scholarly journals Complicated Rheumatoid Nodules in Lung

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Geetha Wickrematilake
Keyword(s):  
Lung Biopsy ◽  
Antibody Test ◽  
Lung Nodules ◽  
Shortness Of Breath ◽  
Imaging Studies ◽  
Rheumatoid Nodules ◽  
Positive Antibody ◽  
Tomography Scan ◽  
Rheumatoid Lung

A 65-year-old nonsmoker lady carrying a diagnosis of seropositive erosive rheumatoid arthritis for nine years presented with acute shortness of breath, following a spontaneous pneumothorax while on combination therapy with methotrexate, leflunomide, and tocilizumab. Imaging studies revealed multiple cavitory lung nodules, and a transbronchial lung biopsy favoured a diagnosis of rheumatoid lung nodules. Her initial pathological samples were negative for any infectious cause. A follow-up computerized tomography scan (CT scan) confirmed enlargement of lung nodules with a positive antibody test for aspergillosis which needed antifungal therapy, and currently, her arthritis is managed well with rituximab therapy, sulfasalazine, and hydroxychloroquine.

scholarly journals SARS-CoV-2 reinfection in a cohort of 43,000 antibody-positive individuals followed for up to 35 weeks

2021 ◽  
Author(s):  
Laith J. Abu-Raddad ◽  
Hiam Chemaitelly ◽  
Peter Coyle ◽  
Joel A. Malek ◽  
Ayeda A. Ahmed ◽  
...  
Keyword(s):  
Incidence Rate ◽  
Genome Sequencing ◽  
Viral Genome ◽  
Natural Infection ◽  
Antibody Test ◽  
Contact Tracing ◽  
Epidemiological Evidence ◽  
Routine Testing ◽  
Positive Antibody

ABSTRACTBackgroundReinfection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been documented, raising public health concerns. Risk and incidence rate of SARS-CoV-2 reinfection were assessed in a large cohort of antibody-positive persons in Qatar.MethodsAll SARS-CoV-2 antibody-positive persons with a PCR-positive swab ≥14 days after the first-positive antibody test were individually investigated for evidence of reinfection. Viral genome sequencing was conducted for paired viral specimens to confirm reinfection. Incidence of reinfection was compared to incidence of infection in the complement cohort of those antibody-negative.ResultsAmong 43,044 anti-SARS-CoV-2 positive persons who were followed for a median of 16.3 weeks (range: 0-34.6), 314 individuals (0.7%) had at least one PCR positive swab ≥14 days after the first-positive antibody test. Of these individuals, 129 (41.1%) had supporting epidemiological evidence for reinfection. Reinfection was next investigated using viral genome sequencing. Applying the viral-genome-sequencing confirmation rate, the risk of reinfection was estimated at 0.10% (95% CI: 0.08-0.11%). The incidence rate of reinfection was estimated at 0.66 per 10,000 person-weeks (95% CI: 0.56-0.78). Incidence rate of reinfection versus month of follow-up did not show any evidence of waning of immunity for over seven months of follow-up. Meanwhile, in the complement cohort of 149,923 antibody-negative persons followed for a median of 17.0 weeks (range: 0-45.6), risk of infection was estimated at 2.15% (95% CI: 2.08-2.22%) and incidence rate of infection was estimated at 13.69 per 10,000 person-weeks (95% CI: 13.22-14.14). Efficacy of natural infection against reinfection was estimated at 95.2% (95% CI: 94.1-96.0%). Reinfections were less severe than primary infections. Only one reinfection was severe, two were moderate, and none were critical or fatal. Most reinfections (66.7%) were diagnosed incidentally through random or routine testing, or through contact tracing.ConclusionsReinfection is rare. Natural infection appears to elicit strong protection against reinfection with an efficacy ∼95% for at least seven months.

scholarly journals Real-world data suggest antibody positivity to SARS-CoV-2 is associated with a decreased risk of future infection

2020 ◽  
Author(s):  
Raymond A. Harvey ◽  
Jeremy A. Rassen ◽  
Carly A. Kabelac ◽  
Wendy Turenne ◽  
Sandy Leonard ◽  
...  
Keyword(s):  
Real World ◽  
Antibody Test ◽  
The United States ◽  
Test Results ◽  
Real World Data ◽  
World Data ◽  
Positive Antibody ◽  
Laboratory Test Results ◽  
Over Time

AbstractImportanceThere is limited evidence regarding whether the presence of serum antibodies to SARS-CoV-2 is associated with a decreased risk of future infection. Understanding susceptibility to infection and the role of immune memory is important for identifying at-risk populations and could have implications for vaccine deployment.ObjectiveThe purpose of this study was to evaluate subsequent evidence of SARS-CoV-2 infection based on diagnostic nucleic acid amplification test (NAAT) among individuals who are antibody-positive compared with those who are antibody-negative, using real-world data.DesignThis was an observational descriptive cohort study.ParticipantsThe study utilized a national sample to create cohorts from a de-identified dataset composed of commercial laboratory test results, open and closed medical and pharmacy claims, electronic health records, hospital billing (chargemaster) data, and payer enrollment files from the United States. Patients were indexed as antibody-positive or antibody-negative according to their first SARS-CoV-2 antibody test recorded in the database. Patients with more than 1 antibody test on the index date where results were discordant were excluded.Main Outcomes/MeasuresPrimary endpoints were index antibody test results and post-index diagnostic NAAT results, with infection defined as a positive diagnostic test post-index, as measured in 30-day intervals (0-30, 31-60, 61-90, >90 days). Additional measures included demographic, geographic, and clinical characteristics at the time of the index antibody test, such as recorded signs and symptoms or prior evidence of COVID-19 (diagnoses or NAAT+) and recorded comorbidities.ResultsWe included 3,257,478 unique patients with an index antibody test. Of these, 2,876,773 (88.3%) had a negative index antibody result, 378,606 (11.6%) had a positive index antibody result, and 2,099 (0.1%) had an inconclusive index antibody result. Patients with a negative antibody test were somewhat older at index than those with a positive result (mean of 48 versus 44 years). A fraction (18.4%) of individuals who were initially seropositive converted to seronegative over the follow up period. During the follow-up periods, the ratio (CI) of positive NAAT results among individuals who had a positive antibody test at index versus those with a negative antibody test at index was 2.85 (2.73 - 2.97) at 0-30 days, 0.67 (0.6 - 0.74) at 31-60 days, 0.29 (0.24 - 0.35) at 61-90 days), and 0.10 (0.05 - 0.19) at >90 days.ConclusionsPatients who display positive antibody tests are initially more likely to have a positive NAAT, consistent with prolonged RNA shedding, but over time become markedly less likely to have a positive NAAT. This result suggests seropositivity using commercially available assays is associated with protection from infection. The duration of protection is unknown and may wane over time; this parameter will need to be addressed in a study with extended duration of follow up.Key PointsQuestionCan real-world data be used to evaluate the comparative risk of SARS-CoV-2 infection for individuals who are antibody-positive versus antibody-negative?FindingOf patients indexed on a positive antibody test, 10 of 3,226 with a NAAT (0.3%) had evidence of a positive NAAT > 90 days after index, compared with 491 of 16,157 (3.0%) indexed on a negative antibody test.MeaningIndividuals who are seropositive for SARS-CoV-2 based on commercial assays may be at decreased future risk of SARS-CoV-2 infection.

Respiratory Complications in Outpatient Endoscopy with Endoscopist-Directed Sedation

2014 ◽  
Vol 23 (3) ◽  
pp. 255-259 ◽  
Author(s):  
Kilian Friedrich ◽  
Sabine G. Scholl ◽  
Sebastian Beck ◽  
Daniel Gotthardt ◽  
Wolfgang Stremmel ◽  
...  
Keyword(s):  
Antibiotic Treatment ◽  
Respiratory Infection ◽  
Endoscopic Procedure ◽  
Shortness Of Breath ◽  
Respiratory Complications ◽  
Endoscopic Procedures ◽  
Increased Risk ◽  
High Incidence ◽  
Respiratory Complaints

Background & Aims: Respiratory complications represent an important adverse event of endoscopic procedures. We screened for respiratory complications after endoscopic procedures using a questionnaire and followed-up patients suggestive of respiratory infection.Method: In this prospective observational, multicenter study performed in Outpatient practices of gastroenterology we investigated 15,690 patients by questionnaires administered 24 hours after the endoscopic procedure.Results: 832 of the 15,690 patients stated at least one respiratory symptom after the endoscopic procedure: 829 patients reported coughing (5.28%), 23 fever (0.15%) and 116 shortness of breath (SOB, 0.74%); 130 of the 832 patients showed at least two concomitant respiratory symptoms (107 coughing + SOB, 17 coughing + fever, 6 coughing + coexisting fever + SOB) and 126 patients were followed-up to assess their respiratory complaints. Twenty-nine patients (follow-up: 22.31%, whole sample: 0.18%) reported signs of clinically evident respiratory infection and 15 patients (follow-up: 11.54%; whole sample: 0.1%) received therefore antibiotic treatment. Coughing or vomiting during the endoscopic procedure resulted in a 156.12-fold increased risk of respiratory complications (95% CI: 67.44 - 361.40) and 520.87-fold increased risk of requiring antibiotic treatment (95% CI: 178.01 - 1524.05). All patients of the follow-up sample who coughed or vomited during endoscopy developed clinically evident signs of respiratory infection and required antibiotic treatment while this occurred in a significantly lower proportion of patients without these symptoms (17.1% and 5.1%, respectively).Conclusions: We demonstrated that respiratory complications following endoscopic sedation are of comparably high incidence and we identified major predictors of aspiration pneumonia which could influence future surveillance strategies after endoscopic procedures.

scholarly journals Isolated Tuberculous Tenosynovitis of the Anterior Tibial and Extensor Digitorum Longus Tendons

2013 ◽  
Vol 3 ◽  
pp. 37 ◽  
Author(s):  
Berhan Genç ◽  
Aynur Solak ◽  
Aslan Mayda ◽  
Nazime Şen
Keyword(s):  
Clinical Symptoms ◽  
Granulomatous Inflammation ◽  
Tendon Sheath ◽  
Imaging Studies ◽  
Rare Form ◽  
Common Diagnosis ◽  
Anterior Tibial ◽  
Histopathological Studies ◽  
Tuberculous Tenosynovitis

Musculoskeletal system is involved in 1-5% of extrapulmonary cases of tuberculosis. Tuberculous tenosynovitis is a rare form of musculoskeletal tuberculosis. Tuberculosis of the tendon sheath in the hand has been seen in a few cases. Involvement of the tendons of the leg is less common. Diagnosis is not easy as there are no specific clinical symptoms or signs. A 33-year-old male presented with painful swelling in the distal right lower limb that caused restriction of movement. Imaging studies showed inflammation and infection of the extensor digitorium longus and tibialis anterior tendons. Histopathological studies showed a necrotizing granulomatous inflammation in the synovial tissue. A diagnosis of tuberculosis was made and medical treatment was initiated that proved successful. Patient remained infection-free at 26-month follow-up examination.

scholarly journals Penile Mondor’s in a Covid-19 patient on prophylactic anti-thrombosis with rivaroxaban: a case report

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Murat Tuğrul Eren ◽  
Hakan Özveri ◽  
Hilal Kurtoğlu
Keyword(s):  
Male Patient ◽  
Antibody Test ◽  
Inflammatory Cells ◽  
Thromboembolism Prophylaxis ◽  
Case Presentation ◽  
Subacute Phase ◽  
Dorsal Vein ◽  
Wide Range ◽  
Underlying Causes

Abstract Background Penile Mondor’s disease (PMD) is thrombophlebitis of the superficial dorsal vein of the penis. Following the occurrence of thrombotic events in the affected veins, the lumen often becomes occluded with fibrin and inflammatory cells. A hyper-coagulative state is one of the underlying causes although most cases of PMD are idiopathic. Coronavirus disease-2019 infection (COVID-19) is associated with frequent thrombotic events. Inflammation and thrombosis play a central role in the course and outcome of COVID-19, which can predispose to both venous and arterial thromboembolism. In this report, we present a 33-year-old male patient diagnosed with PMD during the subacute phase of COVID-19 infection while on prophylactic antithrombotic treatment. Case Presentation A 33-year-old male patient was diagnosed as PMD which occurred during the subacute phase of COVID-19 infection, while he was on active treatment of COVID-19 by prophylactic antithrombotic Rivaroxaban 15 mg therapy and curative antiviral medication. There was no recent sexual intercourse or trauma to the genitals. His PCR test for COVID-19 had become negative, and antibody test was positive at the time of his PMD’s onset. Rivaroxaban was replaced by Enoxaparin (8000 IU/0.8 ml.), a low molecular weight heparin administered subcutaneously and twice daily. On the third day of this medication, all coagulative measurements returned to normal. PMD disappeared in the second week. Conclusion Low-dose Rivaroxaban 15 mg is not safe for some COVID-19-associated thromboembolism prophylaxis, and careful follow-up is critical due to the possibility of a wide range of pathologic thrombotic manifestations in COVID-19 infection.

A case of nodular episcleritis mimicking a solitary giant episcleral mass

2021 ◽  
pp. 112067212110528
Author(s):  
Lan Zhou ◽  
Juanjuan Wang ◽  
Guihua Xu ◽  
Dingding Wang ◽  
Xiaoyi Wang ◽  
...  
Keyword(s):  
Topical Steroid ◽  
Inflammatory Cells ◽  
Systemic Hypertension ◽  
Eye Drops ◽  
Definite Diagnosis ◽  
Imaging Studies ◽  
Immunohistochemical Examination ◽  
History Of ◽  
Inflammatory Drugs

Purpose To describe an atypical nodular episcleritis mimicking a solitary giant episcleral mass, which is not attributed to any systemic diseases and identified only after immunohistochemical examination. Case report A sixty-year-old Chinese woman with systemic hypertension presented with 6-month history of giant, solitary and redness epibulbar mass arising from the superior aspect of her left eye. The lesion gradually enlarged, even with 6-month history of irregular topical steroid eye drops treatment. Imaging studies and laboratory test revealed a 10 mm × 8 mm episcleral mass absence of any infection indicator and autoimmune antibody changes. The mass was completely removed before its extension through the deep scleral, histopathologic examination revealed a nodular episcleritis composed of various chronic inflammatory cells infiltration. Topical steroid eye drops treatment combined with oral steroidal anti-inflammatory drugs was then administrated regularly for 1 month, and no recurrence occurred after 1-year follow-up. Conclusion Nodular anterior episcleritis is characterized by underlying chronic inflammation of the anterior episclera and can be presented as asymptomatic episcleral mass. Besides a thorough investigation systemically, tissue biopsy is required for definite diagnosis.

scholarly journals Significance of lung biopsy for the definitive diagnosis of lung nodules in breast cancer patients

2017 ◽  
Author(s):  
Kazuo Matsuura ◽  
Toshiyuki Itamoto ◽  
Midori Noma ◽  
Masahiro Ohara ◽  
Etsushi Akimoto ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Lung Biopsy ◽  
Definitive Diagnosis ◽  
Lung Nodules ◽  
Breast Cancer Patients

scholarly journals Simultaneous Percutaneous Alcohol Ablation of Pulmonary and Hepatic Hydatid Cysts: “PAIR” in a Pair

2017 ◽  
Vol 01 (02) ◽  
pp. 124-129
Author(s):  
Udit Chauhan ◽  
Sunil Puri ◽  
Neeraj Jain ◽  
Sudheer Pargewar ◽  
Vandana Goel
Keyword(s):  
Cystic Lesion ◽  
Lung Parenchyma ◽  
Liver Lesion ◽  
Hydatid Cysts ◽  
Positive Serology ◽  
Left Chest ◽  
Alcohol Ablation ◽  
Tomography Scan ◽  
Hepatic Hydatid

AbstractWe present a 48-year-old lady with left chest pain and dyspnea of 6 months duration. Computed tomography scan revealed a left-sided cystic lesion in the lung parenchyma abutting the posterior pleura and chest wall along with a similar cystic lesion in the segment IV of the liver. A diagnosis of lung and liver hydatid cysts was made based on the imaging and positive serology. Percutaneous alcohol ablation of the lung and hepatic hydatid cysts was done using catheter drainage (PAIR-D: percutaneous aspiration, instillation of scolicidal agents, reaspiration of contents, and drainage) in the lung cyst and needle-PAIR in the liver lesion. The procedure was well tolerated without any intra- as well as postprocedure complication. The patient is well during 24 months follow-up without any recurrence or morbidity.

scholarly journals Chronic asymptomatic hyperamylasemia unrelated to pancreatic disease

2013 ◽  
pp. 20-24
Author(s):  
Generoso Uomo ◽  
Simona Miraglia ◽  
Pier Giorgio Rabitti
Keyword(s):  
Clinical Practice ◽  
Pancreatic Disease ◽  
Diagnostic Workup ◽  
Pancreatic Diseases ◽  
The Poor ◽  
Previous Diagnosis ◽  
Almost All ◽  
Asymptomatic Subjects ◽  
Tomography Scan

BACKGROUND Almost all patients presenting with chronic hyperamylasemia undergo an expensive, long, difficult and often repeated diagnostic workup even if this occurrence is not associated with symptoms or with known pancreatotoxic factors. This is in relationship with the poor knowledge that, beside hyperenzymemia secondary to pancreatic diseases and systemic illnesses, various non-pathological forms of chronic hyperamylasemia can occur in clinical practice. AIM OF THE STUDY This study was addressed to assess the clinical characteristics of patients presenting with chronic hyperamylasemia unrelated to pancreatic diseases (CHUPD). PATIENTS AND METHODS Data of all patients with CHUPD were retrospectively reviewed (June 1997-March 2007). Forty patients were included in the study; median follow- up was 33 months (range 3-84 months). CHUPD was secondary to: a) chronic benign pancreatic hyperamylasemia, 16 patients (40%); b) macroamylasemia, 15 patients (37.5%); c) salivary hyperamylasemia, 9 patients (22.5%). Gilbert’s syndrome was present in 13 patients (32.5%; 8 with macroamylasemia) and hyperdyslipidemia in 8 patients (20%; 5 with chronic benign pancreatic hyperamylasemia). Diagnostic exams (all in the normal range) performed before our observation were: Ca19-9 serum level in 37/40 (92.5%), ultrasonography and computed tomography-scan in all patients, endoscopic retrograde cholangiopancreatography in 21/40 (52.5%), abdominal magnetic resonance in 14/40 (35%). Previous diagnosis in these asymptomatic subjects were: chronic pancreatitis in 26 cases (65%); recurrent pancreatitis in 10 cases (25%); the remaining 4 patients (10%) were addressed without a specific diagnosis. CONCLUSIONS In clinical practice, the occurrence of an unexplained chronic hyperamylasemia very often allows to an unappropriate diagnostic workup due to the poor familiarity with CHUPD conditions.

scholarly journals Kleine-Levin syndrome is associated with birth difficulties and genetic variants in the TRANK1 gene loci

2021 ◽  
Vol 118 (12) ◽  
pp. e2005753118
Author(s):  
Aditya Ambati ◽  
Ryan Hillary ◽  
Smaranda Leu-Semenescu ◽  
Hanna M. Ollila ◽  
Ling Lin ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Genome Wide Association Study ◽  
Perinatal Outcomes ◽  
Case Control ◽  
Risk Scores ◽  
Circadian Regulation ◽  
Genetic Associations ◽  
Imaging Studies ◽  
Genome Wide

Kleine-Levin syndrome (KLS) is a rare disorder characterized by severe episodic hypersomnia, with cognitive impairment accompanied by apathy or disinhibition. Pathophysiology is unknown, although imaging studies indicate decreased activity in hypothalamic/thalamic areas during episodes. Familial occurrence is increased, and risk is associated with reports of a difficult birth. We conducted a worldwide case−control genome-wide association study in 673 KLS cases collected over 14 y, and ethnically matched 15,341 control individuals. We found a strong genome-wide significant association (rs71947865, Odds Ratio [OR] = 1.48, P = 8.6 × 10−9) within the 3′region of TRANK1 gene locus, previously associated with bipolar disorder and schizophrenia. Strikingly, KLS cases with rs71947865 variant had significantly increased reports of a difficult birth. As perinatal outcomes have dramatically improved over the last 40 y, we further stratified our sample by birth years and found that recent cases had a significantly reduced rs71947865 association. While the rs71947865 association did not replicate in the entire follow-up sample of 171 KLS cases, rs71947865 was significantly associated with KLS in the subset follow-up sample of 59 KLS cases who reported birth difficulties (OR = 1.54, P = 0.01). Genetic liability of KLS as explained by polygenic risk scores was increased (pseudo R2 = 0.15; P < 2.0 × 10−22 at P = 0.5 threshold) in the follow-up sample. Pathway analysis of genetic associations identified enrichment of circadian regulation pathway genes in KLS cases. Our results suggest links between KLS, circadian regulation, and bipolar disorder, and indicate that the TRANK1 polymorphisms in conjunction with reported birth difficulties may predispose to KLS.

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