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1.
Chinese Critical Care Medicine ; (12): 1074-1079, 2023.
Article in Chinese | WPRIM | ID: wpr-1010908

ABSTRACT

OBJECTIVE@#To explore lung ultrasound radiomics features which related to extravascular lung water index (EVLWI), and to predict EVLWI in critically ill patients based on lung ultrasound radiomics combined with machine learning and validate its effectiveness.@*METHODS@#A retrospective case-control study was conducted. The lung ultrasound videos and pulse indicated continuous cardiac output (PiCCO) monitoring results of critically ill patients admitted to the department of critical care medicine of the First Affiliated Hospital of Guangxi Medical University from November 2021 to October 2022 were collected, and randomly divided into training set and validation set at 8:2. The corresponding images from lung ultrasound videos were obtained to extract radiomics features. The EVLWI measured by PiCCO was regarded as the "gold standard", and the radiomics features of training set was filtered through statistical analysis and LASSO algorithm. Eight machine learning models were trained using filtered radiomics features including random forest (RF), extreme gradient boost (XGBoost), decision tree (DT), Naive Bayes (NB), multi-layer perceptron (MLP), K-nearest neighbor (KNN), support vector machine (SVM), and Logistic regression (LR). Receiver operator characteristic curve (ROC curve) was plotted to evaluate the predictive performance of models on EVLWI in the validation set.@*RESULTS@#A total of 151 samples from 30 patients were enrolled (including 906 lung ultrasound videos and 151 PiCCO monitoring results), 120 in the training set, and 31 in the validation set. There were no statistically significant differences in main baseline data including gender, age, body mass index (BMI), mean arterial pressure (MAP), central venous pressure (CVP), heart rate (HR), cardiac index (CI), cardiac function index (CFI), stroke volume index (SVI), global end diastolic volume index (GEDVI), systemic vascular resistance index (SVRI), pulmonary vascular permeability index (PVPI) and EVLWI. The overall EVLWI range in 151 PiCCO monitoring results was 3.7-25.6 mL/kg. Layered analysis showed that both datasets had EVLWI in the 7-15 mL/kg interval, and there was no statistically significant difference in EVLWI distribution. Two radiomics features were selected by using LASSO algorithm, namely grayscale non-uniformity (weight was -0.006 464) and complexity (weight was -0.167 583), and they were used for modeling. ROC curve analysis showed that the MLP model had better predictive performance. The area under the ROC curve (AUC) of the prediction validation set EVLWI was higher than that of RF, XGBoost, DT, KNN, LR, SVM, NB models (0.682 vs. 0.658, 0.657, 0.614, 0.608, 0.596, 0.557, 0.472).@*CONCLUSIONS@#The gray level non-uniformity and complexity of lung ultrasound were the most correlated radiomics features with EVLWI monitored by PiCCO. The MLP model based on gray level non-uniformity and complexity of lung ultrasound can be used for semi-quantitative prediction of EVLWI in critically ill patients.


Subject(s)
Humans , Extravascular Lung Water/diagnostic imaging , Retrospective Studies , Critical Illness , Case-Control Studies , Bayes Theorem , China , Lung/diagnostic imaging
2.
Chinese Journal of Industrial Hygiene and Occupational Diseases ; (12): 396-400, 2023.
Article in Chinese | WPRIM | ID: wpr-986021

ABSTRACT

Interstitial lung abnormalities (ILAs) refer to the subtle or mild signs of ILAs pulmonary parenchyma on chest HRCT scans, which are not yet sufficient to diagnose a certain interstitial lung disease, may be potentially compatible an early stage of the diseases. The signs of ILAs usually includes ground-glass opacities, reticular abnormakicies, honeycombing, traction bronchiectasis or non-emphysematous cysts. This article reviews the research progreses in the definition and classification, risk factors, prognosis, comorbidities and management of ILAs in combination with domestic and foreign literatures.


Subject(s)
Humans , Lung/diagnostic imaging , Tomography, X-Ray Computed , Lung Diseases, Interstitial/diagnosis , Prognosis , Diagnosis, Differential
3.
Journal of Biomedical Engineering ; (6): 912-919, 2023.
Article in Chinese | WPRIM | ID: wpr-1008916

ABSTRACT

Precise segmentation of lung field is a crucial step in chest radiographic computer-aided diagnosis system. With the development of deep learning, fully convolutional network based models for lung field segmentation have achieved great effect but are poor at accurate identification of the boundary and preserving lung field consistency. To solve this problem, this paper proposed a lung segmentation algorithm based on non-local attention and multi-task learning. Firstly, an encoder-decoder convolutional network based on residual connection was used to extract multi-scale context and predict the boundary of lung. Secondly, a non-local attention mechanism to capture the long-range dependencies between pixels in the boundary regions and global context was proposed to enrich feature of inconsistent region. Thirdly, a multi-task learning to predict lung field based on the enriched feature was conducted. Finally, experiments to evaluate this algorithm were performed on JSRT and Montgomery dataset. The maximum improvement of Dice coefficient and accuracy were 1.99% and 2.27%, respectively, comparing with other representative algorithms. Results show that by enhancing the attention of boundary, this algorithm can improve the accuracy and reduce false segmentation.


Subject(s)
X-Rays , Algorithms , Diagnosis, Computer-Assisted , Thorax/diagnostic imaging , Lung/diagnostic imaging , Image Processing, Computer-Assisted
4.
Arch. argent. pediatr ; 120(6): e246-e254, dic. 2022. ilus
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1398301

ABSTRACT

La ecografía pulmonar (EP) ha ganado terreno en el diagnóstico de la mayoría de las patologías respiratorias presentes desde el nacimiento. Es altamente sensible a las variaciones del contenidode aire y fluidos pulmonares, y constituye un verdadero densitómetro del parénquimapulmonar con una sensibilidad superior a la de los estudios radiológicos. Es no invasiva, rápida, fácil de realizar junto a la cama del paciente y, a diferencia de la radiología convencional, no presenta riesgos de radiación. Además, nosproporciona información dinámica en tiempo real en una variedad de entornos neonatales y, al igual que las evaluaciones del corazón y el cerebro, puede ser realizada por el neonatólogo. El objetivo de esta publicación es mostrarlos principales artefactos e imágenes que sepueden encontrar en la EP neonatal, así como los diferentes patrones de aireación, y destacar su utilidad en el estudio de los trastornosrespiratorios más frecuentes del neonato.


Lung ultrasound (LU) has gained ground in the diagnosis of most respiratory conditions present since birth. It is highly sensitive to variations in air content and pulmonary fluids and functions as a true densitometer of the lung parenchyma with a sensitivity superior to that of radiological studies. A LU is a non-invasive, fast and easy tool that can be used at the patient's bedside and, unlike conventional radiology, does not pose risks of radiation. In addition, a LU provides real-time dynamic information in a variety of neonatal settings and, like heart and brain examinations, can be performed by the neonatologist. The objective of this article is to describe the main artifacts and images that can be found in the neonatal LU, as well as the different aeration patterns, and to highlight their usefulness in the study of the most frequent respiratory disorders of neonates.


Subject(s)
Humans , Infant, Newborn , Pneumonia , Neonatology , Thorax , Ultrasonography , Lung/diagnostic imaging
5.
Rev. chil. enferm. respir ; 38(1): 33-36, mar. 2022. ilus
Article in Spanish | LILACS | ID: biblio-1388170

ABSTRACT

Resumen El Paraquat es un herbicida ampliamente utilizado para el control de las malezas en Chile. Su ingesta determina una alta probabilidad de mortalidad dado su inherente toxicidad mediante la producción de radicales libres, que afectan a múltiples órganos, principalmente los pulmones; a esto se suma la falta de un tratamiento efectivo. Se presenta el caso clínico de un hombre de 18 años que en un intento suicida consume 50 mL de paraquat (200 g/L), con desenlace fatal. La presentación clínica depende la cantidad de Paraquat ingerida y los hallazgos radiológicos descritos varían según la temporalidad del cuadro e, inclusive, podrían determinar el pronóstico.


Paraquat is an herbicide widely used for weed control in Chile. Its intake determines a high probability of mortality because of its inherent toxicity through the production of free radicals. Multiple organs are affected, mainly the lungs; to this is added the lack of effective treatment. We present the clinical case of an 18-year-old man who in a suicidal attempt swallows 50 mL of paraquat (200 g/L), with a fatal outcome. The clinical presentation depends on the amount of Paraquat ingested. Radiological findings described vary according to the temporality of the condition and could even determine the prognosis


Subject(s)
Humans , Male , Adolescent , Paraquat/poisoning , Pulmonary Fibrosis/diagnostic imaging , Herbicides/poisoning , Pulmonary Fibrosis/chemically induced , Radiography, Thoracic , Tomography, X-Ray Computed , Fatal Outcome , Lung/diagnostic imaging
6.
Rev. Assoc. Med. Bras. (1992) ; 68(2): 183-190, Feb. 2022. tab
Article in English | LILACS | ID: biblio-1365348

ABSTRACT

SUMMARY OBJECTIVE: The aim of this study was to ascertain the long-term respiratory effects of COVID-19 pneumonia through pulmonary function tests in follow-ups at 1 and 6 months. METHODS: Our study was conducted between August 1, 2020 and April 30, 2021. At 1 month after discharge, follow-up evaluations, PFTs, and lung imaging were performed on patients aged above 18 years who had been diagnosed with COVID-19 pneumonia. In the 6th month, the PFTs were repeated for those with pulmonary dysfunction. RESULTS: A total of 219 patients (mean age, 49±11.9 years) were included. Pathological PFT results were noted in the 1st month for 80 patients and in the 6th month for 46 (7 had obstructive disorder, 15 had restrictive disorder, and 28 had small airway obstruction) patients. A significant difference was found between abnormal PFT results and patient-described dyspnea in the 1st month of follow-up. The 6-month PFT values (especially those for forced vital capacity) were statistically significantly lower in the patients for whom imaging did not indicate complete radiological improvement at the 1-month follow-up. No statistically significant difference was found between the severity of the first computed tomography findings or clinical condition on emergency admission and pulmonary dysfunction (Pearson's chi-square test, P=0.904; Fisher's exact test, P=0.727). CONCLUSION: It is important that patients with COVID-19 pneumonia be followed up for at least 1 month after discharge to be monitored for potential long-term lung damage. PFTs should be administered to those in whom ongoing dyspnea, which started with COVID-19, and/or full recovery were not identified in pulmonary imaging.


Subject(s)
Humans , Adult , Aged , COVID-19 , Respiratory Function Tests , Vital Capacity , Follow-Up Studies , SARS-CoV-2 , Lung/diagnostic imaging , Middle Aged
7.
Neumol. pediátr. (En línea) ; 17(4): 148-152, 2022. ilus
Article in Spanish | LILACS | ID: biblio-1438471

ABSTRACT

Las malformaciones pulmonares congénitas (MPC) conforman un grupo de entidades originadas por alteraciones en la embriogénesis del pulmón y de las vías respiratorias que se producen de acuerdo al nivel del árbol traqueobronquial donde se dé el insulto o el momento de la edad gestacional. Las entidades que en la actualidad forman parte de las MPC son: malformación congénita de la vía aérea, secuestro pulmonar, quiste broncogénico, enfisema lobar congénito, atresia bronquial. Su diagnóstico puede realizarse desde la etapa prenatal, al momento del nacimiento, en la edad pediátrica o adulta por la aparición de síntomas o incidentalmente en pruebas radiológicas. El manejo de estas lesiones depende del tipo de malformación y de la severidad de los síntomas, por lo que se debe individualizar la conducta a seguir en cada caso. Aunque la mayoría de los autores recomienda la resección de la lesión, no existe en la actualidad un consenso sobre la indicación de cirugía, sobre todo en pacientes asintomáticos. Nuestro objetivo es describir los hallazgos clínicos, radiológicos y en algunos casos anatomopatológicos así como el tratamiento empleado de cuatro casos clínicos, atendidos en un hospital de tercer nivel que ejemplifican las presentaciones más frecuentes de las MPC.


Congenital pulmonary malformations (CPM) make up a group of entities caused by alterations in the embryogenesis of the lung and the respiratory tract that occur according to the level of the tracheobronchial tree where the insult occurs or the moment of gestational age. The entities that are currently part of the CPM are: congenital malformation of the airway, pulmonary sequestration, bronchogenic cyst, congenital lobar emphysema, bronchial atresia. Its diagnosis can be made from the prenatal stage, at birth or in pediatric or adult age due to the appearance of symptoms or incidentally in radiological tests. The management of these injuries depends on the type of malformation and the severity of the symptoms, so the conduct to be followed in each case must be individualized. Although most authors recommend resection of the lesion, there is currently no consensus on the indication for surgery, especially in asymptomatic patients. Our objective is to describe the clinical, radiological and in some cases histopathological findings, as well as the treatment used in four clinical cases, treated in a tertiary level hospital that exemplify the most frequent presentations of MPC.


Subject(s)
Humans , Male , Female , Pregnancy , Infant, Newborn , Adult , Respiratory System Abnormalities/diagnostic imaging , Lung/abnormalities , Lung/diagnostic imaging , Lung Diseases/diagnostic imaging , Prenatal Diagnosis , Infant, Premature , Lung Diseases/congenital
8.
Journal of Forensic Medicine ; (6): 46-52, 2022.
Article in English | WPRIM | ID: wpr-984094

ABSTRACT

OBJECTIVES@#To construct a YOLOv3-based model for diatom identification in scanning electron microscope images, explore the application performance in practical cases and discuss the advantages of this model.@*METHODS@#A total of 25 000 scanning electron microscopy images were collected at 1 500× as an initial image set, and input into the YOLOv3 network to train the identification model after experts' annotation and image processing. Diatom scanning electron microscopy images of lung, liver and kidney tissues taken from 8 drowning cases were identified by this model under the threshold of 0.4, 0.6 and 0.8 respectively, and were also identified by experts manually. The application performance of this model was evaluated through the recognition speed, recall rate and precision rate.@*RESULTS@#The mean average precision of the model in the validation set and test set was 94.8% and 94.3%, respectively, and the average recall rate was 81.2% and 81.5%, respectively. The recognition speed of the model is more than 9 times faster than that of manual recognition. Under the threshold of 0.4, the mean recall rate and precision rate of diatoms in lung tissues were 89.6% and 87.8%, respectively. The overall recall rate in liver and kidney tissues was 100% and the precision rate was less than 5%. As the threshold increased, the recall rate in all tissues decreased and the precision rate increased. The F1 score of the model in lung tissues decreased with the increase of threshold, while the F1 score in liver and kidney tissues with the increase of threshold.@*CONCLUSIONS@#The YOLOv3-based diatom electron microscope images automatic identification model works at a rapid speed and shows high recall rates in all tissues and high precision rates in lung tissues under an appropriate threshold. The identification model greatly reduces the workload of manual recognition, and has a good application prospect.


Subject(s)
Humans , Diatoms , Drowning/diagnosis , Liver/diagnostic imaging , Lung/diagnostic imaging , Microscopy, Electron, Scanning
9.
Singapore medical journal ; : 219-224, 2022.
Article in English | WPRIM | ID: wpr-927281

ABSTRACT

INTRODUCTION@#We aimed to compare the early clinical manifestations, laboratory results and chest computed tomography (CT) images of COVID-19 patients with those of other community-acquired pneumonia (CAP) patients to differentiate CAP from COVID-19 before reverse transcription-polymerase chain reaction results are obtained.@*METHODS@#The clinical and laboratory data and chest CT images of 51 patients were assessed in a fever observation ward for evidence of COVID-19 between January and February 2020.@*RESULTS@#24 patients had laboratory-confirmed COVID-19, whereas 27 individuals had negative results. No statistical difference in clinical features was found between COVID-19 and CAP patients, except for diarrhoea. There was a significant difference in lymphocyte and eosinophil counts between COVID-19 and CAP patients. In total, 22 (91.67%) COVID-19 patients had bilateral involvement and multiple lesions according to their lung CT images; the left lower lobe (87.50%) and right lower lobe (95.83%) were affected most often, and all lesions were located in the peripheral zones of the lung. The most common CT feature of COVID-19 was ground-glass opacity, found in 95.83% of patients, compared to 66.67% of CAP patients.@*CONCLUSION@#Diarrhoea, lymphocyte counts, eosinophil counts and CT findings (e.g. ground-glass opacity) could help to distinguish COVID-19 from CAP at an early stage of infection, based on findings from our fever observation ward.


Subject(s)
Humans , COVID-19/diagnostic imaging , China , Community-Acquired Infections/diagnostic imaging , Diarrhea/pathology , Fever , Lung/diagnostic imaging , Retrospective Studies , SARS-CoV-2 , Tomography, X-Ray Computed/methods
10.
Chinese Journal of Traumatology ; (6): 170-176, 2022.
Article in English | WPRIM | ID: wpr-928495

ABSTRACT

PROPOSE@#In this study, we re-assessed the criteria defined by the radiological society of North America (RSNA) to determine novel radiological findings helping the physicians differentiating COVID-19 from pulmonary contusion.@*METHODS@#All trauma patients with blunt chest wall trauma and subsequent pulmonary contusion, COVID-19-related signs and symptoms before the trauma were enrolled in this retrospective study from February to May 2020. Included patients (Group P) were then classified into two groups based on polymerase chain reaction tests (Group Pa for positive patients and Pb for negative ones). Moreover, 44 patients from the pre-pandemic period (Group PP) were enrolled. They were matched to Group P regarding age, sex, and trauma-related scores. Two radiologists blindly reviewed the CT images of all enrolled patients according to criteria defined by the RSNA criteria. The radiological findings were compared between Group P and Group PP; statistically significant ones were re-evaluated between Group Pa and Group Pb thereafter. Finally, the sensitivity and specificity of each significant findings were calculated. The Chi-square test was used to compare the radiological findings between Group P and Group PP.@*RESULTS@#In the Group PP, 73.7% of all ground-glass opacities (GGOs) and 80% of all multiple bilateral GGOs were detected (p < 0.001 and p = 0.25, respectively). Single bilateral GGOs were only seen among the Group PP. The Chi-square tests showed that the prevalence of diffused GGOs, multiple unilateral GGOs, multiple consolidations, and multiple bilateral consolidations were significantly higher in the Group P (p = 0.001, 0.01, 0.003, and 0.003, respectively). However, GGOs with irregular borders and single consolidations were more significant among the Group PP (p = 0.01 and 0.003, respectively). Of note, reticular distortions and subpleural spares were exclusively detected in the Group PP.@*CONCLUSION@#We concluded that the criteria set by RSNA for the diagnosis of COVID-19 are not appropriate in trauma patients. The clinical signs and symptoms are not always useful either. The presence of multiple unilateral GGOs, diffused GGOs, and multiple bilateral consolidations favor COVID-19 with 88%, 97.62%, and 77.7% diagnostic accuracy.


Subject(s)
Humans , COVID-19 , Contusions/diagnostic imaging , Lead , Lung/diagnostic imaging , Lung Injury/etiology , Retrospective Studies , SARS-CoV-2 , Tomography, X-Ray Computed/methods
11.
Journal of Biomedical Engineering ; (6): 462-470, 2022.
Article in Chinese | WPRIM | ID: wpr-939613

ABSTRACT

Percutaneous pulmonary puncture guided by computed tomography (CT) is one of the most effective tools for obtaining lung tissue and diagnosing lung cancer. Path planning is an important procedure to avoid puncture complications and reduce patient pain and puncture mortality. In this work, a path planning method for lung puncture is proposed based on multi-level constraints. A digital model of the chest is firstly established using patient's CT image. A Fibonacci lattice sampling is secondly conducted on an ideal sphere centered on the tumor lesion in order to obtain a set of candidate paths. Finally, by considering clinical puncture guidelines, an optimal path can be obtained by a proposed multi-level constraint strategy, which is combined with oriented bounding box tree (OBBTree) algorithm and Pareto optimization algorithm. Results of simulation experiments demonstrated the effectiveness of the proposed method, which has good performance for avoiding physical and physiological barriers. Hence, the method could be used as an aid for physicians to select the puncture path.


Subject(s)
Humans , Lung/diagnostic imaging , Lung Neoplasms/diagnostic imaging , Punctures , Thorax , Tomography, X-Ray Computed
14.
Rev. Assoc. Med. Bras. (1992) ; 67(10): 1409-1414, Oct. 2021. tab, graf
Article in English | LILACS | ID: biblio-1351436

ABSTRACT

SUMMARY OBJECTIVE: The aim of this study was to describe chest computed tomography image findings in patients with COVID-19. METHODS: The chest computed tomography scans of 453 hospitalized patients with confirmed COVID-19 were collected at two tertiary care Brazilian hospitals. Demographics and clinical data were extracted from the electronic record medical system. RESULTS: The main chest computed tomography findings were ground-glass opacities (92.5%), consolidation (79.2%), crazy-paving pattern (23.9%), parenchymal bands (50%), septal thickening (43.5%), and inverted halo sign (3.5%). Of the 453 hospitalized patients, 136 (30%) died. In this group, ground-glass opacities (94.1%), consolidation (89.7%), septal thickening (58.1%), crazy-paving pattern (52.2%), and parenchymal bands (39.7%) were the most common imaging findings. CONCLUSIONS: In a dynamic disease with a broad clinical spectrum such as COVID-19, radiologists can cooperate in a better patient management. On wisely indicated chest computed tomography scans, the fast identification of poor prognosis findings could advise patient management through hospital care facilities and clinical team decisions.


Subject(s)
Humans , COVID-19 , Thorax , Brazil , Tomography, X-Ray Computed , SARS-CoV-2 , Lung/diagnostic imaging
15.
Rev. Assoc. Med. Bras. (1992) ; 67(9): 1328-1332, Sept. 2021. tab, graf
Article in English | LILACS | ID: biblio-1351488

ABSTRACT

SUMMARY OBJECTIVE: In coronary computed tomography angiography, a part of the lung parenchyma also enters the image area which is called the field of view. The aim of this study was to evaluate the rate of pulmonary abnormalities and document their association with demographic features in subjects undergoing multislice coronary computed tomography angiography obtained for the assessment of coronary artery disease. METHODS: This was a retrospective observational study evaluating the coronary computed tomography angiography scans of 1,050 patients (58.5% males and 47.3% smokers) with a mean age of 52.2±11.2 years, obtained between January 2018 and March 2020. Pulmonary abnormalities were reported as nodules, focal consolidations, ground-glass opacities, consolidations, emphysema, cysts, bronchiectasis, atelectasis, and miscellaneous. RESULTS: In total, 274 pulmonary abnormalities were detected in 266 patients (25.3%). The distribution of incidental lung findings was as follows: pulmonary nodules: 36.4%, emphysema: 15.6%, bronchiectasis: 11%, ground-glass opacities: 7.2%, atelectasis 7.2%, focal consolidations: 5%, cysts: 6%, consolidations: 2.5%, and miscellaneous: 9.1%. The patients with pulmonary pathology were older (55.5±11.4 versus 51.0±10.9 years), and the percentage of smokers was higher (60.1 versus 43.2%). The possibility of the presence of any incidental lung findings in field of view of coronary computed tomography angiography increases significantly over the age of 40.5 years (p<0.001, AUC 0.612, 95%CI 0.573-0.651). CONCLUSION: Multislice coronary computed tomography angiography can give important clues regarding pulmonary diseases. It is essential for the reporting radiologist to review the entire scan for pulmonary pathological findings especially in patients with smoking history and over the age of 40.5 years.


Subject(s)
Humans , Male , Female , Adult , Incidental Findings , Computed Tomography Angiography , Tomography, X-Ray Computed , Retrospective Studies , Coronary Angiography , Lung/diagnostic imaging , Middle Aged
17.
Gac. méd. Méx ; 157(3): 261-266, may.-jun. 2021. tab, graf
Article in Spanish | LILACS | ID: biblio-1346105

ABSTRACT

Resumen Introducción: La implementación del ultrasonido pulmonar (LUS) en los pacientes con COVID-19 puede ayudar a establecer el grado de afectación pulmonar, evaluar la respuesta al tratamiento y estimar el desenlace intrahospitalario. Objetivo: Evaluar la aplicación de un protocolo LUS en pacientes con infección por COVID-19 para predecir mortalidad intrahospitalaria. Métodos: El estudio se realizó del 1 de abril al 1 de agosto de 2020 en pacientes con infección por COVID-19, ingresados en la Unidad de Terapia Intensiva. Se realizó evaluación pulmonar por médicos entrenados en ultrasonografía crítica. Resultados: La mayoría de los pacientes fue del sexo masculino, la edad mediana fue de 56 años y 59 % requirió ventilación mecánica. La mortalidad intrahospitalaria fue de 39.4 % y en aquellos con puntuación de LUS ≥ 19, de 50 %. El modelo de regresión logística múltiple mostró que la puntuación de LUS ≥ 19 se asoció significativamente a mortalidad (cociente de riesgo = 2.55, p = 0.01). Conclusiones: El LUS es una herramienta clínica segura y rápida que puede realizarse al lado de la cama de los pacientes con infección por COVID-19, para establecer el grado de afectación parenquimatosa y predecir la mortalidad.


Abstract Introduction: Lung ultrasound (LUS) implementation in patients with COVID-19 can help to establish the degree of pulmonary involvement, evaluate treatment response and estimate in-hospital outcome. Objective: To evaluate the application of LUS in patients with COVID-19 infection to predict in-hospital mortality. Methods: The study was carried out from April 1 to August 1, 2020 in patients with COVID-19 infection admitted to the Intensive Care Unit. Lung evaluation was carried out by physicians trained in critical care ultrasonography. Results: Most patients were males, median age was 56 years, and 59 % required mechanical ventilation. In-hospital mortality was 39.4 %, and in those with a LUS score ≥ 19, mortality was higher (50 %). The multiple logistic regression model showed that a LUS score ≥ 19 was significantly associated with mortality (hazard ratio = 2.55, p = 0.01). Conclusions: LUS is a safe and fast clinical tool that can be applied at bedside in patients with COVID-19 infection to establish the degree of parenchymal involvement and predict mortality.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Ultrasonography , Hospital Mortality , COVID-19/complications , Intensive Care Units , Lung/diagnostic imaging , Respiration, Artificial/statistics & numerical data , Critical Care , COVID-19/mortality , Hospitalization
18.
São Paulo med. j ; 139(5): 505-510, May 2021. tab
Article in English | LILACS | ID: biblio-1290253

ABSTRACT

ABSTRACT BACKGROUND: The mechanism of exercise limitation in idiopathic pulmonary arterial hypertension (IPAH) is not fully understood. The role of hemodynamic alterations is well recognized, but mechanical, ventilatory and gasometric factors may also contribute to reduction of exercise capacity in these individuals. OBJECTIVE: To investigate whether there is an association between ventilatory pattern and stress Doppler echocardiography (SDE) variables in IPAH patients. DESIGN AND SETTING: Single-center prospective study conducted in a Brazilian university hospital. METHODS: We included 14 stable IPAH patients and 14 age and sex-matched controls. Volumetric capnography (VCap), spirometry, six-minute walk test and SDE were performed on both the patients and the control subjects. Arterial blood gases were collected only from the patients. The IPAH patients and control subjects were compared with regard to the abovementioned variables. RESULTS: The mean age of the patients was 38.4 years, and 78.6% were women. The patients showed hypocapnia, and in spirometry 42.9% presented forced vital capacity (FVC) below the lower limit of normality. In VCap, IPAH patients had higher respiratory rates (RR) and lower elimination of CO2 in each breath. There was a significant correlation between reduced FVC and the magnitude of increases in tricuspid regurgitation velocity (TRV). In IPAH patients, VCap showed similar tidal volumes and a higher RR, which at least partially explained the hypocapnia. CONCLUSIONS: The patients with IPAH showed hypocapnia, probably related to their higher respiratory rate with preserved tidal volumes; FVC was reduced and this reduction was positively correlated with cardiac output.


Subject(s)
Humans , Female , Adult , Pulmonary Arterial Hypertension , Cross-Sectional Studies , Prospective Studies , Echocardiography, Stress , Exercise Test , Familial Primary Pulmonary Hypertension , Lung/diagnostic imaging
19.
Rev. bras. ginecol. obstet ; 43(3): 200-206, Mar. 2021. tab, graf
Article in English | LILACS | ID: biblio-1251306

ABSTRACT

Abstract Objective Covid-19 became a pandemic, and researchers have not been able to establish a treatment algorithm. The pregnant population is also another concern for health care professionals. There are physiological changes related to pregnancy that result in different laboratory levels, radiological findings and disease progression. The goal of the present article is to determine whether the laboratory results and radiological findings were different in non-pregnant women (NPWs) of reproductive age and pregnant women (PWs) diagnosed with the Covid-19 infection. Methods Out of 34 patients, 15 (44.11%) PWs and 19 (55.8%) NPWs were included in the study. Age, comorbidities, complaints, vitals, respiratory rates, computed tomography (CT) findings and stages, as well as laboratory parameters, were recorded from the hospital database. Results Themean age of the PWs was of 27.6 ± 0.99 years, and that of the NPWs was of 37.63 ± 2.00; when agewas compared between the groups, a statistically significant difference (p=0.001) was found. The mean systolic blood pressure of the PWs was of 116.53 ± 11.35, and that of the NPWs was of 125.53 ± 13.00, and their difference was statistically significant (p=0.05). The difference in the minimum respiratory rates of the patients was also statistically significant (p=0.05). The platelet levels observed among the PWs with Covid-19 were lower than those of the NPWs (185.40 ± 39.09 x 109/mcL and 232.00 ± 71.04 x 109/mcL respectively; p=0.05). The mean D-dimer value of the PWs was lower in comparison to that of the NPWs (p<0.05). Conclusion The laboratory findings and imaging studiesmay differ between pregnant and non-pregnant populations. It is important to properly interpret these studies. Future studies with a higher number of patients are required to confirm these preliminary data.


Subject(s)
Humans , Female , Adult , Pregnancy Complications, Infectious/diagnosis , Tomography, X-Ray Computed , COVID-19 Testing/methods , COVID-19/diagnosis , Pregnancy Complications, Infectious/blood , Prognosis , Biomarkers/blood , Cross-Sectional Studies , Retrospective Studies , Disease Progression , COVID-19/blood , Lung/diagnostic imaging
20.
An. bras. dermatol ; 96(2): 240-242, Mar.-Apr. 2021. graf
Article in English | LILACS | ID: biblio-1248742

ABSTRACT

Abstract Small vessel vasculitis with anti-proteinase antibodies 3 is an atypical clinical presentation of tuberculosis. The authors present the case of a 47-year-old male patient, with palpable purpura and palmoplantar hemorrhagic blisters, with subsequent dissemination. He presented severe pulmonary symptoms with cavitation, fever, hemoptysis, and high levels of anti-proteinase 3. Histopathological assessment of the skin revealed small vessel vasculitis; pulmonary histopathology showed granulomas with caseation. Bronchoalveolar lavage was positive for alcohol-acid-fast bacilli. In countries with a high prevalence of tuberculosis, the presence of autoantibodies in a patient with vasculitis, fever, and pulmonary cavitation requires investigation of infectious causes.


Subject(s)
Vasculitis/diagnosis , Skin Diseases, Vascular , Antibodies, Antineutrophil Cytoplasmic , Myeloblastin , Hemoptysis/diagnosis , Hemoptysis/etiology , Lung/diagnostic imaging , Middle Aged
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