In late 2019, an acute, severe lower respiratory tract illness of unknown etiology, linked to contact with a live seafood and animal market, was reported in Wuhan City, Hubei Province, China, subsequently shown to be caused by a novel coronavirus termed the Severe Acute Respiratory Syndrome (SARS) Coronavirus (CoV)-2. The infection caused by this virus is referred to as coronavirus disease 2019, or COVID-19. SARS-CoV-2 infects human cells through binding of viral surface spike protein to human angiotensin-converting enzyme 2 receptors, predominantly expressed on Type II alveolar cells, in the lung. SARS-CoV-2 is highly transmissible, and affected patients can transmit the infection while asymptomatic. Patients commonly complain of fever, dry cough, fatigue, myalgias, headache, and dyspnea. Most infected patients have mild disease and recover, with more severe disease and mortality more commonly present in older individuals and patients with comorbidities, such as hypertension, diabetes, and chronic cardiovascular and respiratory conditions. The diagnosis of COVID-19 is typically established through identification of viral nucleic acid at real-time reverse transcriptase polymerase chain reaction on respiratory tract samples. Chest radiography in COVID-19 infection may be normal; when abnormal, patchy areas of lower lobe ground-glass opacity and/or consolidation are seen. Computed tomography is more sensitive than chest radiography for detection of the infection and commonly shows multifocal, bilateral, peripheral, and basal predominant round or oval areas of ground-glass opacity that may subsequently transition to consolidation. Treatment for COVID-19 is currently supportive, with various ongoing trials evaluating a number of potentially therapeutic agents.
In late 2019, an acute, severe lower respiratory tract illness of unknown etiology, linked to contact with a live seafood and animal market, was reported in Wuhan City, Hubei Province, China, subsequently shown to be caused by a novel coronavirus termed the Severe Acute Respiratory Syndrome (SARS) Coronavirus (CoV)-2. The infection caused by this virus is referred to as coronavirus disease 2019, or COVID-19. SARS-CoV-2 infects human cells through binding of viral surface spike protein to human angiotensin-converting enzyme 2 receptors, predominantly expressed on Type II alveolar cells, in the lung. SARS-CoV-2 is highly transmissible, and affected patients can transmit the infection while asymptomatic. Patients commonly complain of fever, dry cough, fatigue, myalgias, headache, and dyspnea. Most infected patients have mild disease and recover, with more severe disease and mortality more commonly present in older individuals and patients with comorbidities, such as hypertension, diabetes, and chronic cardiovascular and respiratory conditions. The diagnosis of COVID-19 is typically established through identification of viral nucleic acid at real-time reverse transcriptase polymerase chain reaction on respiratory tract samples. Chest radiography in COVID-19 infection may be normal; when abnormal, patchy areas of lower lobe ground-glass opacity and/or consolidation are seen. Computed tomography is more sensitive than chest radiography for detection of the infection and commonly shows multifocal, bilateral, peripheral, and basal predominant round or oval areas of ground-glass opacity that may subsequently transition to consolidation. Treatment for COVID-19 is currently supportive, with various ongoing trials evaluating a number of potentially therapeutic agents.
NUT (nuclear protein in testis) carcinoma is a poorly differentiated aggressive subtype of squamous cell carcinoma. NUT carcinoma is characterized by genetic rearrangements involving the NUT gene, resulting in the formation of oncogenic fusion proteins, most commonly NUT-BRD4. Originally described as a thymic carcinoma with NUT gene rearrangement in children and young adults, NUT carcinoma has been shown to occur in adults in a variety of locations. It is typically seen as an aggressive large soft tissue mass infiltrating adjacent structures. Because of the aggressive nature of NUT carcinoma, patients typically present in late stages of the disease and rapidly succumb to the disease. There are no pathognomonic, radiologic, or histopathologic features, and therefore NUT carcinoma is diagnosed via molecular assay, including a commercially available immunohistochemical assay. Additional molecular assays can be performed to demonstrate NUTM1 rearrangement and also to identify the oncogenic fusion protein. With more recent widespread availability of these assays, the reported incidence of NUT carcinoma is expected to increase. Prognosis remains poor for those diagnosed with NUT carcinoma, as there is no proven effective treatment. Recent research into the oncogenic fusion proteins driven by NUT rearrangement and clinical trials with targeted inhibitors offer hope for future therapy.
Although vaping has been promoted by manufacturers as a safe alternative to traditional smoking, the dangers of vaping and e-cigarette use have come to the forefront of the medical community, particularly the risks associated with tetrahydrocannabinol-containing products. Although many patterns of vaping-associated lung injuries have been reported in the literature, one of the most concerning is that of diffuse alveolar damage. As e-cigarette and vaping use is becoming increasingly popular, particularly in the younger population, it is important to become familiar with this entity to ensure proper and timely diagnosis to prevent lifelong sequelae.
Bronchial asthma is an extended chronic inflammatory respiratory disease that represents a serious health problem. Management of asthmatic patients should be ensured by the use of asthma guidelines such as Global Initiative for Asthma (GINA). The last changes made in the GINA guide have generated controversy. This article reviews the reasons for the changes in the guide and the problems that could emerge in the management of the asthmatic patient.
