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Article ; Online: Spontaneous pneumomediastinum, pneumopericardium, pneumothorax and subcutaneous emphysema in patients with COVID-19 pneumonia, a case report.

Hazariwala, Vikisha / Hadid, Hind / Kirsch, Denise / Big, Cecilia

Journal of cardiothoracic surgery

2020 Volume 15, Issue 1, Page(s) 301

Abstract: Background: Spontaneous pneumomediastinum unrelated to mechanical ventilation is a newly described complication of COVID-19 pneumonia. The objective of this case presentation is to highlight an important complication and to explore potential ... ...

Abstract	Background: Spontaneous pneumomediastinum unrelated to mechanical ventilation is a newly described complication of COVID-19 pneumonia. The objective of this case presentation is to highlight an important complication and to explore potential predisposing risk factors and possible underlying pathophysiology of this phenomenon. Case presentation: We present two patients with COVID-19 pneumonia complicated by spontaneous pneumomediastinum, pneumopericardium, pneumothorax and subcutaneous emphysema without positive pressure ventilation. Both patients had multiple comorbidities, received a combination of antibiotics, steroids and supportive oxygen therapy, and underwent routine laboratory workup. Both patients then developed spontaneous pneumomediastinum and ultimately required intubation and mechanical ventilation, which proved to be challenging to manage. Conclusions: Spontaneous pneumomediastinum is a serious complication of COVID-19 pneumonia, of which clinicians should be aware. Further studies are needed to determine risk factors and laboratory data predictive of development of spontaneous pneumomediastinum in COVID-19 pneumonia.
MeSH term(s)	Betacoronavirus ; COVID-19 ; Coronavirus Infections/complications ; Coronavirus Infections/epidemiology ; Coronavirus Infections/therapy ; Female ; Humans ; Intermittent Positive-Pressure Ventilation/methods ; Male ; Mediastinal Emphysema/diagnosis ; Mediastinal Emphysema/etiology ; Mediastinal Emphysema/therapy ; Middle Aged ; Oxygen Inhalation Therapy/methods ; Pandemics ; Pneumonia, Viral/complications ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/therapy ; Pneumopericardium/diagnosis ; Pneumopericardium/etiology ; Pneumothorax/diagnosis ; Pneumothorax/etiology ; Pneumothorax/therapy ; Radiography, Thoracic ; SARS-CoV-2 ; Subcutaneous Emphysema/diagnosis ; Subcutaneous Emphysema/etiology ; Tomography, X-Ray Computed
Keywords	covid19
Language	English
Publishing date	2020-10-07
Publishing country	England
Document type	Case Reports ; Journal Article
ISSN	1749-8090
ISSN (online)	1749-8090
DOI	10.1186/s13019-020-01308-7
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Spontaneous pneumomediastinum, pneumopericardium, pneumothorax and subcutaneous emphysema in patients with COVID-19 pneumonia, a case report

Vikisha Hazariwala / Hind Hadid / Denise Kirsch / Cecilia Big

Journal of Cardiothoracic Surgery, Vol 15, Iss 1, Pp 1-

2020 Volume 5

Abstract: Abstract Background Spontaneous pneumomediastinum unrelated to mechanical ventilation is a newly described complication of COVID-19 pneumonia. The objective of this case presentation is to highlight an important complication and to explore potential ... ...

Abstract	Abstract Background Spontaneous pneumomediastinum unrelated to mechanical ventilation is a newly described complication of COVID-19 pneumonia. The objective of this case presentation is to highlight an important complication and to explore potential predisposing risk factors and possible underlying pathophysiology of this phenomenon. Case presentation We present two patients with COVID-19 pneumonia complicated by spontaneous pneumomediastinum, pneumopericardium, pneumothorax and subcutaneous emphysema without positive pressure ventilation. Both patients had multiple comorbidities, received a combination of antibiotics, steroids and supportive oxygen therapy, and underwent routine laboratory workup. Both patients then developed spontaneous pneumomediastinum and ultimately required intubation and mechanical ventilation, which proved to be challenging to manage. Conclusions Spontaneous pneumomediastinum is a serious complication of COVID-19 pneumonia, of which clinicians should be aware. Further studies are needed to determine risk factors and laboratory data predictive of development of spontaneous pneumomediastinum in COVID-19 pneumonia.
Keywords	COVID-19 pneumonia ; Spontaneous pneumomediastinum ; Spontaneous pneumopericardium ; Acute respiratory distress syndrome ; Severe acute respiratory syndrome ; Surgery ; RD1-811 ; Anesthesiology ; RD78.3-87.3 ; covid19
Subject code	610
Language	English
Publishing date	2020-10-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Spontaneous pneumomediastinum, pneumopericardium, pneumothorax and subcutaneous emphysema in patients with COVID-19 pneumonia, a case report

Hazariwala, Vikisha / Hadid, Hind / Kirsch, Denise / Big, Cecilia

J Cardiothorac Surg

Abstract: BACKGROUND: Spontaneous pneumomediastinum unrelated to mechanical ventilation is a newly described complication of COVID-19 pneumonia. The objective of this case presentation is to highlight an important complication and to explore potential predisposing ...

Abstract	BACKGROUND: Spontaneous pneumomediastinum unrelated to mechanical ventilation is a newly described complication of COVID-19 pneumonia. The objective of this case presentation is to highlight an important complication and to explore potential predisposing risk factors and possible underlying pathophysiology of this phenomenon. CASE PRESENTATION: We present two patients with COVID-19 pneumonia complicated by spontaneous pneumomediastinum, pneumopericardium, pneumothorax and subcutaneous emphysema without positive pressure ventilation. Both patients had multiple comorbidities, received a combination of antibiotics, steroids and supportive oxygen therapy, and underwent routine laboratory workup. Both patients then developed spontaneous pneumomediastinum and ultimately required intubation and mechanical ventilation, which proved to be challenging to manage. CONCLUSIONS: Spontaneous pneumomediastinum is a serious complication of COVID-19 pneumonia, of which clinicians should be aware. Further studies are needed to determine risk factors and laboratory data predictive of development of spontaneous pneumomediastinum in COVID-19 pneumonia.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #835855
Database	COVID19

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Article ; Online: The vagaries of IgM

Raai Mahmood / Khalid Mohamed / Naba Saeed / Kadhim Al-Banaa / Jonathan Zimmerman / Cecilia Big

The Egyptian Journal of Internal Medicine, Vol 32, Iss 1, Pp 1-

a case report of EBV infection with concomitantly false-positive IgM for CMV, VZV, and HSV

2020 Volume 3

Abstract: Abstract Background Serum IgM (immunoglobulin M) testing is commonly used to diagnose acute viral infections. However, most clinicians are unaware of the vagaries of IgM testing, including antigenic cross-reactivity between multiple viruses and risk ... ...

Abstract	Abstract Background Serum IgM (immunoglobulin M) testing is commonly used to diagnose acute viral infections. However, most clinicians are unaware of the vagaries of IgM testing, including antigenic cross-reactivity between multiple viruses and risk misdiagnosis. Case presentation We report a case of infectious mononucleosis with concomitantly positive IgM for EBV, CMV, VZV, and HSV. A 26-year-old man presented with acute infectious mononucleosis picture. His blood work showed a total bilirubin level of 7.7 mg/dl, ALT 1077 U/L, AST 806 U/L, ALP 325 U/L, and INR 1.0. Monospot was positive; peripheral blood smear showed atypical lymphocytes; however, because EBV infectious mononucleosis does not typically cause elevation of liver enzymes over 1000, other etiologies were explored. Tests for hepatitis A, B, C, HIV, ANA, and ASMA returned negative. IgM for EBV-VCA, CMV, HSV, and VZV all returned positive, and the diagnosis of EBV IM was called into question. Subsequent tests of CMV and HSV PCR for viral load were negative (VZV was not clinically suspected), and later on, EBV-EBNA returned negative and EBV-VCA IgM and IgG returned positive, confirming the diagnosis of acute EBV infection. Conclusion We believe that IgM seropositivity can result from cross-reactivity among several viruses (especially herpes viruses), and although often relied on, a positive IgM should not serve as the sole determinant for diagnosis of acute viral infections.
Keywords	False-positive ; False IgM ; Cross-reactivity ; Internal medicine ; RC31-1245
Subject code	610
Language	English
Publishing date	2020-09-01T00:00:00Z
Publisher	SpringerOpen
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Impact of Early Corticosteroids on Preventing Clinical Deterioration in Non-critically Ill Patients Hospitalized with COVID-19: A Multi-hospital Cohort Study.

Swaminathan, Lakshmi / Kaatz, Scott / Chubb, Heather / Tae, Kim / Ramesh, Mayur S / Fadel, Raef / Big, Cecilia / Jones, Jessica / Flanders, Scott A / Prescott, Hallie C

Infectious diseases and therapy

2022 Volume 11, Issue 2, Page(s) 887–898

Abstract: Introduction: While guidelines stronglyrecommend dexamethasone in critical COVID-19, the optimal threshold to initiate corticosteroids in non-critically ill patients with COVID-19 remains unclear. Using data from a state-wide COVID-19 registry, we ... ...

Abstract	Introduction: While guidelines stronglyrecommend dexamethasone in critical COVID-19, the optimal threshold to initiate corticosteroids in non-critically ill patients with COVID-19 remains unclear. Using data from a state-wide COVID-19 registry, we evaluated the effectiveness of early corticosteroids for preventing clinical deterioration among non-critically ill patients hospitalized for COVID-19 and receiving non-invasive oxygen therapy. Methods: This was a target trial using observational data from patients hospitalized for COVID-19 at 39 hospitals participating in the MI-COVID19 registry between March 16, 2020 and August 24, 2020. We studied the impact of corticosteroids initiated within 2 calendar days of hospitalization ("early steroids") versus no early steroids among non-ICU patients with laboratory-confirmed SARS-CoV2 receiving non-invasive supplemental oxygen therapy. Our primary outcome was a composite of in-hospital mortality, transfer to intensive care, and receipt of invasive mechanical ventilation. We used inverse probability of treatment weighting (IPTW) and propensity score-weighted regression to measure the association of early steroids and outcomes. Results: Among 1002 patients meeting study criteria, 231 (23.1%) received early steroids. After IPTW, to balance potential confounders between the treatment groups, early steroids were not associated with a decrease in the composite outcome (aOR 1.1, 95%CI 0.8-1.6) or in any components of the primary outcome. Conclusion: We found no evidence that early corticosteroid therapy prevents clinical deterioration among hospitalized non-critically ill COVID-19 patients receiving non-invasive oxygen therapy. Further studies are needed to determine the optimal threshold for initiating corticosteroids in this population.
Language	English
Publishing date	2022-03-10
Publishing country	New Zealand
Document type	Journal Article
ZDB-ID	2701611-0
ISSN	2193-6382 ; 2193-8229
ISSN (online)	2193-6382
ISSN	2193-8229
DOI	10.1007/s40121-022-00615-x
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Article ; Online: Staphylococcus aureus bloodstream infections in older adults: clinical outcomes and risk factors for in-hospital mortality.

Big, Cecilia / Malani, Preeti N

Journal of the American Geriatrics Society

2010 Volume 58, Issue 2, Page(s) 300–305

Abstract: Objectives: To assess clinical outcomes and identify risk factors for mortality in older adults with Staphylococcus aureus bloodstream infection (SAB).: Design: Retrospective review.: Setting: University of Michigan Health System, Ann Arbor.: ... ...

Abstract	Objectives: To assess clinical outcomes and identify risk factors for mortality in older adults with Staphylococcus aureus bloodstream infection (SAB). Design: Retrospective review. Setting: University of Michigan Health System, Ann Arbor. Participants: All patients aged 80 and older with SAB between January 2004 and July 2008. Measurements: Clinical data, including comorbid conditions, SAB source, echocardiography results, Charlson Comorbidity Index, mortality (in-hospital and 6-month), and need for rehospitalization or chronic care after discharge. Results: Seventy-six patients aged 80 and older (mean 85.5 +/- 4.2) with SAB were identified. Infection sources included 14 (18.4%) vascular catheter associated, 16 (21.1%) wound related, seven (9.2%) endocarditis, five (6.6%) intravascular, and 19 (25%) with unknown source; 46 (60.5%) patients had methicillin-resistant strains. Twenty-two (28.9%) patients underwent surgery or device placement within 30 days of developing SAB; 10 of these 22 had SAB associated with surgical site infection (SSI). Twenty two (28.9%) patients died in the hospital or were discharged to hospice care; at least 43 (56.6%) patients died within 6 months of presentation, and eight were lost to follow-up. Unknown source of bacteremia (odds ratio=5.2, P=.008) was independently associated with in-hospital death. Echocardiography was not pursued in 45% of patients. Of surviving patients, 40 (74.1%) required skilled care after discharge; eight (20%) required rehospitalization. Conclusion: SAB was associated with high mortality rates in patients aged 80 and older. The observed association between SAB and SSI may direct preventive strategies such as perioperative decolonization or antimicrobial prophylaxis. Interventions to optimize clinical care practices in elderly patients with SAB are essential given the associated morbidity and mortality.
MeSH term(s)	Aged, 80 and over ; Bacteremia/etiology ; Bacteremia/mortality ; Bacteremia/prevention & control ; Cross Infection/etiology ; Cross Infection/mortality ; Cross Infection/prevention & control ; Female ; Hospital Mortality ; Humans ; Logistic Models ; Male ; Methicillin-Resistant Staphylococcus aureus ; Michigan/epidemiology ; Multivariate Analysis ; Retrospective Studies ; Risk Factors ; Staphylococcal Infections/etiology ; Staphylococcal Infections/mortality ; Staphylococcal Infections/prevention & control ; Surgical Wound Infection/microbiology ; Surgical Wound Infection/mortality ; Surgical Wound Infection/prevention & control
Language	English
Publishing date	2010-02
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	80363-7
ISSN	1532-5415 ; 0002-8614
ISSN (online)	1532-5415
ISSN	0002-8614
DOI	10.1111/j.1532-5415.2009.02666.x
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Article ; Online: Viral infections of the central nervous system: a case-based review.

Big, Cecilia / Reineck, Lora A / Aronoff, David M

Clinical medicine & research

2009 Volume 7, Issue 4, Page(s) 142–146

Abstract: Three patients with viral infections of the central nervous system (CNS) were evaluated on an inpatient infectious diseases consultation service within a two-week period. These cases, caused by herpes simplex virus, varicella zoster virus and enterovirus, ...

Abstract	Three patients with viral infections of the central nervous system (CNS) were evaluated on an inpatient infectious diseases consultation service within a two-week period. These cases, caused by herpes simplex virus, varicella zoster virus and enterovirus, highlight the importance of viral pathogens in causing debilitating infections of the CNS and provide examples of the utility of molecular diagnostics in evaluating patients with encephalitis and meningitis. The importance of antiviral therapy is particularly underscored by these cases, as is the variability in response of patients to such agents.
MeSH term(s)	Aged ; Aged, 80 and over ; Encephalitis, Viral/diagnosis ; Encephalitis, Viral/drug therapy ; Encephalitis, Viral/genetics ; Enterovirus/genetics ; Female ; Herpesvirus 3, Human/genetics ; Humans ; Male ; Meningitis, Viral/diagnosis ; Meningitis, Viral/drug therapy ; Meningitis, Viral/genetics ; Middle Aged ; Simplexvirus/genetics
Language	English
Publishing date	2009-11-04
Publishing country	United States
Document type	Case Reports ; Journal Article ; Review
ZDB-ID	2303793-3
ISSN	1554-6179 ; 1539-4182
ISSN (online)	1554-6179
ISSN	1539-4182
DOI	10.3121/cmr.2009.864
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Article ; Online: Compassionate Use of Remdesivir in Pregnant Women With Severe Coronavirus Disease 2019.

Burwick, Richard M / Yawetz, Sigal / Stephenson, Kathryn E / Collier, Ai-Ris Y / Sen, Pritha / Blackburn, Brian G / Kojic, E Milunka / Hirshberg, Adi / Suarez, Jose F / Sobieszczyk, Magdalena E / Marks, Kristen M / Mazur, Shawn / Big, Cecilia / Manuel, Oriol / Morlin, Gregory / Rose, Suzanne J / Naqvi, Mariam / Goldfarb, Ilona T / DeZure, Adam /

Telep, Laura / Tan, Susanna K / Zhao, Yang / Hahambis, Tom / Hindman, Jason / Chokkalingam, Anand P / Carter, Christoph / Das, Moupali / Osinusi, Anu O / Brainard, Diana M / Varughese, Tilly A / Kovalenko, Olga / Sims, Matthew D / Desai, Samit / Swamy, Geeta / Sheffield, Jeanne S / Zash, Rebecca / Short, William R

Clinical infectious diseases : an official publication of the Infectious Diseases Society of America

2020 Volume 73, Issue 11, Page(s) e3996–e4004

Abstract: Background: Remdesivir is efficacious for severe coronavirus disease 2019 (COVID-19) in adults, but data in pregnant women are limited. We describe outcomes in the first 86 pregnant women with severe COVID-19 who were treated with remdesivir.: Methods! ...

Abstract	Background: Remdesivir is efficacious for severe coronavirus disease 2019 (COVID-19) in adults, but data in pregnant women are limited. We describe outcomes in the first 86 pregnant women with severe COVID-19 who were treated with remdesivir. Methods: The reported data span 21 March to 16 June 2020 for hospitalized pregnant women with polymerase chain reaction-confirmed severe acute respiratory syndrome coronavirus 2 infection and room air oxygen saturation ≤94% whose clinicians requested remdesivir through the compassionate use program. The intended remdesivir treatment course was 10 days (200 mg on day 1, followed by 100 mg for days 2-10, given intravenously). Results: Nineteen of 86 women delivered before their first dose and were reclassified as immediate "postpartum" (median postpartum day 1 [range, 0-3]). At baseline, 40% of pregnant women (median gestational age, 28 weeks) required invasive ventilation, in contrast to 95% of postpartum women (median gestational age at delivery 30 weeks). By day 28 of follow-up, the level of oxygen requirement decreased in 96% and 89% of pregnant and postpartum women, respectively. Among pregnant women, 93% of those on mechanical ventilation were extubated, 93% recovered, and 90% were discharged. Among postpartum women, 89% were extubated, 89% recovered, and 84% were discharged. Remdesivir was well tolerated, with a low incidence of serious adverse events (AEs) (16%). Most AEs were related to pregnancy and underlying disease; most laboratory abnormalities were grade 1 or 2. There was 1 maternal death attributed to underlying disease and no neonatal deaths. Conclusions: Among 86 pregnant and postpartum women with severe COVID-19 who received compassionate-use remdesivir, recovery rates were high, with a low rate of serious AEs.
MeSH term(s)	Adenosine Monophosphate/analogs & derivatives ; Adult ; Alanine/analogs & derivatives ; COVID-19/drug therapy ; Compassionate Use Trials ; Female ; Humans ; Infant ; Oxygen Saturation ; Pregnancy ; Pregnancy Complications, Infectious/drug therapy ; Pregnant Women ; SARS-CoV-2
Chemical Substances	remdesivir (3QKI37EEHE) ; Adenosine Monophosphate (415SHH325A) ; Alanine (OF5P57N2ZX)
Keywords	covid19
Language	English
Publishing date	2020-10-08
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1099781-7
ISSN	1537-6591 ; 1058-4838
ISSN (online)	1537-6591
ISSN	1058-4838
DOI	10.1093/cid/ciaa1466
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Article: Compassionate Use of Remdesivir in Pregnant Women with Severe Covid-19

Clin. infect. dis

Abstract: BACKGROUND: Remdesivir is efficacious for severe COVID-19 in adults, but data in pregnant women are limited. We describe outcomes in the first 86 pregnant women with severe COVID-19 who were treated with remdesivir. METHODS: Reported data span March 21 ... ...

Abstract	BACKGROUND: Remdesivir is efficacious for severe COVID-19 in adults, but data in pregnant women are limited. We describe outcomes in the first 86 pregnant women with severe COVID-19 who were treated with remdesivir. METHODS: Reported data span March 21 to June 16, 2020 for hospitalized pregnant women with PCR-confirmed SARS-CoV-2 infection and room air oxygen saturation ≤94% whose clinicians requested remdesivir through the compassionate use program. The intended remdesivir treatment course was 10 days (200mg on Day 1, followed by 100mg for Days 2-10, given intravenously). RESULTS: Nineteen of 86 women delivered before their first dose and were reclassified as immediate "postpartum" (median postpartum day=1; range 0-3). At baseline, 40% of pregnant women (median gestational age 28 weeks) required invasive ventilation, in contrast to 95% of postpartum women (median gestational age at delivery 30 weeks). By Day 28 of follow-up, the level of oxygen requirement decreased in 96% and 89% of pregnant and postpartum women, respectively. Among pregnant women, 93% of those on mechanical ventilation were extubated, 93% recovered, and 90% were discharged. Among postpartum women, 89% were extubated, 89% recovered, and 84% were discharged. Remdesivir was well tolerated, with a low incidence of serious adverse events (16%). Most adverse events were related to pregnancy and underlying disease; most laboratory abnormalities were Grades 1 or 2. There was one maternal death attributed to underlying disease and no neonatal deaths. CONCLUSIONS: Among 86 pregnant and postpartum women with severe COVID-19 who received compassionate use remdesivir, recovery rates were high, with a low rate of serious adverse events.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #837143
Database	COVID19

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Article ; Online: Compassionate Use of Remdesivir in Pregnant Women With Severe Coronavirus Disease 2019

Clinical Infectious Diseases ; ISSN 1058-4838 1537-6591

2020

Abstract: Abstract Background Remdesivir is efficacious for severe coronavirus disease 2019 (COVID-19) in adults, but data in pregnant women are limited. We describe outcomes in the first 86 pregnant women with severe COVID-19 who were treated with remdesivir. ... ...

Abstract	Abstract Background Remdesivir is efficacious for severe coronavirus disease 2019 (COVID-19) in adults, but data in pregnant women are limited. We describe outcomes in the first 86 pregnant women with severe COVID-19 who were treated with remdesivir. Methods The reported data span 21 March to 16 June 2020 for hospitalized pregnant women with polymerase chain reaction–confirmed severe acute respiratory syndrome coronavirus 2 infection and room air oxygen saturation ≤94% whose clinicians requested remdesivir through the compassionate use program. The intended remdesivir treatment course was 10 days (200 mg on day 1, followed by 100 mg for days 2–10, given intravenously). Results Nineteen of 86 women delivered before their first dose and were reclassified as immediate “postpartum” (median postpartum day 1 [range, 0–3]). At baseline, 40% of pregnant women (median gestational age, 28 weeks) required invasive ventilation, in contrast to 95% of postpartum women (median gestational age at delivery 30 weeks). By day 28 of follow-up, the level of oxygen requirement decreased in 96% and 89% of pregnant and postpartum women, respectively. Among pregnant women, 93% of those on mechanical ventilation were extubated, 93% recovered, and 90% were discharged. Among postpartum women, 89% were extubated, 89% recovered, and 84% were discharged. Remdesivir was well tolerated, with a low incidence of serious adverse events (AEs) (16%). Most AEs were related to pregnancy and underlying disease; most laboratory abnormalities were grade 1 or 2. There was 1 maternal death attributed to underlying disease and no neonatal deaths. Conclusions Among 86 pregnant and postpartum women with severe COVID-19 who received compassionate-use remdesivir, recovery rates were high, with a low rate of serious AEs.
Keywords	Microbiology (medical) ; Infectious Diseases ; covid19
Language	English
Publisher	Oxford University Press (OUP)
Publishing country	uk
Document type	Article ; Online
DOI	10.1093/cid/ciaa1466
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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