Background: There is limited information on the clinical characteristics of patients with coronavirus disease 2019 (COVID-19) who are asymptomatic or have mild symptoms. Methods: We performed a retrospective case series of patients with COVID-19 enrolled from February 22 to March 26, 2020. Forty cases of COVID-19 were confirmed using real-time reverse-transcription polymerase chain reaction among patients who underwent screening tests and were consecutively hospitalized at
BackgroundRight ventricular heart failure (RVHF) is a critical complication in patients with respiratory failure particularly among those who transitioned to lung transplantation using veno-venous (V-V) extracorporeal membrane oxygenation (ECMO). In these patients, both cardiac and respiratory functions are supported using veno-arterial (V-A) or veno-arterial-venous (V-AV) ECMO. However, these modalities increase the risk of device-related complications, such as thromboembolism, bleeding, and limb ischemia, and they may disturb early rehabilitation. Due to these limitations, a right ventricular assist device with an oxygenator (Oxy-RVAD) using ECMO may be considered for patients with RVHF with V-V ECMO. MethodsThe study included patients who underwent Oxy-RVAD using ECMO due to RVHF while on V-V ECMO as a bridge to lung transplantation (BTT) due to severe respiratory failure. The patients were enrolled at a tertiary care, university hospital between 2018 and 2020. ResultsEight patients underwent Oxy-RVAD using ECMO due to RVHF for BTT. Seven patients were bridged successfully to lung transplantation. One patient died prior to transplantation from complications of interstitial lung disease. There were no major ECMO-related complications during the Oxy-RVAD using ECMO period in any patient. For those patients who were successfully bridged, the average duration of V-V ECMO was 10 days and Oxy-RVAD using ECMO was 12 days. All patients with BTT were discharged with a 30-day survival rate of 100% (7/7 patients). The 180-day survival rate was 85% (6/7 patients). ConclusionsThis study suggests that Oxy-RVAD using ECMO may be a viable option for bridging patients with RVHF to lung transplantation.
Abstract.Myeloproliferative neoplasms are associated with lymphoproliferative diseases following the administration of cytotoxic drugs or exposure to radiation, but are rare prior to therapy. The present study reports the case of a 61-year-old female with a history of transient ischemic attack. The patient, who presented with a palpable mass in the epitrochlear area of the left arm, was simultaneously diagnosed with follicular lymphoma and an unclassifiable myeloproliferative neoplasm. Excisional lymph node biopsy revealed stage I follicular lymphoma (grade 1). Laboratory findings demonstrated leukocytosis, erythrocytosis, thrombocytosis and decreased erythropoietin. Biopsy of the bone marrow revealed hypercellularity, with predominance of erythroid cells, and large polylobated megakaryocytes with increased mitotic figures, but no evidence of lymphomatous infiltration. The janus kinase 2 V617F mutation was also detected in the cells derived from the bone marrow specimen. Following local excision of the lymph node in the left epitrochlear area, radiation was delivered to the involved field, at a dose of 24 Gy in 12 fractions. The patient was started on hydroxyurea (1 g twice per day, orally) 2 weeks subsequent to radiotherapy, and was administered 500 mg twice per day as maintenance therapy. At the six-month follow-up, the white blood cell count, hemoglobin levels and platelet count had reduced, and the patient was in a healthy condition. A computed tomography scan of the neck, chest and abdomen indicated no abnormalities. To the best of our knowledge, the present study is the first case report of follicular lymphoma coexisting with an unclassifiable myeloproliferative neoplasm in a previously healthy patient. Molecular and genetic studies are required to further evaluate this infrequent disease association.
Introduction:The association of invasive tracheobronchial aspergillosis (ITBA) with invasive pulmonary aspergillosis (IPA) is not well-established. We aimed to compare clinical characteristics between patients who exhibited ITBA with IPA and those who exhibited isolated ITBA (iITBA) and to evaluate the usefulness of serum or bronchial galactomannan (GM) tests in diagnosing ITBA.Methods: This retrospective single-center case-control study was conducted over a period of four years. Fifteen patients were enrolled after the confirmation of the presence of ITBA using bronchoscopy-guided biopsy (iITBA = 7 vs. ITBA+IPA = 8). Clinical characteristics of patients and results of serum or bronchial GM test were compared between the two groups.Mortality was assessed through 6-month follow-up data. Results:The ITBA+IPA group showed a higher prevalence of hematologic malignancy (75% vs 14%; P = 0.029), greater number of patients with multiple bronchial ulcers (75% vs. 14%; P = 0.029), lower platelet counts (63,000/μL vs. 229,000/μL; P < 0.001), and significantly higher mortality (63% vs. 0%; P = 0.026) than the iITBA group. In the ITBA+IPA group, 57% of patients tested positive for serum GM assay, whereas in the iITBA group, patients tested negative (P = 0.070). The bronchial GM level was high in both the iITBA and ITBA+IPA groups, but there was no significant difference between groups. Conclusions:Patients with ITBA+IPA had a greater number of hematologic malignancies with lower platelet counts and worse prognoses than did those with iITBA. Bronchoscopic findings and bronchial GM test results were more useful than serum GM test results for diagnosing ITBA.
Background Humidifier disinfectant-related lung injury (HDLI) is a severe form of toxic inhalational pulmonary parenchymal damage found in residents of South Korea previously exposed to specific guanidine-based compounds present in humidifier disinfectants (HD). HD-associated asthma (HDA), which is similar to irritant-induced asthma, has been recognized in victims with asthma-like symptoms and is probably caused by airway injury. In this study, diffusing capacity of the lung for carbon monoxide (DL CO ) in individuals with HDA was compared to that in individuals with pre-existing asthma without HD exposure. Methods We retrospectively compared data, including DL CO values, of 70 patients with HDA with that of 79 patients having pre-existing asthma without any known exposure to HD (controls). Multiple linear regression analysis and logistic regression analysis were performed to confirm the association between HD exposure and DL CO after controlling for confounding factors. The correlation between DL CO and several indicators related to HD exposure was evaluated in patients with HDA. Result The mean DL CO was significantly lower in the HDA group than in the control group (81.9% vs. 88.6%; P = 0.021). The mean DL CO of asthma patients with definite HD exposure was significantly lower than that of asthma patients with lesser exposure ( P for trend = 0.002). In multivariable regression models, DL CO in the HDA group decreased by 5.8%, and patients with HDA were 2.1-fold more likely to have a lower DL CO than the controls. Pathway analysis showed that exposure to HD directly affected DL CO values and indirectly affected its measurement through a decrease in the forced vital capacity (FVC). Correlation analysis indicated a significant inverse correlation between DL CO % and cumulative HD exposure time. Conclusion DL CO was lower in patients with HDA than in asthma patients without HD exposure, and decreased FVC partially mediated this effect. Therefore, monitoring the DL CO may be useful for early diagnosis of HDA in patients with asthma symptoms and history of HD exposure.
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