Chest-X-ray-based scoring, total leukocyte count, and neutrophil-to-lymphocyte ratio to predict in-hospital mortality in COVID-19 patients: a retrospective study

Background:The objective of this study was to assess the demographical characteristic, laboratory and radiological findings associated with COVID-19 mortality in hospitalizedpatients and also to co-relate neutrophil-to-lymphocyte ratio (NLR)and chest x-ray (CXR)score with severity of the disease.Methods:This is a retrospective study done in Bowring and Lady Curzon hospital between the periodof May 2021 to July 2021. 100 patients who were tested positive for SARS-CoV2 with RT-PCR were taken for the study after fulfilling the inclusion criteria. On day 1 of admission, routine blood investigations including CBC with differential count and chestX ray is taken. From the above said data, NLR and CXR score is calculated and a comparison is made to determine severity and in-hospital mortality between mild, moderate and severe COVID pneumonia patients. This study is being carried out after obtaining institutional ethical committee approval clearance. All analysis were performed using SPSS software version 10.Results: The sample size studied was 100. The mean age of patients was 28.3 in mild, 49.9 in moderate and 62.6 in severe COVID patients. Among these 67% were males and 33% were females. It was noted that, leukocytosis(mean-13245), neutrophilia (mean-83.05%), lymphocytopenia (mean-10.45%) and chest X-ray score (mean-4.98) was seen among severe group with p value being significant.Conclusions: TLC, NLR and CXR score were significantly different between severe and non-severe patients, so assessment of these simple parameters may help identify high risk COVID-19 patients at an early stage in a resource limited setting from the data retrieved from our hospital, NLR and CXR Score showed an acceptable efficiency to separate COVID-19 patients among severe and non-severe patients with a significant p value thereby helping in triaging the patients and need for early ICU needs.

The utility of a chest radiograph in screening COVID-19 patients in a pediatric tertiary government hospital

@#<p><strong>Background:</strong> Coronavirus disease 2019 (COVID-19) continues to be a pandemic to this time, and chest radiography has been used as a first-line triage tool, due to long turnaround times for real-time reverse transcription polymerase chain reaction (RT-PCR), which remains to be the gold standard in COVID-19 diagnosis. Chest x-ray alone has poor sensitivity to diagnosing COVID-19 and pediatric studies on this are scarce.</p><p><strong>Objectives:</strong> The main objective is to evaluate the usefulness of a routine chest radiograph as an adjunct to diagnosing suspected pediatric COVID-19, along with its sensitivity, specificity, accuracy, and correlation with the most common pediatric signs and symptoms. In line with this, the radiographic characteristics seen in pediatric COVID-19 patients are presented.</p><p><strong>Methods:</strong> A cross-sectional study involving a retrospective chart review of 259 pediatric patients admitted in a tertiary hospital with COVID-19 signs and symptoms, with baseline chest x-ray and SARS-CoV2 RT-PCR tests. Correlation of signs and symptoms with chest x-ray findings to RT-PCR positivity was determined using univariate and multivariate logistic regression analysis.</p><p><strong>Results:</strong> The study was composed of 259 pediatric patients (ages 0-18 years old). Of these, 35 had positive findings with RT-PCR (15%). Sensitivity of a chest radiograph with pneumonia is at 62.9%, while specificity is at 39.3%. Overall accuracy of CXR findings leading to RT-PCR positivity is at 42.5%. Ground glass or hazy opacities was the most common radiographic finding (45.5%), followed by reticular opacities (31.8%). Abnormalities were mostly distributed in the inner lung zone distribution with bilateral lung involvement (90%). Those with difficulty of breathing were more likely to have pneumonia on their CXR, though a finding of pneumonia on CXR did not significantly correlate to a positive RT-PCR.</p><p><strong>Conclusions & Recommendations:</strong> Findings of pneumonia on a pediatric CXR may not necessarily lead to a positive SARS-CoV2 RT-PCR, but correlating this with the patient's clinical course and symptoms may be beneficial in effective triaging of patients. Reassessment by another radiologist may provide additional strength to this study.</p>

A Comprehensive Study of Foreign Body Lodgment in Digestive Passage in MGMGH, Trichy

Introduction: Foreign body (FB) among children is vital forclinicians to have a timely diagnosis and effective management.The study aimed to describe the profile and management offoreign body ingestion among children presenting to a tertiarycare hospitalMaterial and methods: The study was a prospectiveobservational study, conducted in the department of ENT ofMGMGH, Trichy, a tertiary care teaching hospital in southIndia. All the FB ingestion cases among children aged 1 to15 years were included. The type of FB, clinical presentation,level of lodgment, management etc. were analyzed. Meanand standard deviation was used to summarize quantitativevariables and frequency and proportion to summarizecategorical variables.Results: Majority (86%) of cases were aged less than 10 years.Males were slightly higher than females (56% Vs 44%). Mostcommon foreign body ingested was Coin 38 (76%) of cases,followed by safety pin and plastic objects. Majority (70%) offoreign bodies lodged in cricopharynx and 30% in proximalesophagus. Among boys, 71.43% of the FBs were found incricopharynx and 68.18% of the girls had FB in cricopharynx.The only type of foreign body found in cricopharynx wascoin. All the FBs in cricopharynx were managed by directlaryngoscopy. Out of the 15 foreign bodies in proximalesophagus, 80% were managed by esophagoscopy and 20%by direct laryngoscopy.Conclusion: FB ingestion Strategies regarding safe behaviorshave a key role in prevention of injuries due to FB and mustbe strictly implemented.

Study of serum magnesium levels and its correlation with febrile convulsions in children aged 6 months to 5 years of age

Background: Various studies have shown the correlation between Magnesium, Zinc and Copper levels in Serum and Cerebrospinal fluid (CSF) and occurrence of Febrile Convulsions. Hypomagnesaemia is characterized by hyper excitability of the central nervous system leading to convulsions. Hence the study is undertaken to find out the Serum Magnesium levels and its correlation with febrile convulsions. Aim: To Study the Serum levels of Magnesium in children: 6 months - 5 years of age with febrile convulsions and to establish the correlation between serum Magnesium levels and febrile convulsions. Materials and methods: This study was done in the Department of Pediatrics, Gandhi Medical College, Secunderabad from July 2015 to July 2016. It was an Observational Prospective study. A total of 120 children 6 months to 5 years of age admitted with history of fever and convulsions diagnosed as febrile convulsions were included in the study. Serum Magnesium levels were measured using catalyst method by Synchron CXR systems. Informed Consent was taken from Parents of all the children. Detailed Clinical History was taken along with thorough Clinical examination. Complete Blood Counts, Serum Magnesium levels, Serum Electrolytes, Blood Glucose and Serum Calcium levels were done. CT scan brain was done wherever required Results: Out of 120 total cases: 104 (86.67%) were Typical Febrile Convulsions. 16 (13.33%) were Atypical Febrile convulsions. Hypomagnesemia was seen in 19 (16%) children. Out of these, 9 (47.36%) cases were Males and 10(52.64%) cases were Females. Out of 104 Typical Febrile convulsions: 17 cases were shown hypomagnesemia, 87 were shown Normal magnesium levels. Out Sreenivasaiah Bharathi, Kotte Chiranjeevi. Study of serum magnesium levels and its correlation with febrile convulsions in children aged 6 months to 5 years of age. IAIM, 2016; 3(11): 61-68. Page 62 of 16 Atypical Febrile convulsion cases: Only 2 cases were having hypomagnesemia and 14 were having Normal Magnesium. Conclusion: No association was found with Gender, Age, and Temperature of the patient and subtype of febrile convulsions. Statistically significant association was found with hypomagnesemia and ‘Typical Febrile convulsions’. No such association was found with Atypical Febrile convulsions. Therapeutic value of administration of Magnesium in children with febrile convulsions associated with hypomagnesemia to be established. This requires further interventional studies. Larger clinical studies are required to establish the association of hypomagnesemia and febrile convulsions. Further studies are suggested to determine the effect of Magnesium administration for the prevention of febrile convulsions.

Chest imaging features of patients afflicted with Influenza A (H1N1) in a Malaysian tertiary referral centre

This is a retrospective descriptive study of the chest imaging findings of 118 patients with confirmed A(H1N1) in a tertiary referral centre. About 42% of the patients had positive initial chest radiographic (CXR) findings. The common findings were bi-basal air-space opacities and perihilar reticular and alveolar infiltrates. In select cases, high-resolution computed tomography (CT) imaging showed ground-glass change with some widespread reticular changes and atelectasis.