Clinical medicine (London, England)
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Reactive axillary lymph nodes (ALN) may occur post-COVID-19 vaccination. This may be confused with malignant nodal metastases on oncological imaging. We aimed to determine the reactive ALN incidence and duration on 18F-fluorodeoxyglucose positron emission tomography - computed tomography (18F-FDG PET-CT), and its relationship with gender, age and vaccine type. ⋯ Physicians' awareness of COVID-19 vaccine-related reactive ALN on 18F-FDG PET-CT is important to avoid inappropriate upstaging of cancers.
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Interstitial lung diseases (ILDs) are a heterogeneous group of diseases characterised by varying degrees of fibrotic and/or inflammatory abnormalities of the lung parenchyma. Management of ILD is often challenging for non-respiratory physicians. We discuss the respiratory assessment and management of patients with ILD presenting with acute breathlessness on the acute take, including acute exacerbations of ILD.
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Lung cancer continues to be the leading cause of cancer death globally. Delayed diagnosis is a major contributing factor to poor outcomes and remains a key challenge to overcome. ⋯ Lung cancer treatment continues to develop with new surgical techniques, radiotherapy options and more drugs being licensed as part of standard treatment. We provide an overview of the core lung cancer diagnostic steps, recognition and management of acute presentations as well as the latest treatment options.
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Observational Study
Failing the frail: The need to broaden the COVID-19 case definition for geriatric patients.
The older population has a high mortality with COVID-19 and this cohort often presents atypically with infection. This study compares presenting complaints and observations of older patients with COVID-19 against the established case definition to determine whether the case definition should be broadened to better identify SARS-CoV-2 infection in this age group. This retrospective observational study analysed the presenting complaints and observations of people aged 70 years and over who were admitted to a district general hospital with confirmed SARS-CoV-2 infection from March to May 2020. ⋯ Only 32.4% recorded a temperature ≥37.6°C on admission while 20.4% were hypothermic with a temperature <36.4°C (p=0.0003). A significant proportion of older patients with COVID-19 presented with non-specific symptoms and observations. The high proportion of falls and delirium emphasises the need for early geriatrician input, awareness of COVID-19 as a differential for confusion in older patients and to include falls in the case definition for COVID-19 in the older population.
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Patients and public have sought mortality risk information throughout the pandemic, but their needs may not be served by current risk prediction tools. Our mixed methods study involved: (1) systematic review of published risk tools for prognosis, (2) provision and patient testing of new mortality risk estimates for people with high-risk conditions and (3) iterative patient and public involvement and engagement with qualitative analysis. ⋯ Informed by patient feedback, we provide such information in 'five clicks' (https://covid19-phenomics.org/OurRiskCoV.html), as context for decision making and discussions with health professionals and family members. Further development requires curation and regular updating of NHS data and wider patient and public engagement.