[Extrathoracic manifestations of COVID-19 in adults and presentation of the disease in children]. / Manifestaciones extratorácicas de la COVID-19 en adultos y presentación de la enfermedad en niños.

In March 2020, the World Health Organization declared a global pandemic of COVID-19, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); epidemic conditions continue in nearly all countries today. Although the symptoms and imaging manifestations of COVID-19 predominantly involve the respiratory system, it is fundamental to know the manifestations of the disease and its possible complications in other organs to help in diagnosis and orient the prognosis. To improve the diagnostic process without increasing the risk of contagion unnecessarily, it is crucial to know when extrathoracic imaging tests are indicated and which tests are best in each situation. This paper aims to provide answers to these questions. To this end, we describe and illustrate the extrathoracic imaging manifestations of COVID-19 in adults as well as the entire spectrum of imaging findings in children.

Acute dialysis in a high-dependency unit: A new service with a long-term legacy

Background: Continuous Renal Replacement Therapy (CRRT) in the intensive care unit (ICU) was stretched to the limit during the COVID-19 pandemic. COVID-19 was commonly associated with dialysis requiring Acute Kidney Injury (AKI) in patients admitted to ICU, in addition to chronic dialysis patients with COVID-19 requiring ICU admission. During the peak of COVID-19 there was a critical national shortage of consumables and dialysis fluids In the United Kingdom (UK) required for CRRT in ICU. The ICU service at Queens hospital, Romford, UK was no exception with the need to develop a viable urgent alternative therapy. A modified prolonged intermittent haemodialysis treatment 4-8 hours every day in selected patients was set up in the high dependency unit. This method required the installation of additional equipment and staff training. Methods: During the peak of the COVID-19 pandemic, 5 beds in HDU were created with mobile reverse osmosis (RO) units to provide acute dialysis. Within 10 days of service approval, the dedicated area in HDU was equipped with all necessary plumbing work, machines and consumables. In the interim nursing training was provided by the senior dialysis nurse from the satellite dialysis unit based in the hospital who also supervised all sessions of dialysis 6 days a week. Patients selected were relatively stable with or without the need for assisted ventilation and inotrope requirement with Noradrenaline up to 0.6mcg/kg/min. Dialysis treatmeant was provided 6 days week for 4-8 hours per session. Results: 12 COVID-19 patients received haemodialysis in the newly established HDU dialysis unit between 30th April to 30th May 2020. 5 had AKI associated with COVID-19 and 7 COVID-19 patients were on chronic dialysis. Total 72 sessions were provided (range 1- 19 sessions per patient). Of the 12 patients 4 died, of whom 2 with AKI and 2 were on chronic dialysis. Of remaining 8, 5 patients were on chronic haemodialysis while 2 AKI patients continue to require haemodialysis and one became dialysis independent. Conclusions: Prolonged intermittent renal replacement therapy in HDU was a viable alternative during the COVID-19 pandemic. The process was safe and manageable. The resources acquired during COVID-19 pandemic can be utilised in managing AKI and acutely ill chronic dialysis patients in a hospital where this service was not available before the pandemic.