scholarly journals Role of markers of inflammation, severity and infusion therapy in COVID-19-defined pneumonia

2020 ◽  
pp. 80-82
Author(s):  
E.M. Khodosh
Keyword(s):  
Respiratory Failure ◽  
Clinical Manifestations ◽  
Lung Parenchyma ◽  
Diagnostic Process ◽  
Infusion Therapy ◽  
Shortness Of Breath ◽  
X Ray ◽  
Markers Of Inflammation ◽  
Arterial Blood ◽  
D Dimer

Background. Coronavirus disease (COVID-19) is likely to remain an important differential diagnosis in the next 2 years for anyone seeing a doctor with a flu-like condition, lymphopenia and/or a change in smell (anosmia) or taste. Objective. To consider by what markers of inflammation it is possible to diagnose the severity of COVID-19-defined pneumonia with the possibility of its infusion correction. Materials and methods. The clinical manifestations of the disease by severity can be classified into five forms: asymptomatic, but rather presymptomatic, according to clinical manifestations, infectious process can be attributed to persons with a positive PCR-test result for SARS-CoV-2 and normal C-reactive protein (CRP), interleukin-6 (IL-6) and ferritin. Lymphopenia is a negative prognostic factor. A mild course of the disease is characterized by any of the different signs and symptoms (eg, fever, cough, sore throat, malaise, headache, muscle pain) without shortness of breath or with shortness of breath, or with atypical images on chest radiographs and within 10-15 % lesion and still normal CRP, IL-6 and ferritin (~70-80 %). Moderate disease occurs in patients who have evidence of lower respiratory disease on clinical assessment or imaging, oxygen saturation (SpO2) ≥94 % and an increase in CRP, IL-6, ferritin, and D-dimer less than 50 % of normal. The severe course of the disease includes patients with a respiratory rate >30 per minute, SpO2 <94 %, the ratio of the partial pressure of oxygen in arterial blood to the fraction of inhaled oxygen (PaO2/FiO2) <300 mm Hg, infiltrates affecting >50 % of the lung parenchyma and a possible increase in CRP, ferritin, IL-6 and D-dimer more than 2-3 times (~20 %). The critical course of the disease is respiratory failure, septic shock and/or multiple organ failure, subtotal lesions of the parenchyma of both lungs (1-5 %). Because the disease manifests itself as pneumonia, radiological imaging plays a fundamental role in the diagnostic process, treatment, and follow-up. Standard X-ray examination of chest has low sensitivity in detecting early changes in the lungs and in the initial stages of the disease. At this stage, it can be completely negative. In later stages of infection, chest X-ray usually reveals bilateral multifocal alveolar opacities, which tend to coalesce until the lung is completely opaque. Pleural effusion may occur. Given the high sensitivity of the method, computed tomography (CT) of the chest, in particular high-resolution CT, is the method of choice in the study of COVID-19 pneumonia, even in the initial stages. There is no specific antiviral treatment recommended for COVID-19, and there is currently no vaccine. Treatment is symptomatic, and oxygen and fluid therapy represent the first step towards resolving respiratory distress and intoxication. Non-invasive and invasive mechanical ventilation may be required in cases of respiratory failure that is resistant to oxygen therapy. For the treatment of severe forms of the disease (>50 % of the lesion of the lung parenchyma), antioxidant therapy is necessary. The key requirement is to influence mitochondrial permeability, that is, to pass through the membrane of cells and mitochondria and accumulate in mitochondria (inactivation of ROS), as well as block the signals of pathways that transmit instructions from the surface to the nucleus to start inflammation (IL-1, -6, -18) in order to ensure the survival of cells as long as possible. With this pathogenetic purpose, to stop the “cytokine shtrom” we use edaravon (Xavron) 30 mg and Tivorel 100.0 ml. Conclusions. We have shown that in patients with moderate, severe and critical COVID-19-defined pneumonia (CRP ≥100 mg/l, ferritin ≥900 ng/ml, IL-6 >202.3 pg/ml) Xavron and Tivorel as an intravenous infusion caused clinical improvement in 71 % of patients.

scholarly journals Possible Complication Pneumothorax of in COVID-19

2021 ◽  
Vol 6 (6) ◽  
Author(s):  
Aslan B ◽  
Aydm F
Keyword(s):  
Sinus Tachycardia ◽  
Drainage System ◽  
Lung Parenchyma ◽  
Shortness Of Breath ◽  
Oxygen Supplementation ◽  
Intensive Care Unit Treatment ◽  
Left Hemithorax ◽  
X Ray ◽  
Male Patients

Two male patients, 57 and 58 years old, were evaluated in our emergency department. The complaints of cough that had been continuing for 1 week was at the forefront in their histories. Diarrhea and fever accompanied. In both patients, the complaint of shortness of breath increased significantly in the last 6 hours. Although 20lt/min oxygen was given to hypoxemic patients, SpO2 values were in the range of 80% to 84%. Despite oxygen supplementation, the current sinus tachycardia (140bpm) did not improve. In the thorax x-ray evaluations which were performed immediately, it was seen that both patients had pneumothorax covering the entire left hemithorax. The patients were connected to the underwater drainage system by inserting a chest tube. In clinical radiological follow-up, pneumothorax regressed and lung parenchyma was re-expanded in both cases. A contralateral pneumothorax occurred in the second patient. Conditions observed in these cases show that pneumothorax can be caused by Covid-19 and may be mortal. Pneumothorax should be kept in mind in the presence of severe dyspnea, hypoxia and tachycardia when suddenly added to the clinic. Both patients died in their second week of intensive care unit treatment.

scholarly journals Unresolving Pneumonia with Pleural effusion: Pulmonary Paragonimiasis

2017 ◽  
Vol 56 (206) ◽  
Author(s):  
Deepshikha Gaire ◽  
Santosh Sharma ◽  
Kumar Poudel ◽  
Pankaj Pant
Keyword(s):  
Differential Diagnosis ◽  
Chest Pain ◽  
Pleural Effusion ◽  
Clinical Manifestations ◽  
Shortness Of Breath ◽  
X Ray ◽  
Fluid Analysis ◽  
Pain Abdomen ◽  
History Of ◽  
Specific Symptoms

Paragonimiasis is a zoonosis caused by many species of Paragonimus commonly P. westermani. Human get infected by eating raw, salted, pickled, smoked, partially cooked crustaceans (crayfish or crabs). Clinical manifestations ranges from non-specific symptoms like pain abdomen, diarrhea, urticarial rashes, fever to pleuropulmonary symptoms like cough, hemoptysis, chest pain and dyspnea. 48 yrs, female presented at TUTH emergency with fever on and off for 9 months, cough and shortness of breath for 3 months, lethargy, malaise and urticaria with history of raw crab intake one month prior to the onset of symptoms. Blood and pleural fluid analysis revealed raised total counts with eosinophilia and x-ray showed bilateral infiltration of lower lobes with pleural effusion. Diagnosis was confirmed by microscopic examination of sputum for Paragonimus. She responded well to Praziquantel. Pulmonary paragonimiasis must be considered in the differential diagnosis of unresolving pneumonia and unexplained hypereosinophilia.  [PubMed]

scholarly journals A study on obstetric patients with corona virus infection requiring critical care

2020 ◽  
Vol 9 (10) ◽  
pp. 3966
Author(s):  
Adarsh Preet ◽  
Tushar Palve
Keyword(s):  
Critical Care ◽  
Pregnant Women ◽  
Clinical Manifestations ◽  
Shortness Of Breath ◽  
X Ray ◽  
Mild Disease ◽  
Abnormal Chest ◽  
Co Morbidity ◽  
Maternal Morbidity And Mortality ◽  
Chest X Ray

Background: Coronavirus cause respiratory tract infection that can range from mild to lethal like cold, fever, cough, shortness of breath, fatigue, chills, body aches, headache, sore throat, loss of smell or taste, nausea, diarrhoea, pneumonia, respiratory failure, septic shock and death. The purpose of this study was to describe the clinical manifestations of obstetric patients with COVID-19 infection requiring critical care, their 02 requirements, complications, co-morbidities associated and mortality related to it.Methods: A study was conducted in the Department of Obstetrics and Gynecology, Cama and Albless hospital, Mumbai including 31 patients with SARS CoV-2 infection requiring critical care. Necessary information such as their detailed clinical, and obstetric history, clinical examination, investigations was noted.Results: In our study, the most common symptoms were shortness of breath, followed by fever. PIH was the most common co morbidity associated and pneumonia as most common complication. Anemia, thrombocytopenia and NLR>4 were found more common in intensive care unit (ICU) admitted patients as compared to non-ICU admitted patients. 77.4% of patients had abnormal chest X-ray with 25.8% requiring mechanical ventilation.Conclusions: COVID 19 infection is affecting pregnant women resulting in mild to lethal disease. Most of pregnant women are asymptomatic or have mild disease but some of them require critical care. These women should be monitored carefully to prevent maternal morbidity and mortality.

scholarly journals FEATURES OF THE COURSE AND TIMING OF DIAGNOSIS OF PLEUROPULMONARY COMPLICATIONS OF CORONAVIRUS INFECTION

2021 ◽  
pp. 3-6
Author(s):  
I. D. Duzhyi ◽  
S. P. Golubnychyi ◽  
G. O. Oleshchenko ◽  
O. М. Yasnikovskyi
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Respiratory Failure ◽  
Interstitial Pneumonia ◽  
Spontaneous Pneumothorax ◽  
Lung Parenchyma ◽  
Blood Oxygenation ◽  
Shortness Of Breath ◽  
Thrombotic Complications ◽  
Coronavirus Infection

Coronavirus infection in most cases is of the type of interstitial pneumonia. According to the literature, the most common complications are thrombotic complications of the lungs, myocardium, central nervous system, liver, and kidneys. There are only isolated reports of pleural complications. The aim. To study the features of the course and term of diagnosis of pleuropulmonary complications, specifying the possibilities of their prevention and exclusion of errors. Materials and methods. Under our supervision, there were 23 patients with various complications of pleuropulmonary character. Among these patients, there were 15 males, 8 – females. There were ten patients under the age of 50 and 13 over the age of 50. The interstitial background in all patients was interstitial changes in the lung parenchyma. Results and discussion. Deterioration of patients (increased temperature, shortness of breath, cough, and decreased blood oxygenation) forced doctors to resort to additional examination and consultation with specialists after a certain period of observation (4–5 days). Pulmonary and pleural hemorrhage occurred in 2 (8,72 %) subjects, spontaneous pneumothorax, including and 1 bilateral, occurred in 5 (21,7 %) patients, pneumohydrothorax – in 4 (14,4 %), pneumomediastinum – in 2 (8,7 %), severe pneumothorax – in 7 (30,4 %) people. The most serious complications were the impression of the pleura with a violation of the integrity of the cortical lungs (pneumohydrothorax, intense pneumothorax), which led to death in 6 (26,1 %) people. The period before the diagnosis of complications was in the range of 4–6 days. Conclusions. Physical control of patients with signs of respiratory failure should be performed every 2 hours, ultrasound – three times a day, examination and lateral radiography – with the duration of shortness of breath more than two days or its increase, without waiting for the time suggested by the radiologist.

Hamman-Rich syndrome in general medical practice

2020 ◽  
pp. 33-38
Author(s):  
Vsevolod Skvortsov ◽  
Zhanna Koltavskova
Keyword(s):  
Quality Of Life ◽  
Respiratory Failure ◽  
Idiopathic Pulmonary Fibrosis ◽  
Pulmonary Fibrosis ◽  
Medical Practice ◽  
Clinical Manifestations ◽  
The Elderly ◽  
Shortness Of Breath ◽  
General Medical Practice

Hamman-Rich syndrome or idiopathic pulmonary fibrosis is a disease of uncertain origin, accompanied by diffuse damage to the lung tissue, with the possible development of respiratory failure and, as a result, death. Its clinical manifestations are coughing and increasing shortness of breath, and «Velcro» rales can also be heard. The disease is usually found among the elderly. The disease greatly reduces quality of life of patients, so it is important to diagnose it in time and draw up the necessary treatment strategy.

Hyperbaric oxygen therapy may be effective to improve hypoxemia in patients with severe COVID-2019 pneumonia: two case reports

2020 ◽  
Vol 47 (2) ◽  
pp. 181-187
Author(s):  
Dazhi Guo ◽  
◽  
Shuyi Pan ◽  
MaoMao Wang ◽  
Yufeng Guo ◽  
...  
Keyword(s):  
Hyperbaric Oxygen ◽  
Randomized Clinical Trials ◽  
Case Reports ◽  
Gas Analysis ◽  
Chest Ct ◽  
Serum Cholinesterase ◽  
Shortness Of Breath ◽  
Arterial Blood ◽  
Hbo2 Therapy ◽  
D Dimer

Objective: To determine whether hyperbaric oxygen (HBO2) therapy be effective to improve hypoxemia for severe COVID-19 pneumonia patients. Method: Two male patients ages 57 and 64 years old were treated. Each met at least one of the following criteria: shortness of breath; respiratory rate (RR) ≥30 breaths/minute; finger pulse oxygen saturation (SpO2) ≤93% at rest; and oxygen index (P/F ratio: PaO2/FiO2 ≤300 mmHg). Each case excluded any combination with pneumothorax, pulmonary bullae or other absolute contraindications to HBO2. Patients were treated with 1.5 atmospheres absolute HBO2 with an oxygen concentration of more than 95% for 60 minutes per treatment, once a day for one week. Patients’ self-reported symptoms, daily mean SpO2 (SO2), arterial blood gas analysis, d-dimer, lymphocyte, cholinesterase (che) and chest CT were conducted and measured. Results: For both patients, dyspnea and shortness of breath were immediately alleviated after the first HBO2 treatment and remarkably relieved after seven days of HBO2 therapy. The RR also decreased daily. Neither patient became critically ill. The decreasing trend of SO2 and P/F ratio was immediately reversed and increased day by day. The lymphocyte count and ratio corresponding to immune function gradually recovered. D-dimer corresponding to peripheral circulation disorders and serum cholinesterase, reflecting liver function had improved. Follow-up chest CT showed that the pulmonary inflammation had clearly subsided. Conclusions: Our preliminary uncontrolled case reports suggest that HBO2 therapy may promptly improve the progressive hypoxemia of patients with COVID-2019 pneumonia. However, the limited sample size and study design preclude a definitive statement about the potential effectiveness of HBO2 therapy to COVID-2019 pneumonia. It requires evaluation in randomized clinical trials in future.

Acute Respiratory Distress Syndrome in Confirmed and Suspected Cases of Covid-19:A Cross Sectional Study

2021 ◽  
Vol 15 (5) ◽  
pp. 1176-1179
Author(s):  
F. Sadiq ◽  
K. Ayoub ◽  
F. Riaz ◽  
S. Razzaq ◽  
A. Farooq ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Inflammatory Markers ◽  
Distress Syndrome ◽  
Shortness Of Breath ◽  
Cross Sectional ◽  
X Ray ◽  
Bilateral Lung ◽  
D Dimer

Aim: To observe the frequency, severity and susceptibility to develop the severe symptoms of acute respiratory distress syndrome in confirmed and suspected cases of COVID-19. Study design: Cross sectional observational study. Place and duration of study: Lahore General Hospital, Lahore. Methodology: After Ethical Committee approval in 164 patients of confirmed or suspected COVID-19 who underwent the complication of ARDS were enrolled, admitted in department of Medicine and Intensive Care Unit at Lahore General Hospital, Lahore. After taking consent we studied different features in these patients like age, gender, comorbidities, symptoms, their radiological findings, SATS, PO2/FIO2 ratio, serum ferritin, CRP, LDH and d-dimer levels, and results were analyzed. Result: Out of 164 patients, 103 were COVID-19 positive. Mostly middle aged to old males developed the complications of ARDS. The most common symptoms observed were fever, cough and shortness of breath. Most common comorbidities present in the patients were diabetes and hypertension. HRCT was done in severe cases and 25 out of 35 patients had either unilateral or bilateral lung opacities. On chest X-ray 76% patients had bilateral lung infiltrates and 12% patients were having unilateral infiltrates. Inflammatory markers such as CRP, serum LDH, serum Ferritin, D-dimers were raised in most of the patients who developed moderate to severe ARDS. Conclusion: We concluded that the middle aged to old males with comorbidities like diabetes and hypertension are more likely to undergo ARDS. They can present with shortness of breath alone or in combination with fever and cough. Their X-ray usually showed bilateral patchy infiltrates and their ferritin, CRP, LDH and d- dimer levels are usually high. Keywords: ARDS, COVID-19, Inflammatory Markers

Polymyalgia Rheumatica - a Disease of the Elderly

2018 ◽  
Vol 69 (1) ◽  
pp. 152-154
Author(s):  
Vasilica Cristescu ◽  
Aurelia Romila ◽  
Luana Andreea Macovei
Keyword(s):  
Giant Cell Arteritis ◽  
Giant Cell ◽  
Polymyalgia Rheumatica ◽  
Temporal Arteritis ◽  
Viral Infections ◽  
Clinical Manifestations ◽  
The Elderly ◽  
Clinical Aspects ◽  
Immune Disorder ◽  
Markers Of Inflammation

Polymyalgia rheumatica is a disease that occurs mostly in the elderly and is rarely seen in patients less than 50 years of age. Polymyalgia rheumatica is a vasculitis, which manifests itself as an inflammatory disease of the vascular wall that can affect any type of blood vessel, regardless of its size. It has been considered a form of giant cell arteritis, involving primarily large and medium arteries and to a lesser extent the arterioles. Clinical manifestations are caused by the generic pathogenic process and depend on the characteristics of the damaged organ. PMR is a senescence-related immune disorder. It has been defined as a stand-alone condition and a syndrome referred to as rheumatic polyarteritis with manifestations of giant cell arteritis (especially in cases of Horton�s disease and temporal arteritis) which are commonly associated with polymyalgia. The clinical presentation is clearly dominated by the painful girdle syndrome, with a feeling of general discomfort. Polymyalgia and temporal arteritis may coexist or be consecutive to each other in the same patient, as in most of our patients. The present study describes 3 cases of polymyalgia rheumatica, admitted to the Clinic of Rheumatology of Sf. Apostol Andrei Hospital, Galati. The cases were compared with the literature. Two clinical aspects (polymyalgia rheumatica and/or Horton�s disease) and the relationship between them were also considered. Polymyalgia rheumatica is currently thought to have a multifactorial etiology, in which the following factors play a role: genetic factors or hereditary predisposition (some individuals are more prone to this disease), immune factors and viral infections (triggers of the disease). Other risk factors of polymyalgia rheumatica include age over 50 years and the association with giant cell arteritis. The characteristic feature of the disease is girdle pain, with intense stiffness of at least one hour�s duration. Markers of inflammation, erythrocyte sedimentation rate and C-reactive protein are almost always increased at the onset of the disease. Diseases that can mimic the clinical picture of polymyalgia rheumatica are neoplasia, infections, metabolic disorders of the bone and endocrine diseases.

scholarly journals POS0369 ELEVATED EXPRESSION OF TIM-3 ON NEUTROPHILS CORRELATES WITH DISEASE ACTIVITY AND SEVERITY OF ANKYLOSING SPONDYLITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 414.2-415
Author(s):  
X. Huang ◽  
T. W. Li ◽  
J. Chen ◽  
Z. Huang ◽  
S. Chen ◽  
...  
Keyword(s):  
Flow Cytometry ◽  
Ankylosing Spondylitis ◽  
Disease Activity ◽  
Immune Cells ◽  
Clinical Manifestations ◽  
Innate Immune ◽  
Innate Immune Cells ◽  
Bacterial Killing ◽  
Markers Of Inflammation ◽  
Significant Difference

Background:Ankylosing spondylitis (AS) is a type of common, chronic inflammatory disease that compromises the axial skeleton and sacroiliac joints, causing inflammatory low back pain and progressive spinal stiffness, over time some patients develop spinal immobility and ankylosis which can lead to a decrease in quality of life. The last few decades, evidence has clearly indicated that neutrophil also plays key roles in the progression of AS. However, the immunomodulatory roles and mechanisms of neutrophils in AS are poorly understood. T-cell immunoglobulin and mucin domain-containing protein 3 (Tim-3) has been reported as an important regulatory molecule, expressed and regulated on different innate immune cells, plays a pivotal role in several autoimmunity diseases. Recent study indicates that Tim3 is also expressed on neutrophils. However, the frequency and roles of Tim3-expressing neutrophils in AS was not clear.Objectives:In this study, we investigated the expression of Tim3 on neutrophils in AS patients and explored the correlation between the level of Tim3-expressing neutrophils and the disease activity and severity of AS.Methods:Patients with AS were recruited from Guangdong Second Provincial General Hospital (n=62). Age/sex-matched volunteers as Healthy controls (HC) (n=39). The medical history, clinical manifestations, physical examination, laboratory measurements were recorded. The expression of costimulatory molecules including programmed death 1 (PD-1), Tim-3 on neutrophils were determined by flow cytometry. The mRNA expression of PD-1 and Tim-3 was determined by real-time PCR. The levels of Tim3-expressing neutrophils in AS patients were further analyzed for their correlation with the markers of inflammation such as ESR,CRP,WBC and neutrophil count(NE), as well as disease activity and severity of AS. The expression of Tim3 on neutrophils was monitored during the course of treatment (4 weeks).Results:The expression of Tim3 on neutrophils in patients with AS was increased compared to the HC (Figure 1A). However, significant difference was observed in the frequency of PD-1-expressing neutrophils between AS patients and HC (Figure 1B). The expression analysis of Tim-3 mRNA, but not PD-1, confirmed the results obtained from flow cytometry (Figure 1C). The level of Tim3-expressing neutrophils in patients with AS showed an positive correlation with ESR, CRP and ASAS-endorsed disease activity score (ASDAS) (Figure 1D). Moreover, the frequency of Tim3-expressing neutrophils in active patients(ASDAS≥1.3) was increased as compare with the inactive patients (ASDAS<1.3) (Figure 1E). As shown in Figure 1F, the frequency of Tim3-expressing neutrophils decreased after the treatment.Conclusion:Increased Tim-3 expression on neutrophils may be a novel indicator to assess disease activity and severity in AS, which may serves as a negative feedback mechanism preventing potential tissue damage caused by excessive inflammatory responses in AS patients.References:[1]Han, G., Chen, G., Shen, B. & Li, Y., Tim-3: an activation marker and activation limiter of innate immune cells. FRONT IMMUNOL 4 449 (2013).[2]Vega-Carrascal, I. et al., Galectin-9 signaling through TIM-3 is involved in neutrophil-mediated Gram-negative bacterial killing: an effect abrogated within the cystic fibrosis lung. J IMMUNOL 192 2418 (2014).Figure 1.(A,B)The expression of Tim3 and PD-1 on neutrophils in AS and HC were determined by flow cytometry.(C) The expression of Tim3 and PD-1 on neutrophils in AS and HC were determined by RT-PCR.(D)The correction between Tim3-expressing neutrophils and ESR,CRP,ASDAS.(E) The expression of Tim3 on neutrophils in active and inactive patients.(F) Influence of treatment on the frequency of Tim3-expressing neutrophils.Disclosure of Interests:None declared

scholarly journals Prehospital Diagnosis of Shortness of Breath Caused by Profound Metformin-Associated Metabolic Acidosis

Healthcare ◽  
2021 ◽  
Vol 9 (1) ◽  
pp. 74
Author(s):  
Pietro Elias Fubini ◽  
Laurent Suppan
Keyword(s):  
Metabolic Acidosis ◽  
Hospital Setting ◽  
Blood Gases ◽  
Shortness Of Breath ◽  
Potential Harm ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
Common Causes ◽  
Prehospital Diagnosis ◽  
Gas Measurement

Shortness of breath is a common complaint among patients in emergency medicine. While most common causes are usually promptly identified, less frequent aetiologies might be challenging to diagnose, especially in the pre-hospital setting. We report a case of prehospital dyspnoea initially ascribed to pulmonary oedema which turned out to be the result of profound metformin-associated metabolic acidosis. This diagnosis was already made during the prehospital phase by virtue of arterial blood gas measurement. Pre-hospital measurement of arterial blood gases is therefore feasible and can improve diagnostic accuracy in the field, thus avoiding unnecessary delay and potential harm to the patient before initiating the appropriate therapeutic actions.

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