scholarly journals Urticarial manifestation in COVID-19 infection: A case report

2020 ◽  
Vol 3 (1) ◽  
Author(s):  
Anita M Djunaidi ◽  
Andrew Y Wirya
Keyword(s):  
Case Report ◽  
Health Sector ◽  
Vital Signs ◽  
Upper Airway ◽  
Rapid Test ◽  
Health Concern ◽  
Cutaneous Manifestations ◽  
Global Challenge ◽  
Additional Information ◽  
Airway Problem

Background: The COVID-19 pandemic outbreak causes a worldwide health concern. As the epidemic progressed, several cutaneous manifestations are increasingly noticed; therefore, the authors hope this report will provide additional information that may benefit fellow healthcare professionals. Case report: A 45 years old Javanese female patient complained of fatigue, dry cough, dyspepsia, and reddish pruritic swelling on her face for one day. There was no fever, dyspnea, anosmia, diarrhea, or uvula, tongue, vocal cords, and the airway problem. She had no history of food or drug allergy, urticaria, other comorbidities, or any medicine consumption in the last 15 days. Facial dermatological status showed circumscribed, raised, erythematous areas of edema, slightly pruritic. Normal vital signs. Blood laboratory results: leucocyte 5.760/mL, decreased ALC 818/mL, increased NLR 5.0. Chest X-ray showed an increase in bronchovascular pattern and slight opacity on the peripheral, basal part of both hemithorax. COVID-19 rapid test was positive for IgM, and her PCR of upper-airway secretions revealed positive COVID-19 infection. The diagnoses were COVID-19 infection, dyspepsia, and urticaria. The treatments were levofloxacin, isoprinosine, chloroquine sulfate, omeprazole, fluimucyl, vitamin C, and diphenhydramine. Within three days of treatment, the urticaria started to fade off, and her overall condition improved. Conclusion: The COVID-19 poses a global challenge in the health sector, and one of its various manifestations is cutaneous symptoms. Further research is necessary to elucidate how COVID-19 triggers dermatological symptoms.

CLINICAL CHALLENGES FOR ANESTHESIOLOGIST FACING PATIENT WITH ACROMEGALY. CASE REPORT

2020 ◽  
Vol 30 (3) ◽  
pp. 56-59
Author(s):  
Jūratė Gudaitytė ◽  
Justina Jermolajevaitė ◽  
Martynas Judickas
Keyword(s):  
Atrial Fibrillation ◽  
Case Report ◽  
General Population ◽  
Metabolic Disorders ◽  
Upper Airway ◽  
Cardiovascular Complications ◽  
Case Presentation ◽  
Increased Risk ◽  
Fluid Regulation ◽  
Class Iv

Background and objectives: Acromegaly is endocri­nal disorder which results in changes involving ge­neral appearance as well as upper airway abnorma­lities, cardiovascular and metabolic disorders which can aggravate the anesthesia and can lead to compli­cations. We aim to discuss the challenges for anesthe­siologist that occurs facing patient with acromegaly and are necessary to investigate before performing any kind of intervention. Case Presentation: 79 years old male patient presen­ted the hospital with recently diagnosed acromegaly for rectal prolapse surgery. From anamnesis he had NYHAIII with cardiomyopathy, atrial fibrillation and arterial hypertension, also multiple old compressive fractures Th10 – L5. He was graded with Mallam­pati score IV and ASA class IV. The complemen­tary examinations were made to assess the possible complications. In induction of general anesthesia the intubation was performed using fibro- bronchoscope and anesthesia went without complications except hypotension which was managed. After surgery the patient was leaded to the postoperative room for furt­her monitoring. Discussion and Conclusion: Acromegalic patients have an increased risk of difficulty during anesthe­sia compared to general population due to difficult intubation, cardiovascular complications , OSA , alte­ration in intraoperative glucose intolerance and fluid regulation. Therefore profound investigation and as­sessment are necessary to predict and prepare for possible difficulties in the surgery room.

scholarly journals A case of neck abscess caused by rare hypervirulent Klebsiella pneumoniae, capsular type K20 and sequence type 420

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
John Alexander McHardy ◽  
Vathshalan Selvaganeshapillai ◽  
Priya Khanna ◽  
Ashley Michael Whittington ◽  
Jane Turton ◽  
...  
Keyword(s):  
Public Health ◽  
Case Report ◽  
Antimicrobial Resistance ◽  
Klebsiella Pneumoniae ◽  
East Asia ◽  
South East Asia ◽  
Neck Abscess ◽  
Global Challenge ◽  
Life Threatening ◽  
The Uk

Abstract Background This case report describes a neck abscess caused by a strain of Hypervirulent Klebsiella pneumoniae in a middle aged man with diabetes without a history of travel to East and South East Asia. This case report is of notable significance as Hypervirulent Klebsiella pneumoniae neck abscesses are rarely seen in the UK and are very infrequently documented in individuals who have not first travelled to the high prevalence areas of East and South East Asia. Case presentation This case report describes a 53 year old diabetic man who contracted a Hypervirulent Klebsiella pneumoniae neck abscess which led to the development of sepsis. Klebsiella pneumoniae was cultured from blood cultures and fluid aspirated from the abscess grew the pathogen with same antimicrobial susceptibility. Hypervirulence was demonstrated after the samples were analysed, at the Antimicrobial Resistance and Healthcare Associated Infections Reference Unit Public Health England Colindale, and found to contain the K20 (rmp)A and rmpA2 virulence genes. Discussion Hypervirulent Klebsiella pneumoniae is a Gram-negative, encapsulated, non-motile bacillus notable for its ability to metastatically spread and cause potentially life threatening infections in otherwise healthy adults, but especially in those with diabetes. Genes responsible for the production of hyperviscous mucoid polysaccharide capsules and siderophores, such as those isolated in this case, enable the bacteria to more efficiently evade the hosts immune system and disseminate and invade surrounding and distant tissues. Data from Public Health England shows Hypervirulent Klebsiella pneumoniae are rare in the UK. A review of current literature also showed Hypervirulent Klebsiella pneumoniae almost exclusively occur in those who have traveled to East and South East Asia. Conclusions This case reported a rare Hypervirulent Klebsiella pneumoniae neck abscess outside of, and without travel to, East and South East Asia. This raises concerns about future, potentially life threatening, Hypervirulent Klebsiella pneumoniae infections becoming more widespread without the need for endemic travel. This concern is further exacerbated by the growing global challenge of antimicrobial resistance.

Necrotizing Fasciitis Occurred in the Lymphedematous leg

2021 ◽  
pp. 153473462110230
Author(s):  
Hisako Hara ◽  
Makoto Mihara ◽  
Takeshi Todokoro
Keyword(s):  
Case Report ◽  
Necrotizing Fasciitis ◽  
Lower Limb ◽  
Gynecologic Cancer ◽  
Vital Signs ◽  
Ethics Committee ◽  
Secondary Lymphedema ◽  
Delayed Treatment ◽  
Institutional Ethics ◽  
Life Threatening

Lymphedema is a chronic edema that sometimes occurs after treatment of gynecologic cancer, and cellulitis often occurs concomitantly with lymphedema. On the other hand, necrotizing fasciitis (NF) is a relatively rare, but life-threatening disease. The symptoms in cellulitis and NF are very similar. In this case report, we describe a case in which the diagnosis of NF in a lymphedematous limb was difficult. A 70-year-old woman had secondary lymphedema in bilateral legs and consulted our department. On the first day of lymphedema therapy, the patient complained of vomiting, diarrhea, and fever (37.7 °C) without local fever in the legs. She was diagnosed with acute gastroenteritis. On the next day, swelling and pain in her left leg occurred and her blood pressure was 59/44 mmHg. She was diagnosed with cellulitis accompanied by lower limb lymphedema and septic shock. On the second day, blisters appeared on the left leg, and computed tomography showed NF. We performed debridement under general anesthesia and her vital signs improved postoperatively. Streptococcus agalactiae (B) was detected in blood culture, and we administered bixillin and clindamycin. Postoperatively, necrosis in the skin and fat around the left ankle gradually spread, and it took 5 months to complete epithelialization. The diagnosis was more difficult than usual NF because patients with lymphedema often experience cellulitis. Clinicians should always think of NF to avoid mortality due to delayed treatment. This case report was approved by the institutional ethics committee.

Case Report: Advanced Upper Airway Obstruction Caused by Cervical Goiter

1989 ◽  
Vol 297 (3) ◽  
pp. 176-177 ◽  
Author(s):  
Maria Chiriboga ◽  
John Oropello ◽  
Krishnan Padmanabhan ◽  
Joel M. Goldman
Keyword(s):  
Case Report ◽  
Airway Obstruction ◽  
Upper Airway ◽  
Upper Airway Obstruction

Simplified rat intubation using a new oropharyngeal intubation wedge

2000 ◽  
Vol 89 (5) ◽  
pp. 1766-1770 ◽  
Author(s):  
I-Ming Jou ◽  
Ya-Ting Tsai ◽  
Ching-Lin Tsai ◽  
Ming-Ho Wu ◽  
Han-Yu Chang ◽  
...  
Keyword(s):  
Low Cost ◽  
Vital Signs ◽  
Upper Airway ◽  
Postmortem Examination ◽  
Normal Range ◽  
Special Equipment ◽  
Vocal Cords ◽  
Oropharyngeal Cavity ◽  
Series Of Experiments ◽  
Proper Setting

Our new oropharyngeal intubation wedge made from a plastic 3-ml syringe has been used successfully for the expansion of the oropharyngeal cavity and visualization of vocal cords for endotracheal intubation in the rat. All the animals we used tolerated the intubation and ventilation procedures in a series of experiments. After the proper setting of the respirator, vital signs were maintained within normal range. The postmortem examination and measurements in the upper airway confirmed that the endotracheal tube was properly sited and also demonstrated the precise size of the device that should be used. The main advantages of this method include low cost, simplicity, and reliability. Furthermore, because no expensive, elaborate, difficult-to-operate, or hard-to-get special equipment is needed, this technique can be used in every laboratory.

Extrapyramidal Symptoms with Ritonavir/Indinavir Plus Risperidone

2002 ◽  
Vol 36 (5) ◽  
pp. 827-830 ◽  
Author(s):  
Deborah V Kelly ◽  
Lizanne C Béïque ◽  
M Ian Bowmer
Keyword(s):  
Adverse Effect ◽  
Drug Interaction ◽  
Case Report ◽  
Vital Signs ◽  
Extrapyramidal Symptoms ◽  
Suspected Drug ◽  
Tic Disorder ◽  
Acute Dystonia ◽  
Active Moiety ◽  
Case Summary

OBJECTIVE: To report a case of suspected extrapyramidal symptoms (EPS) in a patient initiated on ritonavir and indinavir while taking risperidone for a tic disorder. CASE SUMMARY: A 35-year-old white man with AIDS received risperidone 2 mg twice daily for treatment of a Tourette's-like tic disorder. Ritonavir and indinavir were initiated, and 1 week later, he experienced significantly impaired swallowing, speaking, and breathing, and worsening of his existing tremors. Ritonavir and indinavir were discontinued. On the same day, the patient increased the risperidone dosage to 3 mg twice daily. Symptoms continued to worsen over the next 3 days. All investigations and laboratory parameters were unremarkable, and vital signs were stable. Risperidone was discontinued and clonazepam initiated. Three days later, the patient's symptoms were significantly improved. DISCUSSION: The symptoms described herein are consistent with neuroleptic-induced acute dystonia and potentially neuroleptic-induced parkinsonism. We believe this adverse effect occurred as a result of a drug interaction between ritonavir/indinavir and risperidone. Based on the pharmacokinetics of these medications, we hypothesize that inhibition of CYP2D6 and CYP3A4 by ritonavir and indinavir may have resulted in an accumulation of the active moiety of risperidone, which may explain the occurrence of EPS in this patient. CONCLUSIONS: This is the second published case report describing a suspected drug interaction with ritonavir, indinavir, and risperidone. Caution is warranted when risperidone is prescribed with ritonavir/indinavir, and possibly with other antiretrovirals that inhibit the same pathways.

scholarly journals Life–threatening Pulmonary Oedema Secondary to Tracheal Compression

2002 ◽  
Vol 30 (6) ◽  
pp. 804-806 ◽  
Author(s):  
H. Butterell ◽  
R. H. Riley
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Airway Obstruction ◽  
Pulmonary Oedema ◽  
Negative Pressure ◽  
Upper Airway ◽  
Tracheal Compression ◽  
Negative Pressure Pulmonary Oedema ◽  
Life Threatening ◽  
Thyroid Goitre

We present a case of negative pressure pulmonary oedema due to an overlooked cause. A 45-year-old female patient presented to the emergency department unconscious with severe pulmonary oedema. Subsequent investigations revealed a thyroid goitre causing significant tracheal compression. This case report highlights an extremely rare but potentially dangerous sequela of upper airway obstruction.

scholarly journals Development and validation of a prognostic model for early triage of patients diagnosed with COVID-19

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Chansik An ◽  
Hyun Cheol Oh ◽  
Jung Hyun Chang ◽  
Seung-Jin Oh ◽  
Jung Mo Lee ◽  
...  
Keyword(s):  
Prognostic Score ◽  
External Validation ◽  
Vital Signs ◽  
Underlying Disease ◽  
Test Results ◽  
Additional Information ◽  
Patient Will ◽  
National Cohort ◽  
Evaluation Metric ◽  
Development And Validation

AbstractWe developed a tool to guide decision-making for early triage of COVID-19 patients based on a predicted prognosis, using a Korean national cohort of 5,596 patients, and validated the developed tool with an external cohort of 445 patients treated in a single institution. Predictors chosen for our model were older age, male sex, subjective fever, dyspnea, altered consciousness, temperature ≥ 37.5 °C, heart rate ≥ 100 bpm, systolic blood pressure ≥ 160 mmHg, diabetes mellitus, heart disease, chronic kidney disease, cancer, dementia, anemia, leukocytosis, lymphocytopenia, and thrombocytopenia. In the external validation, when age, sex, symptoms, and underlying disease were used as predictors, the AUC used as an evaluation metric for our model’s performance was 0.850 in predicting whether a patient will require at least oxygen therapy and 0.833 in predicting whether a patient will need critical care or die from COVID-19. The AUCs improved to 0.871 and 0.864, respectively, when additional information on vital signs and blood test results were also used. In contrast, the protocols currently recommended in Korea showed AUCs less than 0.75. An application for calculating the prognostic score in COVID-19 patients based on the results of this study is presented on our website (https://nhimc.shinyapps.io/ih-psc/), where the results of the validation ongoing in our institution are periodically updated.

scholarly journals Angiofibrolipoma of the soft palate: A very rare cause of upper air way obstruction in an infant.

2020 ◽  
Vol 6 (1) ◽  
pp. 45-48
Author(s):  
Sonam Gyamtsho
Keyword(s):  
Case Report ◽  
Airway Obstruction ◽  
Soft Palate ◽  
Rare Case ◽  
Upper Airway ◽  
Female Child ◽  
Airway Compromise ◽  
Bipolar Cautery ◽  
History Of ◽  
Infant Case

Introduction: Infants and children are very prone to air way obstruction due to smaller and immature air ways. There are multiple causes of upper airway obstruction in infants like infections, congenital lesions and rarely tumours of the upper airway. However, angiofibrolipoma, a rare variant of lipoma causing intermittent respiratory distress in an infant has not been reported until now. Objective: To report a very rare case of angiofibrolipoma arising from the soft palate in an infant. Case report: Two and half months old female child reported to the department of otolaryngology with a history of intermittent airway obstruction since one month of age. After evaluation she was found to have a fleshy polypoidal mass above the laryngeal inlet arising from soft palate causing airway compromise. She underwent surgical excison with bipolar cautery under general anaesthesia. Conclusion: Few cases of angiofibrolipoma has been reported in adults but none has been reported in children. This is to report a case of angiofibrolipoma in child causing airway obstruction.

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