scholarly journals Prehospital Period in Patients with COVID-19: Cardiovascular Comorbidity and Pharmacotherapy During the First Epidemic Wave (Hospital Registry Data)

2022 ◽  
Vol 17 (6) ◽  
pp. 873-879
Author(s):  
S. Yu. Martsevich ◽  
M. M. Lukyanov ◽  
M. M. Pulin ◽  
N. P. Kutishenko ◽  
E. Yu. Andreenko ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Antihypertensive Drugs ◽  
Lung Ventilation ◽  
Antiplatelet Agents ◽  
Community Acquired Pneumonia ◽  
Low Frequencies ◽  
Entire Cohort ◽  
Cardiovascular Comorbidity ◽  
Medical Histories ◽  
Hospital Registry

Aim. Based on the data from the register of patients with COVID-19 and community-acquired pneumonia (CAP), analyze the duration of the prehospital period, cardiovascular comorbidity and the quality of prehospital pharmacotherapy of concomitant cardiovascular diseases (CVD).Material and methods. Patients were included to the study which admitted to the FSBI "NMHC named after N.I. Pirogov" of the Ministry of Health of the Russian Federation with a suspected or confirmed diagnosis of COVID-19 and/or CAP. The data for prehospital therapy, information from medical histories and a patients’survey in the hospital or by telephone contact 1-2 weeks after discharge were study. The duration of the prehospital stage was determined from the date of the appearance of clinical symptoms of coronavirus infection to the date of hospitalization.Results. The average age of the patients (n=1130; 579 [51.2%] men and 551 [48.8%] women) was 57.5±12.8 years. The prehospital stage was 7 (5,0; 10,0) days and did not differ significantly in patients with the presence and absence of CVD, but was significantly less in the deceased than in the surviving patients, as well as in those who required artificial lung ventilation (ALV). 583 (51.6%) patients had at least one CVD. Cardiovascular comorbidity was registered in 222 (42.7%) patients with hypertension, 210 (95.5%) patients with coronary heart disease (CHD), 104 (91.2%) patients with atrial fibrillation (AF). The inclusion of non-cardiac chronic diseases in the analysis led to an increase in the total proportion of patients with concomitant diseases to 65.8%. Approximately a quarter of hypertensive patients did not receive antihypertensive therapy, a low proportion of patients receiving antiplatelet agents and statins for CHD was revealed – 53% and 31.8%, respectively, anticoagulants for AF – 50.9%.Conclusion. The period from the onset of symptoms to hospitalization was significantly shorter in the deceased than in the surviving patients, as well as in those who required ALV. The proportion of people with a history of at least one CVD was about half of the entire cohort of patients. In patients with CVD before COVID-19 disease, a low frequencies of prescribing antihypertensive drugs, statins, antiplatelet agents and anticoagulants (in patients with AF) were recorded at the prehospital stage.

scholarly journals Rare incidence of non-secretory myeloma with talaromycosis: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Haiting Qin ◽  
Ye Qiu ◽  
Yanmei Huang ◽  
Mianluan Pan ◽  
Dong Lan ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Bone Marrow ◽  
Differential Diagnosis ◽  
Lymph Nodes ◽  
Clinical Symptoms ◽  
Subcutaneous Tissue ◽  
Community Acquired Pneumonia ◽  
Pathological Examination ◽  
Subcutaneous Nodules ◽  
Lung Lymph

Abstract Background Talaromyces marneffei (TM) primarily infects patients with co-morbidities that cause immunodeficiency, but non-secretory myeloma (NSMM) is rare. TSM and NSMM are associated with fever, osteolysis, and swollen lymph nodes, thereby making it difficult for clinicians to make differential diagnosis. In this case, we describe TM infection coexisting with NSMM. Case presentation We retrospectively reviewed the case of a male (without human immunodeficiency virus infection) with fever, thoracalgia, swollen lymph nodes, and subcutaneous nodules who presented to the First Affiliated Hospital of Guangxi Medical University in February 2014. Chest computed tomography revealed patchy infiltration and positron emission tomography/computed tomography showed increased metabolic activity in the lower-right lung, lymph nodes, left ninth rib, and right ilium. Pathological examination of the lung, lymph nodes, subcutaneous nodules, and bone marrow showed no malignancy, he was diagnosed with community-acquired pneumonia. His clinical symptoms did not improve after anti-bacterial, anti-Mycobacterium tuberculosis, and anti-non-M. tuberculosis treatment. Later, etiological culture and pathological examination of the subcutaneous nodule proved TM infection, and the patient was re-diagnosed with disseminated TSM, which involved the lungs, lymph nodes, skin, bone, and subcutaneous tissue. After antifungal treatment, the patient showed significant improvement, except for the pain in his bones. Imaging showed aggravated osteolysis, and bone marrow biopsy and immunohistochemistry indicated NSMM. Thus, we conclusively diagnosed the case as NSMM with TSM (involving the lungs, lymph nodes, skin, and subcutaneous tissue). His condition improved after chemotherapy, and he was symptom-free for 7 years. Conclusion TM infection is rare in individual with NSMM. Since they have clinical manifestation in common, easily causing misdiagnosis and missed diagnosis, multiple pathological examinations and tissue cultures are essential to provide a differential diagnosis.

scholarly journals Mutations in domain V of Mycoplasma pneumoniae 23S rRNA are not associated with clinical characteristics of M. pneumoniae pneumonia in children: a case control study

2020 ◽  
Author(s):  
Huan Deng ◽  
Yifan Zhu ◽  
Jiamin Zhang ◽  
Qiangquan Rong ◽  
Yao Quan ◽  
...  
Keyword(s):  
Mycoplasma Pneumoniae ◽  
Lymphocyte Count ◽  
Clinical Characteristics ◽  
Clinical Symptoms ◽  
Laboratory Data ◽  
Point Mutations ◽  
Community Acquired Pneumonia ◽  
Pulmonary Complications ◽  
23S Rrna ◽  
Domain V

Abstract Background Mycoplasma pneumoniae (MP) is a common agent of community-acquired pneumonia in children and young adults that can lead to refractory or persistent Mycoplasma pneumoniae pneumonia (MPP). Macrolide-resistant MP harbors point mutations in domain V of 23S ribosomal Ribonucleic Acid (rRNA) with substitutions detected at positions 2063, 2064, 2067 and 2617. This study’s purpose is to investigate the prevalence and clinical characteristics of mutations in domain V of MP 23S rRNA. Methods We sequenced the 23S rRNA domain V of MP strains collected from children with MPP. Clinical and laboratory data were also obtained, including gender, age, duration of fever, duration of fever after the start of macrolide therapy, MP-Deoxyribonucleic Acid (DNA) load at enrollment, leukocyte count, neutrophil count, and lymphocyte count, immunomodulators treatment and pulmonary complications.Results Of 276 strains, 255 (92.39 %) harbored A to G transition at the position 2063 (A2063G), and 21 (7.61 %) were not mutated. There were no significant differences in gender, age, duration of fever, duration of fever after the start of macrolide therapy, MP-DNA load at enrollment, hospitalization days, lymphocyte count and pulmonary complications when patients were stratified based on the presence or absence of domain V mutations. We also found that children with refractory MPP experienced higher MP-DNA load than the non-refractory MPP, but the prevalence of domain V mutations was comparable.Conclusions We found that clinical MP strains harbored very high mutation rate in 23S rRNA domain V, especially A2063G mutation. However, these mutations were not associated with clinical symptoms, laboratory results, pulmonary complications and development of refractory pneumonia. Instead, MP-DNA load was significantly different between refractory and non-refractory MPP.

scholarly journals Postoperative Adjuvant Radiotherapy Can Delay the Recurrence of Desmoid Tumors After R0 Resection in Certain Subgroups

2021 ◽  
Vol 8 ◽  
Author(s):  
Tielong Yang ◽  
Haotian Liu ◽  
Zhichao Liao ◽  
Chao Zhang ◽  
Lijie Xiang ◽  
...  
Keyword(s):  
Adjuvant Radiotherapy ◽  
Clinical Symptoms ◽  
Tumor Resection ◽  
Final Analysis ◽  
Postoperative Recurrence ◽  
R0 Resection ◽  
Tumor Diameter ◽  
Desmoid Tumors ◽  
Entire Cohort ◽  
Single Tumor

Background: When patients with desmoid tumors (DTs) present uncontrolled clinical symptoms, surgery is an effective treatment, but the high postoperative recurrence rate is a major problem. The significance of adjuvant radiotherapy has been debated for many years, and the significance of aggressive surgery has not been reported.Methods: Medical records for DT patients were collected. KM analysis and the Mann–Whitney U-test were performed to evaluate the role of radiotherapy and aggressive surgery in the entire cohort and different subgroups.Results: Of 385 DT patients, 267 patients with R0 resection were included in the final analysis. A total of 53 patients (19.85%) experienced recurrence. Although radiotherapy showed no significant effect on recurrence-free survival (RFS) or time to recurrence (TTR) in the entire cohort, radiotherapy delayed recurrence in the age ≤ 30 years old subgroup (TTR = 35 months with surgery plus radiotherapy, TTR = 11 months with surgery alone; p = 0.014) and the tumor diameter >5 cm subgroup (TTR = 26 months with surgery plus radiotherapy, TTR = 11 months with surgery alone; p = 0.02) among patients with a single tumor. Aggressive surgery improved RFS in the tumor diameter >5 cm subgroup (p = 0.049) but not the entire cohort.Conclusions: Although radiotherapy cannot improve RFS, it can delay recurrence in the age ≤ 30 years old subgroup and the tumor diameter >5 cm subgroup among patients with a single tumor. For patients with large invasive tumors and multiple involved sites, aggressive surgery could be selected to achieve complete tumor resection to improve RFS.

scholarly journals COVID-19 pandemic in children of Сhernivtsi region: clinical features and annual treatment experience

2021 ◽  
Vol 16 (3) ◽  
pp. 225-232
Author(s):  
O.K. Кoloskova ◽  
T.M. Bilous ◽  
N.V. Gopko ◽  
M.B. Myroniuk
Keyword(s):  
Dynamic Analysis ◽  
Clinical Features ◽  
Odds Ratio ◽  
Inpatient Treatment ◽  
Clinical Symptoms ◽  
Community Acquired Pneumonia ◽  
Upper Respiratory Tract ◽  
The Third ◽  
Upper Respiratory ◽  
Inflammatory Syndrome

Background. The pandemic of coronavirus disease (COVID-19) has been going on for more than a year and is a problem for the health care system worldwide. At the same time, there are few studies on the peculiarities of COVID-19 in children, in particular how clinical symptoms have changed during the year with the change of types of coronavirus SARS-CoV-2. Objective was to conduct a retrospective generalized analysis of the clinical course, laboratory markers and features of treatment in pediatric cases of ­COVID-19 in Chernivtsi region. Materials and me­thods. Using the retrospective cohort method, 263 clinical cases of ­COVID-19 in children of the Chernivtsi region hospitalized for the period of March 2020 — March 2021 were analyzed. Results. In this work, a dynamic analysis was performed of the clinical features of ­COVID-19 course in the population of children of Chernivtsi region, who were hospitalized during March 2020 — March 2021 at inpatient departments with signs of infection caused by ­SARS-CoV-2. The first group included 65 patients who were treated in the second quarter of 2020, the second group consisted of 90 children who underwent inpatient treatment in the third quarter of 2020, the third group included 87 children who were treated in the fourth quarter of 2020, and the fourth group consisted of 21 children who underwent inpatient treatment in the first quarter of 2021. It was found that the frequency of complaints of malaise was due to infectious-inflammatory, intoxication and catarrhal symptom complexes, although in contrast to the onset of the pandemic, the complaints and signs of intoxication and asthenic syndromes, infectious-inflammatory syndromes, nonspecific neurological symptoms increased with a relatively stable rate of lesions of the upper respiratory tract. In the first quarter of 2021, there was an increase in cases of multisystem inflammatory syndrome (odds ratio = 6.5) and community-acquired pneumonia (odds ratio = 2.7). Conclusions. A dynamic analysis of the course of COVID-19 in children has demonstrated phenotypic deviations of the disease with torpidity to the prescribed treatment for nonspecific symptoms of disorders of the nervous system and gastrointestinal tract with a decrease in duration and severity of fever, increased incidence of pneumonia (odds ratio = 2.7) and multisystem inflammatory syndrome (odds ratio = 6.5).

scholarly journals Pneumonia with negative chest radiography in early childhood: is it a real phenomenon or diagnostic error?

2020 ◽  
Vol 1 (2) ◽  
pp. 31-37
Author(s):  
Sofya A. Tsarkova ◽  
Alexander N. Abdullaev ◽  
Darya A. Surovceva ◽  
Anna V. Pomazkina
Keyword(s):  
Early Childhood ◽  
Chest Radiography ◽  
Complete Blood Count ◽  
Group Versus ◽  
Diagnostic Error ◽  
Community Acquired Pneumonia ◽  
Negative Results ◽  
Comparator Group ◽  
Breath Sounds ◽  
Medical Histories

Background. The existence of community-acquired pneumonia with negative chest radiography (CAPNR) as a clinical phenomenon remains disputable until now. This phenomenon is deemed to occur in subjects with dehydration, neutropenia, diminished immune response. In case of CAPNR the possibility of diagnostic error and ensuing irrational use of antimicrobial drugs is fairly high.Objective. The study aimed at establishing the validity of diagnosis of pneumonia with negative chest radiography in children, using a comparative evaluation of clinical and laboratory criteria amid positive and negative results of radiological diagnosis of pneumonia.Methods. A one-time study was conducted which included analysis of medical documents selected by continuous sampling method, and comparison of children with CAPNR versus children with radiologically confirmed pneumonia. The comparison was based on analysis of medical histories, clinical pictures and results of paraclinical investigations.Results. A total of 35 medical histories have been analyzed (mean age of patients – 1.7 ± 0.2 years), of which 17 children were assigned to group 1 (CAPNR group) and 18 children to group 2 (pneumonia with positive radiography). Most clinical and laboratory signs in early childhood were similar for children with CAPNR and children with radiologically confirmed pneumonia. Veritable differences in terms of respiratory symptoms have been found for children with CAPNR, namely, expiratory dyspnea in 35.29% of children with CAPNR versus none in the comparator group (p < 0.05), respiratory rate (RR) — 33 ± 7.2/min versus 28 ± 7.3/ min in the comparator group (p < 0.05), and auscultatory findings showing predominantly diminished breath sounds on the right-hand side. Complete blood count showed differences in granulocyte counts — 70 ± 12.6% in the CAPNR group versus 62.9 ± 16.8% in the comparator group (p < 0.05). A combination of the majority of classical symptoms of community-acquired pneumonia has been rarely observed in either group (5.9% and 11.1%, respectively).Conclusion. Particular features of the CAPNR did not allow us to speak out with confidence in favor or against the diagnosis of community-acquired pneumonia (CAP) in patient groups. The conduct of prospective studies looking into the etiology of pneumonia, using radiologic and ultrasound diagnosis and analyzing clinical and laboratory particulars of CAP would be a worthwhile undertaking. Without radiographic identification of infiltrative changes the diagnosis of CAP remains problematic.

scholarly journals Management of Vascular Thrombosis in Patients with Thrombocytopenia

2021 ◽  
Author(s):  
Minna Voigtlaender ◽  
Florian Langer
Keyword(s):  
Paroxysmal Nocturnal Hemoglobinuria ◽  
Clinical Symptoms ◽  
Antiplatelet Agents ◽  
Bleeding Risk ◽  
Antithrombotic Drugs ◽  
Heparin Induced Thrombocytopenia ◽  
Myelosuppressive Chemotherapy ◽  
Hematological Disorders ◽  
Platelet Counts ◽  
Risk Of Bleeding

AbstractPlatelets play critical roles in hemostasis and thrombosis. While low platelet counts increase the risk of bleeding, antithrombotic drugs, including anticoagulants and antiplatelet agents, are used to treat thromboembolic events. Thus, the management of thrombosis in patients with low platelet counts is challenging with hardly any evidence available to guide treatment. Recognition of the underlying cause of thrombocytopenia is essential for assessing the bleeding risk and tailoring therapeutic options. A typical clinical scenario is the occurrence of venous thromboembolism (VTE) in cancer patients experiencing transient thrombocytopenia during myelosuppressive chemotherapy. In such patients, the severity of thrombocytopenia, thrombus burden, clinical symptoms, and the timing of VTE relative to thrombocytopenia must be considered. In clinical practice, distinct hematological disorders characterized by low platelet counts and a thrombogenic state require specific diagnostics and treatment. These include the antiphospholipid syndrome, heparin-induced thrombocytopenia (HIT) and (spontaneous) HIT syndromes, disseminated intravascular coagulation, and paroxysmal nocturnal hemoglobinuria.

scholarly journals Erythema Multiforme Major Associated With Community-Acquired Pneumonia: Lessons From a Case Report

2021 ◽  
Vol 9 ◽  
Author(s):  
Xiaomei Fan ◽  
Yong Luo ◽  
Jieluan Lu ◽  
Jinji Xu ◽  
Qing Chen ◽  
...  
Keyword(s):  
Case Report ◽  
Erythema Multiforme ◽  
Clinical Symptoms ◽  
Specific Treatment ◽  
Human Leukocyte ◽  
Community Acquired Pneumonia ◽  
The Body ◽  
Drug Induced ◽  
Chemical Structures ◽  
Erythema Multiforme Major

Background: Erythema multiforme (EM) is an acute immune-mediated inflammatory mucinous skin disorder. The etiology of pediatric EM involves infections, medications, autoimmune diseases, and genetic factors.Case Report: An 8-year-old girl with Mycoplasma pneumoniae (MP) associated community-acquired pneumonia developed erythema target-like symptoms 1 week after azithromycin administration. The erythema quickly spread throughout the body involving the oral and ocular mucous membranes, the trunk, and the extremities, and eventually developed into erythema multiform major (EMM). Through drug withdrawal and specific treatment including systemic corticosteroids and supportive care, her clinical symptoms were improved. After 31 days, most of the mucocutaneous symptoms were relieved, except pigmentation. Human leukocyte antigen (HLA) gene sequencing was performed and 20 HLA genotypes were identified. The patient follow-up lasted for 18 months. Rashes appeared on her trunk when receiving azithromycin orally after discharge and then disappeared after azithromycin withdrawal.Conclusions: Pediatric EM is a rare disease and recognition of its etiology is important for EM management. In this case, azithromycin and HLA-DQB1*03:01 genotype may contribute to EMM.Lesson: For drug-induced EM, rapid identification and withdrawal of the causative drugs is critical. Re-exposure to the same drug or exposure to drugs with similar chemical structures should also be avoided. Patient education and rational use of medicines are essential for pediatric patients.

scholarly journals Differential diagnosis of bilateral lungs opacities in the hospital for admission of community-acquired pneumonia – not only COVID-19

2020 ◽  
Vol 24 (2) ◽  
pp. 78-95
Author(s):  
A. S. Vinokurov ◽  
O. I. Belenkaya ◽  
E. A. Zolotova ◽  
S. V. Michurina ◽  
O. O. Vinokurova ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Clinical Laboratory ◽  
Clinical Symptoms ◽  
Community Acquired Pneumonia ◽  
Lung Damage ◽  
Ground Glass ◽  
Small Areas ◽  
Radiological Data ◽  
Coronavirus Infection ◽  
To Receive

Due to the current epidemiological situation caused by the spread of the new SARS-CoV-2 coronavirus, in March 2020 several Moscow hospitals were completely or partially redesigned to receive patients with community- acquired pneumonia.Purpose. The aim of the survey is to analyze clinical, laboratory and radiological data in patients with coronavirus infection at the early stages of its spread in Russia, and to clarify diseases for differential diagnosis mainly based on CT evidence.Materials and methods. We studied data from 21 patients with verified coronavirus infection admitted to the hospital for community-acquired pneumonia. Clinical symptoms, laboratory and physical indicators, as well as typical lung changes on the CT were evaluated.Results. Major clinical symptoms in coronavirus patients are fever (100%), cough (90.5%), shortness of breath (76.1%). Laboratory indicators showed increases in CRP (85.7%), leukocytosis (66.6%), and LDG (84.6%). According to CT, 95.2% of lung changes involved both sides, and 66.7% occurred in all lung fields. The sign of “ground glass” was observed in a 100% of the cases, its combination with the “paving stone” – in 61,9%, “ground glass” coupled with small areas of consolidations were detected in 33,3% of the cases. Changes such as nodules, cavities and massive areas of consolidation were not identified.Conclusion. On the basis of our own data we confirmed the main trends of diagnostics and clinical features, which were identified by authors from Asia and Europe, who faced this infection earlier, and also considered important CT characteristics useful for differential diagnosis of coronavirus lung damage and other lung diseases.

scholarly journals Pharmaco-economic features of hospital treatment of acute community-acquired pneumonia in children

2021 ◽  
Vol 25 (3 (99)) ◽  
pp. 77-82
Author(s):  
Y. Nechytailo ◽  
N. Popelyuk ◽  
O. Dolzhenko
Keyword(s):  
Clinical Symptoms ◽  
Community Acquired Pneumonia ◽  
Point Of View ◽  
Fourth Generation ◽  
Hospital Treatment ◽  
Cost Of Treatment ◽  
Economic Point ◽  
Corticosteroid Hormones ◽  
Treatment Measures ◽  
Pathogenetic Therapy

The goal. Тo analyze the features of treatment and medical expenses in children hospitalized for acute community-acquired pneumonia. Materials and methods. The study analyzed medical records and examined 51 children aged 2 to 17 months hospitalized for pneumonia. In patients studied clinical symptoms, severity, structure and duration of basic treatment measures, their cost. Results. The duration of inpatient treatment was 13.3±0.62 days with subsequent outpatient treatment and rehabilitation. Antibiotics, antipyretics, antihistamines, mucolytics and corticosteroid hormones were used in the treatment. The total cost of treatment for one case averaged 2346.9±145.7 hryvnias. The most expensive were the costs of antibiotics, and the cheapest - the antipyretics. Given the community-acquired nature of the process, the initial use of third- and fourth-generation cephalosporins was irrational and significantly increased the cost of treatment. Conclusions. The introduction of a new model of medicine focuses on the optimization of treatment tactics and the rational choice of antibiotics for acute community-acquired pneumonia. In antibacterial therapy is still inadequate, from a clinical and economic point of view, the choice of drugs. In the treatment of this disease, the role of pathogenetic therapy to restore the processes of mucociliary clearance and prevention of dysbiosis on the background of the use of antibiotics has increased.

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