scholarly journals Clinical outcomes and lipid-laden macrophages in Electronic cigarette/Vaping product use-Associated Lung Injury (EVALI) in a South Texas population

2021 ◽  
Vol 8 (1) ◽  
pp. 1
Author(s):  
Mahnoor Mir ◽  
Moeezullah Beg ◽  
Jay I. Peters ◽  
Sandra G. Adams
Keyword(s):  
Lung Injury ◽  
Noninvasive Positive Pressure Ventilation ◽  
Supplemental Oxygen ◽  
Electronic Cigarette ◽  
Positive Pressure ◽  
Presenting Symptoms ◽  
Product Use ◽  
Systemic Corticosteroids ◽  
History Of

Objective: To describe the clinical features, proportion of lipid-laden alveolar macrophages in bronchoalveolar lavage (BAL), and short-term and 6-month to 12-month outcomes of patients with Electronic cigarette/Vaping product use-Associated Lung Injury (EVALI).Methods: Retrospective review of clinical characteristics, radiographs, and BAL samples for all patients with a history of vaping who presented with acute hypoxemic respiratory failure to the University Hospital in San Antonio, Texas from 9/2019 to 6/2020 was performed.Results: We report 16 cases (15 men; median age, 30 years [range 19-75]) of EVALI with a history of vaping Tetrahydrocannabinol (THC), nicotine, or both. The most common presenting symptoms were tachycardia, dyspnea, cough, and fever. All patients required supplemental oxygen, including two who required noninvasive positive pressure ventilation, and five who required mechanical ventilation. All 16 patients had bilateral ground-glass opacities (GGO) with peripheral sparing on chest computerizedtomography (CT). Cultures were negative, except for one patient who tested positive for rhinovirus. COVID-19 PCR was done in one individual which was negative. Cytology demonstrated lipid-laden macrophages on Oil-Red-O stain on fresh (i.e., without fixative) BAL in the majority of patients (N = 12) with a mean lipid-saturation percentage of 78% [range, 44%-100%] and the mean Colombo count of 194 [range, 101-359]. Fifteen patients were treated with systemic corticosteroids. The median length of hospital stay was 10 days. At discharge, three patients required supplemental oxygen. Eight of those who had follow-up imaging showed resolution of GGO. One patient had a relapse of symptoms and was again treated with systemic corticosteroids and mycophenolate, with resolution of symptoms. Fourteen patients who were evaluated after discharge denied vaping post-discharge (two patients were not able to be contacted and did not keep follow-up appointments).Conclusions: Successful diagnosis and management of EVALI requires a high clinical suspicion, thorough evaluation to rule out infectious etiologies, and aggressive treatment with systemic corticosteroids, along with sustained abstinence from vaping.

scholarly journals Review of Health Consequences of Electronic Cigarettes and the Outbreak of Electronic Cigarette, or Vaping, Product Use-Associated Lung Injury

2020 ◽  
Vol 16 (3) ◽  
pp. 295-310 ◽  
Author(s):  
Dazhe James Cao ◽  
Kim Aldy ◽  
Stephanie Hsu ◽  
Molly McGetrick ◽  
Guido Verbeck ◽  
...  
Keyword(s):  
Lung Injury ◽  
Electronic Cigarettes ◽  
Electronic Cigarette ◽  
Health Consequences ◽  
Product Use

scholarly journals Vaping in today’s pandemic: E-cigarette, or vaping, product use–associated lung injury mimicking COVID-19 in teenagers presenting with respiratory distress

2020 ◽  
Vol 8 ◽  
pp. 2050313X2096959
Author(s):  
Daphne O Darmawan ◽  
Kriti Gwal ◽  
Brian D Goudy ◽  
Sanjay Jhawar ◽  
Kiran Nandalike
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Lung Injury ◽  
Respiratory Distress ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Case Series ◽  
Product Use ◽  
Abdominal Symptoms ◽  
History Of ◽  
High Index Of Suspicion

The clinical presentation of children and adolescents infected with severe acute respiratory syndrome coronavirus 2 can range from asymptomatic to mild or moderate manifestations. We present a case series of three adolescents who presented during the coronavirus disease 2019 (COVID-19) pandemic with symptoms concerning for COVID-19, including fever, abdominal symptoms, cough, respiratory distress, and hypoxemia. Their laboratory results showed elevated inflammatory markers that are also commonly seen in COVID-19. The chest imaging studies mimicked COVID-19 with non-specific ground glass opacities and interstitial prominence patterns. However, severe acute respiratory syndrome coronavirus 2 testing was negative and further questioning of these adolescents and their parents revealed a history of vaping marijuana-related products leading to the eventual diagnosis of e-cigarette, or vaping, product use–associated lung injury. Our patients were successfully treated with corticosteroids. The providers caring for pediatric patients, especially adolescents, should continue to have a high index of suspicion for e-cigarette, or vaping, product use–associated lung injury in patients presenting with unexplained respiratory failure, while ruling out COVID-19.

scholarly journals E‐cigarette or Vaping Product Use–Associated Lung Injury Produced in an Animal Model From Electronic Cigarette Vapor Exposure Without Tetrahydrocannabinol or Vitamin E Oil

2020 ◽  
Vol 9 (18) ◽  
Author(s):  
Michael T. Kleinman ◽  
Rebecca Johnson Arechavala ◽  
David Herman ◽  
Jianru Shi ◽  
Irene Hasen ◽  
...  
Keyword(s):  
Vitamin E ◽  
Lung Injury ◽  
Inflammatory Cells ◽  
The United States ◽  
Electronic Cigarette ◽  
Alveolar Wall ◽  
Cigarette Use ◽  
Shortness Of Breath ◽  
Product Use ◽  
Vitamin E Acetate

Abstract E‐cigarette or vaping product use–associated lung injury was recognized in the United States in the summer of 2019 and is typified by acute respiratory distress, shortness of breath, chest pain, cough, and fever, associated with vaping. It can mimic many of the manifestations of coronavirus disease 2019 (COVID‐19). Some investigators have suggested that E‐cigarette or vaping product use–associated lung injury was due to tetrahydrocannabinol or vitamin E acetate oil mixed with the electronic cigarette liquid. In experimental rodent studies initially designed to study the effect of electronic cigarette use on the cardiovascular system, we observed an E‐cigarette or vaping product use–associated lung injury‐like condition that occurred acutely after use of a nichrome heating element at high power, without the use of tetrahydrocannabinol, vitamin E, or nicotine. Lung lesions included thickening of the alveolar wall with foci of inflammation, red blood cell congestion, obliteration of alveolar spaces, and pneumonitis in some cases; bronchi showed accumulation of fibrin, inflammatory cells, and mucus plugs. Electronic cigarette users should be cautioned about the potential danger of operating electronic cigarette units at high settings; the possibility that certain heating elements may be deleterious; and that E‐cigarette or vaping product use–associated lung injury may not be dependent upon tetrahydrocannabinol, vitamin E, or nicotine.

Pediatric Chest Radiographic and CT Findings of Electronic Cigarette or Vaping Product Use–associated Lung Injury (EVALI)

Radiology ◽  
2020 ◽  
Vol 295 (2) ◽  
pp. 430-438 ◽  
Author(s):  
Maddy Artunduaga ◽  
Devika Rao ◽  
Jonathan Friedman ◽  
Jeannie K. Kwon ◽  
Cory M. Pfeifer ◽  
...  
Keyword(s):  
Lung Injury ◽  
Electronic Cigarette ◽  
Product Use ◽  
Ct Findings ◽  
Pediatric Chest

Translocation (X;20)(q13;q13.3): Report of Three Additional Cases.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4264-4264
Author(s):  
Chandrika Sreekantaiah
Keyword(s):  
Bone Marrow ◽  
Myeloid Leukemia ◽  
Bone Marrow Aspiration ◽  
Unknown Etiology ◽  
Acute Monocytic Leukemia ◽  
Monocytic Leukemia ◽  
Presenting Symptoms ◽  
Recurrent Translocation ◽  
History Of

We report a recurrent translocation (X;20)(q13;q13.3) in three patients. The translocation was the sole chromosomal abnormality in all three patients and the number of cells with the abnormality varied from three to seventeen out of twenty metaphases analyzed for each patient. The patients were all female with ages ranging from 66 to 83. The presenting symptoms were variable but all included a history of anemia. Bone marrow aspiration showed acute monocytic leukemia in one patient and normocellular bone marrow with no detectable morphologic or immunophenotypic evidence of neoplasm in the other two. Only eight cases with the translocation have previously been reported. Seven of these cases had either myelodysplastic syndrome or acute myeloid leukemia and one patient had pancytopenia of unknown etiology. Repeated bone marrow evaluations on this patient showed no dyspoietic changes. The t(X;20) has clearly been established as a nonrandom abnormality, however, the clinical significance of the translocation is not clear. Close follow up of these patients is therefore essential. Characterization at the molecular level will also help to determine the genes involved and the mechanism of their action.

Craniocervical Instability in the Setting of Os Odontoideum

Neurosurgery ◽  
2015 ◽  
Vol 76 (5) ◽  
pp. 514-521 ◽  
Author(s):  
Deng Zhao ◽  
Shenglin Wang ◽  
Peter G. Passias ◽  
Chao Wang
Keyword(s):  
Surgical Management ◽  
Japanese Orthopaedic Association ◽  
Os Odontoideum ◽  
Complication Rates ◽  
Computed Tomographic ◽  
Presenting Symptoms ◽  
Functional Scores ◽  
Atlantoaxial Fixation ◽  
History Of

Abstract BACKGROUND: Our clinical understanding of os odontoideum (OO) remains incomplete. Congenital and traumatic causes have been proposed and advocated. Clinical presentations range from asymptomatic to axial pain to myelopathy or vertebral-basilar ischemia. A consensus for surgical management exists for those found to have an unstable atlantoaxial complex or symptomatic cranial-vertebral junction compression. OBJECTIVE: To evaluate the clinical presentation and surgical outcomes of patients with OO and an unstable atlantoaxial complex or symptomatic cranial-vertebral junction compression. METHODS: Patients with a diagnosis of OO who underwent surgical management were included. Patients were excluded on the basis of previous C2 fracture, Fielding diagnostic criteria, and inadequate follow-up. History of trauma and presenting symptoms were assessed. Clinical and neurological improvements were measured with the use of patient satisfaction scores and the Japanese Orthopaedic Association scores. Fusion status was documented with the use of radiographs and computed tomographic imaging. RESULTS: Of 279 patients, 112 reported a history of cranial-vertebral junction trauma, whereas 28 were diagnosed with congenital malformations. Clinically, 84.9% of patients presented with myelopathy, with pain presented in 42.6%. Atlantoaxial fixation was performed in 240 patients, occiput-to-C2 fixation in 35 patients, and extended occipito-cervical fixation in 4 patients. Mean follow-up was 40.3 months. Complications were reported in 2.4% of patients. Japanese Orthopaedic Association scores improved from a preoperative mean of 12.4 to 14.8. Two hundred thirty-five patients (77.7%) improved, with 30 patients experiencing no change in symptoms and 14 patients deteriorating. Fusion was achieved in 96.8% of patients. CONCLUSION: Our data reveal that surgical treatment for OO using the indications and techniques delineated is associated with high satisfaction rates, improved functional scores, and high fusion rates with low complication rates.

scholarly journals The presence of symptons and symptom-rhythm correlation in patients with Implantable loop recorders

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
ML Goncalves ◽  
MARIA Goncalves ◽  
INÊS Pires ◽  
JOÃO Santos ◽  
JOANA Correia ◽  
...  
Keyword(s):  
Previous History ◽  
Heart Rhythm ◽  
Coronary Intervention ◽  
Ventricular Rate ◽  
Presenting Symptoms ◽  
Device Implantation ◽  
History Of ◽  
Implantable Loop Recorders ◽  
Diagnostic Outcome

Abstract Funding Acknowledgements Type of funding sources: None. INTRODUCTION Implantable loop recorders (ILR) are a powerful diagnostic tool for heart rhythm diseases, and particularly useful when symptoms are infrequent or when long-term data are required. The main indication is for study of syncope/presyncope due to suspected cardioinhibitory etiology. OBJECTIVE To evaluate the diagnostic profitability of ILR in patient (P) with syncope/ presyncope and to evaluate the effect of symptons on follow-up. METHODS Included P undergoing ILR implantation in 6 consecutive years, to study syncope/presyncope. Information was collected on P characteristics, indication, diagnostic outcome and subsequent management and complications. A follow-up (FU) of 1 year and 3 years were done. Diagnostic outcome was based in symptom-rhythm correlation. Symptons and correlation to ECG during the FU and management after the diagnosis were assessed. RESULTS 99 P were selected. Evaluation of syncope in 91.9% (n = 91) and presyncope in 8.1% (n = 8). 54.5% female, median age 59.4 ± 17.4 years. 55.8% (n = 53) completed the 3 years FU and 84.2% (n = 80) completed the 1 year FU. Death occurred in 4% (n = 4) during the FU. ILR results led to device implantation in 35% of the P (22 pacemakers and 1 ICD) in 1 year FU, with a median time to implantation of 11.6 months after ILR, and the majority of ILR motivated by syncope (87%). If we consider only P that finished the 3 years of FU, in 47.2% P were implanted a device. The most common arrhythmic finding were AV block (47.8%), followed by sinus pauses / asystole (43.5%), AF with slow ventricular rate (4.3%) and VT (4.3%). 4.9% of P experienced a complication related to the device (2 infection and 3 non-infectious pain), that resulted in explantation. 60.9% of the P were symptomatic during the FU, with 24.1% achieving symptom-rhythm correlation and 36.8% who did not. Device implantation was associated with the presence of symptons in FU (82.6% vs 17.4%, p = 0.012) and symptom-rhythm correlation (95% vs 5%,p = 0.001). 38.7% (n = 27) of the P finished the 3 years of FU without a diagnostic outcome or detectable event, with 44.4% being assymptomatic and 55.6% presenting symptoms without ECG correlation. Compared to the P that implanted a device, this type of P was frequently of female sex (57.6% vs 30.4%, p = 0.045), younger age (54.8 ± 18.1 vs 65.8 ± 12.8 years, p = 0.014), with less cardiovascular risk factors like dyslipidemia (37.0% vs 78.3%, p = 0.003) and arterial hypertension (48.1% vs 73.9%, p = 0.05), AF (0% vs 19%, p = 0.025), previous history of myocardial infarction and percutaneous coronary intervention (3.2% vs 17.4%, p = 0.05; 3.0% vs 21.7%, p = 0.028) and more frequently with history of depression (51.9% vs 22.7%, p = 0.037). CONCLUSION In this study, ILR monitoring led to a device implantation in 47.2% of the P that finished the 3 years FU. The presence of symptons and symptom-rhythm correlation during FU was associated with device implantation.

scholarly journals Retropharyngeal space lipoma: an unusual cause of dysphagia

2021 ◽  
Vol 7 (2) ◽  
pp. 379
Author(s):  
Chinyere N. Asoegwu ◽  
Nkiruka A. Wakwe ◽  
Clement C. Nwawolo
Keyword(s):  
Neck Region ◽  
Positive Sign ◽  
Barium Swallow ◽  
Retropharyngeal Space ◽  
Head And Neck Region ◽  
Solid Foods ◽  
Presenting Symptoms ◽  
History Of ◽  
Progressive Dysphagia

<p class="abstract">Lipomas are uncommon in the head and neck region and rare in the retropharyngeal space. Lipoma of the retropharyngeal space may cause aerodigestive tract obstruction presenting as dyspnea and or dysphagia. The presenting symptoms will depend on the size and site of the lipoma in the retropharyngeal space. We present the case of a 57 years old male with 6 months’ history of progressive dysphagia to solid foods only and no positive sign on clinical examination. The barium swallow was normal. The computed tomography (CT) scan showed a moderate-sized homogenous mass of fat density in the hypopharyngeal section of the retropharyngeal space. Diagnosis of dysphagia caused by retropharyngeal lipoma was made. This was surgically excised via the trans-cervical route with no complications, complete resolution of symptoms, and no recurrence 2 years after on follow-up. In the dysphagia of unknown cause, retropharyngeal space lipoma should be considered.</p>

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