Resolution of Ethical Dilemmas Using Basic Ethical Principles in Cases of Pregnancy with Severe Symptoms of Coronavirus Disease 2019 Complications

BACKGROUND: Coronavirus disease 2019 (COVID-19) can attack the entire population, but is more aggressive in vulnerable populations such as the elderly, patients with chronic diseases, and pregnant women. For pregnant women, the management of COVID-19 treatment provided must be in line with efforts to reduce maternal mortality. The method of this study was a case report. A pregnant woman aged 40 years who was confirmed with severe COVID-19 symptoms. This patient had severe symptomatic hypoxemia and had a hypercoagulable state. Termination of pregnancy in patients is considered for the sake of fetomaternal safety so that an ethical dilemma arises. For this reason, a joint conference was held to get the best solution for the patient and the fetus. CASE REPORT: Using several basic ethical principles such as beneficence, nonmaleficence, justice, and autonomy, which are supported by the principles of minus malum, double effect, and prima facie, it was decided for the patient to terminate pregnancy to reduce severe symptoms of COVID-19. Termination of pregnancy in pregnant women with confirmed COVID-19 with severe symptoms is still an ethical dilemma that needs to be discussed further. Therefore, ethical considerations in this patient were carried out by reviewing obstetric, pediatric, pulmonology, anesthesia, and internal medicine indications. CONCLUSION: Termination of pregnancy in this patient with confirmed COVID-19 with severe symptoms can be done. Although termination of pregnancy has not completely saved the mother’s condition, this decision has the potential to provide benefits and safety for the patient and the fetus.

REACTIVATION OF TUBERCULOSIS AND COVID-19

Coronavirus disease 2019 (COVID-19) is a viral disease caused by a novel coronavirus that can lead to severe acute respiratory failure. Recent studies have shown that aggravating factors in the etiology of COVID-19 disease include genetic defects and autoantibodies against type 1 interferon. Mycobacterium tuberculosis is an immobile aerobic bacillus that causes tuberculosis disease. SARS-CoV-2 infection and immunosuppressive drugs may temporarily inhibit immunologic system, then may lead to active tuberculosis by reactivation or infection of M. tuberculosis. We aimed to show that there is a relationship between covid-19 infection and an increase in the number of tuberculosis patients. Eight patients diagnosed with tuberculosis in the Pediatric Pulmonology and Pediatric Infectious Diseases Clinics of Necmettin Erbakan University, Meram Medical Faculty between March 2020 and May 2021 were enrolled in this study. The presence of COVID-19 infection was confirmed by COVID-19 antibody test and patient’s detailed medical history. The patient with negative antibody test was also included in the study if other family members confirmed for COVID-19 infection by RT-PCR. We evaluated demographic data, laboratory findings, imaging tests and pathology results of all patients. The remarkable increase in the number of tuberculosis activation in the recent year suggests the role of COVID-19 infection. The pathologic structure of the virus may be responsible of the increase, although the mechanism is not fully understood. Further research should be done on this topic.

Palliative Care in Pediatric Pulmonology

Children with End Stage Lung Disease (ESLD) are part of the growing population of individuals with life-limiting conditions of childhood. These patients present with a diverse set of pulmonary, cardiovascular, neuromuscular, and developmental conditions. This paper first examines five cases of children with cystic fibrosis, bronchopulmonary dysplasia, neuromuscular disease, pulmonary hypertension, and lung transplantation from Texas Children’s Hospital. We discuss the expected clinical course of each condition, then review the integration of primary and specialized palliative care into the management of each diagnosis. This paper then reviews the management of two children with end staged lung disease at Hospital Civil de Guadalajara, providing an additional perspective for approaching palliative care in low-income countries.

Ventilatory limitations are not associated with dyspnea on exertion or reduced aerobic fitness in pectus excavatum: a critical information that must be highlighted to prevent inappropriate interventions.

Cover letter Pediatric Pulmonology Dear Editor, Enclosed is a manuscript to be considered in Pediatric Pulmonology that does not require an abstract , usually. This letter to the editor entitled “Ventilatory limitations are not associated with dyspnea on exertion or reduced aerobic fitness in pectus excavatum: a critical information that must be highlighted to prevent inappropriate interventions” comments the reports by Hardie and al. which tested the hypothesis that PEX deformities are associated with a pulmonary impairment during exercise and concluded that resting lung volume measurements were associated with the anatomic degree of PEX severity.