ABSTRACT
OBJECTIVE: To evaluate the association of body composition parameters with outcomes in Covid-19. METHODS: 173 patients hospitalized for Covid-19 infection in 6 European centers were included in this retrospective study. Measurements were performed at L3-level and comprised skeletal muscle index (SMI), muscle density (MD), and adipose tissue measurements [visceral adipose tissue (VAT), subcutaneous adipose tissue (SAT), intramuscular adipose tissue (IMAT), visceral-to-subcutaneous-adipose-tissue-area-ratio (VSR)]. The association with mortality, the need for intubation (MV), and the need for admission to ICU within 30 days were evaluated. RESULTS: Higher SAT density was associated with a greater risk of MV (OR = 1.071, 95%CI=(1.034;1.110), p < 0.001). Higher VAT density was associated with admission to ICU (OR = 1.068, 95%CI=(1.029;1.109), p < 0.001). Higher MD was a protective factor for MV and ICU admission (OR = 0.914, 95%CI=(0.870;0.960), p < 0.001; OR = 0.882, 95%CI=(0.832;0.934), p = 0.028). Higher VSR was associated with mortality (OR = 2.147, 95%CI=(1.022;4.512), p = 0.044). Male sex showed the strongest influence on the risk of ICU admission and MV. SMI was not associated with either parameter. CONCLUSION: In patients hospitalized for Covid-19 infection, higher VSR seems to be a strong prognostic factor of short-term mortality. Weak associations with clinical course were found for MD and adipose tissue measurements. Male sex was the strongest prognostic factor of adverse clinical course. ADVANCES IN KNOWLEDGE: VSR is a prognostic biomarker for 30-day mortality in patients hospitalized for Covid-19 disease.
Subject(s)
COVID-19 , Humans , Male , Retrospective Studies , Subcutaneous Fat/diagnostic imaging , Adipose Tissue/diagnostic imaging , Disease Progression , Intra-Abdominal Fat/diagnostic imagingABSTRACT
RATIONALE AND OBJECTIVES: To evaluate the impact of low skeletal muscle mass in patients with COVID-19 on relevant outcomes like 30-day mortality, need for intubation and need for intensive care unit admission. MATERIALS AND METHODS: For this study, data from six centers were acquired. The acquired sample comprises 1138 patients. There were 547 women (48.1%) and 591 men (51.9%) with a mean age of 54.5 ± 18.8 years; median age, 55 years; range, 18-84 years). In every case, thoracic CT without intravenous application of contrast medium was performed. The following parameters of the pectoralis muscles were estimated: muscle area as a sum of the bilateral areas of the pectoralis major and minor muscles, muscle density, muscle index (PMI) (pectoralis muscle area divided by the patient's body height square) as a ratio pectoralis major and minor muscles divided by the patient's body height2, and muscle gauge as PMI x muscle density. RESULTS: Overall, 220 patients (19.33%) were admitted to the intensive care unit. In 171 patients (15.03%), mechanical lung ventilation was performed. Finally, 154 patients (13.53%) died within the observation time of 30-day. All investigated parameters of pectoralis muscle were lower in the patients with unfavorable courses of Covid-19. All pectoralis muscle parameters were associated with 30-day mortality in multivariate analyses adjusted for age and sex: pectoralis muscle area, HR = 0.93 CI 95% (0.91-0.95) p < 0.001; pectoralis muscle density, HR = 0.94 CI 95% (0.93-0.96) p < 0.001; pectoralis muscle index, HR = 0.79 CI 95% (0.75-0.85) p < 0.001, pectoralis muscle gauge, HR = 0.995 CI 95% (0.99-0.996) p < 0.001. CONCLUSION: in COVID-19, survivors have larger areas and higher index, gauge and density of the pectoralis muscles in comparison to nonsurvivors. However, the analyzed muscle parameters cannot be used for prediction of disease courses.
Subject(s)
COVID-19 , Pectoralis Muscles , Male , Humans , Female , Adult , Middle Aged , Aged , Pectoralis Muscles/diagnostic imaging , Prognosis , Tomography, X-Ray Computed , Retrospective StudiesABSTRACT
Kontaktbeschränkungen und Abstandsregeln haben die klinische Weiterbildung vor große Herausforderungen gestellt. Innovative und interaktive Konzepte sind notwendig, um die Weiterbildung auch in Zeiten von Corona aufrechtzuerhalten. In der aktuellen Literatur sind Lehrkonzepte für Ärztinnen und Ärzte in der Facharztweiterbildung jedoch unterrepräsentiert. In dieser Arbeit wird ein onlinebasiertes Fortbildungskonzept in der Radiologie vorgestellt, das die klassische Fallvorstellung in ein dreiphasiges, interaktives Lernmodell umgestaltet. Dieses besteht aus einer selbstständigen Fallbearbeitung mit Anknüpfung an bestehendes Wissen, gefolgt von einer Falldiskussion und gezielten Fragen sowie Feedback durch die teilnehmenden Oberärztinnen und Oberärzte. Nach 12 Monaten erfolgte eine fragebogenbasierte Evaluation durch die Weiterbildungsassistentinnen und -assistenten. Hierbei zeigte sich, dass eine deutliche Mehrheit der Teilnehmerinnen und Teilnehmer das Fortbildungskonzept positiv hinsichtlich seines Schweregrades, der Repräsentativität für die klinische Tätigkeit sowie der Relevanz für den Facharzt bewerteten. Ebenso ergaben sich Erkenntnisse hinsichtlich der zukünftigen Gestaltung des Konzepts in Bezug auf Dauer, Modalität der zu besprechenden Bildgebungsverfahren und Häufigkeit. Alle Befragten gaben an, vom Format profitiert zu haben. Onlinebasierte Fortbildungskonzepte können demnach einen relevanten Beitrag zur Weiterbildung von Assistenzärztinnen und -ärzten leisten und stellen eine adäquate Alternative bzw. Erweiterung analoger Fortbildungskonzepte dar.
ABSTRACT
BACKGROUND/AIM: The effect of sarcopenia on patients with severe Covid-19 disease is unknown. We aimed to assess the influence of baseline computed tomography (CT)-based body composition parameters (pectoralis muscle area, pectoralis muscle index, skeletal muscle gauge) on clinical variables in patients with severe Covid-19 disease. PATIENTS AND METHODS: Chest CT scans of adult patients with confirmed Covid-19 who were hospitalized from March 2020 to May 2021 at a level-one medical center in Germany were retrospectively analyzed. Pectoralis muscle area, pectoralis muscle index and skeletal muscle gauge were measured on the first CT scan after admission. Body composition parameters were assessed for association with clinical variables and 30-day mortality. RESULTS: A total of 46 patients were included. None of the body composition parameters was a predictor for 30-day mortality, duration of hospital stay, duration of intensive care unit treatment, or duration of invasive mechanical ventilation. CONCLUSION: Pectoralis muscle composition parameters in CT chest scans did not predict outcomes in adult patients with severe Covid-19 infection.
Subject(s)
COVID-19 , Sarcopenia , Adult , Humans , Muscle, Skeletal/diagnostic imaging , Pectoralis Muscles/diagnostic imaging , Retrospective Studies , SARS-CoV-2ABSTRACT
BACKGROUND: The COVID-19 pandemic has created multiple challenges for health care, social and economic systems worldwide, but also for school and university teaching. Most learning has been shifted to online classes. So far, it is unclear whether these changes are well received within the student body. OBJECTIVES: The aim of this study was the evaluation of a newly developed online-based teaching concept for medical students studying radiology during the COVID-19 pandemic. MATERIALS AND METHODS: The concept consisted of 12 online seminars of the 11-week course "Imaging Procedures", which were combined with 31 prerecorded video presentations. Five weeks after the start of the summer term, we conducted an anonymous online survey, which consisted of 12 questions and a box for additional comments. Furthermore, we analysed the number of requests of the presentations, the duration and the average viewing time. RESULTS: In all, 110 of 213 students (51.6%) completed the survey; 72.7% stated that the new teaching concept drew their interest for radiology, 78.2% agreed that it incited self-study as well as would facilitate time- and place-independent learning (95.5%). The majority indicated that the time investment for the video presentations was appropriate, but shorter video sections would simplify the learning process (70.9%) and the ideal timeframe would be 10-20â¯min. The majority (80.9%) agreed that the concept should be maintained in upcoming semesters. CONCLUSIONS: This newly developed online-based teaching concept enjoys high acceptance rates among students. It offers advantages such as time- and location-independent learning, possibilities for self-study and should be maintained in upcoming semesters after the end of social distancing due to the COVID-19 pandemic.