Clinical analysis of 132 cases COVID-19 from Wuhan.

Numerous cases of pneumonia from a novel coronavirus (SARS-CoV-2) emerged in Wuhan, China during December 2019.We determined the correlations of patient parameters with disease severity in patients with COVID-19.A total of 132 patients from Wuhan Fourth Hospital who had COVID-19 from February 1 to February 29 in 2020 were retrospectively analyzed.Ninety patients had mild disease, 32 had severe disease, and 10 had critical disease. The severe/critical group was older (P < .05), had a higher proportion of males (P < .05), and had a greater mortality rate (0% vs 61.9%, P < .05). The main symptoms were fever (n = 112, 84.8%) and cough (n = 96, 72.7%). Patients were treated with antiviral agents (n = 94, 71.2%), antibiotics (n = 92, 69.7%), glucocorticoids (n = 46, 34.8%), intravenous immunoglobulin (n = 38, 27.3%), and/or traditional Chinese medicine (n = 40, 30.3%). Patients in the severe/critical group received mechanical ventilation (n = 22, 16.7%) or high-flow nasal can-nula oxygen therapy (n = 6, 4.5%). Chest computed tomography (CT) indicated bilateral pneumonia in all patients. Relative to the mild group, the severe/critical group had higher levels of leukocytes, C-reactive protein (CRP), procalcitonin (PCT), D-dimer, B-type natriuretic peptide (BNP), liver enzymes, and myocardial enzymes (P < .05), and decreased levels of lymphocytes and blood oxygen partial pressure (P < .05).The main clinical symptoms of patients from Wuhan who had COVID-19 were fever and cough. Patients with severe/critical disease were more likely to be male and elderly. Disease severity correlated with increased leukocytes, CRP, PCT, BNP, D-dimer, liver enzymes, and myocardial enzymes, and with decreased lymphocytes and blood oxygen partial pressure.

Retropharyngeal abscess presenting as acute airway obstruction in a 66-year-old woman: A case report.

BACKGROUND: Adult retropharyngeal abscess (RPA) is extremely rare, and most cases reported in the literature were related to tuberculous infection. We present a case of RPA with acute airway obstruction as the main manifestation in a 66-year-old woman that was considered to be non-tubercular suppurative inflammation in the retropharyngeal space. CASE SUMMARY: A 66-year-old woman complaining of chills and fever was admitted to our hospital. She was initially diagnosed with an acute upper respiratory tract infection. She lost consciousness twice during hospitalization. She regained consciousness immediately upon emergency tracheal intubation. Acute upper airway obstruction was suspected as arterial blood gas analysis showed obvious acute retention of carbon dioxide before the second tracheal intubation. The diagnosis of RPA was confirmed by computed tomography and magnetic resonance imaging. Kocuria kristinae was isolated from blood samples taken from both hands. The patient recovered and was subsequently discharged after receiving antibiotic therapy together with surgical incision and drainage of the abscess. CONCLUSION: Clinicians should be alert to the possibility of RPA in patients with acute airway obstruction. Surgical incision and drainage is an effective treatment for RPA.

Bacterial etiology in early re-admission patients with acute exacerbation of chronic obstructive pulmonary disease.

BACKGROUND: Repeatedly hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) are often exposed to more antibiotics, but the distribution of pathogenic bacteria in these patients is poorly understood. The objectives of this study were to analyze the distribution of pathogenic bacteria and the risk factors associated with multidrug-resistant (MDR) bacteria infection in early re-admission patients with AECOPD. METHODS: We retrospectively reviewed charts for patients with AECOPD admitted to our hospital between January 2011 and November 2012. The early re-admission group and non-early readmission group were determined by whether patients were readmitted within 31 days after discharge. Detection of potentially pathogenic microorganisms (PPMs) and MDR bacteria were analyzed. Logistic regression analysis was performed to identify independent risk factors for MDR bacteria infection. RESULTS: PPMs were isolated from 230 (32.0%) cases of respiratory tract specimens; MDR bacteria accounted for 24.7% (57/230). Pseudomonas aeruginosa (43.7%), Klebsiella pneumoniae (15.6%), and Acinetobacter baumannii (12.5%) were the top three PPMs in the early readmission group, while the top three PPMs in the non-early readmission group were K. pneumoniae (23.7%), P. aeruginosa (21.2%), and Streptococcus pneumoniae (17.1%). Multivariate analysis showed that use of antibiotics within 2 weeks (odds ratio [OR] 8.259, 95% confidence interval [CI] 3.056-22.322, p = 0.000) was the independent risk factor for MDR bacteria infection. CONCLUSION: Non-fermentative Gram-negative bacilli (NFGNB) and enterobacteria were the predominant bacteria in early readmission patients with AECOPD. The detection rate of MDR bacteria was high which was related to the use of antibiotics within 2 weeks before admission in these patients.

Relationship between Fractional Exhaled Nitric Oxide Level and Efficacy of Inhaled Corticosteroid in Asthma-COPD Overlap Syndrome Patients with Different Disease Severity.

This study explored the relationship between the fractional exhaled nitric oxide (FeNO) level and the efficacy of inhaled corticosteroid (ICS) in asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) patients with different disease severity. A total of 127 ACOS patients with ACOS (case group) and 131 healthy people (control group) were enrolled in this study. Based on the severity of COPD, the ACOS patients were divided into: mild ACOS; moderate ACOS; severe ACOS; and extremely severe ACOS groups. We compared FeNO levels, pulmonary function parameters including percentage of forced expiratory volume in 1 second (FEV1) to predicted value (FEV1%pred), ratio of FEV1 to forced vital capacity (FEV1/FVC), inspiratory capacity to total lung capacity (IC/TLC) and residual volume to total lung capacity (RV/TLC), arterial blood gas parameters, including PH, arterial partial pressure of oxygen (PaO2) and arterial partial pressure of carbon dioxide (PaCO2), total serum immunoglobulin E (IgE), induced sputum eosinophil (EOS), plasma surfactant protein A (SP-A), plasma soluble receptor for advanced glycation end products (sRAGE), sputum myeloperoxidase (MPO), sputum neutrophil gelatinase-associated lipocalin (NGAL) and Asthma Control Test (ACT) scores, and COPD Assessment Test (CAT) scores. Compared with pre-treatment parameters, the FeNO levels, RV/TLC, PaCO2, total serum IgE, induced sputum EOS, plasma SP-A, sputum MPO, sputum NGAL, and CAT scores were significantly decreased after 6 months of ICS treatment, while FEV1%pred, FEV1/FVC, IC/TLC, PH, PaO2, plasma sRAGE, and ACT scores were significantly increased in ACOS patients with different disease severity after 6 months of ICS treatment. This finding suggests that the FeNO level may accurately predict the efficacy of ICS in the treatment of ACOS patients.

A rare fatal case of a novel bunyavirus-associated hemophagocytic lymphohistiocytosis.

Herein we describe a rare fatal case of a novel bunyavirus-associated hemophagocytic lymphohistiocytosis (HLH) in a 62-year-old female patient. The novel bunyavirus infects patients with or without HLH who have similar clinical features such as fever, thrombocytopenia, and leukocytopenia. Therefore, the diagnosis of HLH can be easily missed. When HLH occurs, the disease worsens and the fatality rate rises. Our finding highlights the importance of bone marrow biopsy performed as soon as possible for patients suspected of having a novel bunyavirus infection and showing marked cytopenia in three cell lines.

Endogenous lipoid pneumonia presenting as solitary pulmonary nodule: a case report.

A 63-year-old woman complained of hemoptysis was admitted to our hospital. Chest computed tomography (CT) showed a solitary pulmonary nodule (SPN) arising from the lower lobe of the right lung which was considered as lung malignancy. The patient underwent video-assisted thoracoscopic surgery (VATS) of pulmonary wedge resection to remove the nodule. Diagnosis of lipoid pneumonia was established by multiple lipid-laden macrophages found in surgical specimen. As there was no history of inhalation or aspiration of lipid containing substances, she was diagnosed as endogenous lipoid pneumonia. The patient discharged from our hospital after surgery and with no recurrence in 9 months period.

Pulmonary oncocytoma: a case report.

A 70-year-old man complained of no discomfort was admitted to our hospital because of a nodules was found in his lung. Chest computer tomography showed a nodules arising from the upper lobe of the left lung, and the lesion became larger in 2 years follow-up period. The patient underwent video-assisted thoracoscopic surgery of lobectomy to remove the nodules. Histologically, the tumor specimen contained multiple glandular structures with oncocytic cells lining. Immunohistochemical staining showed the tissue did not include some neuroendocrine granules. Finally, He was diagnosed as pulmonary oncocytoma. The patient discharged from our hospital after surgery and with no recurrence in 29 months period.

[Identification and bronchoscopic management of broncholithiasis].

OBJECTIVE: To report the diagnostic experience for broncholithiasis, and to evaluate the value of flexible bronchoscopic management for the disease. METHODS: The clinical data, radiological features, bronchoscopy findings, the effect and complications of bronchoscopic management in 31 patients with broncholithiasis admitted to changhai hospital of second military medical university and zhejiang Taizhou Hospital between 2000 and 2007 were retrospectively reviewed. RESULTS: There were 19 men and 12 women, the mean age was 58.6 +/- 12.6. There were 26 cases missed diagnosis, and 19 cases were misdiagnosis. The diagnosis was confirmed by chest CT combined with bronchoscopy in all the patients. Thirty-six broncholiths were revealed, of which 26 were intraluminal, 9 eroding in the bronchial wall, and 1 peribronchial. In 26 patients, 31 broncholiths were managed by flexible bronchoscope, and 25 broncholiths were successfully removed. The success rate for intraluminal free broncholiths was higher (23/25). One patient experienced hemoptysis of 300 ml after therapy, but no significant complications occurred in other patients. CONCLUSIONS: The diagnosis of broncholithiasis can be easily missed or misdiagnosed. Chest CT combined with bronchoscopy were useful methods for the diagnosis of the disease. Extraction of broncholiths with flexible bronchoscope is a safe and effective management, especially for intraluminal broncholiths.