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1.
Bratisl Lek Listy ; 122(1): 65-70, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33393323

RESUMO

OBJECTIVES: The aim of this study was to evaluate the diagnostic capacity of integrated pulmonary index (IPI) in predicting the pulmonary embolism (PE) in patients admitted to emergency departments (ED) with dyspnea. BACKGROUND: The acute dyspnea is one of the most common chief complaints in EDs. PE is a potentially fatal disease and the delay in specific therapy increases the worst outcomes. METHODS: This study is a prospective methodological study, in which we evaluated the diagnostic performance of the IPI in predicting PE in patients admitted to ED with dyspnea. ROC analysis was used for estimating the accuracy of IPI and OCRS. RESULTS: Of the 144 patients included in the study, there were 20 (13.9 %) PE patients. In the ROC analysis, the best cut-off point for IPI was ≤ 2. For this cut-off point, the sensitivity and specificity of IPI were 100.0 % and 96.0 %, respectively. Besides, the accuracy of IPI was 96.5 % with a +LR of 24.8 and a -LR of 0.0. CONCLUSION: IPI was a potential candidate for evaluating the respiratory status, and a limiting tool to prevent unnecessary diagnostic tests and save time in determining the treatment course in dyspneic patients at ED (Tab. 5, Fig. 3, Ref. 34).


Assuntos
Dispneia , Embolia Pulmonar , Doença Aguda , Dispneia/diagnóstico , Dispneia/etiologia , Humanos , Pulmão , Estudos Prospectivos , Embolia Pulmonar/complicações , Embolia Pulmonar/diagnóstico
2.
Int J Infect Dis ; 102: 233-238, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33130200

RESUMO

OBJECTIVES: Describe and evaluate the outcome of a coronavirus disease-2019 (COVID-19) patient without shortness of breath. DESIGN AND METHODS: We retrospectively collected data from COVID-19 patients diagnosed and cared for in Marseille, France. We selected data from patients who at admission, had a low dose CT scanner, dyspnea status, and oxygen saturation available. Blood gas was analyzed in a sample subset of patients. RESULTS: Among 1712 patients with COVID-19, we report that 1107 (64.7%) do not complain of shortness of breath at admission. The low-dose computed tomography (LDCT) scan showed signs compatible with pneumonia in 757/1,107 (68.4%) of patients without dyspnea. In a subset of patients who had underwent at least one blood gas analysis (n = 161) and presented without dyspnea at admission, 28.1% (27/96) presented with a hypoxemia/hypocapnia syndrome. Asymptomatic hypoxia was associated with a very poor outcome (33.3% were transferred to the ICU and 25.9% died). CONCLUSION: The absence of shortness of breath in an old patient with comorbidity merit medical attention and should not be considered as a good sign of well-being. The poor prognosis of asymptomatic hypoxia, highlight the severity of this mild clinical presentation. In these patients, pulse oximetry is an important mean to predict the outcome along with news score and LDCT scanner.


Assuntos
/complicações , Hipóxia/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Doenças Assintomáticas , /mortalidade , Dispneia/diagnóstico , Feminino , França/epidemiologia , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos
5.
Monaldi Arch Chest Dis ; 90(4)2020 Dec 23.
Artigo em Inglês | MEDLINE | ID: mdl-33372742

RESUMO

COVID-19 pneumonia has a significant case fatality rate and no effective antiviral drugs are available even after 9 months of the pandemic. The spectrum of COVID-19 disease ranges from asymptomatic cases to severe ARDS with myriad manifestations. Here we report a case of a male patient with severe COVID-19 ARDS who improved after receiving standard therapy but again 'deteriorated' after being stepped down to ward. He complained of worsening shortness of breath and hypoxemia which was found to be mainly positional. After ruling out other causes, he was labeled as a case of platypnea-orthodeoxia syndrome due to underlying lung involvement.  It is important to be aware of this condition in the context of COVID-19 which can be easily diagnosed bedside with pulse oximetry.


Assuntos
Dispneia , Hipóxia , Pulmão , Posicionamento do Paciente/métodos , Pneumonia Viral , Idoso , /fisiopatologia , Deterioração Clínica , Diagnóstico Diferencial , Dispneia/diagnóstico , Dispneia/etiologia , Humanos , Hipóxia/diagnóstico , Hipóxia/etiologia , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , Masculino , Oximetria/métodos , Oxigenoterapia/métodos , Administração dos Cuidados ao Paciente , Pneumonia Viral/diagnóstico , Pneumonia Viral/etiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Testes de Função Respiratória/métodos , Síndrome , Tomografia Computadorizada por Raios X/métodos
6.
Medicine (Baltimore) ; 99(45): e23031, 2020 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-33157953

RESUMO

RATIONALE: The evidence for outpatient pulmonary embolism (PE) management apart from hospitalization is expanding. The availability and ease of direct oral anticoagulants have facilitated this transition. The literature, however, is sparse on the topic of comprehensive management of pulmonary embolism in the primary care clinic setting. As such, the role of the primary care physician in the complete diagnosis, risk stratification for outpatient eligibility, and initiation of treatment is unclear. CASE PRESENTATIONS: Case 1: A 33-year-old man with known heterozygous Factor V Leiden mutation and a remote history of deep vein thrombosis presented to his primary care physician's office with 2 days of mild pleuritic chest pain and a dry cough after a recent transcontinental flight. Case 2: A 48-year-old man with a complex medical history including recent transverse myelitis presented to his primary care family physician with dyspnea and pleuritic chest pain for 6 days. DIAGNOSIS: Case 1: Computed tomographic pulmonary angiography that same afternoon showed multiple bilateral segmental and subsegmental emboli as well as several small pulmonary infarcts. Case 2: The patient's D-dimer was elevated at 1148 ng/mL. His physician ordered a computed tomographic pulmonary angiography, performed that evening, which showed segmental and subsegmental PE. INTERVENTIONS: Both patients were contacted by their respective physicians shortly after their diagnoses and, in shared decision-making, opted for treatment at home with 5 days of enoxaparin followed by dabigatran. OUTCOMES: Neither patient developed recurrence nor complications in the subsequent 3 months. LESSONS: These cases, stratified as low risk using the American College of Chest Physicians criteria and the PE Severity Index, are among the first in the literature to illustrate comprehensive primary care-based outpatient PE management. Care was provided within an integrated delivery system with ready, timely access to laboratory, advanced radiology, and allied health services. This report sets the stage for investigating the public health implications of comprehensive primary care-based PE management, including cost-savings as well as enhanced patient follow-up and patient satisfaction.


Assuntos
Dor no Peito/etiologia , Dispneia/etiologia , Transferência de Pacientes/métodos , Médicos de Atenção Primária/normas , Embolia Pulmonar/tratamento farmacológico , Doença Aguda , Adulto , Assistência Ambulatorial , Anticoagulantes/uso terapêutico , Antitrombinas/uso terapêutico , Dor no Peito/diagnóstico , Angiografia por Tomografia Computadorizada/métodos , Dabigatrana/uso terapêutico , Tomada de Decisão Compartilhada , Dispneia/diagnóstico , Enoxaparina/uso terapêutico , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Mielite Transversa/complicações , Mielite Transversa/diagnóstico , Transferência de Pacientes/estatística & dados numéricos , Médicos de Atenção Primária/estatística & dados numéricos , Embolia Pulmonar/diagnóstico por imagem , Medição de Risco , Resultado do Tratamento , Trombose Venosa/complicações , Trombose Venosa/diagnóstico
7.
Rev Med Suisse ; 16(715): 2198-2203, 2020 Nov 18.
Artigo em Francês | MEDLINE | ID: mdl-33206476

RESUMO

Dyspnea is a symptom resulting from a complex interaction between multiple mechanisms that are not fully understood to this day. Chronic dyspnea is defined as dyspnea lasting more than one month and this symptom is commonly seen in primary care. Cardio-respiratory pathologies account for approximately 85 % of all cases of dyspnea. Dyspnea significantly impacts the quality of life of the affected patients and is a good predictor of morbidity and mortality. Chronic dyspnea is challenging, especially when the etiology is unclear. Performing pulmonary function tests (PFTs) and a cardiopulmonary exercise test (CPET) allows to better understand the pathophysiology of the dyspnea in order to guide the diagnosis.


Assuntos
Dispneia , Qualidade de Vida , Adulto , Dispneia/diagnóstico , Dispneia/etiologia , Teste de Esforço , Tolerância ao Exercício , Humanos , Testes de Função Respiratória
8.
Acute Med ; 19(4): 230-234, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33215176

RESUMO

IMPORTANCE: Dyspnoea and hypoxia in pregnant women during the COVID-19 pandemic may be due to causes other than SARS Co-V-2 infection which should not be ignored. Shared decision-making regarding early delivery is paramount. OBJECTIVE: To highlight and discuss the differential diagnoses of dyspnoea and hypoxia in pregnant women and to discuss the risks versus benefit of delivery for maternal compromise. DESIGN, SETTING AND PARTICIPANTS: Case series of two pregnant women who presented with dyspnoea and hypoxia during the COVID-19 pandemic. RESULTS: Two pregnant women presented with dyspnoea and hypoxia. The first case had COVID-19 infection in the 3rd trimester. The second case had an exacerbation of asthma without concurrent COVID-19. Only the first case required intubation and delivery. Both recovered and were discharged home. Conclusion and relevance: Our two cases highlight the importance of making the correct diagnosis and timely decision-making to consider if delivery for maternal compromise is warranted. Whilst COVID-19 is a current healthcare concern other differential diagnoses must still be considered when pregnant women present with dyspnoea and hypoxia.


Assuntos
Infecções por Coronavirus , Dispneia/virologia , Pandemias , Pneumonia Viral , Complicações Infecciosas na Gravidez/virologia , Betacoronavirus , Tomada de Decisão Compartilhada , Dispneia/diagnóstico , Feminino , Humanos , Gravidez , Complicações Infecciosas na Gravidez/diagnóstico
9.
J Investig Med High Impact Case Rep ; 8: 2324709620972244, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33167717

RESUMO

The ongoing coronavirus disease-2019 (COVID-19) pandemic has been the focus of health care workers as it has affected millions of people and cost hundreds of thousands of lives around the world. As hospitals struggle to identify and care for those afflicted with COVID-19, it is easy to overlook endemic diseases that potentially worsen or mimic the pulmonary manifestations or may coinfect those with COVID-19. In this case report, we present the case of a 48-year-old Hispanic female who was admitted with respiratory distress from an acute COVID-19 infection but was also found to have acute pulmonary coccidioidomycosis infection and was treated successfully.


Assuntos
Técnicas de Laboratório Clínico , Coccidioidomicose/diagnóstico , Infecções por Coronavirus/diagnóstico , Progressão da Doença , Pneumonia Viral/diagnóstico , Síndrome Respiratória Aguda Grave/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Monofosfato de Adenosina/análogos & derivados , Monofosfato de Adenosina/uso terapêutico , Alanina/análogos & derivados , Alanina/uso terapêutico , Antifúngicos/uso terapêutico , Coccidioidomicose/complicações , Coccidioidomicose/tratamento farmacológico , Coinfecção , Infecções por Coronavirus/complicações , Infecções por Coronavirus/tratamento farmacológico , Diagnóstico Diferencial , Dispneia/diagnóstico , Dispneia/etiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/tratamento farmacológico , Radiografia Torácica/métodos , Síndrome Respiratória Aguda Grave/complicações , Resultado do Tratamento
10.
Medicine (Baltimore) ; 99(43): e22942, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120855

RESUMO

RATIONALE: Tracheobronchial amyloidosis (TBA) associated with Sjögren syndrome is very rare. Here, we describe a case with this phenomenon, in order to better understand the condition. PATIENT CONCERNS: A 52-year-old woman presented after 6 months of coughing, sputum, and dyspnea. Chest computed tomography revealed thickened bronchial walls, which were irregular on the left side the trachea. She had a history of dry eye and dry mouth of at least 3 years' duration. DIAGNOSES: Sjögren syndrome was diagnosed based on her symptoms, ophthalmological and parotid examination, and immunological and autoantibody tests. The diagnosis of TBA was confirmed by Congo red staining of a tracheal biopsy. INTERVENTIONS: The patient was given glucocorticoids without any other immunosuppressants. OUTCOMES: The symptoms improved after 6 months. LESSONS: TBA associated with Sjögren syndrome is a rare condition. TBA is characterized by amyloid deposition to the trachea in the absence of systemic amyloidosis. Diagnosis requires tissue biopsy with demonstration of amyloid deposition.


Assuntos
Amiloidose/etiologia , Broncopatias/patologia , Síndrome de Sjogren/complicações , Doenças da Traqueia/patologia , Amiloidose/diagnóstico , Biópsia , Broncoscopia/métodos , Tosse/diagnóstico , Tosse/etiologia , Dispneia/diagnóstico , Dispneia/etiologia , Feminino , Glucocorticoides/uso terapêutico , Humanos , Pessoa de Meia-Idade , Síndrome de Sjogren/diagnóstico , Síndrome de Sjogren/tratamento farmacológico , Escarro , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
11.
J Cardiovasc Magn Reson ; 22(1): 74, 2020 10 12.
Artigo em Inglês | MEDLINE | ID: mdl-33040733

RESUMO

AIM: Human Immunodeficiency Virus (HIV) patients commonly experience dyspnea for which an immediate cause may not be always apparent. In this prospective cohort study of HIV patients with exercise limitation, we use cardiopulmonary exercise testing (CPET) coupled with exercise cardiovascular magnetic resonance (CMR) to elucidate etiologies of dyspnea. METHODS AND RESULTS: Thirty-four HIV patients on antiretroviral therapy with dyspnea and exercise limitation (49.7 years, 65% male, mean absolute CD4 count 700) underwent comprehensive evaluation with combined rest and maximal exercise treadmill CMR and CPET. The overall mean oxygen consumption (VO2) peak was reduced at 23.2 ± 6.9 ml/kg/min with 20 patients (58.8% of overall cohort) achieving a respiratory exchange ratio > 1. The ventilatory efficiency (VE)/VCO2 slope was elevated at 36 ± 7.92, while ventilatory reserve (VE: maximal voluntary ventilation (MVV)) was within normal limits. The mean absolute right ventricular (RV) and left ventricular (LV) contractile reserves were preserved at 9.0% ± 11.2 and 9.4% ± 9.4, respectively. The average resting and post-exercise mean average pulmonary artery velocities were 12.2 ± 3.9 cm/s and 18.9 ± 8.3 respectively, which suggested lack of exercise induced pulmonary artery hypertension (PAH). LV but not RV delayed enhancement were identified in five patients. Correlation analysis found no relationship between peak VO2 measures of contractile RV or LV reserve, but LV and RV stroke volume correlated with PET CO2 (p = 0.02, p = 0.03). CONCLUSION: Well treated patients with HIV appear to have conserved RV and LV function, contractile reserve and no evidence of exercise induced PAH. However, we found evidence of impaired ventilation suggesting a non-cardiopulmonary etiology for dyspnea.


Assuntos
Dispneia/etiologia , Teste de Esforço , Tolerância ao Exercício , Infecções por HIV/complicações , Pulmão/fisiopatologia , Imagem por Ressonância Magnética , Ventilação Pulmonar , Adulto , Fármacos Anti-HIV/uso terapêutico , Dispneia/diagnóstico , Dispneia/fisiopatologia , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco , Função Ventricular
12.
Sarcoidosis Vasc Diffuse Lung Dis ; 37(2): 158-168, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33093779

RESUMO

Background: Cough is frequent symptom in sarcoidosis and its impact on patient's quality of life (QoL) has not been adequately addressed so far. Objectives: The goal of this study was to determine the significant predictors of cough-specific and generic QoL in sarcoidosis patients. Methods: In the prospective study 275 sarcoidosis patients administered Patient Reported Outcomes instruments for measurement of dyspnea (Borg and MRC scales) and fatigue (Fatigue Assessment Scale (FAS) and Daily Activity List (DAL)), as well as patients' QoL (cough-specific Leicester Cough Questionnaire (LCQ) and generic tool - 15D). The LCQ contains 3 domains covering physical, psychological and social aspects of chronic cough. Pulmonary function tests (spirometry and diffusing capacity for carbon monoxide) and serum angiotensin converting enzyme (sACE) were also measured. Results: Dyspnea measured by Borg scale and impairment of daily activities determined by DAL instrument as well as sACE were the strongest predictors of all cough-specific QoL domains. Mental aspect of patients' fatigue was significantly correlated with all domains except with psychological LCQ domain. Regarding the generic QoL, the following significant predictors were: dyspnea measured by MRC scale, overall fatigue determined by FAS and physical domain of the LCQ. Conclusion: It is important to measure both cough-specific and generic QoL in sarcoidosis patients since they measure different health aspects and their predictors can be different. We demonstrated that physical domain of cough-specific QoL is significant predictor of generic QoL. (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (2): 158-168).


Assuntos
Tosse/diagnóstico , Pulmão/fisiopatologia , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida , Sarcoidose Pulmonar/diagnóstico , Atividades Cotidianas , Adulto , Idoso , Efeitos Psicossociais da Doença , Tosse/etiologia , Tosse/fisiopatologia , Tosse/psicologia , Dispneia/diagnóstico , Dispneia/etiologia , Dispneia/fisiopatologia , Dispneia/psicologia , Fadiga/diagnóstico , Fadiga/etiologia , Fadiga/fisiopatologia , Fadiga/psicologia , Feminino , Nível de Saúde , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Fatores de Risco , Sarcoidose Pulmonar/complicações , Sarcoidose Pulmonar/fisiopatologia , Sarcoidose Pulmonar/psicologia , Índice de Gravidade de Doença
13.
Am J Trop Med Hyg ; 103(6): 2339-2342, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33069265

RESUMO

We describe the first 11 detected COVID-19 cases in Indonesia, resulting from a local transmission occurring in a club and a restaurant. The virus was detected until an average of 21.3 days (range: 11-25, SD: 4.1) after the onset of illness, and the partial N gene sequences (28,321-28,707 nucleotide position) had 100% similarity with the SARS-CoV-2 sequence from Wuhan. Two subjects were asymptomatic, and one subject has died.


Assuntos
/epidemiologia , Pandemias , /genética , Adolescente , Adulto , Doenças Assintomáticas , Busca de Comunicante/estatística & dados numéricos , Tosse/diagnóstico , Tosse/fisiopatologia , Tosse/virologia , Dispneia/diagnóstico , Dispneia/fisiopatologia , Dispneia/virologia , Feminino , Febre/diagnóstico , Febre/fisiopatologia , Febre/virologia , Hospitalização/estatística & dados numéricos , Humanos , Indonésia/epidemiologia , Masculino , Pessoa de Meia-Idade , Faringite/diagnóstico , Faringite/fisiopatologia , Faringite/virologia , Filogenia , Índice de Gravidade de Doença
14.
Am J Trop Med Hyg ; 103(6): 2376-2381, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33124545

RESUMO

There is a paucity of information regarding the epidemiology and outcome of COVID-19 from low/middle-income countries, including from Nigeria. This single-center study described the clinical features, laboratory findings, and predictors of in-hospital mortality of COVID-19 patients. Patients admitted between April 10, 2020 and June 10, 2020 were included. Forty-five patients with a mean age of 43 (16) years, predominantly male (87%), presented with fever (38%), cough (29%), or dyspnea (24%). In-hospital mortality was 16%. The independent predictors of mortality were hypoxemia (adjusted odds ratio [aOR]: 2.5; 95% CI: 1.3-5.1) and creatinine > 1.5 mg/dL (aOR: 4.3; 95% CI: 1.9-9.8).


Assuntos
/epidemiologia , Mortalidade Hospitalar/tendências , Pandemias , /patogenicidade , Adulto , Idoso , Doenças Assintomáticas , Tosse/diagnóstico , Tosse/fisiopatologia , Tosse/virologia , Creatinina/sangue , Dispneia/diagnóstico , Dispneia/fisiopatologia , Dispneia/virologia , Feminino , Febre/diagnóstico , Febre/fisiopatologia , Febre/virologia , Hospitalização/estatística & dados numéricos , Humanos , Hipóxia/diagnóstico , Hipóxia/fisiopatologia , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Centros de Atenção Terciária
16.
BMJ Case Rep ; 13(10)2020 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-33122234

RESUMO

A 60-year-old man presented with sudden onset right-sided chest pain and gradually worsening shortness of breath on exertion. Eleven days earlier, he had an admission with COVID-19 pneumonitis requiring 8 days of continuous positive airway pressure. He was tachypnoeic with a respiratory rate of 24 breaths/min, oxygen saturations on room air of 91%. Examination revealed reduced air entry and a resonant percussion note over the right hemithorax. Chest radiograph suggested a complex right pneumothorax; however, a CT chest was notable for widespread right-sided bullous lung disease. After a day of observation on a COVID-19 ward (and a repeat radiograph with a stable appearance), he was discharged with a 2-week follow-up with the respiratory team, safety netting advice and ambulatory oxygen. This case suggests that bullous lung disease may be a complication of severe COVID-19 pneumonitis.


Assuntos
Infecções por Coronavirus/complicações , Infecções por Coronavirus/terapia , Pneumopatias/patologia , Pneumonia Viral/complicações , Pneumonia Viral/terapia , Pneumotórax/diagnóstico por imagem , Pneumotórax/etiologia , Síndrome Respiratória Aguda Grave/complicações , Dor no Peito/diagnóstico , Dor no Peito/etiologia , Técnicas de Laboratório Clínico/métodos , Pressão Positiva Contínua nas Vias Aéreas/métodos , Infecções por Coronavirus/diagnóstico , Diagnóstico Diferencial , Dispneia/diagnóstico , Dispneia/etiologia , Serviço Hospitalar de Emergência , Humanos , Pneumopatias/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Pneumotórax/terapia , Radiografia Torácica/métodos , Medição de Risco , Síndrome Respiratória Aguda Grave/diagnóstico , Síndrome Respiratória Aguda Grave/terapia , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
17.
BMJ Case Rep ; 13(10)2020 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-33122237

RESUMO

A 50-year-old man presented to our dermatology clinic with itchy skin rash. The rash began 5 days after systemic symptoms appeared such as mild fever and mild dyspnoea. The rashes were a characteristic of follicular eruption, which started on his stomach and spread all over his body. After a thorough evaluation, he was diagnosed with COVID-19 and was started on COVID-19 regimens. Skin lesions disappeared on the ninth day of treatment. Our findings contribute to the growing awareness of dermatological manifestations in patients with COVID-19.


Assuntos
Infecções por Coronavirus/diagnóstico , Exantema/diagnóstico , Pneumonia Viral/diagnóstico , Dermatopatias Virais/diagnóstico , Antibacterianos/uso terapêutico , Antivirais/uso terapêutico , Infecções por Coronavirus/tratamento farmacológico , Diagnóstico Diferencial , Quimioterapia Combinada , Dispneia/diagnóstico , Dispneia/etiologia , Exantema/tratamento farmacológico , Febre/diagnóstico , Febre/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/tratamento farmacológico , Dermatopatias Virais/tratamento farmacológico , Resultado do Tratamento
19.
Am J Case Rep ; 21: e926781, 2020 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-32952147

RESUMO

BACKGROUND Coronavirus disease 2019 (COVID-19) is caused by a novel coronavirus, SARS-CoV-2, and is associated with severe respiratory disease. There are extensive publications on the chest computed tomography (CT) findings of COVID-19 pneumonia, with ground-glass opacities (GGO) and mixed GGO and consolidation being the most common findings. Those with interstitial thickening manifesting as reticular opacities typically show superimposed ground-glass opacities, giving a crazy-paving pattern. CASE REPORT We report the case of a 77-year-old man with a background of asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) who presented with progressive cough and shortness of breath for 2 days. He was in close contact with a confirmed COVID-19 case. Reverse-transcription polymerase chain reaction analysis of a nasopharyngeal swab was positive for SARS-CoV-2. The initial chest radiograph was negative for lung consolidation and ground-glass opacities. During admission, he had worsening shortness of breath with desaturation, prompting a chest CT examination, which was performed on day 14 of illness. The chest CT revealed an atypical finding of predominant focal subpleural interstitial thickening in the right lower lobe. He was provided supportive treatment along with steroid and antibiotics. He recovered well and subsequently tested negative for 2 consecutive swabs. He was discharged after 34 days. CONCLUSIONS Interstitial thickening or reticular pattern on CT has been described in COVID-19 pneumonia, but largely in association with ground-glass opacity or consolidation. This case demonstrates an atypical predominance of interstitial thickening on chest CT in COVID-19 pneumonia on day 14 of illness, which is the expected time of greatest severity of the disease.


Assuntos
Infecções por Coronavirus/diagnóstico , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Tomografia Computadorizada Multidetectores/métodos , Pneumonia Viral/diagnóstico , Intensificação de Imagem Radiográfica , Síndrome Respiratória Aguda Grave/diagnóstico por imagem , Corticosteroides/administração & dosagem , Idoso , Antibacterianos/administração & dosagem , Técnicas de Laboratório Clínico , Meios de Contraste , Infecções por Coronavirus/complicações , Tosse/diagnóstico , Tosse/etiologia , Progressão da Doença , Dispneia/diagnóstico , Dispneia/etiologia , Seguimentos , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Doenças Pulmonares Intersticiais/complicações , Doenças Pulmonares Intersticiais/terapia , Masculino , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/diagnóstico por imagem , Medição de Risco , Síndrome Respiratória Aguda Grave/virologia , Resultado do Tratamento
20.
Acta Biomed ; 91(3): ahead of print, 2020 08 10.
Artigo em Inglês | MEDLINE | ID: mdl-32921749

RESUMO

Platypnea-orthodeoxia syndrome (POS) is a clinical entity characterized by positional dyspnoea (platypnea) and arterial desaturation (orthodeoxia) that occurs when sitting or standing up and usually resolves by lying down. POS may result from some cardiopulmonary disorders or from other miscellaneous aetiologies. We report a case of POS in a patient after fibrotic evolution of SARS-CoV-2 interstitial pneumonia associated with pulmonary embolism. The patient did not have any evidence of an intracardiac/intrapulmonary shunt.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Dispneia/etiologia , Doenças Pulmonares Intersticiais/complicações , Pulmão/diagnóstico por imagem , Pneumonia Viral/complicações , Idoso , Infecções por Coronavirus/diagnóstico , Dispneia/diagnóstico , Feminino , Humanos , Doenças Pulmonares Intersticiais/diagnóstico , Pandemias , Pneumonia Viral/diagnóstico , Tomografia Computadorizada por Raios X
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