scholarly journals Bronchoscopy Manifestation In Severe COVID-19 Patient: Case Series 

2020 ◽  
Author(s):  
Allen Widysanto ◽  
Yusup Subagio Sutanto ◽  
Audrey Suryani Soetjipto ◽  
Nata Pratama Lugito ◽  
Sylvia Sagita Siahaan
Keyword(s):  
Case Series ◽  
Bronchial Wall ◽  
Case Presentation ◽  
Progressive Dyspnea ◽  
Life Saving ◽  
Significant Clinical Improvement ◽  
Bronchial Washing ◽  
Severe Manifestation ◽  
Chest X Ray ◽  
Mucus Plug

Abstract Background: Severe manifestation of COVID-19 are identical with significant inflammation and associated with high mortality due to severe hypoxemia. Bronchoscopy’s role in the management of COVID-19 patients is still controversial and minimally evaluatedCase presentation: Our case series reported unique bronchoscopy presentation. Three patients with COVID-19 were confirmed by PCR nasophryngeal swab suddenly complain of progressive dyspnea and impending respiratory failure not respond with oxygen therapy. An emergency bronchoscopy was performed. All three patient had a normal bronchial wall without inflammation and edema but showed significant thick and copious mucus plug resulting in sudden desaturation. Patient showed significant clinical improvement following bronchoscopy intervention showed by clinical and chest x-ray improvement. Conclusion : Deteriorating severe COVID-19 patient can have normal bronchial mucosa in bronchoscopy and showed marked thick and copious mucus plug. Bronchial washing and suction can be a life-saving modality as therapeutic effort. Significant improvements following the bronchial washing and suction was seen. Bronchoscopy should be performed with precaution and sufficient personal protective equipment to prevent infection transmission.

scholarly journals A case of pleuroperitoneal communication in which establishing a laparoscopic pneumoperitoneum was useful for the detection of a fistula

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Takehiko Manabe ◽  
Kenji Ono ◽  
Soichi Oka ◽  
Yuichiro Kawamura ◽  
Toshihiro Osaki
Keyword(s):  
Thoracic Surgery ◽  
Surgical Repair ◽  
Abdominal Cavity ◽  
Case Presentation ◽  
X Ray ◽  
Video Assisted Thoracic Surgery ◽  
Video Assisted ◽  
Pleuroperitoneal Communication ◽  
Small Pore ◽  
Chest X Ray

Abstract Background Pleuroperitoneal communication (PPC) is rarely observed, accounting for 1.6% of all patients who undergo continuous ambulatory peritoneal dialysis (CAPD). Although there have been several reports concerning the management of this condition, we have encountered several cases in which control failed. We herein report a valuable case of PPC in which laparoscopic pneumoperitoneum with video-assisted thoracic surgery (VATS) was useful for supporting the diagnosis and treatment. Case presentation The patient was a 58-year-old woman with chronic renal failure due to chronic renal inflammation who was referred to a nephrologist in our hospital to undergo an operation for the induction of CAPD. Post-operatively, she had respiratory failure, and chest X-ray and computed tomography (CT) showed right-sided hydrothorax that decreased when the injection of peritoneal dialysate was interrupted. Therefore, PPC was suspected, and she was referred to our department for surgical repair. We planned surgical treatment via video-assisted thoracic surgery. During the surgery, we failed to detect any lesions with thoracoscopy alone; we therefore added a laparoscopic port at her right-sided abdomen near the navel and infused CO2 gas into the abdominal cavity. On thoracoscopy, bubbles were observed emanating from a small pore at the central tendon of the diaphragm, which was considered to be the lesion responsible for the PPC. We closed it by suturing directly. Conclusions VATS with laparoscopic pneumoperitoneum should be considered as an effective method for inspecting tiny pores of the diaphragm, especially when the lesions responsible for PPC are difficult to detect.

scholarly journals A case series of ischemic stroke with coronavirus disease 2019 in two Egyptian centers

2020 ◽  
Vol 56 (1) ◽  
Author(s):  
Nevine El Nahas ◽  
Tamer Roushdy ◽  
Eman Hamid ◽  
Sherien Farag ◽  
Hossam Shokri ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Severe Acute Respiratory Syndrome ◽  
Cerebrovascular Disorders ◽  
Case Series ◽  
Neurological Manifestations ◽  
Case Presentation ◽  
Novel Virus

Abstract Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel virus that has been reported to have various neurological manifestations. Cerebrovascular disorders have been encountered as a coronavirus disease 2019 (COVID-19) presentation in our center during the pandemic. Case presentation We are presenting 10 cases with cerebrovascular manifestations after having COVID-19 few days prior to stroke. Conclusion Cerebrovascular manifestations can occur in association with COVID-19 and may have significant implications on prognosis and management.

scholarly journals Incidental whole-body MRI evidence of COVID-19 in an asymptomatic patient in a high prevalence region

2020 ◽  
Vol 51 (1) ◽  
Author(s):  
Valentina Angelini ◽  
Alberta Villanacci ◽  
Angelo Belotti ◽  
Francesca Castagnoli ◽  
Barbara Frittoli ◽  
...  
Keyword(s):  
Asymptomatic Patient ◽  
Whole Body ◽  
Diagnostic Tools ◽  
Historical Period ◽  
Case Presentation ◽  
Whole Body Mri ◽  
High Prevalence ◽  
Chest X Ray ◽  
Full Knowledge ◽  
Polymerase Chain

Abstract Background The purpose of this case report is to emphasize the importance of curing any clinical radiological elements in this historical period, especially in the area of endemic to coronavirus disease 19 (COVID-19) such as Lombardy and to stress the importance of the management of the asymptomatic patient, their crucial role in the spread of contagion. Case presentation We reported the case of incidental diagnosis of interstitial pneumonia by first finding on whole-body MR (WB-MR) in the patient affected by multiple myeloma (MM), with a negative respiratory symptoms at the time and with previous (1 month before) negative chest X-ray. The patient was promptly subjected to chest CT, which confirmed the suspicion of interstitial COVID-19 pneumonia and, in hospitalization, performed nasopharyngeal swabs for real-time polymerase chain reaction (RNA-PCR), with a doubtful outcome. Once the bacterial nature of the alterations was serologically and radiologically excluded, the patient was definitively diagnosed with COVID-19 and appropriately treated in hospitalization. Conclusion The clinical choices must, therefore, to make use of all the diagnostic tools available and full knowledge of the limitation of each of them.

scholarly journals An Endovascular Surgery Experience in Far-Forward Military Healthcare—A Case Series

2020 ◽  
Vol 185 (11-12) ◽  
pp. 2183-2188
Author(s):  
Daniel J Coughlin ◽  
Jason H Boulter ◽  
Charles A Miller ◽  
Brian P Curry ◽  
Jacob Glaser ◽  
...  
Keyword(s):  
Case Series ◽  
Interventional Neuroradiology ◽  
Military Hospital ◽  
Lingual Artery ◽  
Trauma Patients ◽  
Military Hospitals ◽  
Life Saving ◽  
Military Healthcare ◽  
Internal Iliac ◽  
First World

Abstract Summary   Introduction The advancement of interventional neuroradiology has drastically altered the treatment of stroke and trauma patients. These advancements in first-world hospitals, however, have rarely reached far forward military hospitals due to limitations in expertise and equipment. In an established role III military hospital though, these life-saving procedures can become an important tool in trauma care. Materials and Methods We report a retrospective series of far-forward endovascular cases performed by 2 deployed dual-trained neurosurgeons at the role III hospital in Kandahar, Afghanistan during 2013 and 2017 as part of Operations Resolute Support and Enduring Freedom. Results A total of 15 patients were identified with ages ranging from 5 to 42 years old. Cases included 13 diagnostic cerebral angiograms, 2 extremity angiograms and interventions, 1 aortogram and pelvic angiogram, 1 bilateral embolization of internal iliac arteries, 1 lingual artery embolization, 1 administration of intra-arterial thrombolytic, and 2 mechanical thrombectomies for acute ischemic stroke. There were no complications from the procedures. Both embolizations resulted in hemorrhage control, and 1 of 2 stroke interventions resulted in the improvement of the NIH stroke scale. Conclusions Interventional neuroradiology can fill an important role in military far forward care as these providers can treat both traumatic and atraumatic cerebral and extracranial vascular injuries. In addition, knowledge and skill with vascular access and general interventional radiology principles can be used to aid in other lifesaving interventions. As interventional equipment becomes more available and portable, this relatively young specialty can alter the treatment for servicemen and women who are injured downrange.

Thrombosed Urethral Prolapse: a case series and review of the literature

2021 ◽  
pp. 205141582110328
Author(s):  
Abisola Oliyide ◽  
Ijeoma Chibuzo ◽  
Magda Kujawa
Keyword(s):  
Clinical Condition ◽  
Correct Diagnosis ◽  
Age Distribution ◽  
Case Series ◽  
Review Of The Literature ◽  
Level Of Evidence ◽  
Case Presentation ◽  
Urethral Prolapse ◽  
Evidence Level

Thrombosed urethral prolapse is a rare clinical condition. In this context, we describe our experience and compare our findings with the literature, following presentation of five consecutive cases over 2 years. This will hopefully improve awareness and appropriateness of specialty referrals as a correct diagnosis is rarely established prior to the patient being seen by a urologist. We also wish to highlight a case presentation of thrombosed urethral prolapse outside the bimodal age distribution which has been recorded in the literature. Level of Evidence: Level 4

scholarly journals Mycoplasma hyorhinis as a possible cause of fibrinopurulent meningitis in pigs? - a case series

2020 ◽  
Vol 6 (1) ◽  
Author(s):  
Moritz Bünger ◽  
Rene Brunthaler ◽  
Christine Unterweger ◽  
Igor Loncaric ◽  
Maximiliane Dippel ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Clinical Signs ◽  
Case Series ◽  
Upper Respiratory Tract ◽  
Mycoplasma Hyorhinis ◽  
Case Presentation ◽  
Systemic Spread ◽  
In Situ Detection ◽  
On Farm

Abstract Background Mycoplasma hyorhinis is an invader of the upper respiratory tract in swine that is considered to have ubiquitous distribution. It is mainly known for causing polyserositis and polyarthritis in weaned piglets, even though the mechanisms of systemic spread are not fully understood. Mycoplasma hyorhinis has also been associated with other diseases in pigs such as pneumonia or otitis media, but so far has not been known to cause central nervous disorders. This case series reports the isolation of Mycoplasma hyorhinis from cerebrospinal fluid and/ or meningeal swabs from piglets originating from four different piglet producing farms in Austria. Case presentation On farm 1, coughing, stiff movement and central nervous signs occurred in nursery piglets. Mycoplasma hyorhinis was the only pathogen isolated from meningeal swabs from two piglets showing central nervous signs. Fibrinopurulent leptomeningitis was only observed in one piglet. Only one of two nursery piglets from farm 2 showed mild central nervous signs but no histologic lesions; Mycoplasma hyorhinis was isolated from cerebrospinal fluid of the piglet with neurologic signs. Mycoplasma hyorhinis was isolated from cerebrospinal fluid of all three investigated piglets from farm 3, all of which showed central nervous signs and purulent leptomeningitis. Further, Streptococcus suis was isolated from the cerebrospinal fluid of one piglet. Fibrinopurulent leptomeningitis was detected in two piglets from farm 4 that had died overnight without showing any clinical signs and Mycoplasma hyorhinis was isolated from meningeal swabs from both piglets. Conclusion While causality has yet to be proven by experimental infection and in situ detection of the pathogen in histologic sections, the findings of this study and the absence of other pathogens suggest Mycoplasma hyorhinis as a potential causative agent of meningitis in swine.

scholarly journals NUDT15 polymorphism explains serious toxicity to azathioprine in Indian patients with chronic immune thrombocytopenia and autoimmune hemolytic anemia: a case series

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Anup J. Devasia ◽  
Raveen Stephen Stallon Illangeswaran ◽  
Infencia Xavier Raj ◽  
Biju George ◽  
Poonkuzhali Balasubramanian
Keyword(s):  
Hemolytic Anemia ◽  
Autoimmune Hemolytic Anemia ◽  
Immune Thrombocytopenia ◽  
Case Series ◽  
Severe Toxicity ◽  
Toxic Side Effect ◽  
Case Presentation ◽  
Oral Ulcers ◽  
Asian Patients ◽  
Life Threatening

AbstractObjectivesAzathioprine (AZA) is a commonly used immunosuppressant in patients with autoimmune diseases. The toxic side effect to AZA (myelosuppression, hair loss, and oral ulcers) are highly unpredictable which can be life threatening if not identified earlier and dose adjustments made or the drug is withdrawn.Case presentationHere we report a case series of five patients with severe toxicity while on treatment with AZA for autoimmune hemolytic anemia (n=1) and Immune thrombocytopenia (n=4). The common thiopurine methyltransferase (TPMT) variants (TPMT*2, *3A, *3B) were not present in these patients. However, all these patients had the NUDT15 415C>T variant that has been reported to explain serious toxicity to thioguanine in Asian patients.ConclusionsOur report suggests pre-emptive genotype-based dosing of AZA could reduce adverse toxicity and hence better outcome.

scholarly journals Rituximab Therapy in Renal Amyloidosis Secondary to Rheumatoid Arthritis

Biomolecules ◽  
2018 ◽  
Vol 8 (4) ◽  
pp. 136 ◽  
Author(s):  
Levent Kilic ◽  
Abdulsamet Erden ◽  
Yusuf Sener ◽  
Berkan Armagan ◽  
Alper Sari ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Improvement ◽  
Inflammatory Diseases ◽  
Case Series ◽  
New Drugs ◽  
Renal Amyloidosis ◽  
Secondary Amyloidosis ◽  
Aa Amyloidosis ◽  
Amyloid A ◽  
Significant Clinical Improvement

Secondary amyloid A (AA) amyloidosis is a late and serious complication of poorly controlled, chronic inflammatory diseases. Rheumatoid arthritis (RA) patients with poorly controlled, longstanding disease and those with extra-articular manifestations are under risk for the development of AA amyloidosis. Although new drugs have proven to be significantly effective in the treatment of secondary AA amyloidosis, no treatment modality has proven to be ideal. To date, only in small case series preliminary clinical improvement have been shown with rituximab therapy for AA amyloidosis secondary to RA that is refractory to TNF-α inhibitors (TNF-i) therapy. In these case series, we assessed the efficacy and safety of rituximab therapy for patients with RA and secondary amyloidosis. Hacettepe University Biologic Registry was developed at 2005. The data of the RA patients who were prescribed a biological drug were recorded regularly. Patients with biopsy proven AA amyloidosis patients were screened. Of 1022 RA patients under biologic therapy, 0.7% patients had clinically apparent histologically confirmed amyloidosis. Four of seven patients who were prescribed rituximab at least one infusion enrolled to those case series. Two of four patients showed significant clinical improvement and one of them also had decrease in proteinuria and the other one had stable renal function and proteinuria. The main goal for the treatment of AA amyloidosis is to control the activity of the underlying disorder. In this study, we showed that rituximab may be an effective treatment in RA patients with amyloidosis who were unresponsive to conventional disease modifying anti-rheumatic drugs (DMARDs) and/or TNFi.

Successful treatment of arthritis induced by checkpoint inhibitors with tocilizumab: a case series

2017 ◽  
Vol 76 (12) ◽  
pp. 2061-2064 ◽  
Author(s):  
Sang Taek Kim ◽  
Jean Tayar ◽  
Van Anh Trinh ◽  
Maria Suarez-Almazor ◽  
Salvador Garcia ◽  
...  
Keyword(s):  
Checkpoint Inhibitors ◽  
Case Reports ◽  
Unmet Need ◽  
Case Series ◽  
Receptor Antibody ◽  
Improved Outcomes ◽  
Clinical Scenarios ◽  
Significant Clinical Improvement ◽  
Tnfα Inhibitor ◽  
Factor Α

BackgroundImmune checkpoint inhibitors (ICIs) have significantly improved outcomes for patients with numerous cancers. However, these therapies are associated with immune-related adverse events (irAEs), which are inflammatory side effects potentially affecting any organ. Cases of ICI-induced inflammatory arthritis have also been reported. In general, mild irAEs are treated with corticosteroids, while tumour necrosis factor-α (TNFα) inhibitors are reserved for refractory cases. However, prolonged use of TNFα inhibitor (TNFαi) can induce widespread, significant immunosuppression, which can negatively impact the antitumour efficacy of ICI therapy. Therefore, in clinical scenarios where patients develop severe immunotherapy-induced irAEs, an unmet need exists for alternative therapeutic strategies that are effective and without immune dampening effects.Case reportsThe anti-interleukin (IL)−6 receptor antibody, tocilizumab, is a biological agent Food and Drug Administration approved for the treatment of rheumatoid arthritis and juvenile idiopathic arthritis. Here, we report on three patients who developed severe polyarthritis while receiving ICI therapy and were treated with tocilizumab. All three patients demonstrated significant clinical improvement; one patient maintained a durable antitumour response derived from checkpoint inhibition.ConclusionsThese three cases suggest that anti-IL-6 receptor antibody may be an effective alternative to corticosteroids or TNFαi for the treatment of arthritis irAEs.

scholarly journals Hoarseness of Voice as a Rare Presentation of Tuberculosis: A Case Report Study

2019 ◽  
Vol 7 (19) ◽  
pp. 3262-3264
Author(s):  
Taher Felemban ◽  
Abdullah Ashi ◽  
Abdullah Sindi ◽  
Mohannad Rajab ◽  
Zuhair Al Jehani
Keyword(s):  
Laryngeal Carcinoma ◽  
Incidental Finding ◽  
Chain Reaction ◽  
Rare Presentation ◽  
Case Presentation ◽  
X Ray ◽  
History Of ◽  
Chest X Ray ◽  
Polymerase Chain ◽  
Laryngeal Tuberculosis

BACKGROUND: Having hoarseness of voice as the first clinical manifestation of tuberculosis is rare. This atypical presentation causes some confusion since other more common conditions, such as laryngeal carcinoma, present similarly and might require more invasive tests to confirm the diagnosis. CASE PRESENTATION: A 38-year-old male presented to the otorhinolaryngology clinic with a four-month history of change in voice. Laryngoscopy demonstrated a right glottic mass, raising suspicion of laryngeal cancer. The computed tomography showed a mass and incidental finding of opacities in lung apices. Chest x-ray demonstrated findings suggestive of tuberculosis. Polymerase chain reaction and culture of sputum samples confirmed the diagnosis and the patient was started on anti-tuberculosis treatment. CONCLUSION: Despite accounting for only 1% of pulmonary tuberculosis cases and having a similar presentation to laryngeal carcinoma, we recommend considering laryngeal tuberculosis when evaluating hoarseness of voice in endemic areas.

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