supplement 1):S512, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2154029

RESUMO

Introduction: Recent research showed that persons with mental disorders may represent a population at increased risk for coronavirus disease (COVID-19) infection with more adverse outcomes. Objective(s): We aimed to analyze clinical profile of psychiatric inpatients during their infection with COVID-19, and to explore factors associated with the disease progression. Method(s): Weanalyzed retrospectively the medical records of 32 psychiatric inpatients, hospitalized in psychiatry "B" department at Hedi Chaker hospital (Sfax, Tunisia), and who contracted the COVID-19 infection. We used "Charlson Comorbidity Index Score" (CCIS), predicting 10-year survival in patients with multiple comorbidities. Result(s): Somatic history was reported in 50% of patients. The CCIS ranged between 0 and 4. Psychiatric diagnosis was schizophrenia in 81.3% and bipolar disorder in 18.7% of cases. The clinical symptoms reported were fever (50%), dry cough (75%);dyspnea (34.4%). Biological assessment showed a lymphopenia in 40.6% and a high C-Reactive Protein (CRP) in 53.1%. Among our patients, 37,5% needed oxygen, and 25% were transferred to the intensive care unit. The COVID-19 complications were mostly bacterial pulmonary superinfections (21.9%) and pulmonary embolism (9.4%). Only three (9.4%) patients died from the virus. Patients with medical history were more likely to need oxygen (p<0.001). Clinical and paraclinical parameters associated with oxygen need were: fever (p<0.001);dyspnea (p<0.001);lymphopenia (p<0.001);high CRP (p=0.001). Patients presenting pulmonary superinfection or embolism were more likely to require oxygen (p=0.006 and p=0.044 respectively). Conclusion(s): This study highlighted factors that may worsen the COVID-19 infection evolution, and which require special attention, in order to improve the prognosis of this disease.

12.
The American Heart Journal ; 254:246, 2022.
Artigo em Inglês | ProQuest Central | ID: covidwho-2149198

RESUMO

A 72-year-old female patient presented to the emergency department with one week history of dry cough, sore throat, and dyspnea grade 3, and 9 hours history of retrosternal chest pain. The patient had normal pulse, temperature and blood pressure. She had bilateral decreased air entry, S1 and S2 heard normally and had no lower limb edema. The patient had free past medical and surgical history. Laboratory investigations and ECG were done. Laboratory investigations showed that the patient was infected with SARS-CoV-2, and also showed positive cardiac enzymes, low hemoglobin (10.4 g/dl), high WBCs (14.9) 10

13.
International Journal of Pharmaceutical and Clinical Research ; 14(11):722-735, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2147026

RESUMO

In the 1930's the corona virus was first identified as a highly contagious chicken respiratory virus. Two human coronaviruses were later identified, the human coronavirus 229E causing the flu and secondly the human coronavirus OC43. Others are also important as SARS-CoV. In late 2019 the outbreak of Pneumonia occurred in the Chinese city of Wuhan which was investigated as a result of the corona virus, renamed as 2019-nCoV by the World Health Organization (WHO) and. now called as SARS-CoV-2. The WHO has identified the global health problem as an epidemic. Respiratory droplets produced during coughing and sneezing are the main means of transmission of COVID-19. Infection with COVID-19 in an infected person may remain undetected. Common symptoms of fever and dry cough are less common in the production of sputum, fatigue and in some cases may be dyspnoea or shortness of breath. The COVID-19 virus is a type of RNA virus, the outer envelope containing a lipid bilayer in which various proteins are synthesized such as membrane (M), envelope (E) and spike (S). Hand washing, coughing, social isolation, wearing a face mask in public, disinfection areas, and isolation are various ways to prevent the disease. The diagnosis of COVID-19 can be made on the basis of symptoms and confirmed using reverse transcription polymerase chain reaction (RT-PCR) tests. There are currently no antiretroviral drugs approved for COVID-19, only symptomatic and supportive treatment is used to treat people with this viral infection. Drugs that have been approved for the purpose of treating other viral infections are under investigation. Vaccination is an ultimate prevention and protection;few vaccines are given emergency approval and some are in progressive development phase in various countries to prevent this deadly pandemic. Copyright © 2022, Dr Yashwant Research Labs Pvt Ltd. All rights reserved.

14.
Journal of the American Society of Nephrology ; 33:340-341, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2125672

RESUMO

Introduction: Emergency use authorization and mass vaccination programs worldwide have lowered the burden of the COVID-19 pandemic. Vaccine complications not previously seen in clinical studies continue to manifest. We present a case of membranous nephropathy (MN) following the SARS-CoV-2 vaccination with successful treatment. Case Description: Our patient is a 58-year-old woman with past medical history of hypothyroidism seen at a nephrology clinic for evaluation of new onset symptoms of dyspnea, severe bilateral pedal edema, and proximal muscle weakness for 4 months. The patient had 3+ proteinuria and microscopic hematuria on urinalysis obtained by primary care provider. She also had a rapid decline in serum albumin to 2.2 g/dL and new onset hypercholesteremia at 415 mg/dL. Before initial presentation, she had normal labs and no symptoms. Upon presentation to our nephrology clinic, the patient had proteinuria of 2,360 mg/day on a 24-hour urine collection, random urine protein-to-creatinine ratio (UPCR) of 5,459 mg/g and random urine albumin-to-creatinine ratio (UACR) of 3,539 mg/g. She had no risk factors for chronic kidney disease. The only recent change in the health management of the patient was the administration of two doses of the SARS-CoV-2 vaccine several weeks prior to presenting with her initial symptoms 4 months ago. The phospholipase A2 receptor (PLA2R) antibody was elevated at 287 IU/mL. Serological tests for other sources of proteinuria were negative. Renal biopsy performed was consistent with primary MN. The patient was started on rituximab infusion given 2 weeks apart based on Mentor Trial. Additional treatment included apixaban, sulfamethoxazole/ trimethoprim DS, losartan, and L-carnitine. After two doses of rituximab, she had resolution of dyspnea, pedal edema and muscle weakness. Repeat labs revealed UPCR to 1000 mg/g, UACR to 629 mg/g, improvement of PLA2R to 8 IU/mL. Our patient achieved immunological remission and partial clinical remission. Discussion(s): This case illustrates a potential association of the SARS-CoV-2 vaccination and autoimmune mimicry leading to MN. We hope that this will help clinicians become aware of a potential complication not widely recognized and an effective management strategy. We hope further investigations of this possible association are performed as more cases are discovered.

15.
Journal of the American Society of Nephrology ; 33:805-806, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2125575

RESUMO

Introduction: Lupus podocytopathy (LP) is a glomerular lesion in systemic lupus erythematosus (SLE) patients characterized by diffuse epithelial cell foot process effacement (FPE) without immune complex deposition or with only mesangial immune complex deposition. In SLE, nephrotic syndrome in rare instances, appear as LP, mimicking minimal change disease (MCD) or primary focal segmental glomerulosclerosis (FSGS). Case Description: 21-year-old African American female with a past medical history of eczema, kidney stone, COVID-19, facial rash admitted with persistent shortness of breath, lower extremity swelling with symptomatic anemia. Patient was noted to have nephrotic syndrome with positive serology for SLE and low complements. Renal biopsy showed lupus podocytopathy with features of collapsing glomerulopathy. The absence of endocapillary proliferation, presence of collapsing features, and lack of sub-endothelial immune complexes on electron microscopy (EM) are features consistent with LP with transition to Membranous lupus nephritis (LN) Class V. Patient was started on steroids, mycophenolate mofetil, and hydroxychloroquine. Voclosporin was added at one month follow-up given persistent nephrotic syndrome. Proteinuria improved significantly to 2 g in 4 weeks and prednisone taper was started. APOL1 gene assay revealed presence of G1, G2 risk alleles. Discussion(s): The prevalence of LP in LN biopsies is approximately 1% and is diagnosed based on clinical presentation of nephrotic syndrome with SLE and kidney biopsy findings of diffuse and severe FPE on EM, and absence of subendothelial or subepithelial immune deposits on EM. LP is further subclassified as MCD or FSGS subtypes. The MCD forms respond well to treatment with glucocorticoids as induction therapy, adding a nonglucocorticoid immunosuppressive agent only to treat or, in some cases, to avoid relapses. On the other hand, the FSGS forms with collapsing lesions have worse outcomes, progressing to end-stage renal disease in more than 50% of the cases. LP FSGS subtypes are less steroid-responsive and may benefit from initial induction treatment with glucocorticoids and another agent, such as calcineurin inhibitors. APOL1 genotyping of African American patients with SLE might help identify patients at risk for collapsing glomerulopathy, an entity with poor prognosis and resistance to treatment.

16.
Journal of the American Society of Nephrology ; 33:83, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2125178

RESUMO

Introduction: Anti-Glomerular Basement Membrane (anti-GBM) is an autoimmune disease involving glomerular and pulmonary capillaries diagnosed in 1 patient per million per year. Predominant lung involvement can be seen in 6% of patients most of which still demonstrate microscopic hematuria and biopsy with typical linear IgG immunofluorescence (99%). Case Description: We report a case of a 57-year-old man who presented with several weeks of dyspnea and myalgia, and was found to have acute kidney injury and multifocal tree-in-bud groundglass opacities throughout both lungs (Figure 1). His serum creatinine was elevated to 4.5 mg/dL from baseline of 0.8 mg/dL three months earlier but no proteinuria or hematuria. COVID19 was negative. Bronchoscopy showed blood throughout the tracheobronchial tree. Anti-GBM was elevated at 80 AU/mL. CRP was elevated at 17 mg/dL. Further work-up for other infectious or autoimmune causes was unremarkable. Kidney biopsy showed acute tubular necrosis (ATN), mixed interstitial inflammatory infiltrate, and one isolated fibrous cellular crescent. Immunofluorescence was negative. Due to the concern for progression of untreated anti-GBM disease, the patient was given high dose steroids, plasma exchange, and oral cyclophosphamide. His anti-GBM titer decreased to an undetectable level. Creatinine improved to 2.33 mg/dL. Discussion(s): This case brings to light a rare variant of anti-GBM with no detectable kidney involvement and presents a therapeutic dilemma. Two independent pathologists reviewed kidney biopsy and felt that crescent was a non-specific result of prior glomerular injury or pauci-immune focal glomerulonephritis. ANCA serologies were negative, and there were no other systemic manifestations. ATN was attributed to poor intake and Naproxen use. The patient received a typical anti-GBM treatment but more data are needed to support this approach in mild cases. (Figure Presented).

17.
Journal of the American Society of Nephrology ; 33:337-338, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2125078

RESUMO

Introduction: Infection-related IgA glomerulonephritis with large paramesangial immune deposits appearing like intraluminal cryo deposits have occasionally been described in literature temporally associated with Staphylococcus infection. COVID-19 associated glomerular disease is classically known to manifest as collapsing glomerulopathy, although other types have been reported. Case Description: We present a case of a 76-year old Hispanic female with a history of type 2 diabetes, hypertension and a 2-month old history of COVID-19 pneumonia who recently presented with acute kidney injury, dark urine, shortness of breath and leg edema. 2 weeks prior, she had presented with a history of purpuric rash. Urinalysis had shown hematuria and proteinuria, and a skin biopsy showed IgA vasculitis. Blood culture for Staphylococcus was negative. A kidney biopsy now showed IgA glomerulonephritis with focal crescents along with intraluminal pseudothrombi (cryo-plugs) positive for IgA on immunofluorescence. Electron microscopy showed intraluminal occlusive electron-dense deposits. Serum cryoglobulin was negative. The patient was treated with steroids and oral cyclophosphamide, and she responded significantly to treatment. Discussion(s): Our case shows a unique glomerular manifestation of COVID-19 infection in the form of IgA vasculitis with intraluminal cryo-like features, not previously described in literature.

18.
Cardiovascular Research ; 118(Supplement 2):ii115, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2124865

RESUMO

Thanks to the author's interest, complementary diagnostic tests were performed and the diagnosis was made. The author also made it possible to treat the patient through contact with the colleagues that performed the procedure. 75-year-old woman with past medical history of ischemic stroke in 2019, when complementary diagnostic tests were performed and it was found that the patient had a patent foramen ovale (PFO). Current hospitalization due to COVID-19 pneumonia, which was complicated by bacterial co-infection and intermediate-low risk right main pulmonary artery thromboembolism. The patient was successfully treated, with improvement of the clinical condition and evident imaging resolution of pulmonary cavitations and recanalization of the right pulmonary artery. However, something intriguing was observed: The patient presented dyspnea in the upright position and a decline in transcutaneous oxygen saturation from 96% in the supine position to 85% in orthostatism, with reversal of these findings with the recumbency. This led to the suspicion of platypnea-orthodeoxia syndrome. A transesophageal echocardiogram with bubble test was then performed, revealing an atrial shunt in the supine position without Valsalva maneuver. With these evidences, the diagnosis of platypnea-orthodeoxia syndrome was made. Even though the patient was >60 years, due to important right-to-left shunt, the history of stroke and the current platypnea-orthodeoxia, it was decided to close the PFO. The day after the procedure, the patient was placed in the upright position, maintaining an oxygen saturation of 96%. This case is an example that the decision of closing PFO must be individualized, not focusing only on patient's age, but also on his medical history and current situation, as indicated in the 2022 Guidelines for the Management of Patent Foramen Ovale. (Figure Presented).

19.
Journal of the American Society of Nephrology ; 33:555, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2124733

RESUMO

Background: Kidney transplant recipients (KT) are a vulnerable population with a risk of death after COVID-19 infection (COV-I) four times higher than in the general population. mRNA COVID-19 vaccines changed the prognosis. Although KT have an impaired immunological response to mRNA vaccines, in March 2021 we started a vaccination campaign. Method(s): Among 1611 KT, 72 (4.2%) had COV-I (positive molecular nasopharyngeal swab) between 31 October 2021 and 15 January 2022 (3rd outbreak). Fourty-one (57%) were male and 58 (80.5%) had a deceased donor transplant, median age was 52 (43-60) years, median transplant vintage 57 (27-159) months, median serum creatinine 1.37 (1.0-1.7) mg/dL. KT were on calcineurin inhibitors, prednisone, mycophenolate (MMF) and mTOR inhibitors in 93-87-79% and 5.6% respectively. At COV-I 43 KT had received 3 doses of Comirnaty (BNT162b2), 21 two and 4 one, 4 were not vaccinated. DELTA variant was present in 36. Treatment included: increase of the daily steroid dosage (69%), MMF withdrawal (70%) or halving (5%) and monoclonal antibodies: Ronapreve or Xevudy (32%). Nine delta positive KT were hospitalized for severe respiratory distress: 2 died (6.6%). Result(s): The variables associated with an increased risk for hospitalization were older age and dyspnea (p=0.023, p<0.0001 respectively). At multivariate analysis, dyspnea (p <0.0001) and MMF (p=0.003) were independently associated with the risk for hospitalization. Combination of the two variables increased the significance (p<0.0001). Comparing this series to the 82/1503 (5.4%) KT infected during the previous waves, hospitalization, mortality and cumulative mortality rates dropped from 45%, 29.3% and 13.4% to 30%, 6.6% and 2.7% respectively, main difference being the absence of vaccination in the first group. Conclusion(s): Vaccinations did not reduce the incidence of COV-I among KT but provided certain protection associated with a significantly better outcome.

20.
Prescrire International ; 31(234):44-45, 2022.
Artigo em Inglês | EMBASE | ID: covidwho-2124560
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