Tomography and Prognostic Indices in the State of the Art of Evaluation in Hospitalized Patients with COVID-19 Pneumonia.

Evaluation in medical emergencies of COVID-19 patients represents a challenge to regulate preventive and timely management. There are key imaging and laboratory tools to classify the severity. The aim of the study was to evaluate the chest CT score performance and prognostic indices in COVID-19 patients to predict the progression to critical illness. This was a retrospective study between run between April and December 2020, in which 109 patients were included. Patients of any age and gender and who required hospitalization due to a confirmed COVID-19 diagnosis by RT-PCR and chest CT and laboratory were analyzed. In 75% of them, there was at least one comorbidity, and 30% developed critical illness, and the average mortality was 10%. In 49.5%, there was a CORADS-5 on admission, and in 50%, there was a peripheral distribution of the interstitial infiltrate in the left lower lobe. The risk factors were FiO2, CT score > 18, and the NRL index. The combination of the high-risk Quick COVID-19 Severity Index (qCSI) plus CT score > 18 indices was the best prediction index for the development of a critical condition. The combined use of indices in infected COVID-19 patients showed diagnostic accuracy and predicted severity. Imaging and the laboratory tests are key tools independent of the wave of recurrence.

[Diagnostic accuracy of the automatic quantification software in patients with suspected COVID-19 of the Instituto Nacional de Cardiology Ignacio Chávez]. / Precisión diagnóstica del software de cuantificación automática en pacientes con sospecha de COVID-19 del Instituto Nacional de Cardiología Ignacio Chávez.

Objetivos: Establecer la precisión diagnóstica por tomografía computarizada (TC) de la probabilidad de neumopatía por enfermedad por coronavirus 2019 (COVID-19), dada por el sistema de inteligencia artificial (IA) diseñado por Siemens, y el resultado de la evaluación cualitativa CO-RADS (COVID-19 Reporting and Data System) con el estándar de referencia reacción en cadena de la polimerasa transcriptasa inversa (RT-PCR), entregando así la experiencia de nuestra institución. Métodos: Se realizó un estudio observacional, comparativo y retrolectivo en 192 pacientes adultos con sospecha de infección por coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2) que contaban con prueba PCR. Se obtuvo la información de precisión diagnóstica luego de comparar el estándar de referencia (RT- PCR) con el CO-RADS realizado por los observadores y la probabilidad de COVID-19 que arrojaron las imágenes de TC mediante la IA. Resultados: La comparación de la probabilidad de COVID-19 obtenida por la IA vs. la RT-PCR para SARS-CoV- 2 generó un AUC ROC de 0.774 (IC: 0.69-0.81) con p = 0.0001. La probabilidad de COVID-19 tuvo una precisión aceptable, con un buen valor predictivo positivo del 87.80%, pero con un pobre valor predictivo negativo del 58.80%. La variable CO-RADS vs. PCR obtuvo una mayor precisión con valores de sensibilidad y especificidad del 91.80 y 88.7% respectivamente. Conclusión: La comparación entre los resultados obtenidos por la IA y por la variable CO-RADS mostró mayor efectividad en esta última, sin embargo se logró documentar el alto impacto que tiene el sistema de cuantificación automática en la evaluación de estos pacientes, ya que permite agilizar la valoración del radiólogo y funciona como complemento en casos de dudas diagnósticas.

The kidnapping of mitochondrial function associated with the SARS-CoV-2 infection.

Infection by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) leads to multi-organ failure associated with a cytokine storm and septic shock. The virus evades the mitochondrial production of interferons through its N protein and, from that moment on, it hijacks the functions of these organelles. The aim of this study was to show how the virus kidnaps the mitochondrial machinery for its benefit and survival, leading to alterations of serum parameters and to nitrosative stress (NSS). In a prospective cohort of 15 postmortem patients who died from COVID-19, six markers of mitochondrial function (COX II, COX IV, MnSOD, nitrotyrosine, Bcl-2 and caspase-9) were analyzed by the immune colloidal gold technique in samples from the lung, heart, and liver. Biometric laboratory results from these patients showed alterations in hemoglobin, platelets, creatinine, urea nitrogen, glucose, C-reactive protein, albumin, D-dimer, ferritin, fibrinogen, Ca²âº, K⁺, lactate and troponin. These changes were associated with alterations in the mitochondrial structure and function. The multi-organ dysfunction present in COVID-19 patients may be caused, in part, by damage to the mitochondria that results in an inflammatory state that contributes to NSS, which activates the sepsis cascade and results in increased mortality in COVID-19 patients.