Hospital Practices and Research

Abstract Background: The coronavirus Disease 2019 (COVID-19) pandemic emerged in December 2019, resulting in a high number of deaths worldwide. There is a need to investigate how this condition affected people with different diseases, particularly atopy.
Objectives: This study aimed to compare clinical symptoms, laboratory test results, radiological manifestations, and clinical outcomes between hospitalized COVID-19 patients with and without atopy.
Methods: This single-center cross-sectional study with matched controls was conducted on 106 (out of 334) COVID-19 patients hospitalized in Baqiyatallah Hospital, Tehran, Iran, from March 24 to April 24, 2020. Among them, there were 40 and 66 cases with and without atopy, respectively. The non-atopic patients were also matched with the atopic patients in terms of age, gender, Body Mass Index (BMI), and the prevalence of comorbidities, particularly hypertension and diabetes. Patients' clinical characteristics, laboratory findings, and radiological features, recorded upon their admission, and the outcomes were then compared between both study groups.
Results: Compared with the non-atopic group, weakness, myalgia, and chills were more frequent in the patients affected with atopy (P <0.05), and neutrophil count, Erythrocyte Sedimentation Rate (ESR), C-Reactive Protein (CRP), bilateral lung involvement, bilateral pneumonia, and Ground-Glass Opacity (GGO) were among the laboratory test results and radiological manifestations that were observed significantly less in atopic patients (P <0.05). No significant difference was further detected regarding the COVID-19 outcomes in both study groups (P >0.05).
Conclusion: This study showed that atopic conditions were capable of increasing the frequency of some COVID-19 clinical symptoms and reducing the severity of COVID-19 with regard to laboratory findings and radiological features on admission. In addition, atopy was not correlated with COVID-19 outcomes in atopic patients.

Abstract Background: Pneumomediastinum and pneumothorax are usually rare conditions after pneumonia. This study examines the progress of pneumonia of the coronavirus disease 2019 (COVID-19) to spontaneous pneumothorax and pneumomediastinum in a patient.
Case Presentation: The patient was a 40-year-old man who complained of nonproductive cough and dyspnea. He also complained of fever, sore throat, back, and chest pain. The patient used to smoke but now he quit .His O2 saturation was 89% at the time of admission. He was assessed with suspicion of COVID-19. CT scans of the chest showed brief changes of emphysema and a ground glass view was also seen in the lungs. In the patient’s tests, RT-PCR testing of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was performed and it was positive. Treatment was initiated and because of the progression of symptoms, the serial CT scanning of the patient’s lungs was performed daily; and cavitary changes, air-fluid appearance, and destructive changes of lungs were reported. After eight days, the patient’s cough worsened. CT scans of the patient’s lungs showed some bullaes, pneumothorax, and pneumomediastinum, thus a chest tube was inserted and oxygen therapy was begun on the patient with 3-6 L/min. After 5 days in CT, the patient was relieved of pneumothorax and pneumomediastinum and after a week, the chest tube came out.
Conclusion: Pulmonary lesions of COVID 19 can progress to bullae, pneumomediastinum, and pneumothorax. Deterioration of dyspnea and respiratory symptoms can be a warning of pneumomediastinum and pneumothorax that can be confirmed by graphics and timely treatment of the patient can be life-saving.