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Diagnosis and Treatment of COVID-19
Published in Wenguang Xia, Xiaolin Huang, Rehabilitation from COVID-19, 2021
At the early stage of the disease, multiple small patchy shadows and interstitial changes appear, which are more obvious in the periphery of the lung. Then it develops into multiple ground-glass opacities (GGOs) and infiltration shadows. In severe cases, pulmonary consolidation may occur. Pleural effusion is rare.
Test Paper 4
Published in Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike, Get Through, 2017
Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike
With regard to the progression of pulmonary consolidation on CXR, all of the following options are true except Lung contusion appears in 6 hours and clears in 3–7 days.Aspiration appears in minutes and clears in 24–48 hours unless infected.Lung infarction due to pulmonary embolism manifests after 3–5 days and clears in approximately 3 weeks.Fat embolism appears in 6 hours and clears in 7–10 days.ARDS with diffuse alveolar damage appears after 24–48 hours and clears in 4–6 weeks.
Consolidation, collapse and cavitation
Published in Paul F. Jenkins, Making Sense of the Chest X-ray, 2013
This chapter discusses the radiographic patterns of pulmonary consolidation and illustrates the various pathological processes that can cause it. It also describes the features of partial and complete collapse of the major lobes of the lungs. We are all aware that it may be difficult to decide if there is abnormal parenchymal shadowing on a chest radiograph and most of us will also have missed subtle changes of lobar collapse at some stage in our careers. However, there is a systematic approach to the identification of both consolidation and collapse, and in this chapter I seek to share it. I guarantee that if the system is adopted and practised then eventually ‘pattern recognition’ will take over – in other words, ‘I have seen this pattern of abnormality lots of times before and I know what it is’. However, before any of us reaches this stage of experience, it is vital to be obsessional about following a systematic approach – but then this applies to all aspects of clinical medicine.
Cytokine release syndrome in COVID-19: a major mechanism of morbidity and mortality
Published in International Reviews of Immunology, 2022
Yifan Que, Chao Hu, Kun Wan, Peng Hu, Runsheng Wang, Jiang Luo, Tianzhi Li, Rongyu Ping, Qinyong Hu, Yu Sun, Xudong Wu, Lei Tu, Yingzhen Du, Christopher Chang, Guogang Xu
A study of a cohort of COVID-19 patients showed that excessive amounts of proinflammatory cytokines were detected in the blood of those who died [3]. It was found that levels of cytokines IL-1β, IFN-γ, IL-10, and MCP-1 were higher in COVID-19 patients than healthy controls, and levels of IP-10, MCP1, MIP1a, and TNF-α were higher in ICU patients than in non-ICU patients, suggesting that excessive cytokine production may be associated with severity of the disease [1, 4]. In another study, more than half of the 99 patients (51%) with COVID-19 exhibited elevated IL-6 levels [5]. The effects of CRS may lead to pulmonary consolidation and edema, which may proceed to ARDS and fatal multi-organ failure [6]. Collectively, serum concentrations of cytokines and the resulting CRS are positively correlated with the pathogenesis and severity of COVID-19.
Thoracic endometriosis presented as catamental hemoptysis: a case series of a rare disease
Published in Current Medical Research and Opinion, 2021
Yi Dai, Meng-Hui Li, Yong-Jian Liu, Bing Liu, Yu-Shi Wu, Jing-He Lang, Zhen-Yu Zhang, Jin-Hua Leng
All patients underwent CT scanning during menstruation period and 2 or 3 weeks after periods, and presumed pulmonary lesions could be observed in the CT scans during menstruation. The focal consolidation with a relatively well-defined margin and ground-glass opacity (GGO) (Figure 1(1A, 2A, 3A, 4A, 5A, 6A, 7A)) was observed in CT scanning during menstruation in all patients. The location of the lesions in 7 patients were confined to the right lung, including the middle and lower lobe in 5 cases, whereas the right superior lobe in two cases. The lesion of 4 patients were located in left lung, and 3 patients were confined to the segments of both sides of the lung (Table 2). Conversely, CT scans performed 2–3 weeks after menstruation demonstrated marked improvement of pulmonary consolidation, especially ground-glass opacity (Figure 1(1B, 2B, 3B, 4B, 5B,6B, 7B)) at the same location of the involved segments as in the previous CT scans performed during menstruation (Table 2). For the patients whose lesions were partially absorbed, CT scan was repeated after 3 doses of GnRHa diagnostic treatment, and complete absorption of the original lesions was observed (Figure 1(6C)) (Table 2). Considering the correlation between the episodes of hemoptysis and changes in the series of chest CT scan findings, the possible presence of thoracic endometriosis was suspected.
Overview on the use of IL-6 agents in the treatment of patients with cytokine release syndrome (CRS) and pneumonitis related to COVID-19 disease
Published in Expert Opinion on Investigational Drugs, 2020
Zeyun Zhou, Christina C. Price
Although sarilumab is also an IL-6 inhibitor, its efficacy has only been evaluated in rheumatoid arthritis. Unlike tocilizumab, sarilumab is not being utilized in the management of CRS [30]. With the exhaustion of tocilizumab, sarilumab was proposed as an alternative. A report of eight patients’ clinical course described early administration of sarilumab to be beneficial in reducing the echo score and improving clinical outcomes [31]. Yet, another observational study of patients without invasive mechanical ventilation found that sarilumab resulted in faster recovery only in specific patient groups with minor pulmonary consolidation [32]. A recent report of 53 patients on sarilumab showed short-term clinical improvement and safety, indicating a potential use of this agent to manage COVID-19 [33]. There is one current registered clinical trial by the manufacturers to evaluate the efficacy and safety of sarilumab in hospitalized patients with severe COVID-19 [8]. However, the most recent update from the manufacturers has indicated that sarilumab failed to meet the endpoint of improved clinical status among hospitalized patients requiring mechanical ventilation [34]. Subsequently, the U.S.-based trial of sarilumab has been terminated. Sanofi maintained the trial outside the U.S., and further details on the clinical efficacy and safety of sarilumab may be available once the result is available.