Koriyama N, Moriuchi A, Higashi K
… +5 more, Kataoka T, Arimizu T, Takaguchi G, Matsuoka H, Otsuka M
Clin Med Insights Circ Respir Pulm Med
· 2022 · PMID 35140541
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BACKGROUND: In COVID-19 pneumonia, cases of severe hypoxemia in the early stage and cases of sudden deterioration in respiratory status due to silent hypoxia leading to death, have been reported. CASE SUMMARY: A 70-year-...BACKGROUND: In COVID-19 pneumonia, cases of severe hypoxemia in the early stage and cases of sudden deterioration in respiratory status due to silent hypoxia leading to death, have been reported. CASE SUMMARY: A 70-year-old Japanese man with essential hypertension, dyslipidemia, chronic kidney disease and emphysema was hospitalized with the novel coronavirus disease. He had hypoxemia that was disproportionate to the severity of pneumonia indicated by computed tomography (CT), along with coagulation abnormalities. We speculated that there was a high possibility that he had developed ventilation and blood flow imbalance due to pulmonary intravascular coagulopathy (PIC) or hypoxic pulmonary vasoconstriction (HPV). In this case, early, short-term combination therapy with remdesivir, nafamostat mesylate and low-dose dexamethasone (Dex) was successful. CONCLUSION: In COVID-19 patients with multiple comorbidities who have hypoxemia and coagulation abnormalities that are disproportionate to the severity of pneumonia on CT, it is important to commence antiviral and anticoagulant therapy as soon as possible, followed by use of a low dose of Dex.
Saboe A, Marindani V, Cool CJ
… +4 more, Syawaluddin H, Kartamihardja HS, Santoso P, Akbar MR
Clin Med Insights Circ Respir Pulm Med
· 2022 · PMID 35023984
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Pulmonary hypertension (PH) encompasses several heterogeneous groups of multiple diseases characterized by abnormal pulmonary arterial blood pressure elevation. Unrepaired atrial septal defect (ASD) may be associated wit...Pulmonary hypertension (PH) encompasses several heterogeneous groups of multiple diseases characterized by abnormal pulmonary arterial blood pressure elevation. Unrepaired atrial septal defect (ASD) may be associated with pulmonary arterial hypertension (PAH), indicating pulmonary vascular remodeling. Furthermore, unrepaired ASD could also be associated with other conditions, such as left heart disease or thromboembolism, contributing to the disease progression. We present a case of a 61-years-old woman with complex PH comprising several etiologies, which are PAH due to unrepaired Secundum ASD, mitral regurgitation caused by mitral valve prolapse as a group 2 PH, pulmonary embolism (PE) which progress to chronic thromboembolism PH (CTEPH) and post-acute sequelae of SARS Cov-2. We highlighted the importance of diagnostic investigation in PH, which is crucial to avoid misdiagnosis and inappropriate treatment that could be detrimental for the patient.
Cupaciu A, Cohen V, Dudoignon E
… +1 more, Dépret F
Clin Med Insights Circ Respir Pulm Med
· 2021 · PMID 34899002
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We report the case of a patient with severe COVID-19 ARDS, suggesting a possible therapeutic intervention by applying a continuous lower abdominal compression. In order to assess ventilation distribution, a lung CT scan...We report the case of a patient with severe COVID-19 ARDS, suggesting a possible therapeutic intervention by applying a continuous lower abdominal compression. In order to assess ventilation distribution, a lung CT scan was performed with and without lower abdominal compression.
Clin Med Insights Circ Respir Pulm Med
· 2021 · PMID 34690503
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BACKGROUND: Studies investigating the effects of announcing spirometric lung-age (SLA) on the smokers' self-reported smoking status reported conflicting results. MAIN OBJECTIVE: To evaluate the effects of a single sessio...BACKGROUND: Studies investigating the effects of announcing spirometric lung-age (SLA) on the smokers' self-reported smoking status reported conflicting results. MAIN OBJECTIVE: To evaluate the effects of a single session intervention including an education conference about smoking harms and announcement of SLA on the participants' self-reported smoking status. METHODOLOGY: An interventional study was conducted in a cable factory. The intervention included four steps: PowerPoint presentation about raising smoking hazards awareness; general questionnaire; measurement of the anthropometric and spirometric data, and announcement of SLA; and evaluation of the smokers' self-reported smoking status 10 months later (quitted smoking, decreased consumption; stable consumption, increased consumption). RESULTS: Thirty-six smokers completed the four steps. Ten months after the intervention, 11.1% of smokers quitted smoking, 52.7% decreased their consumption by 7 ± 4 cigarettes/day, 30.5% kept a stable consumption, and 5.5% increased their consumption by 9 ± 6 cigarettes/day. CONCLUSION: Providing an education conference combined with announcing SLA motivated 64% of smokers to quit smoking or to reduce their cigarette consumption.
Yarrarapu SNS, Bansal P, Abia-Trujillo D
… +16 more, Cusick A, Melody M, Moktan V, Rivero A, Brigham TJ, Libertin C, Brumble L, Jennifer JO, Lee A, Klaus T, Santos C, Rivera C, Siegel J, Guru P, Franco PM, Sanghavi D
Clin Med Insights Circ Respir Pulm Med
· 2021 · PMID 34629922
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INTRODUCTION: In the unprecedented era of COVID-19, ongoing research and evolution of evidence has led to ever-changing guidelines for clinical monitoring and therapeutic options. Formulating treatment protocols requires...INTRODUCTION: In the unprecedented era of COVID-19, ongoing research and evolution of evidence has led to ever-changing guidelines for clinical monitoring and therapeutic options. Formulating treatment protocols requires the understanding and application of the evolving research. OBJECTIVE: The primary objective of this study is to present a systematic evidence-based approach to synthesize the necessary data in order to optimize the management of COVID-19. METHODS: At Mayo Clinic Florida, we developed a multidisciplinary centralized COVID Treatment Review Panel (TRP) of expert pulmonologists, intensivists, infectious disease specialists, anesthesiologists, hematologists, rheumatologists, and hospitalists that in real-time reviews the latest evidence in peer-reviewed journals, the available clinical trials, and help guide the rapid application of therapeutics or interventions to the patient and the bedside provider. RESULTS/CONCLUSIONS: The multi-disciplinary team approach of synthesizing clinical data and coordinating care is effective in responding to rapidly evolving and changing evidence. Systematic data collection and evidence-based treatment algorithms enable physicians to rapidly translate the current literature to clinical practice, and improve care and outcomes of patients.
Chandel A, Patolia S, Ahmad K
… +11 more, Aryal S, Brown AW, Sahjwani D, Khangoora V, Shlobin OA, Cameron PC, Singhal A, Holtzclaw AW, Desai M, Nathan SD, King CS
Clin Med Insights Circ Respir Pulm Med
· 2021 · PMID 34602831
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INTRODUCTION: Limited evidence exists regarding use of inhaled nitric oxide (iNO) in spontaneously breathing patients. We evaluated the effectiveness of continuous iNO via high-flow nasal cannula (HFNC) in COVID-19 respi...INTRODUCTION: Limited evidence exists regarding use of inhaled nitric oxide (iNO) in spontaneously breathing patients. We evaluated the effectiveness of continuous iNO via high-flow nasal cannula (HFNC) in COVID-19 respiratory failure. METHODS: We performed a multicenter cohort study of patients with respiratory failure from COVID-19 managed with HFNC. Patients were stratified by administration of iNO via HFNC. Regression analysis was used to compare the need for mechanical ventilation and secondary endpoints including hospital mortality, length of stay, acute kidney injury, need for renal replacement therapy, and need for extracorporeal life support. RESULTS: A total of 272 patients were identified and 66 (24.3%) of these patients received iNO via HFNC for a median of 88 h (interquartile range: 44, 135). After 12 h of iNO, supplemental oxygen requirement was unchanged or increased in 52.7% of patients. Twenty-nine (43.9%) patients treated with iNO compared to 79 (38.3%) patients without iNO therapy required endotracheal intubation ( = .47). After multivariable adjustment, there was no difference in need for mechanical ventilation between groups (odds ratio: 1.53; 95% confidence interval [CI]: 0.74-3.17), however, iNO administration was associated with longer hospital length of stay (incidence rate ratio: 1.41; 95% CI: 1.31-1.51). No difference was found for mortality, acute kidney injury, need for renal replacement therapy, or need for extracorporeal life support. CONCLUSION: In patients with COVID-19 respiratory failure, iNO delivered via HFNC did not reduce oxygen requirements in the majority of patients or improve clinical outcomes. Given the observed association with increased length of stay, judicious selection of those likely to benefit from this therapy is warranted.
Clin Med Insights Circ Respir Pulm Med
· 2021 · PMID 34594145
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Asthma is a chronic inflammatory disease of the respiratory tract that has become a public health problem in various countries. Referring to the Global Initiative for Asthma, the prevalence of asthma continues to increas...Asthma is a chronic inflammatory disease of the respiratory tract that has become a public health problem in various countries. Referring to the Global Initiative for Asthma, the prevalence of asthma continues to increase especially in children. Coronavirus Disease 2019 (COVID-19) is an infectious disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) that has declared a pandemic by the world health organization on March 2020. For many years, it has been known that people with asthma have a worse impact on respiratory viral infections. Asthma has been listed by the centers for disease control and prevention as one of the risk factors for COVID-19, although several studies have different results. SARS-CoV-2 utilizes angiotensin-converting enzyme 2 (ACE2) as its cellular receptor, and it has been known that the expression of the ACE2 receptor is reduced in asthma patients. This reduced expression could also be accounted from the therapy of asthma. This paper aims to discuss the pathophysiology of asthma and COVID-19 and the susceptibility of asthma patients in contracting COVID-19.
Yorke E, Boima V, Dey ID
… +5 more, Amissah-Arthur MB, Ganu V, Amaning-Kwarteng E, Tetteh J, Charles Mate-Kole C
Clin Med Insights Circ Respir Pulm Med
· 2021 · PMID 34566441
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BACKGROUND: Apart from increasing the risk of tuberculosis (TB), diabetes may be associated with more severe disease and lower rates of sputum conversion among TB patients. METHODS: We conducted a baseline cross-sectiona...BACKGROUND: Apart from increasing the risk of tuberculosis (TB), diabetes may be associated with more severe disease and lower rates of sputum conversion among TB patients. METHODS: We conducted a baseline cross-sectional study with a longitudinal follow-up of newly diagnosed smear-positive TB patients for 6 months. Sputum conversion rates between those with dysglycemia and those without were compared at 2 months (end of the intensive phase) and 6 months (end of the treatment). Descriptive statistics and logistic regression were computed to assess factors associated with dysglycemia as well as sputum conversion. RESULTS: A significantly higher proportion of normoglycemic patients had negative sputum compared with those with dysglycemia (83% vs 67%, -value < .05) at 2 months but not at 6 months (87% vs 77%, -value > .05). After controlling for age group and adjusting for other covariates, patients with dysglycemia were 66% less likely to convert sputum than those with normoglycemia. Females were at least 7 times more likely than males and those with high waist-to-hip ratio (WHR) of 88% were less likely compared with those with low WHR for sputum conversion at 2 months, respectively. At 6 months, females (compared with males) and those with high WHR (compared with those with normal WHR) were at over 9 times increased odds and 89% less likely for sputum conversion, respectively. CONCLUSION: A significantly lower proportion of smear-positive TB patients with dysglycemia converted to smear negative after 2 months of treatment but not at the end of the treatment, thus suggesting a transient impact of dysglycemia on sputum conversion.
Clin Med Insights Circ Respir Pulm Med
· 2021 · PMID 34377046
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BACKGROUND: Paraneoplastic hyper-eosinophilia associated with metastatic lung adenocarcinoma is a rare finding and has been associated with a poor prognosis when present. Early hyper-eosinophilia appearing following non-...BACKGROUND: Paraneoplastic hyper-eosinophilia associated with metastatic lung adenocarcinoma is a rare finding and has been associated with a poor prognosis when present. Early hyper-eosinophilia appearing following non-small cell lung cancer (NSCLC) treatment with immune checkpoint inhibitors (ICI) has been previously reported with contradictory outcomes. CASE SUMMARY: We present the case of an elderly man with newly diagnosed metastatic lung adenocarcinoma and baseline hyper-eosinophilia, treated with pembrolizumab, and showing evidence of significant and rapid disease progression suggestive of hyper-progressive disease, worsening baseline hyper-eosinophilia, and a fatal outcome within 1 month of therapy initiation. CONCLUSION: Pre-treatment hyper-eosinophilia could represent a predictive factor of an unfavorable response to ICI treatment in cases of NSCLC. Additional similar cases are needed to draw a more conclusive relationship.
Bajc M, Hedeer F, Lindqvist A
… +1 more, Trägårdh E
Clin Med Insights Circ Respir Pulm Med
· 2021 · PMID 34349582
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V/P SPECT from 4 consecutive patients with COVID-19 suggests that ventilation and perfusion images may be applied to diagnose or exclude pulmonary embolism, verify nonsegmental diversion of perfusion from the ventilated...V/P SPECT from 4 consecutive patients with COVID-19 suggests that ventilation and perfusion images may be applied to diagnose or exclude pulmonary embolism, verify nonsegmental diversion of perfusion from the ventilated areas (dead space ventilation) that may represent inflammation of the pulmonary vasculature, detect the reversed mismatch of poor ventilation and better preserved perfusion (shunt perfusion) in bilateral pulmonary inflammation and indicate redistribution of lung perfusion (antigravitational hyperperfusion) due to cardiac congestion. V/P mismatch and reversed mismatch may be extensive enough to diminish dramatically preserved matching ventilation/perfusion and to induce severe hypoxemia in COVID-19.
Clin Med Insights Circ Respir Pulm Med
· 2021 · PMID 34276233
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OBJECTIVE: The purpose of this review is to highlight the multisystem effects of prone position in ARDS patients with a focus on current findings regarding its use in COVID-19 patients. METHODS: Two reviewers comprehensi...OBJECTIVE: The purpose of this review is to highlight the multisystem effects of prone position in ARDS patients with a focus on current findings regarding its use in COVID-19 patients. METHODS: Two reviewers comprehensively searched PubMed database for literature regarding pathophysiology and efficacy of prone position in ARDS patients as well as specific data regarding this approach in COVID-19 patients. CONCLUSION: Prone positioning is well-documented to improve oxygenation and cardiac function in ARDS patients and might confer increased survival, with benefits that outweigh risks such as facial edema, endotracheal tube displacement, and intraabdominal organ dysfunction in obese patients. Severe COVID-19 pneumonia, while meeting ARDS criteria, differs from typical ARDS in several ways. Data would suggest that advantages of prone position would become limited after significant disease progression and fibrosis. The use of this technique in COVID-19 requires prolonged sessions that are unprecedented in the treatment of ARDS patients. New data regarding COVID-19 pathophysiology and patients continues to evolve daily. More frequently, patients are proned while maintaining spontaneous breathing-the results of this intervention are an area for future studies. There is more to learn about the appropriate use of prone position in COVID-19 patients. The multisystem risks and benefits require clinicians to adopt a patient centered decision-making algorithm when employing this technique in COVID-19 patients. LEVEL OF EVIDENCE: NA.
Rahaghi F, Belperio JA, Fitzgerald J
… +10 more, Gulati M, Hallowell R, Highland KB, Huie TJ, Kim HJ, Kolb M, Lasky JA, Southern BD, Swigris JJ, de Andrade JA
Clin Med Insights Circ Respir Pulm Med
· 2021 · PMID 33854398
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PURPOSE: Nintedanib is an approved treatment for idiopathic pulmonary fibrosis (IPF), which slows disease progression. Management of patients with IPF receiving nintedanib can be complicated by tolerability issues, comor...PURPOSE: Nintedanib is an approved treatment for idiopathic pulmonary fibrosis (IPF), which slows disease progression. Management of patients with IPF receiving nintedanib can be complicated by tolerability issues, comorbidities, and concomitant medications. We developed consensus recommendations on the management of dosing, adverse events and comorbidities in patients with IPF treated with nintedanib. METHODS: A modified Delphi process using 3 questionnaires was used to survey 14 pulmonologists experienced in using nintedanib. Panelists rated their agreement with statements on a Likert scale from -5 (strongly disagree) to +5 (strongly agree). Consensus was predefined as a mean score of ⩽-2.5 or ⩾+2.5 with a standard deviation not crossing zero. RESULTS: The panelists' recommendations were largely aligned with clinical trial data, real-world evidence, and the prescribing information, and provided additional guidance regarding minimizing gastrointestinal effects, periodic monitoring for liver dysfunction, caution with respect to concomitant administration of cytochrome P450 3A4 and P-glycoprotein 1 inhibitors and inducers and anticoagulants, and management of comorbidities. The panelists unanimously agreed that adverse event management should be individualized, based on careful consideration of the risks and benefits of each possible intervention and discussion with the patient. CONCLUSIONS: These consensus recommendations provide additional guidance on the appropriate management of IPF with nintedanib, for use alongside evidence-based literature and the prescribing information.
Sriboonreung T, Leelarungrayub J, Yankai A
… +1 more, Puntumetakul R
Clin Med Insights Circ Respir Pulm Med
· 2021 · PMID 33814938
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OBJECTIVE: To identify the correlations and possible predicted equations of maximal inspiratory (MIP) and expiratory mouth pressure (MEP) values from pulmonary function test (PFT), demographics, and anthropometrics. METH...OBJECTIVE: To identify the correlations and possible predicted equations of maximal inspiratory (MIP) and expiratory mouth pressure (MEP) values from pulmonary function test (PFT), demographics, and anthropometrics. METHODS: This study involved 217 healthy participants (91 males and 126 females) aged 19 to 50 years. The PFT (forced vital capacity; FVC, forced expiratory volume in 1 second; FEV1, maximal mid-expiratory flow; MMEF, and peak expiratory flow; PEF) was performed by spirometry, whereas MIP and MEP were evaluated by a respiratory pressure meter. Pearson correlation and multiple linear regression, with the stepwise method, were used for statistical analysis. RESULTS: The MIP and MEP had a significant positive correlation with weight, height, body mass index (BMI), and waist circumference. MIP had a significant positive correlation with FVC (%) and PEF (L/s and %), as well as a negative correlation with FEV1/FVC (ratio and %) and MMEF (%). Whereas, MEP showed a significant positive correlation with PEF (L/s and %) and negative correlation with FEV1/FVC (ratio and %) and MMEF (L/s). Finally, the predicted MIP and MEP equations were 103.988-97.70 × FEV1/FVC + 31.292 × Sex (male = 1 and female = 0) + 0.662 × PEF (%) and 47.384 + 3.603 × PEF (L/s)-9.514 × MMEF(L/s) + 30.458 × Sex (male = 1 and female = 0) + 0.534 × PEF (%), respectively. CONCLUSION: The respiratory muscle strengths can be predicted from the pulmonary function test, and gender data.
Spinella A, Magnani L, De Pinto M
… +6 more, Marvisi C, Parenti L, Bajocchi G, Salvarani C, Mascia MT, Giuggioli D
Clin Med Insights Circ Respir Pulm Med
· 2021 · PMID 33795941
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OBJECTIVE: COVID-19 pandemic represents a serious health emergency that severely compromised our Public Health system, resulting in a rapid and forced reorganization and involved the management of chronic diseases too. T...OBJECTIVE: COVID-19 pandemic represents a serious health emergency that severely compromised our Public Health system, resulting in a rapid and forced reorganization and involved the management of chronic diseases too. The Scleroderma Unit of Modena and Reggio Emilia follows more than 600 patients suffering from systemic sclerosis (SSc) and recently became the referral center (HUB) in Emilia-Romagna for this rare connective tissue disease. The aim of the present study was to evaluate the extent by which the lockdown and the pandemic has impacted the activity of admissions to Scleroderma Unit of Modena and Reggio Emilia. METHODS: Our daily clinical activity is characterized by outpatient visits, videocapillaroscopy exam, ulcers treatment, therapeutic infusions in day hospital regimen, multidisciplinary visits following our dedicated SSc care pathway, and clinical trials. Our activity has been quickly rescheduled to ensure the proper assistance to our SSc patients during the COVID-19 pressure. RESULTS: The use of telemedicine has certainly assured a robust continuity of health care. Furthermore, telephone pre-triage, nurse/medical triage, proper physical distancing and use of PPE/DPI allowed us to re-organize and continue SSc daily activity. Specifically, therapeutic infusions in day hospital regimen and outpatient visits, including ulcers treatment, was guaranteed and maximized. CONCLUSION: The management of scleroderma patients by an expert specialist reference center is crucial in order to ensure continuity of care and pursue the best SSc practice.
Taha M, Nguyen P, Sharma A
… +2 more, Taha M, Samavati L
Clin Med Insights Circ Respir Pulm Med
· 2021 · PMID 33623466
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BACKGROUND: Hypercoagulation is one of the striking features of COVID-19. Patients hospitalized with COVID-19 are at high risk for venous thromboembolism. However, it is unknown if the risk for venous thromboembolism per...BACKGROUND: Hypercoagulation is one of the striking features of COVID-19. Patients hospitalized with COVID-19 are at high risk for venous thromboembolism. However, it is unknown if the risk for venous thromboembolism persists after discharge. CASE SUMMARY: We report a case with pulmonary embolism 5 months after COVID-19. No risk factors for venous thrombosis have been identified. CONCLUSION: In COVID-19 related hospitalization, large studies are needed to identify the risk of venous thromboembolism after discharge.
Clin Med Insights Circ Respir Pulm Med
· 2021 · PMID 33597813
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OBJECTIVE: This systematic-review and meta-analysis aimed to assess the prevalence of cardiovascular comorbidities and complications in ICU-admitted coronavirus disease 2019 (COVID-19) patients. DATA SOURCES: PubMed and...OBJECTIVE: This systematic-review and meta-analysis aimed to assess the prevalence of cardiovascular comorbidities and complications in ICU-admitted coronavirus disease 2019 (COVID-19) patients. DATA SOURCES: PubMed and Web of Science databases were referenced until November 25, 2020. DATA EXTRACTION: We extracted retrospective and prospective observational studies on critically ill COVID-19 patients admitted to an intensive care unit. Only studies reporting on cardiovascular comorbidities and complications during ICU therapy were included. DATA SYNTHESIS: We calculated the pooled prevalence by a random-effects model and determined heterogeneity by Higgins' test. RESULTS: Of the 6346 studies retrieved, 29 were included in this review. The most common cardiovascular comorbidity was arterial hypertension (50%; 95% confidence interval [CI], 0.42-058; = 94.8%, low quality of evidence). Among cardiovascular complications in the ICU, shock (of any course) was most common, being present in 39% of the patients (95% CI, 0.20-0.59; = 95.6%; 6 studies). Seventy-four percent of patients in the ICU required vasopressors to maintain target blood pressure (95% CI, 0.58-0.88; = 93.6%; 8 studies), and 30% of patients developed cardiac injury in the ICU (95% CI, 0.19-0.42; = 91%; 14 studies). Severe heterogeneity existed among the studies. CONCLUSIONS: Cardiovascular complications are common in patients admitted to the intensive care unit for COVID-19. However, the existing evidence is highly heterogeneous in terms of study design and outcome measurements. Thus, prospective, observational studies are needed to determine the impact of cardiovascular complications on patient outcome in critically ill COVID-19 patients.
Clin Med Insights Circ Respir Pulm Med
· 2020 · PMID 33424231
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In the last years, the presence of multidrug-resistant (MDR) Gram-negative (like ) and Gram-positive bacteria (mostly methicillin-resistant ) was worldwide reported, limiting the options for an effective antibiotic thera...In the last years, the presence of multidrug-resistant (MDR) Gram-negative (like ) and Gram-positive bacteria (mostly methicillin-resistant ) was worldwide reported, limiting the options for an effective antibiotic therapy. For these reasons, inappropriate antimicrobial therapy and delayed prescription can lead to an unfavorable outcome, especially in patients with pneumonia. New antibiotics approved belong to classes of antimicrobials, like beta-lactams with or without beta-lactamase inhibitors, aminoglycosides, oxazolidinones, quinolones, and tetracyclines, or based on new mechanisms of action. These new compounds show many advantages, including a broad spectrum of activity against MDR pathogens, good lung penetration, safety and tolerability, and finally the possibility of intravenous and/or oral formulations. However, the new antibiotics under development represent an important possible armamentarium against difficult-to-treat strains. The safety and clinical efficacy of these future drugs should be tested in clinical practice. In this review, there are reported characteristics of newly approved antibiotics that represent potential future options for the treatment of respiratory tract infections, including those caused by multidrug-resistant bacteria. Finally, the characteristics of the drugs under development are briefly reported.
Saggi SJ, Nath S, Culas R
… +15 more, Chittalae S, Burza A, Srinivasan M, Abdul R, Silver B, Lora A, Ibtida I, Chokshi T, Capric V, Mohamed A, Worah S, OuYang J, Geraghty P, Gruessner A, Salifu MO
Clin Med Insights Circ Respir Pulm Med
· 2020 · PMID 33402859
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BACKGROUND: Coronavirus disease-19 (COVID-19) is associated with acute kidney injury (AKI) and acute respiratory distress syndrome (ARDS) with high mortality rates. In African American (AA) populations, COVID-19 presenta...BACKGROUND: Coronavirus disease-19 (COVID-19) is associated with acute kidney injury (AKI) and acute respiratory distress syndrome (ARDS) with high mortality rates. In African American (AA) populations, COVID-19 presentations and outcomes are more severe. NIH and Interim WHO guidelines had suggested against the use of corticosteroids unless in clinical trials until the recent publication of the RECOVERY trial. Here, we analyzed the treatment effect of methylprednisolone on patients with AKI and ARDS during the initial 2 months of COVID-19 and detail the learning effect within our institution. METHODS: Between March 1 and April 30, 2020, 75 AA patients met our inclusion criteria for ARDS and AKI, of which 37 had received corticosteroids. Twenty-eight-day mortality, improvement in PaO/FiO ratio, and renal function were analyzed. The impact of methylprednisolone treatment was assessed with multivariable methods. RESULTS: Survival in the methylprednisolone group reached 51% at 21 days compared to 29% in the non-corticosteroid group ( < .001). Methylprednisolone improved the likelihood of renal function improvement. PaO/FiO ratio in the methylprednisolone group improved by 73% compared to 45% in the non-corticosteroid group ( = .01). Age, gender, BMI, preexisting conditions, and other treatment factors did not show any impact on renal or PaO/FiO ratio improvement. The use of anticoagulants, the month of treatment, and AKI during hospitalization also influenced outcomes. CONCLUSION: In AA COVID-19 positive patients with ARDS and AKI, IV methylprednisolone lowered the incidence of mortality and improved the likelihood of renal and lung function recovery. Further investigation with a randomized control trial of corticosteroids is warranted.
Berghaus TM, Geissenberger F, Konnerth D
… +3 more, Probst M, Kröncke T, Schwarz F
Clin Med Insights Circ Respir Pulm Med
· 2020 · PMID 33354113
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PURPOSE: Right ventricular (RV) dysfunction in acute pulmonary embolism (PE) is a critical determinant of outcome. Obstructive sleep apnea (OSA) is a common comorbidity of PE and might also affect RV function. Therefore,...PURPOSE: Right ventricular (RV) dysfunction in acute pulmonary embolism (PE) is a critical determinant of outcome. Obstructive sleep apnea (OSA) is a common comorbidity of PE and might also affect RV function. Therefore, we sought to investigate RV dysfunction in PE patients in proportion to the severity of OSA by evaluating the right-to-left ventricular (RV/LV) diameter ratio on computed tomographic pulmonary angiography (CTPA). MATERIALS AND METHODS: 197 PE patients were evaluated for sleep-disordered breathing by portable monitoring and nocturnal polysomnography. RV dilatation was defined as an RV/LV diameter ratio of ⩾ 1.0. RESULTS: RV dilatation was significantly more frequent in OSA patients compared to study participants without OSA (66.4% vs 49.1%, = .036). Elevated troponin I values, indicating myocardial injury due to acute, PE-related RV strain, were significantly more frequent in OSA patients with an apnea-hypopnea index (AHI) ⩾ 15/h compared to those with an AHI < 15/h (62.1% vs 45.8%, = .035). However, RV dysfunction documented by the RV/LV diameter ratio on CTPA was not significantly associated with the severity of OSA in multivariable regression analysis. CONCLUSION: Patients with moderate or severe OSA might compensate acute, PE-related RV strain better, as they are adapted to repetitive right heart pressure overloads during sleep.
Okasha Hamoda H, Abdel Hafez SAM, Abouelkhier Abdalla D
… +3 more, Shebl AAM, Elnahas M, Rezk NA
Clin Med Insights Circ Respir Pulm Med
· 2020 · PMID 33192116
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BACKGROUND: Thoracoscopy allows visualization of the pleural cavity including diaphragm, visceral pleura, and lungs. It provides the physician with information about the disease extent and it has the ability to get a bio...BACKGROUND: Thoracoscopy allows visualization of the pleural cavity including diaphragm, visceral pleura, and lungs. It provides the physician with information about the disease extent and it has the ability to get a biopsy from these lesions to differentiate between tumors and fibrotic reactions. This study aims to compare minithoracoscopy and medical thoracoscope in patients with exudative pleural effusion as regards the diagnostic yield, safety, complications, and duration of hospital stay. PATIENTS AND METHODS: Sixty patients were diagnosed with exudative pleural effusion and were randomly divided into 2 equal groups: Group (1): included 30 patients who underwent minithoracoscopy and Group (2): included the remaining 30 cases who underwent the standard thoracoscope. RESULTS: Pathological examination of the sample revealed that biopsy size was 2.02 and 1.25 in group 1 and group 2 was respectively with highly statistically significant between both groups ( < .001). Group 1 revealed TB, malignant, chronic nonspecific pleurisy, Staph aureus, Klebsiella, and Pseudomonas in 30% (9), 30% (9), 33.3% (10), 69% (9), 15% (2), and 15% (2) of cases respectively. While group 2 reveled TB, malignancy, chronic nonspecific pleurisy, Staph aureus, Klebsiella, Pseudomonas, and other causes in 40% (12), 23.3% (7), 23.3% (7), 67% (8), 8% (1), 8% (1), and 16% (2) respectively with no statistically significant differences between both groups ( > .05). CONCLUSION: Minithoracoscopy is well tolerated by patients as minimal pain and early hospital discharge could be achieved by that approach.