Background Cavities are frequent manifestations of a wide variety of pathological processes involving the lung. There has been a growing body of evidence of coronavirus disease 2019 leading to a cavitary pulmonary disease. Case presentation A healthy 29-year-old Filipino male presented to the hospital a couple of months after convalescence from coronavirus disease 2019 with severe pleuritic chest pain, fever, chills, and shortness of breath, and was found to have a cavitary lung lesion on chest computed tomography. While conservative management alone failed to improve the patient’s condition, he ultimately underwent left lung video-assisted thoracoscopic surgery decortication. Even though the surgical pathology revealed only necrosis with dense acute inflammation and granulation tissue with no microorganisms, he gradually improved with medical therapy adjunct with surgical therapy. Conclusion Documented cases of cavitary lung disease secondary to coronavirus disease 2019 have been mostly reported in the acute or subacute phase of the infection. However, clinicians should recognize this entity as a late complication of coronavirus disease 2019, even in previously healthy individuals.

Background Unlike SARS-CoV and MERS-C0V, SARS-CoV-2 has the potential to become a recurrent seasonal infection; hence, it is essential to compare the clinical spectrum of COVID-19 to the existent endemic coronaviruses. We conducted a retrospective cohort study of hospitalized patients with seasonal coronavirus (sCoV) infection and COVID-19 to compare their clinical characteristics and outcomes. Methods A total of 190 patients hospitalized with any documented respiratory tract infection and a positive respiratory viral panel for sCoV from January 1, 2011, to March 31, 2020, were included. Those patients were compared with 190 hospitalized adult patients with molecularly confirmed symptomatic COVID-19 admitted from March 1, 2020, to May 25, 2020. Results Among 190 patients with sCoV infection, the Human Coronavirus-OC93 was the most common coronavirus with 47.4% of the cases. When comparing demographics and baseline characteristics, both groups were of similar age (sCoV: 74 years vs. COVID-19: 69 years) and presented similar proportions of two or more comorbidities (sCoV: 85.8% vs. COVID-19: 81.6%). More patients with COVID-19 presented with severe disease (78.4% vs. 67.9%), sepsis (36.3% vs. 20.5%), and developed ARDS (15.8% vs. 2.6%) compared to patients with sCoV infection. Patients with COVID-19 had an almost fourfold increased risk of in-hospital death than patients with sCoV infection (OR 3.86, CI 1.99–7.49; p < .001). Conclusion Hospitalized patients with COVID-19 had similar demographics and baseline characteristics to hospitalized patients with sCoV infection; however, patients with COVID-19 presented with higher disease severity, had a higher case-fatality rate, and increased risk of death than patients with sCoV. Clinical findings alone may not help confirm or exclude the diagnosis of COVID-19 during high acute respiratory illness seasons. The respiratory multiplex panel by PCR that includes SARS-CoV-2 in conjunction with local epidemiological data may be a valuable tool to assist clinicians with management decisions.

The emergence of the Whipple procedure revolutionized operative management of pancreatic disease since its introduction (Fernandez-del Castillo et al., 2012 [ 1 ]). This operation classically involves removal of the head of the pancreas along with the duodenum, gallbladder, a portion of the bile duct, and part of the stomach (Warshaw and Thayer, 2004; Evans et al., 2007 [ 2 , 3 ]). We report a beneficial outcome of a modified Whipple on a paediatric trauma patient post- motor vehicle accident (MVA). After Advanced Trauma Life Support (ATLS) was initiated and haemodynamic stability was achieved, exploratory laparotomy revealed pancreatic transection and duodenal rupture. Partial pancreaticoduodenectomy, pancreaticoduodenostomy, cholecystojejunostomy, and pyloric-sparing gastrojejunostomy were performed. Post-operative acute pancreatitis resolved with antibiotics and supportive care. While paediatric abdominal trauma does not typically warrant a Whipple, patients with severe injury to the pancreas and neighboring organs with major vascular injury may offer no other intra-operative choice (Adams, 2014; Thatte and Vaze, 2014; Debi et al., 2013 [ [4] , [5] , [6] ]). Our patient's growth was followed post-operatively. At a 20-year post-operative follow-up, he reported no further hospitalizations or complications such as diabetes, biliary stricture, gallstones, or growth retardation. We review the literature to expose the novelty of using a Whipple to treat paediatric abdominal trauma, and the advantages of a pylorus-preserving Whipple. Indications for damage control surgery and non-operative management were contrasted with those for definitive surgery to reconstruct the biliary tree to further elucidate why the latter option was chosen.

The disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and later called Covid-19 has resulted in considerable morbidity worldwide. The virus mainly affects the respiratory tract, but it can cause various complications and affect many other organ systems. Preliminary reports have shown that Acute Kidney Injury (AKI) is common in patients with Covid-19, however, the incidence and severity of kidney injury in hospitalized patients especially in the ICU settings is not well described. The objective of this study was to describe the incidence, severity, and outcomes of Covid-19 patients with AKI in ICU setting. METHODS:This was a single-center, retrospective observational cohort study. All patients (age $18) with positive by polymerase chain reaction testing (PCR) of a nasopharyngeal sample for Covid-19 who required hospitalization were included in the study. Patients with End-stage kidney disease (ESKD), kidney transplants were excluded. We compared outcomes of patients with and without AKI. We used univariable and multivariable Cox regression model to evaluate the relationship between AKI and in-hospital and ICU mortality. RESULTS:Overall, 220 patients were included in the study. Within the cohort 62 (15%) patients died and 158 (72%) were discharged from the hospital. Total of 71 (32%) patients required ICU admission, 47 (21%) required mechanical ventilation, and 35 (15%) required vasopressor support. Overall, 89 (40%) patients developed AKI. In-hospital mortality of patients with AKI was markedly higher than in patients without AKI (39 (43.8%) vs 23 (17.5%) p<0.001). Univariable and multivariable Cox regression analysis showed that AKI in Covid-19 patients was associated with increased in-hospital death with unadjusted HR 2.01 (CI 1.23-3.14; p<0.001). The risk remained significantly high following adjustment for baseline demographics and comorbidities, adjusted HR 1.8 (CI 1.10-2.74, P¼0.015). In ICU setting 28 (39%) patients developed AKI and the mortality was also markedly higher compared to patients without AKI (12/28 (42%) vs 7/44 (15%) P¼0.011). There was also a significant difference with mechanical ventilation and vasopressor requirement in AKI vs Non-AKI patient, (25 (28%) vs 22 (16%) P¼0.048) and (23 (25%) vs 14 (10%) P¼0.013) respectively. CONCLUSIONS: AKI is a common condition among patients hospitalized with COVID-19, and it is associated with an increased risk of in-hospital and ICU mortality. CLINICAL IMPLICATIONS:The findings in the study highlight the need to consider this complication and outcomes in COVID-19 management.

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