Pneumomediastinum in COVID-19 disease: Outcomes and relation to the Macklin effect

Aim Pneumomediastinum (PM) is associated with several etiologies and mechanisms. Although it has been described more than 100 years ago, the literature is limited to small retrospective studies. This study aimed to follow patients with coronavirus disease (COVID-19) that developed PM during hospitalization and describe their clinical and radiological evolution. Methods A prospective cohort was developed with patients with PM, excluding those with aerodigestive trauma, inside a hospital COVID-19 dedicated hospital. Clinical variables including onset of symptoms, hemodynamic instability, associated complications, the need of interventions, and disease course were all recorded. Also, radiological findings such as the presence of the Macklin effect, extension of lung involvement by COVID-19, and characteristics of the PM were analyzed. Results Twenty-one patients with non-traumatic PM were followed, resulting in an overall incidence of 0.5% during the study period. Seven (33%) patients had associated pneumothorax and malignant/tension PM was observed in three (14%) cases. The Macklin effect could be found in 11 patients (52%) and the majority of them had more than 50% of lung involvement due to COVID-19. The mortality rate was 49%; however, no deaths were directly related to the PM. Conclusions PM incidence is probably increased in the severe acute respiratory syndrome caused by COVID-19, especially in those with greater involvement of the lungs, and the Macklin effect may be an important underlying mechanism of this complication. Usually, PM has a benign course, but complications like tension/malignant PM may occur requiring prompt detection and intervention.

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Lymphocytic colitis: clinical presentation and long term course

Gut ◽

10.1136/gut.43.5.629 ◽

1998 ◽

Vol 43 (5) ◽

pp. 629-633 ◽

Cited By ~ 90

Author(s):

B Mullhaupt ◽

U Güller ◽

M Anabitarte ◽

R Güller ◽

M Fried

Keyword(s):

Colonic Mucosa ◽

Clinical Presentation ◽

Collagenous Colitis ◽

Endoscopic Examination ◽

Watery Diarrhoea ◽

Lymphocytic Colitis ◽

Radiological Findings ◽

Benign Course

Background—Lymphocytic colitis is characterised by chronic watery diarrhoea with normal endoscopic or radiological findings and microscopic evidence of pronounced infiltration of the colonic mucosa with lymphocytes.Aim—To investigate the long term clinical and histological evolution of the disease in a large group of patients with well characterised lymphocytic colitis.Methods—Between 1986 and 1995 the histological diagnosis of lymphocytic colitis was obtained in 35 patients; 27 of these agreed to a follow up examination. All clinical, endoscopic, and histopathological records were reviewed at that time and the patients had a second endoscopic examination with follow up biopsies.Results—The patients initially presented with the typical findings of lymphocytic colitis. After a mean (SD) follow up of 37.8 (27.5) months, diarrhoea subsided in 25 (93%) and histological normalisation was observed in 22 (82%) of the 27 patients. Progression from lymphocytic colitis to collagenous colitis was not observed.Conclusions—Lymphocytic colitis is characterised by a benign course with resolution of diarrhoea and normalisation of histology in over 80% of patients within 38 months. Considering the benign course of the disease, the potential benefit of any drug treatment should be carefully weighed against its potential side effects.

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The early mortality rate of people infected with coronavirus (COVID-2019) in Wuhan, China: Review of three retrospective studies

Journal of Pharmacy And Bioallied Sciences ◽

10.4103/jpbs.jpbs_282_20 ◽

2020 ◽

Vol 12 (3) ◽

pp. 223

Author(s):

AsimAhmed Elnour ◽

Judit Don ◽

Isra Yousif ◽

Kishore Gnana ◽

Semira Abdi ◽

...

Keyword(s):

Mortality Rate ◽

Retrospective Studies ◽

Early Mortality

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Effects of Cigarette Smoking on Influenza Virus/Host Interplay

Pathogens ◽

10.3390/pathogens10121636 ◽

2021 ◽

Vol 10 (12) ◽

pp. 1636

Author(s):

Jerald Chavez ◽

Rong Hai

Keyword(s):

Cigarette Smoking ◽

Influenza A ◽

Underlying Mechanism ◽

Influenza Viruses ◽

Viral Pathogen ◽

Adaptive Immune ◽

Disease Outcomes ◽

The Us ◽

Influenza Viral Infection ◽

The Impact

Cigarette smoking has been shown to increase the risk of respiratory infection, resulting in the exacerbation of infectious disease outcomes. Influenza viruses are a major respiratory viral pathogen, which are responsible for yearly epidemics that result in between 20,000 and 50,000 deaths in the US alone. However, there are limited general summaries on the impact of cigarette smoking on influenza pathogenic outcomes. Here, we will provide a systematic summarization of the current understanding of the interplay of smoking and influenza viral infection with a focus on examining how cigarette smoking affects innate and adaptive immune responses, inflammation levels, tissues that contribute to systemic chronic inflammation, and how this affects influenza A virus (IAV) disease outcomes. This summarization will: (1) help to clarify the conflict in the reports on viral pathogenicity; (2) fill knowledge gaps regarding critical anti-viral defenses such as antibody responses to IAV; and (3) provide an updated understanding of the underlying mechanism behind how cigarette smoking influences IAV pathogenicity.

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Prognostic differences among patients with idiopathic interstitial pneumonias with acute exacerbation of varying pathogenesis: a retrospective study

Respiratory Research ◽

10.1186/s12931-019-1247-z ◽

2019 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Motoyasu Kato ◽

Tomoko Yamada ◽

Shunichi Kataoka ◽

Yuta Arai ◽

Keita Miura ◽

...

Keyword(s):

Mortality Rate ◽

Survival Time ◽

Acute Exacerbation ◽

Significant Risk ◽

Early Death ◽

Patient Characteristics ◽

Serum Markers ◽

University Hospital ◽

Radiological Findings ◽

Idiopathic Interstitial Pneumonias

Abstract Background Acute exacerbation of chronic fibrosing idiopathic interstitial pneumonias (AE-IIPs) is associated with a high mortality rate. In 2016, an international working group proposed a revised diagnostic criteria for AE-IIPs, suggesting that it be classified as idiopathic or triggered. Many factors are known to trigger AE-IIPs, including surgery, infection, and drugs. However, it is unknown which AE-IIPs triggers have a worse prognosis. We aimed to investigate the prognosis of patients with various clinical types of AE-IIPs, particularly infection-triggered, non-infection triggered, and idiopathic AE-IIPs. Methods We retrospectively collected data from 128 chronic fibrosing IIPs (CF-IIPs) patients who were hospitalized by respiratory failure between April 2009 and March 2019 at Juntendo University Hospital. Among these patients, we evaluated 79 patients who developed AE-IIPs and 21 who developed pneumonia superimposed on CF-IIPs. Patients with AE-IIPs were classified into three types: idiopathic, infection-triggered, and non-infection-triggered AE-IIPs. We analyzed differences in patient characteristics, examination findings; level of serum markers, results of pulmonary function, and radiological findings, prior treatment for baseline CF-IIPs, and prognosis. We then evaluated the risk factor for early death (death within 30 days from the onset of AE-IIPs) associated with AE-IIPs. Results Among the patients who developed AE-IIPs, 34 were characterized as having idiopathic, 25 were characterized as having infection-triggered, and 20 were categorized as having non-infection-triggered AE-IIPs. Survival time for pneumonia superimposed on IIPs was significantly longer than that for any AE-IIPs. Survival time for bacterial pneumonia superimposed on CF-IIPs was significantly longer than that for AE-IIPs (for each idiopathic and all triggered IIPs). Thereafter, survival time for infection-triggered was significantly longer than for idiopathic or non-infection-triggered AE-IIPs. The mortality rate was significantly lower in infection-triggered AE-IIPs than in other types of AE-IIPs. Furthermore, the incidence of infection-triggered AE-IIPs in winter was significantly higher than that in other seasons. Moreover, the clinical AE-IIPs types and radiological findings at AE-IIP onset were significant risk factors for AE-IIPs-induced early death. Conclusions Our findings suggest that patients with infection-triggered AE-IIPs can expect a better prognosis than can patients with other clinical types of AE-IIPs.

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The Concentration of Large Extracellular Vesicles Differentiates Early Septic Shock From Infection

Frontiers in Medicine ◽

10.3389/fmed.2021.724371 ◽

2021 ◽

Vol 8 ◽

Author(s):

Latthawan Monnamorn ◽

Chutima Seree-aphinan ◽

Piyatida Molika ◽

Polathep Vichitkunakorn ◽

Kovit Pattanapanyasat ◽

...

Keyword(s):

Septic Shock ◽

Endothelial Cells ◽

Mortality Rate ◽

Extracellular Vesicles ◽

Diverse Group ◽

Disease Course ◽

Longitudinal Trend ◽

Blood Specimens ◽

The Given ◽

Over Time

Septic shock represents a subset of sepsis with severe physiological aberrations and a higher mortality rate than sepsis alone. Currently, the laboratory tools which can be used to identify the state of septic shock are limited. In pre-clinical studies, extracellular vesicles (EVs), especially large EVs (lEVs), have been demonstrated a role as functional inflammatory mediators of sepsis. However, its longitudinal trend during the disease course has not been explored. In this study, the quantities and subtypes of plasma-derived lEVs were longitudinally compared between patients with septic shock (n = 21) and non-sepsis infection (n = 9), who presented within 48 h of their symptom onset. Blood specimens were collected for seven consecutive days after hospital admission. lEVs quantification and subtyping were performed using an imaging flow cytometer. The experiments revealed a higher lEVs concentration in septic shock patients than infected patients at the onset of the disease. In septic shock patients, lEVs concentration decreased over time as opposed to infected patients whose lEVs concentration is relatively static throughout the study period. The major contributors of lEVs in both septic shock and infected patients were of non-leukocyte origins; platelets, erythrocytes, and endothelial cells released approximately 40, 25, and 15% of lEVs, respectively. Among lEVs of leukocyte origins, neutrophils produced the highest number of EVs. Nevertheless, the proportion of each subtype of lEVs among the given amount of lEVs produced was similar between septic shock and infected patients. These findings raise the possibility of employing lEVs enumeration as a septic shock identifying tool, although larger studies with a more diverse group of participants are warranted to extrapolate the findings to a general population.

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COVID-19 IN PATIENTS RECOVERING FROM CARDIAC SURGERY: A SURPRISING MILD DISEASE COURSE

10.22541/au.160674692.22857990/v1 ◽

2020 ◽

Author(s):

Alfredo Cerillo ◽

Niccolò Marchionni ◽

Beatrice Bacchi ◽

Pier Luigi Stefano

Keyword(s):

Care Pathway ◽

Mortality Rates ◽

Surgical Patients ◽

Disease Course ◽

Comorbid Conditions ◽

Mild Disease ◽

Rehabilitation Facility ◽

Nasal Swabs ◽

Rehabilitation Clinic ◽

Benign Course

Cardiac surgical patients are often discharged to a rehabilitation facility to complete the convalescence in a protected setting. This care pathway is usually reserved for elderly and fragile patients, with severe and invalidating comorbid conditions. Between March and April 2020, nineteen patients were discharged from our unit to a rehabilitation clinic where a hotbed of SARS-CoV-2 infection was documented on April 17. After the outbreak, all patients underwent screening with real-time PCR on nasal swabs, and 18/19 patients were found positive. Diversely from other observations on perioperative COVID-19 reporting mortality rates of 30-40%, the COVID-19 had a benign course in our cohort: six patients were completely asymptomatic, and only seven patients required hospitalization (no deaths). We describe the baseline, operative and postoperative features of these patients, and present some potential explanations for the surprisingly benign course of the COVID-19 in this cohort.

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Chest X-ray findings monitoring COVID-19 disease course and severity

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-020-00296-x ◽

2020 ◽

Vol 51 (1) ◽

Cited By ~ 1

Author(s):

Rabab Yasin ◽

Walaa Gouda

Keyword(s):

Mortality Rate ◽

Pulmonary Nodules ◽

Respiratory Illness ◽

Disease Assessment ◽

Common Finding ◽

Disease Course ◽

Radiographic Findings ◽

X Ray ◽

Chest X Ray

Abstract Background Coronavirus related respiratory illness usually manifests clinically as pneumonia with predominant imaging findings of an atypical or organizing pneumonia. Plain radiography is very helpful for COVID-19 disease assessment and follow-up. It gives an accurate insight into the disease course. We aimed to determine the COVID-19 disease course and severity using chest X-ray (CXR) scoring system and correlate these with patients’ age, sex, and outcome. Results In our study, there were 350 patients proven with positive COVID-19 disease; 220 patients (62.9%) had abnormal baseline CXR and 130 patients (37.1%) had normal baseline CXR. During follow-up chest X-ray studies, 48 patients (13.7%) of the normal baseline CXR showed CXR abnormalities. In abnormal chest X-ray, consolidation opacities were the most common finding seen in 218 patients (81.3%), followed by reticular interstitial thickening seen in 107 patients (39.9%) and GGO seen in 87 patients (32.5%). Pulmonary nodules were found 25 patients (9.3%) and pleural effusion was seen in 20 patients (7.5%). Most of the patients showed bilateral lung affection (181 patients, 67.5%) with peripheral distribution (156 patients, 58.2%) and lower zone affection (196 patients, 73.1%). The total severity score was estimated in the baseline and follow-up CXR and it was ranged from 0 to 8. The outcome of COVID-19 disease was significantly related to the age, sex, and TSS of the patients. Male patients showed significantly higher mortality rate as compared to the female patients (P value 0.025). Also, the mortality rate was higher in patients older than 40 years especially with higher TSS. Conclusion Radiographic findings are very good predictors for assessing the course of COVID-19 disease and it could be used as long-term consequences monitoring.

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Early myeloablative therapy for multiple myeloma

Blood ◽

10.1182/blood.v84.12.4278.bloodjournal84124278 ◽

1994 ◽

Vol 84 (12) ◽

pp. 4278-4282 ◽

Cited By ~ 82

Author(s):

R Alexanian ◽

MA Dimopoulos ◽

J Hester ◽

K Delasalle ◽

R Champlin

Keyword(s):

Multiple Myeloma ◽

Autologous Bone Marrow ◽

Initial Therapy ◽

Intensive Treatment ◽

First Year ◽

Disease Course ◽

Survival Times ◽

Resistant Disease ◽

Disease Outcomes ◽

Autologous Bone

The value of early myeloablative therapy supported by autologous bone marrow or blood progenitor cells was assessed in 72 patients with multiple myeloma who were treated within 1 year of initial therapy. Forty-five patients were consolidated during remission, and 27 patients were treated for primary refractory disease. Outcomes were compared with those of similar patients who did not receive intensive treatment primarily for socioeconomic reasons. Among patients who had responded previously, myeloablative therapy increased the rate of complete remission from 5% to 45% (P < .01) but did not prolong progression-free intervals or survival times. The same treatment controlled the myeloma in 70% of patients with primary resistant disease and prolonged the median survival from 37 to 83 months (P = .03). Intensive treatment for primary resistant myeloma administered later in the disease course resulted in significantly lower response rates and shorter progression- free intervals. Current myeloablative regimens supported by autologous stem cells appeared useful primarily in patients with primary resistant disease during the first year of therapy.

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The cytokine storm in multiple sclerosis

Multiple Sclerosis Journal ◽

10.1177/135245859800400104 ◽

1998 ◽

Vol 4 (1) ◽

pp. 12-15 ◽

Cited By ~ 45

Author(s):

Hans Link

Keyword(s):

Multiple Sclerosis ◽

Immune Response ◽

Immune System ◽

Lesion Size ◽

Disease Course ◽

Cytokine Storm ◽

Cytokine Network ◽

Benign Course

MS is associated with a cytokine storm characterized by the parallel upregulation of proinflammatory (IFN-g, TNF-a, and b, and IL-12) and immune response-down-regulating (TGF-b, IL-10) cytokines. Also IL-6 and the cytolytic molecule perforin are upregulated. Even when evaluated in individual MS patients over the disease course, no Th1/Th2 dichotomy is obvious but, instead, upregulation of Th1+Th2+Th3 cytokines simultaneously, probably reflecting the complex pathology of MS in lesion size, time and distribution in the indiviual patient. Few correlations have been observed between cytokines and clinical MS variables, though upregulation of TGF-b seems to correlate with benign course and minor disability. Both pro- and antiinflammatory cytokines are also produced by microglia and astrocytes, constituting a CNS-cytokine network that interacts with the cytokine network of the immune system. This complexity is to be kept in mind when searching for cytokine abnormalities in MS.

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Abstract P89: Covid-19 and Ischemic Stroke: A Systematic Review and Meta-Summary of the Literature

Stroke ◽

10.1161/str.52.suppl_1.p89 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Ying Kiat Tan ◽

Claire Goh ◽

Aloysius S Leow ◽

Paul A Tambyah ◽

Alicia Ang ◽

...

Keyword(s):

Systematic Review ◽

Ischemic Stroke ◽

Mortality Rate ◽

High Mortality ◽

Antiphospholipid Antibodies ◽

Keyword Search ◽

Underlying Mechanism ◽

Life Threatening ◽

The Mean ◽

D Dimer

Background: Acute ischemic stroke (AIS) is a life-threatening complication of coronavirus disease 2019 (COVID-19) infection. Increasing reports suggest an association between COVID-19 and AIS, although the underlying mechanism remains uncertain. Objectives: We performed a systematic review to characterize the clinical characteristics, neuroimaging findings, and outcomes of AIS in COVID-19 patients. Methods: A literature search was performed in PubMed and Embase using a suitable keyword search strategy from 1st December 2019 to 29th May 2020. All studies reporting AIS occurrence in COVID-19 patients were included. Results: A total of 39 studies comprising 135 patients were studied. The pooled incidence of AIS in COVID-19 patients from observational studies was 1.2% (54/4466) with a mean age of 63.4 ± 13.1 years. The mean duration of AIS from COVID-19 symptoms onset was 10 ± 8 days, and the mean NIHSS score was 19 ± 8. Laboratory investigations revealed an elevated mean D-dimer (9.2 ± 14.8 mg/L) and fibrinogen (5.8 ± 2.0 g/L). Antiphospholipid antibodies were detected in a significant number of cases. The majority of AIS neuroimaging patterns observed was large vessel thrombosis, embolism or stenosis (62.1%, 64/103), followed by multiple vascular territory (26.2%, 27/103). A high mortality rate was reported (38.0%, 49/129). Conclusion: We report the pooled incidence of AIS in COVID-19 patients to be 1.2%, with a high mortality rate. Elevated D-dimer, fibrinogen and the presence of antiphospholipid antibodies appear to be prominent in COVID-19 patients with concomitant AIS, but further mechanistic studies are required to elucidate their role in pathogenesis.

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