BACKGROUND Coronavirus disease 2019(COVID-19)is a highly contagious infection caused by the severe acute respiratory syndrome coronavirus 2 virus and has a unique underlying pathogenesis.Hemodialysis(HD)patients exper...BACKGROUND Coronavirus disease 2019(COVID-19)is a highly contagious infection caused by the severe acute respiratory syndrome coronavirus 2 virus and has a unique underlying pathogenesis.Hemodialysis(HD)patients experience high risk of contamination with COVID-19 and are considered to have higher mortality rates than the general population by most but not all clinical series.We aim to highlight the peculiarities in the immune state of HD patients,who seem to have both immune-activation and immune-depression affecting their outcome in COVID-19 infection.CASE SUMMARY We report the opposite clinical outcomes(nearly asymptomatic course vs death)of two diabetic elderly patients infected simultaneously by COVID-19,one being on chronic HD and the other with normal renal function.They were both admitted in our hospital with COVID-19 symptoms and received the same treatment by protocol.The non-HD sibling deteriorated rapidly and was intubated and transferred to the Intensive Care Unit,where he died despite all supportive care.The HD sibling,although considered more“high-risk”for adverse outcome,followed a benign course and left the hospital alive and well.CONCLUSION These cases may shed light on aspects of the immune responses to COVID-19 between HD and non-HD patients and stimulate further research in pathophysiology and treatment of this dreadful disease.展开更多
Background: Although the original clinical description of fat embolism syndrome (FES) dates from 1873, the condition remains a diagnostic challenge for modern clinicians. The syndrome is described as a serious consequ...Background: Although the original clinical description of fat embolism syndrome (FES) dates from 1873, the condition remains a diagnostic challenge for modern clinicians. The syndrome is described as a serious consequence of fat emboli producing a distinct pattern of clinical symptoms and signs. It is mainly associated with fractures of the long-bones and the pelvis. The present paper describes the case of a trauma patient with bilateral tibial fractures that present the syndrome and highlights the importance of early identification and aggressive treatment of FES which is obligatory for the patient’s survival. Case Description: A 32 year-old man reached the hospital as a trauma call after a road traffic accident. Clinical examination was unremarkable with the only finding that the patient was unable to straight leg raise and weight bear. Both shins were painful and swollen at their middle third, while the left one was in varus and posterior displacement. Neurovascular status of both lower extremities was normal. Plain radiographic control (X-Rays) revealed an oblique right tibial fracture of the mid-shaft with a distal third fibular fracture and a comminuted fracture of the left tibia with a fracture of the fibula at the same level. The legs were immobilised on a splint and the decision was to treat the patient surgically. Within a few post admission hours the haemoglobin dropped by 2.9 mg/dL, however a source of active bleeding could not be allocated. The abdomen was soft and not tender in palpation and the central nervous system did not present any abnormalities. The following day the haemoglobin dropped but the new ultrasonography control did not reveal any free abdominal fluid. Both lower limbs were not compromised. The second post-injury day the patient went to theatre and the right tibia was stabilised with an antegrade nail (T2-Stryker) while the left one with an external fixation. During the reaming process the haemoglobin dropped to 7.1 gr/dL, so he was transfused with 3 blood units. Immediately after extubation, the patient desaturated on air and ABG values forced the anaesthetists to intubate him in recovery and place him in mechanical ventilation with high levels of positive end expiratory pressure (PEEP). Symptoms subsided rapidly and he was transferred to the IMU. Clinical image and CT scan were in favour of fat embolism syndrome. On the fifth post-operative day the patient was transferred back to ward and a week later he was discharged being completely free of symptoms. Clinical Relevance: Fat embolism syndrome is typically presented with the following triad: a) respiratory changes;b) neurologic abnormalities;c) petechial rash. These three constitute the major criteria described by Gurd and are pathognomonic for the condition. The patient—described in the present case report—developed progressively all those symptoms within the expected period of time. The FES is a well-known pathological condition that is well described in literature and should be familiar to those clinicians that manage trauma patients. Diagnosing the condition can be highly demanding since there are no laboratory investigations or radiographic imaging techniques specific for FES. Suspicion and diagnosis can be mainly placed based on the criteria described by Gurd, in 1970.展开更多
BACKGROUND Persistent hiccups,lasting more than 48 h,have been described as an atypical presentation of coronavirus disease 19(COVID-19)in the general population.To the best of our knowledge,this is the first report o...BACKGROUND Persistent hiccups,lasting more than 48 h,have been described as an atypical presentation of coronavirus disease 19(COVID-19)in the general population.To the best of our knowledge,this is the first report of persistent hiccups and non-ST elevation myocardial injury(NSTEMI)as an atypical presentation of COVID-19 in a peritoneal dialysis(PD)patient.CASE SUMMARY A 70-year old man,who had been on PD for 3 years with a history of ischemic heart failure and reduced ejection fraction,presented for a scheduled radionuclide myocardial scan.Upon arrival,he complained of anorexia,nausea for 5 d,and unremitting hiccups for the previous 48 h.Clinical and laboratory examinations revealed an NSTEMI plus a positive nasopharyngeal reverse transcriptase polymerase chain reaction testing for severe acute respiratory syndrome coronavirus 2.COVID-19 lung involvement was mild and was resolved without specific treatment.Myocardial injury was managed by coronary catheterization and stenting,while hiccups responded only to baclofen per os.CONCLUSION Persistent hiccups and NSTEMI can be atypical presentations of COVID-19 in peritoneal dialysis patients,which may be due to involvement of the central nervous system and myocardial injuries.展开更多
BACKGROUND Coronavirus disease 2019(COVID-19)is still a menacing pandemic,especially in vulnerable patients.Morbidity and mortality from COVID-19 in maintenance hemodialysis(MHD)patients are considered worse than thos...BACKGROUND Coronavirus disease 2019(COVID-19)is still a menacing pandemic,especially in vulnerable patients.Morbidity and mortality from COVID-19 in maintenance hemodialysis(MHD)patients are considered worse than those in the general population,but vary across continents and countries in Europe.AIM To describe the clinical course and outcomes of hospitalized MHD patients with COVID-19 in a retrospective observational single center study in Greece.METHODS We correlated clinical,laboratory,and radiological data with the clinical outcomes of MHD patients hospitalized with COVID-19 during the pandemic.The diagnosis was confirmed by real-time polymerase chain reaction.Outcome was determined as survivors vs non-survivors and“progressors”(those requiring oxygen supplementation because of COVID-19 pneumonia worsening)vs“non-progressors”.RESULTS We studied 32 patients(17 males),with a median age of 75.5(IQR:58.5-82)years old.Of those,12 were diagnosed upon screening and 20 with related symptoms.According to the World Health Organization(WHO)score,the severity on admission was mild disease in 16,moderate in 13,and severe in 3 cases.Chest computed tomography(CT)showed 1-10%infiltrates in 24 patients.Thirteen“progressors”were recorded among included patients.The case fatality rate was 5/32(15.6%).Three deaths occurred among“progressors”and two in“non-progressors”,irrespective of co-morbidities and gender.Predictors of mortality on admission included frailty index,chest CT findings,WHO severity score,and thereafter the increasing values of serum LDH and D-dimers and decreasing serum albumin.Predictors of becoming a“progressor”included increasing number of neutrophils and neutrophils/lymphocytes ratio.CONCLUSION Patients on MHD seem to be at higher risk of COVID-19 mortality,distinct from the general population.Certain laboratory parameters on admission and during follow-up may be helpful in risk stratification and management of patients.展开更多
文摘BACKGROUND Coronavirus disease 2019(COVID-19)is a highly contagious infection caused by the severe acute respiratory syndrome coronavirus 2 virus and has a unique underlying pathogenesis.Hemodialysis(HD)patients experience high risk of contamination with COVID-19 and are considered to have higher mortality rates than the general population by most but not all clinical series.We aim to highlight the peculiarities in the immune state of HD patients,who seem to have both immune-activation and immune-depression affecting their outcome in COVID-19 infection.CASE SUMMARY We report the opposite clinical outcomes(nearly asymptomatic course vs death)of two diabetic elderly patients infected simultaneously by COVID-19,one being on chronic HD and the other with normal renal function.They were both admitted in our hospital with COVID-19 symptoms and received the same treatment by protocol.The non-HD sibling deteriorated rapidly and was intubated and transferred to the Intensive Care Unit,where he died despite all supportive care.The HD sibling,although considered more“high-risk”for adverse outcome,followed a benign course and left the hospital alive and well.CONCLUSION These cases may shed light on aspects of the immune responses to COVID-19 between HD and non-HD patients and stimulate further research in pathophysiology and treatment of this dreadful disease.
文摘Background: Although the original clinical description of fat embolism syndrome (FES) dates from 1873, the condition remains a diagnostic challenge for modern clinicians. The syndrome is described as a serious consequence of fat emboli producing a distinct pattern of clinical symptoms and signs. It is mainly associated with fractures of the long-bones and the pelvis. The present paper describes the case of a trauma patient with bilateral tibial fractures that present the syndrome and highlights the importance of early identification and aggressive treatment of FES which is obligatory for the patient’s survival. Case Description: A 32 year-old man reached the hospital as a trauma call after a road traffic accident. Clinical examination was unremarkable with the only finding that the patient was unable to straight leg raise and weight bear. Both shins were painful and swollen at their middle third, while the left one was in varus and posterior displacement. Neurovascular status of both lower extremities was normal. Plain radiographic control (X-Rays) revealed an oblique right tibial fracture of the mid-shaft with a distal third fibular fracture and a comminuted fracture of the left tibia with a fracture of the fibula at the same level. The legs were immobilised on a splint and the decision was to treat the patient surgically. Within a few post admission hours the haemoglobin dropped by 2.9 mg/dL, however a source of active bleeding could not be allocated. The abdomen was soft and not tender in palpation and the central nervous system did not present any abnormalities. The following day the haemoglobin dropped but the new ultrasonography control did not reveal any free abdominal fluid. Both lower limbs were not compromised. The second post-injury day the patient went to theatre and the right tibia was stabilised with an antegrade nail (T2-Stryker) while the left one with an external fixation. During the reaming process the haemoglobin dropped to 7.1 gr/dL, so he was transfused with 3 blood units. Immediately after extubation, the patient desaturated on air and ABG values forced the anaesthetists to intubate him in recovery and place him in mechanical ventilation with high levels of positive end expiratory pressure (PEEP). Symptoms subsided rapidly and he was transferred to the IMU. Clinical image and CT scan were in favour of fat embolism syndrome. On the fifth post-operative day the patient was transferred back to ward and a week later he was discharged being completely free of symptoms. Clinical Relevance: Fat embolism syndrome is typically presented with the following triad: a) respiratory changes;b) neurologic abnormalities;c) petechial rash. These three constitute the major criteria described by Gurd and are pathognomonic for the condition. The patient—described in the present case report—developed progressively all those symptoms within the expected period of time. The FES is a well-known pathological condition that is well described in literature and should be familiar to those clinicians that manage trauma patients. Diagnosing the condition can be highly demanding since there are no laboratory investigations or radiographic imaging techniques specific for FES. Suspicion and diagnosis can be mainly placed based on the criteria described by Gurd, in 1970.
文摘BACKGROUND Persistent hiccups,lasting more than 48 h,have been described as an atypical presentation of coronavirus disease 19(COVID-19)in the general population.To the best of our knowledge,this is the first report of persistent hiccups and non-ST elevation myocardial injury(NSTEMI)as an atypical presentation of COVID-19 in a peritoneal dialysis(PD)patient.CASE SUMMARY A 70-year old man,who had been on PD for 3 years with a history of ischemic heart failure and reduced ejection fraction,presented for a scheduled radionuclide myocardial scan.Upon arrival,he complained of anorexia,nausea for 5 d,and unremitting hiccups for the previous 48 h.Clinical and laboratory examinations revealed an NSTEMI plus a positive nasopharyngeal reverse transcriptase polymerase chain reaction testing for severe acute respiratory syndrome coronavirus 2.COVID-19 lung involvement was mild and was resolved without specific treatment.Myocardial injury was managed by coronary catheterization and stenting,while hiccups responded only to baclofen per os.CONCLUSION Persistent hiccups and NSTEMI can be atypical presentations of COVID-19 in peritoneal dialysis patients,which may be due to involvement of the central nervous system and myocardial injuries.
文摘BACKGROUND Coronavirus disease 2019(COVID-19)is still a menacing pandemic,especially in vulnerable patients.Morbidity and mortality from COVID-19 in maintenance hemodialysis(MHD)patients are considered worse than those in the general population,but vary across continents and countries in Europe.AIM To describe the clinical course and outcomes of hospitalized MHD patients with COVID-19 in a retrospective observational single center study in Greece.METHODS We correlated clinical,laboratory,and radiological data with the clinical outcomes of MHD patients hospitalized with COVID-19 during the pandemic.The diagnosis was confirmed by real-time polymerase chain reaction.Outcome was determined as survivors vs non-survivors and“progressors”(those requiring oxygen supplementation because of COVID-19 pneumonia worsening)vs“non-progressors”.RESULTS We studied 32 patients(17 males),with a median age of 75.5(IQR:58.5-82)years old.Of those,12 were diagnosed upon screening and 20 with related symptoms.According to the World Health Organization(WHO)score,the severity on admission was mild disease in 16,moderate in 13,and severe in 3 cases.Chest computed tomography(CT)showed 1-10%infiltrates in 24 patients.Thirteen“progressors”were recorded among included patients.The case fatality rate was 5/32(15.6%).Three deaths occurred among“progressors”and two in“non-progressors”,irrespective of co-morbidities and gender.Predictors of mortality on admission included frailty index,chest CT findings,WHO severity score,and thereafter the increasing values of serum LDH and D-dimers and decreasing serum albumin.Predictors of becoming a“progressor”included increasing number of neutrophils and neutrophils/lymphocytes ratio.CONCLUSION Patients on MHD seem to be at higher risk of COVID-19 mortality,distinct from the general population.Certain laboratory parameters on admission and during follow-up may be helpful in risk stratification and management of patients.
