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Abstract Pneumonia is a key criterion for the severity of COVID-19. Whether COVID-19 symptoms are indicators of pneumonia in patients infected with SARS-CoV-2 Omicron variants is unclear. 6200 non-hospitalized patients with COVID-19 from three sites in three hospitals were divided into three cohorts: Cohort 1 (n = 1971, Outpatient Department), Cohort 2 (n = 1073, Emergency Department), and Cohort 3 (n = 3156, Fever Clinic). The association of COVID-19 symptoms with pneumonia in the patients were analysed. In Cohort 1, dry cough, expectoration, fever, muscle or body aches, sore throat, headache or dizziness, shortness of breath, and difficulty breathing were associated with pneumonia. For Cohort 2, expectoration, fatigue, congestion or runny nose, sore throat, headache or dizziness, chills, chest stuffiness, shortness of breath, and difficulty breathing were related to pneumonia. With Cohort 3, dry cough, expectoration, vomiting, chest stuffiness, shortness of breath, and difficulty breathing had associations with pneumonia. Moreover, duration of symptoms > 7 days was associated with pneumonia in all three cohorts. In the study, expectoration, shortness of breath, difficulty breathing, and duration of symptoms > 7 days were useful predictors of COVID-19 pneumonia in the patients infected with SARS-CoV-2 Omicron variants. Among these predictors, shortness of breath and difficulty breathing were high-risk early-warning factors for pneumonia, and duration of symptoms > 7 days was also a high-risk factor for pneumonia.

Dyspnea, the subjective sensation of breathlessness, is a common source of distress for patients living with advanced cancer. Effective assessment and management of dyspnea among patients living with advanced cancer represents core competencies for front-line clinicians and professional caregivers. However, there is still a lack of standardized procedures for handling dyspnea in China. Based on evidence-based medicine, the American Society of Clinical Oncology practice guidelines for management of dyspnea in advanced cancer was released, which outlines assessment and management of dyspnea among patients living with advanced cancer. This article aims to provide detailed interpretation of key clinical content to guide China's clinical practice.

This case report illuminates an instance of Ludwig’s Angina in a 16-year-old male patient with concurrent Influenza A. Ludwig’s Angina, a potentially fatal, rapidly spreading cellulitis, primarily affects the submandibular and sublingual spaces. This case emphasizes the importance of early detection, immediate intervention, and multidisciplinary management to prevent life-threatening complications. The patient presented with fever, sore throat, swelling under the tongue and submandibular region, and difficulty breathing following a family trip to Puerto Rico. Despite initial respiratory distress and severe soft tissue swelling, the patient responded positively to broad-spectrum antibiotics, with clinical improvement leading to discharge after five days. The report discusses the challenges in diagnosing and managing Ludwig’s Angina, the potential role of the patient’s environment in disease presentation, and the relevance of historical medical literature in contemporary clinical practice. This case underscores the need for vigilance in patients with influenza for potential secondary bacterial complications and the necessity of expedited airway management in patients with Ludwig’s Angina. [ABSTRACT FROM AUTHOR]

Choanal atresia is a rare congenital disorder characterised by anatomical closure of the posterior choana in the nasal cavity due to failed recanalization during foetal development. The main aim of our study is to focus on our experience with choanal atresia and its management. In this study, we are discussing the prospective study of 12 cases of choanal atresia that came to a tertiary hospital from July 2017 to July 2022. All 12 choanal atresia cases underwent thorough evaluation, including history, blood investigations, nasal endoscopy, and CT scanning. Intra-nasal endoscopic choanoplasty with stenting was performed on all patients, followed by a 2-year follow-up, except for one case that missed follow-up after 6 months. All 12 cases were female, with their ages varying from newborn to 4 months old. In our study, 75% were unilateral and 25% were bilateral cases from newborn to 4 months old. The right was more prevalent in unilateral choanal atresia. The mixed type was the most commonly observed. The most common symptom was difficulty breathing and a running nose. All cases achieved an adequate patent airway. No intraoperative complications were noted in any case. All cases of choanal atresia can be diagnosed by a cold spatula test, failure to pass an intra-nasal catheter, and a CT scan is confirmatory. Surgical correction with endoscopic intranasal choanoplasty and stenting has less morbidity, a high success rate, and a lower recurrence rate. [ABSTRACT FROM AUTHOR]

This project is based on the thoracic medicine ward of a medical center in the north. According to statistics, patients' conscious dyspnea level averaged 7.1 points from January to March 2019, and only 36% implemented the self-relief method first, while the complete rate of nursing staff performing dyspnea care was 66%. This project aimed to improve these statistics. The improvement plan included drafting care guidelines for dyspnea, designing a six-step formula for wheezing assessment and reminder slogans, making a five-step health education leaflet for easy breathing, making a fan for relieving wheezing and lungs, making a dyspnea assessment traffic light chart, and setting relief principles for using assistive devices for breathing difficulties. After the implementation of the project, the patients dyspnea level dropped to 2.4 points, and the complete rate of nursing staff in performing dyspnea care increased to 100%, achieving the purpose of the project and increasing the patient's ability to respond to self-relief, reduce the degree of dyspnea, improve the integrity of dyspnea care and the quality of care by the medical team. [ABSTRACT FROM AUTHOR]

During winter 2014-15, England experienced severe strains on acute health services. We investigated whether syndromic surveillance could contribute to understanding of the unusually high level of healthcare needs. We compared trends for several respiratory syndromic indicators from that winter to historical baselines. Cumulative and mean incidence rates were compared by winter and age group. All-age influenza-like illness was at expected levels; however, severe asthma and pneumonia levels were above those expected. Across several respiratory indicators, cumulative incidence rates during 2014-15 were similar to those of previous years, but higher for older persons; we saw increased rates of acute respiratory disease, including influenza like illness, severe asthma, and pneumonia, in the 65-74- and >75-year age groups. Age group-specific statistical algorithms may provide insights into the burden on health services and improve early warning in future winters. [ABSTRACT FROM AUTHOR]

Several episodes of mass poisoning by organophosphates (OPs) have been reported from the developing countries. The diagnosis of OP-poisoning is mainly based on the characteristic clinical features and history of exposure to a known OP compound. Estimation of serum and red blood cell (RBC) cholinesterase activities are helpful in confirming the diagnosis. However, there is controversy regarding a definite relationship between serum cholinesterase activity and the severity of clinical manifestations and prognosis. This report describes an episode of mass monocrotophos poisoning that occurred due to accidental ingestion of monocrotophos-contaminated millet (so called bavta) flour involving eight severely poisoned persons. Clinical presentation included severe abdominal pain, diarrhoea, vomiting, pupil narrowing, and difficulty breathing. On hospital admission, plasma cholinesterase (PChE) and especially RBC acetylcholinesterase (ACHE) activities correlated well with clinical symptoms presented by the patients. This case study highlights the need for clinicians to be aware of OP-pesticide poisoning from food sources and the need to look for depressed PChE and AChE activities that may point to OP exposure, so that OP-poisoning can be identified immediately and patients can receive specific treatment, rather than general treatment for food poisoning. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Recent studies indicate that the U.S. Environmental Protection Agency (EPA) ozone standards may not protect sensitive individuals. In this study we examined respiratory effects of ozone in infants who may be vulnerable, particularly if they are children of asthmatic mothers. DESIGN: Women delivering babies at one of five hospitals in southwestern Virginia between 1994 and 1996 were invited to participate in a cohort study; 780 women enrolled. Ambient air quality data (ozone and particulate matter) were collected at a central monitoring site. PARTICIPANTS: This analysis is of 691 infants followed for approximately 83 days between 10 June and 31 August 1995 and/or 1996; they contributed a total of 52,421 infant-days of follow-up. Mothers were interviewed at enrollment and approximately biweekly to report infants' daily symptoms. Repeated measures logistic regression models were run separately for wheeze, difficulty breathing, and cough. Ozone metrics included 24-hr average, peak 1-hr, and maximum 8-hr average. Analyses were repeated for the 61 infants whose mothers had asthma. RESULTS: For every interquartile-range increase in same-day 24-hr average ozone, likelihood of wheeze increased 37% [95% confidence interval (CI), 2-84%]. Among infants of asthmatic mothers, same-day 24-hr average ozone increased likelihood of wheeze 59% (95% CI, 1-154%) and of difficulty breathing 83% (95% CI, 42-136%). Maximum 8-hr ozone and peak 1-hr ozone were associated with difficulty breathing, but not wheeze, in infants of asthmatic mothers. Ozone was not associated with cough. [ABSTRACT FROM AUTHOR]

Thunderstorm asthma is often characterised by a sudden surge in patients presenting with exacerbated symptoms of asthma linked to thunderstorm activity. Here, we describe a large spike in asthma and difficulty breathing symptoms observed across parts of England on 17 June 2021. The number of healthcare presentations during the asthma event was compared to expected levels for the overall population and across specific regions. Across affected geographical areas, emergency department attendances for asthma increased by 560% on 17 June compared to the average number of weekday daily attendances during the previous 4 weeks. General practitioner out of hours contacts increased by 349%, National Health Service (NHS) 111 calls 193%, NHS 111 online assessments 581% and ambulance call outs 54%. Increases were particularly noted in patient age groups 5-14 and 15-44 years. In non-affected regions, increases were small (<10%) or decreased, except for NHS 111 online assessments where there was an increase of 39%. A review of the meteorological conditions showed several localised, weak, or moderate thunderstorms specifically across parts of Southeast England on the night of June 16. In this unprecedented episode of asthma, the links to meteorologically defined thunderstorm activity were not as clear as previous episodes, with less evidence of 'severe' thunderstorm activity in those areas affected, prompting further discussion about the causes of these events and implications for public health management of the risk.

Introduction: The purpose of the case is to teach health care professionals to recognize Henoch-Schönlein purpura (HSP), including rare and serious complications. The case includes a review of epidemiology, classification, clinical manifestations, and treatment of HSP., Methods: Utilizing an adolescent simulation mannequin, we present the case of an 11-year-old female who presents to a pediatric emergency department with HSP and respiratory symptoms requiring intubation. This case reinforces the appearance of the characteristic rash and helps learners develop an algorithm for HSP management that includes the identification and management of abdominal pain associated with HSP, as well as the rare and serious complication of pulmonary vasculitis. We focus learners on managing severe respiratory distress in the HSP patient. Learners are assessed using standardized forms, and the learner outcome measurements include the recognition of HSP and successful management of abdominal pain and respiratory failure in this unique setting., Results: This module has been used with pediatric residents, emergency medicine residents, pediatric emergency medicine fellows, and pediatric emergency medicine nurse practitioners. Approximately 30 learners have completed this module during seven separate sessions. All learners felt the case provided the opportunity to identify HSP as well as to manage a serious and rare complication of the disease., Discussion: Overall, we have had positive feedback from the learners about this case, and it provides them the opportunity to see more rare complications during their training period. Learners leave the session with enhanced knowledge of HSP, as well as a review of respiratory failure and intubation., Competing Interests: None to report.