LitCovid-sentences  

PMC:7340597 / 21013-28577 JSONTXT 14 Projects

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Id Subject Object Predicate Lexical cue
T180 0-13 Sentence denotes 4 Discussion
T181 14-128 Sentence denotes We report pathology in deceased critically ill ICU COVID patient in the late phase of disease to be heterogeneous.
T182 129-288 Sentence denotes Histopathologically, we observed four distinct histopathological patterns: AFOP, DAD, fibrosis and, in four out of seven patients an organizing pneumonia (OP).
T183 289-496 Sentence denotes Interestingly, our findings are in contrast to previously reported postmortem studies in COVID-19 patients in which DAD is the most common predominant pattern [[10], [11], [12],[15], [16], [17], [18], [19]].
T184 497-615 Sentence denotes In two recent autopsy studies of 21 and 12 deceased COVID-19 patients, prevalence of DAD was 76% and 67% respectively.
T185 616-698 Sentence denotes None of the patients had the postmortem diagnosis of organizing pneumonia [10,11].
T186 699-807 Sentence denotes In the study of Ackermann and colleagues, pulmonary histology of all seven studied patients showed DAD [19].
T187 808-1022 Sentence denotes Although the organizing stage of DAD may overlap with the histopathological features of OP in lung biopsy, the histologic hallmark of DAD, namely remnants of hyaline membranes were not present in our four OP cases.
T188 1023-1293 Sentence denotes Most plausible explanation for the more common pattern of OP in our study population when compared to previous mentioned studies is the difference in length of hospital and ICU stay correlating with more advanced disease and longer treatment with mechanical ventilation.
T189 1294-1441 Sentence denotes In the studies mentioned above the mean hospital stay was six days or less and most of the patients did not receive mechanical ventilatory support.
T190 1442-1598 Sentence denotes In our present series mean hospital stay of 22 days is significant longer and all patients died in the ICU with a mean of 20 days on mechanical ventilation.
T191 1599-1730 Sentence denotes Secondary OP can be seen in association with many types of non-specific lung injury, including viral infections and drug reactions.
T192 1731-1857 Sentence denotes OP is reported following severe influenza infections [[20], [21], [22], [23], [24]] and Middle East Respiratory Syndrome [25].
T193 1858-2051 Sentence denotes Most recently, Copin et al. reported postmortem biopsies on six patients with COVID and reported in five patients with phenotype H and AFOP histology in contrast to their patient with DAD [26].
T194 2052-2147 Sentence denotes Estimated elapsed disease time in the AFOP group was 20 days versus 6 days in the DAD patients.
T195 2148-2221 Sentence denotes In our opinion this supports the theory that pathology changes over time.
T196 2222-2346 Sentence denotes Although the exact pathogenesis of OP remains unknown, it is thought that OP is a consequence of alveolar epithelial injury.
T197 2347-2491 Sentence denotes This initial epithelial injury is followed by leakage of plasma proteins, leading to a cascade of host responses with hyperinflammation [27,28].
T198 2492-2610 Sentence denotes Subsequent fibroblast recruitment and connective tissue and fibroblast organisation is seen within the alveolar space.
T199 2611-2828 Sentence denotes Vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) play a central role in organizing pneumonia and are highly expressed in intraluminal fibromyxoid lesion in organizing pneumonia [29].
T200 2829-3000 Sentence denotes Interestingly, binding to ACE2 receptor is recognized as a critical initial step for SARS-CoV-2 to entry alveolar type II cells, resulting in loss of ACE2 at the membrane.
T201 3001-3121 Sentence denotes ACE 2 is a negative regulator of the renin-angiotensin system (RAS) and this depletion of ACE2 upregulates the RAS [30].
T202 3122-3177 Sentence denotes An activated RAS can induce Fibroblastic Growth Factor.
T203 3178-3239 Sentence denotes ACE2 also plays a role in regulating the effect of VEGF [31].
T204 3240-3394 Sentence denotes Therefore, depletion of ACE2 due to the high affinity of SARS-CO-V2 to ACE2 might play a role in the pathogenesis of COVID19 related organizing pneumonia.
T205 3395-3630 Sentence denotes Being aware that medication can be the cause of OP it is notable is that in our study six out of seven patients received chloroquine, at that time the advised treatment by the Dutch National Institute for Public Health and Environment.
T206 3631-3858 Sentence denotes Although chloroquine use is associated with cardiovascular disorders, pulmonary side effects, i.e. drug induced interstitial lung disease, are not described before, and therefore an unlikely cause of the observed histologic OP.
T207 3859-3942 Sentence denotes We found no studies reporting possible relations between antifungal therapy and OP.
T208 3943-4113 Sentence denotes In retrospect, chest CT scans of each of the patients showed a different development during hospital admission, concordant with the histopathological diagnosis (Table 2).
T209 4114-4241 Sentence denotes Development of peripheral nondependent consolidations warrant further investigation in the presence of an organizing pneumonia.
T210 4242-4301 Sentence denotes Excluding nosocomial infections in such cases is essential.
T211 4302-4489 Sentence denotes The diversity in histopathological findings correlating with radiological findings is interesting considering possible therapeutic implications and should be subject for further research.
T212 4490-4691 Sentence denotes Although steroids are not routinely recommended to be used in de early phase of SARS-CoV-2 pneumonia, they might have a role in the late phase of COVID19 when an organizing pneumonia is suspected [32].
T213 4692-4901 Sentence denotes Recently there is increasing awareness and concern for development of secondary infection in COVID patients e.g. invasive aspergillus co-infection, a contra-indication for (long-term) systemic steroid therapy.
T214 4902-5015 Sentence denotes Criteria and risk factors for invasive pulmonary aspergillosis are well defined in immunocompromised populations.
T215 5016-5226 Sentence denotes Furthermore it is a well known complication of severe influenza pneumonia with reported incidences of 19% in ICU patients admitted for influenza related acute respiratory failure with high mortality rates [33].
T216 5227-5415 Sentence denotes In COVID-19 associated pulmonary aspergillosis (CAPA) case definition is absent, although recently an expert panel proposed a classification for IAPA, which was used to classify CAPA [14].
T217 5416-5628 Sentence denotes Pathophysiology of CAPA consists of lung damage with bilateral alveolar-interstitial damage due to viral replication and cytokine storm in combination with marked low T-lymphocytes CD4 + T and CD8 + T cells [27].
T218 5629-5715 Sentence denotes Secondary infection due to lung tissue damage develop within a median of 17 days [34].
T219 5716-5828 Sentence denotes CAPA data are scarce but increasingly reported, although histological confirmation is still absent [9,13,35,36].
T220 5829-5970 Sentence denotes Of the first 31 COVID-19 patients admitted to our ICU, six where highly suspected for COVID-19 associated pulmonary aspergillosis (CAPA) [9].
T221 5971-6114 Sentence denotes In this case series, BAL fluid galactomannan was positive in six out of the seven cases, concluding in the clinical diagnosis of probable CAPA.
T222 6115-6204 Sentence denotes To our surprise, none of the lung biopsies showed any presence of invasive aspergillosis.
T223 6205-6419 Sentence denotes Lack of evidence for invasive pulmonary aspergillosis in our patients with probable CAPA raises the question whether patients with suspected CAPA truly develop invasive aspergillosis and require antifungal therapy.
T224 6420-6550 Sentence denotes For instance, the three deaths in the CAPA report from France were attributed to bacterial septic shock, and not to aspergillosis.
T225 6551-6758 Sentence denotes Although in our patients adequate antifungal treatment could be an explanation for the absence of histologic fungal features, we find this improbable as respiratory conditions deteriorated despite treatment.
T226 6759-6928 Sentence denotes Further research on the presence of CAPA, its case definition and the necessity for antifungal treatment and (relative) contraindication for steroid treatment is needed.
T227 6929-7103 Sentence denotes We acknowledge the limitations of this report and realize that due to limited sample size of pulmonary tissue, a sampling error in our histologic findings cannot be excluded.
T228 7104-7321 Sentence denotes Although conventional autopsy might be the preferred postmortem examination, postmortem ultrasound guided lung biopsies are a safe and valuable alternative, with an 83% concordance rate with conventional autopsy [37].
T229 7322-7564 Sentence denotes Especially in times of new emerging diseases, like COVID-19, histopathological investigation is essential in understanding the pathogenesis of SARS-CoV-2 infection and thereby providing information leading to possible new therapeutic options.