scholarly journals Pathological findings in organs and tissues of patients with COVID-19: A systematic review

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0250708
Author(s):  
Sasha Peiris ◽  
Hector Mesa ◽  
Agnes Aysola ◽  
Juan Manivel ◽  
Joao Toledo ◽  
...  
Keyword(s):  
Diffuse Alveolar Damage ◽  
Case Reports ◽  
Case Series ◽  
Organ Damage ◽  
Gi Tract ◽  
Hemodynamic Compromise ◽  
Viral Particles ◽  
Pathologic Findings ◽  
Organ Specific ◽  
Skin Biopsies

Background Coronavirus disease (COVID-19) is the pandemic caused by SARS-CoV-2 that has caused more than 2.2 million deaths worldwide. We summarize the reported pathologic findings on biopsy and autopsy in patients with severe/fatal COVID-19 and documented the presence and/or effect of SARS-CoV-2 in all organs. Methods and findings A systematic search of the PubMed, Embase, MedRxiv, Lilacs and Epistemonikos databases from January to August 2020 for all case reports and case series that reported histopathologic findings of COVID-19 infection at autopsy or tissue biopsy was performed. 603 COVID-19 cases from 75 of 451 screened studies met inclusion criteria. The most common pathologic findings were lungs: diffuse alveolar damage (DAD) (92%) and superimposed acute bronchopneumonia (27%); liver: hepatitis (21%), heart: myocarditis (11.4%). Vasculitis was common only in skin biopsies (25%). Microthrombi were described in the placenta (57.9%), lung (38%), kidney (20%), Central Nervous System (CNS) (18%), and gastrointestinal (GI) tract (2%). Injury of endothelial cells was common in the lung (18%) and heart (4%). Hemodynamic changes such as necrosis due to hypoxia/hypoperfusion, edema and congestion were common in kidney (53%), liver (48%), CNS (31%) and GI tract (18%). SARS-CoV-2 viral particles were demonstrated within organ-specific cells in the trachea, lung, liver, large intestine, kidney, CNS either by electron microscopy, immunofluorescence, or immunohistochemistry. Additional tissues were positive by Polymerase Chain Reaction (PCR) tests only. The included studies were from numerous countries, some were not peer reviewed, and some studies were performed by subspecialists, resulting in variable and inconsistent reporting or over statement of the reported findings. Conclusions The main pathologic findings of severe/fatal COVID-19 infection are DAD, changes related to coagulopathy and/or hemodynamic compromise. In addition, according to the observed organ damage myocarditis may be associated with sequelae.

scholarly journals The Fakir Child: Clinical Observation or Invasive Treatment?

2020 ◽  
Vol 12 (3) ◽  
pp. 103-107
Author(s):  
Antonio Gatto ◽  
Serenella Angelici ◽  
Claudia Di Pangrazio ◽  
Lorenzo Nanni ◽  
Danilo Buonsenso ◽  
...  
Keyword(s):  
Emergency Department ◽  
Foreign Bodies ◽  
Case Reports ◽  
Pediatric Population ◽  
Case Series ◽  
Expectant Management ◽  
X Rays ◽  
Gi Tract ◽  
Invasive Treatment ◽  
Foreign Objects

Accidental swallowing of foreign bodies is a common problem among the pediatric population (6 months to 3 years), especially if the foreign body (FB) presents a sharp end that could potentially lead to perforation of the gastrointestinal (GI) tract, resulting in infection and complications. We report the case of a 2-year-old, admitted to the Emergency Department of our hospital after ingesting two FBs classifiable as sharp objects, specifically two metal nails, both approximately 4-cm long, which had been swallowed in one go, as reported by the parents. The patient had been previously admitted to another hospital in the same region, where the Emergency Department (ED) doctors took an X-ray to confirm the ingestion. The foreign bodies ingestion was thus confirmed, and they were, according to their report, located in the GI tract over the stomach. The patient has been monitored through all of his stay in the hospital and the progression of the foreign bodies has been documented with serial X-rays. Since neither clinical nor radiological signs of perforation were present, putting the FBs in the small bowel, a non-operative expectant management was followed. After 4 days of admission, the patient had passed one of the two FBS and later on the second one, without any complication. Thereafter the patient was discharged. The management of sharp gastrointestinal foreign objects ingestion is still debated, and the data of the current literature are poor. A number of case reports and small case series describe successful conservative management for the majority of ingested sharp objects. According to the literature data, our report confirms that the ingestion of sharp objects and relatively big objects in a baby can be successfully non-operatively managed, even despite the age of the patient and though the FBs are multiple.

scholarly journals ECMO in Poisoning

2017 ◽  
Vol 01 (02) ◽  
pp. 82-88
Author(s):  
Vivek Gupta ◽  
Gurpreet S. Wander
Keyword(s):  
Cardiogenic Shock ◽  
Life Support ◽  
Extracorporeal Life Support ◽  
Case Reports ◽  
Case Series ◽  
Supportive Therapy ◽  
Tissue Perfusion ◽  
Western World ◽  
Hemodynamic Compromise ◽  
The World

AbstractSevere poisoning may lead to life-threatening situation or death due to cardiovascular dysfunction, arrhythmia, or cardiogenic shock. The poisoning substance varies in different parts of world; in the Western world, the drugs with cardiotoxic potential are more common, while pesticides and other household toxins are common in the rest of the world. However, most of these patients are relatively young and otherwise healthy irrespective of poisoning substances. Extracorporeal membrane oxygenation (ECMO) has regained interest in recent past and now its use is being explored for newer indications. The use of ECMO in poisoning has shown promising results as salvage therapy and can be used as bridge to recovery, antidote, and toxin removal with renal replacement therapy or transplant. The ECMO has been used in those poisoned patients who have persistent cardiogenic shock or refractory hypoxemia despite adequate supportive therapy. ECMO may be useful in providing adequate cardiac output and maintain tissue perfusion which helps in the redistribution of toxins from central circulation and facilitate the metabolism and excretion. However, the available literature is not sufficient and is based on case reports, case series, and retrospective cohort study. In spite of high mortality with severe poisoning and encouraging outcome with use of ECMO, it is an underutilized modality across the world. Though evidences suggest that early consideration of ECMO in severely poisoned patients with refractory cardiac arrest or hemodynamic compromise refractory to standard therapies may be beneficial, the right time to start ECMO in poisoned patients, criteria to start ECMO, and prognostication prior to initiation of ECMO is yet to be answered. Future studies and publications may address these issues, whereas the ELSO (Extracorporeal Life Support Organization) data registry may help in collecting global data on poisoning more effectively.

scholarly journals A comprehensive review on clinical and mechanistic pathophysiological aspects of COVID-19 Malady: How far have we come?

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Baila Shakaib ◽  
Tanzeel Zohra ◽  
Aamer Ikram ◽  
Muhammad Bin Shakaib ◽  
Amna Ali ◽  
...  
Keyword(s):  
Case Reports ◽  
Case Series ◽  
Signs And Symptoms ◽  
Organ Damage ◽  
Underlying Disease ◽  
The Body ◽  
Host Cells ◽  
Irreversible Damage ◽  
Organ Systems ◽  
Wide Range

AbstractSince its outbreak in 2019, the coronavirus disease (COVID-19) has become a pandemic, affecting more than 52 million people and causing more than 1 million mortalities globally till date. Current research reveals a wide array of disease manifestations and behaviors encompassing multiple organ systems in body and immense systemic inflammation, which have been summarized in this review. Data from a number of scientific reviews, research articles, case series, observational studies, and case reports were retrieved by utilizing online search engines such as Cochrane, PubMed, and Scopus from December 2019 to November 2020. The data for prevalence of signs and symptoms, underlying disease mechanisms and comorbidities were analyzed using SPSS version 25. This review will discuss a wide range of COVID-19 clinical presentations recorded till date, and the current understanding of both the underlying general as well as system specific pathophysiologic, and pathogenetic pathways. These include direct viral penetration into host cells through ACE2 receptors, induction of inflammosomes and immune response through viral proteins, and the initiation of system-wide inflammation and cytokine production. Moreover, peripheral organ damage and underlying comorbid diseases which can lead to short term and long term, reversible and irreversible damage to the body have also been studied. We concluded that underlying comorbidities and their pathological effects on the body contributed immensely and determine the resultant disease severity and mortality of the patients. Presently there is no drug approved for treatment of COVID-19, however multiple vaccines are now in use and research for more is underway.

A Case of Biventricular Failure after Pericardial Window for Large Pericardial Effusion

2015 ◽  
Vol 18 (1) ◽  
pp. 036 ◽  
Author(s):  
Michael M. Koerner ◽  
Mahboob Alam ◽  
Aly El-Banayosy ◽  
Arunima Misra ◽  
Matthew J. Wall, Jr ◽  
...  
Keyword(s):  
Cardiac Tamponade ◽  
Case Reports ◽  
Systolic Dysfunction ◽  
Case Series ◽  
Pericardial Tamponade ◽  
Pericardial Window ◽  
Hemodynamic Compromise ◽  
Large Pericardial Effusion ◽  
Biventricular Failure ◽  
Large Case Series

Pericardial tamponade resulting in hemodynamic compromise requiring either pericardiocentesis [Vandyke 1983] or subxiphoid pericardial window has been reported in literature [Armstrong 1984]. There are no large case series, only scattered case reports. Cardiac tamponade is known to affect the diastolic function of the heart but rare reports have documented systolic impairment of the left and right ventricle in the setting of tamponade [Vandyke 1983; Armstrong 1984]. We report a case of a transient biventricular systolic dysfunction in a patient with early cardiac tamponade after surgical drainage of pericardia1 effusion.

scholarly journals COVID-19 in a Hispanic Woman

2020 ◽  
Vol 144 (9) ◽  
pp. 1041-1047 ◽  
Author(s):  
Lei Yan ◽  
Mahnoor Mir ◽  
Paloma Sanchez ◽  
Moeezullah Beg ◽  
Jay Peters ◽  
...  
Keyword(s):  
Diffuse Alveolar Damage ◽  
Case Reports ◽  
Viral Myocarditis ◽  
Case Series ◽  
Hispanic Woman ◽  
Clinical Impression ◽  
Valuable Insight ◽  
Clinical Effects ◽  
Pulmonary Infarction ◽  
Histopathologic Evaluation

Since making its debut on the global stage in December 2019, coronavirus disease 2019 (COVID-19) has afflicted nearly 4 million people and caused hundreds of thousands of deaths. Case reports and case series depicting the clinical effects of the causative virus—severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)—have been published, yet few demonstrate the cytopathologic alterations of this disease. We present a clinical-pathologic correlation report of a previously healthy Hispanic woman with laboratory-confirmed COVID-19 who had typical features of acute respiratory distress syndrome (ARDS) and also showed cardiac abnormalities thought to represent fulminant viral myocarditis. Congruent with the ARDS clinical impression, autopsy findings were remarkable for extensive and markedly severe acute lung injury consistent with viral pneumonia, characterized by diffuse alveolar damage, pulmonary infarction, severe pulmonary edema, desquamation of pneumocytes with intra-alveolar aggregation, and pneumocyte morphologic alterations suggestive of viral cytopathic effect. However, there was incongruence between the clinical impression and the cardiovascular pathology findings in that viral myocarditis was not detected on histopathologic evaluation. This case highlights the importance of pathologic corroboration of the clinical impression and, in addition, illuminates the key role autopsy plays during a pandemic by providing valuable insight into viral pathology in tissues.

scholarly journals Tissue Expression of Placental Growth Factor in Acute Graft Versus Host Disease after Hematopoietic Stem Cell Transplantation

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 1171-1171 ◽  
Author(s):  
Jessica T. Leonard ◽  
Laura F. Newell ◽  
Guang Fan ◽  
Shernan G. Holtan
Keyword(s):  
Growth Factor ◽  
Graft Versus Host Disease ◽  
Tissue Expression ◽  
Underlying Disease ◽  
Placental Growth Factor ◽  
Gi Tract ◽  
Graft Versus Host ◽  
Organ Specific ◽  
Skin Biopsies ◽  
Acute Graft

Abstract Background: Placental growth factor (PlGF) is a member of the vascular endothelial growth factor family of proteins involved in angiogenesis, with direct effects on endothelial cells as well as a chemotactic effect on monocytes. Outside of normal pregnancy, pathologically high levels of PlGF have been described in the plasma of patients with inflammatory diseases (i.e. sickle cell, inflammatory bowel disease), and increased PlGF tissue expression in rheumatoid inflammation. We have recently identified that circulating levels of PlGF are significantly elevated in patients receiving allogeneic hematopoietic cell transplantation (HCT), with even higher levels seen in those with acute graft-versus-host disease [(aGVHD), Holtan SG et al, ASH 2014]. Given prior reports describing a correlation between higher PlGF tissue expression and inflammatory disease, as well as our findings of higher circulating PlGF levels in the transplant setting and with aGVHD, we sought to determine whether organ tissue expression of PlGF correlates with GVHD organ involvement and severity. Patients and Methods: Immunohistochemical (IHC) staining for PlGF as well as common leukocyte antigen CD45 was performed on tissue biopsies of aGVHD target organs obtained during routine patient care, as part of an IRB-approved clinical research study. Patients with classic or late-onset acute GVHD were eligible for enrollment. Samples from normal human skin, colon, and duodenum collected during routine care and made available through an institutional tissue sample repository were also evaluated as controls. Slides were reviewed by two independent reviewers blinded to the subject’s condition. Expression of PlGF was graded on a semi-quantitative scale of 0-3 with 3+ being the strongest tissue expression. IHC results were then analyzed in the context of the patient’s clinical characteristics including underlying disease, type of transplant, status of the underlying disease (remission, relapse), organ involvement and severity of GVHD, and response to GVHD treatment. Results: 13 patients had biopsies obtained as part of their work-up for aGVHD [9 skin biopsies and 15 gastrointestinal (GI) biopsies] available for review. Of the 9 skin biopsies, 7 biopsies were consistent with aGVHD by clinical pathology review. PlGF was present in moderate to high levels (2-3+) in all 7 cases of acute skin GVHD while the two cases found not to have aGVHD (vasculitis and engraftment rash), as well as normal skin, had little to no PlGF staining (0-1+). All acute skin GVHD patients responded to systemic corticosteroid therapy, with no correlation between the degree of PlGF staining and severity of aGVHD. In the 15 biopsies of the GI tract, 14 were consistent with aGVHD. One biopsy specimen not classified as aGVHD instead had documented Helicobacter pylori infection in the upper GI tissues, with infiltration of CD45+ cells but without increased expression of PlGF relative to control tissues. In contrast to the skin findings, normal colon and duodenal tissue in our controls showed higher baseline PlGF staining (3+ and 2+, respectively). The tissue expression of PlGF in patients with aGVHD was less intense than control in 11 of the 15 cases. Of the 4 patients with more intense PlGF expression than control, 3 had GVHD in the setting of relapsed leukemia. The lowest PlGF scores in colonic mucosa were seen in two patients who ultimately died of steroid refractory aGVHD. Conclusion: These results provide the first evidence of tissue PlGF expression occurring in the setting of HCT and aGVHD. In our cohort, patients diagnosed with aGVHD of the skin had more intense expression of PlGF relative to control (2-3+). In contrast, patients diagnosed with aGVHD of the GI tract had lower expression of PlGF than control GI tissue; and patients with the lowest GI expression of PlGF had refractory aGVHD. These results suggest that tissue PlGF levels may correlate with organ-specific GVHD outcomes. Further studies are ongoing to determine the role of PlGF in neovascularization and tissue repair in aGVHD in an organ-specific manner. Disclosures No relevant conflicts of interest to declare.

scholarly journals Autoimmune and Rheumatic Manifestations Associated With COVID-19 in Adults: An Updated Systematic Review

2021 ◽  
Vol 12 ◽  
Author(s):  
Kuo-Tung Tang ◽  
Bo-Chueh Hsu ◽  
Der-Yuan Chen
Keyword(s):  
Systematic Review ◽  
Case Reports ◽  
Case Series ◽  
Rheumatic Manifestations ◽  
Organ Specific ◽  
Long Term Follow Up ◽  
Clinically Significant ◽  
Autoimmune Cytopenia

Background: Numerous cases of the coronavirus disease 2019 (COVID-19) with autoimmune and rheumatic manifestations have been reported. Despite the available reviews that summarized its autoimmune/rheumatic manifestations, a systematic approach is still lacking. Therefore, we conducted a comprehensive systematic review in order to give an overview upon these rare but clinically significant manifestations.Methods: We performed a literature search of PubMed and EMBASE as of October 9, 2020. All articles relevant to either systemic or organ-specific autoimmune and rheumatic manifestations potentially associated with COVID-19 were collected. The reviewed literature were limited to adults ≥18 years.Results: Although most of the existing evidence was based on case reports or case series without a long-term follow-up, a variety of autoimmune/rheumatic manifestations were associated with COVID-19. The manifestations that have a consistent association with COVID-19 include autoimmune cytopenia, cutaneous vasculitis, encephalitis, and Guillain-Barre syndrome. Such association is conflicting as regards to antiphospholipid syndrome, hemophagocytic lymphohistiocytosis, and myasthenia gravis.Conclusion: Our systematic review indicated the potential of the COVID-19 virus to trigger a myriad of autoimmune and rheumatic manifestations, which should be considered amid global efforts to combat COVID-19.

Cannabis-associated arteritis

VASA ◽  
2010 ◽  
Vol 39 (1) ◽  
pp. 43-53 ◽  
Author(s):  
Grotenhermen
Keyword(s):  
Systematic Review ◽  
Case Reports ◽  
Case Series ◽  
Cardiovascular Effects ◽  
Causative Factor ◽  
Cannabis Use ◽  
Thromboangiitis Obliterans ◽  
Pathological Features ◽  
Scientific Support ◽  
Clinical And Pathological Features

Background: To investigate the hypothesis that cases of arteritis similar to thromboangiitis obliterans (TAO) and associated with the use of cannabis were caused by cannabis or THC (dronabinol), or that cannabis use is a co-factor of TAO. Patients and methods: A systematic review on case reports and the literature on so-called cannabis arteritis, TAO, and cardiovascular effects of cannabinoids was conducted. Results: Fifteen reports with 57 cases of an arteritis associated with the use of cannabis and two additional case series of TAO, in which some patients also used cannabis, were identified. Clinical and pathological features of cannabis-associated arteritis do not differ from TAO and the major risk factor of TAO, tobacco use, was present in most, if not in all of these cases. The proposed pathophysiological mechanisms for the development of an arteritis by cannabis use are not substantiated. Conclusions: The hypothesis of cannabis being a causative factor or co-factor of TAO or an arteritis similar to TAO is not supported by the available evidence. The use of the term “cannabis arteritis” should be avoided until or unless more convincing scientific support is forthcoming.

Thrombosis in Cancer Patients Treated with Hematopoietic Growth Factors - A Meta-Analysis

1996 ◽  
Vol 75 (02) ◽  
pp. 368-371 ◽  
Author(s):  
T Barbul ◽  
G Finazzi ◽  
A Grassi ◽  
R Marchioli
Keyword(s):  
Cancer Patients ◽  
Case Reports ◽  
Meta Analysis ◽  
Case Series ◽  
Hematopoietic Growth Factors ◽  
Patients With Cancer ◽  
Cytotoxic Treatment ◽  
Pertinent Data ◽  
Thrombotic Complications ◽  
Vascular Occlusions

SummaryHematopoietic colony-stimulating factors (CSFs) are largely used in patients with cancer undergoing cytotoxic treatment to accelerate neutrophil recovery and decrease the incidence of febrile neutropenia. Clinical practice guidelines for their use have been recently established (1), taking into account clinical benefit, but also cost and toxicity. Vascular occlusions have been recently reported among the severe reactions associated with the use of CSFs, in anedoctal case reports (2, 3), consecutive case series (4) and randomized clinical trial (5, 6). However, the role of CSFs in the pathogenesis of thrombotic complications is difficult to ascertain, because pertinent data are scanty and widely distributed over a number of heterogenous investigations. We report here a systematic review of relevant articles, with the aims to estimate the prevalence of thrombosis associated with the use of CSFs and to assess if this rate is significantly higher than that observed in cancer patients not receiving CSFs.

Herpetic Whitlow of the Hand in Infants

2020 ◽  
Author(s):  
Mohammad M. Al-Qattan ◽  
Nada G. AlQadri ◽  
Ghada AlHayaza
Keyword(s):  
Bacterial Infection ◽  
Case Reports ◽  
Case Series ◽  
Individual Case ◽  
Senior Author ◽  
Secondary Bacterial Infection ◽  
Clinical Appearance ◽  
History Of ◽  
Mode Of Transmission ◽  
Time Of Presentation

Abstract Introduction Herpetic whitlows in infants are rare. Previous authors only reported individual case reports. We present a case series of six infants. Materials and Methods This is a retrospective study of six cases of herpetic whitlows in infants seen by the senior author (MMA) over the past 23 years (1995–2017 inclusive). The following data were collected: age, sex, digit involved in the hand, mode of transmission, time of presentation to the author, clinical appearance, presence of secondary bacterial infection, presence of other lesions outside the hand, method of diagnosis, treatment, and outcome. Results All six infants initially presented with classic multiple vesicles of the digital pulp. In all cases, there was a history of active herpes labialis in the mother. Incision and drainage or deroofing of the vesicles (for diagnostic purposes) resulted in secondary bacterial infection. Conclusion The current report is the first series in the literature on herpetic whitlows in infants. We stress on the mode of transmission (from the mother) and establishing the diagnosis clinically. In these cases, no need for obtaining viral cultures or polymerase chain reaction; and no medications are required. Once the vesicles are disrupted, secondary bacterial infection is frequent and a combination of oral acyclovir and intravenous antibiotics will be required.

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