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1.
Medicine (Baltimore) ; 100(1): e24018, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33429766

RESUMO

INTRODUCTION: Pembrolizumab, a monoclonal antibody targeting programmed cell death-1 (PD-1), is approved as a therapy for unresectable or metastatic melanoma. Immunotherapy-associated pneumonitis is an uncommon event. PATIENT CONCERNS: A 73-year-old man was admitted to our hospital with a history of melanoma on the left side of the face (resected in December 2012) and metastasis to the left lung upper lobe (resected in November 2016). Recurrence of metastasis to the bilateral lungs and left pleura was detected in April 2018. A complete response was achieved following treatment with pembrolizumab, with lower limb rashes the only adverse events occurring during therapy. The patient was readmitted in March 2019 with a productive cough, shortness of breath, and mild fever, and sputum culture identified Escherichia coli. DIAGNOSIS: A diagnosis of pneumonia was made, and although cough and shortness of breath responded to ceftazidime and levofloxacin, but fever and poor appetite persisted. Computed tomography showed no improvement in the bilateral lower lobe lesions. Prednisone was initiated based on a clinical diagnosis of immunotherapy-related pneumonitis. The response to prednisone confirmed the diagnosis. INTERVENTIONS: The patient first received ceftazidime and levofloxacin, but the symptoms persisted. Prednisone was initiated based on a clinical diagnosis of immunotherapy-related pneumonitis. OUTCOME: Complete resolution of the bilateral lung lesions occurred after 45 days of prednisone therapy. CONCLUSION: This case report highlights that both pneumonitis and bacterial pneumonia can occur as complications of anti-PD-1 immunotherapy.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Imunoterapia/efeitos adversos , Melanoma/tratamento farmacológico , Pneumonia Bacteriana/etiologia , Pneumonia/etiologia , Idoso , Tosse/etiologia , Dispneia/etiologia , Febre/etiologia , Humanos , Imunoterapia/métodos , Imunoterapia/normas , Masculino , Melanoma/complicações , Metástase Neoplásica/tratamento farmacológico , Metástase Neoplásica/fisiopatologia , Pneumonia/fisiopatologia , Pneumonia Bacteriana/fisiopatologia
2.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431481

RESUMO

A 19-year-old man was admitted with a 2-week history of continuous cough along with a day history of acute onset unsteadiness and hiccups. Given the current pandemic, he was initially suspected to have COVID-19, however he tested negative on two occasions. Subsequent brain magnetic resonance imaging (MRI)confirmed a small left acute and subacute lateral medullary infarction with chest X-ray suggesting aspiration pneumonia with right lower lobe collapse. This is a distinctive case of posterior circulation stroke presenting with a new continuous cough in this era of COVID-19 pandemic. We anticipate based on MRI findings that his persistent cough was likely due to silent aspiration from dysphagia because of the subacute medullary infarction. It is therefore imperative that healthcare workers evaluate people who present with new continuous cough thoroughly to exclude any other sinister pathology. We should also be familiar with the possible presentations of posterior circulation stroke in this pandemic era.


Assuntos
/diagnóstico , Tosse/fisiopatologia , Soluço/fisiopatologia , Síndrome Medular Lateral/diagnóstico por imagem , Pneumonia Aspirativa/diagnóstico por imagem , Transtornos das Sensações/fisiopatologia , Vertigem/fisiopatologia , Tosse/etiologia , Diagnóstico Diferencial , Imagem de Difusão por Ressonância Magnética , Soluço/etiologia , Humanos , Síndrome Medular Lateral/complicações , Síndrome Medular Lateral/fisiopatologia , Imagem por Ressonância Magnética , Masculino , Pneumonia Aspirativa/etiologia , Equilíbrio Postural , Transtornos das Sensações/etiologia , Vertigem/etiologia , Adulto Jovem
3.
Pediatrics ; 147(1)2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32788269

RESUMO

A 16-year-old white boy with a history of chronic lung disease of prematurity, cough-variant asthma, and incidental lung nodules presented to the emergency center in spring 2020 with acute onset dry cough, shortness of breath, and fever. An initial history, gathered from his mother because of the patient's respiratory distress, revealed no recent travel. However, his mother is a health care worker at a hospital, and sick contacts included ongoing contact with a friend with cold-like symptoms. He had a variety of animals at home, including a dog, cats, fish, rodents, and reptiles. He had a history of vaping tobacco products >6 months ago. Fever and respiratory symptoms were associated with fatigue, chest tightness, abdominal pain, and myalgias. On examination, he was ill appearing and had tachycardia, tachypnea, borderline hypoxia with an oxygen saturation of 91% on room air, diminished breath sounds at the lung bases, and unremarkable abdominal examination results. A chest radiograph was consistent with the lung examination, revealing bilateral lower lobe hazy infiltrates. He showed initial improvement for 48 hours with antibiotics, intravenous fluid resuscitation, oxygen via nasal cannula, albuterol, and prednisone. Subsequently, he worsened with persistent high fever, increasing respiratory distress with pulmonary findings, and severe persistent epigastric pain, which added a layer of diagnostic complexity. As this patient's clinical course evolved and further history became available, pulmonary medicine and infectious diseases services were consulted to guide diagnostic evaluation and treatment of this patient early in the era of coronavirus disease 2019.


Assuntos
Lesão Pulmonar Aguda/diagnóstico por imagem , Tosse/diagnóstico por imagem , Febre/diagnóstico por imagem , Vaping/efeitos adversos , Lesão Pulmonar Aguda/etiologia , Adolescente , /genética , Tosse/etiologia , Diagnóstico Diferencial , Febre/etiologia , Humanos , Masculino , Reação em Cadeia da Polimerase em Tempo Real/métodos , Vaping/patologia
4.
Ann Otol Rhinol Laryngol ; 130(2): 211-214, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32627566

RESUMO

OBJECTIVES: To educate healthcare providers on Cryptococcus neoformans as a novel cause of glottic webs especially in an immunocompromised patient and discuss recurrence of the glottic web. This case also emphasizes the importance of a comprehensive patient evaluation in cases such as this, as laryngeal involvement in this case was only a portion of the patient's disease burden. METHODS: An extensive review of the patient's clinical course was assessed including patient presentation, diagnostic techniques, medical and surgical treatment, and complications. RESULTS: Prolonged Fluconazole therapy and two excisions of the glottic web, the second with keel placement, was an effective treatment course for our patient. CONCLUSION: Cryptococcal glottic webs are rare, and this case report demonstrates successful treatment in one such case with operative intervention following medical management of disseminated disease.


Assuntos
Confusão/etiologia , Criptococose/diagnóstico , Doenças da Laringe/microbiologia , Meningite Criptocócica/diagnóstico , Líquido da Lavagem Broncoalveolar/microbiologia , Tosse/etiologia , Cryptococcus neoformans , Disfonia/etiologia , Feminino , Humanos , Hospedeiro Imunocomprometido , Laringoscopia , Pessoa de Meia-Idade
5.
Med Clin North Am ; 105(1): 31-38, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33246521

RESUMO

Cough is a common presenting symptom for patients in a primary care setting. Chronic cough is defined as a cough lasting for more than 8 weeks. The most common causes of chronic cough are upper airway cough syndrome, asthma, and gastroesophageal reflux disease. Detailed history and physical examination are critical in identifying potential etiologies of cough. When there is no prevailing diagnosis, step-wise empiric trial of medication is a strategic and cost-effective approach. Certain features of chronic cough should provoke an expedited and invasive diagnostic strategy. Effectively treating patients with chronic cough has a high impact on quality of life.


Assuntos
Tosse/etiologia , Algoritmos , Asma/complicações , Asma/diagnóstico , Doença Crônica , Tosse/diagnóstico , Tosse/fisiopatologia , Tosse/terapia , Refluxo Gastroesofágico/complicações , Refluxo Gastroesofágico/diagnóstico , Humanos , Anamnese , Exame Físico , Infecções Respiratórias/complicações , Infecções Respiratórias/diagnóstico
6.
Medicine (Baltimore) ; 99(50): e23501, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327289

RESUMO

INTRODUCTION: Primary pulmonary lymphoma (PPL) is a rare extranodal lymphoma. Only 5% to 20% of patients suffering from PPL have diffuse large ß-cell lymphoma (DLBCL), and their chest computed tomography (CT) findings show single- or double-lung patchy or flocculated shadows, isolated or multifocal nodules, or masses. In this research paper, we report an older woman having multiple ground-glass nodules, who was eventually diagnosed with primary pulmonary diffuse large ß-cell lymphoma (PPDLBCL). PATIENT CONCERNS: A 69-year-old woman suffering from cough was admitted to the Second Hospital of Jilin University. DIAGNOSES: A chest CT scan showed multiple ground-glass nodules. She had received 2 weeks of antibiotic treatment, but the multiple ground-glass nodules were still present. Lung biopsy was performed by tracheoscopy, which showed non-Hodgkin diffuse large ß-cell lymphoma. INTERVENTIONS: The patient received R-CHOP-21 chemotherapy. OUTCOMES: The multiple ground-glass nodules were absorbed. CONCLUSION: The current study shows that spotting multiple ground-glass nodules in the lungs is a clear indication of the presence of PPDLBCL. It is important to spread awareness of PPDLBCL, which needs timely diagnosis and management.


Assuntos
Neoplasias Pulmonares/diagnóstico , Linfoma Difuso de Grandes Células B/diagnóstico , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Tosse/etiologia , Ciclofosfamida/uso terapêutico , Diagnóstico Diferencial , Doxorrubicina/uso terapêutico , Feminino , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/tratamento farmacológico , Linfoma Difuso de Grandes Células B/complicações , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Prednisona/uso terapêutico , Rituximab/uso terapêutico , Tomografia Computadorizada por Raios X , Vincristina/uso terapêutico
7.
Einstein (Sao Paulo) ; 18: eRC5478, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33263677

RESUMO

A 33-year-old male with house dust mite allergic rhinitis and asthma reported an episode of facial and lip angioedema, dyspnea, cough and dysphagia at the age of 25, minutes after eating a mushroom ( Agaricus bisporus ) pizza. He denied any drug intake, hymenoptera stings or other possible triggers, and no identifiable cofactors were present. Since then he avoided all types of mushrooms, however an accidental contact occurred with mushroom sauce that resulted in angioedema of the lip within minutes. The allergy workup included measurements of total IgE and specific IgE to mushroom, and skin prick test to aeroallergens sources, possible food allergen sources and mushroom extract, a prick to prick test with raw and cooked A. bisporus , in addition to a SDS-PAGE and immunoblotting assay. The study revealed a specific IgE to mushroom of 0.76kUA/L positive skin prick test to mushroom extract, and prick to prick test positive to white and brown A. bisporus (raw and cooked). The immunoblotting identified two IgE binding proteins with 10kDa and 27kDa. We report a case of A. bisporus anaphylaxis probably due to primary mushroom sensitization. We detected two IgE-reactive proteins with 10kDa and 27kDa as possible culprit allergens.


Assuntos
Agaricus , Anafilaxia/etiologia , Angioedema/etiologia , Tosse/etiologia , Transtornos de Deglutição/etiologia , Dispneia/etiologia , Hipersensibilidade Alimentar/imunologia , Adulto , Alérgenos , Alternaria , Anafilaxia/induzido quimicamente , Animais , Gatos , Farinha , Humanos , Imunoglobulina E/sangue , Masculino , Testes Cutâneos
8.
MedEdPORTAL ; 16: 11058, 2020 12 17.
Artigo em Inglês | MEDLINE | ID: mdl-33365392

RESUMO

Introduction: The COVID-19 pandemic has radically disrupted traditional models of medical education, forcing rapid evolution in the delivery of clinical training. As a result, clinical educators must quickly transition away from in-person sessions and develop effective virtual learning opportunities instead. This virtual resource was designed to replace a clinical simulation session for the physical examination course for medical students in the preclinical years. Methods: We designed an online interactive module in three sections for preclinical (first- or second-year) medical students who had not yet learned the respiratory physical exam. The first section incorporated demonstration and practice of the components of the respiratory physical exam that could be effectively taught via videoconferencing software. Following this, students conducted a telemedicine encounter with a standardized patient and received patient-centered feedback evaluating their communication skills. The final segment involved a case discussion and clinical reasoning component. Results: These sessions were implemented for 122 first-year medical students. The module was well received by the students. A majority felt that it helped improve their telemedicine communication skills (93%), interpretation of physical exam findings (84%), development of differential diagnosis (95%), and correlation of clinical and basic science content (93%). Discussion: Our pilot educational session demonstrates that this virtual instruction method is an effective tool for teaching basic clinical skills during medical school. Virtual learning resources allow remote instruction to take place and can be a supplement when face-to-face clinical teaching is not possible.


Assuntos
Competência Clínica , Infecções Comunitárias Adquiridas/diagnóstico , Instrução por Computador , Tosse/etiologia , Educação de Graduação em Medicina/métodos , Exame Físico , Pneumonia/diagnóstico , /diagnóstico , Comunicação , Diagnóstico Diferencial , Feedback Formativo , Humanos , Anamnese , Pandemias , Exame Físico/métodos , Projetos Piloto , Consulta Remota
9.
Isr Med Assoc J ; 22(12): 775-780, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33381951

RESUMO

BACKGROUND: Our 1600-bed teaching hospital opened the first physician-led specialist pleural service in Israel in November 2016. Thoracentesis is one of the frequently performed procedures in clinic. OBJECTIVES: To review the incidence of thoracentesis-related symptoms, complications, and risk factors in a specialist pleural clinic. METHODS: Prospective analysis was conducted of 658 ultrasound-assisted thoracenteses between November 2016 and November 2019. Data were collected on patient demographics, clinical characteristics, procedural aspects, symptoms, complications, and additional interventions required. RESULTS: Of the procedures, 24% were accompanied by a reported symptom of any intensity or duration. Cough and chest discomfort were noted in 56.4% and 52% of these cases, respectively. Large-volume drainage was associated with symptoms (P = 0.002). Ultrasound-estimated effusion volume before drainage predicted pain (P = 0.001) and pneumothorax (P = 0.021). Of 8 cases of pneumothorax, 6 were due to non-expandable lung. Two patients were hospitalized (0.3%), and one required a chest drain. CONCLUSIONS: Symptoms are a common feature of thoracentesis even when performed by experienced operators in ideal settings. Complications, however, are rare when the procedure is performed with bedside ultrasound and attention is paid to patient-reported symptoms and volume drained. Specialist pleural clinics provide a good model for a standardized approach to safe performance of this common procedure.


Assuntos
Toracentese/efeitos adversos , Ultrassonografia de Intervenção/efeitos adversos , Idoso , Dor no Peito/epidemiologia , Dor no Peito/etiologia , Tosse/epidemiologia , Tosse/etiologia , Dispneia/epidemiologia , Dispneia/etiologia , Feminino , Humanos , Incidência , Israel/epidemiologia , Masculino , Estudos Prospectivos , Fatores de Risco , Toracentese/métodos , Ultrassonografia de Intervenção/métodos
10.
JAMA ; 324(22): 2282-2291, 2020 12 08.
Artigo em Inglês | MEDLINE | ID: mdl-33289822

RESUMO

Importance: Idiopathic pulmonary fibrosis (IPF) has a poor prognosis and limited treatment options. Patients with IPF have altered lung microbiota, with bacterial burden within the lungs associated with mortality; previous studies have suggested benefit with co-trimoxazole (trimethoprim-sulfamethoxazole). Objective: To determine the efficacy of co-trimoxazole in patients with moderate and severe IPF. Design, Setting, and Participants: Double-blind, placebo-controlled, parallel randomized trial of 342 patients with IPF, breathlessness (Medical Research Council dyspnea scale score >1), and impaired lung function (forced vital capacity ≤75% predicted) conducted in 39 UK specialist interstitial lung disease centers between April 2015 (first patient visit) and April 2019 (last patient follow-up). Interventions: Study participants were randomized to receive 960 mg of oral co-trimoxazole twice daily (n = 170) or matched placebo (n = 172) for between 12 and 42 months. All patients received 5 mg of folic acid orally once daily. Main Outcomes and Measures: The primary outcome was time to death (all causes), lung transplant, or first nonelective hospital admission. There were 15 secondary outcomes, including the individual components of the primary end point respiratory-related events, lung function (forced vital capacity and gas transfer), and patient-reported outcomes (Medical Research Council dyspnea scale, 5-level EuroQol 5-dimension questionnaire, cough severity, Leicester Cough Questionnaire, and King's Brief Interstitial Lung Disease questionnaire scores). Results: Among 342 individuals who were randomized (mean age, 71.3 years; 46 [13%] women), 283 (83%) completed the trial. The median (interquartile range) duration of follow-up was 1.02 (0.35-1.73) years. Events per person-year of follow-up among participants randomized to the co-trimoxazole and placebo groups were 0.45 (84/186) and 0.38 (80/209), respectively, with a hazard ratio of 1.2 ([95% CI, 0.9-1.6]; P = .32). There were no statistically significant differences in other event outcomes, lung function, or patient-reported outcomes. Patients in the co-trimoxazole group had 696 adverse events (nausea [n = 89], diarrhea [n = 52], vomiting [n = 28], and rash [n = 31]) and patients in the placebo group had 640 adverse events (nausea [n = 67], diarrhea [n = 84], vomiting [n = 20], and rash [n = 20]). Conclusions and Relevance: Among patients with moderate or severe IPF, treatment with oral co-trimoxazole did not reduce a composite outcome of time to death, transplant, or nonelective hospitalization compared with placebo. Trial Registration: ISRCTN Identifier: ISRCTN17464641.


Assuntos
Fibrose Pulmonar Idiopática/tratamento farmacológico , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Administração Oral , Idoso , Tosse/etiologia , Método Duplo-Cego , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Fibrose Pulmonar Idiopática/complicações , Fibrose Pulmonar Idiopática/mortalidade , Transplante de Pulmão , Masculino , Náusea/induzido quimicamente , Gravidade do Paciente , Falha de Tratamento , Combinação Trimetoprima e Sulfametoxazol/efeitos adversos
12.
Rev Paul Pediatr ; 39: e2020305, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33263697

RESUMO

OBJECTIVE: To describe the clinical manifestations and severity of children and adolescents affected by COVID-19 treated at Sabará Hospital Infantil. METHODS: This is a cross-sectional, retrospective, and observational study. All cases of COVID-19 confirmed by RT-qPCR of patients seen at the hospital (emergency room, first-aid room, and ICU) were analyzed. The severity of the cases was classified according to the Chinese Consensus. RESULTS: Among the 115 children included, a predominance of boys (57%) was verified, and the median age was two years. A total of 22 children were hospitalized, 12 in the ICU. Of the total, 26% had comorbidities with a predominance of asthma (13%). Fever, cough, and nasal discharge were the most frequent symptoms. Respiratory symptoms were reported by 58% of children and gastrointestinal symptoms, by 34%. Three children were asymptomatic, 81 (70%) had upper airway symptoms, 15 (13%) had mild pneumonia, and 16 (14%) had severe pneumonia. Hospitalized children were younger than non-hospitalized children (7 months vs. 36 months). In hospitalized patients, a higher frequency of irritability, dyspnea, drowsiness, respiratory distress, low oxygen saturation, and hepatomegaly was observed. Chest radiography was performed in 69 children with 45% of abnormal exams. No child required mechanical ventilation and there were no deaths. CONCLUSIONS: Most of children and adolescents affected by COVID-19 had mild upper airway symptoms. Clinical manifestations of COVID-19 were more severe among younger children who exhibited gastrointestinal and respiratory symptoms more frequently.


Assuntos
/estatística & dados numéricos , Índice de Gravidade de Doença , Adolescente , Brasil , /terapia , Criança , Pré-Escolar , Tosse/etiologia , Estudos Transversais , Feminino , Febre/etiologia , Humanos , Lactente , Tempo de Internação/estatística & dados numéricos , Masculino , Pneumonia/etiologia , Estudos Retrospectivos
13.
Rev Med Suisse ; 16(715): 2204-2210, 2020 Nov 18.
Artigo em Francês | MEDLINE | ID: mdl-33206477

RESUMO

Chronic cough is a common symptom in the consultation of any general practitioner. It may be idiopathic or reflect a chronic disease. However, cough can become excessive, occurring in response to stimuli that do not usually cause this symptom. This entity is called Cough hypersensitivity syndrome (CHS). Its treatment involves the use of neuromodulator substances that specifically target this hypersensitivity, while maintaining intact the cough reflex, essential for protecting the airways. This review aims to present the current knowledge about the pathophysiology of chronic cough, the initial diagnostic approach that this symptom requires and cough treatments either available or in development.


Assuntos
Tosse , Hipersensibilidade , Doença Crônica , Tosse/diagnóstico , Tosse/etiologia , Tosse/terapia , Humanos
14.
J Korean Med Sci ; 35(45): e404, 2020 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-33230989

RESUMO

BACKGROUND: As of April 30, 2020, a total of 2,039 cases of the novel coronavirus disease 2019 (COVID-19) were confirmed in the Republic of Uzbekistan after the first detection on March 15. Reports on symptoms of COVID-19 are non-specific and known to vary from asymptomatic, mild to severe, or fatal. This study aimed to analyze the symptomatic and clinical characteristics of study participants based on the medical records of participants hospitalized with COVID-19 in Uzbekistan. METHODS: We collected all data from medical records of COVID-19 confirmed patients in 19 hospitals from 13 regions of Uzbekistan between March 15 and April 30. We selected 1,030 patients discharged from the hospitals after COVID-19 treatment as study participants, excluding those with missing data. Further, we collected demographics, symptoms, clinical outcomes, and treatment data through medical records. RESULTS: More than half (57.6%) of confirmed cases of COVID-19 were males, and the median age was 36.0 years. The most frequent symptoms at the first inspection on hospital admission of all patients were fatigue (59.7%), dry cough (54.1%), pharyngalgia (31.6%), headache (20.6%), and anorexia (12.5%). Compared to the oldest group, the youngest group showed a lower frequency of symptoms. About half of the group aged 18-49 years reported that they came from abroad. One-fifth of patients in group 50-84 received oxygen support, while no patients in group aged 0-17 years received oxygen support. About two-thirds of the participants from intensive care unit (ICU) came from abroad, whereas 42.1% of the non-ICU group returned from other countries. Regarding symptoms, 16.9% of the patients in the ICU group were asymptomatic, while 5.8% in the non-ICU group were asymptomatic. CONCLUSION: This study suggests that the medical delivery system and resource distribution need to be implemented based on clinical characteristics by age and severity to delay and effectively respond to the spread of infections in the future. This study analyzed symptoms of COVID-19 patients across Uzbekistan, which is useful as primary data for policies on COVID-19 in Uzbekistan.


Assuntos
/diagnóstico , Adolescente , Adulto , Antivirais/uso terapêutico , /terapia , Criança , Pré-Escolar , Tosse/etiologia , Fadiga/etiologia , Feminino , Glucocorticoides/uso terapêutico , Humanos , Oxigenação Hiperbárica , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Uzbequistão/epidemiologia , Adulto Jovem
15.
J Investig Med High Impact Case Rep ; 8: 2324709620972243, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33174465

RESUMO

Globally, health care providers have been challenged to provide adequate care during the coronavirus disease-2019 (COVID-19) pandemic. Due to the ever changing and rapidly evolving nature of the novel coronavirus, there is increased public anxiety and knowledge gaps that have created major dilemmas in health care delivery. In this environment, there is tremendous pressure on clinicians to diagnose each and every case of COVID-19. This has led to a situation in which clinicians are primed to suspect all respiratory illness is due to COVID-19 infection until proven otherwise. Because of this, providers may misdiagnose patients who have illnesses that are distinct from COVID-19 but present in a similar manner. In the current article, we present the case of e-cigarette- and vaping-associated acute lung injury (EVALI) mimicking pneumonia secondary to the novel coronavirus. It is unknown if vaping puts patients at higher risk of respiratory failure if coinfected with COVID-19. Therefore, exposure history in patients presenting with pneumonia-like syndrome is important. Physicians should be aware of the overlap between these conditions and should pay particular attention during history taking to distinguish EVALI from COVID-19 pneumonia.


Assuntos
Infecções por Coronavirus/diagnóstico , Doenças Pulmonares Intersticiais/etiologia , Pneumonia Viral/diagnóstico , Tomografia Computadorizada por Raios X/métodos , Vaping/efeitos adversos , Adulto , Infecções por Coronavirus/diagnóstico por imagem , Tosse/diagnóstico , Tosse/etiologia , Diagnóstico Diferencial , Febre/diagnóstico , Febre/etiologia , Hábitos , Humanos , Doenças Pulmonares Intersticiais/diagnóstico por imagem , Masculino , Pandemias , Pneumonia Viral/diagnóstico por imagem , Radiografia Torácica/métodos , Medição de Risco
16.
PLoS One ; 15(11): e0241407, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33141845

RESUMO

OBJECTIVES: The purpose is to assess the ability of low-dose CT (LDCT) to determine lung involvement in SARS-CoV-2 pneumonia and to describe a COVID19-LDCT severity score. MATERIALS AND METHODS: Patients with SARS-CoV-2 infection confirmed by RT-PCR were retrospectively analysed. Clinical data, the National Early Warning Score (NEWS) and imaging features were recorded. Lung features included ground-glass opacities (GGO), areas of consolidation and crazy paving patterns. The COVID19-LDCT score was calculated by summing the score of each segment from 0 (no involvement) to 10 (severe impairment). Univariate analysis was performed to explore predictive factor of high COVID19-LDCT score. The nonparametric Mann-Whitney test was used to compare groups and a Spearman correlation used with p<0.05 for significance. RESULTS: Eighty patients with positive RT-PCR were analysed. The mean age was 55 years ± 16, with 42 males (53%). The most frequent symptoms were fever (60/80, 75%) and cough (59/80, 74%), the mean NEWS was 1.7±2.3. All LDCT could be analysed and 23/80 (28%) were normal. The major imaging finding was GGOs in 56 cases (67%). The COVID19-LDCT score (mean value = 19±29) was correlated with NEWS (r = 0.48, p<0.0001). No symptoms were risk factor to have pulmonary involvement. Univariate analysis shown that dyspnea, high respiratory rate, hypertension and diabetes are associated to a COVID19-LDCT score superior to 50. CONCLUSIONS: COVID19-LDCT score did correlate with NEWS. It was significantly different in the clinical low-risk and high-risk groups. Further work is needed to validate the COVID19-LDCT score against patient prognosis.


Assuntos
Infecções por Coronavirus/diagnóstico , Pulmão/diagnóstico por imagem , Pneumonia Viral/diagnóstico , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus/genética , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Infecções por Coronavirus/virologia , Tosse/etiologia , Feminino , Febre/etiologia , Humanos , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/virologia , Taxa Respiratória , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Tomografia Computadorizada por Raios X , Adulto Jovem
17.
J Res Health Sci ; 20(3): e00488, 2020 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-33169720

RESUMO

BACKGROUND: COVID-19 is a new viral disease with a rapid outbreak. Pregnant women are at a higher risk of contracting viral infections including COVID-19. We aimed to evaluate the clinical course and risk factors of pregnant women diagnosed with COVID 19 in Hamadan Province, west of Iran. STUDY DESIGN: A retrospective cohort study. METHODS: The convenience sampling was performed using 50 papers and electronic files of pregnant women diagnosed with COVID-19 according to the WHO's temporary guidelines. They were hospitalized in health centers and clinics of Hamadan Province. The data-collecting tool employed was a researcher-made questionnaire. The data were analyzed via SPSS software version 19. RESULTS: The mean age of pregnant women with COVID 19 was estimated to be 29.20 ± 5.8 yr and their average gestational age estimated to be 28.8 ± 8.20 weeks. About 32% of them had an underlying disease, 32% a history of influenza, and 40% recently traveled to infected areas. The most common findings were CT scans and multiple mottling and ground-glass opacity chest radiology. The most common symptoms were fever, cough, and shortness of breath. About 8% of the women required ICU hospitalization and the average length of hospital stay was 4.04 ± 2.38 and 29% had premature births. Moreover, 28% of infected mothers had a normal delivery and 20% had a cesarean section. CONCLUSION: Early diagnosis of Covid-19 disease is essential in pregnant women. Because there is a possibility of worsening complications in the mother and fetus.


Assuntos
Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Complicações Infecciosas na Gravidez/virologia , Adolescente , Adulto , Betacoronavirus , Comorbidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Tosse/epidemiologia , Tosse/etiologia , Demografia , Dispneia/epidemiologia , Dispneia/etiologia , Feminino , Febre/epidemiologia , Febre/etiologia , Hospitalização , Humanos , Recém-Nascido , Irã (Geográfico)/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Nascimento Prematuro , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X , Viagem , Adulto Jovem
20.
Pan Afr Med J ; 36: 256, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33014252

RESUMO

Idiopathic FOP is a rare type of COP. What we know on this subject is made up of a few clinical cases published in recent years. Our patient was admitted to the hospital with an intermittent coughing complaint that worsens over time. Due to a suspicion of malignancy, a radiological evaluation was requested including a PET-CT and a transbronchial biopsy was performed. Until the last part of our algorithm, the patient profile was clinically and radiologically in favor of the diagnosis of malignancy but, in the end, the diagnosis of FOP was fixed with a follow-up decision. In conclusion, FOP is a relatively new entity that should be kept in mind in the differential diagnosis of malignancy.


Assuntos
Tosse/etiologia , Pneumonia em Organização Criptogênica/diagnóstico , Neoplasias Pulmonares/diagnóstico , Idoso , Algoritmos , Biópsia , Pneumonia em Organização Criptogênica/patologia , Diagnóstico Diferencial , Humanos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons
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