The association of serum creatine phosphokinase levels with severity of lung involvement and hypoxia in patients with COVID-19

Background: An increase in the serum levels of creatine phosphokinase (CPK) could be associated with an unfavorable clinical outcome in coronavirus disease (COVID-19) patients;however, detailed information on this association is scarce. The aim of this study was to investigate upon admission CPK serum level and its relationship with the degree of involvement in chest computed tomography (CT) scans and hypoxia in patients with COVID-19. Methods: This cross-sectional survey was conducted on 191 COVID-19 patients who were referred to a major respiratory referral center in Tehran, Iran, in 2019. CPK serum level, oxygen saturation, blood pressure, temperature, and severity of lung involvement (based on lung CT scan) were measured. The severity of lung involvement in cuts of CT imaging was reported with a score between 1 and 4. The descriptive and relational statistics were conducted using Pearson's correlation coefficient and one-way analysis of variance. Results: The average age of the patients was 55.22 ± 15.39 years, and the male was predominant in gender (65.4%). There was a statistically significant relationship between CPK serum level and the severity of lung involvement in patients with COVID-19 (P = 0.04). Furthermore, a significant and reverse correlation was observed between CPK serum level and oxygen saturation in the patients (r =-0.160, P = 0.04). Conclusion: The results of this study showed that COVID-19 patients with elevated CPK levels upon admission are prone to more severe lung involvement, worsening oxygenation, and respiratory failure. Hence, considering the initial critical care strategies for such patients could be of the essence. © 2022 American Society of Civil Engineers (ASCE). All rights reserved.

CT features of community-acquired pneumonia at the emergency department.

BACKGROUND: Chest computed tomography (CT) was reported to improve the diagnosis of community-acquired pneumonia (CAP) as compared to chest X-ray (CXR). The aim of this study is to describe the CT-patterns of CAP in a large population visiting the emergency department and to see if some of them are more frequently missed on CXR. MATERIALS AND METHODS: This is an ancillary analysis of the prospective multicenter ESCAPED study including 319 patients. We selected the 163 definite or probable CAP based on adjudication committee classification; 147 available chest CT scans were reinterpreted by 3 chest radiologists to identify CAP patterns. These CT-patterns were correlated to epidemiological, biological and microbiological data, and compared between false negative and true positive CXR CAP. RESULTS: Six patterns were identified: lobar pneumonia (51/147, 35%), including 35 with plurifocal involvement; lobular pneumonia (43/147, 29%); unilobar infra-segmental consolidation (24/147, 16%); bronchiolitis (16/147, 11%), including 4 unilobar bronchiolitis; atelectasis and bronchial abnormalities (8/147, 5.5%); interstitial pneumonia (5/147, 3.5%). Bacteria were isolated in 41% of patients with lobar pneumonia-pattern (mostly Streptococcus pneumoniae and Mycoplasma pneumonia) versus 19% in other patients (p = 0.01). Respiratory viruses were equally distributed within all patterns. CXR was falsely negative in 46/147 (31%) patients. Lobar pneumonia was significantly less missed on CXR than other patterns (p = 0.003), especially lobular pneumonia and unilobar infra-segmental consolidation, missed in 35% and 58% of cases, respectively. CONCLUSION: Lobar and lobular pneumonias are the most frequent CT-patterns. Lobar pneumonia is appropriately detected on CXR and mainly due to Streptococcus pneumoniae or Mycoplasma pneumoniae. Chest CT is very useful to identify CAP in other CT-patterns. Prior the COVID pandemic, CAP was rarely responsible for interstitial opacities on CT.

Covid-19 and Artificial Intelligence: Potential and Challenges

The COVID-19 has the potential to cause serious pneumonia and is predicted to cost the healthcare sector a lot of money. Early detection is essential for proper treatment and, as a result, for lowering healthcare system tension. The most popular imaging methods for checking pneumonia are chest X-rays (CXR) and Computed Tomography (CT) scans. CXRs are still important despite the fact that CT scans are the gold standard since they are less expensive, faster, and more readily available. The use of Artificial Intelligence (AI) to detect early coronavirus infections and track the health of infected patients is a promising new strategy. The development of effective algorithms will vastly enhance treatment continuity and decision-making. Not only in the safe keeping of COVID-19 patients, as well as in the continuous monitoring of patient wellbeing, AI is effective. It can monitor the COVID-19 spread on such a large scale, inclusion of biochemical, medical and epidemiological application. By analyzing data, it is also advantageous to encourage virus analysis. AI can assist in the development of successful effective treatment therapies, protection strategies, as well as the development of drugs and vaccines. This paper will examine the efficacy and diagnostic results of CXR and CT scan imaging to test for pneumonia caused due to COVID-19, and the ability of AI to determine doctors' ability to discern COVID-19 patients from healthy people. © 2021 IEEE.

CT Characteristics of Coronavirus Disease 2019 Pneumonia and Its Association with C-Reactive Protein, Erythrocyte Sedimentation Rate and Gender.

Background: This research intended to investigate the characteristics of COVID-19, accurately evaluate radiological findings, and compare it with laboratory evidence of coronavirus. Materials and Methods: A retrospective study of 120 consecutive cases with a mean age of 55.9 ± 15.82 years and laboratory-confirmed COVID-19 pneumonia was performed. On admission, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels were tested. Computed tomography (CT) findings and scored pulmonary involvement were evaluated. Results: An elevated level of CRP and mildly raised ESR was seen in all patients. ESR showed a meaningful difference between both genders (P < 0.05). Ninety-four (78.3%) patients showed peripheral pulmonary lesions and 119 patients had ground-glass opacity (99.2%), 110 (92.4%) had consolidation, and 9 patients (7.5%) had linear opacities. Of 120 cases, 25 (20%) had bronchial changes, 25 (20%) had air bronchogram, 11 (9.2%) had bronchial distortion, and 2 had mediastinal lymphadenopathy. The CT scores in males and females were 17.41 ± 4.86 and 14.65 ± 4.96, respectively with a significant difference between both genders (P = 0.001). CT score difference was significant between both genders (P = 0.01). The largest lung lesion diameter in both sexes (male: 46.0725.75 and female: 57.9131.14) showed a meaningful difference. CRP (r = 0.10; P < 0.05) and ESR (r = 0.15; P < 0.05) were correlated with the CT scores. Conclusion: the results indicated that the infection involved lung parenchyma and interstitium. CRP and ESR levels were correlated with lung lesions and showed positive performance in predicting severity and disease monitoring.

Personalized mechanical ventilation in acute respiratory distress syndrome.

A personalized mechanical ventilation approach for patients with adult respiratory distress syndrome (ARDS) based on lung physiology and morphology, ARDS etiology, lung imaging, and biological phenotypes may improve ventilation practice and outcome. However, additional research is warranted before personalized mechanical ventilation strategies can be applied at the bedside. Ventilatory parameters should be titrated based on close monitoring of targeted physiologic variables and individualized goals. Although low tidal volume (VT) is a standard of care, further individualization of VT may necessitate the evaluation of lung volume reserve (e.g., inspiratory capacity). Low driving pressures provide a target for clinicians to adjust VT and possibly to optimize positive end-expiratory pressure (PEEP), while maintaining plateau pressures below safety thresholds. Esophageal pressure monitoring allows estimation of transpulmonary pressure, but its use requires technical skill and correct physiologic interpretation for clinical application at the bedside. Mechanical power considers ventilatory parameters as a whole in the optimization of ventilation setting, but further studies are necessary to assess its clinical relevance. The identification of recruitability in patients with ARDS is essential to titrate and individualize PEEP. To define gas-exchange targets for individual patients, clinicians should consider issues related to oxygen transport and dead space. In this review, we discuss the rationale for personalized approaches to mechanical ventilation for patients with ARDS, the role of lung imaging, phenotype identification, physiologically based individualized approaches to ventilation, and a future research agenda.