post-COVID-19

后 COVID - 19
  • 文章类型: Case Reports
    SARS-CoV-2是呼吸道疾病COVID-19的来源。它通常表现为限制性肺部症状,但自身免疫功能障碍可能偶尔会出现。COVID-19感染可能导致多系统结缔组织疾病,称为系统性硬化症(SSc)。在从COVID-19中康复的患者中,自身免疫可能有多种潜在原因。
    作者报告了一名68岁的女性,感染COVID-19后1个月,主诉呼吸困难和肌肉衰竭。患者接受了COVID后综合征治疗。她出现了慢性呼吸困难的症状,苍白的手指,皱起的嘴唇,咀嚼和吞咽困难,7周后肌肉无力。胸部高分辨率计算机断层扫描(HRCT)扫描提示间质性肺病。临床特征和包含抗Ro52和抗着丝粒抗体的自身抗体谱指向SSc。她接受了减少剂量的硫唑嘌呤和泼尼松龙治疗,她现在每月随访稳定。
    COVID-19可能诱导细胞因子风暴和免疫调节失调,最终导致自身免疫表现。在COVID-19感染后患者的自身免疫性疾病中观察到几种自身抗体。我们的情况是不同的,因为COVID-19感染后的SSc并不通常被视为自身免疫性疾病。
    罕见自身免疫性疾病患者的数量,像SSc,COVID-19之后一直在上升。因此,我们应该考虑自身免疫性疾病的可能性,当调查一个患者出现奇怪的或有新的症状后,应立即联系患者的管理。
    UNASSIGNED: The SARS-CoV-2 is the source of COVID-19, a respiratory disease. It typically manifests as restricted pulmonary symptoms, but autoimmune dysfunction might occasionally show up. A COVID-19 infection may cause a multi-system connective tissue disease known as systemic sclerosis (SSc). In patients who recovered from COVID-19, autoimmunity may have multiple underlying causes.
    UNASSIGNED: The authors report the case of a 68-year-old female who, 1 month after contracting COVID-19, complained of dyspnoea and muscle exhaustion. The patient was treated for post-COVID syndrome. She developed symptoms of chronic dyspnoea, pale fingers, pursed lips, trouble chewing and swallowing, and muscle weakness after 7 weeks. A chest high-resolution computerised tomography (HRCT) scan suggested interstitial lung disease. Clinical characteristics and an autoantibody profile containing anti-Ro 52 and anti-centromere antibodies pointed towards SSc. She was treated with azathioprine and prednisolone at a reduced dosage, and she is now stable with monthly follow-ups.
    UNASSIGNED: COVID-19 might induce cytokine storms and immunological dysregulation, ultimately culminating in autoimmune manifestations. Several autoantibodies are observed in autoimmune illnesses in post-COVID-19 infection patients. Our situation is distinct because SSc following a COVID-19 infection is not commonly seen as an autoimmune illness.
    UNASSIGNED: The number of patients with rare autoimmune diseases, like SSc, following COVID-19 has been rising. Therefore, we should consider the possibility of autoimmune disease when looking into a patient who presents strangely or has developed new symptoms after COVID and should contact the patient\'s management immediately.
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  • 文章类型: Journal Article
    一名50岁的男子在12年前因常染色体显性遗传多囊肾病导致的慢性肾功能衰竭而接受了活体肾移植,感染了19型冠状病毒病(COVID-19)。他的抗原检测呈阳性,症状轻微,喉咙痛,发热37.9℃。该患者接受了莫努比拉韦治疗5天,发病5天后症状消失。然而,发病后10天,他出现了大约37℃的发烧和非生产性咳嗽;发病27天后,患者因厌食症和呼吸系统疾病恶化而住院。入院时的严重急性呼吸系统综合症冠状病毒2(SARS-CoV-2)抗原检测结果为阴性,没有针对SARS-CoV-2的抗病毒药物。计算机断层扫描显示两个肺野中广泛的毛玻璃混浊。病人接受了类固醇脉冲治疗,头孢曲松,atovaquone,阿奇霉素,和使用高流量鼻插管的呼吸管理。联合疗法是成功的,3天后,患者接受了鼻氧气套管治疗。住院6天后停止氧气给药,14天后患者出院。根据实验室的发现,细菌,间质,肺孢子虫肺炎的可能性不大。类固醇脉冲治疗的成功表明,肺炎是由于COVID-19感染后的免疫反应引起的呼吸衰竭。
    A 50-year-old man who had undergone a living-donor kidney transplant 12 years prior for chronic renal failure due to autosomal dominant polycystic kidney disease contracted coronavirus disease 19 (COVID-19). He had a positive antigen test, mild symptoms, sore throat, and fever of 37.9 ℃. The patient was treated with molnupiravir for 5 days, and the symptoms disappeared 5 days after onset. However, 10 days after onset, he developed a fever of approximately 37 ℃ and a non-productive cough; 27 days after onset, the patient was hospitalized for anorexia and a worsening respiratory condition. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antigen test results on admission were negative, and no antiviral medications were administered against SARS-CoV-2. Computed tomography revealed extensive ground-glass opacities in both lung fields. The patient was treated with steroid pulse therapy, ceftriaxone, atovaquone, azithromycin, and respiratory management using a high-flow nasal cannula. The combined therapies were successful, and the patient was managed with a nasal oxygen cannula after 3 days. Oxygen administration was discontinued after 6 days of hospitalization, and the patient was discharged after 14 days. Based on the laboratory findings, bacterial, interstitial, and Pneumocystis pneumonia were unlikely. The success of the steroid pulse therapy suggested that respiratory failure was caused by pneumonia due to the immune response after COVID-19 infection.
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  • 文章类型: Case Reports
    背景:2019年冠状病毒病(COVID-19)是一种新型呼吸道疾病,于2019年首次出现。感染这种疾病的患者表现出无数的症状。肢体缺血和高凝状态是成人的并发症。COVID-19相关性血管炎是一种已知但很少报道的儿科并发症,治疗方法还没有很好的确立。
    方法:我们报告一例健康的4岁女性,有COVID-19病史,出现急性下肢缺血。最初是通过施用抗蛇毒血清而没有改善的急性蛇毒作用。她最终患上了下肢肢端紫癜,无法走动。患者开始使用白介素-6受体抑制剂(托珠单抗),抗凝剂,和脉冲类固醇疗法。患者完全康复,只失去了一个脚趾。
    结论:在没有合并症且有COVID-19病史的儿科患者中,很难确定血栓栓塞并发症。早期识别和治疗对发病率有重大影响,并可增加保肢的可能性。
    Coronavirus Disease 2019 (COVID-19) is a novel respiratory disease that first emerged in 2019. Patients infected with this disease present with a myriad of symptoms. Limb ischemia and hypercoagulability are complications identified in adults. COVID-19-related vasculitis is a known but seldom reported complication in pediatric patients, and the treatment approach is still not well established.
    We report the case of a healthy four-year-old female with a history of COVID-19 who developed acute lower limb ischemia. This was initially treated as a case of acute snake envenomation by administering snake antivenom with no improvement. She eventually developed lower limb acrocyanosis with an inability to ambulate. The patient was started on interleukin-6 receptor inhibitors (tocilizumab), anticoagulants, and pulse steroid therapy. The patient had complete resolution with the loss of only one toe.
    Identification of thromboembolic complications in pediatric patients with no comorbidities and a history of COVID-19 can be difficult. Early recognition and treatment have a major impact on morbidity and can increase the likelihood of limb salvage.
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  • 文章类型: Journal Article
    背景:几乎在2022年底,在COVID-19大流行带来的严酷之后,世界正在经历相对平静。知道这些想法,人们在这种突发事件中使用的感觉和程序,超过了所有既定的教育和健康行动标准,可以帮助我们为可能发生的类似事件做好准备。这项研究旨在确定职前教师在教育的四个基本支柱框架内对大流行和大流行后持有的主要替代概念。
    方法:使用人种学方法进行了一个案例研究。分析单元由北泰大学初等教育专业的227名学生组成。使用了两种研究工具来收集数据:一种用于言语联想的测试,参与者可以通过分层自由表达自己,替代和内涵唤起;以及专门的分析摘要表,以修改和组织专门的科学文本。使用IRaMuTeQ软件分析数据。
    结果:乍一看,在两种情况下表达的是什么,在大流行和大流行后,显示类似的结构;然而,更深入的分析揭示了不同的观点。
    结论:最后,替代概念从表达恐惧转变为宁静。
    Almost at the end of 2022, the world is experiencing a relative calm after the rigors imposed by the COVID-19 pandemic. Knowing the ideas, feelings and procedures used by people in this type of unexpected events, which exceeded all established standards of educational and health actions, can help us be prepared for the possible occurrence of similar events. This study aims to determine the main alternative conceptions that pre-service teachers hold about the pandemic and the post-pandemic within the framework of the four basic pillars of Education.
    A case study was conducted using an ethnographic approach. The unit of analysis was made up of 227 students from the major of Primary Education at Universidad Técnica del Norte. Two research instruments were used to collect the data: a test for verbal associations where participants can express themselves freely with hierarchical, substitution and connotative evocations; and Specialized Analytical Summary sheets to revise and organize specialized scientific texts. The data was analyzed using the IRaMuTeQ software.
    At first glance, what was expressed in the two contexts, both in the pandemic and in the post-pandemic, show a similar structure; however, a deeper analysis reveals different perspectives.
    In the end, the alternative conceptions moved from expressing fear to tranquility.
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  • 文章类型: Journal Article
    背景:2019年冠状病毒病(COVID-19)后持续症状的挑战,尤其是令人衰弱的心肺表现,需要进一步探索。我们的研究旨在评估重症COVID-19患者出院后一年的心肺并发症,将这些结果与非COVID组的结果进行对比。
    方法:OneCoV2研究,一个潜在的,病例对照研究,在印度北部的三级护理教学医院进行。我们登记了43名受试者,平均年龄25.57±7.94岁(COVID组)和27.30±8.17岁(非COVID组)。综合检查包括肺功能检查,心脏功能试验,6分钟步行测试,和实验室调查。
    结果:肺功能[强制肺活量(FVC)(p=0.037),用力呼气流量(FEF)25-75%(p=0.013)],和心功能[左心室射血分数(LVEF)(p=0.032),心率(HR)(p=0.047)],以及两组之间的六分钟步行测试结果。在COVID组中,Pearson相关显示FVC与C反应蛋白(CRP)呈负相关[r=-0.488,p=0.007],六分钟步行试验[r=0.431,p=0.003]与HR[r=0.503,p=0.013]呈正相关。
    结论:我们的数据表明,即使在出院1年后,COVID患者的肺部异常也很普遍。心脏生物标志物也显示出倾向于COVID组。虽然我们发现涉及一些参数如FVC的显著相关性,CRP,HR,六分钟步行测试的结果,在我们的研究中,我们没有发现与其他测试参数有显著相关性.
    BACKGROUND: The evolving challenge of persistent symptoms post-Coronavirus disease-2019 (COVID-19), particularly debilitating cardio-pulmonary manifestations, necessitates further exploration. Our study aimed to assess the cardio-pulmonary complications in patients a year after hospital discharge from severe COVID-19, contrasting these with findings from a non-COVID group.
    METHODS: The OneCoV2 study, a prospective, case-control study, was conducted at a tertiary care teaching hospital in northern India. We enrolled 43 subjects, with a mean age of 25.57 ± 7.94 years (COVID group) and 27.30 ± 8.17 years (non-COVID group). Comprehensive tests included pulmonary function tests, cardiac function tests, 6-min walk tests, and laboratory investigations.
    RESULTS: Significant differences were found in the pulmonary function [forced vital capacity (FVC) (p = 0.037), forced expiratory flow (FEF) 25-75 % (p = 0.013)], and cardiac function [left ventricular ejection fraction (LVEF) (p = 0.032), heart rate (HR) (p = 0.047)], along with the six-minute walk test results between the two groups. In the COVID group, Pearson\'s correlation showed a negative correlation between FVC and C-reactive protein (CRP) [r = -0.488, p = 0.007] and a positive correlation between the six-minute walk test [r = 0.431, p = 0.003] and HR [r = 0.503, p = 0.013].
    CONCLUSIONS: Our data suggest that pulmonary abnormalities are prevalent in COVID patients even after 1-year of hospital discharge. Cardiac biomarkers also show an inclination towards the COVID group. While we found significant correlations involving some parameters like FVC, CRP, HR, and results from the six-minute walk test, we did not find any significant correlations with the other tested parameters in our study.
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  • 文章类型: Journal Article
    背景:在大多数2019年冠状病毒病(COVID-19)后肺部或胸膜并发症病例中,进行手术干预以治疗这些并发症,但这些患者的手术方法及其结局尚不明确.我们介绍了40例需要手术干预的COVID-19术后肺部和胸膜并发症患者。患者和方法:在本病例系列中,患者数据于2022年4月至8月在MasihDaneshvari医院前瞻性收集.纳入标准为COVID-19患者,因胸腔积液转诊至胸外科,气胸,脓胸,感染或非感染的肺炎,和怀疑有真菌感染的肺腔。评估每位患者所需的干预措施。结果:患者平均年龄为49.21±11.5(30-69岁)。9名患者(22.5%)为女性。单纯胸腔积液有5例(12.5%),八例气胸(20%),29例脓胸(72.5%),两名患者(5%)感染了肺炎。12例患者的支气管瘘在手术时已明确,切除后需要修复。13例患者(32.5%)因胸腔积液或气胸,插入胸管,两周后肺完全扩张。所有气胸患者最初均通过胸管进行管理,但在存在持续漏气和非扩张肺部的情况下,考虑进行手术开胸手术或电视辅助胸腔镜手术(VATS)进行矫正。10例需要开胸手术的病人,胸管需要超过一个月。在大多数患者中,有小的囊性病变或周围支气管胸膜瘘。在17例(42.5%)脓胸病例中,记录了坏死性肺炎,8例患者(20%)在病理报告中有曲霉菌感染,2例患者有肺脓肿.结论:胸膜COVID-19并发症可采用胸管置入等常规手术方法治疗,和清创术的感染组织,没有死亡和进一步的并发症。
    Background: In most cases of pulmonary or pleural post-coronavirus disease 2019 (COVID-19) complications, surgical interventions are performed to treat these complications, but the method of the surgery and its outcome in these patients is not clearly defined. We present 40 patients with pulmonary and pleural complications after COVID-19 who required surgical intervention. Patients and Methods: In this case series, patients\' data were prospectively collected from April to August 2022 at Masih Daneshvari Hospital. Inclusion criteria were patients with COVID-19 who were referred to the thoracic surgery department because of pleural effusion, pneumothorax, empyema, infected or non-infected pneumatocele, and lung cavity with suspected fungal infections. The required intervention for each patient was assessed. Results: Patients\' mean age was 49.21 ± 11.5 (30-69 years). Nine patients (22.5%) were female. Pure pleural effusion was reported in five (12.5 %), pneumothorax in eight (20%), empyema in 29 (72.5%), and infected pneumatocele in two patients (5%). Twelve patients had bronchial fistulas that were clarified at the time of surgery that needed repair after resection. In 13 patients (32.5%) because of pleural effusion or pneumothorax, a chest tube was inserted and after two weeks lungs were fully expanded. All patients with pneumothorax were managed by chest tube initially but in the presence of continuous air leakage and non-expanding lungs surgical thoracotomy or video-assisted thoracoscopic surgery (VATS) were considered for correction. In 10 patients who required thoracotomy, the chest tube was necessary for more than one month. In most of the patients, there were small cystic lesions or peripheral bronchopleural fistula. In 17 (42.5%) cases of empyema, necrotic pneumonia was documented and eight patients (20%) had aspergillus infection in the pathology report and two patients had a pulmonary abscess. Conclusions: Pleural COVID-19 complications can be treated with conventional surgical methods such as chest tube insertion, and debridement of infected tissue with no mortality and further complications.
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  • 文章类型: Case Reports
    COVID-19后间质性肺病患者的预后仍不清楚。我们在此报告了一个尸检病例,其中COVID-19后间质性肺病发作后的一系列进展导致急性加重,导致致命的结果。尸检结果包括透明膜形成/间质炎症细胞浸润,提示急性病变,和严重的局部纤维化,表明存在慢性疾病。在目前的情况下,我们在组织病理学上证实了COVID-19后间质性肺病的急性加重。
    The prognosis of patients with post-coronavirus disease 2019 (COVID-19) interstitial lung disease remains unclear. We herein report an autopsy case in which serial progression after the onset of post-COVID-19 interstitial lung disease resulted in an acute exacerbation, leading to a fatal outcome. Autopsy findings included hyaline membrane formation/interstitial inflammatory cell infiltration, suggestive of acute lesions, and severe regional fibrosis, indicating a preexisting chronic condition. In the present case, we histopathologically confirmed the acute exacerbation of post-COVID-19 interstitial lung disease.
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  • 文章类型: Case Reports
    至少10%的患者在SARS-CoV-2感染后出现持续性症状,一种称为急性后COVID-19的疾病,即SARS-CoV-2感染(PASC)的急性后遗症,长COVID,长途COVID,COVID的长期影响,后COVID-19和慢性COVID。在这份报告中,我们描述了一例40岁女性在SARS-CoV-2感染后出现的持续性认知缺陷,该女性有早发性阿尔茨海默病(EOAD)家族史,因为她的父亲在50岁时被诊断为EOAD。我们描述了临床表现和检查,特别强调18-氟脱氧葡萄糖正电子发射断层扫描(FDG-PET)证明的脑葡萄糖代谢改变,这可以被认为是认知缺陷存在和持续存在的有用标志。
    At least 10% of patients experience persistent symptoms after SARS-CoV-2 infection, a condition referred to as post-acute COVID-19, post-acute sequelae of SARS-CoV-2 infection (PASC), long COVID, long-haul COVID, long-term effects of COVID, post-COVID-19 and chronic COVID. In this report, we describe a case of persistent cognitive deficits developed after SARS-CoV-2 infection in a 40-year-old woman with a family history of early-onset Alzheimer\'s disease (EOAD) since her father was diagnosed with EOAD at the age of 50. We describe the clinical picture and workup, with special emphasis on the alterations of brain glucose metabolism evidenced by 18-fluoro-deoxy-glucose positron emission tomography (FDG-PET), which could be considered a useful marker of the presence and persistence of cognitive deficits.
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  • 文章类型: Journal Article
    肺泡蛋白沉积症(PAP)是一种罕见的疾病,其诊断仍然具有挑战性。在COVID-19大流行期间,很难区分PAP和COVID-19后肺后遗症。在这里,我们介绍了一名44岁的男性患者,他在从COVID-19康复后经历了劳力性呼吸困难。他最初被诊断为COVID-19后综合征,并接受全身性皮质类固醇治疗,但没有改善。胸部计算机断层扫描(CT)显示出疯狂的铺路图案,并带有毛玻璃混浊。纤维支气管镜和支气管灌洗液(BLF)分析证实了PAP的最终诊断。患者接受左肺灌洗联合常规治疗,随访期间呼吸状况和整体健康状况均有明显改善。因此,PAP可能在COVID-19感染后发生。该病例强调了将PAP视为COVID-19后持续呼吸道症状患者的潜在诊断的重要性。胸部CT和BLF显示的PAP高度可疑指标可能是区分PAP与COVID-19后肺后遗症的关键。此外,SARS-CoV-2在蛋白质沉积的发展中起作用是合理的,通过诱发发作或直接引起病情。
    Pulmonary alveolar proteinosis (PAP) is an uncommon disease and its diagnosis remains challenging. During the COVID-19 pandemic, it has been difficult to distinguish between PAP and post-COVID-19 pulmonary sequelae. Here we present a case of a 44-year-old male patient who experienced exertional dyspnea after recovering from COVID-19. He was initially diagnosed with post-COVID-19 syndrome and treated with systemic corticosteroid without improvement. Chest computed tomography (CT) showed crazy-paving pattern with ground-glass opacities. Fibreoptic bronchoscopy with bronchial lavage fluid (BLF) analysis confirmed the final diagnosis of PAP. The patient underwent left lung lavage in combination with conventional therapy and experienced significant improvement in his respiratory condition and overall health during follow-up. Hence, PAP could occur after a COVID-19 infection. This case highlights the importance of considering PAP as a potential diagnosis in patients with persistent respiratory symptoms after COVID-19. The high suspicion indicators of PAP revealed by chest-CT and BLF may be a key to differentiating PAP from post-COVID-19 pulmonary sequelae. Moreover, it is plausible that SARS-CoV-2 plays a role in the development of proteinosis, either by inducing a flare-up or by directly causing the condition.
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  • 文章类型: Journal Article
    背景:COVID-19可能需要在重症监护病房(ICU)住院,并且通常与危重病多发性神经病(CIP)和危重病肌病(CIM)的发作有关。由于这种疾病在世界各地的传播,为面临这一系列事件的患者确定新的康复策略越来越重要.病例介绍:我们报告了临床表现和长期治疗的有益效果,一名高度戒断的61岁男性COVID-19患者从ICU出院,并伴有残留CIP和CIM。该计划包括有氧运动,力量,步态,和平衡训练(1小时,每周2次会议)。措施:肺(肺活量测定),代谢(间接量热法和生物阻抗),在基线和训练1年后评估神经肌肉功能(肌电图).结果:相对于基线,改善了几个肺活量参数,如肺活量(VC,+40%),总肺活量(TLC,+25%),1s的用力呼气量(FEV1,28%)是可观的。体内水分等代谢参数(60%-46%),相位角(3.6°-5.9°),呼吸商(0.92-0.8)恢复到生理范围。肌电图参数基本不变。临床参数的整体改善导致患者自主性和生活质量的显着改善。结论:我们的结果强调了AMA对抵抗呼吸,新陈代谢,残留CIM和CIP的COVID-19患者的功能损伤而不是神经肌肉损伤
    Background: COVID-19 may require hospitalization in an intensive care unit (ICU) and is often associated with the onset of critical illness polyneuropathy (CIP) and critical illness myopathy (CIM). Due to the spread of the disease around the world, the identification of new rehabilitation strategies for patients facing this sequence of events is of increasing importance. Case presentation: We report the clinical presentation and the beneficial effects of a prolonged, supervised adapted motor activity (AMA) program in a highly deconditioned 61-year-old male COVID-19 patient discharged from the ICU and complicated by residual CIP and CIM. The program included aerobic, strength, gait, and balance training (1 h, 2 sessions per week). Measures: Pulmonary (spirometry), metabolic (indirect calorimetry and bioimpedance), and neuromuscular functions (electromyography) were evaluated at baseline and after 1 year of training. Results: Relative to baseline, an amelioration of several spirometric parameters such as vital capacity (VC, +40%), total lung capacity (TLC, +25%), and forced expiratory volume in 1 s (FEV1, +28%) was appreciable. Metabolic parameters such as body water (60%-46%), phase angle (3.6°-5.9°), and respiratory quotient (0.92-0.8) returned to the physiological range. Electromyographic parameters were substantially unchanged. The overall amelioration in clinical parameters resulted in a significant improvement of patient autonomy and the quality of life. Conclusion: Our results highlight the importance of AMA for counteracting respiratory, metabolic, and functional but not neuromuscular impairments in COVID-19 patients with residual CIM and CIP.
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