BACKGROUND: Coronavirus disease-2019 (COVID-19) is associated with hypercoagulability and increased thrombotic risk in critically ill patients. To our knowledge, no studies have evaluated whether aspirin use is associated with reduced risk of mechanical ventilation, intensive care unit (ICU) admission, and in-hospital mortality. METHODS: A retrospective, observational cohort study of adult patients admitted with COVID-19 to multiple hospitals in the United States between March 2020 and July 2020 was performed. The primary outcome was the need for mechanical ventilation. Secondary outcomes were ICU admission and in-hospital mortality. Adjusted hazard ratios (HRs) for study outcomes were calculated using Cox-proportional hazards models after adjustment for the effects of demographics and comorbid conditions. RESULTS: Four hundred twelve patients were included in the study. Three hundred fourteen patients (76.3%) did not receive aspirin, while 98 patients (23.7%) received aspirin within 24 hours of admission or 7 days before admission. Aspirin use had a crude association with less mechanical ventilation (35.7% aspirin versus 48.4% nonaspirin, P = .03) and ICU admission (38.8% aspirin versus 51.0% nonaspirin, P = .04), but no crude association with in-hospital mortality (26.5% aspirin versus 23.2% nonaspirin, P = .51). After adjusting for 8 confounding variables, aspirin use was independently associated with decreased risk of mechanical ventilation (adjusted HR, 0.56, 95% confidence interval [CI], 0.37-0.85, P = .007), ICU admission (adjusted HR, 0.57, 95% CI, 0.38-0.85, P = .005), and in-hospital mortality (adjusted HR, 0.53, 95% CI, 0.31-0.90, P = .02). There were no differences in major bleeding (P = .69) or overt thrombosis (P = .82) between aspirin users and nonaspirin users. CONCLUSIONS: Aspirin use may be associated with improved outcomes in hospitalized COVID-19 patients. However, a sufficiently powered randomized controlled trial is needed to assess whether a causal relationship exists between aspirin use and reduced lung injury and mortality in COVID-19 patients.
Patient: Female, 48-year-old Final Diagnosis: COVID 19 infection • severe idiopathic thrombocytopenic purpura Symptoms: Bruising • headcahe • hemoptysis • nausea Medication: — Clinical Procedure: — Specialty: Hematology • Infectious Diseases Objective: Rare coexistence of disease or pathology Background: COVID-19 is associated with many hematological manifestations, including lymphopenia and thrombosis. There have been rare occasions in which thrombocytopenia has been reported as the sole clinical presentation of COVID-19. Case Report: This is the case report of a 48-year-old Hispanic female patient with COVID-19 presenting as severe isolated thrombocytopenia. The patient presented to the Emergency Department with hemoptysis, spontaneous bruising, and excessive vaginal bleeding and also reported a recent flu-like illness. On examination, she was found to have bilateral subconjunctival hemorrhage, diffuse oral ulcers, epigastric abdominal tenderness, and ecchymosis on her chest, with scattered petechiae and palpable purpura on her lower limbs. Laboratory results were significant for a platelet count of 0×10 9 and an immature platelet fraction of 34.1%. Owing to clinical suspicion, the patient was tested for COVID-19, and her test result was positive. She was treated with intravenous immunoglobulin, prednisone, rituximab, vitamin C, and zinc. Upon achieving hemodynamic stability, she was discharged to follow up with a hematologist in the outpatient setting. Conclusions: Hematological consequences of COVID-19 are becoming more prevalent. The mechanism behind this manifestation could be bone marrow failure, formation of platelet autoantibodies, or consumptive coagulopathy. These critical manifestations are necessary to manage, especially in severe forms like in our patient. Steroids and rituximab combination therapy have proven to be the most effective regimen.
We report a case of localized sarcomesothelioma detected during screening via a low-dose CT (LDCT) scan. The patient is a 71-year-old female, a current 56-pack-year cigarette smoker with a past medical history of myocardial infarction and stroke with a Zubrod score of zero. A screening LDCT revealed a 1.9 cm × 1.8 cm × 1.4 cm right lower lobe lesion with smooth margins and close association with the hemidiaphragm. A wedge resection with biopsy showed high-grade sarcomatoid mesothelioma with extensive desmoplastic morphology and negative margins. The patient opted for imaging surveillance, and at 12 months has shown no evidence of tumor recurrence on positron emission tomography (PET)/CT. The case shows that LDCT screening discovers cancers and saves lives. It also presented a dilemma for the patient and her oncologist because common guidelines do not define a recommended treatment.
INTRODUCTION: Sarcomatoid mesothelioma is a rare and aggressive subtype of malignant pleural mesothelioma accounting for only 10% of all cases. It typically presents with extrapulmonary metastases with an average survival rate of 6 months from time of diagnosis and 3.5 months for the desmoplastic mesothelioma subtype (1) . We report an atypical presentation where the tumor was caught on screening low dose CT scan at an initial stage while the patient was still asymptomatic. CASE PRESENTATION:Patient is a 71-year-old female with past medical history significant for Hashimoto's thyroiditis, myocardial infarction, stroke, current smoker (56-pack-year history) who underwent lung cancer screening with low-dose CT scan. She was noted to have a right lower lobe lesion with smooth margins abutting the right hemidiaphragm, measuring 1.9 x 1.8x 1.4 cm. It was classified as lung RADS 1.1 category 4A. Whole body pet CT showed mild hypermetabolic activity within the lesion with a max SUV of 2.6 housenfield units without evidence of nodal involvement. CT-guided biopsy was attempted and was unsuccessful given the location and significant diaphragmatic movement. She was evaluated by cardiothoracic surgery who recommended video assisted thoracoscopic surgical resection. Mass resection involving diaphragmatic and lung wedge resection was successfully performed with confirmed negative margins. A minimum diaphragm defect was closed with staples. The hospital course was complicated with minimal right apical pneumothorax after chest tube removal which was resolving on the day of discharge. During follow-up, the cancer was staged as 1B. Biopsy results revealed high-grade sarcomatoid mesothelioma with extensive desmoplastic morphology, pathology was unable to rule out sarcomatoid carcinoma due to nonspecific immunohistochemical findings. The case was discussed at tumor board and plans were to proceed with chemotherapy with cisplatin & pemetrexed followed by radiation therapy. The patient is currently undergoing chemotherapy.DISCUSSION: Sarcomatoid neoplasmas have a poor prognosis and are usually diagnosed once the cancer has already metastasized. In our case the screening low dose CT scan proved to be valuable as the tumor was caught at an early stage and resected prior to any metastasis. Given the rare nature of the tumor, we hope that the information provided can add to the few other case reports for better understanding of this cancer.CONCLUSIONS: This case highlights the significance of relying on radiographic evidence such as low dose CT scan for early diagnosis of potentially life-threatening illnesses. Recent guideline changes now recommend screening to begin at age 50 years for adults who have a 20 pack-year smoking history and current smokers (2). As providers, we should continue to encourage our patients to undergo lung cancer screening with low-dose CT scan to improve prognosis of common as well as rare tumors.
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