COVID‐19 has been implicated in the development of a range of autoimmune diseases and medical consequences. Sarcoidosis is an inflammatory disease with sustained granulomatous inflammation. The possible main pathogenesis of sarcoidosis is a dysregulation between immune response and certain environmental antigens. We present a case of sarcoidosis as an interesting sequela of COVID‐19. The patient was hospitalized due to SARS‐CoV‐2 without complication. Ten weeks after the illness, his chest computed tomography (CT) showed bilateral hilar, paratracheal and subcarinal lymph node enlargement. Endobronchial ultrasound with transbronchial needle aspiration (EBUS‐TBNA) was performed; pathologic findings were that of well‐formed non‐necrotizing granulomas. Complete eye examination reported panuveitis and papillitis in both eyes. On the basis of these findings, sarcoidosis was diagnosed. Therefore, sarcoidosis developing after COVID‐19 was suggested as a possible link between the viral infection and dysregulation of the inflammation process. However, further studies are needed to confirm this association.
Pulmonary pseudoaneurysms (PAPs) are an uncommon complication of severe acute respiratory syndrome coronavirus 2 infection, although they are a potentially life‐threatening condition. We present this interesting condition of severe coronavirus disease 2019 (Covid‐19) pneumonia. The patient presented with abnormal lung nodule and developed massive haemoptysis after recovering from Covid‐19 pneumonia. PAP was diagnosed by computed tomography angiography. Endovascular embolization was performed and the bleeding was stopped.
Background: Numbers of elderly patients with acute respiratory failure continue to rise with increasing age of the general population worldwide. Ventilatory reserve decreases substantially with age as a result of multiple interrelated physiologic changes. Objective: This study aimed to evaluate the predictive value of conventional and composite weaning parameters among elderly patients. Methods: We conducted an observational prospective study among intubated patients ≥70 years old and readied for undergoing spontaneous breathing trial (SBT). Weaning parameters were recorded [heart rate, respiratory rate, tidal volume, minute ventilation (MV)] at 1 min, 30 min, and 2 hr after beginning of SBT. Cough peak expiratory flow (CPEF) and diaphragmatic thickness (DT) were also measured at 1 min after SBT. Weaning parameters were compared between the 2 patient groups (weaning success vs. weaning failure). Primary outcome was difference in weaning parameters between the 2 groups of patients. Results: All 48 subjects were enrolled. The mean (±SD) age was 80.2 (±6) years. Altogether, 38 patients (79.2%) were in the weaning success group and 10 patients (20.8%) in the weaning failure group. All baseline characteristics did not significantly differ between the 2 groups. While no difference was observed in other isolated weaning parameters between the 2 patient groups, we found that patients in the weaning success group had significantly lower MV than patients in the weaning failure group (8.3±1.8 vs. 9.9±2.5 L/min, p=0.025). Composite weaning parameters included MV/CPEF and MV/(CPEF x DT) increased predictive values for weaning failure than isolated MV with area under the receiver operating characteristics curves of 0.78, 0.80, and 0.72 respectively. The best cutoff point to predict weaning failure were MV ≥8.4 L/min, MV/CPEF ≥0.12, and MV/(CPEF x DT) ≥0.45 cm-1 Conclusion: MV was the only parameter associated with weaning failure among the elderly. Composite parameters demonstrated better predictive value for assessing weaning readiness among elderly patients.
Background: To study effects of increasing vasopressor dosage and fluid resuscitation on ventriculoarterial (VA) coupling and venous return (VR)-related parameters in resuscitated normotensive septic shock patients with persistent hyperlactatemia. Methods: We performed a prospective experimental study in patients with septic shock who was admitted to medical intensive care unit and still had hyperlactatemia even received initial resuscitation to maintain mean arterial pressure (MAP) >65 mmHg. All patients received incremental dose of norepinephrine (NE) to increased MAP, then NE was titrated to baseline dosage and waited for 15 mins, then fluid bolus was given. VA coupling-related parameters [arterial elastance (Ea), left ventricular end-systolic elastance (Ees), left ventricular stroke work (SW), potential energy (PE), stroke volume (SV), and Ea/Ees], and VR-related parameters [central venous pressure (CVP), mean systemic pressure analogue (Pmsa), venous return pressure (Pvr)] were measured at 4 time points including pre-increased NE phase, post-increased NE phase, pre-fluid bolus phase, and post-fluid bolus phase. Primary outcome was average of Ea/Ees. Secondary outcomes were differences in VA coupling-related parameters and VR-related parameters between pre- vs. post- interventions.Results: All 20 patients were normotensive [MAP 74 (66-80) mmHg] with elevated blood lactate [2.7 (2.4-3.6) mmol/L] at enrollment. Average Ea/Ees was 0.89 (0.61-1.16). Compared to pre-increased NE phase, post-increased NE phase had significantly higher MAP, CVP, SV, SW, PE, Pmsa, and Pvr. Likewise, compared to pre-fluid bolus phase, post-fluid bolus raised MAP, CVP, SV, Ees, SW, Pmsa, and Pvr significantly. No difference in Ea/Ees compared between before- vs. after- received both interventions.Conclusions: In resuscitated normotensive septic shock patients with persistent hyperlactatemia, we found an average Ea/Ees of 0.89. Increasing NE dosage or fluid bolus increased most of VA coupling-related parameters and VR-related parameters, but not Ea/Ees. Further large study is warranted to validate these findings.
Background: Farinelli breathing (FB) exercise is a typical breathing exercise used by singers. This study aimed to investigate and compare the effects of FB exercise with diaphragmatic breathing (DB) exercises on respiratory function and symptoms in patients with chronic obstructive pulmonary disease (COPD).Methods: Sixteen patients aged 51-80 years with mild and moderate COPD severity were recruited for the study. They were divided into two groups: the DB (n=8) and FB groups (n=8). Both groups received complete breathing exercise training five times/week for 8 weeks. The respiratory function, effects on COPD symptoms, cytokine level, and oxidative stress variables were analyzed during the pre-and posttests. The dependent variables between the pre-and post-tests were analyzed using paired t-tests. An independent t-test was used to compare the variables between the groups. Differences were considered significant at p < 0.05. Results:The maximal expiratory pressure (MEP), maximum oxygen consumption (VO2max), and COPD Assessment Test (CAT) scores changed significantly in the DB group after the 8-week intervention compared to the pre-test, whereas force vital capacity, forced expiratory volume in the first second, maximum voluntary ventilation, maximal inspiratory pressure (MIP), MEP, VO2max, CAT score, tumor necrosis factor-alpha, and malondialdehyde level changed significantly in the FB group in the post-test. Moreover, both MIP and MEP in the FB group were significantly higher than those in the DB group. Conclusion:FB exercise improves respiratory function and COPD symptoms in patients with COPD, and may provide an alternative intervention for breathing exercises in pulmonary rehabilitation programs.
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