Comparison of chest HRCT severity score in PCR positive and PCR negative clinically suspected COVID-19 Patients.

Background: The limitations and false-negative results of Real-time Polymerase chain reaction (RT PCR) in diagnosing COVID-19 infection demand the need for imaging modalities such as chest HRCT to improve the diagnostic accuracy and assess the severity of the infection. Objectives: The study aimed to compare the chest HRCT severity scores in RT-PCR positive and negative cases of COVID-19. Methods: This cross-sectional study included 50 clinically suspected COVID-19 patients. Chest HRCT and PCR testing of all 50 patients were done and the chest HRCT severity scores for each lung and bronchopulmonary segments were compared in patients with positive and negative PCR results. Chi-square and Mann Whitney U test were used to assess differences among study variables. Results: Chest HRCT severity score was more in PCR negative patients than in those with PCR positive results. However, the difference was not significant (p=0.11). There was a significant association in severity scores of the anterior basal segment of the left lung (p=0.022) and posterior segment upper lobe of right lung (p=0.035) with PCR results. This association was insignificant for other bronchopulmonary segments (p>0.05). Conclusion: CR negativity does not rule out infection in clinically suspected COVID-19 patients. The use of chest HRCT helps to determine the extent of lung damage in clinically suspected patients irrespective of PCR results. Guidelines that consider clinical symptoms, chest HRCT severity score and PCR results for a confirmed diagnosis of COVID-19 in suspected patients are needed.

Living Donor Liver Transplantation During the COVID-19 Pandemic: an Evolving Challenge.

BACKGROUND: Maintaining standards of living donor liver transplantation (LDLT) can be a challenge during the corona virus disease 2019 (COVID-19) pandemic. Center-specific protocols have been developed and transplant societies propose limiting elective LDLT. We have looked at outcomes of LDLT during the pandemic in an exclusively LDLT center. METHODS: Patients were grouped into pre-COVID (January 2019-February 2020) (n = 162) and COVID (March 2020-January 2021) (n = 53) cohorts. We looked at patient characteristics, 30-day morbidity, and mortality. Outcomes were also assessed in donors and recipients who underwent surgery after recovery from COVID-19. RESULTS: The average number of transplants reduced from 11.5/month to 4.8/month. Fewer patients with MELD > 20 underwent LDLT in the COVID cohort (41.3% versus 24.5%, P = 0.03). Out of nine patients with a positive pretransplant COVID-19 PCR, there were 2 (22.3%) deaths on the waiting list. Seven patients underwent LT after recovery from COVID-19 with one 30-day mortality due to biliary sepsis. Three donors with positive COVID-19 PCR underwent uneventful donation after testing negative for COVID-19. No significant difference in 30-day survival was observed in the pre-COVID and COVID cohorts (93.2% versus 90.6%) (P = 0.3). Out of two recipients who developed COVID-19 pneumonia within 30 days after LT, there was one mortality. The 1-year survival for the entire cohort with a MELD cutoff of 20 was 90% and 84% (P = 0.2). CONCLUSION: Despite comparable outcomes, fewer sick patients might undergo LDLT during the pandemic. Individuals recovered from COVID-19 might be safely considered for donation or transplantation.

Taking a step down on the reconstruction ladder for head and neck reconstruction during the COVID-19 pandemic.

BACKGROUND: Most of the head and neck cancers are time-critical and need urgent surgical treatment. Our unit is one of the departments in the region, at the forefront in treating head and neck cancers in Pakistan. We have continued treating these patients in the COVID-19 pandemic with certain modified protocols. The objective of this study is to share our experience and approach towards head and neck reconstruction during the COVID-19 pandemic. RESULTS: There were a total of 31 patients, 20 (64.5%) were males and 11 (35.4%) patients were females. The mean age of patients was 52 years. Patients presented with different pathologies, i.e. Squamous cell carcinoma n = 26 (83.8%), mucoepidermoid carcinoma n = 2 (6.4%), adenoid cystic carcinoma n = 2 (6.4%) and mucormycosis n = 1 (3%). The reconstruction was done with loco-regional flaps like temporalis muscle flap n = 12 (38.7%), Pectoralis major myocutaneous flap n = 8 (25.8%), supraclavicular artery flap n = 10 (32.2%) and combination of fore-head, temporalis major and cheek rotation flaps n = 1 (3%). Defects involved different regions like maxilla n = 11 (35.4%), buccal mucosa n = 6 (19.3%), tongue with floor of mouth n = 6 (19.3%), mandible n = 4 (12.9%), parotid gland, mastoid n = 3 (9.6%) and combination of defects n = 1 (3%). Metal reconstruction plate was used in 3 (9.6%) patients with mandibular defects. All flaps survived, with the maximum follow-up of 8 months and minimum follow-up of 6 months. CONCLUSION: Pedicled flaps are proving as the workhorse for head and neck reconstruction in unique global health crisis. Vigilant use of proper PPE and adherence to the ethical principles proves to be the only shield that will benefit patients, HCW and health system.

An Analysis of High-Resolution Computed Tomography Chest Manifestations of COVID-19 Patients in Pakistan.

Objective The objective of the present study is to describe high-resolution CT (HRCT) chest manifestations of coronavirus disease 2019 (COVID-19) patients presenting to a tertiary healthcare facility in Punjab, Pakistan, and to analyze the distribution of the disease in lung fields. Additionally, we assess the role of chest CT severity scoring (CT-SS) in determining the severity of pneumonia. Methods In this cross-sectional descriptive study conducted from March 30, 2020, to May 30, 2020, 87 confirmed COVID-19 patients undergoing HRCT scan in a tertiary care facility in Punjab, Pakistan were included. The HRCT chest was performed on the patients using a standard protocol. Each study was evaluated for the presence of ground-glass opacities (GGOs), consolidation, mixed pattern, distribution, crazy paving, reverse halo sign, nodules, pleural effusion, and other findings. Additionally, CT-SS was calculated by dividing each lung into 20 zones. Each zone was scored as 0, 1, and 2, representing no involvement, <50% involvement, and >50% involvement of one zone respectively (total score: 0-40 for each patient). The patients were classified into mild, moderate, and severe cases (mild: CT-SS of <20, moderate: CT-SS of 20-30, and severe: CT-SS of >30). Results GGO was the most common finding, as seen in 88.5% of the patients, followed by consolidations (52.8%) and crazy paving (33.3%). The majority of the patients showed the bilateral and peripheral distribution of the disease process. Vascular dilatation and bronchiectasis were seen in 10 patients; pleural effusions were observed in only two study patients, while no patient exhibited reverse halo sign or pulmonary nodules. The superior segment of lower lobes was the most commonly involved segment bilaterally. According to CT-SS, 78 (89.6%), six (6.9%), and three (3.45%) patients had mild, moderate, and severe disease respectively. Conclusion The typical imaging findings of COVID-19 on HRCT are GGOs with multilobe involvement and bilateral, peripheral, and basal predominance. CT-SS is helpful in categorizing pneumonia into mild, moderate, and severe types, thereby helping to identify patients with severe disease. This is particularly helpful in settings where fast triage is required.

Radiology department preparedness for COVID-19 - experience of a central-London hospital.

The COVID-19 pandemic has placed significant strain on healthcare systems across the world, requiring rapid adaptation and a change in approach to the delivery of healthcare services. Although not always immediately at the frontline, radiology has a key role in the effort against the SARS-CoV-2 virus. Radiology preparedness, including the development of a set of policies and procedures designed to acquire and maintain enough capacity to support the ongoing care needs of patients both with and without COVID-19, is essential in this modern-day healthcare crisis of unprecedented magnitude.