Objectives: Community-acquired respiratory infections (CARTIs) are responsible for serious morbidities worldwide. Identifying the aetiology can decrease the use of unnecessary antimicrobial therapy. In this study, we intend to determine the pathogenic agents responsible for respiratory infections in patients presenting to the emergency department of several Lebanese hospitals. Methods: A total of 100 patients presenting to the emergency departments of four Lebanese hospitals and identified as having CARTIs between September 2017 and September 2018 were recruited. Specimens of upper and lower respiratory tract samples were collected. Pathogens were detected by a multiplex polymerase chain reaction respiratory panel. Results: Of 100 specimens, 84 contained at least one pathogen. Many patients were detected with ≥2 pathogens. The total number of pathogens from these 84 patients was 163. Of these pathogens, 36 (22%) were human rhinovirus, 28 (17%) were Streptococcus pneumoniae, 16 (10%) were metapneumovirus, 16 (10%) were influenza A virus, and other pathogens were detected with lower percentages. As expected, the highest occurrence of pathogens was observed between December and March. Respiratory syncytial virus accounted for 2% of the cases and only correlated to paediatric patients. Conclusion: CARTI epidemiology is important and understudied in Lebanon. This study offers the first Lebanese data about CARTI pathogens. Viruses were the most common aetiologies of CARTIs. Thus, a different approach must be used for the empirical management of CARTI. Rapid testing might be useful in identifying patients who need antibiotic therapy.
Since December 2019, the novel coronavirus disease 2019 (COVID-19) outbreak that started in Wuhan, China, has become a global pandemic affecting millions of people around the globe. These patients are prone to a number of complications either related to their disease or to the different treatment modalities. Pulmonary embolism (PE) and benign post-intubation tracheal stenosis (BTS) are among these complications. In this study, we report the case of a patient with a recent COVID-19 infection that got complicated by a massive PE as well as a BTS.
Proper management of stage III non-small cell lung cancer (NSCLC) might result in a cure or patient long-term survival. Management should therefore be preceded by adequate and accurate diagnosis and staging, which will inform therapeutic decisions. A panel of oncologists, surgeons and pulmonologists in Lebanon convened to establish a set of recommendations to guide and unify clinical practice, in alignment with international standards of care. Whilst chest computerized tomography (CT) scanning remains a cornerstone in the discovery of a lung lesion, a positron-emission tomography (PET)/CT scan and a tumor biopsy allows for staging of the cancer and defining the resectability of the tumor(s). A multidisciplinary discussion meeting is currently widely advised for evaluating patients on a case-by-case basis, and should include at least the treating oncologist, a thoracic surgeon, a radiation oncologist and a pulmonologist, in addition to physicians from other specialties as needed. The standard of care for unresectable stage III NSCLC is concurrent chemotherapy and radiation therapy, followed by consolidation therapy with durvalumab, which should be initiated within 42 days of the last radiation dose; for resectable tumors, neoadjuvant therapy followed by surgical resection is recommended. This joint statement is based on the expertise of the physician panel, available literature and evidence governing the treatment, management and follow-up of patients with stage III NSCLC. Contents 1. Context 2. Screening and diagnosis 3. Diagnosing and staging lung cancer 4. Cardiopulmonary assessment 5. Tools to evaluate clinical profiles and performance of patients 6. Treatment and management of stage III NSCLC 7. Post-treatment management 8. Conclusion
Background: During the coronavirus disease 2019 (COVID-19) pandemic, patients with severe pneumonia may require hospitalization and respiratory support. Oropharyngeal dysphagia may occur due to lack of muscle coordination of the respiratory and swallowing mechanisms in acute respiratory distress syndrome (ARDS) or as a consequence of intervention for respiratory support. This report is of a series of three patients who were hospitalized for severe COVID-19 pneumonia who developed dysphagia.Case Series: Three patients patients were diagnosed with severe COVID-19 pneumonia with positive reverse transcription-polymerase chain reaction (RT-PCR) testing for SARS-CoV-2. Case 1: A 69-year-old man hospitalized with COVID-19 pneumonia and who underwent noninvasive mechanical ventilation followed by difficulty in swallowing. Case 2: An 84-year-old woman hospitalized with COVID-19 pneumonia and developed confusion, disorientation, swallowing difficulties, and aspiration pneumonia. Case 3: An 87-year-old man who developed ARDS following hospital admission with COVID-19 pneumonia.
Conclusion:These cases have shown that dysphagia may develop in patients hospitalized with severe COVID-19 pneumonia, either due to respiratory interventions or due to ARDS, and should be identified and actively managed to prevent further complications due to aspiration of gastric contents.
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