scholarly journals Determine the Clinical Presentation and Outcomes of Thoracostomy in Children with Complicated Pneumonia

2021 ◽  
Vol 15 (6) ◽  
pp. 1463-1465
Author(s):  
S. U. Rehman ◽  
S. Khan ◽  
M. Anwar ◽  
A. Rafique ◽  
Z. I. Bhatti ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Chest Pain ◽  
Chest Tube ◽  
Clinical Presentation ◽  
Causative Factor ◽  
Paediatric Surgery ◽  
Shortness Of Breath ◽  
Effective Treatment Modality ◽  
The Common ◽  
Complicated Pneumonia

Objective: To examine the clinical presentation and outcomes of thoracostomy in patients presented with complicated pneumonia. Study Design: Descriptive/Observational Place and Duration of Study: Department of Paediatric Surgery, DHQ Teaching Hospital Sahiwal from 1st January 2019 to 31st December 2020. Methodology: Fifty patients of both genders with ages 0 to 12 years presented with complicated pneumonia were included. All the patients received chest tube intubation. Outcomes of thoracostomy were examined. Radiological examination was done. Results: Thirty eight (76%) patients were males while 24% were females. Majority of patients 64% were ages less than 5 years. Fever, cough, shortness of breath and chest pain were the common symptoms. Staphylococcus aureus was the most common causative factor found in 56% cases followed by streptococcus in 24% cases. 84% cases were successfully removed chest tube. Recollection found in 8% cases, pneumothorax found in 4% patients and 4% patients had pneumatocele. Conclusion: Chest tube intubation was the safe and effective treatment modality for complicated pneumonia with fewer rates of complications. Keywords: Complicated pneumonia, Thoracostomy, Empyema, Pneumothorax, Outcomes

scholarly journals Successful use of endobronchial valve for persistent air leak in a patient with COVID-19 and bullous emphysema

2021 ◽  
Vol 14 (11) ◽  
pp. e246671
Author(s):  
Biplab K Saha ◽  
Alyssa Bonnier ◽  
Woon Hean Chong ◽  
Praveen Chenna
Keyword(s):  
Chest Pain ◽  
Lung Disease ◽  
Chest Tube ◽  
Complete Resolution ◽  
Shortness Of Breath ◽  
Air Leak ◽  
Management Guideline ◽  
Standard Management ◽  
Endobronchial Valve ◽  
Persistent Air Leak

Patients with SARS-CoV-2 pneumonia can suffer from pneumothorax and persistent air leak (PAL). The pneumothorax occurs with or without pre-existing lung disease. PAL refers to air leak lasting more than 5–7 days and arises due to bronchopleural or alveolopleural fistula. The management of PAL can be challenging as a standard management guideline is lacking. Here we present the case of a 42-year-old smoker with COVID-19 who presented to the hospital with fever, cough, acute left-sided chest pain and shortness of breath. He suffered from a large left-sided pneumothorax requiring immediate chest tube drainage. Unfortunately, the air leak persisted for 13 days before one-way endobronchial valve (EBV) was used with complete resolution of the air leak. We also review the literature regarding other cases of EBV utilisation for PAL in patients with COVID-19.

A Case of Spontaneous Esophageo-Pleural Fistula

2018 ◽  
Vol 8 (1) ◽  
pp. 40-45
Author(s):  
Mudasir Mir ◽  
Aadil Beigh ◽  
Arshad Bachh ◽  
Mohsin Mushtaq ◽  
Kunal Bhaskar
Keyword(s):  
Computed Tomography ◽  
Chest Pain ◽  
Nasogastric Tube ◽  
Chest Tube ◽  
Tube Feeding ◽  
Oral Contrast ◽  
Rare Entity ◽  
Shortness Of Breath ◽  
Tube Drainage ◽  
Nasogastric Tube Feeding

Spontaneous esophageal-pleural fistula is a rare entity. The authors describe a case of 60-year-old male who presented with cough with expectoration, severe retrosternal chest pain and shortness of breath and vomiting. Computed tomography with oral contrast showed right esophageal-pleural fistula and hydro pneumothorax. He was managed conservatively keeping the chest tube drainage and nasogastric tube feeding.

An Overview of Dementias

2012 ◽  
Vol 21 (3) ◽  
pp. 75-84
Author(s):  
Venkata Vijaya K. Dalai ◽  
Jason E. Childress ◽  
Paul E Schulz
Keyword(s):  
Clinical Presentation ◽  
Treatment Options ◽  
Current Treatment ◽  
Great Variability ◽  
Health Concern ◽  
Public Health Concern ◽  
Life Threatening ◽  
The Common ◽  
Neurodegenerative Dementias ◽  
Made In

Dementia is a major public health concern that afflicts an estimated 24.3 million people worldwide. Great strides are being made in order to better diagnose, prevent, and treat these disorders. Dementia is associated with multiple complications, some of which can be life-threatening, such as dysphagia. There is great variability between dementias in terms of when dysphagia and other swallowing disorders occur. In order to prepare the reader for the other articles in this publication discussing swallowing issues in depth, the authors of this article will provide a brief overview of the prevalence, risk factors, pathogenesis, clinical presentation, diagnosis, current treatment options, and implications for eating for the common forms of neurodegenerative dementias.

scholarly journals A 28-Year-Old Man With Chest Pain, Shortness of Breath, and Hemoptysis After Recovery From Coronavirus Disease 2019 Pneumonia

CHEST Journal ◽  
2021 ◽  
Vol 159 (1) ◽  
pp. e35-e38
Author(s):  
John Odackal ◽  
Tijana Milinic ◽  
Tim Amass ◽  
Edward D. Chan ◽  
Jeremy Hua ◽  
...  
Keyword(s):  
Chest Pain ◽  
Shortness Of Breath

scholarly journals Real world cost and health outcomes of patients presented with chest pain in England: which is the most cost-effective first-line test?

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Tsiachristas ◽  
H West ◽  
E.K Oikonomou ◽  
B Mihaylova ◽  
N Sabharwall ◽  
...  
Keyword(s):  
Chest Pain ◽  
Health Outcomes ◽  
Diagnostic Tests ◽  
Clinical Presentation ◽  
Cost Effective ◽  
Funding Source ◽  
First Line ◽  
Nice Guidelines ◽  
Exercise Ecg ◽  
Stable Chest Pain

Abstract Background The National Institute for Health and Care Excellence (NICE) updated their guidance for the management of patients with stable chest pain and recommended that all patients undergo computed tomography coronary angiography (CTCA). This update has sparked a great deal of debate, and was followed by upgrade of CTCA into a Class I indication in the recent ESC guidelines. The cost-effectiveness of using CTCA as first line investigation is still unclear. Purpose To describe the current clinical pathway of patients with stable chest pain presented to outpatient clinics, assess the compliance with the updated NICE guideline, and explore the costs and health outcomes of different non-invasive diagnostic tests in real-world clinical setting. Methods We used data of 4,297 patients who attended chest pain clinics in Oxford between 1 January 2014 and 31 July 2018. Data included clinical presentation (e.g. age and previous cardiovascular conditions), diagnostic tests, outpatient visits, hospitalization, and hospital mortality and was compared between 6 alternative first-line diagnostic tests. Multinomial regressions were performed to estimate the probability of receiving each alternative and the associated cost after adjusting for clinical presentation. A decision tree was developed to describe the clinical pathway for each alternative first-line diagnostic in terms of subsequent diagnostic tests and treatments and to estimate the associated costs and life days. Results The proportion of patients who received CTCA as first line diagnostic test increased from 1% in 2014 to 17% in 2018, while the publication of the updated NICE guidelines in 2016 led to a threefold increase in this proportion. CTCA is less likely to be provided as a first-line diagnostic to patients who are younger age, males, smokers, and have angina, PVD, or diabetes. The standardised rate of hospital admission was the lowest in the exercise ECG cohort (0.35 admissions per 1,000 life-days) followed by the CTCA cohort (0.40 admissions per 1,000 life-days) while the latter cohort had the lowest standardised rate of cardiovascular treatment (2.74% per 1,000 life days). Stress echocardiography and MPS were associated with higher costs compared with CTCA, other ECG, and exercise ECG after adjusting for clinical presentation and days of follow-up. CTCA is the pathway most likely to be cost-effective, even compared to exercise ECG, while the other diagnostic alternatives are dominated (i.e. they cost more for less life-days). Conclusions Currently, the updated NICE guidelines for stable chest pain are implemented only to a fifth of the cases in England. Our findings support existing evidence that CTCA is the most-cost effective first-line diagnostic test for this population. Hopefully, this will inform the debate around the implementation of the guidelines and help commissioning and clinical decision processes worldwide. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Institute of Health Research Oxford Biomedical Research Centre

scholarly journals Epidemiological characteristics and mortality risk factors among COVID-19 patients in Ardabil, Northwest of Iran

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Davoud Adham ◽  
Shahram Habibzadeh ◽  
Hassan Ghobadi ◽  
Shabnam Asghari Jajin ◽  
Abbas Abbasi-Ghahramanloo ◽  
...  
Keyword(s):  
Clinical Presentation ◽  
Multiple Model ◽  
Shortness Of Breath ◽  
Imaging Data ◽  
Demographic Information ◽  
Runny Nose ◽  
Data Registration ◽  
Northwestern Iran ◽  
Northwest Of Iran ◽  
Epidemiological Characteristics

Abstract Background Coronavirus disease highly contagious, is prevalent in all age and sex groups infecting the respiratory system. The present study seeks to investigate the epidemiology and effective factors in mortality of patients with COVID-19 in Ardabil province, northwestern Iran. Methods In a retrospective study, the hospitalized patients with laboratory-diagnosed COVID-19 between February to August 2020 were enrolled. The data registration portal was designated according to Iranian Ministry of Health and Medical Education guidelines. In this portal, demographic information, clinical presentation, laboratory and imaging data were registered for patients in all hospitals in the same format. The Hosmer-Lemeshow strategy was used for variable selection in a multiple model. Results Of the patients involved 2812(50.3%) were male and 150 (2.7%) had contact with a confirmed case of COVID-19 in the last 14 days. Pre-existing comorbidity was reported in 1310 (23.4%) patients. Of all patients, 477(8.5%) died due to COVID-19. the result of the multiple logistic regression model indicated that after adjusting for other factors, higher age (OR = 3.11), fever or chills (OR = 1.61), shortness of breath (OR = 1.82), fatigue (OR = 0.71), headache (OR = 0.64), runny nose (OR = 1.54), Skeletal muscle pain (OR = 1.53), hospitalization (OR = 5.66), and hospitalization in ICU (OR = 5.12) were associated with death. Conclusions Hospitalization had the strongest effect on mortality followed by hospitalization in ICU, and higher age. This study showed that having some extra-pulmonary symptoms in contrast with pulmonary symptoms can predict as good prognostic factors.

scholarly journals A Systematic Review of Characteristics Associated with COVID-19 in Children with Typical Presentation and with Multisystem Inflammatory Syndrome

2021 ◽  
Vol 18 (16) ◽  
pp. 8269
Author(s):  
Jeffrey Kornitzer ◽  
Jacklyn Johnson ◽  
Max Yang ◽  
Keith W. Pecor ◽  
Nicholas Cohen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Sore Throat ◽  
Literature Search ◽  
Clinical Presentation ◽  
Pediatric Population ◽  
Chinese Language ◽  
Clinical Information ◽  
Shortness Of Breath ◽  
Global Pandemic ◽  
Inflammatory Syndrome

Setting off a global pandemic, coronavirus disease 2019 (COVID-19) has been marked by a heterogeneous clinical presentation that runs the gamut from asymptomatic to severe and fatal. Although less lethal in children than adults, COVID-19 has nonetheless afflicted the pediatric population. This systematic review used clinical information from published literature to assess the spectrum of COVID-19 presentation in children, with special emphasis on characteristics associated with multisystem inflammatory syndrome (MIS-C). An electronic literature search for English and Chinese language articles in COVIDSeer, MEDLINE, and PubMed from 1 January 2020 through 1 March 2021 returned 579 records, of which 54 were included for full evaluation. Out of the total 4811 patients, 543 (11.29%) exhibited MIS-C. The most common symptoms across all children were fever and sore throat. Children presenting with MIS-C were less likely to exhibit sore throat and respiratory symptoms (i.e., cough, shortness of breath) compared to children without MIS-C. Inflammatory (e.g., rash, fever, and weakness) and gastrointestinal (e.g., nausea/vomiting and diarrhea) symptoms were present to a greater extent in children with both COVID-19 and MIS-C, suggesting that children testing positive for COVID-19 and exhibiting such symptoms should be evaluated for MIS-C.

Triage Ability of Emergency Medical Services Providers and Patient Disposition: A Prospective Study

1999 ◽  
Vol 14 (3) ◽  
pp. 67-72 ◽  
Author(s):  
John R. Richards ◽  
Stephen J. Ferrall
Keyword(s):  
Chest Pain ◽  
Emergency Medical Services ◽  
Patient Characteristics ◽  
University Hospital ◽  
Medical Services ◽  
Shortness Of Breath ◽  
Study Objective ◽  
Patient Disposition ◽  
Emergency Medical ◽  
Respiratory Complaints

AbstractStudy objective:To determine the ability of emergency medical services (EMS) providers to subjectively triage patients with respect to hospital admission and to determine patient characteristics associated with increased likelihood of admission.Methods:A prospective, cross-sectional study of a consecutive sample of patients arriving by ambulance during the month of February 1997 at an urban, university hospital, Emergency Department. Emergency medical services providers completed a questionnaire asking them to predict admission to the hospital and requested patient demographic information. Predictions were compared to actual patient disposition.Results:A total of 887 patients were included in the study, and 315 were admitted to the hospital (36%). With respect to admission, emergency medical services providers had an accuracy rate of 79%, with a sensitivity of 72% and specificity of 83% (kappa = 0.56). Blunt traumatic injury and altered mental status were the most common medical reasons for admission. Variables significantly associated with high admission rates were patients with age > 50 years, chest pain or cardiac complaints, shortness of breath or respiratory complaints, Medicare insurance, and Hispanic ethnicity. The emergency medical services providers most accurately predicted admission for patients presenting with labor (kappa = 1.0), shortness of breath / respiratory complaints (kappa = 0.84), and chest pain (kappa = 0.77).Conclusion:Emergency medical services providers can predict final patient disposition with reasonable accuracy, especially for patients presenting with labor, shortness of breath, or chest pain. Certain patient characteristics are associated with a higher rate of actual admission.

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